Barriers and facilitators of effective self-management in asthma: systematic review and thematic synthesis of patient and healthcare professional views

Self-management is an established, effective approach to controlling asthma, recommended in guidelines. However, promotion, uptake and use among patients and health-care professionals remain low. Many barriers and facilitators to effective self-management have 25 been reported, and views and beliefs of patients and health care professionals have been explored in qualitative studies. We conducted a systematic review and thematic synthesis of qualitative research into self-management in patients, carers and health care professionals regarding self-management of asthma, to identify perceived barriers and facilitators associated with reduced effectiveness of asthma self-management interventions. Electronic databases and guidelines were searched systematically for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in patients with asthma. Thematic synthesis of the 56 included studies identified 11 themes: 1) partnership between patient and health care professional; 2) issues around medication; 3) education about asthma and its management; 4) health beliefs; 5) self-management interventions; 6) co-morbidities 7) mood disorders and anxiety; 8) social support; 9) non-pharmacological methods; 10) access to healthcare; 11) professional factors. From this, perceived barriers and facilitators were identified at the level of individuals with asthma (and carers), and health-care professionals. Future work addressing the concerns and beliefs of adults, adolescents and children (and carers) with asthma, effective communication and partnership, tailored support and education (including for ethnic minorities and at risk groups), and telehealthcare may improve how self-management is recommended by professionals and used by patients. Ultimately, this may achieve better outcomes for people with asthma

in keeping with the spirit of the albertine statute constitutionalisation of the national unification

This chapter deals with the difficult process of constitutionalisation which characterised Italian Unification. Constitutionalisation is a long-term phenomenon which had the purpose of giving constitutional forms to the Nation. The promulgation of the Albertine Statute is more the start than the arrival of this phenomenon. The focus of this investigation is, therefore, to study the Constitution through its evolution paying particular attention to the process of legal integration within the structures of the Albertine Statute and to the amendment mechanisms of the constitutional text. The preamble of the Albertine Statute speaks of «perpetual and irrevocable fundamental law». The word «perpetual» meant the prohibition of revoking constitutional concession, while the word «irrevocable» was intended as a pact between the Sovereign and the Nation. Over the years, very few were the changes to the letter of the Albertine Statute. The interpretation and the practice represented the most important mechanisms of constitutional change (implicit constitutional changes). A primary role was acknowledged to non-written norms. In this perspective, it may well be said that the Italian Constitution consisted in something more than the written text and dwelt in the spirit and not in the letter of the Albertine Statute

Helical multi-walled carbon nanotube-coated fibers for SPME determination of polycyclic aromatic hydrocarbons at ultra-trace levels in ice and snow samples

Polycyclic Aromatic Hydrocarbons (PAHs) detected in polar environment are recognized tracers of anthro- pogenic pollution. High sensitivity and selectivity are required for their analysis in ice and snow samples due to the presence at ultra-trace levels. In this study a solid-phase microextraction (SPME) gas chromatography-mass spectrometry (GC-MS) method for simultaneous determination of the 16 US-EPA priority pollutant PAHs in polar snow and ice samples was developed and validated. Helical multiwalled carbon nanotubes (HMWCNTs) were proposed for the first time as novel SPME coating. For optimization purposes a Central Composite Design and the multicriteria method of the desirability functions were applied to investigate the influence of extraction parameters, i.e. time and temperature as main factors. The optimal values were 68 °C for the extraction temperature and 60 min for the extraction time. The developed SPME-GC-MS method exhibited detection limits of 16 PAHs in the 0.1–1.2 ng/L range, a repeatability and an intermediate precision within 15% and 22% relative standard deviation, respectively, and good recovery rates in the 93.7 ( ±0.1)–119.7 ( ±0.2)% range for real spiked water sample, showing better analytical performance compared to commercial PDMS fibers. Enrichment factors in the 2670 ( ±290)–142120 ( ±580) range were calculated and a long fiber shelf-life with the possibility to reuse the fiber more than 200 times was achieved. Finally, the proposed method was successfully applied to the determination of PAHs in surface snow sam- ples collected in April 2019 at Ny- ̊Alesund, Svalbard. Its application to the detection of PAHs in samples collected during monitoring campaigns in the polar regions is expected in the near futur