SCREENING FOR HEPATITIS C Response from Hepatitis C Trust, BASL, BIA, BVHG, BSG, and BHIVA to article asking whether widespread screening for hepatitis C is justified

This is the peer reviewed published version of the following article: Response from Hepatitis C Trust, BASL, BIA, BVHG, BSG, and BHIVA to article asking whether widespread screening for hepatitis C is justified, which has been published in final form at 10.1136/bmj.h998. This article may be used for non-commercial purposes in accordance with BMJ's Terms and Conditions for Self-Archiving.This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/ by/4.0

Malaria: an update on treatment of adults in non-endemic countries.

Every year people die from malaria in Britain and other industrialised countries. Most of these deaths are avoidable: they occur because a patient or doctor has underestimated the severity of the disease or has not considered the diagnosis early enough. This article provides the essential facts on treating malaria in adults in a non-endemic setting and is based on the best available evidenc

Use of the wellness thermometer to improve consultations for patients with human immunodeficiency virus

Aim To evaluate the effectiveness of using the wellness thermometer in healthcare consultations with patients with HIV. Method This was a service evaluation that was undertaken in three UK HIV clinics in 2014. After using the wellness thermometer, patients and healthcare professionals completed a survey to indicate whether they felt the tool improved their consultations. Results A total of 231 patients completed the survey. It was found that 80% (n = 185) of patients felt the wellness thermometer helped to identify their concerns, while 79% (n = 182) of patients felt the wellness thermometer improved their conversation with the healthcare professional. Of the 12 healthcare professionals who completed the survey, most felt that the tool helped patients to identify their concerns (n = 10) and that it was easy to use (n = 11). Conclusion There are several benefits associated with using the wellness thermometer in healthcare consultations, and it may support patients with HIV to report any concerns they have in relation to their treatment and quality of life. The authors hope envisage that the tool will become a routine part of the care of these patients

IL16 and IL18 gene polymorphisms in women with gestational diabetes

Objectives: Gestational diabetes mellitus is a carbohydrate intolerance that occurs during pregnancy. Various inflammatory mediators are considered to be risk factors leading to GDM development. Among them are pro-inflammatory cytokines, such as IL16 and IL18. The aim of this study was to examine the association between IL16 and IL18 polymorphisms and GDM. Material and methods: This study included 204 pregnant women with GDM and 207 pregnant women with normal glucose tolerance (NGT). All samples were genotyped in duplicate using allelic discrimination assays with TaqMan® probes. Results: We observed that there was a decreased frequency of IL16 rs4778889 CC genotype carriers among women with GDM (CC vs. CT + TT: OR = 0.14; 95% CI = 0.02–1.15; p = 0.034). However, there was no significant difference in the distri­bution of alleles (C vs. T: OR = 0.81; 95% CI = 0.54–1.21; p = 0.30). There was a decreased frequency of the IL18 rs187238 G allele among GDM women (G vs. C: OR = 0.71; 95% CI = 0.53–0.96; p = 0.027). We also observed a decreased frequency of the IL18 rs1946518 T allele among women with GDM; however, this difference had only borderline statistical significance. We observed an association between IL18 rs187238, rs1946518 and BMI in pregnant women. Conclusions: The results of this study suggest that IL18 rs187238 and rs1946518 polymorphisms may be associated with an increased risk of GDM as well as with BMI in pregnant women

The Global Campaign to Eliminate Leprosy

While effective drug treatments have reduced the global disease burden, there remain important challenges to fighting and controlling the disease

EPICE-HIV: An Epidemiologic Cost-Effectiveness Model for HIV Treatment.

The goal of this research was to establish a new and innovative framework for cost-effectiveness modeling of HIV-1 treatment, simultaneously considering both clinical and epidemiological outcomes. EPICE-HIV is a multi-paradigm model based on a within-host micro-simulation model for the disease progression of HIV-1 infected individuals and an agent-based sexual contact network (SCN) model for the transmission of HIV-1 infection. It includes HIV-1 viral dynamics, CD4+ T cell infection rates, and pharmacokinetics/pharmacodynamics modeling. Disease progression of HIV-1 infected individuals is driven by the interdependent changes in CD4+ T cell count, changes in plasma HIV-1 RNA, accumulation of resistance mutations and adherence to treatment. The two parts of the model are joined through a per-sexual-act and viral load dependent probability of disease transmission in HIV-discordant couples. Internal validity of the disease progression part of the model is assessed and external validity is demonstrated in comparison to the outcomes observed in the STaR randomized controlled clinical trial. We found that overall adherence to treatment and the resulting pattern of treatment interruptions are key drivers of HIV-1 treatment outcomes. Our model, though largely independent of efficacy data from RCT, was accurate in producing 96-week outcomes, qualitatively and quantitatively comparable to the ones observed in the STaR trial. We demonstrate that multi-paradigm micro-simulation modeling is a promising tool to generate evidence about optimal policy strategies in HIV-1 treatment, including treatment efficacy, HIV-1 transmission, and cost-effectiveness analysis

Evaluation of the Quality of Sleep of the Professional Soldiers Population

The aim of this study was to identify sleep problems in a select group of professional soldiers. For the study used a questionnaire containing the Athens Insomnia Scale by Soldatos, allowing klinimetric evaluation of sleep disorders reflecting mainly insomnia. Material Data were obtained from 200 professional soldiers. The results showed no pathological abnormalities of sleep study population, however, the results show some reduction in the prevalence of symptoms of sleep quality based on the selected factors. The health status of all the soldiers experiencing combat stress requires periodic and thorough control since the diagnosis of disorders is difficult and they can appear even after a long period of lived events. This may lead to look for other ways to deal with problems; the use of psychoactive substances or drug abuse. Therefore it is extremely important to use therapeutic activities

System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK:the AMR-X framework

Antimicrobial resistance (AMR) threatens human, animal, and environmental health. Acknowledging the urgency of addressing AMR, an opportunity exists to extend AMR action-focused research beyond the confines of an isolated biomedical paradigm. An AMR learning system, AMR-X, envisions a national network of health systems creating and applying optimal use of antimicrobials on the basis of their data collected from the delivery of routine clinical care. AMR-X integrates traditional AMR discovery, experimental research, and applied research with continuous analysis of pathogens, antimicrobial uses, and clinical outcomes that are routinely disseminated to practitioners, policy makers, patients, and the public to drive changes in practice and outcomes. AMR-X uses connected data-to-action systems to underpin an evaluation framework embedded in routine care, continuously driving implementation of improvements in patient and population health, targeting investment, and incentivising innovation. All stakeholders co-create AMR-X, protecting the public from AMR by adapting to continuously evolving AMR threats and generating the information needed for precision patient and population care.</p