L’attività dei Centri Antifumo italiani tra problematiche e aree da potenziare: i risultati di un’indagine svolta attraverso un questionario on-line

Introduzione. In Italia sono 295 i Servizi per la cessazione dal fumo di tabacco (Centri Antifumo - CA) afferenti al Servizio Sanitario Nazionale (SSN) censiti nel 2011 dall’Osservatorio Fumo, Alcol e Droga (OssFAD) dell’Istituto Superiore di Sanità. La presente indagine, condotta dall’OssFAD in collaborazione con i CA, è stata volta a rilevare alcune delle problematiche con le quali il personale dei CA si confronta per portare avanti la propria attività e le iniziative ritenute utili per migliorarla. Materiali e metodi. L’indagine è stata condotta dal 7 al 21 maggio 2012, mediante un questionario compilabile on-line composto da 5 brevi sezioni di domande con un totale di 38 items da completare. Il link al questionario on-line è stato inviato per e-mail a 322 indirizzi dei CA censiti nel 2011 dall’OssFAD. I dati raccolti sono stati elaborati statisticamente con il programma SPSS 20. Risultati. All’indagine hanno risposto 146 operatori dei CA (45,3%). Sebbene ci siano aspetti ormai consolidati dell’attività dei CA, sono ancora molte le criticità che gli operatori riscontrano nella loro attività. Le principali problematiche che influiscono in modo fondamentale/rilevante per la buona attività del centro sono le “Scarse o nulle risorse economiche” per il 60,7% del personale, “la mancanza di personale dedicato” per il 52,4% del personale; il “riconoscimento/mandato istituzionale del CA” per il 40,9% del personale. Tra le azioni ritenute più efficaci per facilitare l’accesso ai CA sono risultate la sensibilizzazione del personale sanitario (91%), in particolare dei medici di famiglia e l’inserimento delle prestazioni antitabagiche nei LEA (76,8%). Conclusioni. È auspicabile che l’attività dei CA riceva una maggiore attenzione, attraverso la dotazione di strutture, personale e finanziamenti adeguati a svolgere un importante ruolo nella tutela e promozione della salute

Latent tuberculosis infection in patients with chronic plaque psoriasis: Evidence from the Italian Psocare Registry

Background The nationwide prevalence of latent tuberculosis infection (LTBI) in Italian patients with psoriasis has never been investigated.Objectives To estimate the nationwide prevalence of LTBI in Italian patients with psoriasis who are candidates for systemic treatment.Methods Data were obtained from the Psocare Registry on those patients (n = 4946) with age > 18 years, systemic treatment at entry specified and tuberculin skin test (TST) performed according to the Mantoux method. LTBI diagnosis was based on a positive TST result in the absence of any clinical, radiological or microbiological evidence of active tuberculosis.Results Latent tuberculosis infection was diagnosed in 8.3% of patients with psoriasis (409 of 4946). The prevalence of LTBI was lower in patients on biologics than in those on conventional systemic treatments, ranging from 4.3% (19 of 444) of patients on adalimumab to 31% (eight of 26) of those on psoralenultraviolet A (P < 0.05). Independent factors associated with LTBI were male sex [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.04-1.62; P = 0.02], age over 55 years (OR 2.93, 95% CI 2.18-3.93; P < 0.001) and being entered into a conventional treatment (OR 3.83, 95% CI 3.10-4.74; P < 0.001). Positive history of tuberculosis was seen in 1% of patients (n = 49).Conclusions The nationwide prevalence of LTBI in Italian patients with psoriasis candidate to systemic treatment is high, and screening is recommended prior to biological treatment

Metabolic abnormalities associated with initiation of systemic treatment for psoriasis: evidence from the Italian Psocare Registry.

NCBINCBI Logo Skip to main content Skip to navigation Resources How To About NCBI Accesskeys Sign in to NCBI PubMed US National Library of Medicine National Institutes of Health Search database Search term Clear input Advanced Help Result Filters Display Settings: Abstract Send to: J Eur Acad Dermatol Venereol. 2013 Jan;27(1):e30-41. doi: 10.1111/j.1468-3083.2012.04450.x. Epub 2012 Feb 7. Metabolic abnormalities associated with initiation of systemic treatment for psoriasis: evidence from the Italian Psocare Registry. Gisondi P1, Cazzaniga S, Chimenti S, Giannetti A, Maccarone M, Picardo M, Girolomoni G, Naldi L; Psocare Study Group. Collaborators (368) Author information Abstract OBJECTIVE: To evaluate variations in laboratory parameters and diagnoses of selected clinical conditions up to 16 weeks after starting a new systemic psoriasis treatment for Psocare Registry enrollees. DESIGN: Prospective cohort study. SETTING: Italian public referral centres for psoriasis treatment. PATIENTS: First-time recipients (n = 10,539) of continuous systemic psoriasis treatment for at least 16 weeks. MAIN OUTCOME MEASURE: Mean variations in (weeks 8 and 16) and proportions of patients reaching a clinically meaningful increase in serum levels (week 16) of total and low-density lipoprotein cholesterol, triglycerides, aspartate amino transferase, alanine amino transferase and creatinine, as well as week-16 cumulative incidences of new diagnoses of diabetes mellitus and arterial hypertension. RESULTS: Mean cholesterol and triglyceride levels significantly increased in patients treated with acitretin or cyclosporine. Mean triglyceride levels also increased in efalizumab- and etanercept-treated patients. Mean transaminase values increased in methotrexate-treated patients, and mean aspartate amino transferase levels increased in infliximab-treated patients. The average serum creatinine value increased in cyclosporine-treated patients. Acitretin and cyclosporine were associated with risk of hypercholesterolaemia (odds ratios 1.51 and 1.34) and acitretin with risk of hypertriglyceridaemia (odds ratio 1.43). Methotrexate and infliximab were associated with risk of more than doubling the upper normal aspartate amino transferase (odds ratios 2.06 and 1.87) and alanine amino transferase (odds ratios 2.38 and 1.74) values. The relative risk of developing arterial hypertension and diabetes was increased for patients receiving cyclosporine (odds ratios 3.31 and 2.88). CONCLUSION: Systemic treatments for psoriasis resulted in heterogeneous effects on the parameters analysed

The cerebral cortex and complex cerebral functions

The cerebral cortex can be divided into a large isocortex or neocortex, a smaller allocortex (the hippocampal formation and the olfactory cortex) and a transition zone (the mesocortex) in between. The heterogeneous allocortex and the mesocortex have been discussed in Chap. 14. The various parts of the neocortex show large variations in the development of their constituent layers. The cortical areas that receive the primary sensory pathways via the thalamus form the granular cortex, in which layers II and IV are especially well developed. In the motor cortex, these layers are poorly developed (the agranular cortex), whereas the pyramidal layers III and V are well developed. Based on such differences in cytoarchitecture, Brodmann, von Economo and Koskinas and Sarkissov et al. published their brain maps (Sect. 15.2). Myeloarchitectonic maps were prepared by the Vogts and more recently by Nieuwenhuys et al. Nowadays, atlases combine data describing multiple aspects of brain structure from different subjects. The various cortical lobes are discussed in Sect. 15.3. The neocortex is the end station of all sensory projections from the thalamus and has extensive corticofugal projections via the internal capsule to the basal ganglia, the thalamus, the brain stem and the spinal cord. These connections have been extensively discussed in previous chapters. In this chapter, emphasis is on corticocortical projections, the long association and commissural tracts in particular, our knowledge of which has greatly increased (Sect. 15.4), hemispheric differences (Sect. 15.5), language and the brain (Sect. 15.6) and disorders of cortical connectivity, known as disconnection syndromes (Sect. 15.7). Classic disconnection syndromes were described in the late nineteenth century by Wernicke, Lissauer, Liepmann and Dejerine and include conduction aphasia, associative visual agnosia, apraxia and alexia without agraphia. Of some of these syndromes, old and new, the involvement of white matter tracts was studied. In 1965, Norman Geschwind reintroduced the disconnection paradigm, and, more recently, other disorders such as visual amnesia and prosopagnosia have also been attributed to disconnection mechanisms. The hodological paradigm may be extended beyond the classic disconnection syndromes by including disorders of hyperconnectivity. The term hodological syndromes was introduced to refer to cognitive and behavioural dysfunctions arising from pathologies of white matter pathways. Section 15.8 contains a discussion of the neuroanatomical basis of cognitive impairment in the primary degenerative dementias and is illustrated by a series of Clinical cases. The English terms of the Terminologia Neuroanatomica are used throughout.</p