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Biomedical subjects

Stefano Lazzari

Publications and source records attributed to Stefano Lazzari.

11 recordsLinked to original sources
PubMed2007

Related trends in locomotor and respiratory muscle oxygenation during exercise.

PURPOSE: We investigated the potential effect of respiratory muscle work on leg muscle oxygenation without artificial intervention in non-endurance-trained young subjects and searched for the range of intensity when this effect could occur. METHODS: We simultaneously monitored accessory respiratory and leg muscle oxygenation patterns with near-infrared spectroscopy (NIRS) in 15 healthy young men performing maximal incremental exercise on a cycle ergometer. Pulmonary gas exchange was measured. The respiratory compensation point (RCP) was determined. Oxygenation (RMO2) and blood volume (RMBV) of the serratus anterior (accessory respiratory muscle) and of the vastus lateralis (LegO2 and LegBV) were monitored with NIRS. The breakdown point of accessory respiratory muscle oxygenation (BPRMO2) and the accelerated (BP1LegO2) and attenuated fall (BP2LegO2) in leg muscle oxygenation were detected. RESULTS: BPRMO2 occurred at approximately 85% .VO2max and was related to RCP (r = 0.88, P < 0.001). BP2LegO2 appeared at approximately 83% .VO2max and was related to RCP (r = 0.57, P < 0.05) and with BPRMO2 (r = 0.64, P = 0.01). From BP2LegO2 to maximal exercise, LegBV was significantly reduced (P < 0.05). CONCLUSION: In active subjects exercising at heavy exercise intensities, we observed that the appearance of the accelerated drop in accessory respiratory muscle oxygenation-associated with high ventilatory level-was related with the attenuated fall in leg muscle oxygenation detected with near-infrared spectroscopy. This suggests that the high oxygen requirement of respiratory muscle leads to limited oxygen use by locomotor muscles as demonstrated in endurance-trained subjects. The phenomenon observed was associated with reduced leg blood volume, supporting the occurrence of leg vasoconstriction. These events appeared not only at maximal exercise but onward above the respiratory compensation point.

Adolescent↗
PubMed2005

The antimicrobial resistance containment and surveillance approach--a public health tool.

Antimicrobial drug resistance (AMR) is widely recognized as a global public health threat because it endangers the effectiveness of treatment of infectious diseases. In 2001 WHO issued the Global Strategy for Containment of Antimicrobial Resistance, but it has proved difficult to translate the recommendations of the Global Strategy into effective public health actions. The purpose of the Antimicrobial Resistance Containment and Surveillance (ARCS) approach is to facilitate the formulation of public health programmes and the mobilization of human and financial resources for the containment of AMR. The ARCS approach highlights the fundamental link between rational drug use and containment of AMR. Clinical management of human and animal infections should be improved through better disease control and prevention, high quality diagnostic testing, appropriate treatment regimens and consumer health education. At the same time, systems for supplying antimicrobial drugs should include appropriate regulations, lists of essential drugs, and functional mechanisms for the approval and delivery of drugs. Containment of AMR is defined in the ARCS approach as the continuous application of this package of core interventions. Surveillance of the extent and trends of antimicrobial resistance as well as the supply, selection and use of antimicrobial drugs should be established to monitor the process and outcome of containment of AMR. The ARCS approach is represented in the ARCS diagram (Fig. 2) which provides a simplified, but comprehensive illustration of the complex problem of containment and monitoring of AMR.

Animals↗
PubMed2005

Considerations for a WHO European strategy on health-care-associated infection, surveillance, and control.

Health-care-associated infection (HAI) is a major issue of patient safety with a substantial impact on morbidity, mortality, and use of additional resources worldwide. In April 2004, the WHO Regional Office for Europe organised the first international consultation to address the issue of HAI in eastern and central Europe. The main objectives of the consultation were to identify the primary needs and obstacles for the prevention and control of HAI at country level, to design the essential components of an international strategy to effectively address the issue of HAI, and to identify specific priorities and recommendations for interventions by the WHO and other international institutions. An update on HAI activities and related networks throughout Europe, together with the outcome of the meeting, are presented, with special emphasis on future considerations for a European WHO strategy on HAI prevention.

Cross Infection↗
PubMed2004

The use of blood donor data for HIV surveillance purposes.

We reviewed the use of HIV prevalence data from blood donors for surveillance purposes and for the estimation of HIV prevalence. Fifty countries with generalized epidemics were considered. Data on HIV prevalence in blood donors were compared with published estimates of adult HIV prevalence. In most of the 19 countries with similar estimates, blood donations came primarily from replacement donors. Our analysis suggests that blood donors are usually not a good proxy for the general population.

Adolescent↗
PubMed2004

Second-generation HIV surveillance: better data for decision-making.

This paper seeks to outline the key elements of the expanded surveillance efforts recommended by the second-generation HIV surveillance approach. Second-generation systems focus on improving and expanding existing surveillance methods and combine them in ways that have the greatest explanatory power. The main elements of this approach include: considering biological surveillance - HIV, AIDS, sexually transmitted infections (STIs) - and behavioural surveillance as integral components, targeting surveillance efforts at segments of the population where most new infections are concentrated - which might differ depending on the stage and type of the epidemic - and providing the rationale for the optimal use of data generated for monitoring the HIV epidemic and evaluating national AIDS control programmes. The paper emphasizes improvements in existing surveillance methodologies and discusses in detail crucial issues such as the validity of HIV prevalence data measured in pregnant women and linking HIV surveillance and behavioural data collection. In addition, a strategic partnership between second-generation surveillance and AIDS programme evaluation is proposed that stresses the complementary roles of these data collection activities in determining the effectiveness of prevention and care programmes and explaining the epidemiological trend data collected by sentinel serosurveillance systems. In conclusion, second-generation HIV surveillance systems provide a comprehensive, cost-effective and appropriate response to the information needs of AIDS control programmes. The implementation of such systems, including a better use of the data generated by the system, will ensure that national programmes are in the best possible position to respond to the challenges of the epidemic.

Behavioral Risk Factor Surveillance System↗
PubMed2004

HIV drug resistance surveillance: summary of an April 2003 WHO consultation.

The widespread use of any antimicrobial agent, including antiretroviral agents, has the potential to select drug-resistant populations of microorganisms. HIV drug-resistant strains have been recognized as a serious threat to the efficacy of current antiretroviral treatments and could jeopardize efforts to increase access to treatment in countries most affected by the HIV epidemic. The WHO Global HIV Drug Resistance Surveillance Programme aims at enhancing and enabling the response to the threat of antiretroviral drug resistance by assessing the geographical and temporal trends in HIV drug resistance, increasing our understanding of the determinants of HIV drug resistance, and identifying ways to minimize its appearance, evolution and spread. Based on a global network of experts and collaborating institutions, the programme is developing and field-testing tools and guidelines for the regular monitoring of the level and spread of HIV resistance, particularly in treatment-naive patients. Although relevant progress has been made, several important challenges still exist to the implementation of this essential and innovative programme.

Costs and Cost Analysis↗
PubMed2004

Making hospitals safer: the need for a global strategy for infection control in health care settings.

Healthcare Associated Infections (HAI) have a substantial impact on morbidity, mortality and health costs. At least 5 to 10% of patients admitted to acute care hospitals acquire an infection. Factors that promote HAI include underlying diseases and decreased patient immunity; invasive diagnostic and therapeutic techniques, the widespread antimicrobial resistance, lack of infection control measures and environmental hygiene. HAI are preventable and infection control programmes are cost-effective. Health care workers education, HAI surveillance, appropriate legislation and basic infection control measures are the essential elements of an infection control programme. A recent consultation on the 'Prevention and Control of HAI' identified the need for an international strategy that would establish standards, procedures and methods for HAI surveillance, prevention and control and promote their implementation at national level.

Cross Infection↗
PubMed2003

Methods and procedures for estimating HIV/AIDS and its impact: the UNAIDS/WHO estimates for the end of 2001.

BACKGROUND: The Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO) have produced country-specific estimates of HIV/AIDS biannually since 1997. These estimates are a primary source of information about the extent and spread of the HIV/AIDS epidemic and its impact. The importance of having comparable country-specific estimates of HIV/AIDS is growing as estimates are used to determine how international resources to fight HIV/AIDS will be allocated to countries. OBJECTIVES: This paper describes the procedures and process used to make the 2001 round of UNAIDS/WHO estimates of HIV/AIDS. The paper focuses on the different approaches used to make estimates of prevalence in countries with generalized and low-level and concentrated epidemics as well as on new curve-fitting software that was developed to produce epidemic curves for each country. In addition, it presents the assumptions used (e.g. survival from infection to death, the rate of mother-to-child transmission) that are required to derive estimates of incidence and mortality in adults, as well as prevalence, incidence and mortality in children. CONCLUSION: The paper describes the general process by which the estimation and modelling procedures have been refined and improved over time. The paper also discusses the limitations and weaknesses of the procedures and the data used to make the estimates, and suggests areas where further improvements need to be made.

Acquired Immunodeficiency Syndrome↗
PubMed2003

HIV surveillance: a global perspective.

This article provides an overview of recommendations for HIV surveillance. Results of surveillance are used in practice to inform program decisions, judge the effectiveness of the national response, lobby for effective programs, and to provide accurate measures of trends and the absolute state of the epidemic. Recommended surveillance activities differ for different epidemic situations-epidemics that are concentrated in defined groups with high-risk behavior, and epidemics that are well established among heterosexuals in the population at large. Surveillance systems in countries with different levels of the epidemic face major challenges, most of which revolve around identifying and obtaining information from representative samples of the at-risk populations. A brief examination of surveillance systems in Botswana and Vietnam illustrate how these challenges are being met in practice. While there is room for improvement, HIV surveillance systems in many developing countries are relatively robust, and are growing stronger all the time. In most countries, however, insufficient use is made of the information generated by these systems in terms of strengthening HIV prevention and care programs.

Adolescent↗
PubMed2002

Status of the HIV/AIDS epidemic and methods to monitor it in the Latin America and Caribbean region.

The paper presented is a review of the available epidemiological data on the situation in the Latin America and Caribbean (LAC) region, and looks at HIV prevalence in specific population groups. At the end of 2001, HIV remains an important health issue in the LAC region. Twelve countries in the region have an estimated prevalence of 1% or higher among pregnant women. Most of the LAC countries with generalized epidemics are located in the Caribbean basin. In the past decade there has been a slow but continuous increase in HIV prevalence rates among the general population and vulnerable groups, although information in some countries is limited. In many countries, the highest HIV prevalence among vulnerable groups is found among men who have sex with men. HIV infections related to injecting drug use are concentrated in the countries of the Southern Cone and Brazil. HIV is well anchored in the region, concentrated in vulnerable groups in most countries, but with an increasing presence in some countries in the general population. There is a need to improve data collection and introduce new tools to monitor behavior trends and the impact of interventions.

Acquired Immunodeficiency Syndrome↗