Trends in chronic hepatitis B virus infection in Italy over a 10-year period: Clues from the nationwide PITER and MASTER cohorts toward elimination

Objectives: The study measures trends in the profile of patients with chronic hepatitis B virus linked to care in Italy. Methods: A cross-sectional, multicenter, observational cohort (PITER cohort) of consecutive patients with hepatitis B surface antigen (HBsAg) over the period 2019-2021 from 46 centers was evaluated. The reference was the MASTER cohort collected over the years 2012-2015. Standard statistical methods were used. Results: The PITER cohort enrolled 4583 patients, of whom 21.8% were non-Italian natives. Compared with those in MASTER, the patients were older and more often female. The prevalence of hepatitis B e antigen (HBeAg) declined (7.2% vs 12.3; P <0.0001) and that of anti-hepatitis D virus (HDV) remained stable (9.3% vs 8.3%). In both cohorts, about 25% of the patients had cirrhosis, and those in the PITER cohort were older. HBeAg-positive was 5.0% vs 12.6% (P <0.0001) and anti-HDV positive 24.8% vs 17.5% (P <0.0017). In the logistic model, the variables associated with cirrhosis were anti-HDV-positive (odds ratio = 10.08; confidence interval 7.63-13.43), age, sex, and body mass index; the likelihood of cirrhosis was reduced by 40% in the PITER cohort. Among non-Italians, 12.3% were HBeAg-positive (vs 23.4% in the MASTER cohort; P <0.0001), and 12.3% were anti-HDV-positive (vs 11.1%). Overall, the adherence to the European Association for the Study of the Liver recommendations for antiviral treatment increased over time. Conclusion: Chronic hepatitis B virus infection appears to be in the process of becoming under control in Italy; however, HDV infection is still a health concern in patients with cirrhosis and in migrants

Clinical features and comorbidity pattern of HCV infected migrants compared to native patients in care in Italy: A real-life evaluation of the PITER cohort

Background: Direct-acting antivirals are highly effective for the treatment of hepatitis C virus (HCV) infection, regardless race/ethnicity. We aimed to evaluate demographic, virological and clinical data of HCV-infected migrants vs. natives consecutively enrolled in the PITER cohort. Methods: Migrants were defined by country of birth and nationality that was different from Italy. Mann-Whitney U test, Chi-squared test and multiple logistic regression were used. Results: Of 10,669 enrolled patients, 301 (2.8%) were migrants: median age 47 vs. 62 years, (p < 0.001), females 56.5% vs. 45.3%, (p < 0.001), HBsAg positivity 3.8% vs. 1.4%, (p < 0.05). Genotype 1b was prevalent in both groups, whereas genotype 4 was more prevalent in migrants (p < 0.05). Liver disease severity and sustained virologic response (SVR) were similar. A higher prevalence of comorbidities was reported for natives compared to migrants (p < 0.05). Liver disease progression cofactors (HBsAg, HIV coinfection, alcohol abuse, potential metabolic syndrome) were present in 39.1% and 47.1% (p > 0.05) of migrants and natives who eradicated HCV, respectively. Conclusion: Compared to natives, HCV-infected migrants in care have different demographics, HCV genotypes, viral coinfections and comorbidities and similar disease severity, SVR and cofactors for disease progression after HCV eradication. A periodic clinical assessment after HCV eradication in Italians and migrants with cofactors for disease progression is warranted

Evaluation of a real-time virtual intervention to empower persons living with HIV to use therapy self-management: study protocol for an online randomized controlled trial

Background: Living with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I'immunodeficience Humaine-Traitement Assistance Virtuelle Infirmiere et Enseignement; VIH-TAVIE (TM)) intervention was developed to provide persons living with HIV (PLHIV) with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT) will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART) among PLHIV.Methods/design: A convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0), after 3 months (T3) and 6 months (T6) of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT) analysis will be carried out to evaluate the true value of the intervention in a real context.Discussion: Carrying out this online RCT poses various challenges in terms of recruitment, ethics, and data collection, including participant follow-up over an extended period. Collaboration between researchers from clinical disciplines (nursing, medicine), and experts in behavioral sciences information technology and media will be crucial to the development of innovative solutions to supplying and delivering health services

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

La cartografía digital como herramienta dinámica e integrativa para el estudio del poblamiento medieval. La propuesta metodológica del proyecto «Muntanya Viva»

This paper, of a decidedly methodological nature, offers a detailed approach to the historical-archaeological information system designed from the Muntanya Viva research project for studying the medieval settlement in the Pallars Jussà region between the 4th and 12th centuries. It is a relational data model that allows the integration of all available information –whether it comes from written or archaeological sources– and its subsequent representation in a digital cartography through a Geographic Information System (GIS). All this aims to analyse synchronically the relationship between the different elements that made up the landscape at a specific moment, as well as its evolution diachronically over time.Este artículo, de marcado carácter metodológico, ofrece una aproximación detallada al sistema de información histórico- arqueológico diseñado desde el proyecto de investigación Muntanya Viva para el estudio del poblamiento medieval en la zona del Pallars Jussà entre los siglos IV y XII. Se trata de un modelo de datos relacional que permite la integración de toda la información disponible, ya provenga de fuentes escritas o arqueológicas, y su posterior representación en una cartografía digital a través de un Sistema de Información Geográ_ca (SIG). Todo esto con el objetivo de poder analizar sincrónicamente la relación entre los distintos elementos que configuraban el paisaje en un momento concreto, así como diacrónicamente su evolución a lo largo del tiempo

La cartografía digital como herramienta dinámica e integrativa para el estudio del poblamiento medieval. La propuesta metodológica del proyecto «Muntanya Viva»

This paper, of a decidedly methodological nature, offers a detailed approach to the historical-archaeological information system designed from the Muntanya Viva research project for studying the medieval settlement in the Pallars Jussà region between the 4th and 12th centuries. It is a relational data model that allows the integration of all available information –whether it comes from written or archaeological sources– and its subsequent representation in a digital cartography through a Geographic Information System (GIS). All this aims to analyse synchronically the relationship between the different elements that made up the landscape at a specific moment, as well as its evolution diachronically over time.Este artículo, de marcado carácter metodológico, ofrece una aproximación detallada al sistema de información histórico- arqueológico diseñado desde el proyecto de investigación Muntanya Viva para el estudio del poblamiento medieval en la zona del Pallars Jussà entre los siglos IV y XII. Se trata de un modelo de datos relacional que permite la integración de toda la información disponible, ya provenga de fuentes escritas o arqueológicas, y su posterior representación en una cartografía digital a través de un Sistema de Información Geográ_ca (SIG). Todo esto con el objetivo de poder analizar sincrónicamente la relación entre los distintos elementos que configuraban el paisaje en un momento concreto, así como diacrónicamente su evolución a lo largo del tiempo

Arqueología del paisaje en la alta montaña. Una primera aproximación al estudio de las ocupaciones ganaderas de época medieval en el Parque Nacional de Aigüestortes i Estany de Sant Maurici (Pirineo Occidental de Cataluña)

This article is focused on the medieval archaeological sites recorded in the Aigüestor tes i Estany de Sant Maurici National Park, located in the western Catalan Pyrenees. The archaeological analysis combined with palaeoenvironmental studies are used to discuss the historical role of seasonal livestock farming in the high mountain valleys of the Pyrenees. The goal is showing how this activity, combined with agriculture, structured the territory and modified the landscape. It also presents some hypotheses to contextualise the archaeological record within the historical knowledge of the region. In shor t, it highlights the value of the archaeological study of high mountain areas for research into pastoralism in medieval times and the origins of transhumance.Este artículo trata sobre los sitios arqueológicos de época medieval descubiertos en el Parque Nacional de Aigüestortes i Estany de Sant Maurici, que se localiza en el Pirineo occidental catalán. A través del análisis arqueológico, combinado con los estudios paleoambientales, se discute sobre el rol histórico de la ganadería estacional en los valles pirenaicos de alta montaña y cómo esta actividad, juntamente con la agricultura, estructuró el territorio y modificó el paisaje. Asimismo, se presentan algunas hipótesis que contextualizan históricamente la materialidad arqueológica expuesta en este trabajo. En definitiva, se pone en valor el estudio arqueológico de las zonas de alta montaña para las investigaciones sobre el pastoreo en época medieval y los orígenes de la trashumancia

Arqueología del paisaje en la alta montaña. Una primera aproximación al estudio de las ocupaciones ganaderas de época medieval en el Parque Nacional de Aigüestortes i Estany de Sant Maurici (Pirineo Occidental de Cataluña)

This article is focused on the medieval archaeological sites recorded in the Aigüestor tes i Estany de Sant Maurici National Park, located in the western Catalan Pyrenees. The archaeological analysis combined with palaeoenvironmental studies are used to discuss the historical role of seasonal livestock farming in the high mountain valleys of the Pyrenees. The goal is showing how this activity, combined with agriculture, structured the territory and modified the landscape. It also presents some hypotheses to contextualise the archaeological record within the historical knowledge of the region. In shor t, it highlights the value of the archaeological study of high mountain areas for research into pastoralism in medieval times and the origins of transhumance.Este artículo trata sobre los sitios arqueológicos de época medieval descubiertos en el Parque Nacional de Aigüestortes i Estany de Sant Maurici, que se localiza en el Pirineo occidental catalán. A través del análisis arqueológico, combinado con los estudios paleoambientales, se discute sobre el rol histórico de la ganadería estacional en los valles pirenaicos de alta montaña y cómo esta actividad, juntamente con la agricultura, estructuró el territorio y modificó el paisaje. Asimismo, se presentan algunas hipótesis que contextualizan históricamente la materialidad arqueológica expuesta en este trabajo. En definitiva, se pone en valor el estudio arqueológico de las zonas de alta montaña para las investigaciones sobre el pastoreo en época medieval y los orígenes de la trashumancia