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1.
BMC Infect Dis ; 24(1): 1054, 2024 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-39333922

RESUMEN

BACKGROUND: Hepatitis C virus (HCV) antibody self-testing (HCVST) may help expand screening access and support HCV elimination efforts. Despite potential benefits, HCVST is not currently implemented in Pakistan. This study aimed to assess the usability and acceptability of HCVST in a high HCV prevalence informal settlement in Karachi, Pakistan. METHODS: We performed a cross-sectional study in a hepatitis C clinic from April through June 2023. Participants were invited to perform a saliva-based HCVST (OraSure Technologies, USA) while following pictorial instructions. A study member evaluated test performance using a standardized checklist and provided verbal support if a step could not be completed. Perceived usability and acceptability were assessed using a semi-structured questionnaire. The HCVST was considered successful if the participant was able to complete all steps and correctly interpret test results. Overall concordance and positive and negative agreement were estimated in comparison with the HCVST result read by the study member (inter-reader concordance and agreement) and result of a second rapid HCV test (Abbott Diagnostics Korea Inc, South Korea) performed by a trained user (inter-operator concordance and agreement). RESULTS: The study included 295 participants of which 97 (32%) were illiterate. In total, 280 (95%, 95% CI 92-97%) HCVSTs were successful. Overall, 38 (13%) people performed the HCVST without verbal assistance, 67 (23%) needed verbal assistance in one step, 190 (64%) in two or more. Assistance was most often needed in managing the test buffer and test reading times. The inter-reader concordance was 96% and inter-operator concordance 93%. Inter-reader and inter-operator positive percent agreement were 84 and 70%, respectively. All participants reported they would use HCVST again and would recommend it to friends and family. CONCLUSION: Saliva-based HCVST was very well accepted in this clinic-based setting. However, many people requested verbal support in several steps, highlighting the need for clear instructions for use and test devices that are simple to use, particularly in low literacy settings. Moderately low positive percent agreement with the results of a rapid test performed by a trained user highlights potential uncertainty in the accuracy of HCVST in the hands of lay users.


Asunto(s)
Hepatitis C , Autoevaluación , Humanos , Pakistán/epidemiología , Masculino , Femenino , Estudios Transversales , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Adulto , Persona de Mediana Edad , Prevalencia , Hepacivirus/aislamiento & purificación , Tamizaje Masivo/métodos , Anticuerpos contra la Hepatitis C/sangre , Aceptación de la Atención de Salud/estadística & datos numéricos , Población Urbana , Encuestas y Cuestionarios , Adulto Joven , Saliva/virología
2.
BMC Infect Dis ; 24(1): 362, 2024 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-38553731

RESUMEN

This comprehensive retrospective data-linkage study aimed at evaluating the impact of Direct-Acting Antivirals (DAAs) on Hepatitis C Virus (HCV) testing, treatment trends, and access to care in Tuscany over six years following their introduction. Utilizing administrative healthcare records, our work reveals a substantial increase in HCV tests in 2017, attributed to the decision to provide universal access to treatment. However, despite efforts to eradicate chronic HCV through a government-led plan, the target of treating 6,221 patients annually was not met, and services contracted after 2018, exacerbated by the COVID-19 pandemic. Key findings indicate a higher prevalence of HCV screening among females in the 33-53 age group, influenced by pregnancy-related recommendations, while diagnostic tests and treatment uptake were more common among males. Problematic substance users constituted a significant proportion of those tested and treated, emphasizing their priority in HCV screening. Our paper underscores the need for decentralized HCV models and alternative testing strategies, such as point-of-care assays, especially in populations accessing harm reduction services, communities, and prisons. The study acknowledges limitations in relying solely on administrative records, advocating for improved data access and timely linkages to accurately monitor HCV care cascades and inform regional plans. Despite challenges, the paper demonstrates the value of administrative record linkages in understanding the access to care pathway for hard-to-reach populations. The findings emphasize the importance of the national HCV elimination strategy and the need for enhanced data collection to assess progress accurately, providing insights for future regional and national interventions.


Asunto(s)
Hepatitis C Crónica , Hepatitis C , Abuso de Sustancias por Vía Intravenosa , Masculino , Embarazo , Femenino , Humanos , Hepacivirus , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/epidemiología , Estudios Retrospectivos , Antivirales/uso terapéutico , Pandemias , Hepatitis C/diagnóstico , Hepatitis C/tratamiento farmacológico , Hepatitis C/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología
3.
Int J Health Geogr ; 23(1): 8, 2024 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-38575967

RESUMEN

BACKGROUND: It has been shown that COVID-19 affects people at socioeconomic disadvantage more strongly. Previous studies investigating the association between geographical deprivation and COVID-19 outcomes in Italy reported no differences in case-hospitalisation and case-fatality. The objective of this research was to compare the usefulness of the geographic and individual deprivation index (DI) in assessing the associations between individuals' deprivation and risk of Sars-CoV-2 infection and disease severity in the Apulia region from February to December 2020. METHODS: This was a retrospective cohort study. Participants included individuals tested for SARS-CoV-2 infection during the study period. The individual DI was calculated employing polychoric principal component analysis on four census variables. Multilevel logistic models were used to test associations between COVID-19 outcomes and individual DI, geographical DI, and their interaction. RESULTS: In the study period, 139,807 individuals were tested for COVID-19 and 56,475 (43.5%) tested positive. Among those positive, 7902 (14.0%) have been hospitalised and 2215 (4.2%) died. During the first epidemic wave, according the analysis done with the individual DI, there was a significant inversely proportional trend between the DI and the risk of testing positive. No associations were found between COVID-19 outcomes and geographic DI. During the second wave, associations were found between COVID-19 outcomes and individual DI. No associations were found between the geographic DI and the risk of hospitalisation and death. During both waves, there were no association between COVID-19 outcomes and the interaction between individual and geographical DI. CONCLUSIONS: Evidence from this study shows that COVID-19 pandemic has been experienced unequally with a greater burden among the most disadvantaged communities. The results of this study remind us to be cautious about using geographical DI as a proxy of individual social disadvantage because may lead to inaccurate assessments. The geographical DI is often used due to a lack of individual data. However, on the determinants of health and health inequalities, monitoring has to have a central focus. Health inequalities monitoring provides evidence on who is being left behind and informs equity-oriented policies, programmes and practices. Future research and data collection should focus on improving surveillance systems by integrating individual measures of inequalities into national health information systems.


Asunto(s)
COVID-19 , Humanos , COVID-19/diagnóstico , COVID-19/epidemiología , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Gravedad del Paciente
4.
BMC Public Health ; 24(1): 1001, 2024 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-38600540

RESUMEN

BACKGROUND: Evidence has shown that the risk of transmission of SARS-CoV-2 is much higher in prisons than in the community. The release of the COVID-19 vaccine and the recommendation by WHO to include prisons among priority settings have led to the inclusion of prisons in national COVID-19 vaccination strategies. Evidence on prison health and healthcare services provision is limited and often focuses on a single country or institution due to the multiple challenges of conducting research in prison settings. The present study was done in the framework of the EU-founded project RISE-Vac. It aimed to analyse the best practices and challenges applied in implementing COVID-19 universal vaccination services during the pandemic to support future expansion of routine life course vaccination services for people living in prison (PLP). METHODS: Two online cross-sectional surveys were designed and piloted: survey1 on prison characteristics and (non-COVID-19) immunisation practices; survey2 on the implementation and coverage of COVID-19 vaccination with open-ended questions for thematic analysis. Each RISE-Vac project partner distributed the questionnaire to one or two prisons in their country. Answers were collected from eight European prisons' directors or medical directors between November 2021-May 2022. RESULTS: According to our findings, the implementation modalities of COVID-19 vaccination services in the surveyed prisons were effective in improving PLP vaccination coverage. Strategies for optimal management of the vaccination campaign included: periodic time slot for PLP vaccination; new staff recruitment and task shifting; distribution of informational material both to PLP and prison staff. Key challenges included continuity of care after release, immunisation information system, and vaccine hesitancy. CONCLUSIONS: To the best of our knowledge, this is the first study describing the implementation of COVID-19 vaccination services in European prisons, suggesting that the expansion of vaccination provision in prison is possible. There is no unique solution that will fit every country but commonalities likely to be important in the design and implementation of future vaccination campaigns targeting PLP emerged. Increased availability of vaccination services in prison is not only possible, but feasible and highly desirable, and can contribute to the reduction of health inequalities.


Asunto(s)
COVID-19 , Prisioneros , Humanos , Prisiones , Vacunas contra la COVID-19/uso terapéutico , Estudios Transversales , Acontecimientos que Cambian la Vida , COVID-19/epidemiología , COVID-19/prevención & control , SARS-CoV-2 , Vacunación
5.
Euro Surveill ; 29(35)2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39212061

RESUMEN

On 22 April 2024, a locally-acquired case of cholera was confirmed in Mayotte. Subsequently, local transmission resulted in eight outbreak clusters with 221 notified cases in densely populated neighbourhoods with limited or no access to drinking water. The last case was detected on 12 July. A case-area targeted intervention strategy was applied to contain the outbreak. However, improving access to drinking water and basic sanitation is crucial to prevent further exposure.


Asunto(s)
Cólera , Brotes de Enfermedades , Vibrio cholerae , Humanos , Cólera/epidemiología , Francia/epidemiología , Vibrio cholerae/aislamiento & purificación , Adulto , Persona de Mediana Edad , Masculino , Adolescente , Femenino , Niño , Anciano , Agua Potable/microbiología , Preescolar , Adulto Joven , Lactante , Saneamiento
6.
J Community Psychol ; 2023 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-37566403

RESUMEN

This review aimed at evaluating the state of availability, accessibility and model of delivery of oral health services in prisons, globally. Five databases of peer-reviewed literature and potential sources of grey literature were systematically searched. Inclusion criteria encompassed oral health papers related to prisons globally, with exclusion of certain article types. Selection involved independent evaluations by two researchers, followed by quality assessment. Data on the availability of oral health interventions in prisons came from 18 countries, while information on the model of delivery of the services is scarce. In addition, two sets of individual and organizational barriers toward oral health service uptake in prisons were revealed and discussed in the text. Lack of oral health services in prisons affects people living in prisons and jeopardizes their reintegration. Urgent and concrete international actions are required to ensure the availability, accessibility, and quality of oral health services among people living in prisons.

7.
J Community Psychol ; 2023 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-37462954

RESUMEN

The objective of this study is to examine interventions implemented to increase vaccine uptake among people who live and work in prisons around the world. Peer-reviewed and gray literature databases were searched systematically to identify relevant information published from 2012 to 2022. Publications were evaluated by two researchers independently and underwent quality assessment through established tools. Of the 11,281 publications identified through peer-reviewed (2607) and gray literature (8674) search, 17 met the inclusion criteria. In light of limited data, the identified interventions were categorized into two categories of educational and organizational interventions, and are discussed in the text. The lack of availability of vaccination services and interventions to increase vaccine uptake among people who live and work in prisons, worldwide, is a serious public health concern. These interventions reported in this review can be adapted and adopted to mitigate the burden of infectious diseases among people who live and work in prisons.

8.
J Community Psychol ; 2023 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-37172289

RESUMEN

Substance use is a global phenomenon that is particularly affecting the prison population. This study aimed to describe the prevalence of drug use among people in prison before and during incarceration in seven European countries and to compare it with the prevalence in the general population. Individual data collection was carried out between 2014 and 2018 with a model European Questionnaire on Drug Use among people in prison. A total of 12,918 people living in prison filled in the survey. People in prison report higher level of drug use when compared with the general population and the use of drug inside prison exist, although at lower levels when compared with predetention. Prisons can represent a point of access to engage individuals who use drugs in interventions that address drug use and risk factors related to both drug use and imprisonment.

9.
Int J Mol Sci ; 23(19)2022 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-36232651

RESUMEN

Actinic keratosis is an intraepithelial proliferation of atypical keratinocytes that could progress into invasive squamous cell carcinoma. Most evidence suggests an important role of the dermal matrix metalloproteinases in the progression of atypical skin epithelial lesions. We evaluated the clinical efficacy of three different therapeutic modalities (a medical device containing 0.8% piroxicam cream and 50+ sunscreen, photodynamic therapy, and ingenol mebutate gel) to treat suspicious actinic keratoses, which were biopsied for histopathological examination and then analyzed for the expression of matrix metalloproteinases by immunohistochemistry. Clinical, dermoscopic, and reflectance confocal microscopy evaluations revealed a gradual decrease in all standard scores validated for actinic keratosis assessment at the end of the treatments. From a histopathological point of view, we documented the substantial restoration of normal skin architecture, while the immunohistochemical evaluation of matrix metalloproteinases showed a reduction in expression in the treated skin lesions compared to the baseline. As actinic keratoses are considered the precursors of squamous cell carcinoma, their treatment is crucial to prevent the development of a more aggressive disease. Our study monitored the evolution of actinic keratoses subjected to three different topical therapies, with the value of correlating clinical and histopathological findings. Moreover, as the matrix metalloproteinases are largely recognized factors involved in the pathogenesis and evolution of actinic keratosis to squamous cell carcinoma, the demonstration by immunohistochemistry of a reduction in their expression after the treatments adds new valuable concern to the field.


Asunto(s)
Carcinoma de Células Escamosas , Diterpenos , Queratosis Actínica , Carcinoma de Células Escamosas/tratamiento farmacológico , Humanos , Queratosis Actínica/tratamiento farmacológico , Queratosis Actínica/patología , Metaloproteasas/uso terapéutico , Piroxicam , Estudios Retrospectivos , Protectores Solares , Resultado del Tratamiento
10.
Lupus ; 30(1): 125-133, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33019879

RESUMEN

Main subtypes of cutaneous lupus erythematosus are represented by acute, subacute cutaneous, intermittent and chronic cutaneous lupus erythematosus. Discoid lupus erythematosus represents the most common phenotype of chronic cutaneous lupus erythematosus. The spectrum of clinical manifestations mirrors that of several and distinct histopathological features. Such variability among different CLE subtypes is also observed at dermoscopy. Dermoscopy is nowadays considered an additional valuable method for skin lesions assessment in general dermatology, following and completing the well-known clinical diagnostic steps, such as medical history and clinical examination. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool able to assess the epidermis and upper dermis producing high resolution (horizontal ∼1.25 µm, vertical ∼5 µm), en face tissue sections used for melanocytic and inflammatory evaluation. In this study, we reported dermoscopic and RCM features about 9 patients affected by subacute and chronic lupus erythematosus retrospectively analyzed.


Asunto(s)
Dermoscopía/métodos , Lupus Eritematoso Discoide/patología , Microscopía Confocal/métodos , Adulto , Anciano , Biopsia , Femenino , Humanos , Lupus Eritematoso Discoide/diagnóstico , Masculino , Persona de Mediana Edad
11.
J Cell Mol Med ; 24(23): 13554-13563, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33128843

RESUMEN

Psoriasis and psoriatic arthritis are multifactorial chronic disorders whose etiopathogenesis essentially derives from the alteration of several signalling pathways and the co-occurrence of genetic, epigenetic and non-genetic susceptibility factors that altogether affect the functional and structural property of the skin. Although shared and differential susceptibility genes and molecular pathways are known to contribute to the onset of pathological phenotypes, further research is needed to dissect the molecular causes of psoriatic disease and its progression towards Psoriatic Arthritis. This review will therefore be addressed to explore differences and similarities in the etiopathogenesis and progression of both disorders, with a particular focus on genes involved in the maintenance of the skin structure and integrity (keratins and collagens), modulation of patterns of recognition (through Toll-like receptors and dectin-1) and immuno-inflammatory response (by NLRP3-dependent inflammasome) to microbial pathogens. In addition, special emphasis will be given to the contribution of epigenetic elements (methylation pattern, non-coding RNAs, chromatin modifiers and 3D genome organization) to the etiopathogenesis and progression of psoriasis and psoriatic arthritis. The evidence discussed in this review highlights how the knowledge of patients' clinical and (epi)genomic make-up could be helpful for improving the available therapeutic strategies for psoriasis and psoriatic arthritis treatment.


Asunto(s)
Artritis Psoriásica/diagnóstico , Artritis Psoriásica/etiología , Susceptibilidad a Enfermedades , Fenotipo , Psoriasis/diagnóstico , Psoriasis/etiología , Colágeno/genética , Colágeno/metabolismo , Epigénesis Genética , Epigenómica/métodos , Expresión Génica , Perfilación de la Expresión Génica , Regulación de la Expresión Génica , Predisposición Genética a la Enfermedad , Humanos , Piel/metabolismo , Piel/patología , Transcriptoma
12.
J Pharmacol Sci ; 144(1): 52-56, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32565006

RESUMEN

The use of biological drugs in psoriasis is replacing traditional therapies due to their specific mechanism and limited side effects. However, the use of Interleukin 17 inhibitors and the modification of its cytokine pathway could favor the risk of fungal infections. All-trans retinoic acid is an active metabolite of vitamin A with anti-inflammatory and immunoregulatory properties through its capacity to stimulate both innate and adaptive immunity and to its effects on proliferation, differentiation and apoptosis in a variety of immune cells. Furthermore, it has been recently discovered that All-trans retinoic acid has a direct fungistatic effect against Candida and Aspergillus Fumigatus. On the basis of these new insights, in the current review, we suggest that the evaluation of serum level of All-trans retinoic acid or vitamin A should be considered as a predictive marker for the development of fungal infections among psoriatic patients treated with Interleukin 17 inhibitors. In clinical practice, vitamin A test could be added in the routine hospital diagnostic management for a better selection of psoriatic patients eligible to Interleukin 17 inhibitors.


Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Candidiasis/diagnóstico , Candidiasis/etiología , Dermatomicosis/diagnóstico , Dermatomicosis/etiología , Interleucina-17/antagonistas & inhibidores , Micosis/diagnóstico , Micosis/etiología , Psoriasis/tratamiento farmacológico , Psoriasis/inmunología , Vitamina A/sangre , Biomarcadores/sangre , Candidiasis/prevención & control , Citocinas/metabolismo , Dermatomicosis/prevención & control , Humanos , Interleucina-17/metabolismo , Micosis/prevención & control , Selección de Paciente , Valor Predictivo de las Pruebas , Riesgo , Transducción de Señal/efectos de los fármacos , Tretinoina/sangre
13.
Dermatol Ther ; 32(6): e13089, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31577864

RESUMEN

Hidradenitis suppurativa and psoriasis are chronic inflammatory skin disorders. The onset of these pathologies is due to the interaction between genetic, environmental, and immunological factors making them classifiable as immuno-mediated inflammatory diseases, deriving from immunological deregulation. The coexistence of hidradenitis suppurativa (HS) and psoriasis in the same patient is rare and choosing the right therapy to treat both the conditions can be challenging. Here, we report the case of a patient affected by multidrug-resistant psoriasis and HS who reached a complete healing with apremilast, suggesting its possible therapeutic role in patients showing both the diseases.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Hidradenitis Supurativa/tratamiento farmacológico , Psoriasis/tratamiento farmacológico , Talidomida/análogos & derivados , Resistencia a Múltiples Medicamentos , Hidradenitis Supurativa/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/fisiopatología , Talidomida/uso terapéutico , Resultado del Tratamiento
14.
Dermatol Ther ; 32(4): e12946, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31025500

RESUMEN

Acrodermatitis continua of Hallopeau (ACH) is a chronic, inflammatory, and relapsing disorder characterized by the progressive destruction of fingernails and toenails. This condition is rare, difficult to treat, and often misdiagnosed. Several antipsoriatic treatments have been used, without any therapeutic guideline and no real improvement. Apremilast is an oral phosphodiesterase 4 inhibitor, approved for the treatment of chronic plaque psoriasis and psoriatic arthritis. It increases the intracellular concentration of cAMP and restores cytokine equilibrium, especially IL-10, which is particularly involved in nail psoriasis. We reported the case of a 58-year-old man affected by ACH, successfully treated with Apremilast, who achieved a complete healing in just 1 month of treatment without any side effect. We suggest this drug as a successful new treatment for ACH, which can improve clinical manifestations rapidly and has no or few adverse effects. Future formal clinical trials and additional case reports are needed to establish the safety and efficacy of Apremilast in the treatment of ACH.


Asunto(s)
Acrodermatitis/tratamiento farmacológico , Enfermedades de la Uña/tratamiento farmacológico , Talidomida/análogos & derivados , Acrodermatitis/patología , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Uña/patología , Talidomida/efectos adversos , Talidomida/uso terapéutico , Resultado del Tratamiento
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