Antiretroviral therapy for prevention of HIV transmission: implications for Europe.

The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

Use of a prescription-based measure of antiretroviral therapy adherence to predict viral rebound in HIV-infected individuals with viral suppression.

OBJECTIVE: The aim of the study was to assess whether a simple, routinely available measure of antiretroviral therapy (ART) adherence predicts viral rebound at the next HIV viral load (VL) measurement in virally suppressed patients. METHODS: The analysis was performed on the Royal Free HIV Cohort, London, UK. Each 'drug coverage-viral load episode' (DCVL episode) was defined as a 6-month period immediately prior to a VL < or =50 HIV-1 RNA copies/mL (time-zero), during which the patient had been continuously on HAART, with all measured VLs < or =50 copies/mL. The next VL after time-zero was used to assess whether VL rebound (defined as >200 copies/mL) had occurred. Drug coverage, our measure of adherence, was calculated as the proportion of days in the 6-month period covered by a valid prescription for at least three antiretroviral drugs. RESULTS: A total of 376 (2.4%) VL rebounds occurred in 15 660 DCVL episodes among 1632 patients. Drug coverage was 100% for 32% of episodes, 95-99% for 16% of episodes and < or =60% for 10% of episodes. The risk ratio of rebound associated with a 10% increase in drug coverage, adjusted for potential confounding variables, was 0.93 (95% confidence interval 0.88-0.98). CONCLUSIONS: Antiretroviral drug coverage assessed at the time of VL measurement in patients with undetectable VL is potentially clinically useful for predicting VL rebound at the next VL measurement.

[Assessment of job strain and its consequencies in a large public organisation. Findings from the SEMM Study]. / Valutazione del disagio psicosociale ed organizzativo in aziende pubbliche. L'esperienza dello Studio SEMM.

The demand-control model originally developed by Robert Karasek is in Italy the preferred tool to investigate perceived work stress due to work-related organizational constrains. We wish to report the comprehensive results of the SEMM Study, carried on a wide sample of civil servants. N. 5271 women and 2601 men, employed at the Municipality of Milan in the years 1991-1996 were enrolled into the study. The overall participation rate was high in both gender group (75% or more), indicating a good compliance of employees for health prevention programmes carried out in work settings. Each participant, who has given consent, in addition to the medical examinations and biological tests related to the investigation of work exposures, underwent to a structured procedure to measure cardiovascular risk factors, according to the methods developed in the WHO MONICA Project, job strain adopting the Job Content Questionnaire (JCQ), and the Baecke Questionnaire to investigate major quotes of physical activity. In this contest the JCQ has shown an acceptable level of internal and external consistency as well as of acceptance, measured by employees compliance. Psychological job demand and decision latitude can be assessed with two different JCQ revisions available in Italian, which were validated with the contribution of the author, at different complexity, but with comparable results of weighted scores. For a comprehensive assessment of the working conditions social support at work is also of relevance. In the work public sector considered, the JCQ major scores resulted to be valid descriptors of key aspects of the work organization. The concurrent assessment of sick leaves, known marker of burnout, allows to identify work- and individual-related determinants and, in a specific work setting, to give indications for coping actions which may improve workers' integration. In addition, the assessment of cardiovascular risk factors, carried out with standardised and then reliable methods, allow to measure overall global CVD risk and to identify unhealthy behaviours that can be addressed with specific preventive programmes.

[Sick leave risk factors in a sample of women employed in the public sector. The SEMM study]. / Determinanti delle assenze per malattia in un campione di donne dipendenti di ente pubblico. Lo studio SEMM.

OMS reports describe an increase of levels of sickness leaves (SL) at work in all industrialized countries in last decades. Aims of this study are to assess incidence of SL from work in a sample of women public employees and to identify significant factors, among individual, behavioural, familiar, occupational and work strain related. The survey took place between April 1992 and December 1998. After the baseline examination, a two years follow-up was conducted, to detect any SL longer than one day. N. 8123 female employees of the Municipality of Milan were enrolled, undergoing a baseline health examination. They belong to the following municipality sectors (SM): kindergarten, register office, clerks and police. The overall response rate was 76% (3698 females and 2448 males). The present analysis was restricted to female only, who showed almost double incidence of SL than men. Interpolation of logistic models allowed to identify the following predictive independent factors: physical activity in leisure time, work length and social support at work, for incidence of short SL; physical activity at work, hypertension and smoking habit for intermediate SL; and perceived work strain and number of familiar contacts for long SL.

[Diagnostic agreement between two different analytic methods for in vitro measurement of specific IgE and comparison with clinical evaluation and in vivo test for ubiquitarian and professional allergens]. / Concordanza diagnostica tra due differenti metodi analitici per la determinazione in vitro di IgE specifiche e confronto con valutazione clinica e test in vivo per allergeni ubiquitari e professionali.

This study surveys the diagnostic agreement between two different analytic systems for the measurement of serum specific IgE (sLgE), Immulite 2000 (IML) and ImmunoCap (CAP), with clinic evaluation and in vivo test. Our sample is represented by 33 adults (27 females and 6 males), with suspect of immediate allergic disease and suspect of sensitization to at least one allergen of the study panel (18 allergens: inhalant, alimentary and professional). All patients have been subjected to Skin Prick Test (SPT) for all the studied allergens, therefore sIgE measurement with IML and CAP systems has been executed (twice for each method) only for the allergens which resulted positive to the diagnostic suspect and to SPT, and for an equal number of allergens chosen by bound randomisation. In vitro methods (IML and CAP), evaluated by K Cohen statistics, give good diagnostic agreement. In the same way, the diagnostic agreement of the used analytic systems both with clinical suspect and with in vivo test is satisfying, with higher K values for IML.

[Occupational safety and health in hospitals of Regione Lombardia. Are there differences among public, private nonprofit and private profit hospitals?]. / Sicurezza occupazionale e salute negli ospedali della Regione Lombardia. Ci sono differenze tra ospedali pubblici e privati, profit e no profit?

In 2006 an extensive survey took place in all hospitals of Lombardia, to assess, through inspections, the safety conditions and the efficiency of the organisations invested to assure that. During these inspections were evaluated 6 safety sections and hospital organization and efficiency, by means of a questionnaire. The aim was to assess the internal consistency of questionnaire sections, the presence of differences of such scores among public, private non-profit and profit hospitals and the correlations among safety scores and among these latter and efficiency indexes. Significant differences for size factors and efficiency indexes have been pointed out among different types of hospitals. Instead, safety scores showed good internal consistency and have been resulted statistically significant correlated in most cases. For all types of hospital have been observed high values for safety scores, with exception of occupational health service, better organized in public hospitals, and of safety conditions of worker from external agencies, which have been displayed low. This last consideration stick out the need to pay more attention to safety conditions of these workers.