Epidemiological, demographic and clinical data on chronic viral hepatitis C in Tuscany.

BACKGROUND: Recent introduction of direct antiviral agents (DAAs) has completely changed the scenario regarding hepatitis C virus (HCV) treatment. Certain countries' economic health programs prioritize DAAs according to specific clinical features of HCV-infected patients. The aim of this study was to define epidemiological, demographic and clinical characteristics of HCV-infected patients in the Tuscany region of central Italy. METHODS: We enrolled HCV patients with chronic viral hepatitis who were referred to the outpatient services of 16 hospitals in Tuscany from 1 January 2015 to 31 December 2015. Case report forms contained patient information including main demographic data, blood chemistry data, viral hepatitis markers, instrumental evaluations (liver biopsy or transient elastometry, liver ultrasound), eligibility for DAAs, and liver transplantation or therapy already in progress. RESULTS: Of all patients considered, 2919 HCV patients were enrolled (mean age: 57.44 ± 15.15; 54% males, 46% females). All routes of transmission were well represented (intravenous drug use in 20.7%; nosocomial/dental care in 20.6%; and coagulation factors/blood transfusions in 13.3%). Diabetes was the highest represented comorbidity (20.8%), followed by metabolic syndrome (15.5%) and ischemic heart disease (6.2%). The most prevalent HCV genotypes were 1b (47.4%) and 2 (16.5%). In the whole cohort of patients, 32.8% were cirrhotic (40 patients were listed for liver transplantation). Signs of portal hypertension were present mostly in the group older than 45 years (92.3%). Extrahepatic HCV-related diseases were present in 13.3% of cases (cryoglobulinemic syndrome in 58.3% and B-cell non-Hodgkin's lymphoma in 10.5%). CONCLUSIONS: Our study provides evidence of a high prevalence of epidemiological changes in HCV infection with a major prevalence of advanced liver disease, such as portal hypertension, in this elderly cohort of patients.

[The health conditions of prison inmates in Tuscany]. / Lo stato di salute della popolazione detenuta all'interno delle strutture penitenziarie della Regione Toscana.

OBJECTIVE: Investigation of health conditions of prison inmates in Tuscany (Italy) compared with non-institutionalized population and literature data. DESIGN: Cross-sectional descriptive study of a sample recruited for a prospective cohort study. SETTING E PARTICIPANTS: Prison inmates detained in Tuscany on June 15th 2009. Istat data concerning the survey "Aspects of daily life" 2006-2009 has been used for comparison. MAIN OUTCOME MEASURES: The measures used for the analysis are prevalence data by age classes and odds ratios obtained through a logistic regression model. Outcome variables are: broad disease groups, in particular infectious and parasitic diseases and psychic disorders. RESULTS: Prison inmates from Northern Africa and Eastern Europe are 40% of the population studied. A high consumption of tobacco is observed, with 70.6% of regular smokers among prisoners vs 33.2% among free citizens. Digestive system diseases are the most frequent diseases (25.1%), followed by infectious and parasitic diseases (15.7%). Among digestive disease,more than half are teeth and oral cavity pathologies that affect 13.7% of prisoners.Other frequently reported disease groups were diseases of the bone-muscular and connective systems (11.0%), of the circulatory system (10.8%), endocrine and metabolic systems (9.2%), traumatisms and poisonings (6.8%), respiratory system diseases (5.9%), and nervous system diseases (4.9%). The prevalence of ischemic heart diseases, diabetes, obesity and esophagitis, gastritis and gastro-duodenal ulcers is significantly higher among prisoners than in the general population. The most frequent infectious and parasitic diseases are Hepatitis C Virus (HCV) infection with a prevalence of 9.0%, Hepatitis B Virus (HBV) infection (2.2%), and Human Immunodeficiency Virus (HIV) infection (1.4%). Hepatitis C, HIV and hepatitis A have a higher prevalence among inmates of Italian nationality, while syphilis is more common among prisoners from Eastern Europe (1.2%). The prevalence of psychic disorders among prison inmates is 33.3% (vs 11.6% in the general population), while it decreases to 29.3% if we exclude the population detained in the Psychiatric Prison. CONCLUSIONS: According to previous national and international studies, the cohort is more affected than the general population by physical and psychic disorders, partly associated to the prison inmate's country of origin.