Donne e creatività. La generatività del materno tra natura e cultura

Sul corpo femminile, le due dimensioni (quella biologica e quella culturale) hanno avuto modo nel corso del tempo di con-fondersi, in un processo insieme prima filogenetico e poi ontogenetico, generando un sapere capace di prendersi cura del mondo. Un sapere che è stato escluso dalla cultura dominante e da esplicitare pressoché solo nel privato: legato alla cura della famiglia, alla maternità, all’educazione dei figli, ritenuto debole rispetto a quello forte, oggettivo, neutro, trasmesso dalla cultura ufficiale. Eppure, per quanto sia difficile liberarsi da una visione essenzialista, le donne ci dimostrano che esistono diversi modi di generare la vita, di essere madri. A partire da quel sapere, acquisito e impresso su di loro nell’esercizio secolare della cura dell’altro, si è generato nel corso del tempo un pensare e agire differente, che riconosce il ruolo epistemico di categorie considerate marginali dalla cultura ufficiale come la corporeità, l’affettività e la creatività, e che utilizza queste categorie per proporre nuove pratiche con cui prendersi cura del mondo. Pratiche rappresentative del desiderio, troppo spesso taciuto, di libertà da realizzare non solo per sé ma anche per le altre e per gli altri

The Fibrosis-4 index predicts all-cause mortality in a cohort of patients at high cardiovascular risk partly through glomerular filtration rate reduction

Background and aim: Fibrosis-4 (FIB-4) index is a widely used test for non-invasively assessing liver fibrosis. We aimed to investigate the association between FIB-4 index and risk of all-cause mortality in patients at high cardiovascular (CV) risk and to determine whether coexisting renal dysfunction mediates this association. Methods and results: Single-center prospective study of 994 patients with established or suspected coronary artery disease undergoing coronary angiography, followed for a median of 44 months. Mortality data were obtained through the Italian Health Card Database. At baseline, the median FIB-4 index was greater in deceased vs. alive patients (1.71 vs. 1.38, p < 0.001) and in those with reduced eGFR than in those with normal eGFR (1.65 vs. 1.37, p < 0.001). For each unit increase in the baseline log-FIB-4 index, the risk of all-cause mortality sharply increased during the follow-up (hazard ratio [HR] 2.31, 95%CI 1.31–4.08, p = 0.004). Similarly, assuming the lowest baseline FIB-4 risk category as the reference, the risk of all-cause mortality progressively increased across the indeterminate (HR 1.82, 95%CI 1.18–2.82, p = 0.007) and the highest baseline FIB-4 risk categories (HR 2.33, 95%CI 1.37–3.97; p = 0.002). A causal mediation analysis showed that about one-third of the effect of FIB-4 index on mortality risk was mediated by reduced eGFR (32.8 %, p = 0.01). Conclusions: Increased FIB-4 index predicts the long-term risk of all-cause mortality in patients at high CV risk, and this risk is, at least in part, mediated by reduced eGFR. Further prospective studies are needed to confirm these findings

Association of race with incidence, characteristics, and mortality from incidental prostate cancer: Analysis of two North American contemporary cohorts

Background: Non-Hispanic Black (NHB) men are at higher risk both for incidence and mortality from prostate cancer (PCa) compared to Non-Hispanic White (NHW) men, but these findings arise from biopsy-detected PCa reports. We aimed to compare the incidence, subsequent management and cancer-specific mortality (CSM) of incidental PCa among NHB and NHW men, using two different North American cohorts. Methods: The Surveillance, Epidemiology and End-Result (SEER: 2004-2017) and our institutional Henry Ford Health (HFH: 1995-2022) databases were queried to identify men diagnosed with incidental PCa. Cumulative incidence estimates were used to calculate CSM differences between NHB and NHW men. Competing-risk multivariable regression analysis tested the impact of race on CSM, after accounting for all available covariates. Results: A total of 418 and 6,124 incidental PCa cases were recorded in HFH and SEER database respectively. No pathological differences were observed between NHB and NHW men in both the cohorts, except for prostate-specific antigen (PSA) value at diagnosis, which was higher in NHB men. At 10-years, the CSM rates were 5.5% vs 7.2% in our cohort and 8.6% vs 10.3% in the SEER cohort for NHW and NHB men, respectively (all Gray's test p-value > 0.05). At multivariable, race was not an independent predictor of CSM in our HFH cohort (HR: 1.46, 95% CI: 0.57-3.71, p = 0.6). In the SEER cohort, NHB men were 34% less likely to die from PCa from 1 year to the next (95% CI: 0.49-0.90, p = 0.008), when compared with NHW men. Conclusions: In the comparison of incidental PCa findings between NHB and NHW men, both groups had similar pathological characteristic and survival outcomes. These findings are different from the 'conventional' screening-detected PCa and suggest that racial differences have minimal to no adverse effects on PCa-specific mortality after incidental diagnosis

Towards a biological view of multiple sclerosis from early subtle to clinical progression: an expert opinion

The classification of multiple sclerosis (MS) into the two distinct phases of relapsing-remitting and progressive, including primary progressive and secondary progressive phenotypes (PPMS and SPMS, respectively) has long been accepted; however, there are several unmet needs associated with this particular model. The observation that both inflammation and neurodegeneration are present from the onset of MS has resulted in a paradigm shift towards MS as a disease continuum driven by pathological mechanisms underlying clinical progression. Here we report the results from a meeting of Italian MS specialists, exploring the evolving perception of MS pathobiology and its implications for diagnosis and treatment. Insights garnered from the expert panel advocate for a redefined understanding of MS. This expert opinion paper reviews the disease continuum and the intertwined nature of inflammatory and neurodegenerative processes. Also, the need for changes in diagnostic criteria and treatment strategies, including the development of novel biomarkers and new therapies targeting smouldering disease, is discussed

Global Andrology Forum Clinical Practice Guidelines on the Management of Premature Ejaculation

Purpose: Premature ejaculation (PE) is a commonly encountered male sexual dysfunction (MSD) with various definitions, diagnostic criteria, and treatment options, leading to significant heterogeneity and controversy in its management. This study aimed to explore the global practice patterns of the diagnosis and management of PE. Materials and methods: A cross-sectional, global, online survey on PE was conducted using a questionnaire developed by an international cohort of experts. Results were analyzed using R version 4.1.2. Additionally, expert recommendations were formulated using a modified Delphi method. Results: The survey was completed by 264 participants from 41 countries. The majority of respondents were below the age of 45 years and were urologists focusing on andrology and sexual health. PE diagnosis was primarily based (by 61.5%) on an intravaginal ejaculatory latency time of less than one minute. Lifelong PE was the most common category reported (47.7%), and most respondents (84.2%) observed ante-portas PE in less than 25% of cases. Distinguishing PE from erectile dysfunction was challenging for many respondents (60.7%). Diabetes mellitus was the most common comorbidity (17.1%). Pharmacological therapy was the most common treatment method (34.3%), with dapoxetine being the most preferred medication (37.9%). Surgical methods were infrequently used. Emerging treatments like hyaluronic acid gel glans augmentation were favored by only 11.7%. Patient satisfaction was the primary criterion for successful PE treatment (55.9%), and cost was a significant concern for many (35.5%). Conclusions: This global survey highlights significant diversity in the diagnostic and treatment strategies for PE. Standard diagnostic criteria are generally accepted, off-label medication is widely used in therapy, and the role of surgery is still controversial. A multi-modal therapy approach, tailored to the patient's specific needs, is favored. Further research into the neurobiology of PE and the development of effective and safe options is crucial for improving the management of PE

Analysis of the Development of Gender Stereotypes and Sexist Attitudes Within a Group of Italian High School Students and Teachers: A Grounded Theory Investigation

Gender stereotypes and sexist attitudes continue to persist in educational settings, with significant implications for students’ achievement and well-being. This study aimed to investigate the development of gender stereotypes and sexist attitudes among Italian high school students and trainee teachers. A series of focus groups were conducted with a group of Italian school students and trainee teachers to uncover the complex interplay of individ- ual, interpersonal, institutional, and societal factors that contribute to the formation and perpetuation of these biases. Analysis was conducted using a grounded theory approach. The findings reveal a nuanced and multifaceted understanding of the issue, highlighting the critical role of teacher attitudes, peer influence, and broader cultural norms in shaping students’ perceptions and behaviors. This study offers insights for educators, policymak- ers, and researchers seeking to address gender inequities in education and promote more inclusive and equitable learning environments

Long-Term Clinical Remission on Benralizumab Treatment in Severe Eosinophilic Asthma: A Four-Year Real-Life Study

Background: The current availability of monoclonal antibodies against key mediators of type-2 (T2) inflammation has led to a redefinition of the ultimate objectives of severe asthma treatment to a more composite concept of disease remission. Objectives: The aim of this real-life study was to estimate the percentage of patients who achieved clinical remission over 4 years of treatment with benralizumab, and to identify baseline predictors for the achievement of such a composite outcome in the long term. Methods: Data from a 4-year follow-up of 23 patients who were prescribed benralizumab as an add-on therapy because of uncontrolled severe eosinophilic asthma were retrospectively analyzed and compared. Clinical remission was considered to be “complete” if oral corticosteroid (OCS) use was not required, there were no exacerbations, an asthma control test (ACT) score ≥ 20 was achieved and a pre-bronchodilation percent predicted a forced expiratory volume in 1 s (FEV1%) ≥ 80%. Clinical remission was considered to be “partial” if OCS use was not required, plus at least two of the other three aforementioned criteria. Results: The overall percentage of patients who achieved clinical remission was 86.9% after 12 months, and 91.3% after 24 and 48 months of treatment. The rate of complete remission over partial remission increased over time. After 12 months of treatment, 65% of patients fulfilled the criteria for complete remission and 35.0% for partial remission. After 48 months of treatment, 71.4% of patients were in a status of complete remission and 28.6% in a status of partial remission. A long-term composite outcome of complete clinical remission was more likely to be achieved by severe eosinophilic asthma patients with comorbid nasal polyposis, bronchiectasis and osteoporosis, and with OCS dependency, a predicted pre-bronchodilation FEV1% ≥ 80% and a predicted FEF25–75% < 65% at baseline. Conclusions: Our real-life experience suggests that treatment with benralizumab may allow the achievement and long-term maintenance of clinical remission in a high percentage of severe eosinophilic asthma patients, up to 4 years of follow-up

L’emergenza nello Stato regionale: uno studio comparato tra Italia e Spagna

La presente tesi di dottorato si propone di analizzare in prospettiva comparata la gestione delle emergenze nello Stato regionale, utilizzando quale case study la gestione dell’emergenza pandemica da Covid-19 in Italia e Spagna. La metodologia della ricerca si basa su un esercizio di comparazione sia diacronica che sincronica tra Italia e Spagna, configurabili come "most similar cases". L'obiettivo primario della ricerca è stato comprendere come gli eventi emergenziali influenzino i sistemi regionali e se la pandemia abbia innescato o meno evoluzioni nei modelli di regionalismo dei due paesi. A tal fine, il lavoro di ricerca è stato articolato in due parti: la prima parte si è focalizzata sulla ricostruzione delle teorie sull'emergenza e sui modelli di "Costituzione delle emergenze" affermatisi nel Secondo dopoguerra in Europa. In particolare, si è ricostruito lo sviluppo delle teorie sull'emergenza, dal decisionismo di Carl Schmitt alle riflessioni di Santi Romano in Italia, fino ad arrivare al "derecho de excepción" spagnolo. Si sono poi confrontati i modelli di gestione dell'emergenza, distinguendo tra ordinamenti nei quali vi è una disciplina costituzionale dell'emergenza (come Francia, Germania e Spagna) e ordinamenti, i quali si configurano come "non modello" o “modello ambiguo” (come Stati Uniti e Italia). Nell’ambito di tale classificazione, la Costituzione italiana è stata definita come “non modello” in quanto non prevede uno Statuto delle emergenze, affidandosi la gestione emergenziale al decreto-legge (art. 77 Cost.) e alla legislazione ordinaria sulla protezione civile. Al contrario, l’ordinamento spagnolo è stato classificato come “modello razionalizzato a tutele parallele” in quanto la Costituzione del 1978 disciplina minuziosamente tre stati di eccezione, stato di allarme, stato di eccezione e stato di assedio (art. 116 CE), poi regolati dalla Ley Orgánica 4/1981, de 1 de junio, de los estados de alarma, excepción y sitio. La seconda parte della tesi è stata dedicata all'analisi della gestione dell'emergenza sanitaria da Covid-19 in Italia e Spagna con particolare attenzione ai raccordi tra Stato centrale e Autonomie territoriali. La pandemia, configurabile come Complex Intergovernmental Problem per la necessità di coordinamento tra diversi livelli di governo, ha messo in luce le criticità dei sistemi regionali. In Italia, la gestione della prima ondata pandemica è stata caratterizzata da un forte accentramento del potere nel Governo, con un ruolo marginale delle Regioni, attraverso l'uso massiccio di decreti del Presidente del Consiglio dei ministri (d.P.C.m.). Solo con il decreto-legge n. 33/2020 si è assistito a una maggiore autonomia regionale. In Spagna, la dichiarazione dell’estado de alarma ha inizialmente centralizzato la gestione, ma la successiva fase 2 di desescalada ha condotto ad una forma attenuata di "federalismo collaborativo" con maggiore autonomia per le Comunità Autonome. Durante la seconda ondata pandemica, l'Italia ha mantenuto un modello centralizzato con una debole cooperazione regionale, mentre la Spagna ha adottato un modello decentrato, attribuendo ai Presidenti delle Comunità Autonome un ruolo chiave. La gestione della campagna vaccinale ha visto in Italia le Regioni come esecutrici del piano nazionale con margini di manovra, ma con disomogeneità nell'attuazione. In Spagna, le Comunità Autonome hanno avuto un ruolo fondamentale non solo nell'attuazione ma anche nella definizione della strategia vaccinale. Tendenze che si sono mantenute anche durante la gestione della terza e della quarta ondata pandemica. Infine, la tesi analizza l'impatto delle decisioni delle Corti costituzionali italiana e spagnola sulla gestione dell'emergenza. Il Tribunal Constitucional spagnolo ha dapprima adottato un approccio "demolitorio" censurando diversi decreti emergenziali, in particolare riguardo alla limitazione dei diritti fondamentali durante lo stato di allarme (STC 148/2021) e alla delega di poteri alle CCAA (STC 183/2021), per poi operare un overruling con la STC 136/2024. La Corte costituzionale italiana, con la sentenza n. 37/2021, ha affermato la competenza esclusiva dello Stato in materia di profilassi internazionale, centralizzando la gestione dell'emergenza e promuovendo un "regionalismo della separazione". Le conclusioni della ricerca evidenziano come la pandemia abbia messo in discussione l'equilibrio tra poteri centrali e periferici in entrambi i paesi, rivelando criticità nei sistemi di decentramento e la necessità di ripensare i regionalismi. Si suggerisce di attenuare la rigida separazione delle competenze in Italia e di valorizzare le sedi di raccordo, proponendo anche per la Spagna un regionalismo più cooperativo. La tesi auspica un modello multilivello con strumenti di concertazione strutturati per una governance efficace delle emergenze, basato sui principi dello Stato regionale e su una pianificazione strategica