Mediterranean leishmaniasis in HIV-infected patients: epidemiological, clinical, and diagnostic features of 22 cases.

Twenty-two Italian HIV-infected patients developed leishmaniasis, clinically manifested as visceral (13 cases), cutaneous (2 cases) and disseminated disease (7 cases). Twenty were males and two females (mean age: 32.8 years) with a mean CD4+ cell count of 46.8/microliter at diagnosis; risk factors were intravenous drug use (17 patients) and sexual behaviour (two bisexual, two homosexual, one heterosexual). All but one patient lived or travelled in hypoendemic Italian regions and other Mediterranean countries. Apart from the two patients with cutaneous leishmaniasis, the clinico-pathological and biological spectrum of the infection was often atypical, especially in patients with disseminated disease. The diagnosis was routinely made by direct recovery of parasites in biological specimens, mainly in bone marrow aspirate, whereas serology was negative or borderline in most of the patients. Among 17 in vitro isolates, Leishmania infantum was the only species involved with previously undescribed isoenzyme patterns in two cases. Treatment with antimonials and other drugs showed only temporary clinical improvement in some patients. Relapses were the rule. Leishmaniasis confirms itself as an opportunistic infection in HIV-positive persons. Secondary chemoprophylaxis should be considered in cases of relapsing disease.

PIP: The majority of the 850 HIV-associated Leishmania infections reported worldwide involve men and women from Mediterranean countries, particularly Spain, Italy, and France. This article describes a retrospectively identified series of 22 patients (20 men and 2 women) from northern Italy's Lombardy region with HIV/Leishmania coinfection in the period 1989-97. At leishmania diagnosis, the mean CD4+ lymphocyte count was 46.8/mcl and 21 patients had been previously diagnosed with an AIDS-defining illness. Intravenous drug use was the HIV risk factor in 17 patients; an additional 4 were bisexual or homosexual. The diagnosis of leishmaniasis was made by direct recovery of parasites in biologic specimens, mainly in bone marrow aspirate. Serology was generally negative or borderline due to the frequent occurrence of humoral immunity imbalances. Anemia, leukopenia, thrombocytopenia, and hypergammaglobulinemia were present in all but 1 patient. Leishmaniasis was clinically manifested as visceral in 13 cases, cutaneous in 2 cases, and disseminated disease in 7 cases. The clinicopathologic and biologic spectrum of infection tended to be atypical, especially in patients with disseminated disease. Leishmania infantum was the only species involved in 17 in vitro isolates; 2 cases exhibited previously undescribed isoenzyme patterns. Treatment with antimonials and other drugs produced, at best, only temporary clinical improvement. Relapses were the rule during follow-up in all but the 2 patients with cutaneous leishmaniasis. Inclusion of Leishmania spp. among the infectious agents of AIDS-defining diseases is recommended.

From the Alps to Atitlan: Italian emigration to Guatemala, 1870-1945.

PIP: "Based on interviews and archival research, this paper traces Italian immigration to Guatemala from 1870 to the immediate post-war period. The author notes that among European immigrants, Italians and Spaniards were favored by most Guatemalan governments because they were viewed as more likely to assimilate.... In a country where the majority indigenous population was considered an obstacle to progress, Italians were looked upon favorably, as skilled workers who would develop the country's agriculture, commerce, and industry." (EXCERPT)^ieng

Distribution and prevalence of major risk factors of noncommunicable diseases in selected countries: the WHO Inter-Health Programme.

The Inter-Health Programme was launched in 1986 by WHO, with the collaboration of a coordination centre (National Public Health Institute, Finland) to control and prevent chronic noncommunicable diseases (CNCDs) among adults. Programmes for action were organized based on the concept that most major CNCDs share common risk factors and that those that are lifestyle related are modifiable through efficient interventions using multifactorial strategies involving community participation and behaviour changes carried out at the primary health care level. Twelve countries from all WHO Regions have joined the programme. A baseline survey was undertaken in all countries with a common protocol, following the criteria and methods employed in the MONICA Project. Altogether 36815 men and women aged 35-64 years were included in the present analysis from the following Inter-Health countries: Chile, China, Cyprus, Finland, Lithuanian SSR, Malta, Mauritius, Russian SFSR, United Republic of Tanzania, and USA. In addition to individual country analysis, centralized analysis was carried out at the Finnish National Public Health Institute and the Department of Community Health, Kuopio University, Finland. Reported here are the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolaemia.

PIP: The Inter-Health Program was launched in 1986 by the World Health Organization (WHO) with the collaboration of Finland's National Public Health Institute to control and prevent chronic noncommunicable diseases (CNCDs) among adults. The program consists of interventions designed to modify the levels of the major risk factors of CNCDs in the community through an integrated, community-oriented approach to health promotion and maintenance. 12 countries from all WHO regions have joined the program. The effects of intervention activities were measured by examining changes in the status of risk factors in populations before and after a given intervention. A baseline survey was conducted in all of the Inter-Health countries with a common protocol to identify the relevant risk factors. 36,815 men and women aged 35-64 from Chile, China, Cyprus, Finland, Lithuania, Malta, Mauritius, Russia, Tanzania, and the US were surveyed. This paper reports the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolemia.

Enhancement of professional skills to address gender differences at Ente per le Nuove Tecnologie, l'energia e l'ambiente (ENEA).

PIP: ENEA, Italy's national agency charged with research and development in the areas of technology, energy, and the environment, has 3800 employees. Of these, 25% are women, and nearly 50% are researchers (15% women). However, only 2 of 43 top management positions are filled by women, and only 1 of 100 high-level managers is a woman. In addition, women reach the top level of their career an average of 3 years later than men. Studies conducted to uncover the reasons for this sex discrimination and to discern the influence of gender on careers revealed that many changes were required that depended upon matching changes in ENEA's organization and management systems, which could be brought about by communication, diffused leadership, empowerment, and mainstreaming women into the decision-making process. The research has resulted in creation of a prototype management project that will be tested on a sample of approximately 250 employees and will seek to balance the number of women and men at all levels. After this experiment has been conducted, educational efforts will be made to restructure the basic ways ENEA functions.^ieng

[Contraception and the right of the state in the Catholic Church]. / Anticoncepcion y razon de estado en la Iglesia Catolica.

PIP: The Catholic Church hierarchy is condemning contraception and abortion as never before. The current pope obsessively opposes the condom, even as a means of preventing HIV/AIDS, and opposes abortion even if it is the only possible means of saving the mother¿s life. The commission created by Pope John XXIII in the 1960s during the Second Vatican Council demonstrated that specialists, lay people, and some high prelates of the Church were inclined to revise Church policy on contraception. The commission was the only group created to examine contraception at a time when the population explosion of the poorest nations and the marketing of oral contraceptives were attracting the attention of demographers, and also Catholics, throughout the world. After the death of Pope John, the commission swelled to 109 persons including 50 cardinals and bishops designated the ¿official commission¿ to distinguish them from the experts. The two groups each prepared reports, which the pope studied for two years before releasing the encyclical Humanae Vitae, in July 1968. Against the expectations of the majority on the commission, the pope reiterated condemnation of contraception and designated rhythm as the only permissible family planning method. The majority on the Commission were explicit that social changes in marriage and the family and in the role of women, declining infant mortality, new scientific knowledge, and a different appreciation of the value and significance of human sexuality should be taken into account. The pope was persuaded by an argument completely unrelated to contraception itself: that if the Church changed its stand, the authority of the bishops on moral questions would be diminished.^ieng

[Umberto Eco and abortion]. / Umberto Eco y el aborto.

PIP: The Cardinal of Milan and the linguist and writer Umberto Eco maintained a correspondence in the mid-1990s in connection with the Italian magazine ¿Liberal¿. One of the issues discussed was the conflict between belief in the value of human life and existing abortion legislation. Umberto Eco stated that he would do all in his power to dissuade a woman pregnant with his child from having an abortion, regardless of the personal cost to the parents, because the birth of a child is a miracle. He would not, however, feel capable of imposing his ethical position on anyone else. Terrible moments occur in which women have a right to make autonomous decisions concerning their bodies, their feelings, their futures. Those who disagree cite the right to life, a rather vague concept about which even atheists can be enthusiastic. The moment at which a new human being is formed has been brought to the center of Catholic theology, despite its uncertainty; the beginning of a new life may always need to be understood as a process whose end result is the newborn. Only the mother should decide at what moment the process may be interrupted. The cardinal¿s response distinguished between psychic and physical life, on the one hand, and life participating in the life of God on the other. The threshold is the moment of conception, reflecting a continuity of identity. The new being is worthy of respect. Any violation of the affection and care owed to the being can only be experienced as a profound suffering and painful laceration that may never heal. The response of Eco is unknown.^ieng

[Marchigiani in Buenos Aires: work and associated life]. / Marchigianos en Buenos Aires: trabajo y vida asociativa.

PIP: "Studies on Italian immigration in Argentina have shown that approaches at the provincial level add to our understanding of migration patterns and processes. The case study of urban immigrants from a region in central Italy shows similarities and differences with Italian immigration in Buenos Aires in general. Residential patterns and occupations are analyzed through a combination of mutual association membership registers and shipping lists; the linkage of available sources showed, at least for these immigrants, a considerable gap between arrival and entry in a mutual aid society, a fact which reduces the importance of the voluntary associations in assisting recent immigrants to obtain a job." (EXCERPT)^ieng

[Spanish migration to Argentina as seen through "Partes Consulares" 1910. An exercise in regional typology]. / Las migraciones espanolas a la Argentina desde la perspectiva de los Partes Consulares (1910). Un ejercicio de tipologia regional.

PIP: "By using the shipping lists contained in Argentine immigration files, it is possible to analyze Spanish immigration in Argentina [in the early twentieth century] by province of origin. In this case, the provinces of Pontevedra, Salamanca and Vizcaya are considered, and three different typologies are presented, showing differences in age structure, family status, occupation and previous migratory experience. The implications for the formulation of European typologies are suggested." (EXCERPT)^ieng

[Migration and professions: deducing Italian immigration to Argentina from nominative sources]. / Migracion y profesiones: una lectura del movimiento inmigratorio italiano a la Argentina desde las fuentes nominativas.

PIP: "The article examines the possibilities of systematically exploiting nominative document corpuses related to immigration in Buenos Aires [Argentina] in the period of mass migration [1885-1910], and proposes to focus on the occupations declared by the Italian immigrants. After reviewing the formal aspects of the documental series used (missing information, polysemy of professional aggregates) the immigration of masons is analyzed, taking into account demographic characteristics, annual rhythms of arrival, [and] migration typologies." (EXCERPT)^ieng

[The U.S. census: source for an international history of immigrant women, family, and gender?]. / El censo de los Estados Unidos: ?fuente para una historia internacional de mujeres inmigrantes, familia y genero?

PIP: "The author discusses the fruitful use of nominal lists for a gendered analysis of international migration. [U.S.] studies carried out in the 1970s and 1980s produced interesting information as to female work for wages outside the home, but found the census a flawed source for work done by women within their homes. Combination with other nominal sources [has revealed] the role played by women in the organization and maintenance of kin and neighborhood networks. The approach to the Italian diaspora abroad requires the linkage of different nominal sources at origin and in the different places of destination." (EXCERPT)^ieng

[Possibilities and problems of linking nominal records to further the study of the Italian migration process]. / Posibilidades y problemas del cruzamiento de registros nominativos en el estudio del proceso migratorio italiano.

PIP: "[Based] on research on emigration from Agnone, Italy, to the United States and Argentina, the author analyzes the possibilities of linking different sources available at the countries of origin and destination, classified in three main groups: sources at origin, sources at destination and sources linking origin with destination. The members of an Agnone community in Pueblo, Colorado, are traced by using Agnone Census and Family Files, Agnone Passport Records, U.S. Census, Ships Passenger Lists and Naturalization Records, as well as interviews with members of the community." (EXCERPT)^ieng

[Social history, the nominative method, and the study of migration]. / La historia social, el metodo nominativo y el estudio de las migraciones.

PIP: "The aspiration to recover the daily experiences of ordinary people drove social historians to the use of the nominative method; but it was the personal computer that made the analysis of nominative data at all possible. The author conducted research on Spanish immigration in Buenos Aires on the basis of data collected from census manuscripts for Buenos Aires (1855, 1869, 1895); police files of suspected anarchists and membership records of voluntary association (railway workers' union and several ethnic associations). Baptism and marriage records in Buenos Aires churches were used. Data were then checked with personal interviews." (EXCERPT)^ieng

[Passport registers: their limits and possibilities for the study of emigration]. / Registros de pasaportes: sus limitaciones y sus posibilidades para el estudio de la emigracion.

PIP: "There are two main nominal sources of data on Portuguese emigration during the nineteenth and early twentieth centuries: the Rois de Confessados or Rois de Desobriga and the Livros de Registos de Passaportes.... The major question regarding passport registers concerns the level of clandestine emigration. Thus a comparison with U.S. ship lists reveals two different pictures of Portuguese emigration [with regard to] sex ratio, occupations and age distribution. Data obtained point at a larger generalization: sources containing data on legal emigration only do not reflect ¿true' emigration in countries with important clandestine streams." (EXCERPT)^ieng

[The use of personal sources for the study of emigration from Galicia: present state and perspectives]. / El uso de fuentes personales para el estudio de la emigracion de Galicia: estado presente y perspectivas.

PIP: "Spanish sources for the study of emigration are sparse and fragmentary.... Mortgage documents for the payment of ocean transportation enable us to appreciate the spreading action of shipping agents; official listings of draft dodgers reveal that in general the River Plate was a favorite destination, rather than Cuba or Brazil. People from Galicia emigrated from rural origins to urban destinations in America; the analysis of place of birth of emigrants residing in A Coruna at the time of emigration show that there was also, in some cases, a first stage of rural-urban migration within Galicia. The general picture of emigration from Galicia is built [up] through the combination of the existing sources in Spain." (EXCERPT)^ieng

[Latin American women in Italy: a new reality of the international migration system]. / Mujeres latinoamericanas en Italia: una nueva realidad del sistema de migraciones internacionales.

PIP: The authors examine characteristics of female migration from Latin America to Italy. Aspects considered include country of origin, fertility behavior, age, employment status, household characteristics, and marriage patterns.^ieng

[Latin Americans in Spain (1981-1994). Estimation of a recent migratory phenomenon]. / Latinoamericanos en Espana (1981-1994). Aproximacion a un fenomeno migratorio reciente.

PIP: The author analyzes characteristics of Latin American migration to Spain during the period 1981-1994. Aspects considered include causes of the increase of Latin American migration to Spain; policies limiting migration to Spain; spatial distribution and sex of immigrants; labor force activity; and country of origin.^ieng

[The first transatlantic transfer: Spanish migration to the New World, 1493-1810]. / El primer traslado transatlantico: la migracion espanola al Neuvo Mundo, 1493-1810.

"The Spanish emigration to America along three centuries divided in two periods of equal length is analyzed. Between 1493 and 1650 roughly four hundred thousand people emigrated, mostly from Andalusia, Extremadura and New Castile.... The bulk of emigrants came from urban middle strata and settled in towns. Emigration between 1650 and 1810 is estimated at roughly a quarter million people, whereby military men, colonists and public servants sent at public expense become relevant, as well as merchants travelling on their own.... Throughout the three centuries, the emigration of Spaniards was mostly of [a] spontaneous nature." (SUMMARY IN ENG)

[Population. It is necessary to know how to act]. / Poblacion. Es necesario saber actuar.

PIP: This work constitutes a critique of the influence exerted by the Vatican on preparations for the International Conference on Population and Development to be held in Cairo in September 1994. It argues for the need to distinguish between the pastoral works of the Holy See, which are its mission, and attempts to exert political influence through moral authority. The Vatican has sought to influence the workings of successive World Population Conferences beginning in 1974, when it stated that "...any policy favoring contraception, sterilization, or abortion is a loss of respect for the dignity of the life of each married person and should be clearly excluded". In a March 1994 meeting with the president of the UN Population and Development Fund, the Pope severely criticized the draft of the final document for the Cairo Conference. During the meeting, the Pope stated that "...contraception is immoral, voluntary sterilization is unacceptable, and population policies should not be formulated in terms of the rights of women." The Vatican objected to implicit or explicit approval of abortion, to the concept of reproductive rights, and to implications that family planning and contraception are synonymous terms, because that would not distinguish natural family planning. The Vatican called upon delegations especially of "Catholic" countries such as those of Latin America to revise their positions or to remove their signatures from the draft document, and to join a block attempting to dictate ethical norms, irrespective of the beliefs of the rest of the world. In this attempt it used procedures that failed to respect the minimal norms of diplomatic ethics, using moral manipulations. This intervention of the Vatican into the internal affairs of other states is impermissible, since the Vatican is the only observer with a voice and vote capable of exercising this type of influence. The Vatican is a society of celibate men without families, which has succeeded in appropriating for itself the right of interpreting the relationships and destinies of families according to its own definitions. Several Latin American countries have pledged their support to the Vatican positions and have acted as spokesmen. Other Latin American countries have maintained their positions and withstood pressures. It is necessary to provide support to delegations and to take measures to reinforce their commitment to respect reproductive and sexual rights and the needs of women and children in Latin America.^ieng

[Population policy: the legacy of Greek thought]. / Politica de poblacion: la herencia del pensamiento griego.

The author "explains that the Greek philosophy and scientific thought developed elements of what is known today as population policies. These include roles and gender relationships, the population volume, the family, sexuality, birth control, eugenics, abortion and [quality of life]....The first part of the article reviews issues on family and women's roles. The second part is related to aspects associated with sexuality and...population policy." (SUMMARY IN ENG)

[The difficulties in evaluating the integration of migrants]. / Los problemas de evaluacion de la integracion de los migrantes.

"Migrations in Europe have changed significantly in the last three decades, both in scope and nature, and involving new countries. It is therefore necessary to reconsider the concept of integration and the ways to measure it. It must also be taken into account that migration matters cannot be dealt with within national units, but require coordinated, agreed upon policies in countries (or even greater units) of origin and destination. The particular case of Italy with a large quantity of emigrants abroad and an important incoming flow of new immigrants is considered especially. Also the difficulties and possibilities of an accurate estimation of Italians abroad are analyzed." (SUMMARY IN ENG)