Sleep Disturbance and Noise Annoyance and Environmental Noise Exposure in Residents of Two Major Slovakian Cities

The significant growth in traffic density in Slovakia, combined with the country’s economic change, has resulted in new environmental noise issues, particularly in road traffic noise. The objective of this study was to assess and evaluate the impact of environmental noise on the psychosocial well-being of young healthy individuals in the two main Slovak cities of Bratislava and Kosice. To assess noise annoyance, interference with activities, and sleep disturbance, the ICBEN (The International Commission on the Biological Effects of Noise) anonymous validated “Noise annoyance questionnaire” was applied; noise levels were objectified by direct measurements using a sound level analyzer with a frequency analysis module. Young individuals between the ages of 20 and 30 were interviewed in Bratislava (533 respondents, 155 males) and Kosice (355 respondents, 111 males). The majority of the respondents in both cities were exposed to medium levels of road traffic noise LAeq ≥ 60 dB. In Bratislava, 27.82 % of respondents resided in the higher noise exposure category LAeq ≥ 70 dB, while in Kosice, 39.9 % resided in the lower noise exposure category LAeq < 50 dB. Road traffic noise annoys respondents in the higher noise exposure category in Bratislava 63.51 %, and even in the lower noise exposure category in Kosice, it interferes with reading and mental work, sleep and falling asleep 46.51 %. The study has identified traffic noise as an environmental issue in large cities, emphasizing the need for vulnerable individuals to be protected, particularly at night.

Profile of Acquired Immunodeficiency Syndrome (AIDS): an Epidemiological Study

Objective: To describe the profile of the population with Acquired Immunodeficiency Syndrome (AIDS) in Brazil from 2009 to 2019. Methods: This is a descriptive, quantitative study, performed with secondary data from the Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS). The analyzed data referred to cases diagnosed with Acquired Immunodeficiency Syndrome between 2009 and 2019. The variables evaluated were selected from categories, “year of diagnosis”, “sex”, “age range”, “race/skin color” and “exposure category”. Data were made available in absolute frequency, and relative frequencies were calculated in Microsoft Excel ® 2016 software. Results: It is observed that 91.14% (n=383,531) of Acquired Immunodeficiency Syndrome cases in Brazil occur in the population from 20 to 59 years. Among these, 66.44% (n= 254,840) were male and 33.55% (n=128,691) female. Since 44.97% (n=108,327) were white people; 10.93% (n=26,337) black; 0.48% (n=1.168) yellow; 43.30% (n=104.306) brown; 0.32% (n=772) indigenous. And, 24.03% (n=49,596) from homosexual exposure category; 6.40% (n=13,216) bisexual; 65.27% (n=134,703) heterosexual; 3.70% (n=7,623) UDI; 0.02% (n=48) transfusion; 0.01% (n=14) Biological material accident; 0.54 (n=1,126) vertical transmission; 0.03 (n=53) hemophiliac. Conclusion: Epidemiological profile of Acquired Immunodeficiency Syndrome in Brazil, presents a greater prevalence in male, aged from 20 to 59 years, white, posteriorly the brown race, being of heterosexual exposure category. This knowledge enables contributions to the scientific field and planning of possible public policies for the prevention and treatment of Acquired Immunodeficiency Syndrome.

Interpreting Mendelian randomization estimates of the effects of categorical exposures such as disease status and educational attainment

Mendelian randomization has been previously used to estimate the effects of binary and ordinal categorical exposures - e.g. type 2 diabetes or educational attainment defined by qualification - on outcomes. Binary and categorical phenotypes can be modelled in terms of liability, an underlying latent continuous variable with liability thresholds separating individuals into categories. Genetic variants typically influence an individual’s categorical exposure via their effects on liability, thus Mendelian randomization analyses with categorical exposures will capture effects of liability which act independent of exposure category.We discuss how groups where the categorical exposure is invariant can be used to detect liability effects acting independently of exposure category. For example, associations between an adult educational attainment polygenic score (PGS) and BMI measured before the minimum school leaving age (e.g. age 10), cannot indicate the effects of years in full-time education on this outcome. Using UK Biobank data, we show that a higher education PGS is strongly associated with lower smoking initiation and higher glasses use at age 15. These associations were replicated in sibling models. An orthogonal approach using the raising of the school leaving age (ROSLA) policy change found that individuals who chose to remain in education to age 16 before the reform likely had higher liability to educational attainment than those who were compelled to remain in education to 16 after the reform, and had higher income, decreased cigarette smoking, higher glasses use and lower deprivation in adulthood. These results suggest that liability to educational attainment associates with health and social outcomes independent of years in full-time education.Mendelian randomization studies with non-continuous exposures should be interpreted in terms of liability, which may affect the outcome via changes in exposure category and/or independently.

Updated EUCAST Clinical Breakpoints against Aspergillus, Implications for the Clinical Microbiology Laboratory

Azole resistance poses a problem for the management of patients with invasive aspergillosis. Former species are in fact groups of closely related species (or complexes); cryptic species frequently show high antifungal resistance. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) Definitive Document (E.Def) 9.3.2 includes guidelines for antifungal susceptibility testing on Aspergillus spp. and clinical breakpoints for amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole against A. flavus, A. fumigatus, A. nidulans, A. niger, and A. terreus. New clinical breakpoints were released in February 2020 and one of the most relevant modifications was the definition of the new “susceptible, increased exposure” (formerly “intermediate”) category. Another relevant change was the adoption of the concept of area of technical uncertainty (ATU) that refers to problematic areas which involve uncertainty of susceptibility categorisation (e.g., when minimum inhibitory concentrations (MICs) for susceptible and resistant organisms overlap). To accommodate both the new “susceptible, increased exposure” category and the concept of ATU, MICs of azoles and amphotericin B that fall in the former “intermediate” category have been automatically categorized as either R (amphotericin B) or ATU (triazoles). Finally, EUCAST-AFST (Antifungal Susceptibility Testing) decided to adopt new breakpoints for less common species provided that the epidemiological cut-off value (ECOFF) is below or comparable to the breakpoint for the type species (A. fumigatus).

Determinants of HIV-1 late presentation in a cohort of Portuguese HIV-1 patients

BackgroundUndiagnosed HIV-1 patients still account for 25% of worldwide HIV patients. Studying late presenters for HIV care may help to identify characteristics of such patients.ObjectiveThe present study aims to identify factors associated with late presentation (LP) and late presentation with advanced disease (LPAD) based on a population of patients followed in a Portuguese hospital between 1984 and 2017.MethodsSociodemographic and clinical data from infected patients with HIV-1 aged 18 years and older, followed in Egas Moniz Hospital, in Portugal were collected.ResultsOf the 907 patients included in this study, 68.7% were males and the median age was 37 years (IQR 30-47). 459 patients (50.6%) were LP and, of these, 284 patients (61.9%) were LPAD. The LP population mostly originated from Portugal and Sub-Saharan Africa (64.4% and 28.8%; p=0.004) and the HIV exposure category mainly heterosexuals and MSM (57.0% and 24.9%; p<0.001). The stage of disease and viral load at diagnosis were significantly associated with both LP and LPAD (p<0.001). Factors associated with LP in the logistic regression included age at diagnosis lower than 30y (aOR 0.34; 0.17-0.68; p=0.002) and origin from Sub-Saharan Africa (aOR 2.24; 1.44-3.50; p<0.001).ConclusionLate presentation is a major obstacle to halt the HIV epidemic. In this population, the majority of newly diagnosed HIV-infected individuals were late presenters. Our results characterize vulnerable populations that should be frequently tested for HIV.

Differential Seasonality of Legionnaires’ Disease by Exposure Category

Legionnaires’ disease (LD) shows a seasonal pattern with most cases occurring in summer. We investigate if seasonality can be observed for all three exposure categories (community-acquired (CALD), travel-associated (TALD) and healthcare-associated (HCA)). Methods: LD cases (2005–2015) were classified by exposure categories and we calculated the relative case ratio for each month from February to December using January as reference. The TALD relative case ratio was compared with flight frequencies. Results: Overall case numbers in Germany (N = 7351) peaked in August. CALD had a curve similar to all cases. TALD displayed a bimodal curve with peaks in June/July and October. The latter was attributable to LD cases aged 60+. The relative case ratio of TALD surpassed clearly that of CALD. The curve was similar to that of the relative flight frequencies, but was shifted by about one month. HCA showed no apparent seasonality. Conclusions: Although the overall seasonality in LD is heavily influenced by CALD, seasonal differences are more pronounced for TALD which may reflect travel behavior. The bimodal pattern of TALD is attributable to the curve among those aged 60+ and may reflect their preference to travel outside school holiday periods. Heightened vigilance for HCA cases is necessary throughout the entire year.

Particulate Matter Air Pollution Effects on Pulmonary Tuberculosis Activation in a Semi-Desert City on the US-Mexican Border

In this paper, we assessed the association (relative risk, RR) between the exposure to PM10 and PM2.5 (as a continuous variable and as categories of low or high pollution exposure) on the incidence of pulmonary tuberculosis (PTB) in Mexicali, Baja California, Mexico. We used a weekly, lagged multiple Poisson regression model. We observed a 10-week delayed effect for PM10 and PM2.5 in all PTB cases and in male cases with PTB. An 11-week delayed effect occurred in the female PTB cases. For all the PTB cases, the RR rose by 2.4% (95% CI: 2.1, 2.6, p<0.10) for each 10 µg/m3 increase of PM10 in the continuous exposure and by 3.6% (CI: 3.3, 4.0, p<0.05) in the high pollution exposure category, and by 3.2% (CI: 2.9, 3.4, p<0.05) for each 10 µg/m3 increase of PM2.5 in the continuous exposure and by 3.9% (CI: 3.6, 4.3, p<0.05) in the high pollution exposure category. In men, the RR rose by 2.8% (CI: 2.5, 3.1, p<0.10) for each 10 µg/m3 increase of PM10 in the continuous exposure and by 4.6% (CI: 4.2, 5.0, p<0.05) in the high pollution exposure category, and by 3.4% (CI: 3.1, 3.7, p<0.05) for each 10 µg/m3 increase of PM2.5 in the continuous exposure and by 4.2% (CI: 3.8, 4.6, p<0.05) in the high pollution exposure category. In women, the RR rose by 5.1% (CI: 4.7, 5.5, p<0.05) for each 10 µg/m3 increase of PM10 in the continuous exposure and by 5.3% (CI: 4.7, 5.8, p<0.10) in the high pollution exposure category, and by 4.3% (CI: 3.8, 4.8, p<0.10) for each 10 µg/m3 increase of PM2.5 in the continuous exposure and by 5.3% (CI: 4.8, 5.9, p<0.10) in the high pollution exposure category. PM air pollution appears to associate with the incidence of PTB in the population of Mexicali.