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Background: Alopecia areata (AA) is an immune-mediated form of hair loss that can occur at any age, often with a significant mental health burden., Objectives: We aimed to provide estimates of the lifetime incidence of AA, and the impacts on mental health, healthcare utilization and work-related outcomes, assessing variation across major sociodemographic subgroups., Methods: AA cases were identified in primary care from the UK population-based Oxford-Royal College of General Practitioners Research and Surveillance Centre database (2009-2018). Lifetime incidence of AA was estimated at age 80 years using modified time-to-event models with age as the timescale, overall and stratified by sex, ethnicity, deprivation and geography. Mental health, healthcare utilization and work-related outcomes were assessed in the 2 years after AA diagnosis compared with matched unaffected controls, and stratified by the same sociodemographic subgroups., Results: During the study period, 6961 people developed AA. Overall lifetime incidence of AA was 2.11% [95% confidence interval (CI) 2.06-2.16]. Females had a higher lifetime incidence (2.35%, 95% CI 2.28-2.43) than males (1.88%, 95% CI 1.81-1.94). Lifetime incidence was higher in those of Asian ethnicity (5.87%, 95% CI 5.51-6.24), Other (4.5%, 95% CI 3.63-5.31), Mixed (4.4%, 95% CI 3.50-5.37) and Black (3.0%, 95% CI 2.63-3.42) ethnicity, compared with White ethnicity (1.7%, 95% CI 1.68-1.80). Lifetime incidence was highest in those with the greatest deprivation: most-deprived quintile (2.92%, 95% CI 2.77-3.07) compared with least-deprived (1.68%, 95% CI 1.59-1.78). Across sociodemographic subgroups, people with AA of Black ethnicity were most likely to have anxiety (adjusted odds ratio vs. matched controls 2.92, 95% CI 1.71-4.91), and had the greatest risk of time off work (adjusted hazard ratio vs. matched controls 2.54, 95% CI 1.80-3.56)., Conclusions: AA affects around 1 in 50 people over their lifetime. The incidence and impact of AA on mental health and work outcomes is highest in ethnic groups other than White. Clinicians should be aware of the marked heterogeneity in the incidence and impact of AA, and support targeted healthcare to groups at the highest risk of alopecia and its consequences., Competing Interests: Conflicts of interest ART has no competing interest to declare. CT is a principal and (national) chief investigator on the Pfizer-funded ALLEGRO clinical trials in alopecia areata; CT provides consulting services to Pfizer, and has received speaker fees from Leo Pharma. JN, RR and MC are employees and shareholders of Pfizer Ltd. AGM provides consultancy for Manentia and Pfizer., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Background: COVID-19 is likely to have had an impact on the mental wellbeing of prison staff because of the high risk for infectious disease outbreaks in prisons and the pre-existing high burden of mental health issues among staff., Methods: A cross-sectional study of staff within 26 prisons in England was carried out between 20th July 2020 and 2nd October 2020. Mental wellbeing was measured using the Short-version of Warwick-Edinburgh Wellbeing Scale (SWEMWBS). Staff wellbeing was compared to that of the English population using indirectly standardised data from the Health Survey for England 2010-13 and a one-sample t -test. Multivariate linear regression modelling explored associations with mental wellbeing score., Results: Two thousand five hundred and thirty-four individuals were included (response rate 22.2%). The mean age was 44 years, 53% were female, and 93% were white. The sample mean SWEMWBS score was 23.84 and the standardised population mean score was 23.57. The difference in means was statistically significant (95% CI 0.09-0.46), but not of a clinically meaningful level. The multivariate linear regression model was adjusted for age category, sex, ethnicity, smoking status, occupation, and prison service region. Higher wellbeing was significantly associated with older age, male sex, Black/Black British ethnicity, never having smoked, working within the health staff team, and working in certain prison regions., Interpretation: Unexpectedly, prison staff wellbeing as measured by SWEMWBS was similar to that of the general population. Reasons for this are unclear but could include the reduction in violence within prisons since the start of the pandemic. Qualitative research across a diverse sample of prison settings would enrich understanding of staff wellbeing within the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Johnson, Czachorowski, Gutridge, McGrath, Parkes and Plugge.)

Objectives: The aim of this paper was to describe the results of mass asymptomatic testing for COVID-19 in a male prison in England following the declaration of an outbreak. It provides novel data on the implementation of a mass testing regime within a prison during the pandemic., Methods: The paper is an observational evaluation of the mass testing conducted for 6 months following the declaration of a COVID-19 outbreak within a prison. It investigated the incidence of positive cases in both staff and residents using polymerase chain reaction testing., Results: Data from October 2020 until March 2021 was included. A total of 2170 tests were performed by 851 residents and 182 staff members; uptake was 48.3% for people living in prison and 30.4% for staff. Overall test positivity was 11.6% (14.3% for residents, 3.0% for staff), with around one-quarter of these reporting symptoms. The prison wing handling new admissions reported the second-lowest positivity rate (9.4%) of the eight wings., Conclusion: Mass testing for COVID-19 over a short space of time can lead to rapid identification of additional cases, particularly asymptomatic cases. Testing that relies on residents and staff reporting symptoms will underestimate the true extent of transmission and will likely lead to a prolonged outbreak., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: Prisons are high-risk settings for infectious disease outbreaks because of their highly dynamic and crowded nature. During late 2020, prisons in England observed a surge in COVID-19 infection. This study describes the emergence of the Alpha variant in prisons during this period., Methods: Alpha and non-Alpha variant COVID-19 cases were identified in prisoners in England using address-matched laboratory notifications and genomic information from COG-UK., Results: Of 14,094 COVID-19-positive prisoner cases between 1 October 2020 and 28 March 2021, 11.5% (n = 1621) had sequencing results. Of these, 1082 (66.7%) were identified as the Alpha variant. Twenty-nine (2.7%) Alpha cases required hospitalisation compared with only five (1.0%; P = 0.02) non-Alpha cases. A total of 14 outbreaks were identified with the median attack rate higher for Alpha (17.9%, interquartile range [IQR] 3.2%-32.2%; P = 0.11) than non-Alpha outbreaks (3.5%, IQR 2.0%-10.2%)., Conclusion: Higher attack rates and increased likelihood of hospitalisations were observed for Alpha cases compared with non-Alpha. This suggests a key contribution to the rise in cases, hospitalisations and outbreaks in prisons in the second wave. With prisons prone to COVID-19 outbreaks and the potential to act as reservoirs for variants of concern, sequencing of prison-associated cases alongside whole-institution vaccination should be prioritised., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Background: There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ventilated conditions facilitate the rapid spread of infectious diseases., Objective: The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors., Methods: Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: as soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons., Results: The UK Government's Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants., Conclusions: This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons., International Registered Report Identifier (irrid): DERR1-10.2196/30749., (©Emma Plugge, Danielle Burke, Maciej Czachorowski, Kerry Gutridge, Fiona Maxwell, Nuala McGrath, Oscar O'Mara, Eamonn O'Moore, Julie Parkes. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 12.01.2022.)

Using laboratory data and a novel address matching methodology, we identified 734 cases of coronavirus disease in 88 prisons in England during March 16-October 12, 2020. An additional 412 cases were identified in prison staff and household members. We identified 84 prison outbreaks involving 86% of all prison-associated cases.

The mammalian Slc11a1 and Slc11a2 proteins define a large family of secondary metal transporters. Slc11a1 and Slc11a2 function as pH-dependent divalent cation transporters that play a critical role in host defenses against infections and in Fe2+ homeostasis, respectively. The position and polarity of individual transmembrane domains (TMD) of Slc11a2 were studied by an epitope tagging method based on the insertion of small antigenic hemagglutinin A (HA) peptides (YPYDVPDYAS) in predicted intra- or extracellular loops of the protein. The tagged proteins were expressed in transfected LLC-PK1 kidney cells and tested for transport activity, and the polarity of inserted tags with respect to the plasma membrane was determined by immunofluorescence in intact and permeabilized cells. HA epitope tags were inserted at positions 1, 98, 131, 175, 201, 243, 284, 344, 403, 432, 468, 504, and 561. Insertions at positions 98, 131, 175, 403, and 432 abrogated metal transport by Slc11a2, while insertions at positions 1, 201, 243, 284, 344, 468, 504, and 561 resulted in functional proteins. Topology mapping in functional HA-tagged Slc11a2 proteins indicated that the N-terminus (1), as well as loops delineated by TMD4-5 (201), TMD6-7 (284), and TMD10-11 (468), and C-terminus (561) are intracellular, while loops separating TMD5-6 (243), TMD7-8 (344), and TMD11-12 (504) are extracellular. These results are compatible with a topology of 12 transmembrane domains, with intracellular amino and carboxy termini. Structural models constructed by homology threading support this 12TMD topology and show 2-fold structural symmetry in the arrangement of membrane helices for TM1-5 and TM6-10 (conserved Slc11 hydrophobic core).