Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Tuberculosis among correctional facility workers: A systematic review and meta-analysis.

INTRODUCTION:Prison inmates can transmit tuberculosis, including drug-resistant strains, to correctional facility workers and the community. In this systematic literature review, we investigated the magnitude of active and latent tuberculosis infection (LTBI) and associated risk factors among correctional facility workers. METHODS:We searched MEDLINE, EMBASE, LILACS, Cochrane CENTRAL, ISI Web of Science, CINAHL, and SCOPUS databases (January 1, 1989-December 31, 2017) for studies with the MeSH terms "prison" (and similar) AND "tuberculosis", without language restriction. We searched for gray literature in Google Scholar and conference proceedings. Stratified analyses according to tuberculosis burden were performed. RESULTS:Of the 974 titles identified, 15 (nine good, six fair quality) fulfilled the inclusion criteria (110,393 correctional facility workers; six countries; 82,668 active tuberculosis; 110,192 LTBI). Pooled LTBI prevalence and incidence rates were 26% (12-42, I2 = 99.0%) and 2% (1-3, I2 = 98.6%), respectively. LTBI prevalence reached 44% (12-79, I2 = 99.0%) in high-burden countries. Active tuberculosis was reported only in low-burden countries (incidence range, 0.61-450/10,000 correctional facility workers/year). LTBI-associated risk factors included job duration, older age, country of birth, current tobacco smoking, reported contact with prisoners, and BCG vaccination. CONCLUSION:Despite the risk of bias and high heterogeneity, LTBI was found to be prevalent in correctional facility workers, mainly in high-burden countries. LTBI risk factors suggest both occupational and community exposure. Active tuberculosis occurrence in low-burden countries suggests higher vulnerability from recent infection among correctional facility workers in these countries. Systematic surveillance and infection control measures are necessary to protect these highly vulnerable workers

Seroprevalence of hepatitis B virus infection and associated factors among prison inmates in state of Mato Grosso do Sul, Brazil

INTRODUCTION: This study aimed to estimate the prevalence of HBV infection and associated factors among prison inmates in Campo Grande, MS. METHODS: A total of 408 individuals were interviewed regarding sociodemographic characteristics, associated factors and HBV vaccination using a standardized questionnaire. Blood samples were collected from all participants and serological markers for HBV were detected by enzyme-linked immunosorbent assay. Hepatitis B surface antigen (HBsAg) and/or antibodies against hepatitis B core antigen (anti-HBc) positive samples were tested for HBV-DNA by polymerase chain reaction. RESULTS: The overall prevalence of HBV infection was 17.9% (95%CI: 14.4-22.0). The HBsAg carrier rate was 0.5%; 56 (13.7%) individuals had been infected and developed natural immunity and 15 (3.7%) were positive for anti-HBc only. Ninety eight (24%) prisoners had only anti-HBs, suggesting that they had low vaccine coverage. An occult HBV infection rate of 0% was verified among anti-HBc-positive individuals. Multivariate analysis of associated factors showed that age > 35 years-old, low schooling level and illicit drug use are significantly associated with HBV infection. CONCLUSIONS: Analysis of the data showed HBV infection prevalence similar or slightly lower than that reported in other of Brazilian prisons. Independent predictors of HBV infection in this population include older age, low schooling level and illicit drug use

Prevalence and Incidence of HCV Infection among Prisoners in Central Brazil

Submitted by Sandra Infurna ([email protected]) on 2017-05-04T13:09:43Z No. of bitstreams: 1 barbara_lago_etal_IOC_2017.pdf: 2294511 bytes, checksum: d3e34b2cddbbe7813fed3a35ecb9cb2e (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-05-04T13:22:45Z (GMT) No. of bitstreams: 1 barbara_lago_etal_IOC_2017.pdf: 2294511 bytes, checksum: d3e34b2cddbbe7813fed3a35ecb9cb2e (MD5)Made available in DSpace on 2017-05-04T13:22:45Z (GMT). No. of bitstreams: 1 barbara_lago_etal_IOC_2017.pdf: 2294511 bytes, checksum: d3e34b2cddbbe7813fed3a35ecb9cb2e (MD5) Previous issue date: 2017Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Mato Grosso do Sul, MS. Brasil / Universidade Federal do Grande Dourados. Mato Grosso do Sul, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal de Goiás. Escola de Enfermagem. Goiânia, GO, Brasil.Universidade Federal do Grande Dourados.. Mato Grosso do Sul, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ. Brasil.Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brasil / Fundação Oswaldo Cruz. Mato Grosso do Sul, MS, Brasil.The aim of this multicenter, cross sectional study was to assess the prevalence, incidence and associated risk factors among incarcerated populations from twelve Brazilian prisons. The total of 3,368 individuals from twelve prisons was randomly recruited between March 2013 and March 2014. Participants were interviewed, and provided blood samples which were tested for antibodies to Hepatitis C (HCV ab). One year after the first investigation, a cohort study was conducted with 1,656 inmates who participated the cross sectional study. Positive samples were tested for the presence of HCV RNA. Out of 3,368 inmates, 520 (15.4%) were females, and 2,848 (84.6%) were males. The overall prevalence of HCV was 2.4% (95% CI: 1.9 to 2.9), with 0.6% (95% CI: 0.4 to 0.8) in females, and 2.7% (95% CI: 2.1 to 3.3) in males (p<0.01). HCV RNA was detected in 51/80 (63.7%) samples. Among men prisoners, multivariate analysis of associated factors showed independent associations between HCV exposure and increasing age, inject drug use, length of incarceration, smoking hashish, sharing needle and syringe and HIV positivity. During the cohort study, 7/1,656 new cases of HCV infection were detected, and the incidence rate was 0.4/100 person-year. Once high frequency rates of specific HCV risk behaviors and new HCV infections have been identified inside prisons, effective interventions strategies such as screening, clinical evaluation and treatment to reduce the spread of HCV infection are essential

A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities

<div><p>Background</p><p>Prior studies have reported higher HIV prevalence among prisoners than the general population in Brazil, but data have been derived from single prisons. The aim of this study was to evaluate HIV testing practices, prevalence and linkage to care among inmates in a network of 12 prisons.</p><p>Methods</p><p>We administered a questionnaire to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV and syphilis testing from January to December 2013. We evaluated factors associated with HIV testing and infection using multivariable logistic regression models. Six months after HIV testing, we assessed whether each HIV-infected prisoner was engaged in clinical care and whether they had started antiretroviral therapy.</p><p>Results</p><p>We recruited 3,362 inmates, of whom 2,843 (85%) were men from 8 prisons, and 519 (15%) were women from 4 prisons. Forty-five percent of participants reported never having been tested for HIV previously. In multivariable analysis, the variables associated with previous HIV testing were lack of a stable partner (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18–1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20–1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43–1.98), history of mental illness (AOR 1.52; 95% CI: 1.31–1.78) and previous surgery (AOR 1.31; 95% CI: 1.12–1.52). Fifty-four (1.6%) of all participants tested positive for HIV; this included 44 (1.54%) men and 10 (1.92%) women. Among male inmates, HIV infection was associated with homosexuality (AOR 6.20, 95% CI: 1.73–22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13–4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64–6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20–5.39). Among HIV-infected individuals, 34 (63%) were unaware of their HIV status; only 23 of these 34 (68%) newly diagnosed participants could be reached at six month follow-up, and 21 of 23 (91%) were engaged in HIV care.</p><p>Conclusions</p><p>HIV testing rates among prison inmates are low, and the majority of HIV-infected inmates were unaware of their HIV diagnosis. Incarceration can be an opportunity for diagnosis and treatment of HIV among vulnerable populations who have poor access to health services, but further work is needed on transitional HIV care for released inmates.</p></div

Variables associated with previous HIV testing among prisoners (N = 3,362).

<p>Abbreviations: OR—odds ratio, IDU—intravenous drug user, STI—sexually transmitted infections.</p><p>Variables associated with previous HIV testing among prisoners (N = 3,362).</p

Sociodemographic and risk behaviors variables in 4 female Brazilian prisons.

<p>Abbreviations: HIV- Human Immunodeficiency vírus, SD–Stardard deviation, IDU–Intravenous drug user, STI–Sexually transmitted infections, EPFCAJG—Estabelecimento Penal Feminino Carlos Alberto Jonas Giordano, EPFTL—Estabelecimento Penal Feminino de Três Lagoas, EPFPP—Estabelecimento Penal Feminino de Ponta Porã, EPFIIZ—Estabelecimento Penal Feminino Irmã Irma Zorzi.</p><p>Sociodemographic and risk behaviors variables in 4 female Brazilian prisons.</p

Flow chart of the study enrollment and screening process for HIV.

<p>Flow chart of the study enrollment and screening process for HIV.</p

Sociodemographic and risk behaviors variables in 8 male Brazilian prisons.

<p>Abbreviations: HIV- Human Immunodeficiency vírus, SD–Stardard deviation, IDU–Intravenous drug user, STI–Sexually transmitted infections, EPC—Estabelecimento Penal de Corumbá, PTL—Penitenciária de Três Lagoas, EPRB—Estabelecimento Penal Ricardo Brandão, CTAL—Centro de Triagem Anízio Lima, PTCG—Presídio de Transito de Campo Grande, IPCG—Instituto Penal de Campo Grande, PHAC—Penitenciária Harry Amorim Costa and EPJFC—Estabelecimento Penal Jair Ferreira de Carvalho.</p><p>Sociodemographic and risk behaviors variables in 8 male Brazilian prisons.</p