HCV epidemiology in high-risk groups and the risk of reinfection

Injecting risk behaviours among people who inject drugs (PWID) and high-risk sexual practices among men who have sex with men (MSM) are important routes of hepatitis C virus (HCV) transmission. Current direct-acting antiviral treatment offers unique opportunities for reductions in HCV-related liver disease burden and epidemic control in high-risk groups, but these prospects could be counteracted by HCV reinfection due to on-going risk behaviours after successful treatment. Based on existing data from small and heterogeneous studies of interferon-based treatment, the incidence of reinfection after sustained virological response range from 2-6/100 person years among PWID to 10-15/100 person years among human immunodeficiency virus-infected MSM. These differences mainly reflect heterogeneity in study populations with regards to risk behaviours, but also reflect variations in study designs and applied virological methods. Increasing levels of reinfection are to be expected as we enter the interferon-free treatment era. Individual- and population-level efforts to address and prevent reinfection should therefore be undertaken when providing HCV care for people with on-going risk behaviour. Constructive strategies include acknowledgement, education and counselling, harm reduction optimization, scaled-up treatment including treatment of injecting networks, post-treatment screening, and rapid retreatment of reinfections

Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesIn the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden), the prevalence of chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a public health threat.Fourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country.Stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly.The Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere.Gilead Science

Impairment of Sexual Life in 3,485 Dermatological Outpatients From a Multicentre Study in 13 European Countries

Skin conditions may have a strong impact on patients' sexual life, and thus influence personal relationships. Sexual issues are difficult to discuss directly in clinical practice, and a mediated instrument may be useful to capture such information. In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation.Peer reviewedFinal Published versio

Navigating the future Rails: Enhancing Project Efficiency through Automatic Train Operations (ATO)

Den norske jernbanen står overfor utfordringer knyttet til kapasitet, punktlighet og høye utslipp. Gjennom en omfattende gjennomgang av en konseptvalgutredning (KVU) angående automatiske tog operasjoner (ATO) på den norske jernbanen, tidligere forskning og intervjuer med bransjeansatte, skal denne rapporten belyse ulike fordeler og ulemper som kan oppstå ved ulike nivåer av ATO. Denne studien prøver å gi forståelse og innsyn i hva slags innvirkninger ATO kan ha på industrien og andre berørte parter. Fra resultatene i KVU-en kommer det frem at en innføring av en C-DAS-løsning, etter installeringen av ERTMS, er det alternativet som gir best lønnsomhet grunnet lave kostnader og økt punktlighet. Denne anbefalingen stemmer overens med tidligere studier og resultatene fra intervjuene, som legger vekt på reduksjon av energibruk og forsinkelser. Tidligere studier og meninger fra bransjeansatte peker på at det er muligheter for å innføre dette før installeringen av ERTMS. KVU-en, tidligere forskning og intervju data er også enige om at ubemannet førerløs operasjoner er umoden teknologi grunnet høye kostnader relatert til sikkerhet og utfordringer som kommer med å fjerne togføreren. Når vi ser på kun førerløs operasjoner, er resultatene forskjellige fra de ulike kildene. Noen argumenterer for at det er neste steg å ta og gjennomfører for tiden tester som viser lovende resultater innenfor kapasitet, energi bruk og punktlighet. Imidlertid er andre skeptiske til gjennomførbarheten og argumenterer for at de mange utfordringene knyttet til fjerning av føreren gjør det vanskelig å implementere. I KVU-en er det de prissatte virkningene som gir retningslinjer for valg av konsept. Ikke-prissatte virkninger som menneskelige faktorer og togførerens rolle er utfordringer som i tillegg legges vekt på blandt bransjeansatte og tidligere studier, særlig når det gjelder ATO ved høyere nivå. Basert på resultatene anbefaler denne studien å prioritere implementering av C-DAS, men også å vurdere om det er muligheter for å implementere det før innføringen av ERTMS. Det anbefales å følge nøye med på hva andre land gjør når det kommer til førerløs operasjoner, som viser lovende resultater fra studier og intervjudata. Om høyere nivåer av ATO skal forskes på, anbefales det å se på flere alternativer når det kommer til sikring av togspor, samt legge større vekt på togførerens rolle og hva effekten blir ved å fjerne hen. Høyere nivå innen ATO kan gi økte fordeler, men med det kommer også større kostnader og sikkerhetsutfordringer. Disse anbefalingene har som mål å gi en nyansert tilnærming til fremdriften av ATO i det norske jernbanesystemet, og sikre økonomisk bærekraft, operasjonell effektivitet og trygg drift. Ved å ta tak i disse områdene, bidrar forskningen med verdifulle innsikter i den strategiske implementeringen av ATO. For fremtidige studier anbefales det å undersøke videre på implementeringen av C-DAS før implementeringen av ERTMS. Nøkkelord: ATO, Norske jernbanen, Kvalitetssikring, Prosjekt ledelseThe Norwegian railway faces challenges with capacity, punctuality, and high emissions. This thesis investigates the potential and possible advantages of automatic train operations (ATO) in solving these problems. It attempts to provide an understanding of ATO's impact on the industry and the various benefits and problems that may arise through a thorough investigation of an appraisal study, previous research, and views from industry professionals. According to the appraisal study, a C-DAS installation after the implementation of ERTMS is the best choice due to its minimal installation costs and increased punctuality. This recommendation aligns with previous studies and interview findings, highlighting the benefits of C-DAS in improving energy efficiency and reducing delays. However, previous research and expert opinions point out that it is possible to implement it before ERTMS installation. The appraisal study, previous research, and interviews also agree that concepts regarding unattended driverless operations are immature due to high safety costs or challenges when removing the driver. Looking into driverless operations, there are diverse results from different sources. Some argue that it is the next way to go and are currently doing tests showing promising capacity, energy efficiency, and punctuality results. However, others are skeptical about its feasibility, arguing that the numerous challenges of removing the driver make it difficult to implement. Most of the reasoning behind the chosen alternative in the appraisal study is done based on financial metrics in contrast with the broader perspective of previous research and interview findings, which also considers human factors and driver roles as significant challenges when investigating higher levels of ATO. Based on the findings, the thesis recommends prioritizing C-DAS implementation but investigates whether it is possible to do so before the ERTMS launch. It also recommends closely monitoring driverless operations trials in other countries due to promising results from studies and interview data. If research into higher levels of ATO progresses, it is advisable to explore more options for securing the trackside and to examine the challenges of removing the driver from operations. While advancing ATO levels can offer increased benefits, they also come with greater costs and safety challenges. These recommendations aim to provide a balanced and practical approach to advancing ATO in the Norwegian railway system, ensuring economic viability, operational effectiveness, and safe operations. By addressing these areas, the research contributes valuable insights into the strategic implementation of ATO. For future studies, this thesis recommends looking into the implementation of a C-DAS before the implementation of ERTMS. Keywords: ATO, Norwegian Railway, Quality Assurance, Project Managemen

Fatigue Intervention by Nurses Evaluation - The FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: study protocol. [ISRCTN74156610]

Background: Chronic fatigue syndrome, also known as ME (CFS/ME), is a condition characterised primarily by severe, disabling fatigue, of unknown origin, which has a poor prognosis and serious personal and economic consequences. Evidence for the effectiveness of any treatment for CFS/ME in primary care, where most patients are seen, is sparse. Recently, a brief, pragmatic treatment for CFS/ME, based on a physiological dysregulation model of the condition, was shown to be successful in improving fatigue and physical functioning in patients in secondary care. The treatment involves providing patients with a readily understandable explanation of their symptoms, from which flows the rationale for a graded rehabilitative plan, developed collaboratively with the therapist. The present trial will test the effectiveness and cost-effectiveness of pragmatic rehabilitation when delivered by specially trained general nurses in primary care. We selected a client-centred counselling intervention, called supportive listening, as a comparison treatment. Counselling has been shown to be as effective as cognitive behaviour therapy for treating fatigue in primary care, is more readily available, and controls for supportive therapist contact time. Our control condition is treatment as usual by the general practitioner (GP). Methods and design: This study protocol describes the design of an ongoing, single-blind, pragmatic randomized controlled trial of a brief (18 week) self-help treatment, pragmatic rehabilitation, delivered by specially trained nurse-therapists in patients' homes, compared with nurse-therapist delivered supportive listening and treatment as usual by the GP. An economic evaluation, taking a societal viewpoint, is being carried out alongside the clinical trial. Three adult general nurses were trained over a six month period to deliver the two interventions. Patients aged over 18 and fulfilling the Oxford criteria for CFS are assessed at baseline, after the intervention, and again one year later. Primary outcomes are self-reported physical functioning and fatigue at one year, and will be analysed on an intention-to-treat basis. A qualitative study will examine the interventions' mechanisms of change, and also GPs' drivers and barriers towards referral

Recommendations for the Management of Hepatitis C Virus Infection Among People Who Inject Drugs

In the developed world, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). The burden of HCV-related liver disease in this group is increasing, but treatment uptake among PWID remains low. Among PWID, there are a number of barriers to care that should be considered and systematically addressed, but these barriers should not exclude PWID from HCV treatment. Furthermore, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provides a framework for HCV assessment, management, and treatment. Further research is needed to evaluate strategies to enhance assessment, adherence, and SVR among PWID, particularly as new treatments for HCV infection become availabl

Sofosbuvir based treatment of chronic hepatitis C genotype 3 infections-A Scandinavian real-life study

Background and aims Chronic hepatitis C virus (HCV) genotype 3 infection with advanced liver disease has emerged as the most challenging to treat. We retrospectively assessed the treatment outcome of sofosbuvir (SOF) based regimes for treatment of HCV genotype 3 infections in a real life setting in Scandinavia. Methods Consecutive patients with chronic HCV genotype 3 infection were enrolled at 16 treatment centers in Denmark, Sweden, Norway and Finland. Patients who had received a SOF containing regimen were included. The fibrosis stage was evaluated by liver biopsy or transient liver elastography. The following treatments were given according availability and local guidelines: 1) SOF + ribavirin (RBV) for 24 weeks, 2) SOF + daclatasvir (DCV) +/-RBV for 12-24 weeks, 3) SOF + pegylated interferon alpha (peg-IFN-a) + RBV for 12 weeks or 4) SOF/ledipasvir (LDV) + RBV for 12-16 weeks. The primary endpoint was sustained virological response (SVR) assessed at week 12 (SVR12) after end of treatment. Results We included 316 patients with a mean age of 55 years (range 24-79), 70% men, 49% treatment experienced, 58% with compensated cirrhosis and 12% with decompensated cirrhosis. In the modified intention to treat (mITT) population SVR12 was achieved in 284/311 91%) patients. Among 26 treatment failures, five had non-response, 3 breakthrough and 18 relapse. Five patients were not included in the mITT population. Three patients died from reasons unrelated to treatment and two were lost to follow-up. The SVR12 rate was similar for all treatment regimens, but lower in men (p = 0.042), and in patients with decompensated liver disease (p = 0.004). Conclusion We found that sofosbuvir based treatment in a real-life setting could offer SVR rates exceeding 90% in patients with HCV genotype 3 infection and advanced liver disease.Peer reviewe

Quality of life in South African Black women with alopecia: A pilot study

BACKGROUND: Alopecia has been shown to have a significant impact on quality of life (QoL), particularly in women. However, there are no data for African populations. This study was conducted to pilot an original questionnaire and a model-based methodology to measure QoL and its determinants in a sample of South African Black women of African ancestry with alopecia. METHODS: Fifty participants aged 21-79 years were randomly chosen from patients presenting to dermatologists with alopecia. We used an original questionnaire consisting of 24 items grouped into those assessing the respective impacts of subjective symptoms, objective signs, and relationship issues, measured on a four-level scale. These were then combined using component-based structural equation modeling to return a QoL index (QLI) and to rank the factors contributing to this. RESULTS: On a scale ranging from 0 (high QoL) to 100 (severely decreased QoL), we found a mean QLI of 67.7. The negative impact of alopecia on QoL was higher in younger patients than older patients. The factors with the highest impact were those relating to the subjective experience of alopecia and self-image (56.3%), followed by those relevant to relationships and interaction with other people (34.8%). The presence of objective symptoms and signs such as pruritus was of minor importance (8.9%). CONCLUSIONS: Although not a life-threatening condition, alopecia may seriously impair QoL, particularly by inducing anxiety and reducing self-esteem among African women. Healthcare practitioners should be mindful of this and intervene appropriately to mitigate these effects