T o preserve human health security, a global surveillance system able to rapidly detect, verify, and assess burgeoning outbreaks is key. The World Health Organization (WHO) International Health Regulations (2005) (1) provides an international and legally binding framework for the early detection of, reporting of, and response to any public health threat (e.g., infectious disease outbreaks) that might be of international concern using an all-hazards approach (2). Event-based surveillance through informal sources now represents a critical source for epidemic intelligence (3). Almost all major outbreaks during 1994-2017 investigated by the WHO were early reported and identified through informal sources (4-7). One of the most valued, internationally acknowledged sources for epidemic intelligence activities that is also available as an open source is ProMED-mail (4,8). By relying on local media, professional networks, and on-the-ground experts, ProMED-mail staff produce reports on occurrences of emerging infectious diseases and outbreaks in near real-time. Specialist moderators curate these reports and provide subject matter expert commentaries. ProMED-mail captures many reports of undiagnosed diseases (i.e., reports of public health

Background The purpose of this study was to compare cervical cancer screening by pap smear (PS) versus preliminary HPV testing based on self-collected samples (SC-HPV). Methods Interventional study among underprivileged women from 25 to 65 years old in four French cities. The control group (CG) was referred for a PS. The experimental group (EG) conducted a SC-HPV test followed by a PS in case of positivity. Differences on screening completion and cytological abnormalities were analysed by logistic and Cox regression. Results 383 women were assigned to the EG and 304 to the CG. The screening completion proportion was 39.5% in the CG compared to 71.3% in the EG (HR = 2.48 (CI 95% [1.99–3.08]; p < 0.001). The proportion of cytological abnormalities was 2.0% in the CG and 2.3% in the EG (OR = 1.20 (CI 95% [0.42–3.40]; p = 0.7). The proportion of participants lost to follow-up was 60.5% in the CG and 63.2% in the EG HPV positive (p = 0.18). Conclusion Providing an SC-HPV-test increased the participation of underprivileged women in CCS. Nevertheless, the significant number of lost to follow-up in both groups can undermine the initial benefits of the strategy for HPV positive women. Registration: Clinicaltrials.gov: NCT03118258.

Background Some patients who test positive for sexually transmitted infections (STIs) fail to return for results and treatment. To target improvement actions, we need to find out who these patients are. This study aimed to explore factors associated with failure to return within 30 days (FTR30) after testing among patients with positive results in a free STI testing centre in Paris. Methods All patients with at least one positive result between October 2016 and May 2017 and who completed a self-administered questionnaire were included in this cross-sectional study (n = 214). The questionnaire included sociodemographic factors, sexual behaviour and history of testing. Factors associated with FTR30 were assessed using logistic regression models. Results More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (22%). Men who had sex with men represented 36% of the study population. The FTR30 rate was 14% (95% CI [10–19%]). In multivariate analysis, previous HIV testing in younger persons (aOR: 3.36, 95% CI [1.27–8.84]), being accompanied by another person at the pretest consultation (aOR: 3.45, 95% CI [1.36–8.91]), and lower self-perceived risk of HIV infection (aOR: 2.79, 95% CI [1.07–7.30]) were associated with a higher FTR30. Testing for chlamydia/gonorrhoea without presumptive treatment was associated with a lower FTR30 (aOR: 0.21, 95% CI [0.07–0.59]). Conclusions These factors that affect failure to return are related to the patient’s representations and involvement in the STI screening process. Increasing health literacy and patient empowerment could help to decrease failure to return after being tested positive for HIV/STI. Trial registration Not applicable.

Abstract. High-mountain ecosystems are experiencing acute effects of climate change, most visibly through glacier recession and the greening of the terrestrial environment. The streams draining these landscapes are affected by these shifts, integrating hydrologic, geologic, and biological signals across the catchment. We examined the organic and inorganic carbon dynamics of streams in four Alpine catchments in Switzerland to assess how glacier loss and vegetation expansion are affecting the carbon cycle of these high mountain ecosystems. We find that organic carbon concentration and fluorescence properties associated with humic-like compounds increase with vegetation cover within a catchment, demonstrating the increasing importance of allochthonous carbon sources following glacier retreat. Meanwhile, streams transitioned from carbon dioxide sinks to sources with decreasing glacier coverage and increased vegetation coverage, with chemical weathering and soil respiration likely determining the balance. Periods of sink behavior were also observed in non-glaciated streams, indicating geochemical consumption of carbon dioxide may be more common in high-mountain, minimally vegetated catchments than previously described. Together, these results demonstrate the dramatic shifts in carbon dynamics of alpine streams following glacier recession, with significant changes to both the organic and inorganic carbon cycles. The clear link between the terrestrial and aquatic zones further emphasizes the coupled dynamics with which all hydrologic and biogeochemical changes in these ecosystems should be considered, including the role of mountain streams in the global carbon cycle.

Abstract. High-mountain ecosystems are experiencing the acute effects of climate change, most visibly through glacier recession and the greening of the terrestrial environment. The streams draining these landscapes are affected by these shifts, integrating hydrologic, geologic, and biological signals across the catchment. We examined the organic and inorganic carbon dynamics of streams in four Alpine catchments in Switzerland to assess how glacier loss and vegetation expansion are affecting the carbon cycle of these high-mountain ecosystems. We find that the organic carbon concentration and fluorescence properties associated with humic-like compounds increase with vegetation cover within a catchment, demonstrating the increasing importance of allochthonous dissolved organic carbon sources following glacier retreat. Meanwhile, streams transitioned from carbon dioxide sinks to sources with decreasing glacier coverage and increased vegetation coverage, with chemical weathering and soil respiration likely determining the balance. Periods of sink behavior were also observed in non-glaciated streams, possibly indicating that the chemical consumption of carbon dioxide could be more common in high-mountain, minimally vegetated catchments than previously known. Together, these results demonstrate the dramatic shifts in carbon dynamics of high-mountain streams following glacier recession, with significant changes to both the organic and inorganic carbon cycles. The clear link between the terrestrial and aquatic zones further emphasizes the coupled dynamics with which all hydrologic and biogeochemical changes in these ecosystems should be considered, including the carbon sink or source potential of montane ecosystems.