Publications by authors named "Silvia Stringhini"

114 Publications

Adverse Childhood Events and Health Biomarkers: A Systematic Review.

Front Public Health 2021 19;9:649825. Epub 2021 Aug 19.

EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.

This systematic review aimed to summarize evidence reporting epigenetic and/or neuro-immuno-endocrine embedding of adverse childhood events (ACEs) in children, with a particular focus on the short-term biological effect of those experiences. A search was conducted in PsycINFO®, PubMed®, Isi Web of Knowledge and Scopus, until July 2019, to identify papers reporting the short-term biological effects of exposure to ACEs. The search identified 58 studies, that were included in the review. Regarding exposure, the type of ACE more frequently reported was sexual abuse ( = 26), followed by life stressors ( = 20) and physical abuse ( = 19). The majority ( = 17) of studies showed a positive association between ACEs and biomarkers of the immune system. Regarding DNA methylation 18 studies showed more methylation in participants exposed to ACEs. Two studies presented the effect of ACEs on telomere length and showed that exposure was associated with shorter telomere length. Overall the associations observed across studies followed the hypothesis that ACEs are associated with biological risk already at early ages. This is supporting evidence that ACEs appear to get "under the skin" and induce physiological changes and these alterations might be strongly associated with later development of disease.
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http://dx.doi.org/10.3389/fpubh.2021.649825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417002PMC
August 2021

Detection of Spatiotemporal Clusters of COVID-19-Associated Symptoms and Prevention using A Participatory Surveillance App: The @choum Study Protocol.

JMIR Res Protoc 2021 Jul 19. Epub 2021 Jul 19.

Division of Primary Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, CH.

Background: The early detection of clusters of infectious diseases, such as the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)-related disease (COVID-19), can promote timely testing, recommendation compliance and help prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic.

Objective: To detect active and emerging spatiotemporal clusters of COVID-19-associated symptoms and examine, a posteriori, the association between clusters' characteristics and socio-demographic and environmental determinants.

Methods: This report presents the methodology and development of the @choum (en: "atishoo") study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 or above, with COVID-19-associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile application (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and non-sensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19-associated symptoms at their onset (e.g., symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19-recommendations websites. Geospatial clustering analyses are conducted using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm.

Results: The study began on September 01st, 2020, and will be completed on February 28th, 2022. Multiple tests conducted at various time points throughout the 5-month preparation phase have helped improve the tool's user experience and the accuracy of the clustering analyses. A 1-month pilot conducted among 38 pharmacists working in 7 Geneva-based pharmacies has confirmed the proper functioning of the tool. Since the tool's launch to the entire population of Geneva on February 11th, 2021, data are being collected, and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022.

Conclusions: The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19-associated symptoms. @choum collects precise geographic information while protecting user's privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing.
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http://dx.doi.org/10.2196/30444DOI Listing
July 2021

SARS-CoV-2 infection as a trigger of humoral response against apolipoprotein A-1.

Eur J Clin Invest 2021 Jul 29:e13661. Epub 2021 Jul 29.

Division of Laboratory Medicine, Department of Diagnostics and of Medical Specialties, Geneva University Hospitals and Geneva University, Geneva, Switzerland.

Background: Unravelling autoimmune targets triggered by SARS-CoV-2 infection may provide crucial insights into the physiopathology of the disease and foster the development of potential therapeutic candidate targets and prognostic tools. We aimed at determining (a) the association between anti-SARS-CoV-2 and anti-apoA-1 humoral response and (b) the degree of linear homology between SARS-CoV-2, apoA-1 and Toll-like receptor 2 (TLR2) epitopes.

Design: Bioinformatics modelling coupled with mimic peptides engineering and competition experiments were used to assess epitopes sequence homologies. Anti-SARS-CoV-2 and anti-apoA-1 IgG as well as cytokines were assessed by immunoassays on a case-control (n = 101), an intensive care unit (ICU; n = 126) and a general population cohort (n = 663) with available samples in the pre and post-pandemic period.

Results: Using bioinformatics modelling, linear sequence homologies between apoA-1, TLR2 and Spike epitopes were identified but without experimental evidence of cross-reactivity. Overall, anti-apoA-1 IgG levels were higher in COVID-19 patients or anti-SARS-CoV-2 seropositive individuals than in healthy donors or anti-SARS-CoV-2 seronegative individuals (P < .0001). Significant and similar associations were noted between anti-apoA-1, anti-SARS-CoV-2 IgG, cytokines and lipid profile. In ICU patients, anti-SARS-CoV-2 and anti-apoA-1 seroconversion rates displayed similar 7-day kinetics, reaching 82% for anti-apoA-1 seropositivity. In the general population, SARS-CoV-2-exposed individuals displayed higher anti-apoA-1 IgG seropositivity rates than nonexposed ones (34% vs 16.8%; P = .004).

Conclusion: COVID-19 induces a marked humoral response against the major protein of high-density lipoproteins. As a correlate of poorer prognosis in other clinical settings, such autoimmunity signatures may relate to long-term COVID-19 prognosis assessment and warrant further scrutiny in the current COVID-19 pandemic.
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http://dx.doi.org/10.1111/eci.13661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420318PMC
July 2021

Persistence of anti-SARS-CoV-2 antibodies: immunoassay heterogeneity and implications for serosurveillance.

Clin Microbiol Infect 2021 Jul 7. Epub 2021 Jul 7.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

Objectives: Serological studies have been critical in tracking the evolution of the COVID-19 pandemic. Data on anti-SARS-CoV-2 antibodies persistence remain sparse, especially from infected individuals with few to no symptoms. The objective of the study was to quantify the sensitivity for detecting historic SARS-CoV-2 infections as a function of time since infection for three commercially available SARS-CoV-2 immunoassays and to explore the implications of decaying immunoassay sensitivity in estimating seroprevalence.

Methods: We followed a cohort of mostly mild/asymptomatic SARS-CoV-2-infected individuals (n = 354) at least 8 months after their presumed infection date and tested their serum for anti-SARS-CoV-2 antibodies with three commercially available assays: Roche-N, Roche-RBD and EuroImmun-S1. We developed a latent class statistical model to infer the specificity and time-varying sensitivity of each assay and show through simulations how inappropriately accounting for test performance can lead to biased serosurvey estimates.

Results: Antibodies were detected at follow-up in 74-100% of participants, depending on immunoassays. Both Roche assays maintain high sensitivity, with the EuroImmun assay missing 40% of infections after 9 months. Simulations reveal that without appropriate adjustment for time-varying assay sensitivity, seroprevalence surveys may underestimate infection rates.

Discussion: Antibodies persist for at least 8 months after infection in a cohort of mildly infected individuals with detection depending on assay choice. Appropriate assay performance adjustment is important for the interpretation of serological studies in the case of diminishing sensitivity after infection.
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http://dx.doi.org/10.1016/j.cmi.2021.06.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261139PMC
July 2021

Health Insurance Deductibles and Health Care-Seeking Behaviors in a Consumer-Driven Health Care System With Universal Coverage.

JAMA Netw Open 2021 Jul 1;4(7):e2115722. Epub 2021 Jul 1.

Unit of Population Epidemiology, Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.

Importance: Characteristics of a health care system can facilitate forgoing of health care owing to economic reasons and can influence population health. Whether health insurance deductibles are associated with forgoing of health care in a consumer-driven health care system with universal coverage, such as the Swiss health system, remains to be determined.

Objective: To assess the association between insurance plan deductibles and forgoing of health care with consideration of socioeconomic factors.

Design, Setting, And Participants: This cross-sectional study was conducted in Geneva, Switzerland, using data collected from January 1, 2007, to December 31, 2019. Population-based samples were obtained yearly through random stratified sampling by age and sex of the general population aged 20 to 74 years. Participants were invited to an appointment at 1 of the 3 study sites in Geneva, where they completed a sociodemographic and health questionnaire.

Exposures: Insurance plan deductible level.

Main Outcomes And Measures: The main outcome was forgoing of health care owing to economic reasons. Unadjusted and multivariable Poisson models were used to assess the association between deductible level and forgoing of health care. Differences in forgoing health care across the range of health insurance deductibles or household income levels were quantified using the relative index of inequality (RII).

Results: The study group included 11 872 participants (5974 [50.3%] male; median age, 48.1 years [interquartile range, 38.7-59.1 years]); 1146 (9.7%) reported forgoing health care. Participants with high-deductible plans reported forgoing health care more frequently than those with low-deductible plans (331 [13.5%] vs 591 [8.7%]). In adjusted analysis, higher-deductible plans were associated with a greater likelihood of forgoing health care (RII, 2.2; 95% CI, 1.7-3.0; P < .001) independently of socioeconomic status, known comorbidities, and cardiovascular risk factors. Deductible level was associated with forgoing of health care among participants younger than 40 years (RII, 2.5; 95% CI, 1.6-4.0; P < .001) and those aged 40 to 64 years (RII, 1.9; 95% CI, 1.3-2.9; P = .002) but not among those older than 65 years (RII, 2.9; 95% CI, 0.8-10.4; P = .11).

Conclusions And Relevance: In this cross-sectional study, high insurance plan deductibles were associated with forgoing of health care independent of socioeconomic status and preexisting conditions in a universal consumer-driven health care system with good population outcomes in Switzerland. Uncovering health care system design features that could lead to suboptimal population care may help decision makers improve their current health care system design to achieve better outcomes.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.15722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261614PMC
July 2021

Spatial clusters of daily tobacco consumption before and after a smoke-free policy implementation.

Health Place 2021 Jul 3;70:102616. Epub 2021 Jul 3.

Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland; Division of Primary Care, Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland. Electronic address:

This study assessed the spatial dependence of daily tobacco consumption and how it is spatially impacted by individual and neighborhood socioeconomic determinants, and tobacco consumption facilities before and after a smoke-free implementation. Individual data was obtained from the Bus Santé, a cross-sectional survey in Geneva. Spatial clusters of high and low tobacco consumption were assessed using Getis-Ord Gi*. Daily tobacco consumption was not randomly clustered in Geneva and may be impacted by tobacco consumption facilities independently of socioeconomic factors and a smoking ban. Spatial analysis should be considered to highlight the impact of smoke-free policies and guide public health interventions.
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http://dx.doi.org/10.1016/j.healthplace.2021.102616DOI Listing
July 2021

Vulnerable patients forgo health care during the first wave of the Covid-19 pandemic.

Prev Med 2021 09 23;150:106696. Epub 2021 Jun 23.

Division of Prison Health, Geneva University Hospitals, Chemin du Petit Bel Air 2, 1226 Thônex, Switzerland; Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabriel-Perret-Gentil 4, 1205 Geneva, Switzerland.

During the first wave of the Covid-19 pandemic, access to health care was limited, and patients encountered important delays for scheduled appointments and care. Empirical data relying on patients' reports of forgoing health care are scarce. This study investigated Covid-19-related self-reports of forgoing health care in a sample of vulnerable outpatients in Geneva, Switzerland. We collected data from 1167 adult outpatients, including clinically vulnerable patients (with chronic diseases), geriatric patients (involved in a health care network for people aged 60 or older), and socially vulnerable patients (involved in a migrant health program or a mobile outpatient community care center) in June 2020. Data on sociodemographic factors, forgoing health care, and anti-SARS-CoV-2 antibodies were collected. Of the patients, 38.5% reported forgoing health care. Forgoing health care was more frequent for younger patients, women, patients with a low level of education, and patients with a chronic disease (p < .001). There was no significant association between the presence of anti-SARS-CoV-2 antibodies and forgoing health care (p = .983). As the decrease in routine management of patients might have important and unpredictable adverse health consequences, avoiding delayed health care is crucial.
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http://dx.doi.org/10.1016/j.ypmed.2021.106696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220858PMC
September 2021

Insights into household transmission of SARS-CoV-2 from a population-based serological survey.

Nat Commun 2021 06 15;12(1):3643. Epub 2021 Jun 15.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Understanding the risk of infection from household- and community-exposures and the transmissibility of asymptomatic infections is critical to SARS-CoV-2 control. Limited previous evidence is based primarily on virologic testing, which disproportionately misses mild and asymptomatic infections. Serologic measures are more likely to capture all previously infected individuals. We apply household transmission models to data from a cross-sectional, household-based population serosurvey of 4,534 people ≥5 years from 2,267 households enrolled April-June 2020 in Geneva, Switzerland. We found that the risk of infection from exposure to a single infected household member aged ≥5 years (17.3%,13.7-21.7) was more than three-times that of extra-household exposures over the first pandemic wave (5.1%,4.5-5.8). Young children had a lower risk of infection from household members. Working-age adults had the highest extra-household infection risk. Seropositive asymptomatic household members had 69.4% lower odds (95%CrI,31.8-88.8%) of infecting another household member compared to those reporting symptoms, accounting for 14.5% (95%CrI, 7.2-22.7%) of all household infections.
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http://dx.doi.org/10.1038/s41467-021-23733-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206123PMC
June 2021

Large variation in anti-SARS-CoV-2 antibody prevalence among essential workers in Geneva, Switzerland.

Nat Commun 2021 06 8;12(1):3455. Epub 2021 Jun 8.

Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Limited data exist on SARS-CoV-2 infection rates across sectors and occupations, hindering our ability to make rational policy, including vaccination prioritization, to protect workers and limit SARS-CoV-2 spread. Here, we present results from our SEROCoV-WORK + study, a serosurvey of workers recruited after the first wave of the COVID-19 pandemic in Geneva, Switzerland. We tested workers (May 18-September 18, 2020) from 16 sectors and 32 occupations for anti-SARS-CoV-2 IgG antibodies. Of 10,513 participants, 1026 (9.8%) tested positive. The seropositivity rate ranged from 4.2% in the media sector to 14.3% in the nursing home sector. We found considerable within-sector variability: nursing home (0%-31.4%), homecare (3.9%-12.6%), healthcare (0%-23.5%), public administration (2.6%-24.6%), and public security (0%-16.7%). Seropositivity rates also varied across occupations, from 15.0% among kitchen staff and 14.4% among nurses, to 5.4% among domestic care workers and 2.8% among journalists. Our findings show that seropositivity rates varied widely across sectors, between facilities within sectors, and across occupations, reflecting a higher exposure in certain sectors and occupations.
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http://dx.doi.org/10.1038/s41467-021-23796-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187639PMC
June 2021

Geospatial Analysis of Sodium and Potassium Intake: A Swiss Population-Based Study.

Nutrients 2021 May 25;13(6). Epub 2021 May 25.

Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.

Inadequate sodium and potassium dietary intakes are associated with major, yet preventable, health consequences. Local public health interventions can be facilitated and informed by fine-scale geospatial analyses. In this study, we assess the existence of spatial clustering (i.e., an unusual concentration of individuals with a specific outcome in space) of estimated sodium (Na), potassium (K) intakes, and Na:K ratio in the Bus Santé 1992-2018 annual population-based surveys, including 22,495 participants aged 20-74 years, residing in the canton of Geneva, using the local Moran's spatial statistics. We also investigate whether socio-demographic and food environment characteristics are associated with identified spatial clustering, using both global ordinary least squares (OLS) and local geographically weighted regression (GWR) modeling. We identified clear spatial clustering of Na:K ratio, Na, and K intakes. The GWR outperformed the OLS models and revealed spatial variations in the associations between explanatory and outcome variables. Older age, being a woman, higher education, and having a lower access to supermarkets were associated with higher Na:K ratio, while the opposite was seen for having the Swiss nationality. Socio-demographic characteristics explained a major part of the identified clusters. Socio-demographic and food environment characteristics significantly differed between individuals in spatial clusters of high and low Na:K ratio, Na, and K intakes. These findings could guide prioritized place-based interventions tailored to the characteristics of the identified populations.
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http://dx.doi.org/10.3390/nu13061798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229307PMC
May 2021

Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study.

Clin Infect Dis 2021 May 27. Epub 2021 May 27.

Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.

Background: Serological assays detecting anti-SARS-CoV-2 antibodies are being widely deployed in studies and clinical practice. However, the duration and effectiveness of the protection conferred by the immune response remains to be assessed in population-based samples. To estimate the incidence of newly acquired SARS-CoV-2 infections in seropositive individuals as compared to seronegative controls we conducted a retrospective longitudinal matched study.

Methods: A seroprevalence survey including a representative sample of the population was conducted in Geneva, Switzerland between April and June 2020, immediately after the first pandemic wave. Seropositive participants were matched one-to-two to seronegative controls, using a propensity-score including age, gender, immunodeficiency, BMI, smoking status and education level. Each individual was linked to a state-registry of SARS-CoV-2 infections. Our primary outcome was confirmed infections occurring from serological status assessment to the end of the second pandemic wave (January 2021).

Results: Among 8344 serosurvey participants, 498 seropositive individuals were selected and matched with 996 seronegative controls. After a mean follow-up of 35.6 (SD 3.2) weeks, 7 out of 498 (1.4%) seropositive subjects had a positive SARS-CoV-2 test, of whom 5 (1.0%) were classified as reinfections. In contrast, the infection rate was higher in seronegative individuals (15.5%, 154/996) during a similar follow-up period (mean 34.7 [SD 3.2] weeks), corresponding to a 94% (95%CI 86% to 98%, P<0.001) reduction in the hazard of having a positive SARS-CoV-2 test for seropositives.

Conclusions: Seroconversion after SARS-CoV-2 infection confers protection against reinfection lasting at least 8 months. These findings could help global health authorities establishing priority for vaccine allocation.
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http://dx.doi.org/10.1093/cid/ciab495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241483PMC
May 2021

Head-to-Head Evaluation of Five Automated SARS-CoV-2 Serology Immunoassays in Various Prevalence Settings.

J Clin Med 2021 Apr 10;10(8). Epub 2021 Apr 10.

Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1211 Geneva, Switzerland.

Purpose: To assess the diagnostic performances of five automated anti-SARS-CoV-2 immunoassays, Epitope (N), Diasorin (S1/S2), Euroimmun (S1), Roche N (N), and Roche S (S-RBD), and to provide a testing strategy based on pre-test probability.

Methods: We assessed the receiver operating characteristic (ROC) areas under the curve (AUC) values, along with the sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs), of each assay using a validation sample set of 172 COVID-19 sera and 185 negative controls against a validated S1-immunofluorescence as a reference method. The three assays displaying the highest AUCs were selected for further serodetection of 2033 sera of a large population-based cohort.

Results: In the validation analysis (pre-test probability: 48.1%), Roche N, Roche S and Euroimmun showed the highest discriminant accuracy (AUCs: 0.99, 0.98, and 0.98) with PPVs and NPVs above 96% and 94%, respectively. In the population-based cohort (pre-test probability: 6.2%) these three assays displayed AUCs above 0.97 and PPVs and NPVs above 90.5% and 99.4%, respectively. A sequential strategy using an anti-S assay as screening test and an anti-N as confirmatory assays resulted in a 96.7% PPV and 99.5% NPV, respectively.

Conclusions: Euroimmun and both Roche assays performed equally well in high pre-test probability settings. At a lower prevalence, sequentially combining anti-S and anti-N assays resulted in the optimal trade-off between diagnostic performances and operational considerations.
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http://dx.doi.org/10.3390/jcm10081605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069412PMC
April 2021

Brain tissue properties link cardio-vascular risk factors, mood and cognitive performance in the CoLaus|PsyCoLaus epidemiological cohort.

Neurobiol Aging 2021 06 16;102:50-63. Epub 2021 Feb 16.

Department of Clinical Neurosciences, Laboratory for Research in Neuroimaging LREN, Centre for Research in Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Neurology Department, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. Electronic address:

Given the controversy about the impact of modifiable risk factors on mood and cognition in ageing, we sought to investigate the associations between cardio-vascular risk, mental health, cognitive performance and brain anatomy in mid- to old age. We analyzed a set of risk factors together with multi-parameter magnetic resonance imaging (MRI) in the CoLaus|PsyCoLaus cohort (n > 1200). Cardio-vascular risk was associated with differences in brain tissue properties - myelin, free tissue water, iron content - and regional brain volumes that we interpret in the context of micro-vascular hypoxic lesions and neurodegeneration. The interaction between clinical subtypes of major depressive disorder and cardio-vascular risk factors showed differential associations with brain structure depending on individuals' lifetime trajectory. There was a negative correlation between melancholic depression, anxiety and MRI markers of myelin and iron content in the hippocampus and anterior cingulate. Verbal memory and verbal fluency performance were positively correlated with left amygdala volumes. The concomitant analysis of brain morphometry and tissue properties allowed for a neuro-biological interpretation of the link between modifiable risk factors and brain health.
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http://dx.doi.org/10.1016/j.neurobiolaging.2021.02.002DOI Listing
June 2021

Socioeconomically Disadvantaged Neighborhoods Face Increased Persistence of SARS-CoV-2 Clusters.

Front Public Health 2020;8:626090. Epub 2021 Jan 27.

Geneva University Hospitals, Geneva, Switzerland.

To investigate the association between socioeconomic deprivation and the persistence of SARS-CoV-2 clusters. We analyzed 3,355 SARS-CoV-2 positive test results in the state of Geneva (Switzerland) from February 26 to April 30, 2020. We used a spatiotemporal cluster detection algorithm to monitor SARS-CoV-2 transmission dynamics and defined spatial cluster persistence as the time in days from emergence to disappearance. Using spatial cluster persistence measured outcome and a deprivation index based on neighborhood-level census socioeconomic data, stratified survival functions were estimated using the Kaplan-Meier estimator. Population density adjusted Cox proportional hazards (PH) regression models were then used to examine the association between neighborhood socioeconomic deprivation and persistence of SARS-CoV-2 clusters. SARS-CoV-2 clusters persisted significantly longer in socioeconomically disadvantaged neighborhoods. In the Cox PH model, the standardized deprivation index was associated with an increased spatial cluster persistence (hazard ratio [HR], 1.43 [95% CI, 1.28-1.59]). The adjusted tercile-specific deprivation index HR was 1.82 [95% CI, 1.56-2.17]. The increased risk of infection of disadvantaged individuals may also be due to the persistence of community transmission. These findings further highlight the need for interventions mitigating inequalities in the risk of SARS-CoV-2 infection and thus, of serious illness and mortality.
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http://dx.doi.org/10.3389/fpubh.2020.626090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894360PMC
March 2021

Socioeconomic circumstances and lung function growth from early adolescence to early adulthood.

Pediatr Res 2021 Feb 18. Epub 2021 Feb 18.

EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

Background: A reduced lung function in early adulthood is associated with respiratory and non-respiratory diseases and is a long-term predictor of mortality. This study investigated the association between early socioeconomic circumstances (SEC) and lung function growth trajectories from early adolescence until early adulthood.

Methods: We analysed data from the EPITeen population-based study, including adolescents born in 1990. Study waves occurred at 13, 17 and 21 years of age. Information on sociodemographic, behavioural and health factors, anthropometry and spirometry was collected. Early-life SEC were assessed using maternal education and paternal occupational position. The forced expiratory volume in the first second (FEV) growth trajectories were drawn considering sex-and-height interactions over an 8-year period. Our sample included 2022 participants with complete information for the relevant variables.

Results: Participants from most disadvantaged SEC presented lower FEV at early adolescence compared to high-SEC counterparts, but differences seem to diminish with height growth. The effect of paternal occupational position in lung function growth trajectories was moderated by height, thus individuals from fathers with less advantaged occupational position had lower FEV at early adolescence, but they had a faster FEV growth over time.

Conclusions: Individuals from most disadvantaged SEC presented lower lung function at early adolescence compared to high-SEC counterparts; nevertheless, a catch-up growth was observed.

Impact: Lower socioeconomic circumstances were previously associated with reduced lung function and a higher risk of respiratory diseases in adults. Fewer studies analysed the effects of early-life socioeconomic circumstances in lung function growth during adolescence. Disadvantaged socioeconomic circumstances were associated with lower lung function in early adolescence. However, social differences diminished over adolescence, suggesting a catch-up growth of lung function among those from lower socioeconomic circumstances. An improved understanding of the mechanism underlying lung function catch-up (or the absence of catch-up) might support interventions to narrow social inequalities in respiratory health and should be further investigated.
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http://dx.doi.org/10.1038/s41390-021-01380-2DOI Listing
February 2021

Gene regulation contributes to explain the impact of early life socioeconomic disadvantage on adult inflammatory levels in two cohort studies.

Sci Rep 2021 Feb 4;11(1):3100. Epub 2021 Feb 4.

Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

Individuals experiencing socioeconomic disadvantage in childhood have a higher rate of inflammation-related diseases decades later. Little is known about the mechanisms linking early life experiences to the functioning of the immune system in adulthood. To address this, we explore the relationship across social-to-biological layers of early life social exposures on levels of adulthood inflammation and the mediating role of gene regulatory mechanisms, epigenetic and transcriptomic profiling from blood, in 2,329 individuals from two European cohort studies. Consistently across both studies, we find transcriptional activity explains a substantive proportion (78% and 26%) of the estimated effect of early life disadvantaged social exposures on levels of adulthood inflammation. Furthermore, we show that mechanisms other than cis DNA methylation may regulate those transcriptional fingerprints. These results further our understanding of social-to-biological transitions by pinpointing the role of gene regulation that cannot fully be explained by differential cis DNA methylation.
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http://dx.doi.org/10.1038/s41598-021-82714-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862626PMC
February 2021

Education, biological ageing, all-cause and cause-specific mortality and morbidity: UK biobank cohort study.

EClinicalMedicine 2020 Dec 19;29-30:100658. Epub 2020 Nov 19.

Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands.

Background: Socioeconomic position as measured by education may be embodied and affect the functioning of key physiological systems. Links between social disadvantage, its biological imprint, and cause-specific mortality and morbidity have not been investigated in large populations, and yet may point towards areas for public health interventions beyond targeting individual behaviours.

Methods: Using data from 366,748 UK Biobank participants with 13 biomarker measurements, we calculated a Biological Health Score (BHS, ranging from 0 to 1) capturing the level of functioning of five physiological systems. Associations between BHS and incidence of cardiovascular disease (CVD) and cancer, and mortality from all, CVD, cancer, and external causes were examined. We explored the role of education in these associations. Mendelian randomisation using genetic evidence was used to triangulate these findings.

Findings: An increase in BHS of 0.1 was associated with all-cause (HR = 1.14 [1.12-1.16] and 1.09 [1.07-1.12] in men and women respectively), cancer (HR = 1.11 [1.09-1.14] and 1.07 [1.04-1.10]) and CVD (HR = 1.25 [1.20-1.31] and 1.21 [1.11-1.31]) mortality, CVD incidence (HR = 1.15 [1.13-1.16] and 1.17 [1.15-1.19]). These associations survived adjustment for education, lifestyle-behaviours, body mass index (BMI), co-morbidities and medical treatments. Mendelian randomisation further supported the link between the BHS and CVD incidence (HR = 1.31 [1.21-1.42]). The BHS contributed to CVD incidence prediction (age-adjusted C-statistic = 0.58), other than through education and health behaviours.

Interpretation: The BHS captures features of the embodiment of education, health behaviours, and more proximal unknown factors which all complementarily contribute to all-cause, cancer and CVD morbidity and premature death.
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http://dx.doi.org/10.1016/j.eclinm.2020.100658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788440PMC
December 2020

The Relationship between Life Course Socioeconomic Conditions and Objective and Subjective Memory in Older Age.

Brain Sci 2021 Jan 6;11(1). Epub 2021 Jan 6.

Centre for the Interdisciplinary Study of Gerontology and Vulnerability (CIGEV), University of Geneva, Boulevard du Pont d'Arve 28, 1205 Geneva, Switzerland.

While objective memory performance in older adults was primarily shown to be affected by education as indicator of life course socioeconomic conditions, other life course socioeconomic conditions seem to relate to subjective memory complaints. However, studies differ in which life course stages were investigated. Moreover, studies have explored these effects in an isolated way, but have not yet investigated their unique effect when considering several stages of the life course simultaneously. This study, therefore, examined the respective influence of socioeconomic conditions from childhood up to late-life on prospective memory (PM) performance as an objective indicator of everyday memory as well as on subjective memory complaints (SMC) in older age using structural equation modeling. Data came from two waves of the Vivre-Leben-Vivere aging study (n=993, Mage=80.56). The results indicate that only socioeconomic conditions in adulthood significantly predicted late-life PM performance. PM performance was also predicted by age and self-rated health. In contrast, SMC in older age were not predicted by socioeconomic conditions at any stage of the life course but were predicted by level of depression. In line with the cognitive reserve hypothesis, present results highlight the significance of education and occupation (adulthood socioeconomic conditions) for cognitive functioning in later life.
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http://dx.doi.org/10.3390/brainsci11010061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825056PMC
January 2021

Geospatial digital monitoring of COVID-19 cases at high spatiotemporal resolution.

Lancet Digit Health 2020 08 16;2(8):e393-e394. Epub 2020 Jun 16.

Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Geographic Information Systems, School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/S2589-7500(20)30139-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832151PMC
August 2020

Life-course socioeconomic disadvantage and lung function: a multicohort study of 70 496 individuals.

Eur Respir J 2021 03 18;57(3). Epub 2021 Mar 18.

Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland.

Background: Lung function is an important predictor of health and a marker of physical functioning at older ages. This study aimed to quantify the years of lung function lost according to disadvantaged socioeconomic conditions across the life-course.

Methods: This multicohort study used harmonised individual-level data from six European cohorts with information on life-course socioeconomic disadvantage and lung function assessed by forced expiratory volume in 1 s (FEV) and forced vital capacity (FVC). 70 496 participants (51% female) aged 18-93 years were included. Socioeconomic disadvantage was measured in early life (low paternal occupational position), early adulthood (low educational level) and adulthood (low occupational position). Risk factors for poor lung function ( smoking, obesity, sedentary behaviour, cardiovascular and respiratory diseases) were included as potential mediators. The years of lung function lost due to socioeconomic disadvantage were computed at each life stage.

Results: Socioeconomic disadvantage during the life-course was associated with a lower FEV. By the age of 45 years, individuals experiencing disadvantaged socioeconomic conditions had lost 4-5 years of healthy lung function their more advantaged counterparts (low educational level -4.36 (95% CI -7.33--2.37) for males and -5.14 (-10.32--2.71) for females; low occupational position -5.62 (-7.98--4.90) for males and -4.32 (-13.31--2.27) for females), after accounting for the risk factors for lung function. By the ages of 65 years and 85 years, the years of lung function lost due to socioeconomic disadvantage decreased by 2-4 years, depending on the socioeconomic indicator. Sensitivity analysis using FVC yielded similar results to those using FEV.

Conclusion: Life-course socioeconomic disadvantage is associated with lower lung function and predicts a significant number of years of lung function loss in adulthood and at older ages.
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http://dx.doi.org/10.1183/13993003.01600-2020DOI Listing
March 2021

Perceptions of immunity and vaccination certificates among the general population: a nested study within a serosurvey of anti-SARS-CoV-2 antibodies (SEROCoV-POP).

Swiss Med Wkly 2020 11 16;150:w20398. Epub 2020 Nov 16.

Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Geneva, Switzerland.

At a time when COVID-19 immunity certificates are debated and vaccination certificates might potentially be made available if an effective vaccine is established, we conducted a study to elucidate public opinion on this issue. Our objective was to determine social and individual perceptions of COVID-19 immunity certificates through a population-based study. A nested survey within the SEROCoV-POP study, a population-based serosurvey of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland, was conducted with a self-administered questionnaire. The questionnaire was proposed to 1520 SEROCoV-POP participants. Measures included percentage of participants agreeing or disagreeing with statements on immunity and vaccination certificates. Stratification by age, gender, education and work status was used to examine socio-demographic variations. Of the 1520 SEROCoV-POP participants, 1425 completed the questionnaire (response rate 93%; mean age ± standard deviation 52 ± 15.1 years; 51.9% women). About 80% of participants agreed that knowing one’s serology status would lead to a change in one’s behaviour. In the event that the presence of antibodies correlated with immunity, 60% of participants reported that certificates should be offered to the general population. The results showed variations in perceptions of certificates depending on the context (73% agreed on certificates’ utility for travel, 72% for entering a country, and 32% for the right to work). Provided an effective vaccine was available, 55% of participants agreed that vaccination should be mandatory and 49% agreed that a vaccination certificate should be mandatory. About 68% reported a potential risk of discrimination and 28% a risk of deliberate infection. Differences were seen with age, gender and education level. This study shows that the general adult population in Geneva, Switzerland can envisage scenarios where COVID-19 immunity, and eventually vaccination, certificates would be useful. Seroprevalence estimates of anti-SARS-CoV-2 antibodies remain low to date, and the interpretability of serological testing and immunity remains undefined. However, the information from this study is important, especially the differences based on context and the socio-demographic variations, and should be taken into account if COVID-19-related certificates are to be implemented.
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http://dx.doi.org/10.4414/smw.2020.20398DOI Listing
November 2020

Prevalence of Immunoglobulin G (IgG) Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Evaluation of a Rapid MEDsan IgG Test in Children Seeking Medical Care.

Clin Infect Dis 2021 04;72(7):e192-e195

Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

In 208 children seeking medical care, the seropositivity rate of anti-SARS-CoV-2 IgG antibodies was 8.7%, suggesting an infection rate similar to that observed in adults but >100-fold the incidence of RT-PCR-confirmed pediatric cases. Compared with the gold-standard combined ELISA + immunofluorescence, the MEDsan IgG rapid diagnostic test performed accurately.
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http://dx.doi.org/10.1093/cid/ciaa1702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717220PMC
April 2021

Corona Immunitas: study protocol of a nationwide program of SARS-CoV-2 seroprevalence and seroepidemiologic studies in Switzerland.

Int J Public Health 2020 Dec 24;65(9):1529-1548. Epub 2020 Oct 24.

Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.

Objectives: Seroprevalence studies to assess the spread of SARS-CoV-2 infection in the general population and subgroups are key for evaluating mitigation and vaccination policies and for understanding the spread of the disease both on the national level and for comparison with the international community.

Methods: Corona Immunitas is a research program of coordinated, population-based, seroprevalence studies implemented by Swiss School of Public Health (SSPH+). Over 28,340 participants, randomly selected and age-stratified, with some regional specificities will be included. Additional studies in vulnerable and highly exposed subpopulations are also planned. The studies will assess population immunological status during the pandemic.

Results: Phase one (first wave of pandemic) estimates from Geneva showed a steady increase in seroprevalence up to 10.8% (95% CI 8.2-13.9, n = 775) by May 9, 2020. Since June, Zurich, Lausanne, Basel City/Land, Ticino, and Fribourg recruited a total of 5973 participants for phase two thus far.

Conclusions: Corona Immunitas will generate reliable, comparable, and high-quality serological and epidemiological data with extensive coverage of Switzerland and of several subpopulations, informing health policies and decision making in both economic and societal sectors. ISRCTN Registry: https://www.isrctn.com/ISRCTN18181860 .
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http://dx.doi.org/10.1007/s00038-020-01494-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584867PMC
December 2020

Nutritional Status and Obstacles to Healthy Eating Among Refugees in Geneva.

J Immigr Minor Health 2020 Dec 17;22(6):1126-1134. Epub 2020 Sep 17.

Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland.

Refugees face various nutritional challenges during and after migration. This cross-sectional, mixed-methods study seeks to investigate the prevalence of undernutrition and obesity among refugees in Geneva, and to identify barriers to healthy eating. Anthropometric measurements of 354 adult refugees were collected between 2017 and 2019 by trained nurses and dietitians. Seven focus group discussions totaling 51 participants, refugees and social workers, investigated conceptions and needs regarding diet. The mean Body Mass Index is 24.6 ± 4.8 kg/m. Women are disproportionately affected by obesity compared to men (p < 0.001). Weight gain post-migration is correlated positively with length of stay in Geneva (p < 0.001). Major obstacles to healthy eating are economic and linguistic. For participants, cooking workshops and free physical activities are highly needed interventions. Post-migration lifestyle interventions should be implemented to prevent weight gain in this population. Such interventions must be multi-level, to overcome structural, social and behavioral barriers to healthy eating.
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http://dx.doi.org/10.1007/s10903-020-01085-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683482PMC
December 2020

A multi-omics approach to investigate the inflammatory response to life course socioeconomic position.

Epigenomics 2020 08 2;12(15):1287-1302. Epub 2020 Sep 2.

LEASP, UMR 1027, Inserm-Université Toulouse III Paul Sabatier, Toulouse, France.

Inflammation represents a potential pathway through which socioeconomic position (SEP) is biologically embedded. We analyzed inflammatory biomarkers in response to life course SEP by integrating multi-omics DNA-methylation, gene expression and protein level in 178 European Prospective Investigation into Cancer and Nutrition-Italy participants. We identified 61 potential acting CpG loci whose methylation levels were associated with gene expression at a Bonferroni correction. We examined the relationships between life course SEP and these 61 -acting regulatory methylation sites individually and jointly using several scores. Less-advantaged SEP participants exhibit, later in life, a lower inflammatory methylome score, suggesting an overall increased expression of the corresponding inflammatory genes or proteins, supporting the hypothesis that SEP impacts adult physiology through inflammation.
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http://dx.doi.org/10.2217/epi-2019-0261DOI Listing
August 2020

Head-to-Head Accuracy Comparison of Three Commercial COVID-19 IgM/IgG Serology Rapid Tests.

J Clin Med 2020 Jul 24;9(8). Epub 2020 Jul 24.

Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1205 Geneva, Switzerland.

Background: Comparative data of SARS-CoV-2 IgM/IgG serology rapid diagnostic tests (RDTs) is scarce. We thus performed a head-to-head comparison of three RDTs.

Methods: In this unmatched case-control study, blood samples from 41 RT-PCR-confirmed COVID-19 cases and 50 negative controls were studied. The diagnostic accuracy of three commercially available COVID-19 RDTs: NTBIO (RDT-A), Orient-Gene (RDT-B), and MEDsan (RDT-C), against both a recombinant spike-expressing immunofluorescence assay (rIFA) and Euroimmun IgG ELISA, was assessed. RDT results concordant with the reference methods, and between whole blood and plasma, were established by the Kendall coefficient.

Results: COVID-19 cases' median time from RT-PCR to serology was 22 days (interquartile range (IQR) 13-31 days). Whole-blood IgG detection with RDT-A, -B, and -C showed 0.93, 0.83, and 0.98 concordance with rIFA. Against rIFA, RDT-A sensitivity (SN) was 92% (95% CI: 78-98) and specificity (SP) 100% (95% CI: 91-100), RDT-B showed 87% SN (95% CI: 72-95) and 98% SP (95% CI: 88-100), and RDT-C 100% SN (95% CI: 88-100) and 98% SP (95% CI: 88-100). Against ELISA, SN and SP were above 90% for all three RDTs.

Conclusions: RDT-A and RDT-C displayed IgG detection SN and SP above 90% in whole blood. These RDTs could be considered in the absence of routine diagnostic serology facilities.
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http://dx.doi.org/10.3390/jcm9082369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463984PMC
July 2020

Diagnostic accuracy of Augurix COVID-19 IgG serology rapid test.

Eur J Clin Invest 2020 Oct 11;50(10):e13357. Epub 2020 Aug 11.

Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, Geneva, Switzerland.

Aims: To validate the diagnostic accuracy of the Augurix SARS-CoV-2 IgM/IgG rapid immunoassay diagnostic test (RDT) for COVID-19.

Methods: In this unmatched 1:1 case-control study, blood samples from 46 real-time RT-PCR-confirmed SARS-CoV-2 hospitalized cases and 45 healthy donors (negative controls) were studied. Diagnostic accuracy of the IgG RDT was assessed against both an in-house recombinant spike-expressing immunofluorescence assay (rIFA), as an established reference method (primary endpoint), and the Euroimmun SARS-CoV-2 IgG enzyme-linked immunosorbent assays (ELISA) (secondary endpoint).

Results: COVID-19 patients were more likely to be male (61% vs 20%; P = .0001) and older (median 66 vs 47 years old; P < .001) than controls. Whole blood IgG-RDT results showed 86% and 93% overall Kendall concordance with rIFA and IgG ELISA, respectively. IgG RDT performances were similar between plasma and whole blood. Overall, RDT sensitivity was 88% (95% confidence interval [95%CI]: 70-96), specificity 98% (95%CI: 90-100), PPV 97% (95%CI: 80-100) and NPV 94% (95%CI: 84-98). The IgG-RDT carried out from 0 to 6 days, 7 to 14 days and > 14 days after the SARS-CoV-2 RT-PCR test displayed 30%, 73% and 100% positivity rates in the COVID-19 group, respectively. When considering samples taken >14 days after RT-PCR diagnosis, NPV was 100% (95%CI:90-100), and PPV was 100% (95%CI:72-100).

Conclusions: The Augurix IgG-RDT done in whole blood displays a high diagnostic accuracy for SARS-CoV-2 IgG in high COVID-19 prevalence settings, where its use could be considered in the absence of routine diagnostic serology facilities.
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http://dx.doi.org/10.1111/eci.13357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404380PMC
October 2020

Serology-informed estimates of SARS-CoV-2 infection fatality risk in Geneva, Switzerland.

Lancet Infect Dis 2021 04 14;21(4):e69-e70. Epub 2020 Jul 14.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, MD, USA; Institute of Global Health, University of Geneva, Switzerland; Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/S1473-3099(20)30584-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833057PMC
April 2021

Thirteen-year trends in the prevalence of diabetes according to socioeconomic condition and cardiovascular risk factors in a Swiss population.

BMJ Open Diabetes Res Care 2020 07;8(1)

Unit of Diabetology, Service of Endocrinology, Diabetology, Hypertension and Nutrition Services, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland.

Introduction: To estimate the prevalence of and trends in diabetes according to sociodemographic indicators and cardiovascular risk factors in a Swiss population.

Research Design And Methods: Annual cross-sectional study of adults residing in the state of Geneva. We included 9886 participants (51% women; mean age (SD) of 48.9 (13.4) years). Diagnosed diabetes was self-reported; undiagnosed diabetes was defined as having fasting plasma glucose level of ≥7 mmol/L and no previous diagnosis; total diabetes as the sum of diagnosed and undiagnosed diabetes. To assess trends, we grouped survey years into three time periods: 2005-2010, 2011-2014, and 2015-2017. To assess inequalities, we constructed the relative index of inequality (RII) and the slope index of inequality (SII) for education, income, and health insurance subsidy (state program based on socioeconomic disadvantage).

Results: In total, 683 diabetes cases were identified. In 2015-2017, total diabetes prevalence was 11.8% (8.6%-14.9%) among lowest income participants, and 4.7% (3.4%-5.9%) among highest income participants (p<0.01). Similar findings were observed for education. Among participants with full health insurance subsidy, diabetes prevalence was 19.4% (12.1%-26.8%), and 6.1% (5.3%-7.0%) among those without (p<0.01). High diabetes prevalence was observed among participants who were men, older, overweight or obese, hypertensive, and hypercholesterolemic. Among participants with diabetes, 74.0% (63.5%-84.4%) in the lowest income group were diagnosed, compared with 90.2% (81.9%-98.4%) in the highest income group (p=0.04). Over the 13-year period, widening relative and absolute inequalities in total diabetes prevalence were observed for education and income. The education-RII (95% CI) increased from 1.51 (95% CI 1.01 to 2.32) in 2005-2010 to 2.54 (95% CI 1.58 to 4.07) in 2015-2017 (p=0.01), and the education-SII (95% CI) from 0.04 (95% CI 0.01 to 0.08) to 0.08 (95% CI 0.04 to 0.10; p<0.01). The income-RII increased from 2.35 (95% CI 1.44 to 3.84) to 3.91 (95% CI 2.24 to 6.85; p<0.01), and the income-SII from 0.08 (95% CI 0.04 to 0.12) to 0.011 (95% CI 0.07 to 0.14; p=0.01). Inequalities by health insurance subsidy were large (RII 3.56 (95% CI 1.90 to 6.66) and SII 0.10 (95% CI 0.05 to 0.15)) but stable across the study period.

Conclusion: Among adults living in Geneva, Switzerland, substantial differences were observed in diabetes prevalence across socioeconomic and cardiovascular risk groups over a 13-year period, and relative and absolute socioeconomic inequalities appeared to have increased.
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http://dx.doi.org/10.1136/bmjdrc-2020-001273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359178PMC
July 2020
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