Hard-to-reach populations

难以到达的人群
  • 文章类型: Published Erratum
    [这更正了文章DOI:10.3389/fpubh.2023.1175482。].
    [This corrects the article DOI: 10.3389/fpubh.2023.1175482.].
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  • 文章类型: Journal Article
    播散性结核病通常与诊断延迟和预后较差有关。
    描述COVID-19期间低结核病负担国家的传播结核病病例系列和诊断延迟。
    我们连续纳入了2019年至2021年在巴塞罗那都会区北冠参考医院报告的所有播散性结核病患者。我们收集了社会人口统计信息,临床,实验室和放射学发现。
    我们纳入了研究期间报告的所有30例患者,分别为2019年、2020年和2021年的5例、9例和16例,其中20例(66.7%)为男性,平均年龄为41岁。25(83.3%)是非欧盟血统。最常见的系统受累是中枢神经系统(N=8;26.7%),其次是内脏系统(N=7;23.3%),胃肠道(N=6,20.0%),肌肉骨骼(N=5;16.7%),和肺(N=4;13.3%)。低蛋白血症和贫血非常普遍(72%和77%)。诊断延迟的中位数为6.5个月(IQR1.8-30),女性中的比例更高(36.0vs.3.5个月;p=0.002)。中枢神经系统受累和肺部受累与女性的诊断延迟有关。我们记录了24名治愈的病人,两人死亡,三名患者治疗后后遗症,还有一个失踪者.我们观察到低收入社区患者的聚集效应(p<0.001)。
    在我们的研究区域中,播散性结核病的诊断有很大的延迟,这可能会影响预后,女性受到的影响更大。我们的结果表明,由于诊断延迟而引起的播散性结核病的发生率增加可能是COVID-19大流行的次要影响。
    Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis.
    To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.
    We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings.
    We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001).
    There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic.
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  • 文章类型: Journal Article
    为了应对移动的霍乱爆发,奇尔瓦湖上难以到达的渔民,马拉维在2016年,一种新的疫苗分销策略利用了经过验证的疫苗热稳定性。渔民,在监管下服用第一剂疫苗时,在密封的袋子里接受了第二剂,两周后被告知要喝。这项研究评估了该策略的短期疫苗保护。
    对在湖边医疗机构就诊的腹泻患者进行了访谈,并收集了粪便样本进行PCR检测。通过比较病例(霍乱弧菌O1的PCR阳性)和对照(腹泻但PCR阴性的患者),并使用筛选方法比较了霍乱病例中接种疫苗的比例,在病例对照试验阴性设计中评估了疫苗的有效性。
    在145名研究参与者中,120人是生活在湖上的渔民。3个月时,渔民的疫苗有效率为90.0%[95CI:38.8;98.4],病例对照试验阴性设计的所有参与者的有效率为83.3%[95CI:20.8;96.5],和97.5%[95CI:90.9;99.3]的筛选方法。
    这一策略在为渔民提供短期霍乱保护方面是有效的。需要进一步的研究来确定第二剂量的附加值,并确定针对不同情况的最佳疫苗接种策略。
    In response to a cholera outbreak among mobile, difficult-to-reach fishermen on Lake Chilwa, Malawi in 2016, a novel vaccine distribution strategy exploited the proven vaccine thermostability. Fishermen, while taking the first vaccine dose under supervision, received the second dose in a sealed bag, and were told to drink it two weeks later. This study assessed short-term vaccine protection of this strategy.
    Patients with diarrhoea admitted to health facilities around lake were interviewed and a stool sample collected for PCR testing. Vaccine effectiveness was assessed in a case-control test-negative design by comparing cases (PCR-positive for V. cholerae O1) and controls (patients with diarrhoea but PCR-negative) and with the screening method that compared the proportions of vaccinated among cholera cases versus the general fishermen population.
    Of 145 study participants, 120 were fishermen living on the lake. Vaccine effectiveness at three-months was 90.0% [95%CI:38.8;98.4] among fishermen and 83.3% [95%CI: 20.8; 96.5] among all participants in the case-control test-negative design, and 97.5% [95%CI: 90.9;99.3] with the screening method.
    This strategy was effective in providing short-term protection in fishermen against cholera. Further research is needed to determine the adding value of the second dose and to identify the optimal vaccination strategies for different contexts.
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  • 文章类型: Journal Article
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