Daniel Novak

Simplifying chlamydia testing: an innovative Chlamydia trachomatis testing approach using the internet and a home sampling strategy: population based study.

Objectives: To measure the coverage, gender distribution, and participants’ prevalence of genital Chlamydia trachomatis infections using a new internet based self selective testing approach by means of home sampling in the general population in Sweden. To investigate factors associated with these measures. Methods: Observational survey of people actively ordering coded testing packages, and checking their test results, from a known website. No personal invitations were sent out. All inhabitants (256 885 men and women) in a Swedish county were eligible to participate. A special interest was taken in coverage, gender distribution, participants’ chlamydia prevalence, and determinants for infection. Results: Testing was highest in the age group 20–24 years, where 298/9495 (3.1%) of all women and 171/9574 (1.8%) of all men in the population participated. The overall population participation (all ages) was 906/256 885 (0.4%). 40% (364/906) of the tests were from men and 60% (542/906) from women. The prevalence of Chlamydia trachomatis infection was 6.0% (95% CI: 3.6% to 8.4%) among male participants and 4.6% (95% CI: 2.8% to 6.4%) among female participants. Prevalence increased with decreasing age. Believing to be infected and having symptoms were the strongest determinants of infection. Conclusion: Simplifying and increasing the accessibility of chlamydia testing by means of internet and home sampling proved feasible. Self risk assessment improves the chance of finding people infected by Chlamydia trachomatis, especially among men, if an accessible testing method is offered. This new method can serve as a supplement to regular preventive methods and might encourage young people to be tested.

Characterization of Th17 responses to Streptococcus pneumoniae in humans: comparisons between adults and children in a developed and a developing country.

Intranasal exposure to Streptococcus pneumoniae as well as mucosal or parenteral immunization with a recently developed killed pneumococcal whole cell vaccine, confer Th17-mediated protection against subsequent S. pneumoniae colonization in mice. Given our interest in the function of Th17 cells and the ongoing efforts to develop this vaccine for use in infants and children in developing countries, we analyzed Th17 responses to the whole cell antigen (WCA) and individual pneumococcal antigens in healthy individuals and patients with pneumococcal disease and compared responses in children and adults from Sweden and Bangladesh. Peripheral blood mononuclear cells (PBMCs) isolated from Swedish adults produced IL-17A after stimulation with WCA, with the pneumolysoid PdT and with the protein required for cell separation in group B streptococci (PcsB). IL-22 and IFN-γ responses were also detected, but these cytokines originated from separate CD4+ T cell subsets. PBMCs from Swedish children produced lower levels of IL-17A in response to WCA compared to adults, whereas no such difference was noted from the samples from Bangladesh, where responses by children and adults were both significantly higher than those in Sweden. High IL-17A responses to stimulation with WCA were also observed in children with proven or probable pneumococcal pneumonia. Our results thus demonstrate the presence of Th17-type T cells that are specific for pneumococcus in both children and adults. The different levels of Th17 responses to pneumococci in children and adults in developing and developed countries, which may at least partly be due to differences in exposure to pneumococci, are important factors to consider in the evaluation of candidate pneumococcal protein-based vaccines in human trials.

Gender differed factors affecting male condom use. A population-based study of 18-year old Swedish adolescents

UNLABELLED Despite preventive measures promoting the condom as a good barrier method and a good preventive measure for STIs, teenage abortions and STIs are increasing in our society. OBJECTIVE The aim of this study was to explore which male factors are associated with non-condom use and also which female factors are associated with non-condom use among their sexual partners. STUDY GROUP A population-based study, among all 18-year old girls and boys in four cities in northern Sweden. METHOD The participants answered a questionnaire regarding their social lifestyle, psychological-, and sexual health. The associations between the independent variables and the dependent variable (non-condom use) were investigated by multivariate logistic regression analysis. RESULTS Four significant (p<0.05) male variables associated with non-condom use were identified: living with partner during the weekends, feeling depressed, being a party smoker, and girl partner taking oral contraceptives. Two significant (p<0.05) female variables were associated with non-condom: using oral contraceptives and feeling forced into sex. Having TV and movie watching as favourite free time activity was identified as a significant protective female variable associated with condom use. CONCLUSION The study found several male and female factors associated with non-condom use, where the usage of oral contraception was the strongest indicator for non-condom use. The study showed a gender difference in the variables associated with condom use and the results have been suggested as useful in future preventive measures promoting condom usage.

Detection of major diarrheagenic bacterial pathogens by multiplex PCR panels

Diarrheal diseases remain a major threat to the youngest population in low- and middle-income countries. The main bacterial pathogens causing diarrhea are diarrheagenic Escherichia coli (DEC) that consists of enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enterohemorrhagic EHEC and enteroinvasive E. coli (EIEC), Salmonella, Shigella spp. (S. dysenteria, S. sonnei, S. flexneri) Campylobacter (C. coli, C. jejuni), Vibrio (V. vulnificus, V. parahaemolyticusm, V. cholerae), Yersinia enterocolitica and Aeromonas hydrophila. The aim of this study was to set up rapid multiplex PCR (mPCR) panels to identify these diarrheagenic pathogens based on their specific virulence genes. Primers against specific target genes were combined into three mPCR panels: one for diarrheal E. coli, one for pathogens causing mainly bloody diarrhea, and the third for the remaining pathogens. The panels were tested against a set of stool samples from Swedish children with diarrhea and controls and the analysis identified bacterial pathogens in 14/54 (26%) of the samples. These results show that our three developed mPCR panels can detect main bacterial diarrheagenic pathogens in clinical samples.

A comparison of seasonal variations in rotavirus antibodies in the breast milk of Swedish and Bangladeshi mothers

The rotavirus has been identified as the most common cause of severe gastroenteritis in young children. This study compared the levels of rotavirus‐specific antibodies in breast milk and serum samples in Swedish and Bangladeshi mothers to identify any seasonal variations.

A population-based study of 18-year old Swedish youths and factors correlated with their total number of lifetime sexual partners.

UNLABELLED The number of sexual partners has in studies been shown to be a factor correlated with STI but there is little published knowledge on what factors are associated with number of sexual partners. OBJECTIVES To examine which variables are correlated with the number of lifetime sexual partners (NLSP) among youths. STUDY GROUP All 18-year old girls and boys in four cities in northern Sweden. METHODS A population-based study where participants answered a questionnaire regarding their social lifestyle, psychological and sexual health. The associations between these independent variables and the dependent variable (NLSP) were investigated by multivariate linear regression analysis. RESULTS The boy and girl median NLSP was 2.0 (P25 =1.0, P75=3.0). The final model explained 29% of the total boy NLSP variation and 46% of the total girl NLSP variation. Eight boy variables and thirteen girl variables significantly correlated with NLSP were found. The two strongest variables associated with increased NLSP among boys and girls, was feelings of guilt or shame after sex and smoking regularly. Variables prior associated with an increased risk of acquiring STIs were associated with increased NLSP. The study found new gender differed behaviour variables correlated to NLSP not previously considered to be risk factors for STI. CONCLUSIONS To prevent the spread of STI it is important that persons with many partners are identified, treated if necessary and possible, or encouraged to change their behaviour. The study found several boy and girl variables associated with increased NLSP, which could facilitate both primary- and secondary preventions.

Two cases of hemolytic uremic syndrome caused by Streptococcus pneumoniae serotype 3, one being a vaccine failure.

Abstract We report two cases of Streptococcus pneumoniae-associated hemolytic uremic syndrome (SP-HUS) caused by serotype 3. One case occurred in an unvaccinated boy and 1 in a girl vaccinated with the 13-valent pneumococcal conjugate vaccine. SP-HUS must be considered in children, and conjugate vaccines may be less effective against serotype 3 than other serotypes.

Children's BMI is strongly effected by family income at birth – but parental education is of major importance for the growing social gap up to 8 years of age

Background: The development of BMI in early childhood is dependent on socioeconomic factors. Our aim was to explore the impact of parental education level and family income for development of BMI from birth to 8 years age.Methods: 3018 children born in 1998–2006 from the IDEFICS study and register controls were included. Weight and height measurements from birth up to 8 years of age were obtained from the Child Health Services. Parental education and family disposable income, obtained from Statistics Sweden and the Medical Birth Register, were defined as high/low. Obesity was defined by WHO references. Confounders were sex and age of the child, parental origin, maternal smoking and maternal BMI.Results: At birth, the children’s mean BMI (SD) was lower in families of low vs. high income (13,74 (1,35) vs. 13,94 (1,36), p<0.0001). Results remained significant after adjusting for confounders. No differences in birth BMI were detected between children of low and high-educated parents (13,87 (1,37) vs. 13,83 (1,35), p=0.48). From 6 months onwards, children of low-educated parents showed higher mean BMI than children of high-educated. At 8 years, mean BMI in the low/high educated groups were 17.12 (2.44) and 16.38 (1.94), p<0.0001. Results remained significant after adjusting for confounders. Prevalence of obesity in the low and high-educated groups were 11% and 4,1%, p<0,0001. The difference in BMI at 8 years seen in the low/high income group disappeared after adjusting for confounders (17.5 vs. 17.6, p=0,63).Conclusion: Impact of family socioeconomic factors on children’s BMI differs by income and education. The effect of parental education becomes more evident by age up to 8 years of age. Interventions for healthy weight development must start very early in life.Background: Compelling evidence links obesity induced systemic inflammation to the development of chronic kidney disease (CKD). This systemic inflammation may result from exacerbated adipose inflammation. Besides the known detrimental effects of typical pro-inflammatory factors secreted by the adipose tissue (TNF-α, MCP-1 and IL-6) on the kidney, we hypothesize the enhanced obesity-induced secretion of serum amyloid A (SAA), an acute inflammatory protein, to play a key role in aggravating obesity-induced CKD. Methods: Groups of male C57Bl/6J mice (n = 99 in total) were fed a low (10% lard) or high (45% lard) fat diet for a maximum of 52 weeks. Mice were sacrificed after 24, 40 and 52 weeks. Whole blood samples, kidneys and adipose tissues were collected. The development of adipose and renal tissue inflammation was assessed on gene expression and protein level. Adipocytokine levels were measured in plasma samples. Results: A distinct inflammatory phenotype was observed in the adipose tissue of HFD mice prior to renal inflammation, which was associated with an early systemic elevation of TNF-α, leptin and SAA (1A-C). With aging, sclerotic lesions appeared in the kidney, the extent of which was severely aggravated by HFD feeding. Lesions exhibited typical amyloid characteristics (2A) and pathological severity positively correlated with bodyweight (2B). Interestingly, more SAA protein was detected in lesions of HFD mice. Conclusion: Our data suggest a causal link between obesity induced chronic inflammation and AA amyloidosis in C57Bl/6J mice. Though future studies are necessary to prove this causal link and to determine its relevance for the human situation, obesity may hence be considered a risk factor for the development and progression of renal AA amyloidosis in the course of CKD. (Figure Presented).Introduction: Existing treatment programs for obese children prove limited effectiveness and sustainability. Health Information System (HIS) enhanced interventions have the potential for higher accessibility and cost-effectiveness of multi-professional family-based obesity therapy. The aim was not only to modify the patient’s behavior but also to positively influence their family system. Methods: In cooperation with therapists, extremely obese children, their parents, computer scientists and information systems researcher, a mobile HIS was developed, consisting of a tablet PC with photo and patient’s privacy services, relaxation tools and the ability to measure speed of eating by electronic stop watch, emotional parameters by self-assessment manikin mood scale and physical activity by 3-axes accelerometer, Fitbit, combined with telephone interviews. Three groups of each six extremely obese children (BMI > 99.5, median BMI z-score 3.0, age 13.2 2.3 years) were assigned to therapy in either an (1) individual or (2) group setting with HIS, or (3) individual care without HIS. Physical activity, speed of eating and physical and emotional parameters were evaluated before and after 12 months of therapy. All patients and parents gave informed consent for adherence to therapy, monitoring and the use of tablet PC’s. Results: A total of 25% of extremely obese children with HIS and 60% without HIS decreased their BMI-SDS. Children using HIS did not reduce their obesity more than the control group without HIS, if parents did not support their children at home. Those children with parental support did use HIS for activity, mood and nutrition monitoring regularly. Conclusion: In extremely obese children, home support with HIS is only effective, when children are guided by their parents while using HIS. To select appropriate families for HIS home support, careful examination of the family system including their motivation and psychosocial factors is needed.Basel · Freiburg · Paris · London · New York · Chennai · New Delhi · Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney