Suchergebnisse

Ce texte est une synthèse juridique du statut législatif et réglementaire des plans de prévention des risques d'incendies de forêt, ceci à travers trois sources : le code de l'environnement, le code forestier, les circulaires.

Ce texte est une synthèse juridique du statut législatif et réglementaire des plans de protection des forêts contre les incendies de forêt : définition du massif forestier, contenu du plan, élaboration et révision du plan.

Background: Despite the centrality of health personnel to the health of the population, the planning, production and management of human resources for health remains underdeveloped in many low- and middle-income countries (LMICs). In addition to the general shortage of health workers, there are significant inequalities in the distribution of health workers within LMICs. This is especially true for countries like Fiji, which face major challenges in distributing its health workforce across many inhabited islands. Methods: In this study, we describe and measure health worker distributional inequalities in Fiji, using data from the 2007 Population Census, and Ministry of Health records of crude death rates and health workforce personnel. We adopt methods from the economics literature including the Lorenz Curve/Gini Coefficient and Theil Index to measure the extent and drivers of inequality in the distribution of health workers at the sub-national level in Fiji for three categories of health workers: doctors, nurses, and all health workers (doctors, nurses, dentists and health support staff). Population size and crude death rates are used as proxies for health care needs. Results: There are greater inequalities in the densities of health workers at the provincial level, compared to the divisional level in Fiji - six of the 15 provinces fall short of the recommended threshold of 2.3 health workers per 1,000 people. The estimated decile ratios, Gini co-efficient and Thiel index point to inequalities at the provincial level in Fiji, mainly with respect to the distribution of doctors; however these inequalities are relatively small. Conclusion: While populations with lower mortality tend to have a slightly greater share of health workers, the overall distribution of health workers on the basis of need is more equitable in Fiji than for many other LMICs. The overall shortage of health workers could be addressed by creating new cadres of health workers; employing increasing numbers of foreign doctors, including specialists; and increasing funding for health worker training, as already demonstrated by the Fiji government. Close monitoring of the equitable distribution of additional health workers in the future is critical.

Purpose of the studyTo investigate if boosted protease inhibitor monotherapy is associated with a higher risk of neurocognitive impairment (NCI).MethodsHIV‐infected patients from two hospitals in Madrid (Spain) without concomitant major neurocognitive confounders, currently receiving for ≥1 year lopinavir/ritonavir (LPV) or darunavir/ritonavir (DRV) as monotherapy or with two N(t)RTIs were included if they had prolonged (≥1 year) plasma viral suppression (<50 c/mL, single blip allowed). Patients underwent full neurocognitive assessment (7 domains) by two psychologists blinded to the treatment group. NCI was defined as per 2007 Frascati criteria using demographically adjusted normative scores. Rates of NCI and the association between NCI and boosted protease inhibitor monotherapy, adjusted by significant confounders, were analyzed. Two categories of monotherapy duration were considered: short‐term (1–2 years) and long‐term (2–9 years). We evaluated as potential confounding variables: demographics, HIV risk factor, AIDS, CD4 (nadir/current), smoking, alcohol/illicit drug use, prior medical, neurological and psychiatric disease, HCV coinfection, years of ART, prior blips, time with HIV viral suppression, type of protease inhibitor, lipids and HOMA index.Summary of results191 patients (89.5% Caucasian) were included (Table 1).










Triple therapy (n=95)
Monotherapy (n=96)
p value




Male. n (%)
70 (73.7)
70 (72.9)
0.91


Former IVDU. n (%)
30 (31.6)
34 (35.4)
0.85


MSM. n (%)
29 (30.5)
30 (31.3)
0.85


Age. Median (IQR)
44.7 (40.6–48.4)
47.4 (44.8–51.4)
<0.01


Years of education. Mean (SD)
11.3 (4.1)
10.4 (4.4)
0.13


Prior neurologic disease. N (%)
12 (12.6)
10 (10.4)
0.63


Prior psychiatric disease. n (%)
19 (20.0)
24 (25.0)
0.44


Current or past use of illicit drugs. n (%)
49 (53.6)
46 (47.9)
0.66


HCV coinfection (past or active)
43 (47.3)
43 (45.3)
0.54


Years of ART. Median (IQR)
10.7 (4.8–15.7)
14.1 (10.7–15.9)
0.01


Years of monotherapy. Median (IQR)
Not applicable
2.3 (1.7–3.2)
Not applicable


Years suppressed (<50 c/mL). Median (IQR)
4.8 (2.9–8.9)
7.5 (4.5–10.0)
<0.01


No prior blip
63 (66.3)
61 (63.5)
0.17


Currently on LPV. n (%)
70 (73.7)
53 (55.2)
<0.01


Currently on DRV. n (%)
25 (26.3)
43 (44.8)
<0.01


CPE score (2010). Median (IQR)
7 (7–7)
3 (3–3)
Not applicable


CD4 cell nadir. Median (IQR)
153 (49–255)
182 (76–288)
0.11


CD4 cell current. Median (IQR)
560 (440–754)
629.5 (476–845.5)
<0.05




Proportion (95% CI) with NCI: Overall: 27.2% (20.9–33.6, all asymptomatic or mild). Triple therapy: 31.6 (22.1–41.0). 1–2 years of monotherapy (n=40): 25.0 (11.3–38.7). 2–9 years of monotherapy (n=56): 21.4 (10.5–32.3) No differences in rates of NCI were found by treatment group (p=0.38). In our regression model confounding variables for NCI were years on ART, ethnicity, years of education, transmission category and the HOMA index. Adjusted by those variables the odds ratio (95% CI) for NCI of patients receiving boosted protease inhibitor monotherapy monotherapy during 1–2 years was 0.85 (0.29–2.50) and for 2–9 years was 0.40 (0.14–1.15).ConclusionsBoosted protease inhibitor monotherapy, regardless of duration, was not associated with a higher rate of neurocognitive impairment than triple drug ART. These results call into question the ability of neuropenetrance scores to predict the neuroefficacy of antiretroviral regimens in HIV‐infected patients with adequate blood viral suppression.