Epidemiological dynamics of Tuberculosis within the prison population and the community

[eng] INTRODUCTION: The control of tuberculosis (TB) in Central America and South America has significantly progressed over the past 20 years. However, it has particularly stagnated during the second decade of the 21st century. Despite national and regional efforts, the stagnation of indicators has revealed a common pattern in some countries across the Latin American region. This pattern has been characterized by the concentration of the epidemic within prisons, coupled with a rising trend in incarceration rates across several countries in the region(1). Despite the decline and subsequent rebound during and after the COVID-19 pandemic, as observed in several countries, Paraguay has maintained a stable TB incidence rate over the past 15 years (2). This rate typically ranges between 38 and 45 cases per 100,000 inhabitants, which translates to approximately 3,100 cases per year. During this period, healthcare institutions have made efforts to expand and universally provide free access to diagnostic, laboratory, and radiological services, as well as treatment, extending these services to the primary level of care(3). Over the past decade, although the total number of cases in the country appears to be stable, there has been a concentration of the epidemic within the prison population. It was seen that the proportion of cases in prisons rise from approximately 7% of the total cases in 2009 to over 15% in 2018, and in recent reports, exceeding 20% of the total cases in the country (4). This concentration coincides with a doubling of the prison population, leading to overcrowding and exacerbating the TB concern. This situation may be contributing to the spread of TB to the rest of the population, undermining progress in TB control within the broader community. HYPOTHESIS: Thorough analysis of records from the National TB Program (NTP) and the Ministry of Justice, including the utilization of complete genomic sequencing of Mycobacterium tuberculosis (Mtb) for cases occurring in prisons and surrounding communities, will provide us with a more precise understanding of the disease burden attributable to prisons and transmission patterns between these facilities and the broader community. MAIN OBJECTIVE The aim of this study is to describe and characterize the transmission dynamics of Mtb in penitentiary centres and the broader community in Paraguay, South America.[spa] INTRODUCCIÓN: El control de la tuberculosis (TB) en Centroamérica y Sudamérica ha avanzado de manera considerable desde finales de los 90 y durante los últimos 20 años. Pero particularmente durante la segunda década del siglo XXI se ha estancado. Este estancamiento de los indicadores, a pesar de los esfuerzos nacionales y regionales, ha expuesto un patrón común en algunos países de la región latinoamericana. El patrón común ha sido la concentración de la epidemia en las prisiones, acompañado de un proceso de aumento de los niveles de tasas de encarcelamientos en varios países de la región(1). A pesar del descenso y el repunte posterior durante y después de la Pandemia por COVID-19, como ocurrió en varios países, Paraguay es un país que tiene una tasa de incidencia de TB estable durante los últimos 15 años, que ronda entre 38 y 45 casos por 100.000 habitantes, lo que equivale a una media de 3100 casos por año(2). Durante este periodo desde las instituciones de salud se ha hecho el esfuerzo de expandir y universalizar gratuitamente el acceso al diagnóstico, laboratorial y radiológico, y al tratamiento, llegando hasta primer nivel de atención(3). Durante la última década, aunque la cantidad de casos totales en el país pareciera ser estable, ocurrió una concentración de la epidemia en la población penal, pasando de valores de cercanos al 7% del total de casos en prisiones en el 2009 a superiores al 15% en el 2018, y en últimos informes por encima del 20% del total de casos del país(4). Esta concentración ocurre en un proceso también de duplicación de la población penal, generando hacinamiento y potenciando el problema de la TB, el cual puede estar condicionando un derrame de este problema al resto de la población, torpedeando los avances del control de la enfermedad en el resto de la comunidad. La urgencia de focalizar estrategias para interrumpir la transmisión y prevenir nuevas infecciones dentro y fuera de los centros penales es fundamental. Sin embargo, aún se desconoce la dimensión que juegan las instituciones penitenciarias a sus poblaciones aledañas en la transmisión. En tal sentido, esta tesis tiene el objetivo de describir el riesgo para desarrollar TB en prisión, sus factores asociados, cómo persiste este riesgo una vez que se sale de prisión, además de detallar filogenéticamente cómo se generan clústeres comunes entre la prisión y la comunidad. HIPÓTESIS: Un análisis profundo de los registros del Programa Nacional de Tuberculosis (PNT) y del Ministerio de Justicia, incluyendo la secuenciación genómica completa de Mycobacterium tuberculosis (Mtb) para casos ocurridos en prisiones y comunidades circundantes, nos proporcionará una comprensión más precisa de la carga de enfermedad atribuible a las prisiones y los patrones de transmisión entre prisiones y comunidad en general. OBJETIVO: El objetivo principal de esta tesis es caracterizar las dinámicas de transmisión del Mtb entre los centros penitenciarios y el resto de la comunidad en Paraguay, Sudamérica

Educating on professional habits: attitudes of medical students towards diverse strategies for promoting influenza vaccination and factors associated with the intention to get vaccinated

BACKGROUND: Influenza vaccination coverage in medical students is usually low. Unlike health care workers, there is little information on the attitudes to and predictors of vaccination among medical students, and their attitudes towards institutional strategies for improving rates are unknown. METHODS: This cross-sectional study evaluated the effect of three influenza vaccination promotional strategies (Web page, video and tri-fold brochure) on medical students’ intention to get vaccinated and associated factors. A total of 538 medical students were asked to answer an anonymous questionnaire assessing the intention to get vaccinated after exposure to any of the promotional strategies. Sociodemographic data collected included: sex, age, university year, influenza risk group and cohabiting with member of a risk group. RESULTS: Four hundred twenty-one students answered the questionnaire, of whom 312 (74.1%) were female, 113 (26.8%) had done clinical rotations, and 111 (26.6%) reported intention to get the flu shot. Logistic regression showed the web group had a greater intention to get vaccinated than the reference group (OR: 2.42 95% CI: 1.16-5.03). Having done clinical rotations (OR: 2.55 95% CI: 1.36-4.38) and having received the shot in previous flu seasons (OR: 13.69 95% CI: 7.86-23.96) were independently associated with the intention to get vaccinated. CONCLUSION: Given that previous vaccination is a factor associated with the intention to get vaccinated, education on vaccination of health care workers should begin while they are students, thereby potentiating the habit. In addition, the intention to get vaccinated was greater during the clinical phase of the university career, suggesting this is a good time to introduce promotion strategies. Online promotional campaigns, such as a thematic Web to promote vaccination of health workers, could improve the intention to get vaccinated

Vaccinations in prisons: A shot in the arm for community health

From the first day of imprisonment, prisoners are exposed to and expose other prisoners to various communicable diseases, many of which are vaccine-preventable. The risk of acquiring these diseases during the prison sentence exceeds that of the general population. This excess risk may be explained by various causes; some due to the structural and logistical problems of prisons and others to habitual or acquired behaviors during imprisonment. Prison is, for many inmates, an opportunity to access health care, and is therefore an ideal opportunity to update adult vaccination schedules. The traditional idea that prisons are intended to ensure public safety should be complemented by the contribution they can make in improving community health, providing a more comprehensive vision of safety that includes public health

Epidemiology of Suicide Mortality in Paraguay from 2005 to 2019 : A Descriptive Study

Publisher Copyright: © 2024 by the authors.Suicide is an important public health problem, fundamentally affecting the younger population and responding to multiple biological, psychological, and social causes. The objective of this study was to characterize changes in suicide mortality, suicide methods, and years of potential life lost from 2005 to 2019 in Paraguay. This observational, descriptive study used data from the Vital Statistics Information Subsystem of the Ministry of Public Health and Social Welfare. The average mortality rate from suicide was 4.9 per 100,000 inhabitants, with an increase from 4.2 between 2005 and 2009 to 5.8 from 2014 to 2019. Suicide was more common in men (75%) than in women. In men, the highest mortality rate was observed among those 20–24 years old, whereas in women, the ages most affected were the 15–19-year-old age group. The most-used method for suicide was hanging. The most frequent place of suicide occurrence was at home (73%). The seasonality of suicide occurrence showed a slight increase in the spring–summer months compared with autumn–winter (53% vs. 47%). The rate of potential years of life lost statistically significantly increased from 2005 to 2019. Public health measures need to be implemented to investigate the underlying reasons and implement interventions in the population to decrease suicide mortality in Paraguay.Peer reviewe

Seminario sobre investigación en tuberculosis en Paraguay : Resumen del evento

Cada año cerca de 3000 casos de Tuberculosis son registrados en el Paraguay. Esta enfermedad es siempre un tema vigente en congresos nacionales e internacionales de infectología o neumología que se realizan el país, pero nunca fue enfocado como tema central de debate, investigación de vanguardia o innovación. Hay registros de varios eventos en donde la tuberculosis es uno, entre varios temas abordados, pero pocas veces fue profundo el nivel de análisis y hasta la fecha nunca estuvieron juntos en nuestro país varios expertos de nivel global sobre el tema, discutiendo los nuevos aspectos de la investigación, las nuevas líneas globales de innovación en el diagnóstico, el tratamiento y el control de la enfermedad.CONACYT – Consejo Nacional de Ciencia y TecnologíaPROCIENCI

Increasing the magnesium concentration in various dialysate solutions differentially modulates oxidative stress in a human monocyte cell line

Oxidative stress is exacerbated in hemodialysis patients by several factors, including the uremic environment and the use of dialysis fluids (DFs). Since magnesium (Mg) plays a key role in modulating immune function and in reducing oxidative stress, we aimed to evaluate whether increasing the Mg concentration in different DFs could protect against oxidative stress in immunocompetent cells in vitro. Effect of ADF (acetate 3 mM), CDF (citrate 1 mM), and ACDF (citrate 0.8 mM + acetate 0.3 mM) dialysates with Mg at standard (0.5 mM) or higher (1, 1.25, and 2 mM) concentrations were assessed in THP-1 monocyte cultures. Reactive oxygen species (ROS) and malondialdehyde (MDA) levels were quantified under basal and uremic conditions (indoxyl sulfate (IS) treatment). Under uremic conditions, the three DFs with 0.5 mM Mg promoted higher ROS production and lipid damage than the control solution. However, CDF and ACDF induced lower levels of ROS and MDA, compared to that induced by ADF. High Mg concentration (1.25 and/or 2 mM) in CDF and ACDF protected against oxidative stress, indicated by reduced ROS and MDA levels compared to respective DFs with standard concentration of Mg. Increasing Mg concentrations in ADF promoted high ROS production and MDA content. Thus, an increase in Mg content in DFs has differential effects on the oxidative stress in IS-treated THP-1 cells depending on the dialysate used

Identifying Populations Most Susceptible To Get Benefit From Broadening The Scope For Prevention Of Cervical Cancer: Example From Uruguay

Objectives: To identify factors associated with high-risk human papillomavirus (HPV) infection and high grade squamous intraepithelial lesion (HSIL) among a high-risk group of HPV-unvaccinated women in Montevideo. Methods: Participants completed a questionnaire on socio-demographics, sexual behavior and gynecological history and received a gynecological examination. HPV DNA was detected by PCR using MY09/11 primers. Logistic regression analyses were performed to identify factors associated with high-risk HPV infection and HSIL. Results: A total of 469 women with HPV DNA and cytological results completed the questionnaire. Among women older than 30 years, those with high number of sexual partners and regular housing conditions were more likely to be positive for high-risk HPV infection (adjusted OR: 2.94, 95% CI: 1.01-8.51 and 2.68, 95% CI: 1.01-7.21, respectively). A marginally non-statistically significant association between getting a HSIL and having a high number of sexual partners was also observed (adjusted OR: 3.22, 95% CI: 0.97-10.75). Conclusions: In an era of development of new strategies for accelerating the reduction of cervical cancer incidence and mortality, our results may contribute to identify populations most susceptible to get benefit from broadening the scope for prevention of cervical cancer and could be used with other triage strategies

Immunogenicity and immunization costs of adjuvanted versus non-adjuvanted hepatitis B vaccine in chronic kidney disease patients

Hepatitis B virus (HBV) vaccination is recommended for all susceptible chronic pre-hemodialysis and hemodialysis patients. This study assessed the immunogenicity of HBV vaccines (adjuvanted and non-adjuvanted) in chronic kidney disease patients vaccinated at the Hospital Clinic of Barcelona (Spain) between January 2007 and July 2012. In addition, the costs for the health system were evaluated according to the proportion of vaccine responders after receiving either vaccine. Patients receiving three doses of hepatitis B adjuvanted vaccine were three times more likely to seroconvert than patients immunized with non-adjuvanted vaccines, OR 3.56 (95% CI 1.84-6.85). This resulted in fewer patients requiring a second course of HBV vaccination and fewer outpatient visits, saving more than euro9,500 per 100 patients. The higher immunogenicity of the adjuvanted HBV vaccine would counterbalance the lower costs associated with the non-adjuvanted vaccine

Mechanisms of cardiovascular disorders in patients with chronic kidney disease: a process related to accelerated senescence

Cardiovascular diseases (CVDs), especially those involving a systemic inflammatory process such as atherosclerosis, remain the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). CKD is a systemic condition affecting approximately 10% of the general population. The prevalence of CKD has increased over the past decades because of the aging of the population worldwide. Indeed, CVDs in patients with CKD constitute a premature form of CVD observed in the general population. Multiple studies indicate that patients with renal disease undergo accelerated aging, which precipitates the appearance of pathologies, including CVDs, usually associated with advanced age. In this review, we discuss several aspects that characterize CKD-associated CVDs, such as etiopathogenic elements that CKD patients share with the general population, changes in the cellular balance of reactive oxygen species (ROS), and the associated process of cellular senescence. Uremiaassociated aging is linked with numerous changes at the cellular and molecular level. These changes are similar to those observed in the normal process of physiologic aging. We also discuss new perspectives in the study of CKD-associated CVDs and epigenetic alterations in intercellular signaling, mediated by microRNAs and/or extracellular vesicles (EVs), which promote vascular damage and subsequent development of CVD. Understanding the processes and factors involved in accelerated senescence and other abnormal intercellular signaling will identify new therapeutic targets and lead to improved methods of diagnosis and monitoring for patients with CKD-associated CVDs