Suchergebnisse

Livestock farming and the environmentally friendly management of Alpine pastures represent a traditional form of mountain farming. Grazing and the maintenance of pastures and alps are publically subsidised in recognition of the ecological importance of the activities and because production costs are higher than usual due to the mountainous topography. In the complex of numerous support measures, payments made in the context of agri-environmental measures and compensatory allowances for disadvantaged areas prove to be the most effective arrangements for an ongoing management of Alpine pastures. The paper analyses international and regional differences and similarities in objectives, procedures, definitions/specifications and financial resources of these agricultural policy regulations for the preservation of this mountain landscape. Since the contribution system is not the only influence on the development of alpine farming, the relationship between the development of farms and tourism and regional economic conditions is analysed by way of an example. Based on the results and on findings from expert interviews, the authors deduce recommendations for action for sustainable policies in mountain areas.

IntroductionData on patients with long‐term exposure to ART is scarce because controlled studies usually do not follow up patients for more than five to seven years. We were interested whether baseline parameters such as CD4 T‐cell nadir or pre‐treatment viraemia do have an impact on ART success after more than a decade of treatment.MethodsELBE is a cross‐sectional study on adult HIV+ patients presenting consecutively with viral suppression (<50 HIV RNA copies/mL) and with ART exposure of at least five years. In this sub‐analysis, all patients with more than 10 years of ART exposure were evaluated for immune reconstitution and for intermittent transient viraemia (50–1000 copies/mL, defined as "blips") during the last five years.ResultsFrom a total of 894 patients included in the three participating ELBE centres, 524 patients had an ART exposure of at least 10 years and had been treated continuously during the last 5 years. Of these, 33.4% had at least one "blip" while 63.5% did not show any transient viraemia of more than 50 copies/mL. Patients with at least one blip had a higher pre‐treatment viraemia compared to patients without blips (5.30 versus 5.06 log copies/mL, p=0.0003). In patients with a pre‐treatment viraemia of more than 100,000, 50,000–100,000 and less than 50,000 copies/mL, the proportions of patients with blips during the last five years were 39.5%, 30.5% and 21.8% (p=0.007), respectively. The history of an AIDS‐defining illness or the CD4 T‐cell nadir was not associated with a higher frequency of blips. However, CD4 T‐cell nadir was a strong predictor for current CD4 T‐cell counts. In patient groups with a CD4 T‐cell nadir of 0–99, 100–199, 200–349, 350+ cells/µL, the median current CD4 T cells were 571, 667, 710 and 890 cells/µL, respectively. These differences remained significant when the analysis was restricted to patients with more than 15 years of ART exposure (n=268).ConclusionsIn this large group of positively selected HIV+ patients with long‐term exposure to ART of at least 10–15 years, high pre‐treatment viraemia was still associated with a higher frequency of intermittent transient viraemia ("blip"). A low CD4 T‐cell nadir remained associated with a lower CD4 cell recovery. The clinical implications of these findings remain to be evaluated.

IntroductionLittle is known about the well‐being on long‐term exposure to antiretroviral therapy. The ACTG Augmented Symptoms Distress Module (ASDM) is a validated tool which measures the presence of a total of 22 symptoms seen with HIV and quantifies the extent to which they cause distress to the patient.MethodsELBE was a cross‐sectional study that consecutively included adult HIV‐infected patients presenting with viral suppression (<50 HIV RNA copies/mL) and ART exposure for at least five years. Patients were evaluated by four different questionnaires, including ASDM.ResultsOf a total of 894 patients included in the three participating ELBE centres, complete data on ASDM were available for 698 patients (626 male, 69 female, 3 transsexual). Median age was 49.7 years (range, 23.3–82.5 years) and median exposure to ART was 11.5 years (range, 5–28 years). Median CD4 T‐cell counts had increased from a CD4 nadir of 180 to currently 640 cells/µL. Despite immunological and virological success, a high degree of symptom‐related distress was noted in this patient population. In total, 63.8% and 36.3% of the patients had at least one "bothersome" or one "very bothersome" symptom, respectively. The symptoms most frequently reported to be "bothersome" or "very bothersome" were fatigue and energy loss (18.5% and 11.0% respectively), insomnia (12.8% and 11.6%), sadness and depression (13.0% and 10.0%), sexual dysfunction (12.0% and 10.0%), and changes in body appearance (11.0% and 10.9%). There was no association between the degree of symptom‐related distress and gender, age or CD4 T‐cell nadir. However, the history of AIDS‐defining illnesses, comorbidities such as depression but also the duration of ART were significantly associated with a higher overall symptom summary score and with a higher frequency of symptoms. For example, in patients with at least 15 years of ART exposure, only 27.3% of the patients did not report at least one "bothersome" or "very bothersome" symptom.ConclusionsIn this large group of positively selected HIV+ patients with virological success and long‐term exposure to ART, a high degree of symptom‐related distress was found. Medical care of HIV‐infected patients should not only focus on optimal virological outcome. More data on quality of life in patients with long‐term exposure to ART is needed.

IntroductionDoravirine (DOR) is an investigational NNRTI (aka MK‐1439) that retains activity against common NNRTI‐resistant mutants. We have previously reported the Part 1 results from a two‐part, randomized, double‐blind, Phase IIb study in ART‐naïve HIV‐1‐positive patients [1]. At doses of 25, 50, 100 and 200 mg qd, DOR plus open‐label tenofovir/emtricitabine (TDF/FTC) demonstrated potent antiretroviral activity comparable to EFV 600 mg qhs plus TDF/FTC and was generally well tolerated at week 24. DOR 100 mg was selected for use in patients continuing in Part 1 and those newly enrolled in Part 2.MethodsPatients receiving DOR 25, 50 or 200 mg in Part 1 were switched to 100 mg after dose selection. In Part 2, 132 additional patients were randomized 1:1 to DOR 100 mg qd or EFV 600 mg qhs (each with TDF/FTC). We present week 48 efficacy and safety results for all patients in Part 1, and early (week 8) CNS tolerability only for patients randomized to DOR 100 mg or to EFV in Parts 1 and 2 combined. The primary safety endpoint is the % of patients with pre‐specified CNS events (all causality) by week 8 for DOR 100 mg qd vs EFV (Parts 1 + 2 combined).ResultsPart 1 week 48 efficacy and safety results are shown below.The most common DR clinical AEs in the DOR and EFV groups, respectively, were abnormal dreams (10.2%; 9.5%), nausea (7.8%; 2.4%), fatigue (7.2%; 4.8%), diarrhoea (4.8%; 9.5%) and dizziness (3.0%; 23.8%), and were generally mild to moderate.Part 1 + 2 Week 8 CNS Event Analysis: One hundred thirty‐two patients were randomized in Part 2, 66 to DOR 100 mg and 66 to EFV. Combining Part 1 and 2, a total of 108 patients received DOR 100 mg and 108 received EFV. By week 8, at least one CNS AE was reported in 22.2% of the DOR group and 43.5% of the EFV group (p<0.001). The most common CNS AEs were dizziness (DOR 9.3%; EFV 27.8%), insomnia (6.5%; 2.8%), abnormal dreams (5.6%; 16.7%) and nightmares (5.6%; 8.3%).ConclusionsIn ART‐naïve, HIV‐1‐positive patients also receiving TDF/FTC, DOR 100 mg qd demonstrated potent antiretroviral activity and immunological effect at week 48 and was generally safe and well tolerated. Patients who received DOR 100 mg qd had significantly fewer treatment‐emergent CNS AEs by week 8 than those who received EFV.

In Zusammenarbeit mit zehn Berufsbildungswerken wurden im Projekt PAUA neue Angebote für benachteiligte junge Menschen und junge Menschen mit Fluchthintergrund entwickelt. Der Band präsentiert die entwickelten Konzepte sowie Materialsammlungen und stellt diese ambulanten und stationären Einrichtungen beruflicher Rehabilitation zur Verfügung. Ziel der Autor:innen ist es, die Kompetenzen der Berufsbildungswerke in Richtung Inklusion aufzuzeigen und ihre Entwicklungsprozesse und Fortschritte zu präsentieren. Mit der Entwicklung neuer Angebote und Dienstleistungen für ausbildende Unternehmen wird gleichzeitig die Chance auf eine betriebliche Ausbildung für Menschen mit Förderbedarf erhöht. Das Projekt Anfänge, Übergänge und Anschlüsse gestalten - Inklusive Dienstleistungen von Berufsbildungswerken (PAUA) wurde vom Bundesministerium für Arbeit und Soziales gefördert und soll das Prinzip Inklusion in der beruflichen Bildung stärker verankern.