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Brito J, Silva P, Aguiar-Ricardo I, Cunha N, Pinto R, Raposo M, Gregorio C, Sousa P, Caldeira E, Miguel S, Abreu A. Cardiac Optimal Point: Identifying high risk patients for an optimal approach. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In recent years it has been proposed the concept of cardiorespiratory optimal point (COP) to best characterize populations who underwent cardiac rehabilitation programmes (CRP). The COP is defined as the minimum ratio between ventilation and oxygen consumption (VE/VO2) obtained during the cardiopulmonary exercise test (CPET) and it has been suggested that COP values > 30 conveyed worse prognosis.
Purpose
To validate OP as a predictor of events and its correlation with exercise activity and quality of life on the long term.
Methods
Single center observational study of patients enrolled on CRP - from February 2018 to May 2019 – who did CPET as part of routine evaluation. COP was defined as the lowest point of VE/VO2 ratio. Clinical and laboratorial characteristics were obtained at admission and discharge of CRP. Exercise practice was accessed using IPAQ questionnaire and quality of life was assessed based on a validated inquire - Kansas City Cardiomyopathy Questionnaire (KCCQ-23) – both by phone interview.
Results
A total of 78 patients (mean age 63.2 ±11.6, 84.6% male) were evaluated and followed for a mean follow-up of 2,68±0,53 years. Main aetiology was ischemic heart disease (86%), followed by dilated cardiomyopathy (5,1%) and valvular heart disease (2,6%).
A COP value above 30 correlated with a worse global score in KCC-23 (r =0.283, p = 0.47), and in particular domains such as frequency and severity of symptoms (p = 0.046, r 0.335 and p=0.16, r= 0.4, respectively), quality of life (p=0.039, r= 0.293) and social limitation (p = 0.001, r=0.5). COP also correlated with VO2 peak in basal CPET (p<0.001, r= 0.450) and on follow-up CPET (p= 0.39, r= 0.303).
COP failed to predict events or levels of exercise activity on the long term, as evaluated by the IPAQ score. However, COP>30 did seem to correlate with a higher mortality rate on the follow-up although such trend was not statistically significant (possibly due to short follow-up time and sample size).
Conclusion
COP values > 30 identify patients with worse prognosis, predicting worse quality of life and higher mortality. Although it did not seem to be a good predictor of exercise adherence after CRP.
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Affiliation(s)
- J Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - M Raposo
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - C Gregorio
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Sousa
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - E Caldeira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - S Miguel
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - A Abreu
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Alves Da Silva P, Brito J, Aguiar-Ricardo I, Cunha N, Abrantes A, Fonseca J, Pinto R, Caldeira E, Sousa P, Pinto FJ, Abreu A, Miguel S. Shorter cardiac rehabilitation programs: taking time is taking effectiveness? Eur J Prev Cardiol 2022. [PMCID: PMC9383979 DOI: 10.1093/eurjpc/zwac056.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP. Objective To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program. Methods Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation. Results A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities. After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112). Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157). Conclusion Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.
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Affiliation(s)
- P Alves Da Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Abrantes
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Fonseca
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - E Caldeira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Sousa
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - S Miguel
- Hospital de Santa Maria Faculty of Medicine, Serviço Medicina Física Reabilitação, Lisbon, Portugal
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Pinto R, Pires ML, Borges M, Pinto ML, Guerreiro CS, Miguel S, Santos O, Ricardo I, Cunha N, Silva PAD, Correia AL, Fiúza S, Caldeira E, Salazar F, Rodrigues C, Ferreira MC, Afonso G, Araújo G, Martins J, Ramalhinho M, Sousa P, Pires S, Jordão A, Pinto FJ, Abreu A. [Digital home-based multidisciplinary cardiac rehabilitation: How to counteract physical inactivity during the COVID-19 pandemic]. Rev Port Cardiol 2021; 41:209-218. [PMID: 34840415 PMCID: PMC8604709 DOI: 10.1016/j.repc.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/29/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction and Objectives Center-based cardiac rehabilitation (CR) programs have been forced to close due to COVID-19. Alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be considered. The aim of this study was to assess physical activity (PA) levels after completing a home-based digital CR program. Methods A total of 116 cardiovascular disease (CVD) patients (62.6±8.9 years, 95 male) who had been attending a face-to-face CR program were recruited and assessed (baseline and at three months) on the following parameters: PA, sedentary behavior, adherence, cardiovascular and non-cardiovascular symptoms, feelings toward the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted of a multidisciplinary digital CR program, including regular patient assessment, and exercise, educational and psychological group sessions. Results Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out rate). A favorable main effect of time was an increase in moderate to vigorous PA and a decrease in sedentary time at three months. Almost half of the participants completed at least one online exercise training session per week and attended at least one of the online educational sessions. No major adverse events were reported and only one minor event occurred. Conclusion During the pandemic, levels of moderate to vigorous PA improved after three months of home-based CR in CVD patients with previous experience in a face-to-face CR model. Diversified CR programs with a greater variety of content tailored to individual preferences are needed to meet the motivational and clinical requirements of CVD patients.
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Affiliation(s)
- Rita Pinto
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Madalena Lemos Pires
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Borges
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Liñan Pinto
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Sousa Guerreiro
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sandra Miguel
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Olga Santos
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Inês Ricardo
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Nelson Cunha
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Alves da Silva
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Luísa Correia
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sílvia Fiúza
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Edite Caldeira
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fátima Salazar
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Carla Rodrigues
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Cordeiro Ferreira
- Serviço de Psiquiatria e Saúde Mental, Unidade de Psicologia, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Gisela Afonso
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Graça Araújo
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Joana Martins
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Marta Ramalhinho
- Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Paula Sousa
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Susana Pires
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alda Jordão
- Serviço de Medicina III, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Abreu
- Serviço de Cardiologia, Departamento Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Alves Da Silva P, Aguiar-Ricardo I, Cunha N, Rodrigues T, Valente-Silva B, Silverio-Antonio P, Couto-Pereira S, Brito J, Pinto R, Lemos-Pires M, Borges M, Cordeiro-Ferreira M, Caldeira E, Pinto FJ, Abreu A. Home-based Cardiac Rehabilitation: the patients claim for new strategies but do they adhere? Eur J Prev Cardiol 2021. [PMCID: PMC8136070 DOI: 10.1093/eurjpc/zwab061.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac rehabilitation (CR) programs are established interventions to improve cardiovascular health, despite asymmetries in referral. With covid 19 outbreak, cardiac rehabilitation home based (CR-HB) programs emerged as an alternative. However, its adherence and implementation may vary greatly with socio-demographic factors.
Purpose
To assess adherence to the various components of a CR-HB program.
Methods
Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.patient clinical and exercise risk assessment; 2.psychological tele-appointments; 3. online exercise training sessions; 4.structured online educational program for patients and family members/caregivers; 5. follow-up questionnaires; 6. nutrition tele-appointments; 7. physician tele-appointments
Adherence to the program was assessed by
drop-out rate; number of exercise sessions in which each patient participated; number of educational sessions attended and a validated questionnaire on therapeutic adherence (composed of 7 questions with minimum punctuation of 7 and maximum of 40 points).
Results
116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure; the mean LVEF was 52 ± 11%. Regarding risk factors, obesity was the most common risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%).
Ninety-eight pts (85.5%) successfully completed the program. Almost half (46.9%) of the participants did at least one online exercise training session per week. Among the pts who did online exercise training sessions, 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week.
The pts participated, on average, in 1.45 ± 2.6 education sessions (rate of participation of 13,2%) and therapeutic adherence was high (39,7 ± 19; min 35-40).
Regarding educational status of the pts, 33 pts (45,2%) had a bachelor degree. These pts tended to participate more in exercise sessions (1,7 ± 1,7 vs 1,2 ± 1,4 sessions per week) and in education sessions (2.13 vs 1.6), although this difference was not statistically significant. The therapeutic adherence did not vary with patients’ level of education.
Conclusion
Our results showed that a high percentage of patients completed the program and almost half were weekly physically active. However, in regard to educational sessions, the degree of participation was much lower. Educational status seemed to correlate with a higher degree of participation and, in the future, patient selection might offer better results in these kinds of programs.
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Affiliation(s)
- P Alves Da Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - B Valente-Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Silverio-Antonio
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - S Couto-Pereira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - M Lemos-Pires
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - M Borges
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - M Cordeiro-Ferreira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - E Caldeira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
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Gomez-Cantarino S, Espina-Jerez B, Dominguez-Isabel P, Bouzas-Mosquera C, Dias H, Caldeira E, Sim-Sim M. P16 Students’ attitudes toward the patient’s sexuality versus the perception of their sexual life. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz093.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - H Dias
- Health Higher School of Santarém, Monitoring Unity of Health Indicators (UMIS), IPSantarém Research Unit, Polytechnic Institute of Santarém, Santarém, PORTUGAL
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, PORTUGAL
| | - E Caldeira
- São João de Deus School of Nursing, University of Évora, Évora, PORTUGAL
| | - M Sim-Sim
- São João de Deus School of Nursing, University of Évora, Évora, PORTUGAL
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Abstract
The prevalence of those with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is higher among inmates of correctional facilities than among the general population. This raises the need to identify inmates living with or at risk of HIV/AIDS and to provide counseling and appropriate services for HIV treatment and prevention. The Maryland Division of Corrections (DOC) offers voluntary testing to all inmates on entry and tests inmates when clinically indicated. We reviewed all 1998 HIV antibody tests and confirmed AIDS cases in the Maryland DOC. Inmate demographics, testing acceptance, rates of seropositivity, and AIDS cases and comparisons based on gender, race/ethnicity, and age were examined. Comparisons were also made to HIV testing and AIDS cases from the nonincarcerated Maryland population. Trends in DOC AIDS diagnoses and AIDS-related deaths over time were also examined. Of the inmates, 39% were voluntarily tested for HIV on entry to the Maryland DOC in 1998 (38% of males and 49% of females). Overall, HIV seropositivity was 3.3% (5% for females and 3% for males). The 888 cumulative AIDS cases diagnosed in the DOC inmate population were concentrated among males (90% vs. 77% statewide), African Americans (91% vs. 75% statewide), and among IDUs (84% vs. 39% statewide). Due to high rates of HIV and AIDS, inmate populations are a crucial audience for HIV/AIDS testing, treatment, and prevention efforts, especially women. Prison-based programs can identify significant numbers of HIV and AIDS cases and bring HIV prevention interventions to a population characterized by frequent high-risk behavior.
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Affiliation(s)
- E N Kassira
- Center for Surveillance, AIDS Administration, Department of Health and Mental Hygiene, Baltimore, Maryland 21202, USA.
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Abstract
Recent advances in AIDS-related therapies have delayed the onset of AIDS-defining illnesses and reduced the usefulness of AIDS surveillance in assessing the incidence of early HIV disease and estimating future needs of the HIV-infected population. These changes have prompted renewed interest in expanding surveillance to include HIV and have engendered national debate on whether an HIV surveillance system should be based on reports of the names of infected individuals or employ non-name-based data codes. In 1994, the state of Maryland implemented a program to require HIV surveillance by unique identifier (UI) patient code. This evaluation of Maryland's program found that when complete, the 12-digit UI number provided a virtually unduplicated count 99.8% unique, was 99.9% unique with only the last four digits of the U.S. government Social Security Number (SSN), date of birth (DOB), and race, and 77.7% unique if the last four digits of the SSN were missing. Health care providers were willing to create the UI, with DOB and gender present 98.3% and 98.8% of the time, race was complete 84.1% and last four digits of SSN were complete 72.4%. The overall completeness of reporting for HIV tests was 87.8%.and 84.8%, respectively, using different methodologies. Evidence from the Maryland UI evaluation demonstrates that a non-name-based system can provide accurate, timely and valid data concerning the scope of the HIV epidemic, without the creation of state-wide name-based registry.
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Affiliation(s)
- L Solomon
- AIDS Administration, Department of Health and Mental Hygiene, Baltimore, Maryland 21205, USA
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