Elimination of hepatitis C virus in a prison: An 18-year experience.

INTRODUCTION: Despite the decrease of hepatitis C in Spanish prisons in the last years, it still remains a reservoir for infection. The aim of this work is to analyze the characteristics of these patients and the response to antiviral treatment over the last 18 years. METHODS: Retrospective observational study in inmates of Araba penitentiary center diagnosed with HCV infection between 2002 and 2020. A descriptive analysis of patient characteristics and the response to the three antiviral treatment modalities was performed: peg-interferon and ribavirin, peg-interferon, ribavirin and a first-generation protease inhibitor and different combinations of direct-acting antivirals. RESULTS: A total of 248 antiviral treatments were prescribed. Treatment response rate up to 2015 was 65% and 93,7% after that year. Interferon non-responders were the main cause of non-response to treatment in periods 1 and 2 (40%-50%). Conversely, in period 3 viral breakthrough (67%) was the main culprit. CONCLUSION: After 18 years, active hepatitis C infection in prison inmates has resolved with treatment according to clinical criteria. Therefore, the stay in prison may represent an opportunity to reduce the reservoir of the disease in the community, together with continued health care for those released from prison.

Effects of the Pelotas (Brazil) Peace Pact on violence and crime: a synthetic control analysis.

Background: City-led interventions are increasingly advocated to achieve the UN's Sustainable Development Goal to reduce violence for all. We used a new quantitative evaluation method to examine whether a flagship programme, called the "Pelotas Pact for Peace" (the Pacto), has been effective in reducing violence and crime in the city of Pelotas, Brazil. Methods: We used synthetic control methodology to assess the effects of the Pacto from August 2017 to December 2021, and separately before and during the COVID-19 pandemic. Outcomes included monthly rates of homicide and property crime, and yearly rates of assault against women and school drop-out. We constructed synthetic controls (counterfactuals) based on weighted averages from a donor pool of municipalities in Rio Grande do Sul. Weights were identified using pre-intervention outcome trends and confounders (sociodemographics, economics, education, health and development, and drug trafficking). Findings: The Pacto led to an overall 9% reduction in homicide and 7% reduction in robbery in Pelotas. These effects were not uniform across the full post-intervention period as clear effects were only seen during the pandemic period. A 38% reduction in homicide was also specifically associated with the criminal justice strategy of Focussed Deterrence. No significant effects were found for non-violent property crimes, violence against women, and school dropout, irrespective of the post-intervention period. Interpretation: City-level interventions that combine public health and criminal justice approaches could be effective in tackling violence in Brazil. Continued monitoring and evaluation efforts are increasingly needed as cities are proposed as key opportunities for reducing violence for all. Funding: This research was funded by the Wellcome Trust [grant number: 210735_Z_18_Z].

Sociodemographic and health profile of asylum-seekers in Rio de Janeiro, 2016-2017.

OBJECTIVE: To analyze the sociodemographic profile and self-reported health conditions of asylum-seekers in Rio de Janeiro. METHODS: A cross-sectional study of secondary data, collected from asylum claims forms completed in 2016 and 2017, at Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Descriptive analyses were performed and absolute and relative frequencies and 95% confidence intervals were calculated. RESULTS: Claims completed by 818 asylum-seekers from 49 different countries were identified, of whom 126 (20.3%) were stateless, 510 (62.7%) were male, 797 (97.4%) were adults, with a mean age of 30.5 years, 551 (73.5%) were single, 340 (44.1%) had higher education, and 27 (4.0%) were unemployed in their country of origin before coming to Brazil. Fear of persecution for political opinion, violation of human rights, and risk of torture stood out among the reasons stated for requesting asylum. To reach Brazil, 629 (80.5%) traveled only by plane. Regarding health conditions, 216 (29.0%) reported having some symptom, disease or health problem, the most frequent being pain, vision problems, infectious diseases (including HIV/AIDS), and hypertension. Only 15 individuals (2.2%) reported being in some medical or psychological treatment; 42 (6.0%) reported visual impairments, 14 (2.0%) reported physical impairments and 4 (0.6%) hearing impairments. CONCLUSIONS: Unlike other countries, where forced migrants with a low level of education enter clandestinely by sea or land, asylum-seekers residing in Rio de Janeiro between 2016 and 2017 were mostly adults with higher education who migrated using air transport. They had primary care-sensitive health conditions that could be treated via access to public primary health care services.

Sociodemographic and health profile of asylum-seekers in Rio de Janeiro, 2016-2017 / Perfil sociodemográfico e de saúde de solicitantes de refúgio no Rio de Janeiro, 2016-2017

ABSTRACT OBJECTIVE To analyze the sociodemographic profile and self-reported health conditions of asylum-seekers in Rio de Janeiro. METHODS A cross-sectional study of secondary data, collected from asylum claims forms completed in 2016 and 2017, at Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Descriptive analyses were performed and absolute and relative frequencies and 95% confidence intervals were calculated. RESULTS Claims completed by 818 asylum-seekers from 49 different countries were identified, of whom 126 (20.3%) were stateless, 510 (62.7%) were male, 797 (97.4%) were adults, with a mean age of 30.5 years, 551 (73.5%) were single, 340 (44.1%) had higher education, and 27 (4.0%) were unemployed in their country of origin before coming to Brazil. Fear of persecution for political opinion, violation of human rights, and risk of torture stood out among the reasons stated for requesting asylum. To reach Brazil, 629 (80.5%) traveled only by plane. Regarding health conditions, 216 (29.0%) reported having some symptom, disease or health problem, the most frequent being pain, vision problems, infectious diseases (including HIV/AIDS), and hypertension. Only 15 individuals (2.2%) reported being in some medical or psychological treatment; 42 (6.0%) reported visual impairments, 14 (2.0%) reported physical impairments and 4 (0.6%) hearing impairments. CONCLUSIONS Unlike other countries, where forced migrants with a low level of education enter clandestinely by sea or land, asylum-seekers residing in Rio de Janeiro between 2016 and 2017 were mostly adults with higher education who migrated using air transport. They had primary care-sensitive health conditions that could be treated via access to public primary health care services.

RESUMO OBJETIVO Analisar o perfil sociodemográfico e as condições de saúde autorrelatadas por solicitantes de refúgio no Rio de Janeiro. MÉTODOS Estudo transversal de dados secundários, coletados de formulários de solicitação de refúgio preenchidos em 2016 e 2017, na Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Foram realizadas análises descritivas e calculadas frequências absolutas, relativas e intervalos de 95% de confiança. RESULTADOS Foram identificados formulários preenchidos por 818 solicitantes de refúgio, originários de 49 países diferentes, dos quais 126 (20,3%) eram apátridas, 510 (62,7%) do sexo masculino, 797 (97,4%) adultos, com idade média de 30,5 anos, 551 (73,5%) solteiros, 340 (44,1%) com ensino superior e 27 (4,0%) desempregados no país de origem antes da vinda para o Brasil. Entre os motivos declarados para solicitação de refúgio, destacaram-se o temor de perseguição por opinião política, violação de direitos humanos e risco de tortura. Para chegar ao Brasil, 629 (80,5%) viajaram somente de avião. Em relação às condições de saúde, 216 (29,0%) afirmaram ter algum sintoma, doença ou agravo em saúde, sendo as mais frequentes dores, problemas de visão, doenças infecciosas (incluindo HIV/aids) e hipertensão. Apenas 15 indivíduos (2,2%) relataram estar em algum tratamento médico ou psicológico; 42 (6,0%) relataram deficiências visuais, 14 (2,0%) relataram deficiências físicas e 4 (0,6%) deficiências auditivas. CONCLUSÕES Diferentemente de outros países, onde migrantes forçados de baixo grau de instrução entram por vias clandestinas marítimas ou terrestres, os solicitantes de refúgio residentes no Rio de Janeiro entre 2016 e 2017, eram, em sua maioria, adultos com ensino superior que migraram usando transporte aéreo. Apresentavam condições de saúde sensíveis à atenção primária que poderiam ser tratadas via acesso aos serviços públicos da atenção primária em saúde.

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study.

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. PURPOSE: To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. METHODS: Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. RESULTS: A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. CONCLUSIONS: Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis.

Criminal justice involvement of crack cocaine users in the city of Rio de Janeiro and Greater Metropolitan Area: Implications for public health and the public security agenda.

BACKGROUND: The international literature has expressed different and sometimes contrasting perspectives when addressing criminal involvement by crack cocaine users, highlighting psychopharmacological aspects, the cycles of craving and pressing economic need, and the interplay with overall deprivation and structural violence. The current study aims to identify variables associated with the arrest and imprisonment of regular crack cocaine users. METHODS: Interviewees were recruited from open drug scenes in the city of Rio de Janeiro and Greater Metropolitan Area from September 2011 to June 2013. Multilevel logistic regression models were fitted to the data. RESULTS: Most of the recruited crack cocaine users were male (78.2% [95%CI: 76.3-79.4]), 18-30 years old (64.7% [95%CI: 62.5-66.2]), non-white (92.9% [95%CI: 91.2-93.4]), single (68.9% [95%CI: 66.8-70.3]), and with 0-7 years of schooling (70.6% [95%CI: 68.5-71.9]). Factors independently associated with arrest were history of inpatient addiction treatment (adjOR 4.31 [95%CI: 1.70-11.32]); male gender (adjOR 2.05 [95%CI: 1.40-3.04); polydrug use (adjOR 1.82 [95%CI: 1.32-2.51]); and 0 to 7 years of schooling (adjOR 1.64 [95%CI: 1.17-2.32]). As for the outcome variable lifetime history of incarceration, the independently associated factors were: male gender (adjOR 2.47 [95%CI: 1.74-3.55]) and longer use of crack cocaine and related substances (e.g., free base and local varieties/denominations of coca products) (adjOR 1.05 [95%CI: 1.01-1.10]). CONCLUSION: The study's findings support the use of comprehensive multisector interventions, integrating health promotion and mental health rehabilitation, access to quality education, and management of combined/concomitant use of different substances to reduce and/or prevent criminal involvement by individuals that use crack cocaine and other substances, as well as to prevent/manage relapse.

Consentimiento informado para el uso de medios de constraste en radiología / Informe consent for the use of contrast media in radiology

La utilización de los métodos de radiología e imagen en el diagnóstico médico requieren con frecuencia el uso de medios de contraste que son potencialmente riesgosos y de acuerdo a la legislación vigente, es necesario recabar el consentimiento del paciente al ser sometido a dichos procedimientos.Es importante que el paciente entienda claramente en qué consiste el estudio y los riesgos que implica, antes de que firme el consentimiento informado.Es de la incumbencia del médico tratante explicar al paciente, de una manera clara, sencilla y objetiva, lo que implica el hecho de someterse a los múltiples procedimientos diagnósticos o terapéuticos.

Uso da força letal pela polícia do Rio de Janeiro: os fatos e o debate / The use of lethal force by the Rio de Janeiro police: the facts and the debate

O presente artigo analisa os dados existentes sobre o uso da força letal por parte da polícia do Rio de Janeiro, a partir de uma pesquisa encomendada pela Assembléia Legislativa do Estado do Rio e realizada pelo ISER. Diversos indicadores confirmam um uso excessivo da força letal por parte da polícia e os relatórios médico-legais mostram vários casos com fortes indícios de execução. O número de mortos ocasionados pelas intervenções policiais e a letalidade das mesmas dobram depois da entrada em vigos de certas políticas da Secretaria de Segurança, marcadamente as premiações por bravura. O artigo recolhe o debate gerado por estes resultados e analisa os argumentos e as atitudes da Secretaria de Segurança para responder aos mesmos. Por último, o autor apointa dois equívocos que na su a opinião estão na abas das atuais políticas de segurança. (AU)

Impactos da violência sobre a saúde dos profissionais de saúde e segurança pública e perspectivas de atendimento às vítimas e seus familiares - debate

O debate ocorreu após as palestras apresentadas no dia 29/11 no Seminário. Fizeram parte da mesa a Pesquisadora do Centro Latino-Americano de Estudos de Violência e Saúde Jorge Careli (CLAVES), Maria Cecília de Souza Minayo, o Pesquisador Ignácio Cano e a integrante da Unidade de Apoio Psicossocial às Equipes dos Médicos Sem Fronteiras, Carla Uriarte. O arquivo está disponível para audição e/ou download no ícone ao lado.