Prison primary care and non-communicable diseases: a data-linkage survey of prevalence and associated risk factors.

BACKGROUND: The size and mean age of the prison population has increased rapidly in recent years. Prisoners are a vulnerable group who, compared with the general population, experience poorer health outcomes. However, there is a dearth of research quantifying the prevalence of non-communicable diseases (NCDs) among prisoner populations. AIM: To explore both the prevalence of NCDs and their risk factors. DESIGN & SETTING: A cross-sectional survey was undertaken that was compared with clinical records in two male prisons in the north of England. METHOD: Self-report surveys were completed by 199 prisoners to assess sociodemographic characteristics, general health, NCD prevalence, and risk factor prevalence. Data were checked against that retrieved from prison clinical records. RESULTS: It was found that 46% reported at least one NCD and 26% reported at least one physical health NCD. The most common self-reported NCD was 'anxiety and depression' (34%), followed by 'respiratory disease' (17%), and 'hypertension' (10%). Having a physical health NCD was independently associated with increasing age or drug dependence.The level of agreement between clinical records and self-report ranged from 'fair' for alcohol dependence (kappa 0.38; P<0.001) to 'very good' for diabetes (kappa 0.86; P<0.001). CONCLUSION: Compared with mainstream populations and despite high prevalence of risk factors for NCDs physical illness NCDs, with the exception of respiratory disease, are less common. However, poor mental health is more common. These differences are possibly owing to the younger average age of prison populations, since prevalence of risk factors was reported as high.Secondary data analysis of clinical records is a more methodologically robust way of monitoring trends in prisoner population disease prevalence.

Cocaine and thrombosis: a narrative systematic review of clinical and in-vivo studies.

PURPOSE: To systematically review the literature pertaining to the link between cocaine and either arterial or venous thrombosis. PROCEDURES: Narrative systematic review of Medline, CINAHL, Embase, Psycinfo and Cochrane databases supplemented by hand trawling of relevant journals and reference lists up to April 2007. In-vivo studies and those with clinical endpoints were included in the review. RESULTS: A total of 2458 abstracts led to 186 full-text papers being retrieved. 15 met the criteria for inclusion in the review. The weight of evidence would support cocaine as a pro-thrombotic agent. There is evidence of it activating thrombotic pathways. The effect of cocaine upon clinical endpoints has not been quantified though there is evidence of an association between cocaine and myocardial infarction particularly amongst young adults. Cocaine may also be a causal agent in cerebrovascular accident though studies lacked sufficient power to determine a statistically significant effect. There is a gap in the evidence pertaining to the issue of cocaine and venous thrombosis. CONCLUSION: Clinicians should consider questioning for cocaine use particularly amongst young adults who present with cardiac symptoms. More epidemiological work is required to quantify the effect of cocaine upon both arterial and venous clotting mechanisms.

Impact of a positive hepatitis C diagnosis on homeless injecting drug users: a qualitative study.

BACKGROUND: Increasing numbers of injecting drug users are presenting to primary care and a growing number of general practices are specifically providing care for homeless people. Injecting drug users are at the greatest risk of hepatitis C infection and homeless drug misusers, because of their drug-taking behaviour and patterns, have been identified as being at greater risk of harm of blood-borne diseases than the general population. However, little work has been conducted with injecting drug users or homeless people who have hepatitis C and little is known about how the virus may affect them. AIM: To explore the impact of a positive hepatitis C diagnosis on homeless injecting drug users. DESIGN OF STUDY: This study employed qualitative research. In-depth interviews allowed the exploration of the impact of a potentially life-threatening diagnosis within the context of a person's expressed hierarchy of needs. SETTING: A primary care centre for homeless people in the north of England. METHOD: In-depth interviews about the impact of a positive hepatitis C diagnosis on their lives were conducted with 17 homeless injecting drug users who had received a positive hepatitis C diagnosis. The interviews were audiotaped, transcribed, and analysed using the framework approach. RESULTS: Receiving a positive diagnosis for hepatitis C resulted in feelings of shock, devastation, disbelief, anger, and questioning. A positive diagnosis had lasting social, emotional, psychological, behavioural, and physical effects on homeless injecting drug users, even years after the initial diagnosis. Most responders were diagnosed by a doctor in primary care or by hospital staff; however, not all had sought testing and a number were tested while inpatients and were unaware that blood had been taken for hepatitis C virus serology. CONCLUSIONS: The implications for clinical policy and primary care practice are discussed, including the issues of patient choice, confidentiality, and pre- and post-test discussions. Posttest discussions should be followed up with additional social, psychological, and medical support and counselling.

Каковы фактические данные об эффективности мер по снижению распространенности гепатита С и связанной с ним заболеваемости?

Вашему вниманию предлагается синтезированный доклад Сети фактических данных по вопросам здоровья (HEN) об эффективных вмешательствах с целью снижения распространенности инфекции гепатита С. Наибольшая распространенность гепатита С отмечается среди потребителей инъекционных наркотиков, где даже при низкой распространенности ВИЧ-инфекции инфицированными могут быть до 98% входящих в эту категорию лиц. Меры вмешательства нужны, особенно среди потребителей инъекционных наркотиков. Перспективными вмешательствами, заслуживающими дальнейшего экспериментального изучения и оценки, являются вмешательства, направленные на изменение поведения, раздача наряду с чистыми иглами и шприцами дезинфектанта на основе хлорной извести и других приспособлений для инъекционного введения наркотиков, а также организация пунктов введения наркотиков под наблюдением медперсонала. Там, где потребителям наркотиков проводится опиат-заместительная терапия, необходимо применять правильные режимы дозировки, чтобы минимизировать риск при проведении инъекций. Анализ затрат в сопоставлении с достигаемым эффектом нынешних вмешательств, направленных на первичную профилактику инфекции гепатита С, показывает, что они приносят и сопутствующую пользу, выражающуюся в снижении распространенности ВИЧ-инфекции. Сеть HEN, созданная по инициативе Европейского регионального бюро ВОЗ и координируемая им, является информационной службой, предназначенной для лиц, принимающих решения в области общественного здравоохранения и медико-санитарной помощи в Европейском регионе ВОЗ. Услугами HEN также могут пользоваться и другие заинтересованные стороны.

What is the evidence for the effectiveness of interventions to reduce hepatitis C infection and the associated morbidity?

This is a Health Evidence Network (HEN) synthesis report on effective interventions to reduce hepatitis C infection. Prevalence is most common among injecting drug user populations, where up to 98% can be infected despite a low HIV prevalence. Interventions are needed, particularly among injecting drug user populations. Behavioural interventions, distribution of bleach disinfectant and other injecting devices alongside clean needles and syringes, and supervised injecting centres are all promising interventions that merit further piloting and evaluation. Where opiate replacement therapy is provided for drug users, adequate dosing regimes should be used to minimize the risk of injecting practice. Cost-effectiveness analysis of current interventions aimed at primary prevention of hepatitis C infection shows additional benefits in reducing the prevalence of HIV. HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN.

Каким образом системы здравоохранения могут эффективно удовлетворять основные потребности бездомных в медицинской помощи?

В данном сводном докладе Сети фактических данных по вопросам здоровья акцент ставится на фактических данных, указывающих на эффективные методы лечения различных видов заболеваний и проблем со здоровьем, от которых часто страдают бездомные. Бездомные представляют собой разнородную группу людей, одной из характеристик которой является сочетанная заболеваемость (представленная главным образом алкоголизмом, наркоманией и психическими расстройствами) и преждевременная смертность. Для решения этих проблем необходимо принимать целый ряд комплексных мер, требующих целевых действий первичных звеньев здравоохранения и сотрудничества целого ряда учреждений различного профиля. Сеть фактических данных по вопросам здоровья (СФДЗ), работа которой была инициирована и координируется Eвропейским региональным бюро ВОЗ, представляет собой информационную службу для лиц, принимающих решения в области общественного здравоохранения и медицинской помощи в Европейском регионе ВОЗ. СФДЗ может также быть полезна и другим заинтересованным сторонам.

How can health care systems effectively deal with the major health care needs of homeless people?

This is a Health Evidence Network (HEN) synthesis report focusing on the evidence of effective treatment for the types of ill health from which homeless people often suffer. Homeless people constitute a heterogeneous population characterized by multiple morbidity (primarily alcohol and drug dependence, and mental disorders) and premature mortality. The problems need to be addressed by many measures, requiring a focused primary health care system and multi-agency cooperation. HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN.