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Background: The epidemiological situation generated by COVID-19 has cast into sharp relief the delicate balance between public health priorities and the economy, with businesses obliged to toe the line between employee health and continued production. In an effort to detect as many cases as possible, isolate contacts, cut transmission chains, and limit the spread of the virus in the workplace, mass testing strategies have been implemented in both public health and industrial contexts to minimize the risk of disruption in activity. Objective: To evaluate the economic impact of the mass workplace testing strategy as carried out by a large automotive company in Catalonia in terms of health and healthcare resource savings. Methodology: Analysis of health costs and impacts based on the estimation of the mortality and morbidity avoided because of screening, and the resulting savings in healthcare costs. Results: The economic impact of the mass workplace testing strategies (using both PCR and RAT tests) was approximately €10.44 per test performed or €5575.49 per positive detected, 38% of this figure corresponds to savings derived from better use of health resources (hospital beds, ICU beds, and follow-up of infected cases), while the remaining 62% corresponds to improved health rates due to the avoided morbidity and mortality. In scenarios with higher positivity rates and a greater impact of the infection on health and the use of health resources, these results could be up to ten times higher (€130.24 per test performed or €69,565.59 per positive detected). Conclusion: In the context of COVID-19, preventive actions carried out by the private sector to safeguard industrial production also have concomitant public benefits in the form of savings in healthcare costs. Thus, governmental bodies need to recognize the value of implementing such strategies in private settings and facilitate them through, for example, subsidies.

Background: The epidemiological situation generated by COVID-19 has cast into sharp relief the delicate balance between public health priorities and the economy, with businesses obliged to toe a line between employee health and continued production. In an effort to detect as many cases as possible, isolate contacts, cut transmission chains and limit the spread of the virus in the workplace, mass testing strategies have been implemented in both public health and industrial contexts to minimize the risk of disruption in activity. Objective: To evaluate the economic impact of mass workplace testing strategy as carried out by a large automotive company in Catalonia in terms of health and healthcare resource savings. Methodology: Analysis of health costs and impacts based on the estimation of mortality and morbidity avoided because of screening and the resulting savings in healthcare costs. Results: The economic impact of the mass workplace testing strategies (using both PCR and RAT tests) was approximately €10.44 per test performed or €5,575.49 per positive detected. 38% of this figure corresponds to savings derived from better use of health resources (hospital beds, ICU beds and follow-up of infected cases), while the remaining 62% corresponds to improved health rates due to avoided morbidity and mortality. In scenarios with higher positivity rates and a greater impact of the infection on health and the use of health resources, these results could be up to ten times higher (€130.24 per test performed or €69,565.59 per positive detected). Conclusion: In the context of COVID-19, preventive actions carried out by the private sector to safeguard industrial production also have concomitant public benefits in the form of savings in healthcare costs. Thus, governmental bodies need to recognize the value of implementing such strategies in private settings and facilitate them through, for example, subsidies. Funding Statement: This research received no external funding. Declaration of Interests: None declared.

OBJECTIVE Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder. METHODS A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ∼2 hours). Multiple score combinations were compared to find a paper-based method that took ≤10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated. RESULTS Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individuals (48%) and was associated with lower nadir CD4 count (P < 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P < 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of attention/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper-based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ∼35 minutes). CONCLUSIONS The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV-infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.

Contains fulltext : 52621.pdf (Publisher’s version ) (Open Access) The relationship between adherence to highly active antiretroviral therapy (HAART) and RNA-HIV viral load outcomes has been extensively shown. Although there are different procedures for assessing treatment adherence, there is no ideal method. We present the SERAD (Self-Reported Adherence) questionnaire, a qualitative and quantitative self-reported instrument designed to provide an easier adherence measurement. We also compared the questionnaire to three other methods to evaluate adherence to HAART regimens in HIV-infected patients. Two prospective, observational, longitudinal studies were developed: a single-center pilot study followed by a multicenter study. A total of 530 HIV-infected outpatients was prospectively included, 66 in the pilot study and 464 in the multicenter study. Four methods were used to study adherence to HAART regimens: the SERAD questionnaire, pill count, electronic monitoring, and plasma drug monitoring. Pearson's correlations and Bland and Altman's method were developed. The SERAD questionnaire showed good feasibility and significant validity. Adequate levels of agreement between methods were observed, particularly when adherence was high. Differences increased as adherence fell. Moreover, the questionnaire was completed correctly, the interviewers did not report uncovered aspects, and the information was collected easily. Our results suggest that the SERAD questionnaire is a feasible and useful instrument for assessing adherence to HAART regimens in HIV-infected patients, and makes it possible to obtain reliable qualitative and quantitative information related to treatment adherence.

Recent research has shown that very high levels of adherence are required to obtain the maximum benefit of highly active antiretroviral therapy (HAART). This situation justifies the importance of developing efficient strategies to improve adherence to drugs against HIV. A comprehensive range of factors are the targets of the most effective interventions to improve adherence, including cognitive, behavioral, emotional, and social aspects. The authors describe three theoretical models that can help identify barriers and guide interventions. Most of the interventions are complex and may include more convenient care, provision of information, counseling, reminders, reinforcement, self-monitoring, family therapy, or additional supervision or attention. The authors suggest aspects that should be included in interventions to promote adherence based on a review of the literature and clinical experience. Limited evidence suggests that interventions to enhance adherence to antiretroviral therapy in people with HIV are most likely to be successful when they are comprehensive, longitudinal, and tailored to the person.

Background: Nearly perfect compliance seems to be indispensable to obtain the maximum benefit from highly active antiretroviral therapy (HAART). Interventions to ensure a high level of adherence during a relatively long-term period of therapy are necessary. Methods: This is a prospective, randomized, two-arm controlled study including patients starting their first- or second-line HAART who were randomized to receive psychoeducative intervention to implement adherence (experimental group [EG]) or a usual medical follow-up (control group [CG]). We aimed to study the efficacy of a psychoeducative intervention to ensure long-term adherence to HAART, its relation with the virologic efficacy of treatment, and to determine the variables related to long-term adherence. Visits were made at weeks 0, 4, 24, and 48 for data collection. Self-reported adherence was registered at each visit and its veracity was tested by randomized blood analyses performed without previous warning to 40% of patients. Appropriate adherence was defined as the consumption of ≥95% of medication prescribed. Statistical analyses were performed both by the as treated (AT) and the intention to treat missing = failure (ITT) methods. Results: In all, 116 patients were included. At week 48, 94% of patients in the EG versus 69% controls achieved adherence ≥95% (p =.008); 89% of patients in the EG versus 66% controls had HIV-1 RNA levels

This multicentre, randomized, open-label, prospective trial is evaluating the effects of switching treatment from a protease inhibitor (PI)-containing regimen to one containing the non-nucleoside reverse transcriptase (RT) inhibitor nevirapine in human immunodeficiency virus (HIV)-infected patients with durable viral suppression but suffering from lipodystrophy. Objectives of this ongoing study are to evaluate the effects of this switch on changes in body shape and metabolic abnormalities associated with acquired HIV-related lipodystrophy syndrome (AHL), as well as on maintenance of viral suppression and immunological and psychological effects. Preliminary data involving 57 patients with 3 months of follow-up show an initial improvement of AHL in two regions, the face and arms. There is also a tendency toward improved cholesterol and triglyceride levels and improved quality of life among patients receiving the nevirapine-containing regimen. Maintenance of viral suppression was equivalent in both treatment groups. Additional data with longer follow-up are needed to confirm these results.

Fins a mitjans de la dècada dels 90 no existia un tractament capaç de controlar l'evolució de la infecció pel virus d'immunodeficiència humana (VIH) causant de la SIDA. L'aparició de noves famílies de fàrmacs i el seu ús combinat va significar un canvi radical en aquest escenari, podent-se començar a parlar de la cronificació de la malaltia. Tanmateix, els nous tractaments exigeixen un consum pràcticament perfecte per tal que siguin realment eficaços. El compliment inadequat de les dosis i condicions de posologia facilita que el virus es faci resistent als fàrmacs limitant l'eficàcia del tractament, alhora que hipoteca les alternatives terapèutiques.Aquesta tesi conté una primera aproximació teòrica on es revisen els aspectes propis del virus d'immunodeficiència humana, de la infecció que causa, el seu tractament farmacològic i el problema de l'adhesió terapèutica des d'un punt de vista general i en el cas del tractament del VIH en particular. La part empírica es composa de tres treballs que intenten donar resposta a tres preguntes al voltant de l'adhesió al tractament antiretroviral: a) quina adhesió existeix en el nostre medi, b) com es pot intervenir per millorar-la?, i c) com es pot avaluar de forma sistemàtica l'adhesió?El primer és un estudi pilot per conèixer els nivells d'adhesió reals de la nostra població i les principals variables implicades. S'introdueix una valoració de l'autoeficàcia seguint la teoria de Bandura, variable que es relaciona fortament amb l'adhesió, juntament amb l'esforç percebut per seguir el tractament En el segon estudi es vol comprovar experimentalment l'eficàcia d'una intervenció per millorar l'adhesió. No es valida un model, tot i que, com a qualsevol recerca, es parteix d'una hipòtesi i unes premisses a partir de les teories existents. La intervenció psicoeducativa està dirigida a millorar la informació i habilitats del pacient per afrontar el tractament. La seva eficàcia es comprova en un estudi prospectiu en que els pacients són aleatoritzats en dos grups, un que rep la intervenció i l'altre com a control. Es comprova que l'èxit de la intervenció no depèn tant dels resultats observats a curt termini sinó del que succeeix després d'un període llarg de tractament. Cal observar també si l'obtenció d'uns nivells d'adhesió elevats es tradueixen també en un millor control de la infecció, com així succeeix. Es controlen també una sèrie de variables que podrien ajudar a conèixer els factors que determinen el compliment de les prescripcions mèdiques. Finalment, en el tercer estudi es valida un qüestionari per tal d'avaluar l'adhesió de forma referida pel pacient. Aquest qüestionari respon a la necessitat de sistematització en la recollida de dades sobre adhesió, sent comparable a altres mètodes d'avaluació i, sobretot, aplicable a la pràctica clínica.La tesi acaba amb una discussió conjunta dels tres treballs presentats tot i que cada un d'ells té una discussió particular., Until the end of the 90s there was no treatment that could control the evolution of the human immunodeficiency virus (HIV) that causes AIDS. The emergence of new families of drugs and their combined use heralded a radical change in this scenario, and it became possible to talk about the chronification of the disease. Nevertheless, the new treatments require a virtually perfect intake to be efficacious. Unsuitable compliance of doses and posology conditions leads to the virus becoming resistant to the drugs, limiting the efficacy of the treatment, while also jeopardising therapeutic alternatives.This thesis contains an initial theoretical approach which analyses the specific aspects of the human immunodeficiency virus, the infection it causes, its drug treatment and the problem of treatment compliance from the general standpoint and the specific case of HIV treatment. The empirical part is comprised of three works that aim to respond to the three questions concerning antiretroviral treatment adherence: a) what adherence exists in our setting, b) how can we intervene to improve it? and c) how can adherence be evaluated systematically?The first one is a pilot study to ascertain the real levels of adherence in our population and the main variables involved. A self-efficacy assessment according to the theory of Bandura is brought in, a variable which is strongly related to adherence, together with the perceived effort to follow treatmentThe second study aims to experimentally verify the efficacy of an intervention to improve adherence. A model is not being validated, but like any research, it is based on a hypothesis and certain premises drawn from the existing theories. The psycho-educational intervention targets improving the patient's information and skills to face up to the treatment. Its efficacy is verified in a prospective study in which patients are randomised to two groups, one receiving the intervention and the other as control group. We check that the success of the intervention does not depend so much on the short-term results but rather on what happens after a long period of treatment. We also have to observe whether high levels of adherence actually translate into better infection control, which is the case. A series of variables that might help to ascertain the factors that determine compliance with medical prescriptions is also analysed. Finally, a third study validates a questionnaire for patient self-reported adherence. This questionnaire responds to the need for systematisation in the collection of data on adherence, and is comparable to other methods of assessment and above all applicable to clinical practice.The thesis ends with a joint discussion of the work presented , although each one is discussed separately.

We assessed the impact of an efavirenz-containing regimen versus a protease inhibitor-containing regimen on quality of life, emotional status, and adherence of HIV-1-infected patients. In addition, we sought to define the adverse events associated with these treatments, with a special focus on central nervous system disorders in the efavirenz treatment group. This prospective, randomized, two-arm, controlled study included 100 patients for whom initial treatment with a protease inhibitor-containing regimen failed. Patients were randomized to start treatment with two nucleoside retrotranscriptase inhibitors plus efavirenz (group 1; 51 patients) or two nucleoside retrotranscriptase inhibitors plus one or more new protease inhibitors (group 2; 49 patients). Quality of life was assessed by a five-point item adapted from the HIV questionnaire of the Medical Outcomes Study, emotional status was evaluated by the Profile of Mood State questionnaire, and patients self-reported adherence. Data were analyzed by both an as-treated method and an intention-to-treat-last observation carried forward method. Patients in group 1 reported the following findings at week 4: dizziness (66%), abnormal dreaming (48%), light-headedness (37%), and difficulty sleeping (35%). At week 24, dizziness (13%; p

Structured treatment interruption strategies may help overcome problems of highly active antiretroviral therapy, but might also represent a cause of stress. We present data that indicate a psychological benefit from structured treatment interruption. Although some disturbances appear at the resumption of therapy, no definitive problems are found that preclude such therapeutic approaches from a psychological perspective. However, a close follow-up of patients during interruption periods is advisable to avoid difficulties reported at treatment resumption presenting a risk to patients' health.

Seventy-seven subjects infected with human immunodeficiency virus were randomized to switch from protease inhibitor (PI) therapy to nevirapine therapy (group A; n=26) or to efavirenz therapy (group B; n=25) or to continue PI therapy (group C; n=26). At month 12, viral suppression had been maintained in 96% of patients in group A, 92% of patients in group B, and 92% of patients in group C. A significant increase in the CD4(+) level was observed in all 3 groups. In group A, lipid profiles improved, whereas levels of gamma-glutamiltransferase and alanine aminotransferase significantly increased; 1 subject interrupted treatment because of hepatotoxicity. In group B, an increase in gamma-glutamiltransferase levels was also observed, and 3 patients interrupted treatment because of central nervous system symptoms. Two patients in group C withdrew therapy. Quality of life significantly improved for groups A and B. In patients receiving effective PI-based therapy, the replacement of the PI with either nevirapine or efavirenz is safe and virologically effective.

The year-long antiviral efficacy of a high-dose salvage regimen consisting of saquinavir (800 mg twice daily) plus ritonavir (400 mg twice daily) was evaluated in 58 HIV-positive patients who had seen no improvement under first-line protease inhibitor-containing regimens, nor in baseline predictors of virologic response. The efficacy of therapy was determined by CD4+/CD8+ and HIV-1 RNA values. The primary endpoint of our study was the percentage of patients with HIV-1 RNA levels200 copies/ml (virologic success) at 6 and 12 months of of follow-up. Secondary endpoints were log10 reduction in HIV-1 RNA levels and CD4+ increases through follow-up. Surrogate markers related with a lower HIV-1 RNA area under the curve were identified at baseline. Kaplan-Meier analysis and Cox proportional hazards models were applied to identify baseline predictors of achieving viral suppression at200 copies/ml. All analyses were intention to treat-last observation carried forward. Patients achieved a median HIV-1 RNA level reduction of0.5 log through 1 year (-0.59 log10 at 12 months), as well as CD4+ counts increased significantly (89 cells/mm3 at 12 months). Overall, 53% of patients were likely to achieve HIV-1 RNA levels200 copies/ml at 6 months. Seventy-six percent of patients who started therapy at HIV-1 RNA levels5000 copies/ml but only 42% with baseline viral load of 5000 to 30,000 copies/ml and 18.7% with baseline viral load30,000 copies/ml were likely to achieve viral suppression at 6 months (p.001, log-rank test). Patients with baseline HIV-1 RNA levels between 5000 and 30,000 copies/ml (relative hazard [RH], 0.39; 95% confidence interval [CI], 0.01 to 0.98; p = .0396) and patients with baseline HIV-1 RNA levels30,000 copies/ml (RH, 0.20; 95% CI, 0.07-0.61; p = .0040) were less likely to reach undetectable HIV-1 RNA levels than those with baseline HIV-1 RNA levels5000 copies/ml. Salvage highly active antiretroviral therapy (HAART) strategies including saquinavir (SQV) at high doses plus ritonavir (RTV) exert a significant long-term efficacy in more than half of PI-experienced patients without significant additional toxicity. This therapeutic efficacy is strongly implemented by a switch at the lower HIV-1 RNA levels.

El projecte desenvolupa un Sistema d’Informació Geogràfica per a gestionar la Recollida Selectiva de Residus al districte de Gràcia, realitzant un mapa base de la situació geogràfica dels punts de recollida (Punts de Brossa Neta, contenidors i bústies), analitzant la recollida i els mètodes utilitzats. L’objectiu final és fer una aplicació amb ArcView® per al Departament de Neteja que integri dues fonts d’informació: la Cartogràfica i la Base de Dades, relacionant-les dins un SIG.