Abitudini ed ereditarietà: la rivincita di Lamarck?

Human phenotype, the set of characteristics manifested by a living organism, is determined by genetic information expression dependent on genome, epigenome and microbiome. There is a kind of bidirectionality between humans and their genome with significant influence by environment and human behaviour. In the timeline of evolution we see that genetic modifications take millions of years to take place and consolidate, as per Darwinian principles, but environment and our habits are able much more rapidly to influence our phenotypic response, through epigenetic and microbiotic pathways, as per Lamarckian hypothesis (Fig. 1). Our habits (physical, psychological, environment) are able to determine changes in gene expression and potentially influence our children's one. The evidence of these new concepts should be a further stimulus to a more conscious lifestyle

Un "selfie" in dialisi: valutazione delle abitudini personali degli infermieri di un centro dialisi

Introduction: Healthcare workers represent a population that is well analysed by health studies: since 1976, the Nurses' Health Study has been examining American nurses for health-related risks and is currently recruiting its third cohort. The survey models used are predominantly biomedical, i.e. based on the disease-healing scheme which focuses on purely biological factors with little or no assessment of psychological, behavioural and environmental aspects. The biopsychosocial assessment model, in its multifaceted nature, is probably more suitable for assessing occupational distress as a progressive cause of health worker burnout. It attributes the outcome of illness, as well as that of health, to the numerous, complex interactions of biological, psychological and social factors. In this work, we decided to evaluate the lifestyle and habits of a homogeneous population of nurses, all belonging to an Operative Unit of Nephrology (Pistoia). Methods: We decided to use unconventional instruments: a "selfie" questionnaire on habits, constructed with scientifically validated items, aimed at the self-assessment of habits, scientifically recognised as determinants of health (nutritional, behavioural, relational, physiological...), correlating it with the analysis of the receipts of the weekly shopping of the family unit of the nurse in the study, according to the principle that "we eat what we buy". Results and conclusion: Nurses evaluated in the study showed a frequent unhealthy lifestyle which can have negative effects on their health, on their family and, consequently, on their work environment. Questionnaire and focus group discussions were appreciated and potentially useful and effective in changing bad habits

Le abitudini al tempo del Coronavirus

Introduction: The COVID-19 pandemic that hit the humankind in December 2019, is steering quick and drastic changes to our habits. The goal of our research is the analysis of the emotional, healthy and physiological effects of this radical routine disruption, in a sample of 3000 Italian people. Methods: We made use of a 5-days flash survey in an anonymous way, available from April the 5th until April the 10th. Results: As expected, results show a healthy decrease, after just one month of lockdown, at several stages: emotional, relational, nutritional and physical. Conclusions: This quarantine period can be considered as an extreme example of immediate sedentary and isolation effects on people. Home habits such as basic physical activity, circadian rhythm routine, proper diet, and correct information consumption can be useful to increase our resilience in difficult times like the current one, but also in our next future

Physical Activity and Renal Transplantation

Renal transplantation is burdened by high cardiovascular risk because of increased prevalence of traditional and disease-specific cardiovascular risk factors and, consequently, patients are affected by greater morbidity and mortality. In renal transplanted patients, healthy lifestyle and physical activity are recommended to improve overall morbidity and cardiovascular outcomes. According to METs (Metabolic Equivalent Task; i.e. the amount of energy consumed while sitting at rest), physical activities are classified as sedentary (<3.0 METs), of moderate-(3.0 to 5.9 METs) or vigorous-intensity (≥6.0 METs). Guidelines suggest for patients with chronic kidney disease an amount of physical activity of at least 30 minutes of moderate-intensity activity five times per week (min 450 MET-minutes/week). Data on physical activity in renal transplanted patients, however, are limited and have been mainly obtained by mean of non-objective methods. Available data suggest that physical activity is low either at the start or during renal transplantation and this may be associated with poor patient and graft outcomes. Therefore, in renal transplanted patients more data on physical activity obtained with objective, accelerometer-based methods are needed. In the meanwhile, physical activity have to be considered as an essential part of the medical care for renal transplanted recipients

Barriers to Physical Activity in Chronic Hemodialysis Patients: A Single-Center Pilot Study in an Italian Dialysis Facility

Background/Aims: In patients on chronic dialysis a sedentary lifestyle is a strong, yet potentially modifiable, predictor of mortality. The present single-center pilot study evaluated social, psychological and clinical barriers that may hinder physical activity in this population. Methods: We explored the association between barriers to physical activity and sedentarism in adult patients at a chronic dialysis facility in Parma, Italy. We used different questionnaries exploring participation in physical activity, physical functioning, patient attitudes and preferences, and barriers to physical activity perceived by either patients or dialysis doctors and nurses. Results: We enrolled 104 patients, (67 males, 65%), mean age 69 years (79% of patients older than 60 years); median dialysis vintage 60 months (range 8-440); mean Charlson score 5.55, ADL (Activities of Daily Living) score 5.5. Ninety-two participants (88.5%) reported at least one barrier to physical activity. At multivariable analysis, after adjusting for age and sex, feeling to have too many medical problems (OR 2.99, 95% CI 1.27 to 7.07; P=0.012), chest pain (OR 10.78, 95% CI 1.28 to 90.28; P=0.029) and sadness (OR 2.59, 95% CI 1.10 to 6.09; P=0.030) were independently associated with physical inactivity. Lack of time for exercise counseling and the firm belief about low compliance/interest by the patients toward exercise were the most frequent barriers reported by doctors and nurses. Conclusion: We identified a number of patient-related and health personnel-related barriers to physical activity in patients on chronic dialysis. Solutions for these barriers should be addressed in future studies aimed at increasing the level of physical activity in this population

L'attività fisica in dialisi peritoneale: le opinioni dei nefrologi

In occasione del XVII convegno nazionale del Gruppo di Studio SIN "Dialisi Peritoneale", svoltosi a Montecatini Terme (20–22 Marzo 2014), è stato distribuito un questionario a 141 medici con l'intento di rilevare le opinioni dei nefrologi italiani sulla problematica dell'attività fisica nei pazienti in dialisi peritoneale, e sulle "barriere" che ne impediscono lo sviluppo. La totalità del campione intervistato concorda sull'utilità dell'esercizio fisico e sulla necessità di incrementarlo nella popolazione dialitica. Il 90% degli intervistati reputa che l'attività fisica sia un'importante problematica clinica, e il 78% riesce a trovare il tempo per informarsi riguardo le abitudini del paziente in merito all'esercizio. La maggioranza degli intervistati (61%) ritiene il paziente interessato e, se opportunamente stimolato, disposto ad incrementare l'esercizio fisico (64%). Tuttavia, nonostante le preoccupazioni in merito alla sicurezza dell'attività fisica in dialisi (85%), non tutti si considerano capaci di effettuare una prescrizione in merito (78%). L'86% degli intervistati riferisce di fornire consigli in merito all'attività fisica ma di fornire solo raramente materiale informativo scritto (7%), consigliare al paziente specialisti del settore, e quasi mai di consegnare attrezzature atte a svolgere l'attività fisica indicata (3%). In conclusione, mentre traspare l'interesse a contrastare la sedentarietà e favorire l'attività fisica nei pazienti in dialisi peritoneale, la reale implementazione appare difficile e problematica. È quindi auspicabile una collaborazione scientifica e applicativa che coinvolga più gruppi di studio e più figure professionali dedicate allo sviluppo dell'attività ed esercizio fisico in dialisi peritoneale

Citrate high volume on-line hemodiafiltration modulates serum Interleukin-6 and Klotho levels: the multicenter randomized controlled study \u201cHephaestus

Background: Studies addressing the anti-inflammatory properties of citrate dialysate enrolled patients in both hemodialysis (HD) and hemodiafiltration (HDF), the latter not adjusted for adequate convective exchange. This is a potential source of confounding in that HDF itself has anti-inflammatory effects regardless of the buffer, and optimal clinical outcomes are related to the amount of convection. Methods: To distinguish the merits of the buffer from those of convection, we performed a 6-month, prospective, randomized, crossover AB-BA study. Comparisons were made during the 3-month study period of on-line HDF with standard dialysate containing three mmol of acetic acid (OL-HDFst) and the 3-month of OL-HDF with dialysate containing one mmol of citric acid (OL-HDFcit). Primary outcome measure of the study was interleukin-6 (IL-6). Klotho, high sensitivity C-reactive protein (hsCRP), fetuin and routine biochemical parameters were also analyzed. Results: We analyzed 47 patients (mean age 64 years, range 27-84 years) enrolled in 10 participating Nephrology Units. Convective volumes were around 25 L/session with 90 percent of sessions > 20 L and f2-microglobulin reduction rate 76% in both HDFs. Baseline median IL-6 values in OL-HDFst were 5.6 pg/ml (25:75 interquartile range IQR 2.9:10.6) and in OL-HDFcit 6.6 pg/ml (IQR 3.4:11.4 pg/ml). The difference was not statistically significant (p 0.88). IL-6 values were lower during OL-HDFcit than during OL-HDFst, both when analyzed as the median difference of overall IL-6 values (p 0.02) and as the median of pairwise differences between the baseline and the 3-month time points (p 0.03). The overall hsCRP values too, were lower during OL-HDFcit than during OL-HDFst (p 0.01). Klotho levels showed a time effect (p 0.02) and the increase was significant only during OL-HDFcit (p 0.01). Conclusions: Citrate buffer modulated IL-6, hsCRP and Klotho levels during high volume OL-HDF. These results are not attributable to differences in the dialysis schedule and may suggest a potential anti-inflammatory and anti-senescent effect of citrate even in dialysis patients with low grade inflammatio

Born to run… ma anche per camminare. Attività motoria, il primo pilastro dell'evoluzione umana

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