Suchergebnisse

[EN] The state of accessibility for the disabled in Spain has undergone remarkable improvements in recent years due to the steps taken in agreement with the law 51/2003 of December 2 (LIONDAU). These improvements have had important impacts in urban environments, but this seems not to have been the case in rural areas in spite of the fact that their demographic weight is still considerable. Therefore, there is still a long way to go before all citizens with a disability could be granted sufficient participation in public and private spheres of life under the same conditions as all other citizens. In Spain there are 3 847 700 people with a disability, and 944 440 of them (24, 5%) live in rural communities. According to population projections to come, these figures are expected to increase. As the population ageing rate in rural communities is higher than that in urban areas, the number of disabled people will grow here in even greater proportion. Thus, the description of the state of accessibility for the disabled in these towns is necessary to propose measures aimed at the improvement of such conditions, as they are indispensable for the better living standards of such a large part of the population. Most of the existing papers and approaches as far as accessibility is concerned refer to urban environments. Thus, the following methodology proposes the selection of a certain number of parameters in accordance to the analysis of the existing legislation, the various standards of accessibility established by the law, and the study of the different types of functional impairment. These parameters will be used to compose a data collection sheet to examine the state of accessibility in any given municipality. In turn, such parameters will be grouped in the different fields of action considered in this paper. Data collection will allow us to assess accessibility parameters. This assessment will be also useful to decide on a rating scale for the accessibility features and fields of action under research. Thus, two ...

IntroductionInversion of the CD4:CD8 ratio (<1) has been identified as a hallmark of immunosenescence and an independent predictor of mortality in the general population. We aimed to assess the association between the CD4:CD8 ratio and intima‐media thickness (IMT) progression in treated HIV‐infected patients as a marker of early atherosclerosis.Materials and MethodsA longitudinal study during three years was conducted in 120 HIV‐infected patients receiving antiretroviral treatment (ART). We analyzed the associations between the CD4:CD8 ratio, cardiovascular risk factor and antiretroviral (ARV) treatment and progression of subclinical atherosclerosis assessed using carotid IMT at baseline and after three years.ResultsFinally, 96 patients completed the study. Seventy‐six (79.1%) patients were male, aged 44±10 years, 39 (40.6%) were on treatment with Protease inhibitors, 49 (51.04%) with non‐nucleoside reverse transcriptase inhibitors (NNRTI), 6 (6.25%) with integrase inhibitors, 3 (3.12%) with maraviroc and 2 (2.08%) only with nucleoside reverse transcriptase inhibitors (NRTI). The mean of ARV exposition was 6.9±5.9 years. Twenty six (27 %) patients had family history of ischemic heart disease, 51 (53.12%) were smokers, 12 (12.5%) hypertensive, 4 (4.16%) type 2 diabetes, 23 (23.9%) with dyslipidemia and 31 (32.3%) were infected with C hepatitis virus. Baseline IMT was significantly associated with age (rho=0.497; p<0.001), basal glucemia (rho=0.323; p=0.001), triglycerides (rho=0.232; p=0.023), Framingham score (rho=0.324; p=0.001), CD4:CD8 ratio (rho=−0.176; p=0.05) and dyslipidemia (0.72±0.16 mm vs 0.63±0.11 mm; p=0.029). In multivariable analysis where cardiovascular risk factor and ARV were included, IMT progression was inversely associated with CD4:CD8 ratio (OR=0.283; CI 95% 0.099–0.809; p=0.019) and treatment with NNRTI (OR=0.283; CI 95% 0.099–0.809; p=0.019).ConclusionsThe inversion of CD4:CD8 ratio in treated HIV‐infected patients is independently associated with IMT progression, a marker of age‐associated disease. Therefore, it might be clinically useful as predictor of cardiovascular events. Surprisingly, there was a positive correlation between receiving NNRTI and progression of IMT.