Late diagnosis of HIV infection among prisoners.

HIV-risk populations are over-represented in prisons. It is very important to identify late HIV infection diagnosis in this setting from a public health perspective. The objectives of this study are to estimate the prevalence of late diagnosis and identify the predictive factors among inmates of two prisons in Barcelona from 2010 to 2012, and to review late diagnosis in other prisons. A cross-sectional study design was used on inmates with newly-diagnosed HIV infection. Less than 350 CD4 lymphocytes/µl was considered late diagnosis. A Medline search was performed. Of the 3,933 total inmates, 1.2% (n = 47) were diagnosed with HIV infection, 1.7% from Prison A and 0.6% from Prison B (p < 0.001). Late diagnosis occurred in 47.7% of cases. A higher number of cases with late diagnosis were found in Prison A, among the immigrant population, and among intravenous drug users (p = 0.026, p = 0.007, p = 0.03, respectively). The proportion of late diagnosis decreased from 60% in 2010, to 44.4% in 2011 and 20% in 2012 (p = 0.05). The multivariate analysis confirmed an association between late diagnosis and immigrant status (OR: 7.85; 95% CI: 1.8-34.13) and the declining prevalence (p = 0.032). This is the first study to estimate late diagnosis in a prison population. Late diagnosis occurs mainly among the immigrant inmate population. The prison can serve as an opportunity to identify and treat HIV infection among people who have little contact with health services, thus avoiding further transmission.

Evaluación de la influencia de los factores de riesgo en la incidencia y dinámica de aparición de las flebitis de via periférica: Estudio de cohortes observacional / Assessing the influence of risk factors on rates and dynamics of peripheral vein phlebitis: An observational cohort study

Fundamento y objetivo: Valorar la influencia de los factores de riesgo en la incidencia y cinética de flebitis.Material y métodos: Todos los catéteres cortos de inserción periférica insertados durante un mes (1201 catéteres y 967 pacientes) en un hospital médico-quirúrgico general. Los factores de riesgo de flebitis se analizaron mediante regresión de Cox. Se calcularon la probabilidad acumulada, el riesgo condicional de flebitis y el beneficio teórico del recambio en diferentes periodos. Resultados: Fueron predictores independientes de desarrollo de flebitis el sexo femenino, la inserción de un catéter en el servicio de urgencias o en las unidades medico-quirúrgicas, la localización en el antebrazo y la administración de amoxicilina-clavulánico y aminoglucósidos con hazard ratios (intervalo de confianza al 95%) respectivas de: 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51(1.29-4.88), 1.93(1.10-3.01), 2.15 (1.45-3.20) y 2.10 (1.01-4.63). La máxima incidencia se alcanzó de forma más precoz en los catéteres con ≥2 factores de riesgo (dias 3 y 4) que en los de <2 (dias 4 y 5). El riesgo condicional aumentó de 0.08 flebitis/1 cat-día para los catéteres de ≤1 factor de riesgo hasta 0.26 para aquellos con ≥3. El mayor beneficio del recambio del catéter se obtuvo a las 60 horas, variando en función de los factores de riesgo: 24.8% reducción con ≥3, 13.1% con 2 y 9.2% con ≤1. Conclusiones: La dinámica de aparición de flebitis se halla muy influenciada por la interacción de los factores de riesgo. El recambio sistemático cada 72 horas solo parece ser estrictamente necesario en los catéteres de alto riesgo (AU)

Background and objectives: To assess the influence of risk factors on the rates and kinetics of peripheral vein phlebitis (PVP) development and its theoretical influence in absolute PVP reduction after catheter replacement. Methods:All peripheral short intravenous catheters inserted during one month were included (1201 catheters and 967 patients). PVP risk factors were assessed by a Cox proportional hazard model. Cumulative probability, conditional failure of PVP and theoretical estimation of the benefit from replacement at different intervals were performed. Results: Female gender, catheter insertion at the emergency or medical-surgical wards, forearm site, amoxicillin-clavulamate or aminoglycosides were independent predictors of PVP with hazard ratios (95 confidence interval) of 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51 (1.29-4.88), 1.93 (1.20-3.01), 2.15 (1.45-3.20) and 2.10 (1.01-4.63), respectively. Maximum phlebitis incidence was reached sooner in patients with ≥2 risk factors (days 3-4) than in those with <2 (days 4-5). Conditional failure increased from 0.08 phlebitis/one catheter-day for devices with ≤1 risk factors to 0.26 for those with ≥3. The greatest benefit of routine catheter exchange was obtained by replacement every 60h. However, this benefit differed according to the number of risk factors: 24.8% reduction with ≥3, 13.1% with 2, and 9.2% with ≤1. Conclusions: PVP dynamics is highly influenced by identifiable risk factors which may be used to refine the strategy of catheter management. Routine replacement every 72h seems to be strictly necessary only in high-risk catheters (AU)

Assessing the influence of risk factors on rates and dynamics of peripheral vein phlebitis: an observational cohort study.

BACKGROUND AND OBJECTIVES: To assess the influence of risk factors on the rates and kinetics of peripheral vein phlebitis (PVP) development and its theoretical influence in absolute PVP reduction after catheter replacement. METHODS: All peripheral short intravenous catheters inserted during one month were included (1201 catheters and 967 patients). PVP risk factors were assessed by a Cox proportional hazard model. Cumulative probability, conditional failure of PVP and theoretical estimation of the benefit from replacement at different intervals were performed. RESULTS: Female gender, catheter insertion at the emergency or medical-surgical wards, forearm site, amoxicillin-clavulamate or aminoglycosides were independent predictors of PVP with hazard ratios (95 confidence interval) of 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51 (1.29-4.88), 1.93 (1.20-3.01), 2.15 (1.45-3.20) and 2.10 (1.01-4.63), respectively. Maximum phlebitis incidence was reached sooner in patients with ≥2 risk factors (days 3-4) than in those with <2 (days 4-5). Conditional failure increased from 0.08 phlebitis/one catheter-day for devices with ≤1 risk factors to 0.26 for those with ≥3. The greatest benefit of routine catheter exchange was obtained by replacement every 60h. However, this benefit differed according to the number of risk factors: 24.8% reduction with ≥3, 13.1% with 2, and 9.2% with ≤1. CONCLUSIONS: PVP dynamics is highly influenced by identifiable risk factors which may be used to refine the strategy of catheter management. Routine replacement every 72h seems to be strictly necessary only in high-risk catheters.

[Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007]. / Vigilancia de la tuberculosis en las Islas Baleares y caracterización de los casos infradeclarados entre los años 2005 y 2007.

We performed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance System in the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported cases in sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosis was approximately 20%. Significant factors in multivariate analysis were social marginality (consisting of alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR: 3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengthening notification by hospital specialists through the use of hospital electronic records. Our findings show that the information obtained from the primary care computerized history is helpful in improving the epidemiological surveillance of tuberculosis.

Vigilancia de la tuberculosis en las Islas Balearesy caracterización de los casos infradeclarados entre los a˜nos 2005 y 2007 / Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007

Estudio descriptivo de los casos de tuberculosis detectados por el Sistema de Vigilancia Epidemiológicaen Baleares, en el trienio de 2005 a 2007. El objetivo fue caracterizar los casos infradeclarados en términossociodemográficos y de su contacto con la atención primaria de salud. Globalmente, la infradeclaraciónde la tuberculosis se sitúa en torno al 20%. Las características que resultan significativas en el análisismultivariado son la marginalidad social (alcoholismo, usuarios de drogas por vía parenteral o indigencia)(odds ratio ajustada [ORa] : 2,6 [1,2-5,3]), el contacto con la atención primaria (ORa : 3,2 [1,4-7,1]) y latuberculosis extrapulmonar (ORa : 5,5 [3,2-9,6]). Se recomienda reforzar la notificación de los especialistashospitalarios mediante la adecuación informática de la historia clínica hospitalaria, y se observa quela información obtenida desde la informatización de la historia en atención primaria resulta de utilidadpara mejorar la vigilancia epidemiológica de la tuberculosis (AU)

Weperformed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance Systemin the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported casesin sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosiswas approximately 20%. Significant factors in multivariate analysis were social marginality (consistingof alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR:3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengtheningnotification by hospital specialists through the use of hospital electronic records. Our findings showthat the information obtained from the primary care computerized history is helpful in improving theepidemiological surveillance of tuberculosis (AU)

[HCV and HIV infection, and coinfection in the León health area in the period 1993-2004]. / Infección por los virus de la hepatitis C y de la inmunodeficiencia humana y coinfección por ambos en el área de salud de León durante el período 1993-2004.

BACKGROUND: As few population studies exist, the study of positive serological tests detected in laboratory services may be an acceptable approximation for the assessment of HIV and Hepatitis C infection and coinfection by both. METHODS: A study was made of the database of positive serologies of the Laboratory Service of León General Hospital. Data were treated in accordance with the origin of the samples. To calculate rates, the municipal census of persons over 14 was used. For the prison population, the number of inmates on the last day of each year was considered. The period analysed was 1993-2004. The Chi-square test and Chi-square test for tendencies were used. RESULTS: The number of positive serologies for HCV, HIV and coinfection were 467, 112 and 78 in 1993; 217, 24 and 15 in 2002, and 294, 42 and 21 in 2004. According to the samples from the hospital, blood bank and health centres, the average annual rate per 100,000 inhabitants for the three-year periods 1993-95 and 2001-04 in men varied from 153.3 to 69.5 for HCV, from 26.2 to 10,0 for HIV and from 21.7 to 3.8 for coinfection. The figures for women were 56.6-37.7 for HCV, 9.2-2.3 for HIV and 6.3-0.4 for coinfection. In all cases, there was a significant downward trend (p<0.05). The positive serologies from the prison for the period 1993-2004 varied between 34.5% and 7.2% for HCV, 11.7%-1.1% for HIV and 9.55 and 1.0% for coinfection. Of those infected by HCV, 11.5% were HIV positive, and of those infected by HIV, 65.5% were also positive for HCV. CONCLUSIONS: A drop was observed in the number and rates of positive serological tests over the period studied.

Infección por los virus de la hepatitis C y de la inmunodeficiencia humana y coinfección por ambos en el área de salud de León durante el período 1993-2004 / HCV and HIV infection, and coinfection in the León health area in the period 1993-2004

Fundamento: Ante la escasez de registros poblacionales, elestudio de las serologías positivas detectadas en los servicios delaboratorio puede ser una aceptable aproximación para conocerlas tendencias de determinadas infecciones. El objetivo de estetrabajo es conocer la evolución de las infecciones por los virus dela inmunodeficiencia humana (VIH) y de la hepatitis C (VHC) asícomo de la coinfección (COIN) durante el período 1993-2004.Métodos: Se utilizó la base de datos de serologías positivasdel Servicio de Laboratorio del Hospital de León. La informaciónse estudió en función de la fuente origen de las muestras. Para elcálculo de las tasas se utilizó el padrón municipal de personasmayores de 14 años. Para la población reclusa el número de internadosel último día de cada año. Se analizó el periodo comprendidoentre 1993 y 2004. Se utilizaron las pruebas de Chi-cuadradoy de Chi-cuadrado para tendencias.Resultados: El número de serologías positivas para VHC,VIH y COIN fueron respectivamente 467, 112 y 78 en 1993; 217,24 y 15 para 2002 y 294, 42 y 21 en 2004. De acuerdo con lasmuestras procedentes del hospital, banco de sangre y ambulatorios,la tasa promedio anual por 100.000 habitantes para los períodos1993-95 y 2001-04 en hombres variaron de 153,3 a 69,5 paraVHC; de 26,2 a 10,0 para VIH y de 21,7 a 3,8 para COIN. En elcaso de las mujeres de 56,6 a 37,7 para VHC, de 9,2 a 2,3 paraVIH y de 6,3 a 0,4 para COIN. En todos los casos las tendenciasfueron significativamente descendentes (p<0,05). La razón deserologías positivas de las muestras provenientes de prisión bajóentre 1993-2004 del 34,5% al 7,2% para VHC; del 11,7% al 1,1%para VIH y del 9,5% al 1,0% para COIN. De los sujetos infectadospor VHC lo estaban también por VIH el 11,5% y el 65,6% yde los infectados por VIH lo estaban por VHC.Conclusiones: Se ha observado un descenso en el número ytasas de serologías positivas a lo largo del periodo de estudio(AU)

Background: As few population studies exist, the study ofpositive serological tests detected in laboratory services may bean acceptable approximation for the assessment of HIV andHepatitis C infection and coinfection by both.Methods: A study was made of the database of positiveserologies of the Laboratory Service of León General Hospital.Data were treated in accordance with the origin of the samples. Tocalculate rates, the municipal census of persons over 14 was used.For the prison population, the number of inmates on the last dayof each year was considered. The period analysed was 1993-2004.The Chi-square test and Chi-square test for tendencies were used.Results: The number of positive serologies for HCV, HIVand coinfection were 467, 112 and 78 in 1993; 217, 24 and 15 in2002, and 294, 42 and 21 in 2004. According to the samples fromthe hospital, blood bank and health centres, the average annualrate per 100,000 inhabitants for the three-year periods 1993-95and 2001-04 in men varied from 153.3 to 69.5 for HCV, from 26.2to 10,0 for HIV and from 21.7 to 3.8 for coinfection. The figuresfor women were 56.6-37.7 for HCV, 9.2-2.3 for HIV and 6.3-0.4for coinfection. In all cases, there was a significant downwardtrend (P<0.05). The positive serologies from the prison for theperiod 1993-2004 varied between 34.5% and 7.2% for HCV,11.7%-1.1% for HIV and 9.55 and 1.0% for coinfection. Of thoseinfected by HCV, 11.5% were HIV positive, and of those infectedby HIV, 65.5% were also positive for HCV.Conclusions:A drop was observed in the number and rates ofpositive serological tests over the period studied(AU)