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Jacques-Aviñó C, Alarcón Guitiérrez M, Barbera MJ, Fuertes I, Martin-Ezquerra G, Lopez-Contreras J, Vives Á, Rodriguez R, Ros M, Rius C, de Olalla PG. Epidemiological Characteristics and Factors Associated with Repeat Sexually Transmitted Infections in Barcelona, Spain Over a Decade. Arch Sex Behav 2024; 53:735-744. [PMID: 37875628 PMCID: PMC10844332 DOI: 10.1007/s10508-023-02711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023]
Abstract
In the last few years, the frequency of sexually transmitted infections (STI) has increased, as has the number of people with multiple infections. The aim of our study was to describe the epidemiological characteristics of persons with repeated bacterial STI and to determine the risk factors for these episodes in persons living in Barcelona during the period 2007-2018. We studied all cases of bacterial STI included in the STI registry of Barcelona. Repeated STI were defined as a diagnosis of gonorrhea, syphilis, or lymphogranuloma venereum (LGV) after a first episode of one of these infections. Analysis was stratified by sex and place of birth. The factors associated with time to reinfection were determined by Kaplan-Meier estimates, while the factors associated with risk of infection were determined by a Cox proportional hazards model. Of 9927 persons with a diagnosis of bacterial STI, 1690 (17.0%) had at least two episodes of STI during the study period. On multivariate analysis, repeat STI were independently associated with male sex assigned at birth (HR: 3.45; 95%CI 2.22-5.36), age less than 34 years (HR: 1.22; 95%CI 1.10-1.35); gay, bisexual, and other men who have sex with men, and transgender o transsexual woman (GBSMS/Trans) (HR: 4.03; 95%CI 3.24-5.03), having gonorrhea as first diagnosis (HR:1.49, 95%CI 1.34-1.66) or LGV (HR:1.75; 95%CI 1.47-2.08) and coinfection with HIV (HR:1.98; 95%CI 1.78-2.21). Sexual health programs should be strengthened to prevent STI and reinfection in key populations.
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Affiliation(s)
- Constanza Jacques-Aviñó
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Gran Via Corts Catalanes, 587, àtic, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), Bellaterra, Spain.
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.
| | - Miguel Alarcón Guitiérrez
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), Bellaterra, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - María Jesús Barbera
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Irene Fuertes
- Dermatology Department, Hospital Clinic, Barcelona, Spain
| | - Gemma Martin-Ezquerra
- Dermatology Department, Institut Hospital del Mar d'Investigacions Mèdiques, Hospital del Mar, Barcelona, Spain
| | - Joaquín Lopez-Contreras
- Infectious Diseases Unit-Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Raquel Rodriguez
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Miriam Ros
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Cristina Rius
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Patricia Garcia de Olalla
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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2
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Sentís A, Montoro-Fernandez M, Lopez-Corbeto E, Egea-Cortés L, Nomah DK, Díaz Y, Garcia de Olalla P, Mercuriali L, Borrell N, Reyes-Urueña J, Casabona J. STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017-2019: a retrospective population-based cohort study. BMJ Open 2021; 11:e052817. [PMID: 34903544 PMCID: PMC8672020 DOI: 10.1136/bmjopen-2021-052817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection. DESIGN Retrospective population-based cohort. SETTING Catalonia, Spain. PARTICIPANTS 42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017-2019. PRIMARY AND SECONDARY OUTCOMES Descriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering. RESULTS The incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017-2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30-39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5-7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection. CONCLUSIONS We recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.
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Affiliation(s)
- Alexis Sentís
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- Epidemiology Department, Epiconcept, Paris, France
| | - Marcos Montoro-Fernandez
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Evelin Lopez-Corbeto
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Laia Egea-Cortés
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Daniel K Nomah
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yesika Díaz
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Patricia Garcia de Olalla
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Lilas Mercuriali
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Núria Borrell
- Epidemiological Surveillance and Response to Public Health Emergencies Service in Tarragona, Agency of Public Health of Catalonia, Generalitat of Catalonia, Tarragona, Spain
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Politi J, Martín-Sánchez M, Mercuriali L, Borras-Bermejo B, Lopez-Contreras J, Vilella A, Villar J, Orcau A, de Olalla PG, Rius C. Epidemiological characteristics and outcomes of COVID-19 cases: mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020. ACTA ACUST UNITED AC 2021; 26. [PMID: 34018483 PMCID: PMC8138960 DOI: 10.2807/1560-7917.es.2021.26.20.2001138] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Population-based studies characterising outcomes of COVID-19 in European settings are limited, and effects of socio-economic status (SES) on outcomes have not been widely investigated. Aim We describe the epidemiological characteristics of COVID-19 cases, highlighting incidence and mortality rate differences across SES during the first wave in Barcelona, Catalonia, Spain. Methods This population-based study reports individual-level data of laboratory-confirmed COVID-19 cases diagnosed from 24 February to 4 May 2020, notified to the Public Health Agency of Barcelona and followed until 15 June 2020. We analysed end-of-study vital status and the effects of chronic conditions on mortality using logistic regression. Geocoded addresses were linked to basic health area SES data, estimated using the composed socio-economic index. We estimated age-standardised incidence, hospitalisation, and mortality rates by SES. Results Of 15,554 COVID-19-confirmed cases, the majority were women (n = 9,028; 58%), median age was 63 years (interquartile range: 46–83), 8,046 (54%) required hospitalisation, and 2,287 (15%) cases died. Prevalence of chronic conditions varied across SES, and multiple chronic conditions increased risk of death (≥ 3, adjusted odds ratio: 2.3). Age-standardised rates (incidence, hospitalisation, mortality) were highest in the most deprived SES quartile (incidence: 1,011 (95% confidence interval (CI): 975–1,047); hospitalisation: 619 (95% CI: 591–648); mortality: 150 (95% CI: 136–165)) and lowest in the most affluent (incidence: 784 (95% CI: 759–809); hospitalisation: 400 (95% CI: 382–418); mortality: 121 (95% CI: 112–131)). Conclusions COVID-19 outcomes varied markedly across SES, underscoring the need to implement effective preventive strategies for vulnerable populations.
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Affiliation(s)
- Julieta Politi
- Preventive Medicine and Public Health Training Unit, PSMar-UPF-PHAB (Parc de Salut Mar - Pompeu Fabra University - Public Health Agency of Barcelona), Barcelona, Spain.,Epidemiology Service, Public Health Agency of Barcelona (PHAB), Barcelona, Spain
| | - Mario Martín-Sánchez
- Preventive Medicine and Public Health Training Unit, PSMar-UPF-PHAB (Parc de Salut Mar - Pompeu Fabra University - Public Health Agency of Barcelona), Barcelona, Spain.,Epidemiology Service, Public Health Agency of Barcelona (PHAB), Barcelona, Spain
| | - Lilas Mercuriali
- Epidemiology Service, Public Health Agency of Barcelona (PHAB), Barcelona, Spain
| | - Blanca Borras-Bermejo
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Lopez-Contreras
- Infectious Diseases-Internal Medicine, Hospital de Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Vilella
- Preventive Medicine and Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Judit Villar
- Service of Infectious Diseases, Hospital del Mar, Barcelona, Spain
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- Members are listed under Investigators
| | - Angels Orcau
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Epidemiology Service, Public Health Agency of Barcelona (PHAB), Barcelona, Spain
| | - Patricia Garcia de Olalla
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Epidemiology Service, Public Health Agency of Barcelona (PHAB), Barcelona, Spain
| | - Cristina Rius
- Department of Pediatrics, Obstetrics, Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Epidemiology Service, Public Health Agency of Barcelona (PHAB), Barcelona, Spain
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Besoain F, Perez-Navarro A, Jacques Aviñó C, Caylà JA, Barriga NA, Garcia de Olalla P. Prevention of HIV and Other Sexually Transmitted Infections by Geofencing and Contextualized Messages With a Gamified App, UBESAFE: Design and Creation Study. JMIR Mhealth Uhealth 2020; 8:e14568. [PMID: 32181752 PMCID: PMC7109613 DOI: 10.2196/14568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Advances in the development of information and communication technologies have facilitated social and sexual interrelationships, thanks to the websites and apps created to this end. However, these resources can also encourage sexual contacts without appropriate preventive measures in relation to HIV and other sexually transmitted infections (STIs). How can users be helped to benefit from the advantages of these apps while keeping in mind those preventive measures? Objective This study aimed to prevent STIs by helping users to remember preventive measures in the risky situations. Methods We have used the design and creation methodology and have developed a software system. This system has two parts: an Android operating system app with emphasis on ubiquitous computing and gamification as well as a server with a webpage. First, a functional test with 5 men who have sex with men (MSM) allowed us to test the app with end users. In addition, a feasibility test with 4 MSM for a month allowed us to try the UBESAFE system with all its functionalities. Results The main output is a system called UBESAFE that is addressed to MSM. The system has two main parts: (1) an app that sends preventive contextualized messages to users when they use a contact app or when they are near a point where sexual contacts are likely and (2) a server part that was managed by the public health agency of Barcelona (ASPB), which preserves the quality and pertinence of messages and places and offers instant help to users. To increase users’ adherence, UBESAFE uses a gamified system to engage users in the creation of preventive messages. Users increased the initial pool of messages by more than 100% (34/30) and created more than 56% (9/16) of places (named hot zones). Conclusions The system helped MSM who used it to become conscious about HIV and other STIs. The system also helped the ASPB to stay in contact with MSM and to detect behaviors that could benefit from preventive measures. All functions were performed in a nonintrusive manner because users used the app privately. Furthermore, the system has shown how important it is to make users a part of the creation process as well as to develop apps that work by themselves and thus become useful to the users.
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Affiliation(s)
- Felipe Besoain
- School of Videogames Development and Virtual Reality Engineering, Faculty of Engineering, Universidad de Talca, Campus Talca, Chile.,Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Castelldefels, Spain
| | - Antoni Perez-Navarro
- Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Castelldefels, Spain.,Faculty of Computer Sciences, Multimedia and Telecommunication, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Constanza Jacques Aviñó
- Epidemiologic Service - Public Health Agency of Barcelona, Plaça Lesseps 1, Barcelona, Spain
| | - Joan A Caylà
- Foundation of the Tuberculosis Research Unit of Barcelona, Barcelona, Spain
| | - Nicolas A Barriga
- School of Videogames Development and Virtual Reality Engineering, Faculty of Engineering, Universidad de Talca, Campus Talca, Chile
| | - Patricia Garcia de Olalla
- Epidemiologic Service - Public Health Agency of Barcelona, Plaça Lesseps 1, Barcelona, Spain.,Biomedical Research Network on Epidemiology and Public Health (CIBEResp), Barcelona, Spain
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Sentís A, Martin-Sanchez M, Arando M, Vall M, Barbera MJ, Ocaña I, González Cordón A, Alsina M, Martin-Ezquerra G, Knobel H, Gurguí M, Vives A, Coll J, Caylà JA, Garcia de Olalla P. Sexually transmitted infections in young people and factors associated with HIV coinfection: an observational study in a large city. BMJ Open 2019; 9:e027245. [PMID: 31061051 PMCID: PMC6502227 DOI: 10.1136/bmjopen-2018-027245] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Young people are a critical target group for sexually transmitted infections (STI) surveillance due to their particular behavioural and social related vulnerability. The aim of this study was to describe the epidemiological characteristics and trends in the incidence of gonorrhoea, syphilis, HIV and venereal lymphogranuloma (LGV) among 15-24-year-olds in Barcelona, and to determine factors associated with HIV coinfection. DESIGN We performed a population-based incidence study covering the 2007-2015 period. PARTICIPANTS All new cases of STI-HIV, gonorrhoea, infectious syphilis and LGV-notified to the epidemiological surveillance system in Barcelona between 2007 and 2015. 1218 cases were studied: 84.6% were men, 19.3% were 15-19 years old and 50.6% were born in Spain. Among men, 73.7% were men who have sex with men (MSM); among women, 85.6% were women that have sex with men. PRIMARY AND SECONDARY OUTCOMES Incidence of HIV, gonorrhoea, infectious syphilis and LGV. HIV coinfection. RESULTS There was an increase in the incidence of gonorrhoea, from 1.9 cases per 10 000 people in 2007 to 7.6/10 000 in 2015 (p<0.01), in MSM from 27.1 to 228.8/10 000 (p<0.01). The incidence of syphilis increased from 0.4/10 000 in 2007 to 3.1/10 000 in 2015 (significant in men only, p<0.01), in MSM from 18.1 to 116.9/10 000 (p<0.01). The incidence of HIV showed a non-significant increase in men (p=0.27), and that of LGV remained stable (p=0.59). Factors associated with increased risk of HIV coinfection included being MSM (adjusted OR[ORa]=14.14, 95% CI 3.34 to 59.91) and having >10 sexual partners (ORa=4.11, 95% CI 1.53 to 11.01) or STI diagnosis during the previous 12 months (ORa=2.06; 95% CI 1.13 to 3.77). CONCLUSIONS The incidence of gonorrhoea and syphilis among 15-24-year-olds increased, while HIV infection remained stable but with a high incidence among MSM. Being MSM, having sex with multiple partners and having a diagnosis of an STI in the previous 12 months were factors associated with HIV coinfection.
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Affiliation(s)
- Alexis Sentís
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain
| | - Mario Martin-Sanchez
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar - Pompeu Fabra University - Agència de Salut Pública de Barcelona), Barcelona, Spain
| | - Maider Arando
- Hospital de la Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Martí Vall
- Hospital de la Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | | | - Inma Ocaña
- Hospital de la Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | | | - Mercè Alsina
- Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Hernando Knobel
- Hospital del Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Mercè Gurguí
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Vives
- Hospital Puigvert, Universitat Autònoma de Barcelona, Spain
| | - Josep Coll
- Hospital Tries i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Joan Artur Caylà
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Foundation of Tuberculosis Research Unit of Barcelona, Spain
| | - Patricia Garcia de Olalla
- Epidemiology Service, Public Health Agency of Barcelona (ASPB), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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6
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Godoy P, Broner S, Manzanares-Laya S, Martínez A, Parrón I, Planas C, Sala-Farré MR, Minguell S, de Olalla PG, Jané M, Dominguez A. Outbreaks of hepatitis A associated with immigrants travelling to visit friends and relatives. J Infect 2015; 72:112-5. [PMID: 26404744 DOI: 10.1016/j.jinf.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/08/2015] [Accepted: 09/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Pere Godoy
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Sonia Broner
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sandra Manzanares-Laya
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agencia de Salut Pública de Barcelona, Barcelona, Spain
| | - Ana Martínez
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ignasi Parrón
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Caritat Planas
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | | | - Sofia Minguell
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Patricia Garcia de Olalla
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agencia de Salut Pública de Barcelona, Barcelona, Spain
| | - Mireia Jané
- Agencia de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Angela Dominguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
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7
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Garcia de Olalla P, Molas E, Barberà MJ, Martín S, Arellano E, Gosch M, Saladie P, Carbonell T, Knobel H, Diez E, Caylà JA. Effectiveness of a pilot partner notification program for new HIV cases in Barcelona, Spain. PLoS One 2015; 10:e0121536. [PMID: 25849451 PMCID: PMC4388637 DOI: 10.1371/journal.pone.0121536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An estimated 30% of HIV cases in the European Union are not aware of their serological status. This study aimed to assess the effectiveness of a pilot HIV partner notification program. METHODS HIV cases diagnosed between January 2012 and June 2013 at two healthcare settings in Barcelona were invited to participate in a prospective survey. We identified process and outcome measures to evaluate this partner notification program, including the number of partners identified per interviewed index case, the proportion of partners tested for HIV as a result of the partner notification, and the proportion of new HIV diagnoses among their sex or needle-sharing partners. RESULTS Of the 125 index cases contacted, 108 (86.4%) agreed to provide information about partners. A total of 199 sexual partners were identified (1.8 partners per interviewed index case). HIV outcome was already known for 58 partners (70.7% were known to be HIV-positive), 141 partners were tested as result of partner notification, and 26 were newly diagnosed with HIV. The case-finding effectiveness of the program was 18.4%. CONCLUSION This pilot program provides evidence of the effectiveness of a partner notification program implemented in healthcare settings. This active partner notification program was feasible, acceptable to the user, and identified a high proportion of HIV-infected patients previously unaware of their status.
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Affiliation(s)
- Patricia Garcia de Olalla
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
- * E-mail:
| | - Ema Molas
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - María Jesús Barberà
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Silvia Martín
- Preventive Interventions and Programs Service,Agència de SalutPública de Barcelona, Barcelona, Spain
| | - Encarnació Arellano
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Mercè Gosch
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Pilar Saladie
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Teresa Carbonell
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - Hernando Knobel
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - Elia Diez
- Preventive Interventions and Programs Service,Agència de SalutPública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
| | - Joan A Caylà
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
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8
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Engsig FN, Zangerle R, Katsarou O, Dabis F, Reiss P, Gill J, Porter K, Sabin C, Riordan A, Fätkenheuer G, Gutiérrez F, Raffi F, Kirk O, Mary-Krause M, Stephan C, de Olalla PG, Guest J, Samji H, Castagna A, d'Arminio Monforte A, Skaletz-Rorowski A, Ramos J, Lapadula G, Mussini C, Force L, Meyer L, Lampe F, Boufassa F, Bucher HC, De Wit S, Burkholder GA, Teira R, Justice AC, Sterling TR, M Crane H, Gerstoft J, Grarup J, May M, Chêne G, Ingle SM, Sterne J, Obel N. Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery. Clin Infect Dis 2014; 58:1312-21. [PMID: 24457342 DOI: 10.1093/cid/ciu038] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/µL after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality. METHODS We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 1 RNA copies/mL) for >3 years with CD4 count ≤200 cells/µL at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery (≤200 cells/µL) and Cox regression to identify associations with mortality. RESULTS Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/µL after 3 years of suppression. Increasing age, lower initial CD4 count, male heterosexual and injection drug use transmission, cART initiation after 1998, and longer time from initiation of cART to start of the virally suppressed period were risk factors for not achieving a CD4 count >200 cells/µL. Individuals with CD4 ≤200 cells/µL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with those who achieved CD4 count >200 cells/µL. The increased mortality was seen across different patient groups and for all causes of death. CONCLUSIONS Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/µL have substantially increased long-term mortality.
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Affiliation(s)
- Frederik N Engsig
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital
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9
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Millet JP, Orcau A, Casals M, Garcia de Olalla P, Caylà JA. Recurrences in tuberculosis in a cohort of human immunodeficiency virus-infected patients: the influence of highly active antiretroviral therapy. Enferm Infecc Microbiol Clin 2012; 31:227-9. [PMID: 23219687 DOI: 10.1016/j.eimc.2012.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/25/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Little is known about recurrent tuberculosis (TB) among HIV-infected patients and the influence of highly active antiretroviral therapy (HAART). METHODS A population-based retrospective longitudinal study was conducted on all HIV-infected TB patients in Barcelona (Spain) notified in 1987-2003, and followed up until 2005. TB recurrence and HAART influence were analysed according to calendar period. RESULTS Patients with no-treatment and those in pre-HAART had more risk of TB recurrence (RR: 2.3; CI: 1-5.8 and RR: 4.8; CI: 2-12). CONCLUSIONS HAART decreases probability of TB recurrence and should be extended to all cases.
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Torner N, Broner S, Martinez A, Tortajada C, Garcia de Olalla P, Barrabeig I, Sala M, Camps N, Minguell S, Alvarez J, Ferrús G, Torra R, Godoy P, Dominguez A. Factors associated to duration of hepatitis a outbreaks: implications for control. PLoS One 2012; 7:e31339. [PMID: 22355358 PMCID: PMC3280286 DOI: 10.1371/journal.pone.0031339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/06/2012] [Indexed: 11/24/2022] Open
Abstract
Even though hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. The aim of this study was to investigate the association between duration and characteristics of hepatitis A outbreaks. Hepatitis A (HA) outbreaks reported between 1991 and 2007 were studied. An outbreak was defined as ≥2 epidemiologically-linked cases with ≥1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Relationships between explanatory variables and outbreak duration were assessed by logistic regression. During the study period, 268 outbreaks (rate 2.45 per million persons-year) and 1396 cases (rate 1.28 per 10(5) persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95% CI: 0.94-0.98) and school setting (OR = 0.39; 95% CI: 0.16-0.92). In person-to-person transmission outbreaks only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95% CI: 0.95-0.98). The only variables associated with shorter outbreak duration were early administration of IG or vaccine and a school setting. Timely reporting HA outbreaks was associated with outbreak duration. Making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration.
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Affiliation(s)
- Nuria Torner
- Department of Health. Generalitat of Catalonia. Barcelona, Spain.
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11
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Garcia-Villarrubia M, Millet JP, de Olalla PG, Gascón J, Fumadó V, i Prat JG, Treviño B, Pinazo MJ, Cabezos J, Muñoz J, Zarzuela F, Caylà JA. Epidemiology of imported malaria among children and young adults in Barcelona (1990-2008). Malar J 2011; 10:347. [PMID: 22118531 PMCID: PMC3250960 DOI: 10.1186/1475-2875-10-347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 11/25/2011] [Indexed: 11/21/2022] Open
Abstract
Background Increasing international travel and migration is producing changes in trends in infectious diseases, especially in children from many European cities. The objective of this study was to describe the epidemiology and determine the trends of imported malaria in patients under 20 years old in the city of Barcelona, Spain, during an 18-year period. Methods The study included malaria cases that were laboratory confirmed and reported to the malaria register at the Public Health Agency of Barcelona from 1990 to 2008, residing in Barcelona and less than 20 years old. Patients were classified as natives (born in Spain) or immigrants. Differences in the distribution of demographic, clinical characteristics, and incidence per 100,000 person-year evolution were analysed. Natives and immigrants were compared by logistic regression by calculating the odds ratio (OR) with a 95% confidence interval (CI) and Chi-square for a linear trend (p < 0.05). Results Of the total 174 cases, 143 (82.1%) were immigrants, 100 (57.5%) were female, 121 (69.5%) Plasmodium falciparum, and 108 (62.1%) were visiting friends and relatives (VFR) as the reason for travel. Among the immigrants, 99 (67.8%) were from Equatorial Guinea. Immigrant cases more frequently travelled to Africa than natives (p = 0.02). The factors associated with imported malaria among immigrant residents was travelling for VFR (OR: 6.2 CI 1.9-20.2) and age 15-19 (OR: 3.7 CI 1-13.3). The incidence increased from 1990 to 1999 (p < 0.001) and decreased from 2000 to 2008 (p = 0.01), although the global linear trend was not statistically significant (p = 0.41). The fatality rate was 0.5%. Conclusions The majority of cases of malaria in population less than 20 years in Barcelona were immigrants, travelling to Africa for VFR and Plasmodium falciparum was most frequently detected. The trend analysis of the entire study period did not show a statistically significant decline. It is recommended to be aware of malaria, especially among children of immigrants who travel to their parent's home country for VFR. Better access to pre travel advice should be provided.
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Millet JP, de Olalla PG, Gascón J, Prat JGI, Treviño B, Pinazo MJ, Cabezos J, Muñoz J, Zarzuela F, Caylà JA. Imported malaria among African immigrants: is there still a relationship between developed countries and their ex-colonies? Malar J 2009; 8:111. [PMID: 19463171 PMCID: PMC2693516 DOI: 10.1186/1475-2875-8-111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 05/22/2009] [Indexed: 11/16/2022] Open
Abstract
Background The objective of this study was to compare cases of imported malaria originating from the Spanish ex-colony of Equatorial Guinea (EG) with those originating from the rest of Africa (RA). Methods All the African cases detected in Barcelona between 1989 and 2007 were investigated in a retrospective analysis. Clinical-epidemiological variables such as sex, age, visiting friends and relatives (VFR), species, hospital admission and chemo-prophylaxis were compared. Data were analysed by logistic regression, calculating the Odds Ratio (OR) and 95% Confidence Intervals (95% CI). Results Of the 489 African patients, 279 (57,1%) had been born in EG and 210 (42,9%) in the rest of Africa. The cumulative incidence of imported malaria among those from EG was 179.6 per thousand inhabitants, while in those from the RA it was 33.7 per thousand (p < 0.001). Compliance with chemoprophylaxis (CP) was very low, but there were no differences between the two groups. Comparing those from EG to those from RA, the former were characterized by having more patients in the visiting friends and relatives (VFR) category, and more individuals younger than 15 years or older than 37 years, and more women. They also visited a traveller's health centre more often, had fewer hospital admissions and were less likely to reside in the inner city. Conclusion Cases of imported malaria originating in Africa, are more likely to come from the Spanish ex-colony of EG, and VFR are more likely to be affected. It is recommended that developed countries promote prevention programmes, such as CP advice directed at African immigrants, and develop programmes of cooperation against malaria in their ex-colonies.
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Affiliation(s)
- Juan Pablo Millet
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
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13
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Millet JP, Garcia de Olalla P, Carrillo-Santisteve P, Gascón J, Treviño B, Muñoz J, Gómez I Prat J, Cabezos J, González Cordón A, Caylà JA. Imported malaria in a cosmopolitan European city: a mirror image of the world epidemiological situation. Malar J 2008; 7:56. [PMID: 18397524 PMCID: PMC2362124 DOI: 10.1186/1475-2875-7-56] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 04/08/2008] [Indexed: 11/25/2022] Open
Abstract
Background International travel and migration have been related with an increase of imported malaria cases. There has been considerable immigration to Barcelona from low-income countries (LIC) in recent years. The objective is to describe the epidemiology and to determine the trends of the disease in Barcelona. Methods Analysis of the cases notified among city residents between 1989 and 2005. Patients were classified as: tourists, voluntary workers, resident immigrants (visiting friends and relatives, VFR) and recently arrived immigrants. An analysis was conducted using the chi2 test and comparison of means. As a measure of association we calculated the Relative Risk (RR) and Odds Ratio (OR) with a Confidence Interval of 95% (CI) and carried out a trends analysis. Results Of the total of 1,579 imported cases notified, 997 (63.1%) lived in Barcelona city, and 55.1% were male. The mean age of patients was 32.7 years. The incidence increased from 2.4 cases/100,000 in 1989 to 3.5 cases/100,000 in 2005 (RR 1.46 CI:1.36–1.55). This increase was not statistically significant (trends analysis, p = 0.36). In terms of reason for travelling, 40.7% were VFR, 33.6% tourists, 12.1% voluntary workers and 13.6% were recently arrived immigrants. The most frequent species found was Plasmodium falciparum (71.3%), mainly in visitors to Africa (OR = 2.3, CI = 1.7–3.2). The vast majority (82.2%) had had some contact with Africa (35.9% with Equatorial Guinea, a Spanish ex-colony) and 96.6% had not completed chemoprophylaxis. Six deaths were observed, all tourists who had travelled to Africa and not taken chemoprophylaxis (3.9% fatality rate). Conclusion Over the period studied there is an increase in malaria incidence, however the trend is not statistically significant. Lack of chemoprophylaxis compliance and the association between Africa and P. falciparum are very clear in the imported cases. Most of the patients with malaria did not take chemoprophylaxis.
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Affiliation(s)
- Juan Pablo Millet
- Epidemiology Service, Public Health Agency of Barcelona, Pza Lesseps, 1, 08023 Barcelona, Spain.
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Pérez-Hoyos S, Ferreros I, del Amo J, Muga R, del Romero J, de Olalla PG, Hernández-Aguado I. Survival and progression to AIDS in a seroconverter cohort in the post-highly active antiretroviral therapy era: effectiveness goes on. AIDS 2006; 20:289-91. [PMID: 16511426 DOI: 10.1097/01.aids.0000202651.41397.db] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Progression to AIDS and death for 1129 HIV seroconverters from the GEMES cohort were analysed by calendar period (1996-1997, 1998-1999, 2000 onwards). A further hazard reduction was observed for a later period for both. Intravenous drug users (IDU) had a faster progression. The results highlighted the importance of monitoring the effectiveness of highly active antiretroviral therapy and to improve public health strategies directed to IDU to reduce inequity in HIV infection care.
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