Crusted (Norwegian) scabies treated with oral ivermectin : a case report and overview

Crusted (Norwegian) scabies is a severe and highly contagious form of infestation caused by the mite Sarcoptes scabiei var. hominis. It occurs in a subgroup of patients who are either immunocompromised or physically or mentally debilitated. Due to its atypical clinical presentation as well as difficulties associated with its management it presents a number of challenges both from a therapeutic aspect as well as from public health perspective. Failure to diagnose this condition may give rise to a massive epidemic when the patient is in an institutional setting. We describe a case of crusted scabies which occurred in a nursing home leading to an institutional outbreak. She received a combination of oral ivermectin and topical scabicidal with good results. This case highlights the importance of being alert to the possible diagnosis of crusted scabies and gives an overview of the condition as well as management strategies.peer-reviewe

Do we know how scabies outbreaks in residential and nursing care homes for the elderly should be managed? A systematic review of interventions using a novel approach to assess evidence quality.

Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high quality randomized controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literatures. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks

Effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries: a realist review protocol

Background Several stigma reduction intervention strategies have been developed and tested for effectiveness in terms of increasing human immunodeficiency virus (HIV) test uptake. These strategies have been more effective in some contexts and less effective in others. Individual factors, such as lack of knowledge and fear of disclosure, and social-contextual factors, such as poverty and illiteracy, might influence the effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries. So far, it is not clearly known how the stigma reduction intervention strategies interact with these contextual factors to increase HIV test uptake. Therefore, we will conduct a review that will synthesize existing studies on stigma reduction intervention strategies to increase HIV test uptake to better understand the mechanisms underlying this process in low- and middle-income countries. Methods A realist review will be conducted to unpack context-mechanism-outcome configurations of the effect of stigma reduction intervention strategies on HIV test uptake. Based on a scoping review, we developed a preliminary theoretical framework outlining a potential mechanism of how the intervention strategies influence HIV test uptake. Our realist synthesis will be used to refine the preliminary theoretical framework to better reflect mechanisms that are supported by existing evidence. Journal articles and grey literature will be searched following a purposeful sampling strategy. Data will be extracted and tested against the preliminary theoretical framework. Data synthesis and analysis will be performed in five steps: organizing extracted data into evidence tables, theming, formulating chains of inference from the identified themes, linking the chains of inference and developing generative mechanisms, and refining the framework. Discussion This will be the first realist review that offers both a quantitative and a qualitative exploration of the available evidence to develop and propose a theoretical framework that explains why and how HIV stigma reduction intervention strategies influence HIV test uptake in low- and middle-income countries. Our theoretical framework is meant to provide guidance to program managers on identifying the most effective stigma reduction intervention strategies to increase HIV test uptake. We also include advice on how to effectively implement these strategies to reduce the rate of HIV transmission.status: publishe

Fil-lejl li kiber miegħi

Ġabra ta’ poeżiji u proża li tinkludi: Flus lura ta’ Charles Clews – Afrika ta’ Oliver Friggieri – 5 ta’ Ottubru 1798: Ir-rewwixta taż-Żabbarin kontra l-Franċiżi ta’ Achille Mizzi – Durham ta’ Joe Friggieri – Tifkiriet: Għand Majsi l-parrukkier ta’ Maurice Mifsud Bonnici – Jacqueline ta’ Carmel Azzopardi – Is-Sibt 29 ta’ Marzu 1986 ta’ Alfred Massa – Lill-għasfur ta’ Nikol Vella Apap – Nixtieq nibki ta’ John Caruana – Imbierka s-sapjenza ta’ Charles Clews – Par għajnejn fid-dlam ta’ Val. V. Barbara – Iż-żmien u l-bniedem ta’ Paul J. Debono – Dixx ta’ l-istejnles stil ta’ Paul P. Borg – Nota bene ta’ Sergio Grech – Ħitan ta’ Alfred Degabriele – Data base ta’ Philip Sciberras – Freddie Mercury – Ġieħ ta’ Charles Briffa – Ħolma ta’ Joe Bugeja – L-imsiebaħ firxu d-dwal ta’ Emanuel F. Attard – Żamma ta’ Manwel Cassar – Awtur tal-baħar ta’ Charles Bezzina – Nixxiegħa tal-kuxjent minn Triq Ħas-Sajjied Birkirkara ta’ Tarcisio Zarb – Ċfuf u żigarelli ta’ Ġorġ Borg – Taħt is-saffi tqal ta’ Ġorġ Borg – Fil-lejl li kiber miegħi ta’ Ġorġ Borg.peer-reviewe

The migrant worker and EU social policies An evaluation of the EU policy process towards migration of labour from the Maghreb countries in the nineties in the new receiving states

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN029426 / BLDSC - British Library Document Supply CentreGBUnited Kingdo