Neighbourhood socio-economic position, late presentation and outcomes in people living with HIV in Switzerland.

OBJECTIVES: Inequalities and inequities in health are an important public health concern. In Switzerland, mortality in the general population varies according to the socio-economic position (SEP) of neighbourhoods. We examined the influence of neighbourhood SEP on presentation and outcomes in HIV-positive individuals in the era of combination antiretroviral therapy (cART). METHODS: The neighbourhood SEP of patients followed in the Swiss HIV Cohort Study (SHCS) 2000-2013 was obtained on the basis of 2000 census data on the 50 nearest households (education and occupation of household head, rent, mean number of persons per room). We used Cox and logistic regression models to examine the probability of late presentation, virologic response to cART, loss to follow-up and death across quintiles of neighbourhood SEP. RESULTS: A total of 4489 SHCS participants were included. Presentation with advanced disease [CD4 cell count <200 cells/μl or AIDS] and with AIDS was less common in neighbourhoods of higher SEP: the age and sex-adjusted odds ratio (OR) comparing the highest with the lowest quintile of SEP was 0.71 [95% confidence interval (95% CI) 0.58-0.87] and 0.59 (95% CI 0.45-0.77), respectively. An undetectable viral load at 6 months of cART was more common in the highest than in the lowest quintile (OR 1.52; 95% CI 1.14-2.04). Loss to follow-up, mortality and causes of death were not associated with neighbourhood SEP. CONCLUSION: Late presentation was more common and virologic response to cART less common in HIV-positive individuals living in neighbourhoods of lower SEP, but in contrast to the general population, there was no clear trend for mortality.

The Swiss Public Initiative against Mass Immigration (‘Masseneinwanderungsinitiative’): Caught between Constitutional Sovereignty and Pacta Sunt Servanda

This article seeks to bring some clarity to the publicly held debate on the Swiss federal popular initiative to limit immigration as it was adopted on 9 February 2014 by the Swiss people. It considers the crux of the matter, which is the implementation of the new Swiss constitutional article in the context of public international law. The initiative is stuck in between Swiss constitutional sovereignty and Swiss treaty obligations flowing from the agreement on free movement of persons between the European Union and the Swiss Confederation. Specific attention is paid to the democratic element anchored in the Swiss Constitution which, in contrast to other systems where the judicial element prevails, is of high importance for whole the process of a bilateral contractual relationship between the European Union and the Swiss Confederation.

Privacy Preserving Probabilistic Record Linkage (P3RL): a novel method for linking existing health-related data and maintaining participant confidentiality.

BACKGROUND Record linkage of existing individual health care data is an efficient way to answer important epidemiological research questions. Reuse of individual health-related data faces several problems: Either a unique personal identifier, like social security number, is not available or non-unique person identifiable information, like names, are privacy protected and cannot be accessed. A solution to protect privacy in probabilistic record linkages is to encrypt these sensitive information. Unfortunately, encrypted hash codes of two names differ completely if the plain names differ only by a single character. Therefore, standard encryption methods cannot be applied. To overcome these challenges, we developed the Privacy Preserving Probabilistic Record Linkage (P3RL) method. METHODS In this Privacy Preserving Probabilistic Record Linkage method we apply a three-party protocol, with two sites collecting individual data and an independent trusted linkage center as the third partner. Our method consists of three main steps: pre-processing, encryption and probabilistic record linkage. Data pre-processing and encryption are done at the sites by local personnel. To guarantee similar quality and format of variables and identical encryption procedure at each site, the linkage center generates semi-automated pre-processing and encryption templates. To retrieve information (i.e. data structure) for the creation of templates without ever accessing plain person identifiable information, we introduced a novel method of data masking. Sensitive string variables are encrypted using Bloom filters, which enables calculation of similarity coefficients. For date variables, we developed special encryption procedures to handle the most common date errors. The linkage center performs probabilistic record linkage with encrypted person identifiable information and plain non-sensitive variables. RESULTS In this paper we describe step by step how to link existing health-related data using encryption methods to preserve privacy of persons in the study. CONCLUSION Privacy Preserving Probabilistic Record linkage expands record linkage facilities in settings where a unique identifier is unavailable and/or regulations restrict access to the non-unique person identifiable information needed to link existing health-related data sets. Automated pre-processing and encryption fully protect sensitive information ensuring participant confidentiality. This method is suitable not just for epidemiological research but also for any setting with similar challenges.

Tuberculosis Mortality and Living Conditions in Bern, Switzerland, 1856-1950.

BACKGROUND Tuberculosis (TB) is a poverty-related disease that is associated with poor living conditions. We studied TB mortality and living conditions in Bern between 1856 and 1950. METHODS We analysed cause-specific mortality based on mortality registers certified by autopsies, and public health reports 1856 to 1950 from the city council of Bern. RESULTS TB mortality was higher in the Black Quarter (550 per 100,000) and in the city centre (327 per 100,000), compared to the outskirts (209 per 100,000 in 1911-1915). TB mortality correlated positively with the number of persons per room (r = 0.69, p = 0.026), the percentage of rooms without sunlight (r = 0.72, p = 0.020), and negatively with the number of windows per apartment (r = -0.79, p = 0.007). TB mortality decreased 10-fold from 330 per 100,000 in 1856 to 33 per 100,000 in 1950, as housing conditions improved, indoor crowding decreased, and open-air schools, sanatoria, systematic tuberculin skin testing of school children and chest radiography screening were introduced. CONCLUSIONS Improved living conditions and public health measures may have contributed to the massive decline of the TB epidemic in the city of Bern even before effective antibiotic treatment became finally available in the 1950s.

Ability to Work and Employment Rates in Human Immunodeficiency Virus (HIV)-1-Infected Individuals Receiving Combination Antiretroviral Therapy: The Swiss HIV Cohort Study

Background.  Limited data exist on human immunodeficiency virus (HIV)-infected individuals' ability to work after receiving combination antiretroviral therapy (cART). We aimed to investigate predictors of regaining full ability to work at 1 year after starting cART. Methods.  Antiretroviral-naive HIV-infected individuals <60 years who started cART from January 1998 through December 2012 within the framework of the Swiss HIV Cohort Study were analyzed. Inability to work was defined as a medical judgment of the patient's ability to work as 0%. Results.  Of 5800 subjects, 4382 (75.6%) were fully able to work, 471 (8.1%) able to work part time, and 947 (16.3%) were unable to work at baseline. Of the 947 patients unable to work, 439 (46.3%) were able to work either full time or part time at 1 year of treatment. Predictors of recovering full ability to work were non-white ethnicity (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), higher education (OR, 4.03; 95% CI, 2.47-7.48), and achieving HIV-ribonucleic acid <50 copies/mL (OR, 1.83; 95% CI, 1.20-2.80). Older age (OR, 0.55; 95% CI, .42-.72, per 10 years older) and psychiatric disorders (OR, 0.24; 95% CI, .13-.47) were associated with lower odds of ability to work. Recovering full ability to work at 1 year increased from 24.0% in 1998-2001 to 41.2% in 2009-2012, but the employment rates did not increase. Conclusions.  Regaining full ability to work depends primarily on achieving viral suppression, absence of psychiatric comorbidity, and favorable psychosocial factors. The discrepancy between patients' ability to work and employment rates indicates barriers to reintegration of persons infected with HIV.

Gender differences in colorectal cancer screening and incidence in large nationwide, population-based cohorts

Background. A few studies have reported gender differences along the colorectal cancer (CRC) continuum but none has done so longitudinally to compare a cancer and a non-cancer populations.^ Objectives and Methods. To examine gender differences in colorectal cancer screening (CRCS); to examine trends in gender differences in CRC screening among two groups of patients (Medicare beneficiaries with and without cancer); to examine gender differences in CRC incidence; and to examine for any differences over time. In Paper 1, the study population consisted of men and women, ages 67–89 years, with CRC (73,666) or without any cancer (39,006), residing in 12 U.S. Surveillance Epidemiology and End-Results (SEER) regions. Crude and age-adjusted percentages and odds ratios of receiving fecal occult blood test (FOBT), sigmoidoscopy (SIG), or colonoscopy (COL) were calculated. Multivariable logistic regression was used to assess gender on the odds of receiving CRC screening over time.^ In Paper 2, age-adjusted incidence rates and proportions over time were reported across race, CRC subsite, CRC stage and SEER region for 373,956 patients, ages 40+ years, residing in 9 SEER regions and diagnosed with malignant CRC. ^ Results. Overall, women had higher CRC screening rates than men and screening rates in general were higher in the SEER sample of persons with CRC diagnosis. Significant temporal divergence in FOBT screening was observed between men and women in both cohorts. Although the largest temporal increases in screening rates were found for COL, especially among the cohort with CRC, little change in the gender gap was observed over time. Receipt of FOBT was significantly associated with female gender especially in the period of full Medicare coverage. Receipt of COL was also significantly associated with male gender, especially in the period of limited Medicare coverage.^ Overall, approximately equal numbers of men (187,973) and women (185,983) were diagnosed with malignant CRC. Men had significantly higher age-adjusted CRC incidence rates than women across all categories of age, race, subsite, stage and SEER region even though rates declined in all categories over time. Significant moderate increases in rate difference occurred among 40-59 year olds; significant reductions occurred among patients age 70+, within subsite rectum, unstaged and distant stage CRC, and eastern and western SEER regions. ^ Conclusions. Persistent gender differences in CRC incidence across time may have implications for gender-based interventions that take age into consideration. A shift toward proximal cancer was observed over time for both genders, but the high proportion of men who develop rectal cancer suggests that a greater proportion of men may need to be targeted with newer screening methods such as fecal DNA or COL. Although previous reports have documented higher CRC screening among men, higher incidence of CRC observed among men suggests that higher risk categories of men are probably not being reached. FOBT utilization rates among women have increased over time and the gender gap has widened between 1998 and 2005. COL utilization is associated with male gender but the differences over time are small.^

Intellectual disability: A quandary for immigration

Current immigration options for individuals with intellectual disabilities do not adequately address their special needs and under existing immigration laws, intellectually disabled adult dependents of United States citizens suffer an excessive burden. This problem causes undue hardship of persons whose families lawfully reside in the United States or have the opportunity to immigrate to the United States. The aim of this review is to examine materials relevant to the issue and answer the question: What are the barriers and pathways for adults with intellectual disability within the family-based preference system under United States immigration law? ^ Adults with intellectual disability are a vulnerable population that often relies upon family members to be their principle caregiver and provide financial support. Under the family-based preference system, the United States has maintained that the reunion of family members with their close relatives promotes the health and welfare of the United States, but a review of the number of findings of inadmissibility due to a mental/physical disorder with associated harmful behavior and the number of waivers granted show otherwise. The lack of reviewability of the decisions made by the Board of Immigration Appeals in addition to the lack of transparency surrounding the immigration process only serve to compound this problem. ^

TRPV1 Channels Contribute to Behavioral Hypersensitivity and Spontaneous Activity in Nociceptors After Spinal Cord Injury

A majority of persons who have sustained spinal cord injury (SCI) develop chronic pain. While most investigators have assumed that the critical mechanisms underlying neuropathic pain after SCI are restricted to the central nervous system (CNS), recent studies showed that contusive SCI results in a large increase in spontaneous activity in primary nociceptors, which is correlated significantly with mechanical allodynia and thermal hyperalgesia. Upregulation of ion channel transient receptor vanilloid 1 (TRPV1) has been observed in the dorsal horn of the spinal cord after SCI, and reduction of SCI-induced hyperalgesia by a TRPV1 antagonist has been claimed. However, the possibility that SCI enhances TRPV1 expression and function in nociceptors has not been tested. I produced contusive SCI at thoracic level T10 in adult, male rats and harvested lumbar (L4/L5) dorsal root ganglia (DRG) from sham-treated and SCI rats 3 days and 1 month after injury, as well as from age-matched naive control rats. Whole-cell patch clamp recordings were made from small (soma diameter <30 >μm) DRG neurons 18 hours after dissociation. Capsaicin-induced currents were significantly increased 1 month, but not 3 days, after SCI compared to neurons from control animals. In addition, Ca2+ transients imaged during capsaicin application were significantly greater 1 month after SCI. Western blot experiments indicated that expression of TRPV1 protein in DRG is also increased 1 month after SCI. A major role for TRPV1 channels in pain-related behavior was indicated by the ability of a specific TRPV1 antagonist, AMG9810, to reverse SCI-induced hypersensitivity of hindlimb withdrawal responses to heat and mechanical stimuli. Similar reversal of behavioral hypersensitivity was induced by intrathecal delivery of oligodeoxynucleotides antisense to TRPV1, which knocked down TRPV1 protein and reduced capsaicin-evoked currents. TRPV1 knockdown also decreased the incidence of spontaneous activity in dissociated nociceptors after SCI. Limited activation of TRPV1 was found to induce prolonged repetitive firing without accommodation or desensitization, and this effect was enhanced by SCI. These data suggest that SCI enhances TRPV1 expression and function in primary nociceptors, increasing the excitability and spontaneous activity of these neurons, thus contributing to chronic pain after SCI.

La intervención profesional de los/as trabajadores/as sociales en relación con la inclusión laboral de personas en situación de discapacidad en talleres protegidos de la provincia de Mendoza

La temática de las personas en situación de discapacidad ha motivado en los últimos años gran interés en distintos ámbitos tantos académicos como de ejecución de políticas sociales, pero el cambio en la mirada ha comenzado a correr el velo sobre la inserción laboral de las personas que durante años fueron asociadas al concepto de enfermedad. Ello se encuentra relacionado también con diversos modelos conceptuales sobre la discapacidad que conviven en la actualidad. Se hace el aporte desde el Modelo Social de la Discapacidad, que apunta a reconocer la diversidad como un elemento inherente a la condición humana. Se propone un estudio comparado de dos instituciones: la cooperativa de trabajo y taller protegido de producción La Rañatela y el centro de capacitación y rehabilitación laboral Milenio, y se muestran las representaciones sociales que subyacen en relación con la discapacidad e inclusión laboral que sustentan los profesionales del Trabajo Social.

Docencia universitaria en ambientes saludables : diseño ergonómico para espacios y equipamiento

El trabajo plantea el estudio de ‘ambientes saludables’ en edificios de instituciones académicas, particularmente del campus de la Universidad Nacional de Cuyo. Su propósito es mejorar la calidad de vida, salud y seguridad de las personas en el trabajo. Se elaboraron propuestas como ‘guía de recomendaciones’ para el diseño y adquisición de equipamiento universitario. El método aplicado es el propio de la Ergonomía, incluyendo: análisis de tareas, desarrollo de propuestas, experimentación, validación, seguimiento. El resultado puede aplicarse a los edificios del contexto antes señalado y a otros similares, pudiendo transferirse asimismo a la enseñanza de la Ergonomía en diferentes disciplinas.

Visiones de sí de jóvenes mujeres con discapacidad que asisten a escuelas públicas de la provincia de Buenos Aires

La presente tesis tiene como propósito central estudiar las visiones de sí de jóvenes mujeres con discapacidad incluidas en procesos de escolarización en escuelas públicas del sistema de educación tanto común como especial de la ciudad de La Plata y el Gran La Plata, provincia de Buenos Aires. La relevancia de la temática propuesta radica en que, en los estudios de juventud y género así como en los referidos al campo escolar, se observan escasas investigaciones sobre las mujeres con discapacidad. Desde una perspectiva socio-antropológica y a través de un enfoque etnográfico, se intenta comprender e interpretar las visiones de sí de las jóvenes con discapacidad en la trama de sus narrativas autobiográficas. Las estrategias metodológicas están orientadas a registrar la situación vivida por integrantes de este grupo social específico, focalizando en las relaciones entre el contexto social y cultural de pertenencia, el sexo género y la escolarización de las mujeres. El estudio realizado ha identificado que las jóvenes mujeres con discapacidad constituyen una de las poblaciones menos escolarizadas y más vulneradas en sus derechos. Asimismo, ha sido posible registrar que las visiones discapacitantes e inferiorizantes de las jóvenes están vinculadas a sus experiencias en la vida escolar, signada por rupturas, exclusiones, discontinuidades y violaciones a múltiples derechos, incluido el derecho a la educación. Se observa así la forma en que las instituciones y el sistema educativo no hacen efectivo el reconocimiento de las jóvenes mujeres con discapacidad como sujetas de derecho, prevista en la Convención sobre los Derechos de las Personas con Discapacidad, de jerarquía constitucional en la Argentina

¿Incluir las diferencias? Sobre un problema mal planteado y una realidad insoportable

Este texto se plantea una relectura ética acerca del derecho a la educación de las personas con discapacidades, con un énfasis prioritario de la situación en América Latina. A partir de considerar los sistemas jurídicos, los modos de financiamiento políticos, los porcentajes de inclusión y los programas de seguimiento de la población con discapacidad en edad escolar, se deriva toda una serie de discusiones sobre la idea de formación educativa, el estar junto a otros y las responsabilidades éticas en la tarea de educar.

Should differences be included? On a wrongly framed problem and an unbearable reality

Este texto se plantea una relectura ética acerca del derecho a la educación de las personas con discapacidades, con un énfasis prioritario de la situación en América Latina. A partir de considerar los sistemas jurídicos, los modos de financiamiento políticos, los porcentajes de inclusión y los programas de seguimiento de la población con discapacidad en edad escolar, se deriva toda una serie de discusiones sobre la idea de formación educativa, el estar junto a otros y las responsabilidades éticas en la tarea de educar.

La educación de los niños y niñas con diversidad funcional desde la perspectiva de sus pares y docentes

En este artículo se presentan las investigaciones que venimos desarrollando sobre concepciones de niñas, niños y adultos acerca de las personas con diversidad funcional. Se trata de indagaciones descriptivas y exploratorias que recogen los puntos de vista de diferentes actores en el ámbito educativo. Las conceptualizaciones sobre la diversidad funcional resultan de construcciones sociales, culturales y científicas, siendo interpretadas por los individuos como modelos que implican valoraciones, actitudes, pensamientos y prácticas hacia el colectivo "personas con discapacidades", el que se visualiza como diferente y diverso. Desde el campo de la Ética y los Derechos Humanos la consideración de la discapacidad en la educación se concentra en el tema de la igualdad y de la equiparación de oportunidades, propiciando ambientes inclusivos. Nuestras investigaciones, centradas inicialmente en niñas, niños y adolescentes, y recientemente en docentes, intentan realizar aportes y brindar insumos para la reflexión que merece este problema en el marco de la escuela como parte de una sociedad más equitativa y justa

Visiones de sí de jóvenes mujeres con discapacidad que asisten a escuelas públicas de la provincia de Buenos Aires

La presente tesis tiene como propósito central estudiar las visiones de sí de jóvenes mujeres con discapacidad incluidas en procesos de escolarización en escuelas públicas del sistema de educación tanto común como especial de la ciudad de La Plata y el Gran La Plata, provincia de Buenos Aires. La relevancia de la temática propuesta radica en que, en los estudios de juventud y género así como en los referidos al campo escolar, se observan escasas investigaciones sobre las mujeres con discapacidad. Desde una perspectiva socio-antropológica y a través de un enfoque etnográfico, se intenta comprender e interpretar las visiones de sí de las jóvenes con discapacidad en la trama de sus narrativas autobiográficas. Las estrategias metodológicas están orientadas a registrar la situación vivida por integrantes de este grupo social específico, focalizando en las relaciones entre el contexto social y cultural de pertenencia, el sexo género y la escolarización de las mujeres. El estudio realizado ha identificado que las jóvenes mujeres con discapacidad constituyen una de las poblaciones menos escolarizadas y más vulneradas en sus derechos. Asimismo, ha sido posible registrar que las visiones discapacitantes e inferiorizantes de las jóvenes están vinculadas a sus experiencias en la vida escolar, signada por rupturas, exclusiones, discontinuidades y violaciones a múltiples derechos, incluido el derecho a la educación. Se observa así la forma en que las instituciones y el sistema educativo no hacen efectivo el reconocimiento de las jóvenes mujeres con discapacidad como sujetas de derecho, prevista en la Convención sobre los Derechos de las Personas con Discapacidad, de jerarquía constitucional en la Argentina