Consensus statement of the European guidelines on clinical management of HIV-1 tropism testing

Introduction: Testing for HIV tropism is recommended before prescribing a chemokine receptor blocker. To date, in most European countries HIV tropism is determined using a phenotypic test. Recently, new data have emerged supporting the use of a genotypic HIV V3-loop sequence analysis as the basis for tropism determination. The European guidelines group on clinical management of HIV-1 tropism testing was established to make recommendations to clinicians and virologists. Methods: We searched online databases for articles from Jan 2006 until March 2010 with the terms: tropism or CCR5-antagonist or CCR5 antagonist or maraviroc or vicriviroc. Additional articles and/or conference abstracts were identified by hand searching. This strategy identified 712 potential articles and 1240 abstracts. All were reviewed and finally 57 papers and 42 abstracts were included and used by the panel to reach a consensus statement. Results: The panel recommends HIV-tropism testing for the following indications: i) drug-naïve patients in whom toxicity or limited therapeutic options are foreseen; ii) patients experiencing therapy failure whenever a treatment change is considered. Both the phenotypic Enhanced Trofile assay (ESTA) and genotypic population sequencing of the V3-loop are recommended for use in clinical practice. Although the panel does not recommend one methodology over another it is anticipated that genotypic testing will be used more frequently because of its greater accessibility, lower cost and shorter turnaround time. The panel also provides guidance on technical aspects and interpretation issues. If using genotypic methods, triplicate PCR amplification and sequencing testing is advised using the G2P interpretation tool (clonal model) with an FPR of 10%. If the viral load is below the level of reliable amplification, proviral DNA can be used, and the panel recommends performing triplicate testing and use of an FPR of 10%. If genotypic DNA testing is not performed in triplicate the FPR should be increased to 20%. Conclusions: The European guidelines on clinical management of HIV-1 tropism testing provide an overview of current literature, evidence-based recommendations for the clinical use of tropism testing and expert guidance on unresolved issues and current developments. Current data support both the use of genotypic population sequencing and ESTA for co-receptor tropism determination. For practical reasons genotypic population sequencing is the preferred method in Europe.

Work Meaningfulness as a Key Enhancer of Ethical Values in Business

Despite abundant research on work meaningfulness, the link between work meaningfulness and general ethical attitude at work has not been discussed so far. In this article, we propose a theoretical framework to explain how work meaningfulness contributes to enhanced ethical behavior. We argue that by providing a way for individuals to relate work to one's personal core values and identity, work meaningfulness leads to affective commitment - the involvement of one's cognitive, emotional, and physical resources. This, in turn, leads to engagement and so facilitates the integration of one's personal values in the daily work routines, and so reduces the risk of unethical behavior. On the contrary, anomie, that is, the absence of meaning and consequently of personal involvement, will lead to lower rational commitment rather than affective commitment, and consequently to disengagement and a-morality. We conclude with implications for the management of ethical attitudes.

Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations

Summary Points Brucellosis remains the commonest anthropozoonosis worldwide, and its treatment remains complex, requiring protracted administration of more than one antibiotic. In November 2006, a consensus meeting aimed at reaching a common specialist statement on the treatment of brucellosis was held in Ioannina, Greece under the auspices of the International Society of Chemotherapy and the Institute of Continuing Medical Education of Ioannina. The author panel suggests that the optimal treatment of uncomplicated brucellosis should be based on a six-week regimen of doxycycline combined either with streptomycin for 2–3 weeks, or rifampicin for six weeks. Gentamicin may be considered an acceptable alternative to streptomycin, while all other regimens/combinations should be considered second-line. The development of a common global therapeutic language for human brucellosis, and future, properly conducted clinical trials would definitely solve controversies regarding the disease.

Comienza el decenio de acción para la seguridad vial 2011-2020

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Día mundial sin tabaco 2011: por el derecho a la salud

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Agua para las ciudades: responder al desafío urbano

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Combatir la resistencia a los antimicrobianos, lema del día mundial de la salud 2011

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

La participación infantil en las políticas de salud

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Celebrado el día mundial de la salud 2010: ‘La salud urbana es importante’

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Día mundial de la salud 2010: la salud urbana es importante

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Cuestiones controvertidas en evaluación económica (II): medidas de resultado en salud de las intervenciones sanitarias

In this second article of a series of three, we will discuss using the Metaplan technique on controversial issues of health outcomes in economic evaluation of health care interventions. The four-discussion areas focus on: choice of health outcomes measures, where any outcome measure is superior to another; extrapolation and transferability of health outcomes measures, which should not be assumed the results of an EEIS of one country to another without making certain adjustments; appropriate instruments to measure quality of life in Spain, where the EQ-5D was indicated as convenient due to its widespread international use; and, indirect comparisons, where the combination of both comparisons, direct and indirect, it would be advisable if the test for indirect estimates is consistent and has been validated. Finally, research lines to try to overcome the identified discrepancies were identified in each of these areas, some of those are: doing studies of correlation between scores of specific and generic instruments measuring quality of life; update or create a database of economic evaluations in Spain; estimating utilities for the Spanish population by existing generic and specific instruments; or, establish a common way to show the results of a meta-analysis network.

Addressing the natural resource curse: An illustration from Nigeria

Some natural resources oil and minerals in particular exert a negative andnonlinear impact on growth via their deleterious impact on institutionalquality. We show this result to be very robust. The Nigerian experienceprovides telling confirmation of this aspect of natural resources. Wasteand corruption from oil rather than Dutch disease has been responsible forits poor long run economic performance. We propose a solution for addressingthis resource curse which involves directly distributing the oil revenuesto the public. Even with all the difficulties of corruption and inefficiencythat will no doubt plague its actual implementation, our proposal will, atthe least, be vastly superior to the status quo. At best, however, it couldfundamentally improve the quality of public institutions and, as a result,transform economics and politics in Nigeria.

Pitfalls to avoid when measuring institutions: Is "Doing Business" damaging business?

Over recent years, both governments and international aid organizations have been devoting large amounts of resources to simplifying the procedures for setting up and formalizing firms. Many of these actions have focused on reducing the initial costs of setting up the firm, disregarding the more important role of business registers as a source of reliable information for judges, government departments and, above all, other firms. This reliable information is essential for reducing transaction costs in future dealings with all sorts of economic agents, both public and private. The priorities of reform policies should therefore be thoroughly reviewed, stressing the value of the legal institutions rather than trivializing them as is often the case.

Electronic titling: Potential and risks

Initiatives in electronic conveyancing and registration show the potential of new technologies to transform such systems, reducing costs and enhancing legal security. However,they also incur substantial risks of transferring costs and risks among registries, conveyancersand rightholders, instead of reducing them; entrenching the private interests of conveyancers,instead of increasing competition and disintermediating them; modifying the allocation of tasksin a way that leads in the long term to the debasement of registries of rights with indefeasibletitle into mere recordings of deeds; and empowering conveyancers instead of transactors andrightholders, which increases costs and reduces security. Fulfilling the promise of newtechnologies in both costs and security requires strengthening registries incentives andempowering rightholders in their interaction with registries.