Combination prevention: new hope for stopping the epidemic.

HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, "treatment as prevention" for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa.

Skin tags, leptin, metabolic syndrome and change of the life style.

BACKGROUND: Skin tags (STs), are papillomas commonly found in the neck and in the axillae of middle-aged and elderly people. Metabolic syndrome (MS) is a complex of interrelated risk factors for cardiovascular disease and diabetes. Epidemiologic studies of different ethnic populations have indicated that hyperleptinaemia and leptin resistance are strongly associated with MS. AIM: To study the possible relation of skin tags and leptin levels to MS guided by the International Diabetes Federation (IDF) diagnostic criteria. METHODS: This study included 80 participants, 40 ST patients and 40 apparently healthy controls. Age, sex, waist circumference (WC), body mass index (BMI), smoking status, fasting glucose level, insulin level and insulin resistance were estimated as well as cholesterol, triglycerides, HDL, criteria of MS, and leptin levels. RESULTS: The univariate analysis showed that WC, BMI, fasting glucose, insulin levels, insulin resistance, cholesterol, triglycerides, HDL, and leptin levels were significantly higher in ST patients compared to controls (P<0.001). The multivariate analysis between MS components and ST showed that only high triglyceride levels (OR 1.205/95% CI 1.044-1.391/P=0.011) and low HDL levels (OR 0.554/95% CI 0.384-0.800/P=0.002) were significantly associated with ST. Multivariate linear regression analysis of the predictors of high plasma leptin levels, showed that high triglyceride levels (OR 0.287/95% CI 0.410-3.56/P=0.014), and low HDL levels (OR -0.404/95% CI -8.7 to -2.08/P=0.002) were significant predictors. CONCLUSION: The results of this study suggested that the presence of both ST and hyperleptinaemia in patients with STs may be associated with high levels of triglycerides and low levels of HDL and this could suggest that changing the life style of patients with ST may have a beneficial role.

Programas de prevención de ocio alternativo / Prevention programs on alternative activities

Los programas de ocio alternativo han cobrado un gran interés en España, durante los últimos seis años, como consecuencia de la rápida expansión de los nuevos patrones de uso recreativo de las drogas entre importantes sectores de la población juvenil. Aunque bajo ese epígrafe se reúnen muy diversos tipos de intervenciones, puede afirmarse que se trata de un tipo de programas de base comunitaria que se ejecuta en horarios y espacios de ocio y que tienen como objetivo primordial el desarrollo de actividades incompatibles a la vez que alternativas al uso de drogas. Sin embargo, existe poca evidencia en investigaciones rigurosas que nos indiquen exactamente qué tipo de programas, qué tipo de actividades dentro de ellos o con qué poblaciones específicas son más efectivos. En Estados Unidos, donde estos programas se vienen aplicando durante las dos últimas décadas, autores como Hansen y Tobler han llevado a cabo revisiones sistemáticas y aplicaciones de metaanálisis que sí nos permiten acceder a una evaluación de resultados e identificar algunas claves para garantizar su buen funcionamiento. De igual modo, en España existe una evaluación de resultados de dos conocidos programas -Abierto hasta el Amanecer (Gijón) y La noche más Joven (Ayuntamiento de Madrid)- así como diversas fuentes de información que recogen programas de este tipo–Idea Prevención y OED-. De su revisión se extrae la necesidad de mejorar la fundamentación científica de estos programas así como su adecuación a una definición de necesidades más precisas y unas expectativas más realistas respecto a los resultados de su aplicación (AU)

Alternative leisure programmes have aroused widespread interest in Spain in the last six years as a consequence of the rapid expansion of the new recreational drug use patterns in significant sectors of the juvenile population. Although this heading can cover many kinds of different interventions, it can be said that it includes a type of programme with a community basis that is carried out in leisure hours and spaces. Their overall priority objective is to organise activities which are both incompatible with drug use and as an alternative to it. Nonetheless, there is little evidence of any rigorous research that would indicate exactly which kind of programme, which of their activities or on which of their specific populations these are the most effective. In the United States, where these programmes have been operating for the last twenty years, authors such as Hansen and Tobbler have carried out systematic reviews and used metaanalysis, enabling us to make an assessment of the results and identify certain keys to guarantee their good operation. Similarly, in Spain, there is an evaluation of the results of two well-known programmes Abierto hasta el Amanecer (Gijón) and La Noche más Joven (Madrid City Council) as well as a database- - Idea Prevención, which has accumulated and analysed a total of 73 programmes. One result of the investigation is the need to improve the scientific foundation of these programmes in addition to adjusting them to a definition of more precise needs and to more realistic expectations from the results of their application (AU)