Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
109,993
result(s) for
"RISK GROUPS"
Sort by:
Hepatitis A: Epidemiology, High-Risk Groups, Prevention and Research on Antiviral Treatment
The hepatitis A virus (HAV) is a leading cause of acute viral hepatitis worldwide. It is transmitted mainly by direct contact with patients who have been infected or by ingesting contaminated water or food. The virus is endemic in low-income countries where sanitary and sociodemographic conditions are poor. Paradoxically, improving sanitary conditions in these countries, which reduces the incidence of HAV infections, can lead to more severe disease in susceptible adults. The populations of developed countries are highly susceptible to HAV, and large outbreaks can occur when the virus is spread by globalization and by increased travel and movement of foodstuffs. Most of these outbreaks occur among high-risk groups: travellers, men who have sex with men, people who use substances, and people facing homelessness. Hepatitis A infections can be prevented by vaccination; safe and effective vaccines have been available for decades. Several countries have successfully introduced universal mass vaccination for children, but high-risk groups in high-income countries remain insufficiently protected. The development of HAV antivirals may be important to control HAV outbreaks in developed countries where a universal vaccination programme is not recommended.
Journal Article
Characterizing the HIV/AIDS epidemic in the Middle East and North Africa : time for strategic action
Despite a fair amount of progress on understanding human immunodeficiency virus (HIV) epidemiology globally, the Middle East and North Africa (MENA) region is the only region where knowledge of the epidemic continues to be very limited, and subject to much controversy. It has been more than 25 years since the discovery of HIV, but no scientific study has provided a comprehensive data-driven synthesis of HIV/AIDS (acquired immunodeficiency syndrome) infectious spread in this region. The current report provides the first comprehensive scientific assessment and data-driven epidemiological synthesis of HIV spread in MENA since the beginning of the epidemic. It is based on a literature review and analysis of thousands of widely unrecognized publications, reports, and data sources extracted from scientific literature or collected from sources at the local, national, and regional levels. The recommendations provided here focus on key strategies related to the scope of this report and its emphasis on understanding HIV epidemiology in MENA as a whole. The recommendations are based on identifying the status of the HIV epidemic in MENA, through this synthesis, as a low HIV prevalence setting with rising concentrated epidemics among priority populations. General directions for prevention interventions as warranted by the outcome of this synthesis are also discussed briefly, but are not delineated because they are beyond the scope of this report. This report was not intended to provide intervention recommendations for each MENA country.
eBook
Quantitative analysis of self-reporting and contact tracing in heterogeneous risk groups: a stochastic modeling study of the COVID-19 outbreak in Daegu, Korea
Background
In the early stages of a novel infectious disease outbreak, when vaccines, treatments, and herd immunity are lacking, non-pharmaceutical interventions—particularly self-reporting and contact tracing—play a critical role in suppressing transmission. During the first wave of COVID-19 in Korea, a large outbreak centered around a religious community in Daegu rapidly escalated, thus highlighting the transmission risks associated with a closed and low-reporting high-risk group. This study aimed to quantitatively assess the effectiveness of self-reporting and contact tracing strategies across heterogeneous risk groups.
Methods
The population of Daegu was stratified into two groups: a high-risk group characterized by high transmissibility and low reporting rate, and a low-risk group with lower transmissibility and higher reporting compliance. We developed a stochastic model and applied a modified Gillespie algorithm incorporating both Markovian and non-Markovian processes. Scenario-based simulations were conducted to evaluate the impact of changes in self-reporting rates and delays in contact tracing. We simulated each scenario 10,000 times to estimate the mean and 95% credible intervals for the number of infections.
Results
When the self-reporting rate in the high-risk group was lowered to 0.1, the total infections increased by approximately 22%, while unreported infections rose by 164% compared to the baseline. Conversely, increasing the self-reporting rate in the high-risk group to 0.8 reduced the total cases by approximately 21% and unreported infections by 86%. Notably, unreported infections in the low-risk group increased by approximately 416% when their reporting rate declined to 0.4, although this group had a lower transmission potential. Even a modest contact tracing delay of 4–7 d resulted in an 85% increase in unreported cases, with diminishing returns for longer delays, highlighting the critical importance of timely tracing in outbreak control.
Conclusions
In situations with heterogeneous risk groups, improving the self-reporting behavior of high-risk populations and maintaining high compliance in the low-risk group are essential for effective outbreak control. Contact tracing should be completed within 1–4 d to prevent further spread. Our study which accounts for behavioral heterogeneity, provides a scientific foundation for designing group-specific intervention strategies in future outbreaks of emerging infectious diseases.
Journal Article
Perspectives of at-Risk Individuals on Preventive Intervention for Rheumatoid Arthritis: A Mini Review
There has been intense research focus on the biological mechanisms underlying the transition from health to disease for rheumatoid arthritis (RA) over recent years, and it is now well established that a state of autoimmunity precedes the development of symptoms for a large proportion of patients. This has led to an increased interest in the identification of at-risk groups and the potential for preventive intervention. The ability of several immunomodulatory agents to delay or prevent RA is under investigation and novel cellular therapies are in development. Preventive approaches are also being assessed in other chronic autoimmune diseases. For example, an anti-CD3 antibody has recently been shown to delay progression to type 1 diabetes in non-diabetic relatives of patients identified as being at high risk. The identification and treatment of individuals as being at risk of a disease where there is a degree of uncertainty around the potential for benefit is socially and ethically challenging. Recently reported difficulties in recruitment to RA prevention trials have underlined the importance of understanding the perspectives of at-risk individuals to identify barriers and facilitators that need to be addressed in order for preventive strategies to be acceptable. Understanding of their preferences for benefits and risks of preventive interventions can inform efficient intervention prioritization, prevention trial design and the development of informational resources for those at risk. In this review we summarize current knowledge of preferences for RA prevention and make recommendations for further research needed to ensure efficient development of preventive therapies and clinical implementation.
Journal Article
Limits of the social-benefit motive among high-risk patients: a field experiment on influenza vaccination behaviour
Background
Influenza vaccine uptake remains low worldwide, inflicting substantial costs to public health. Messages promoting social welfare have been shown to increase vaccination intentions, and it has been recommended that health professionals communicate the socially beneficial aspects of vaccination. We provide the first test whether this
prosocial vaccination hypothesis
applies to actual vaccination behaviour of high-risk patients.
Methods
In a field experiment at a tertiary care public hospital in Istanbul, Turkey, we compare the effects of two motivational messages for promoting vaccination. Using a between-subjects single-blind experimental design patients were randomly assigned to frames emphasizing the vaccine’s benefits to self (
n
= 125) or social benefits (
n
= 119). Free influenza vaccination was offered to each patient.
Results
Among 222 patients who were not vaccinated for the season prior to the study (72% medically assessed to be at high risk), 42% in the self-benefit frame chose to receive a vaccination compared with 34% in the social-benefits frame, but the difference was not statistically significant (aOR = 1.63, 95% CI 0.90 to 2.95,
p
= 0.108). Reasons for vaccination focused primarily on self-benefit (67%) rather than social-benefit (5%). Exploratory analysis showed that the effect of messages depended on patient perception of risk group membership (aOR
High
/ aOR
Low
= 5.59, 95% CI 1.30 to 24.05,
p
= 0.021). In particular, emphasis on self-benefit was more influential among patients who perceived themselves to be in the risk group (aOR = 6.22, 95% CI 1.69 to 22.88,
p
= 0.006).
Conclusions
In contrast to the literature observing intentions of low-risk populations, we found no evidence that social-benefit motivates actual vaccination behaviour among a high-risk patient population. Instead, those who self-categorize as being in the high risk group are more motivated by the self-benefit message. Our results suggest that a stratified approach can improve coverage: even if an emphasis on social-benefit could be effective among low-risk groups, an emphasis on self-benefit holds more promise for increasing vaccination in medical organizational settings where high-risk groups are prevalent.
Trial registration
ClinicalTrials.gov
NCT04230343
Retrospectively registered on the 13th January 2020.
Journal Article
Validation of novel grading schemes and refinement of the Leibovich risk groups for chromophobe renal cell carcinoma
Background
Traditional grading systems have proven inadequate in stratifying chRCC patients based on recurrence risk. Recently, several novel grading schemes, including three-tiered, two-tiered, and four-tiered systems, have been proposed, but their prognostic value remains controversial and lacks external validation.
Materials and methods
We included 528 patients with pathologically proven chRCC (chromophobe renal cell carcinoma) from multiple medical institutions and the Cancer Genome Atlas-Kidney Chromophobe cohort. Three experienced pathologists independently reassessed the slides based on the three novel grading schemes. Survival outcomes, including disease-specific survival (DSS), recurrence-free survival (RFS), were analyzed using Kaplan-Meier methods and Cox proportional hazards regression models. The prognostic value of the original and adjusted Leibovich risk groups was compared using Harrell’s C-index.
Results
All grading systems demonstrated significant survival differences among their respective groups (
p
< 0.001 for all). However, within the four-tiered system, no significant survival disparity was observed between grade 1 and grade 2 tumors (GTG2 without necrosis) (
p
= 0.619 for DSS). When patients with necrosis were excluded, no survival difference was detected between CTG1 and CTG2 tumors in the three-tiered system (
p
= 0.870 for DSS), challenging the prognostic utility of distinguishing between these two grades. The adjusted Leibovich risk stratification (C-index = 0.840 for DSS), incorporating necrosis and tumor thrombus, demonstrated superior prognostic value compared to the original model (C-index = 0.762 for DSS), with more pronounced survival distinctions and improved predictive performance.
Conclusion
Our study validates the prognostic significance of recently developed grading systems for chRCC. The observed survival difference between CTG1 and CTG2 in the three-tiered system may be attributed to varying percentages of coagulative necrosis. By integrating necrosis and tumor thrombus into the Leibovich risk groups, we enhanced the model’s ability to distinguish between patients and improved its predictive performance.
Journal Article
Why are older adults and individuals with underlying chronic diseases in Germany not vaccinated against flu? A population-based study
Background
Older adults and individuals with underlying chronic diseases are at increased risk of developing influenza-related complications and are target groups for seasonal influenza vaccination in many countries. In Germany, an annual national information campaign is conducted to increase influenza vaccination uptake in the target groups. However, data are lacking on knowledge and attitudes toward influenza vaccination among older adults and those with chronic diseases. The present study aimed to (i) estimate influenza vaccination uptake for the 2012/13 and 2013/14 seasons, (ii) assess knowledge and attitudes about influenza vaccination, and (iii) identify factors associated with vaccination uptake in two risk groups.
Methods
Between March and June 2014, we conducted a nationwide cross-sectional survey in adults (≥18 years) living in Germany using computer-assisted telephone interviewing. We calculated weighted vaccination coverage rates in two at-risk groups. Group 1 comprised participants aged 18–59 years with underlying chronic diseases. Group 2 comprised participants aged 60+, irrespective of underlying disease. We used univariate and multivariable logistic regression analyses to identify associations between influenza vaccination uptake and sociodemographic characteristics, and to evaluate attitudes and knowledge.
Results
In total, 1,519 interviews were conducted. Seasonal influenza vaccination uptake in people with underlying chronic diseases aged 18–59 years was 24 % in 2012/2013 and 23 % in 2013/2014. In older adults, uptake was 50 % and 49 % in 2012/13 and 2013/14 respectively. There were considerable vaccination-related knowledge gaps among respondents. For example, about half of the participants who aged ≥60 years and/or suffered from underlying chronic diseases believed that influenza vaccination could cause influenza. The most commonly stated reasons for not being immunized were mistrust of the vaccination (22 %) and the perception that influenza is not dangerous (21 %). For both groups, vaccination uptake was independently associated with sex, perceived severity of influenza, perceived vaccination effectiveness, and the perceived likelihood or severity of vaccination side effects. For older adults, additional factors influencing vaccination uptake were age, underlying chronic diseases, and recent advice through physician consultation.
Conclusions
Influenza vaccination coverage rates in Germany remain low. Individual perceptions regarding harms and benefits are crucial in the decision-making process. Communication strategies should focus on improving understanding and perception of personal risks arising from the disease and the vaccination.
Journal Article
The Burden of Comorbidity and Complexity in Sarcoidosis: Impact of Associated Chronic Diseases
Purpose
To evaluate comorbidity, complexity and poor outcomes in patients with sarcoidosis and to compare those scores with a control group.
Methods
218 consecutive patients were diagnosed with sarcoidosis according to the ATS/ERS/WASOG criteria; extrathoracic involvement was evaluated using the 2014 WASOG organ assessment instrument. Sarcoidosis patients were compared with an age- and gender-matched control group of primary care outpatients without sarcoidosis. Comorbidities were assessed retrospectively using the Charlson Comorbidity Index (CCI); complexity was evaluated according to the classification into Clinical Risk Groups (CRG) and severity levels.
Results
The cohort included 142 women and 76 men; the mean age was 47.1 years at diagnosis of sarcoidosis and 55.9 years at the last visit. Patients with a CCI > 1 had a higher frequency of calcium/vitamin D abnormalities (
p
< 0.001), kidney involvement (
p
= 0.005) and a higher mortality rate (
p
< 0.001) compared with patients with a CCI ≤ 1. Patients with a CRG ≥ 6 had a higher frequency of extrathoracic involvement (
p
= 0.039), calcium/vitamin D abnormalities (
p
= 0.019) and treatment with glucocorticoids (
p
= 0.032) compared with patients with a CRG < 6. 11% patients died after a mean follow-up of 102.3 months. Country of birth, kidney involvement and extrathoracic disease were significantly associated with death. Patients with sarcoidosis had a higher frequency of liver (
p
< 0.001), pulmonary (
p
= 0.002) and autoimmune disease (
p
= 0.011) and cancer (
p
= 0.007) compared with the control group.
Conclusion
We found higher rates of comorbidity and complexity in patients with sarcoidosis compared with a control group. Liver, pulmonary, autoimmune and neoplastic diseases were the main comorbidities found in patients with sarcoidosis.
Journal Article