917 resultados para B-to-B services
Resumo:
This study deals with the protection of social rights in Europe and aims to outline the position currently held by these rights in the EU law. The first two chapters provide an overview of the regulatory framework in which the social rights lie, through the reorganisation of international sources. In particular the international instruments of protection of social rights are taken into account, both at the universal level, due to the activity of the United Nations Organisation and of its specialized agency, the International Labour Organization, and at a regional level, related to the activity of the Council of Europe. Finally an analysis of sources concludes with the reconstruction of the stages of the recognition of social rights in the EU. The second chapter describes the path followed by social rights in the EU: it examines the founding Treaties and subsequent amendments, the Charter of Fundamental Social Rights of Workers of 1989 and, in particularly, the Charter of Fundamental Rights of the European Union, the legal status of which was recently treated as the primary law by the Treaty of Lisbon signed in December 2007. The third chapter is, then, focused on the analysis of the substantive aspects of the recognition of the rights made by the EU: it provides a framework of the content and scope of the rights accepted in the Community law by the Charter of Fundamental Rights, which is an important contribution to the location of the social rights among the fundamental and indivisible rights of the person. In the last section of the work, attention is focused on the two profiles of effectiveness and justiciability of social rights, in order to understand the practical implications of the gradual creation of a system of protection of these rights at Community level. Under the first profile, the discussion is focused on the effectiveness in the general context of the mechanisms of implementation of the “second generation” rights, with particular attention to the new instruments and actors of social Europe and the effect of the procedures of soft law. Second part of chapter four, finally, deals with the judicial protection of rights in question. The limits of the jurisprudence of the European Union Court of Justice are more obvious exactly in the field of social rights, due to the gap between social rights and other fundamental rights. While, in fact, the Community Court ensures the maximum level of protection to human rights and fundamental freedoms, social rights are often degraded into mere aspirations of EU institutions and its Member States. That is, the sources in the social field (European Social Charter and Community Charter) represent only the base for interpretation and application of social provisions of secondary legislation, unlike the ECHR, which is considered by the Court part of Community law. Moreover, the Court of Justice is in the middle of the difficult comparison between social values and market rules, of which it considers the need to make a balance: despite hesitancy to recognise the juridical character of social rights, the need of protection of social interests has justified, indeed, certain restrictions to the free movement of goods, freedom to provide services or to Community competition law. The road towards the recognition and the full protection of social rights in the European Union law appears, however, still long and hard, as shown by the recent judgments Laval and Viking, in which the Community court, while enhancing the Nice Charter, has not given priority to fundamental social rights, giving them the role of limits (proportionate and justified) of economic freedoms.
Resumo:
The thesis deals with channel coding theory applied to upper layers in the protocol stack of a communication link and it is the outcome of four year research activity. A specific aspect of this activity has been the continuous interaction between the natural curiosity related to the academic blue-sky research and the system oriented design deriving from the collaboration with European industry in the framework of European funded research projects. In this dissertation, the classical channel coding techniques, that are traditionally applied at physical layer, find their application at upper layers where the encoding units (symbols) are packets of bits and not just single bits, thus explaining why such upper layer coding techniques are usually referred to as packet layer coding. The rationale behind the adoption of packet layer techniques is in that physical layer channel coding is a suitable countermeasure to cope with small-scale fading, while it is less efficient against large-scale fading. This is mainly due to the limitation of the time diversity inherent in the necessity of adopting a physical layer interleaver of a reasonable size so as to avoid increasing the modem complexity and the latency of all services. Packet layer techniques, thanks to the longer codeword duration (each codeword is composed of several packets of bits), have an intrinsic longer protection against long fading events. Furthermore, being they are implemented at upper layer, Packet layer techniques have the indisputable advantages of simpler implementations (very close to software implementation) and of a selective applicability to different services, thus enabling a better matching with the service requirements (e.g. latency constraints). Packet coding technique improvement has been largely recognized in the recent communication standards as a viable and efficient coding solution: Digital Video Broadcasting standards, like DVB-H, DVB-SH, and DVB-RCS mobile, and 3GPP standards (MBMS) employ packet coding techniques working at layers higher than the physical one. In this framework, the aim of the research work has been the study of the state-of-the-art coding techniques working at upper layer, the performance evaluation of these techniques in realistic propagation scenario, and the design of new coding schemes for upper layer applications. After a review of the most important packet layer codes, i.e. Reed Solomon, LDPC and Fountain codes, in the thesis focus our attention on the performance evaluation of ideal codes (i.e. Maximum Distance Separable codes) working at UL. In particular, we analyze the performance of UL-FEC techniques in Land Mobile Satellite channels. We derive an analytical framework which is a useful tool for system design allowing to foresee the performance of the upper layer decoder. We also analyze a system in which upper layer and physical layer codes work together, and we derive the optimal splitting of redundancy when a frequency non-selective slowly varying fading channel is taken into account. The whole analysis is supported and validated through computer simulation. In the last part of the dissertation, we propose LDPC Convolutional Codes (LDPCCC) as possible coding scheme for future UL-FEC application. Since one of the main drawbacks related to the adoption of packet layer codes is the large decoding latency, we introduce a latency-constrained decoder for LDPCCC (called windowed erasure decoder). We analyze the performance of the state-of-the-art LDPCCC when our decoder is adopted. Finally, we propose a design rule which allows to trade-off performance and latency.
Resumo:
Life expectancy at birth is the average number of years that a group of people born in the same year should live. The estimate for those born in 2010 is 80.2 years for Italy. On the other side of the chart are a number of countries in sub Saharan Africa. Haiti is in last place: children born in this country in 2010 have a life expectancy by an average of even 30 years, fifty in less than peers born in Italy. From a bioethical point of view, the first question that arises is: Is it right? Is it right that there is such inequality in health? The answer is simple: it is not right. But if we ask ourselves what are the best solution to remedy this situation, the answers become more than one. The differences in life expectancy depends on many factors, including no doubt the effectiveness of health systems. The scope of this work is precisely that of justice in health care and how the different general concepts related to it can be applied in health care settings with very limited financial and human resources. The first chapter describes the main inequalities in global health. The second discusses the main theories of justice. In the next chapter we reason on official development assistance and health cooperation. In the fourth we analyze the contribution of theories of justice through such issues as equity in health, the right of access to health services and right to health. In the fifth chapter the aim is to reason about global justice, the role of health in this context and how the official development assistance in health can contribute.
Resumo:
The ever increasing demand for new services from users who want high-quality broadband services while on the move, is straining the efficiency of current spectrum allocation paradigms, leading to an overall feeling of spectrum scarcity. In order to circumvent this problem, two possible solutions are being investigated: (i) implementing new technologies capable of accessing the temporarily/locally unused bands, without interfering with the licensed services, like Cognitive Radios; (ii) release some spectrum bands thanks to new services providing higher spectral efficiency, e.g., DVB-T, and allocate them to new wireless systems. These two approaches are promising, but also pose novel coexistence and interference management challenges to deal with. In particular, the deployment of devices such as Cognitive Radio, characterized by the inherent unplanned, irregular and random locations of the network nodes, require advanced mathematical techniques in order to explicitly model their spatial distribution. In such context, the system performance and optimization are strongly dependent on this spatial configuration. On the other hand, allocating some released spectrum bands to other wireless services poses severe coexistence issues with all the pre-existing services on the same or adjacent spectrum bands. In this thesis, these methodologies for better spectrum usage are investigated. In particular, using Stochastic Geometry theory, a novel mathematical framework is introduced for cognitive networks, providing a closed-form expression for coverage probability and a single-integral form for average downlink rate and Average Symbol Error Probability. Then, focusing on more regulatory aspects, interference challenges between DVB-T and LTE systems are analysed proposing a versatile methodology for their proper coexistence. Moreover, the studies performed inside the CEPT SE43 working group on the amount of spectrum potentially available to Cognitive Radios and an analysis of the Hidden Node problem are provided. Finally, a study on the extension of cognitive technologies to Hybrid Satellite Terrestrial Systems is proposed.
Resumo:
Come si evince dal titolo della tesi, la ricerca effettuata dal presente candidato nel corso del dottorato di ricerca ha avuto ad oggetto l’analisi delle competenze che, a diverso livello, comunitario, nazionale e regionale, sono attribuite agli enti in materia di rilascio di concessioni di servizi in abito interportuale, portuale e demaniale marittimo. L’attenzione, pertanto, ha dovuto innanzitutto essere rivolta ai compiti ed alle facoltà che, in forza del trattato che istituisce la Comunità Europea, sono attribuite alla Comunità stessa. Si è provveduto, pertanto, ad analizzare l’evoluzione della normativa per giungere all’attuale sistema giuridico. Gli aspetti della disciplina delle concessioni, oggetto di ricerca, hanno dovuto ripercorrere i vari procedimenti di infrazione comminati dalla Corte Europea, per i quali il sistema giuridico nazionale si è dovuto adattare con non poche difficoltà, soprattutto per la presenza di posizioni e prassi, negli anni, divenute consolidate.
Resumo:
La tesi affronta il tema degli istituti e degli strumenti di tutela della condizione di disoccupazione. In mancanza d’una nozione giuridica generale di disoccupazione, l’obiettivo è quello di ricercare gli elementi comuni ai differenti istituti in grado di definire l’ambito della protezione garantita alla persona priva d’impiego. Lo studio fornisce, dapprima, una complessiva ricognizione storico-critica degli strumenti per il sostegno del reddito nelle ipotesi di mancanza di lavoro. L’esame dei modelli d’intervento legislativo evidenzia finalità, caratteristiche e criticità dei singoli istituti, sia di quelli più consolidati, che degli interventi più recenti. La seconda parte della tesi si propone d’integrare la ricognizione delle forme di tutela economica con l’analisi delle politiche attive nel mercato del lavoro e degli interventi a sostegno all’occupabilità. L’intento è di verificare le modalità attraverso le quali l’ordinamento tenta di collegare tutela del reddito e promozione dell’occupazione. La ricerca affronta anche la questione dei limiti alla libertà di circolazione nell’Unione Europea dei cittadini non lavoratori, nonché il condizionamento determinato dalle misure che riducono o scoraggiano l’esportabilità delle prestazioni previdenziali negli altri Paesi europei. La parte finale si propone d’individuare gli elementi che caratterizzano il complesso degli istituti analizzati, al fine di verificare a quale evento giuridico l’ordinamento offra protezione. Lo studio identifica due elementi rilevanti: la condizione di “mancanza di lavoro”, che accomuna l’intervento per la disoccupazione e quello a favore dei rapporti di lavoro sospesi, nonché l’attualità dello stato di disoccupazione, parametro generale per gli interventi protettivi. L’analisi svolta sottolinea, però, che i meccanismi di c.d. condizionalità per l’accesso alle prestazioni economiche e ai servizi per l’impiego non consentono un’adeguata promozione della qualità del lavoro e della professionalità del lavoratore. La tesi individua un possibile terreno di sviluppo della protezione della condizione del disoccupato nell’integrazione tra strumenti di sostegno all’impiego e interventi a base universalistica.
Resumo:
Come risposta positiva alle richieste provenienti dal mondo dei giuristi, spesso troppo distante da quello scientifico, si vuole sviluppare un sistema solido dal punto di vista tecnico e chiaro dal punto di vista giurico finalizzato ad migliore ricerca della verità. L’obiettivo ci si prefigge è quello di creare uno strumento versatile e di facile utilizzo da mettere a disposizione dell’A.G. ed eventualmente della P.G. operante finalizzato a consentire il proseguo dell’attività d’indagine in tempi molto rapidi e con un notevole contenimento dei costi di giustizia rispetto ad una normale CTU. La progetto verterà su analisi informatiche forensi di supporti digitali inerenti vari tipi di procedimento per cui si dovrebbe richiedere una CTU o una perizia. La sperimentazione scientifica prevede un sistema di partecipazione diretta della P.G. e della A.G. all’analisi informatica rendendo disponibile, sottoforma di macchina virtuale, il contenuto dei supporti sequestrati in modo che possa essere visionato alla pari del supporto originale. In questo modo il CT diventa una mera guida per la PG e l’AG nell’ambito dell’indagine informatica forense che accompagna il giudice e le parti alla migliore comprensione delle informazioni richieste dal quesito. Le fasi chiave della sperimentazione sono: • la ripetibilità delle operazioni svolte • dettare delle chiare linee guida per la catena di custodia dalla presa in carico dei supporti • i metodi di conservazione e trasmissione dei dati tali da poter garantire integrità e riservatezza degli stessi • tempi e costi ridotti rispetto alle normali CTU/perizie • visualizzazione diretta dei contenuti dei supporti analizzati delle Parti e del Giudice circoscritte alle informazioni utili ai fini di giustizia
Resumo:
La tesi di dottorato "Unione Europea e Sanità" è uno studio sistematico del diritto alla salute e della protezione della sanità pubblica nell'ordinamento giuridico dell'Unione Europea. Il primo capitolo analizza le competenze sanitarie dell'Unione Europea, introdotte per la prima volta dal Trattato di Maastricht e definitivamente sistemate all'art. 168 TFUE. La norma identifica alcuni settori specifici nei quali l'Unione può agire e altri, quali l'organizzazione dei sistemi sanitari e la fornitura di cure mediche, che rimangono in capo agli Stati membri. Il secondo capitolo esamina le deroghe e le esigenze imperative connesse alla salvaguardia della salute nel mercato interno ed è suddiviso in tre sezioni dedicate alla libera circolazione delle merci, al diritto di stabilimento e alla libera prestazione dei servizi. Nella prima ci si è occupati dello sviluppo della legislazione farmaceutica. Nella seconda si sono analizzati il mutuo riconoscimento delle qualifiche professionali e le legislazioni statali che restringono il diritto di stabilimento degli operatori sanitari transfrontalieri. Nella terza si è rivolta l'attenzione alla mobilità dei pazienti che, attraverso la giurisprudenza della Corte di Giustizia, è stata trasfusa in un atto di diritto derivato. Il terzo capitolo si concentra sul ruolo del diritto alla salute nell'ordinamento giuridico dell'Unione Europea in considerazione del valore vincolante della Carta dei diritti fondamentali. Coerentemente, si è scelto di mantenere una struttura tripartita. Nella prima sezione, ci si interroga sull'esistenza di tale diritto alla luce dei pochi casi presenti. Nella seconda, lo si analizza per il tramite delle obbligazioni di proteggere, rispettare ed adempiere, enucleate attraverso alcuni strumenti internazionali e si verifica il ruolo del principio di non discriminazione in relazione all'accesso alle cure. Nella terza, infine, si verifica il ruolo del consenso informato rispetto alla sperimentazione clinica ed alla donazione di materiale biologico.
Resumo:
Im Rahmen der interdisziplinären Zusammenarbeit zur Durchsetzung des »Menschenrecht Gesundheit« wurde ein geomedizinisches Informationssystem erstellt, das auf die nordexponierten Bergdörfer zwischen 350 m ü. NN und 450 m ü. NN des Kabupaten Sikka auf der Insel Flores in Indonesien anwendbar ist. Es wurde eine Analyse der Zeit-Raum-Dimension der Gesundheitssituation in Wololuma und Napun Lawan - exemplarisch für die nordexponierten Bergdörfer - durchgeführt. Im Untersuchungsraum wurden Gesundheitsgefahren und Gesundheitsrisiken analysiert, Zonen der Gefahren herausgearbeitet und Risikoräume bewertet. Trotz eines El Niño-Jahres waren prinzipielle Bezüge der Krankheiten zum jahreszeitlichen Rhythmus der wechselfeuchten Tropen zu erkennen. Ausgehend von der Vermutung, dass Krankheiten mit spezifischen Klimaelementen korrelieren, wurden Zusammenhänge gesucht. Für jede Krankheit wurden Makro-, Meso- und Mikrorisikoräume ermittelt. Somit wurden Krankheitsherde lokalisiert. Die Generalisierung des geomedizinischen Informationssystems lässt sich auf der Makroebene auf die nordexponierten Bergdörfer zwischen 350 m ü. NN und 450 m ü. NN des Kabupaten Sikka übertragen. Aus einer Vielzahl von angetroffenen Krankheiten wurden sechs Krankheiten selektiert. Aufgrund der Häufigkeitszahlen ergibt sich für das Gesundheitsrisiko der Bevölkerung eine Prioritätenliste:rn- Dermatomykosen (ganzjährig)rn- Typhus (ganzjährig)rn- Infektionen der unteren Atemwege (Übergangszeit)rn- Infektionen der oberen Atemwege (Übergangszeit)rn- Malaria (Regenzeit)rn- Struma (ganzjährig)rnDie Hauptrisikogruppe der Makroebene ist die feminine Bevölkerung. Betroffen sind weibliche Kleinkinder von null bis sechs Jahren und Frauen ab 41 Jahren. Die erstellten Karten des zeitlichen und räumlichen Verbreitungsmusters der Krankheiten und des Zugangs zu Gesundheitsdienstleistungen dienen Entscheidungsträgern als Entscheidungshilfe für den Einsatz der Mittel zur Primärprävention. Die Geographie als Wissenschaft mit ihren Methoden und dem Zeit-Raum-Modell hat gezeigt, dass sie die Basis für die interdisziplinäre Forschung darstellt. Die interdisziplinäre Zusammenarbeit zur Gesundheitsforschung im Untersuchungszeitraum 2009 hat sich bewährt und muss weiter ausgebaut werden. Die vorgeschlagenen Lösungsmöglichkeiten dienen der Minimierung des Gesundheitsrisikos und der Gesundheitsvorsorge. Da die Systemzusammenhänge der Ätiologie der einzelnen Krankheiten sehr komplex sind, besteht noch immer sehr großer Forschungsbedarf. rnDas Ergebnis der vorliegenden Untersuchung zeigt, dass Wasser in jeder Form die primäre Ursache für das Gesundheitsrisiko der Bergdörfer im Kabupaten Sikka auf der Insel Flores in Indonesien ist.rnDer Zugang zu Wasser ist unerlässlich für die Verwirklichung des »Menschenrecht Gesundheit«. Das Recht auf Wasser besagt, dass jeder Mensch Zugang zu nicht gesundheitsgefährdendem, ausreichendem und bezahlbarem Wasser haben soll. Alle Staaten dieser Erde sollten sich dieser Forderung verpflichtet fühlen.rn
Resumo:
La tesi analizza, sotto vari aspetti del diritto dell’Unione Europea, i servizi che sono offerti su spazi demaniali. Si articola in quattro capitoli: Il primo capitolo ricostruisce, valutandone l’impatto sui servizi che sono oggetto della presente indagine, lo sviluppo giurisprudenziale della Libertà di Stabilimento e della Libera Prestazione di Servizi, analizzando, altresì, i principi generali e l’art.16 della Carta dei Diritti Fondamentali dell’Unione. Il secondo capitolo è, invece, dedicato al diritto secondario, ossia alla Direttiva 2006/123/CE, alle Direttive “Appalti” e alla Direttiva “Concessioni”. La prima, che nulla aggiunge al quadro normativo trattato nel primo capitolo, svolge, pertanto una vera e propria funzione appaltante e concessoria. Le seconde, invece, seppur non applicabili alle fattispecie ivi esaminate, restano utili per comprendere quale declinazione possano avere i principi di eguaglianza, di non discriminazione, di trasparenza, di pubblicità e di concorrenza nella regolazione dei servizi offerti su spazi demaniali. La terza, invece, in quanto a rilevanza, presenta alcuni punti critici che fanno propendere per una sua non applicabilità. Resta comunque utile sempre in materia di principi, i quali, come evidenziato nell’ultima parte del secondo capitolo, sono stati utilizzati dalla Corte di Giustizia, pur nella totale assenza, fino alla recente direttiva, di strumenti di diritto secondario applicabili alle concessioni. Il terzo capitolo, invece, affronta le problematiche emerse all’interno dell’ordinamento italiano e attua una comparazione tra il sistema italiano e quello portoghese, croato, francese, spagnolo. Il quarto capitolo, da ultimo, prende in considerazione il delicato equilibrio, sempre più attuale, tra principi in materia di appalti pubblici e aiuti di Stato, valutando come, sia il permanere dello status quo, sia un riordino non conforme alla Direttiva 2006/123/CE e ai principi da essa richiamati possa costituire un aiuto di Stato incompatibile con il mercato interno.
Resumo:
Il fine principale della tesi è di dimostrare che il concetto di economia verde, pur non avendo natura giuridica, ha un rilievo notevole nel diritto dell’Unione europea, in particolare rispetto al mercato dei servizi. L’indagine concerne innanzitutto lo sviluppo sostenibile, del quale l’economia verde rappresenta uno strumento, per poi incentrarsi sul concetto di economia verde, al fine di ricostruire la sua veste giuridica e la sua collocazione nel diritto (primario) dell’Unione europea. In secondo luogo, si analizza come l’Unione stia utilizzando il proprio diritto per favorire la transizione verso un’economia verde e per stimolare la circolazione dei relativi servizi. Da ultimo, vengono prospettate le varie relazioni che si ritiene possano intercorrere tra l’economia verde (nella sua dimensione giuridica a livello sovranazionale) e la libera prestazione dei servizi.
Resumo:
The main objective of this study is to reveal the housing patterns in Cairo as one of the most rapidly urbanizing city in the developing world. The study outlines the evolution of the housing problem and its influencing factors in Egypt generally and in Cairo specifically. The study takes into account the political transition from the national state economy to the open door policy, the neo-liberal period and finally to the housing situation after the January 2011 Revolution. The resulting housing patterns in Cairo Governorate were identified as (1) squatter settlements, (2) semi-informal settlements, (3) deteriorated inner pockets, and (4) formal settlements. rnThe study concluded that the housing patterns in Cairo are reflecting a multifaceted problem resulting in: (1) the imbalance between the high demand for affordable housing units for low-income families and the oversupply of upper-income housing, (2) the vast expansion of informal areas both on agricultural and desert lands, (3) the deterioration of the old parts of Cairo without upgrading or appropriate replacement of the housing structure, and (4) the high vacancy rate of newly constructed apartmentsrnThe evolution and development of the current housing problem were attributed to a number of factors. These factors are demographic factors represented in the rapid growth of the population associated with urbanization under the dictates of poverty, and the progressive increase of the prices of both buildable land and building materials. The study underlined that the current pattern of population density in Cairo Governorate is a direct result of the current housing problems. Around the depopulation core of the city, a ring of relatively stable areas in terms of population density has developed. Population densification, at the expense of the depopulation core, is characterizing the peripheries of the city. The population density in relation to the built-up area was examined using Landsat-7 ETM+ image (176/039). The image was acquired on 24 August 2006 and considered as an ideal source for land cover classification in Cairo since it is compatible with the population census 2006.rnConsidering that the socio-economic setting is a driving force of change of housing demand and that it is an outcome of the accumulated housing problems, the socio-economic deprivations of the inhabitants of Cairo Governorate are analyzed. Small administrative units in Cairo are categorized into four classes based on the Socio-Economic Opportunity Index (SEOI). This index is developed by using multiple domains focusing on the economic, educational and health situation of the residential population. The results show four levels of deprivation which are consistent with the existing housing patterns. Informal areas on state owned land are included in the first category, namely, the “severely deprived” level. Ex-formal areas or deteriorated inner pockets are characterized as “deprived” urban quarters. Semi-informal areas on agricultural land concentrate in the third category of “medium deprived” settlements. Formal or planned areas are included mostly in the fourth category of the “less deprived” parts of Cairo Governorate. rnFor a better understanding of the differences and similarities among the various housing patterns, four areas based on the smallest administrative units of shiakhat were selected for a detailed study. These areas are: (1) El-Ma’desa is representing a severely deprived squatter settlement, (2) Ain el-Sira is an example for an ex-formal deprived area, (3) El-Marg el-Qibliya was selected as a typical semi-informal and medium deprived settlement, and (4) El-Nozha is representing a formal and less deprived area.rnThe analysis at shiakhat level reveals how the socio-economic characteristics and the unregulated urban growth are greatly reflected in the morphological characteristics of the housing patterns in terms of street network and types of residential buildings as well as types of housing tenure. It is also reflected in the functional characteristics in terms of land use mix and its degree of compatibility. It is concluded that the provision and accessibility to public services represents a performance measure of the dysfunctional structure dominating squatter and semi-informal settlements on one hand and ample public services and accessibility in formal areas on the other hand.rn
Resumo:
Acquired cataract and cognitive impairment are both common age-related problems, and ophthalmologists are increasingly likely to encounter patients who have both. Patients with dementia types who display early visuoperceptual impairment may present first to ophthalmology services. When these patients have coexisting cataract, it may be difficult to distinguish visual complaints due to cataract from those due to dementia. The interaction between visual impairment due to cataract and neurodegenerative disorders affecting the central visual pathways, is not fully understood. Visual impairment due to cataract may stress impaired attentional mechanisms and cataract extraction may improve cognitive performance in some patients with early cognitive impairment; however, the benefits of cataract surgery in established dementia are less clear. In this study, the literature on this subject was reviewed and the implications for practice were considered.
Resumo:
Immigrants from high-burden countries and HIV-coinfected individuals are risk groups for tuberculosis (TB) in countries with low TB incidence. Therefore, we studied their role in transmission of Mycobacterium tuberculosis in Switzerland. We included all TB patients from the Swiss HIV Cohort and a sample of patients from the national TB registry. We identified molecular clusters by spoligotyping and mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analysis and used weighted logistic regression adjusted for age and sex to identify risk factors for clustering, taking sampling proportions into account. In total, we analyzed 520 TB cases diagnosed between 2000 and 2008; 401 were foreign born, and 113 were HIV coinfected. The Euro-American M. tuberculosis lineage dominated throughout the study period (378 strains; 72.7%), with no evidence for another lineage, such as the Beijing genotype, emerging. We identified 35 molecular clusters with 90 patients, indicating recent transmission; 31 clusters involved foreign-born patients, and 15 involved HIV-infected patients. Birth origin was not associated with clustering (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 0.73 to 3.43; P = 0.25, comparing Swiss-born with foreign-born patients), but clustering was reduced in HIV-infected patients (aOR, 0.49; 95% CI, 0.26 to 0.93; P = 0.030). Cavitary disease, male sex, and younger age were all associated with molecular clustering. In conclusion, most TB patients in Switzerland were foreign born, but transmission of M. tuberculosis was not more common among immigrants and was reduced in HIV-infected patients followed up in the national HIV cohort study. Continued access to health services and clinical follow-up will be essential to control TB in this population.
Resumo:
Acquired cataract and cognitive impairment are both common age-related problems, and ophthalmologists are increasingly likely to encounter patients who have both. Patients with dementia types who display early visuoperceptual impairment may present first to ophthalmology services. When these patients have coexisting cataract, it may be difficult to distinguish visual complaints due to cataract from those due to dementia. The interaction between visual impairment due to cataract and neurodegenerative disorders affecting the central visual pathways, is not fully understood. Visual impairment due to cataract may stress impaired attentional mechanisms and cataract extraction may improve cognitive performance in some patients with early cognitive impairment; however, the benefits of cataract surgery in established dementia are less clear. In this study, the literature on this subject was reviewed and the implications for practice were considered.