PERCORSI DI SCRITTURA PER COMUNICARE, INVENTARE, IMPARARE. ATTIVITÀ DIDATTICHE E PROVE DI VERIFICA DALLA SCUOLA PRIMARIA AL BIENNIO DELLA SCUOLA SECONDARIA DI SECONDO GRADO

Da una ricerca condotta inizialmente nell’ambito dell’IRRE Lombardia, e successivamente ripresa e aggiornata alla luce dei più recenti documenti per la scuola primaria e secondaria, nascono questi percorsi di scrittura destinati alla scuola dell’obbligo e guidati dall’idea che saper scrivere, in quanto strumento essenziale per l’esercizio di una cittadinanza consapevole, sia una competenza da introdurre, fondare e praticare fin dai primi anni di scuola, perché ciascuno possa poi svilupparla per tutto il corso della vita.L’ipotesi curricolare si articola in tre filoni “verticali”, dal primo al decimo anno di scolarità, orientati rispetto ad uno scopo: scrivere per comunicare, scrivere per inventare, scrivere per imparare. Il curricolo si struttura in unità di apprendimento, in cui la scrittura viene sviluppata in situazioni significative e per lo più autentiche, con attività via via più complesse in ragione del livello scolare e in modo integrato alle altre abilità d’uso della lingua.In questa proposta tipologie e forme testuali vengono analizzate e utilizzate come strumenti efficaci per raggiungere un risultato comunicativo e non come dispositivi per esercitazioni tecniche e/o decontestualizzate.Al termine dei tre percorsi complessivi si sono predisposte delle prove di verifica, strutturate per livelli di scolarizzazione, in modo da poter testare, per gli allievi, le competenze specifiche dichiarate per i tre filoni e in modo da poter offrire all’insegnante una visione articolata dello sviluppo dell’abilità di scrittura negli anni e rispetto a scopi e testi differenziati.Using writing to communicate, invent, learnFrom a study conducted initially within IRRE Lombardia which was subsequently resumed and updated in the light of the most recent documents for primary and secondary school, these experiences in writing at school are guided by the idea that knowing how to write is an essential tool for becoming aware citizens. This skill needs to be introduced, established and practiced starting from the first years at school, so that people can continue to develop it throughout life.The proposed curriculum is divided into three "vertical" segments, from first to tenth grade, each one aimed at a single purpose: writing to communicate, writing to invent, writing to learn. The curriculum is structured in learning units where writing is developed in authentic, meaningful situations, with more and more complex activities based on the academic level and in an integrated manner with the other language skills.In this proposal, textual types and forms are analyzed and used as effective tools to achieve communication results rather than as devices for technical and/or decontextualized exercises.Upon completion of the three experiences, verification tests structured according to level were administered in order to test the specific competence in each of the three areas. This offers the teacher an articulated vision of the development of the ability to write over the years, with regard to different texts and purposes

Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation

Background: Acromegaly, an orphan disease usually caused by a benign pituitary tumour, is characterised by hyper-secretion of growth hormone (GH) and insulin-like growth factor I (IGF-1). It is associated with reduced life expectancy, cardiovascular problems, a variety of insidiously progressing detrimental symptoms and metabolic malfunction. Treatments include surgery, radiotherapy and pharmacotherapy. Pegvisomant (PEG) is a genetically engineered GH analogue licensed as a third or fourth line option when other treatments have failed to normalise IGF-1 levels. Methods: Evidence about effectiveness and cost-effectiveness of PEG was systematically reviewed. Data were extracted from published studies and used for a narrative synthesis of evidence. A decision analytical economic model was identified and modified to assess the cost-effectiveness of PEG. Results: One RCT and 17 non-randomised studies were reviewed for effectiveness. PEG substantially reduced and rapidly normalised IGF-1 levels in the majority of patients, approximately doubled GH levels, and improved some of the signs and symptoms of the disease. Tumour size was unaffected at least in the short term. PEG had a generally safe adverse event profile but a few patients were withdrawn from treatment because of raised liver enzymes. An economic model was identified and adapted to estimate the lower limit for the cost-effectiveness of PEG treatment versus standard care. Over a 20 year time horizon the incremental cost-effectiveness ratio was pound81,000/QALY and pound212,000/LYG. To reduce this to pound30K/QALY would require a reduction in drug cost by about one third. Conclusion: PEG is highly effective for improving patients' IGF-1 level. Signs and symptoms of disease improve but evidence is lacking about long term effects on improved signs and symptoms of disease, quality of life, patient compliance and safety. Economic evaluation indicated that if current standards (UK) for determining cost-effectiveness of therapies were to be applied to PEG it would be considered not to represent good value for money

Clinical, quality of life, and economic value of acromegaly disease control

Although acromegaly is a rare disease, the clinical, economic and health-related quality of life (HRQoL) burden is considerable due to the broad spectrum of comorbidities as well as the need for lifelong management. We performed a comprehensive literature review of the past 12 years (1998–2010) to determine the benefit of disease control (defined as a growth hormone [GH] concentration <2.5 μg/l and insulin-like growth factor [IGF]-1 normal for age) on clinical, HRQoL, and economic outcomes. Increased GH and IGF-1 levels and low frequency of somatostatin analogue use directly predicted increased mortality risk. Clinical outcome measures that may improve with disease control include joint articular cartilage thickness, vertebral fractures, left ventricular function, exercise capacity and endurance, lipid profile, and obstructive apnea events. Some evidence suggests an association between controlled disease and improved HRQoL. Total direct treatment costs were higher for patients with uncontrolled compared to controlled disease. Costs incurred for management of comorbidities, and indirect cost could further add to treatment costs. Optimizing disease control in patients with acromegaly appears to improve outcomes. Future studies need to evaluate clinical outcomes, as well as HRQoL and comprehensive economic outcomes achieved with controlled disease

Italian regional health service costs for diagnosis and 1-year treatment of ADHD in children and adolescents

The main aim of this study was to estimate the costs associated with diagnostic assessment and 1-year therapy in children and adolescents enrolled in 18 ADHD reference centres. Data concerning 1887 children and adolescents from the mandatory ADHD registry database during the 2012-2014 period were analysed. The overall diagnostic and treatment costs per patient amounts to \u20ac574 and \u20ac830, respectively. The ADHD centre, the school as sender, and the time to diagnosis constitute cost drivers. Non-pharmacological therapy resulted as being more expensive for patients concomitantly treated with drugs (\u20ac929) compared to those treated with psychological interventions alone (\u20ac590; p=0.006). This study gives the first and reliable estimate of the costs associated with both diagnosis and treatment of ADHD in Italy. Although costs associated with mental disorders are difficult to estimate, continuing efforts are need to define costs and resources to guarantee appropriate care, also for ADHD

One-year prospective follow-up of pharmacological treatment in children with attention-deficit/hyperactivity disorder.

OBJECTIVES: To delineate the safety and tolerability profile of methylphenidate and atomoxetine in children and adolescents with attention deficit hyperactivity disorder (ADHD) monitored for more than 1 year. DESIGN: A cohort study analyzing data from the national ADHD register on patients from the Lombardy Region treated with MPH or atomoxetine. PARTICIPANTS: A total of 229 children (median age 11 years, range 6-17), enrolled in 15 regional centers between June 2007 and May 2010. RESULTS: The prevalence rate of pharmacological treatment for ADHD was 0.23%, whereas the estimated ADHD prevalence in the population was 0.95%. In total, 73.8% of patients had been treated with atomoxetine (10-90 mg daily) or MPH (10-75 mg daily); 22% of patients also received an additional psychotropic drug. Of the treated children, 26.9% discontinued the drug prior to 1 year of treatment, mostly because of adverse effects (28.6%). No new or unexpected adverse events (rate 39.2%) were encountered. Decreased appetite, headache, and unstable mood were the leading events. The most severe events occurred in two boys: one experienced absence seizures for the first time with MPH, the other experienced hallucinations with atomoxetine. Therapy was discontinued in ten male patients (7.7%) because of adverse events. All patients with adverse effects recovered well. CONCLUSIONS: A very low rate of ADHD prevalence was estimated in Italian children compared to that reported in other countries. Although the medications for ADHD are generally well tolerated, with only mild or minor adverse effects in most cases, their rational use can only be guaranteed by disseminating and monitoring evidence-based practices and by monitoring the safety and efficacy of treatments in both the short and long terms with appropriate tools and approache

27-Hydroxycholesterol modulation of low density lipoprotein metabolism in cultured human hepatic and extrahepatic cells

27-Hydroxycholesterol**, 25-hydroxycholesterol and cholesterol suppressed LDL uptake and degradation in human extrahepatic and hepatic cell lines in a concentration-dependent manner. Cholesterol was the least potent, and the inhibitory effect of oxysterols was more pronounced in skin fibroblasts and in endothelial cell line EAhy 926 than in hepatoma HepG2 cells. Shorter incubations were required for oxysterols to achieve 50% inhibition of LDL uptake and degradation in all cultured cells. The inhibition of LDL catabolism in extrahepatic cells by 27-hydroxycholesterol occurred at concentrations close to those observed in human plasma (0.2-0.6 microM). The results support a possible role of 27-hydroxycholesterol, a physiological oxysterol, in the regulation of cellular cholesterol homeostasis in non-hepatic tissues

One-year prospective follow-up of pharmacological treatment in children with attention-deficit/hyperactivity disorder

OBJECTIVES: To delineate the safety and tolerability profile of methylphenidate and atomoxetine in children and adolescents with attention deficit hyperactivity disorder (ADHD) monitored for more than 1 year. DESIGN: A cohort study analyzing data from the national ADHD register on patients from the Lombardy Region treated with MPH or atomoxetine. PARTICIPANTS: A total of 229 children (median age 11 years, range 6-17), enrolled in 15 regional centers between June 2007 and May 2010. RESULTS: The prevalence rate of pharmacological treatment for ADHD was 0.23%, whereas the estimated ADHD prevalence in the population was 0.95%. In total, 73.8% of patients had been treated with atomoxetine (10-90 mg daily) or MPH (10-75 mg daily); 22% of patients also received an additional psychotropic drug. Of the treated children, 26.9% discontinued the drug prior to 1 year of treatment, mostly because of adverse effects (28.6%). No new or unexpected adverse events (rate 39.2%) were encountered. Decreased appetite, headache, and unstable mood were the leading events. The most severe events occurred in two boys: one experienced absence seizures for the first time with MPH, the other experienced hallucinations with atomoxetine. Therapy was discontinued in ten male patients (7.7%) because of adverse events. All patients with adverse effects recovered well. CONCLUSIONS: A very low rate of ADHD prevalence was estimated in Italian children compared to that reported in other countries. Although the medications for ADHD are generally well tolerated, with only mild or minor adverse effects in most cases, their rational use can only be guaranteed by disseminating and monitoring evidence-based practices and by monitoring the safety and efficacy of treatments in both the short and long terms with appropriate tools and approaches