Barriers and facilitators to Hepatitis C (HCV) Screening and Treatment – A Prisoners’ Perspective

Background: Hepatitis C Virus (HCV) infection is a global epidemic with an estimated 71 million people infected worldwide. People who inject drugs (PWID) are over represented in prison populations globally and have higher levels of HCV infection than the general population. Despite increased access to primary health care while in prison, many HCV infected prisoners do not engage with screening or treatment. With recent advances in treatment regimes, HCV in now a curable and preventable disease and prisons provide an ideal opportunity to engage this hard to reach population. Aim: To identify barriers and enablers to HCV screening and treatment in prisons Methods: A qualitative study of four prisoner focus groups (n=46) conducted at two prison settings in Dublin, Ireland. Results: The following barriers to HCV screening and treatment were identified, lack of knowledge, concerns regarding confidentiality and stigma experienced and inconsistent and delayed access to prison health services. Enablers identified included; access to health care, opt-out screening at committal, peer support, and stability of prison life which removed many of the competing priorities associated with life on the outside. Unique blocks and enablers to HCV treatment reported were, fear of treatment and having a liver biopsy, the requirement to go to hospital and in-reach hepatology services and fibroscaning. Conclusion; The many barriers and enablers to HCV screening and treatment reported by Irish prisoners will inform both national and international public health HCV elimination strategies. Incarceration provides a unique opportunity to upscale HCV treatment and linkage to the community would support effectiveness

Hepatitis C virus screening and treatment in Irish prisons from a governor and prison officer perspective - A qualitative exploration

Background: Prisons are a key location to access Hepatitis C Virus (HCV) infected people who inject drugs (PWID). Prison health care structures are complex and optimising health care delivery to this high need, marginalised and underserved population remains challenging. Despite international guidelines recommending that prisons are a priority location for HCV screening and treatment levels of prisoner engagement in HCV care remain low. Competing priorities between security and healthcare is a key feature of prison health care. A collaborative approach to health care delivery in prisons can maximise the benefits for prisoners, staff and the wider community. Aim: To identify the barriers and enablers to HCV screening and treatment in Irish prisons and inform the implementation of a HCV screening program within the Irish Prison Services (IPS). Methods: Qualitative study using focus group methodology underpinned by grounded theory. Results: The following themes emerged from the analysis: priority of safety and security, staffing and resources, concerns about personal risk, lack of knowledge, concerns around confidentiality, prisoners' fear of treatment and stigma, timing of screening, use of peer workers, in-reach hepatology and fibroscanning services. The primary role of prison security is to ensure the safety of staff and prisoners with a secondary but important supporting role in health care delivery. Maintaining adequate staffing levels and the provision of training and education were seen as priorities and impacted on prison officers' fear for personal safety and risk of HCV transmission. Opt-out screening and peer support workers had high levels of support among participants. Conclusion: Upscaling HCV management in prisons requires an in-depth understanding of all barriers and facilitators to HCV screening and treatment. Engaging prison officers in the planning and delivery of health care initiatives is a key strategy to optimising the public health opportunity that prisons provides. © 2018 The Author(s)

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Seasonality in hospital admissions of Crimean-Congo hemorrhagic fever and its dependence on ambient temperature-empirical evidence from Pakistan

Crimean-Congo hemorrhagic fever (CCHF) has been reported from all provinces of Pakistan. Little is known about the seasonal variations in the disease and its association with weather conditions. In this study, we explored time-series data about monthly number of CCHF admissions (2007-2010) in three public sector hospitals of Quetta-the capital city of Baluchistan province of Pakistan. Cosinor analysis was carried out to investigate seasonality in the data. To assess the effect of average monthly ambient temperature (A degrees C) on disease, a distributed lag nonlinear model (DLNM) was applied. Cosinor model revealed statistically significant seasonality in monthly number of CCHF patients admitted to the study hospitals. The estimated amplitude was 3.24 cases per month with phase in mid-June and low point in mid-December. DLNM confirmed nonlinear and delayed effect of temperature on hospital admissions. At a lag of 2 months, the cumulative relative risk was more than 1 at temperature at 18.37 A degrees C and above. In addition, relative risk was significantly high at 60th (21.98 A degrees C), 70th (24.50 A degrees C), 80th (27.33 A degrees C), and 90th (29.25 A degrees C) percentiles of temperature (relative to median value, 18.37 A degrees C). Inclusion of Eid-al-Adha as a predictor did not improve the fitness of DLNM. Based on our analysis, we concluded significant seasonality in CCHF hospital admissions. Our findings also suggested average monthly ambient temperature (A degrees C) as a significant predictor of CCHF hospitalizations. DLNM presented in this study may be improved with inclusion of other possible time-varying predictors particularly meteorological conditions of this region

Between evidence-based education and professional judgment : what future for teachers and their knowledge ?

This chapter deals with the question of what is perceived as legitimate knowledge for constructing, discussing or questioning teachers’ work. After noting the importance of knowledge in the emergence and recognition of a professional group, we argue that the professional group of teachers has traditionally occupied a position of relative exteriority with respect to the definition of knowledge useful for the profession. Our hypothesis is that the development of New Public Management in the educational field, combined with the promotion of evidence-based education, contributes to a definition that is even more external to the group of knowledge and techniques considered legitimate for the professional activity of teaching. By contrast, the criticisms of evidence-based education seem to encourage the development of an alternative conception of teacher knowledge that is more rooted in the professional group and peer interactions, based on a professional judgment structured by the singular features of the situations encountered

The Impact of Climate Trends on a Tick Affecting Public Health: A Retrospective Modeling Approach for Hyalomma marginatum (Ixodidae)

The impact of climate trends during the period 1901-2009 on the life cycle of Hyalomma marginatum in Europe was modeled to assess changes in the physiological processes of this threat to public health. Monthly records of temperature and water vapour at a resolution of 0.5° and equations describing the life cycle processes of the tick were used. The climate in the target region affected the rates of the life cycle processes of H. marginatum: development rates increased, mortality rates in molting stages decreased, and the survival rates of questing ticks decreased in wide territories of the Mediterranean basin. The modeling framework indicated the existence of critical areas in the Balkans, central Europe, and the western coast of France, where the physiological processes of the tick improved to extents that are consistent with the persistence of populations if introduced. A spatially explicit risk assessment was performed to detect candidate areas where active surveys should be performed to monitor changes in tick density or persistence after a hypothetical introduction. We detected areas where the critical abiotic (climate) and biotic (host density) factors overlap, including most of the Iberian peninsula, the Mediterranean coast of France, eastern Turkey, and portions of the western Black Sea region. Wild ungulate densities are unavailable for large regions of the territory, a factor that might affect the outcome of the study. The risk of successfully establishing H. marginatum populations at northern latitudes of its current colonization range seems to be still low, even if the climate has improved the performance of the tick in these areas