Prison inmates are highly susceptible for several infectious diseases, including vaccine-preventable diseases. We conducted a systematic international literature review on vaccination coverage against hepatitis B virus (HBV), hepatitis A virus (HAV), combined HAV/HBV, tetanus-diphtheria, influenza, pneumococcal, and combined measles, mumps, and rubella (MMR) in prison inmates, according to the PRISMA guidelines. The electronic databases were used Web of Science, MEDLINE, Scopus, and Cinhal. No language or time limit were applied to the search. We defined vaccination coverage as the proportion of vaccinated prisoners. There were no limitations in the search strategy regarding time period or language. Of 1079 identified studies, 28 studies were included in the review. In total, 21 reported on HBV vaccine coverage (range between 16–82%); three on HAV (range between 91–96%); two studies on combined HAV/HBV (77% in the second dose and 58% in the third); three studies on influenza vaccine (range between 36–46%), one of pneumococcal vaccine coverage (12%), and one on MMR coverage (74%). We found that data on vaccination coverage in prison inmates are scarce, heterogeneous, and do not include all relevant vaccines for this group. Current published literature indicate that prison inmates are under-immunized, particularly against HBV, influenza, MMR, and pneumococci. Strengthen immunization programs specifically for this population at risk and improvement of data record systems may contribute to better health care in prisoners.
BackgroundTo evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals.Methods/designExperimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records.Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents.Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use.DiscussionThis study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations.Trial registrationNCT01826929
An intervention based on models for chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes.
The rapid spread of highly transmissible respiratory infections in carceral settings occurs due to their conglomerate nature. The COVID-19 pandemic has resulted in large outbreaks in jails and prisons in many settings. Herein, we describe an outbreak of SARS-CoV2 infection in a prison in Alicante, Spain. Prior to January 2021, testing for coronavirus infection was not widely available in jails and prisons nationwide. Offering of testing services in Spanish carceral facilities, coincided with the deployment of COVID-19 vaccination in the larger community. However, COVID-19 vaccine role out of incarcerated individuals occurred later during the deployment plan. With the identification of the initial cases of this outbreak, two units of the facility were assigned for population management: one for inmates with confirmed infection by positive PCR detection of SARS-COV-2 infection in nasopharyngeal swabs. Inmates with confirmed exposure and thus considered close contacts were place in a second isolation unit. Functional quarantine was employed in some instances. A reactive testing strategy was instituted at baseline, and at 7 and 14 days of nasopharyngeal specimens by PCR. A total of 1,097 nasopharyngeal specimens were obtained for PCR testing during the outbreak, which lasted a total of 80 days between the index case the end of medical isolation of the last case. A total of 103 COVID-19 cases were identified during the outbreak. Of these, three inmates developed severe manifestations requiring hospitalization, and one died. Were identified, among which there were three hospitalized and one deceased. Among cases and confirmed contacts, we conducted close clinical monitoring, symptom screening, and daily temperature checks. The implementation of these interventions along with early medical isolation of cases, quarantining of contacts, and interval testing to detect presymptomatic or asymptomatic cases were instrumental in containing this outbreak.
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