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2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases
To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.
Journal Article
Guidelines for Preventing Opportunistic Infections among HIV-Infected Persons—2002: Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America
In 1995, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) developed guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV); these guidelines were updated in 1997 and 1999. This fourth edition of the guidelines, made available on the Internet in 2001, is intended for clinicians and other health-care providers who care for HIV-infected persons. The goal of these guidelines is to provide evidence-based guidelines for preventing OIs among HIV-infected adults and adolescents, including pregnant women, and HIV-exposed or infected children. Nineteen OIs, or groups of OIs, are addressed, and recommendations are included for preventing exposure to opportunistic pathogens, preventing first episodes of disease by chemoprophylaxis or vaccination (primary prophylaxis), and preventing disease recurrence (secondary prophylaxis). Major changes since the last edition of the guidelines include 1) updated recommendations for discontinuing primary and secondary OI prophylaxis among persons whose CD4+ T lymphocyte counts have increased in response to antiretroviral therapy; 2) emphasis on screening all HIV-infected persons for infection with hepatitis C virus; 3) new information regarding transmission of human herpesvirus 8 infection; 4) new information regarding drug interactions, chiefly related to rifamycins and antiretroviral drugs; and 5) revised recommendations for immunizing HIV-infected adults and adolescents and HIV-exposed or infected children.
Journal Article
Terrorism, radicalisation & countering violent extremism : practical considerations & concerns
This text brings together research that covers perspectives and case studies on terrorism, radicalisation and countering violent extremism (CVE). Written by experts involved in these issues at the grassroots, it bridges the academic-practitioner gap in the field. The proliferation of academic studies and conferences devoted to these subjects has meant that policymakers and practitioners in the same fields sometimes struggle to digest the sheer volume of academic output. The same critical questions keep coming up, but it is debatable the level to which there have been tangible improvements to our real state of knowledge: knowledge in especially in terms of what 'best practices' exist in the field (and what can be translated, versus what approaches remain context and location specific).
Book
New approaches to countering terrorism : designing and evaluating counter radicalization and de-radicalization programs
Hamed El-Said investigates the emergence of new, 'soft' approaches to counter violent extremists, generally known as counter radicalization and deradicalization programmes (Counter-de-Rad). This is the first work to develop a holistic framework which will allow policy makers and practitioners to better understand conditions conducive to violent extremism, and to better design and effectively implement such programmes in the future. This book, supported and facilitated by a wealth of primary research and consideration of all stakeholders, addresses cultural and legal differences between countries while developing its holistic approach. In addition, the research focuses on and identifies conditions conducive to either the success or the failure of Counter-de-Rad programmes. Finally, it provides a new, broader approach to evaluate the performance of such programmes, one that goes beyond the current narrow models which treat recidivism rates as the main indicator of success or failure.
Book
Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source
In a randomized trial involving patients who had a first stroke from an embolus of unknown source, rivaroxaban at a daily dose of 15 mg did not result in a lower incidence of recurrent stroke than aspirin at a dose of 100 mg. Bleeding rates were higher with rivaroxaban.
Journal Article
Dietary supplements and disease prevention — a global overview
Key Points
In developing countries, limited access or adaptation to a healthful, well-balanced diet can cause micronutrient malnutrition, with irreversible health consequences affecting morbidity and mortality
Deficiencies in vitamin A and/or iron are prevalent among reproductive-aged women, infants and children in developing countries, with therapeutic doses required for treatment
In developing and developed countries, reproductive-aged women or those who are pregnant must ensure adequate intakes of folic acid, iron, calcium and iodine, which might require supplementation
In developed countries, adequate nutrient intake can usually be achieved through a well-balanced diet and supplementation might not confer additional health benefits (except among individuals with increased requirements)
Postmenopausal women and elderly men could benefit from a combination of low-dose calcium and vitamin D for bone health
Use of a multivitamin supplement with low levels of essential vitamins and minerals could be linked to reductions in the incidence of cancer and cataracts among men
Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. This Review summarizes the available data on dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.
Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.
Journal Article