Complex network model for COVID-19: Human behavior, pseudo-periodic solutions and multiple epidemic waves.

We propose a mathematical model for the transmission dynamics of SARS-CoV-2 in a homogeneously mixing non constant population, and generalize it to a model where the parameters are given by piecewise constant functions. This allows us to model the human behavior and the impact of public health policies on the dynamics of the curve of active infected individuals during a COVID-19 epidemic outbreak. After proving the existence and global asymptotic stability of the disease-free and endemic equilibrium points of the model with constant parameters, we consider a family of Cauchy problems, with piecewise constant parameters, and prove the existence of pseudo-oscillations between a neighborhood of the disease-free equilibrium and a neighborhood of the endemic equilibrium, in a biologically feasible region. In the context of the COVID-19 pandemic, this pseudo-periodic solutions are related to the emergence of epidemic waves. Then, to capture the impact of mobility in the dynamics of COVID-19 epidemics, we propose a complex network with six distinct regions based on COVID-19 real data from Portugal. We perform numerical simulations for the complex network model, where the objective is to determine a topology that minimizes the level of active infected individuals and the existence of topologies that are likely to worsen the level of infection. We claim that this methodology is a tool with enormous potential in the current pandemic context, and can be applied in the management of outbreaks (in regional terms) but also to manage the opening/closing of borders.

Awareness and Attitudes towards Advance Care Directives (ACDs): An Online Survey of Portuguese Adults.

(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = -0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death.

Development and psychometric properties of the general public's attitudes toward advance care directives scale in Portugal.

Background: To date, no instrument in Portugal has evaluated the attitudes of the population about advance care directives. This paper describes the development and testing of the General Public's Attitudes Toward Advance Care Directives (GPATACD) Scale. Design and Methods: Methodological study. The development of the instrument was based on a literature review, updated in 2018. Face and content validity were verified by an expert panel and piloted among six participants. Data were collected in an online survey of 1024 Portuguese adults. The obtained data were analyzed using Varimax rotation, while the reliability was evaluated by calculating Cronbach's alpha. Results: The scale achieves good Item-Content Validity Index (I-CVI) values, between 0.89 and 1.00, and scale-CVI values of 0.91. A principal component analysis generated four dimensions with 26 items as a final scale, with overall Cronbach's alpha of 0.848. Conclusions: The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of the general public's attitudes toward advance care directives.

Optimal control of the COVID-19 pandemic: controlled sanitary deconfinement in Portugal.

The COVID-19 pandemic has forced policy makers to decree urgent confinements to stop a rapid and massive contagion. However, after that stage, societies are being forced to find an equilibrium between the need to reduce contagion rates and the need to reopen their economies. The experience hitherto lived has provided data on the evolution of the pandemic, in particular the population dynamics as a result of the public health measures enacted. This allows the formulation of forecasting mathematical models to anticipate the consequences of political decisions. Here we propose a model to do so and apply it to the case of Portugal. With a mathematical deterministic model, described by a system of ordinary differential equations, we fit the real evolution of COVID-19 in this country. After identification of the population readiness to follow social restrictions, by analyzing the social media, we incorporate this effect in a version of the model that allow us to check different scenarios. This is realized by considering a Monte Carlo discrete version of the previous model coupled via a complex network. Then, we apply optimal control theory to maximize the number of people returning to "normal life" and minimizing the number of active infected individuals with minimal economical costs while warranting a low level of hospitalizations. This work allows testing various scenarios of pandemic management (closure of sectors of the economy, partial/total compliance with protection measures by citizens, number of beds in intensive care units, etc.), ensuring the responsiveness of the health system, thus being a public health decision support tool.

Risk Factors, Length of Stay and In-Hospital Mortality of Methicillin-Resistant Staphylococcus aureus Infections: A Case-Control Study.

INTRODUCTION: The emergence of strains of methicillin-resistant Staphylococcus aureus is a serious therapeutic challenge in healthcare provision. With this study, we aimed to investigate the risk factors and clinical outcomes (mortality and length of hospital stay) associated with methicillin-resistant Staphylococcus aureus infections in patients admitted to a district hospital in Portugal. MATERIAL AND METHODS: A case-control study was performed in 96 cases and 122 controls, selected, respectively, as function of antibiotic resistance or sensitivity to methicillin. Data were obtained through consultation of clinical records and subjected to multivariate statistical analysis. RESULTS: We identified the following independent risk factors for the occurrence of methicillin-resistant Staphylococcus aureus infection: urinary catheter (aOR = 10.62, 95% CI 3.66 - 30.78), prior use of antibiotics in the last 30 days (aOR = 5.60, 95% CI 2.15 - 14.62), exposure to 5 - 7 days of hospitalization (aOR = 4.99, 95% CI 1.20 - 20.79) or to ≥ 8 days (aOR = 5.34, 95% CI 1.18 - 24.22), chronic obstructive pulmonary disease (aOR = 4.27, 95% CI 1.64 - 11.13) and recent hospitalization (aOR = 2.66, 95% CI 1.14 - 6.23). Compared to infections due to methicillin-susceptible Staphylococcus aureus, we found increased probability of having a longer hospital stay (aHR = 1.74, 95% CI 1.11 - 2.71) and in-hospital mortality was significantly higher (p = 0.001) between patients infected by methicillin-resistant Staphylococcus aureus. DISCUSSION: The results demonstrate that methicillin resistance is associated with an increased clinical risk to patients infected by Staphylococcus aureus, in particular, a raised mortality and prolonged hospitalization. CONCLUSION: Our study underlines the additional burden imposed by methicillin resistance in Staphylococcus aureus infections. This highlights an urgent need to reinforce and optimize prevention, control, timely detection and effective treatment strategies for multidrug--resistant Staphylococcus aureus strains.

Introdução: A emergência de estirpes de Staphylococcus aureus resistentes à meticilina constitui um sério desafio terapêutico na prestação de cuidados de saúde. Com esta investigação, pretendeu-se estudar os fatores de risco e os resultados clínicos (mortalidade e tempo de internamento) associados a infeções por Staphylococcus aureus resistentes à meticilina em doentes internados numa unidade hospitalar em Portugal. Material e Métodos: Realizou-se um estudo caso-controlo. Integraram o estudo 96 casos e 122 controlos, selecionados, respetivamente, em função da resistência ou sensibilidade antibiótica à meticilina. Os dados obtidos, por consulta de registos clínicos, foram alvo de análise estatística multivariada. Resultados: Identificaram-se os seguintes fatores de risco independentes para desenvolvimento de infeção por Staphylococcus aureus resistentes à meticilina: cateter urinário (aOR = 10,62, IC 95% 3,66 ­ 30,78), antibioterapia nos últimos 30 dias (aOR = 5,60, IC 95% 2,15 ­ 14,62), exposição a cinco a sete dias de internamento (aOR = 4,99, IC 95% 1,20 ­ 20,79) ou a oito ou mais dias (aOR = 5,34, IC 95% 1,18 ­ 24,22), doença pulmonar obstrutiva crónica (aOR = 4,27, IC 95% 1,64 ­ 11,13) e internamento hospitalar recente (aOR = 2,66, IC 95% 1,14 ­ 6,23). Comparativamente a infeções por Staphylococcus aureus sensíveis à meticilina, constatou-se uma probabilidade acrescida de prolongamento do internamento (aHR = 1,74, IC 95% 1,11 ­ 2,71) e uma mortalidade intra-hospitalar significativamente superior (p = 0,001) em doentes infetados por Staphylococcus aureus resistentes à meticilina. Discussão: Os resultados demonstram que a resistência à meticilina se encontra associada a um risco clínico acrescido para os doentes infetados por Staphylococcus aureus, com tradução no aumento da mortalidade e no prolongamento do tempo de internamento. Conclusão: Este estudo salienta a sobrecarga adicional associada à resistência à meticilina em infeções por Staphylococcus aureus. Urge, portanto, reforçar e optimizar estratégias de controlo, prevenção, deteção atempada e tratamento efetivo de estirpes multirresistentes de Staphylococcus aureus.

Public health: The voice of professionals.

OBJECTIVE: To monitor, for the first time in Portugal, job satisfaction on public health units (PHUs). DESIGN: Observational, transversal and descriptive/correlational study. SETTING: All 55 PHUs of mainland Portugal. PARTICIPANTS: This study targeted all 1196 public health professionals working in PHUs. MAIN OUTCOME MEASURES: Instrument to Assess Satisfaction of Professionals (IASP), filled online, respecting the ethical considerations and a conceptual measurement model. RESULTS: Data were obtained from 64% of professionals serving in PHUs, 73% of them female. Response rate of the physicians was 59.1%, with 72.3% of environmental health technicians, 62.0% of nurses and 58.3% of technical assistants. The average age was 47.6(±10.4) years, from 22 to 69 years. We found fair/good satisfaction with men, less educated and professionals with coordination functions more satisfied and low-level satisfaction with salary. Sociodemographic and labour characteristics play a relevant role on job satisfaction. Being female, a physician and an environmental health technician or working in a public setting increases the probability of low satisfaction. CONCLUSIONS: Public health professionals are satisfied with their job, revealing high pride in their professions and strongly recommending their units to family and friends. Some variables, for example gender, leadership, marital status and education, do influence satisfaction. However, we found dissatisfaction among physicians when practice is compared with what is thought in the internship. It is possible to change the reality in which public health professionals work and to contribute to a reorganization of resources, new internal dynamics and establishment of improvement plans, aimed at a full accomplishment and job satisfaction.

[Professional Satisfaction within Family Health Units of Central Region]. / Satisfação Profissional nas Unidades de Saúde Familiar da Região Centro.

INTRODUCTION: Job satisfaction, as an organizational climate indicator, is a complex and subjective phenomenon. It is prone to individual variation, social settings and suitable to multiple explanatory theories. It can impact productivity and absenteeism, predict well-being, and it is associated with mental health, self-esteem and perception of physical health. It is comprised as one of the National Health Service evaluation criteria. This study aimed to assess the level of job satisfaction in family health units of Central Region of the country. MATERIAL AND METHODS: This was an observational, cross-sectional study with a descriptive analysis model and a correlational component. The Centro de Estudos e Investigação em Saúde da Universidade de Coimbra's Professional Satisfaction Assessment Instrument was selected as data collection instrument. Among a universe of 809 health professionals, a total of 774 professionals participated in this study population. RESULTS: The observed response rate was 66.4% at the Professional Satisfaction Assessment Instrument, corresponding to 514 professionals. Eighty two per cent of the respondents were female and 18% male. From the total subjects, 64.8% worked in model A units and the remaining 35.2% in model B units. Regarding professional categories, 34.2% were nurses, 39.8% were doctors and 26.0% clinical secretaries. The global level of satisfaction was 71.5% being 67.4% with the quality of the work setting, 78.3% with the quality of the care provided and 80.7% with the continuous improvement of quality. DISCUSSION: The sample was predominantly composed by female subjects (82%), in line with current gender distribution of professionals. Found levels of job satisfaction (71.5%) were 5.4% lower than previously recorded in 2009. CONCLUSION: We recommend systematic evaluation of job satisfaction in contracting regimens, similarly to user satisfaction.

Introdução: A satisfação profissional, indicador de clima organizacional, é um fenómeno complexo e subjetivo, sujeito a variação individual e à conjetura social, existindo múltiplas teorias explicativas. Pode ter impacto na produtividade e no absentismo e ser fator preditor do bem-estar, por estar associada à saúde mental, à autoestima e à perceção da saúde física. A sua avaliação é um dos critérios de avaliação do Serviço Nacional de Saúde. O presente estudo teve como objetivo avaliar o nível de satisfação profissional nas unidades de saúde familiar da Região Centro. Material e Métodos: Tratou-se de um estudo observacional, transversal, com um modelo de análise descritivo e com uma componentecorrelacional. Utilizou-se, para colheita de dados, o Instrumento de Avaliação da Satisfação Profissional do Centro de Estudos e Investigação em Saúde da Universidade de Coimbra. O universo foi de 809 profissionais de saúde, sendo a população em estudo constituída por 774 profissionais. Resultados: A taxa de resposta ao Instrumento de Avaliação da Satisfação Profissional foi de 66,4%, sendo a amostra constituída por 514 profissionais, 82% dos quais do sexo feminino. Trabalhavam em unidades de saúde familiar modelo A 64,8% e em modelo B 35,2%, sendo que 34,2% eram enfermeiros, 39,8% médicos e 26,0% secretários clínicos. O nível de satisfação global foi de 71,5%, sendo de 67,4% com a qualidade do local de trabalho, 78,3% com a qualidade da prestação de cuidados e 80,7% com a melhoria contínua da qualidade. Discussão: A amostra, predominantemente do sexo feminino (82%), está de acordo com a distribuição real dos profissionais e o nível de satisfação profissional de 71,5% é inferior em 5,4% ao verificado em 2009. Conclusão: Recomenda-se a contratualização do indicador satisfação profissional à semelhança do que acontece com a satisfação dos utilizadores.

[Evaluation of the antimicrobial susceptibility of community-acquired urinary tract infection]. / Avaliação do Perfil de Sensibilidade aos Antibióticos na Infeção Urinária da Comunidade.

INTRODUCTION: The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal. MATERIAL AND METHODS: We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%). RESULTS: Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin. DISCUSSION: Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%). CONCLUSION: Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapyrecommendations for optimized therapeutical choices.

IntroduçÉo: As infeções do trato urinário, depois das infeções respiratórias, sÉo as mais comuns na comunidade. O conhecimento sobre a prevalência das estirpes microbianas e a sua suscetibilidade aos antibióticos é fundamental para instituir uma terapêutica empírica eficaz. O objetivo deste estudo foi determinar os padrões de suscetibilidade aos antibióticos das estirpes bacterianas isoladas em uroculturas positivas efetuadas em doentes da regiÉo centro de Portugal.Material e Métodos: Procedemos a uma análise documental dos 6008 resultados de uroculturas, a disponibilizar aos médicos no ano de 2013, a maioria das quais executadas através do sistema automatizado VITEK 2 da bioMérieux. A análise dos dados foi efetuada através do SPSS versÉo 21.Resultados: A maioria (80%) das 6008 uroculturas positivas foi efetuada no sexo feminino. A Escherichia coli foi a bactéria mais prevalente na amostra (65,9%), seguida pela Klebsiella spp (12%). A Nitrofurantoína apresentou elevada eficácia (96%) para as estirpes de E. coli, bem como a Fosfomicina (96,6%). A Amoxicilina-Écido Clavul'nico apresentou um nível de eficácia de apenas 81,1%, para o mesmo gérmen. As quinolonas apresentaram eficácia para 78% das estirpes de E. coli, sendo inferior à registada para a Fosfomicina e para a Nitrofurantoína.DiscussÉo: O presente estudo revelou que a E. coli foi o agente patogénico predominante nas infeções do trato urinário da comunidade (65,9%) apresentando percentagens de sensibilidade elevadas à Fosfomicina (96,6%) e à Nitrofurantoína (96%).ConclusÉo: Recomenda-se a monitorizaçÉo do perfil sensibilidade dos microrganismos aos antibióticos, de modo a otimizar a terapêutica empírica das ITU.

[Alcohol consumption in the schooled youth: an old question revisited]. / Uma Velha Questão numa População Jovem: o Consumo do Álcool nos Adolescentes Escolarizados.

INTRODUCTION: Adolescents crave for new experiences. Alcohol consumption arises in this context as an attitude trivialized and sometimes even urged socially, since access to alcohol is facilitated. It is associated to risky behaviors, with serious consequences for public health. MATERIAL AND METHODS: A descriptive cross-sectional through an anonymous questionnaire applied to pupils in the district of Leiria. RESULTS: The final sample consisted of 405 individuals, 56% female, mean age of 16.5 ± 1 years (15 - 18 years). The majority (48%) attended the 10th grade, 15.4% had reproved at least once. Ninety percent of the individuals had already consumed alcohol, at least once. The first contact with the alcohol was preferentially with friends (63%) in most cases due to curiosity (47%). The results showed higher rates of beer consumption and higher educational failure in males compared to females, which had a higher consumption of distilled beverages. In both sexes, there was a tendency for "binge drinking". The majority of the individuals (60%) consumed an average of 2-3 glasses per occasion but about 30% of boys reported consuming more than 4 drinks per occasion (7% until they are drunk), a trend that was not observed in girls. Most consumption took place in bars and nightclubs (60%). It was found that 41% of respondents went out at night at least once a week, 66% started out at night between 13 and 15 years of age, when they went 70% used to drink alcohol and 9% had experienced drugs at least once. When asked about false myths about alcohol, about 20% of young people felt that alcoholic beverages may quench your thirst, 34% believed that alcohol whet your appetite, 15.4% believed that there was no problem driving if they had not drunk a lot. CONCLUSION: The pattern of alcohol consumption in these adolescents is worrisome and with characteristics similar to those reported in other European studies. A strategy is needed urgently to change this old paradigm.

Introdução: É principalmente na adolescência que os jovens procuram novas experiências. O consumo de álcool surge neste contexto como uma atitude banalizada e, por vezes, até incitada socialmente, já que o acesso a bebidas alcoólicas é facilitado. Associa-se a comportamentos de risco, com consequências sérias do ponto de vista de saúde pública. O nosso objectivo é caracterizar os padrões de consumo de álcool numa amostra de adolescentes residentes no distrito de Leiria. Material e Métodos: Estudo transversal, descritivo, através de um questionário anónimo aplicado em alunos do distrito de Leiria. Resultados: A amostra final foi de 405 indivíduos, 56% do sexo feminino, com idade média de 16,5 ± 1 anos (15 - 18 anos). A maioria (48%) frequentava o 10º ano, 15,4% reprovaram pelo menos uma vez. Noventa por cento dos inquiridos afirmaram ter experimentado bebidas alcoólicas pelo menos uma vez. O primeiro contacto com o álcool ocorreu preferencialmente com amigos (63%), na maioria dos casos por curiosidade (47%). Os resultados apontaram para maiores índices de consumo de cerveja e maior insucesso escolar no género masculino, comparativamente ao género feminino, que apresentava um maior consumo de bebidas brancas. Em ambos os sexos verificou-se uma tendência para o binge drinking. A maioria dos inquiridos (60%) consumia 2 a 3 copos por ocasião mas cerca de 30% dos rapazes afirmaram consumir mais de quatro copos por ocasião (7% até ficarem embriagados), tendência que não se verificou nas raparigas. A maioria dos consumos efectuou-se nos bares e discotecas (60%). Constatou-se que 41% dos inquiridos saíam à noite, e 70% ingeriam bebidas alcoólicas; 66% começaram a sair à noite entre os 13 e os 15 anos de idade e 9% já tinham experimentado drogas pelo menos uma vez. Os jovens estão mal informados quanto ao consumo do álcool: 20% achavam que as bebidas alcoólicas podem matar a sede, 34% acreditavam que abrem o apetite, 15,4% defendiam que não havia problemas em conduzir desde que não se bebesse demasiado. Conclusão: O padrão de consumo de álcool nestes adolescentes é preocupante e com características semelhantes às descritas noutros estudos europeus. É necessária uma estratégia urgente para mudar este velho paradigma.

[Children's oral hygiene: healthy mouth, families supervise?]. / Higiene oral na criança: boca sã, família vigilante?

UNLABELLED: Dental caries results from a complex interaction between the host and environmental factors and it is an important public health issue. AIMS: To determine the prevalence of dental caries in a school population of six and 12 years old children from Leiria; to establish a relationship between dental caries and related known risk factors; parental dental health care, parental control of their children oral hygiene and to compare our results with the National Dental Care Study of 1999. METHODS: Descriptive and statistical analysis based on a questionnaire and dental examination. RESULTS: In our sample of 248 children, 43% were six years old and 57% 12 years old; 52% were female and 72% reside in a suburban area. The prevalence of dental caries was 42% (48% for the six year and 33% for the 12 years old groups. Dental caries were more prevalent in males (p = 0, 01) and 25% of these had three or more caries. Analysis of the questionnaire revealed that 87% of children brushed their teeth daily, findings that were unrelated to gender, age or residential area. Of this group, 68% brushed their teeth twice or more daily (p = 0,008). This routine was commenced in 32% of children prior to the age of three and these had less dental caries (p = 0,022). With regard to the children's dietary habits, we found them to be similar in both groups. The children who did not sweeten their milk (23 and 24% of the six and 12 years group, respectively) had fewer dental caries (p = 0,031). Dental treatment was required in 53% of 12 year old group and in 41% of six year old group. Dental caries was also less prevalent in children who also had taken fluoride (p = 0,045). We found a significant statistical relationship between parental and their children's dietary habits (p = 0,000). Parents who brushed their teeth twice daily had children with similar oral hygiene habits and had fewer caries (p = 0,002). Parents who oversee their children's dental care (52%) include the group of parents and children that brush their teeth at least twice daily (p = 0,003). CONCLUSIONS: Dental caries was more prevalent in the six year old group with a male predominance. Children who brushed their teeth twice a day had less caries and the 12 year old group had more visits to the dentist. To ensure adequate oral hygiene habits it is important that parents supervise their children' habits.

[Prevalence infections and risk factors due to HIV, Hepatitis B and C in a prison establishment in Leiria]. / Prevalência e factores de risco das infecções por VIH, Hepatite B e C num estabelecimento prisional de Leiria.

The present study emerged due to HIV, Hepatitis B and C test samples that have been taking place in a prison establishment in Leiria. The samples were taken from 788 (77%) of the 1019 prisoners that entered the prison during the periods between February of 1999 to September 2003. A questionnaire was carried to the transmission of HIV, Hepatitis B and C infections and blood samples were also taken to determine the immunologic situation in relationship to the same viruses. Of the 788 prisoners that participated, 699 (89%) were male and 89(11%) were female. The average age was 32.3, the oldest person was 70 and the youngest was 16 years old. 294 (40%) prisoners admitted using injectable drugs and 606 (84%) confirmed they had more than one sexual partner. HIV infection were found in 47 (6%) of the prisoners, HCV infection in 326 (42%), HBsAg in 21 (3%), HBsAc in 309 (40%) and HBcAc in 312 (40%) of the prisoners. Statistics confirm a significant relationship between injectable drugs and the presence of HIV infection and HBcAc and between sexual relationships with an infected partner and the presence of HBcAc, anti-HCV and HIV infection. The prevalence of infected prisoners with HIV was 6%, with HBV 40% and with HCV 42%. Hepatitis B and C infected 70% of the prisoner who used injectable drugs. The prevalence of hepatitis B and C and HIV infection that were found compel for the continuation of prevention.