Burden of acute otitis media in primary care pediatrics in Italy: A secondary data analysis from the Pedianet database

Background: The incidence of acute otitis media (AOM) vary from country to country. Geographical variations together with differences in study designs, reporting and settings play a role. We assessed the incidence of AOM in Italian children seen by primary care paediatricians (PCPs), and described the methods used to diagnose the disease.Methods: This secondary data analysis from the Pedianet database considered children aged 0 - 6 years between 01/2003 and 12/2007. The AOM episodes were identified and validated by means of patient diaries. Incidence rates/100 person-years (PY) were calculated for total AOM and for single or recurrent AOM.Results: The 92,373 children (52.1% males) were followed up for a total of 227,361 PY: 23,039 (24.9%) presented 38,241 episodes of AOM (94.6% single episodes and 5.4% recurrent episodes). The total incidence rate of AOM in the 5-year period was 16.8 episodes per 100 PY (95% CI: 16.7-16.9), including single AOM (15.9 episodes per 100 PY; 95% CI: 15.7-16.1) and recurrent AOM (0.9 episodes per 100 PY; 95% CI: 0.9-0.9). There was a slight and continuously negative trend decrease over time (annual percent change -4.6%; 95%CI: -5.3, -3.9%). The AOM incidence rate varied with age, peaking in children aged 3 to 4 years (22.2 episodes per 100 PY; 95% CI 21.8-22.7). The vast majority of the AOM episodes (36,842/38,241, 96.3%) were diagnosed using a static otoscope; a pneumatic otoscope was used in only 3.7%.Conclusions: Our data fill a gap in our knowledge of the incidence of AOM in Italy, and indicate that AOM represents a considerable burden for the Italian PCP system. Educational programmes concerning the diagnosis of AOM are needed, as are further studies to monitor the incidence in relation to the introduction of wider pneumococcal conjugate vaccines

T cell cytolytic capacity is independent of initial stimulation strength.

How cells respond to myriad stimuli with finite signaling machinery is central to immunology. In naive T cells, the inherent effect of ligand strength on activation pathways and endpoints has remained controversial, confounded by environmental fluctuations and intercellular variability within populations. Here we studied how ligand potency affected the activation of CD8+ T cells in vitro, through the use of genome-wide RNA, multi-dimensional protein and functional measurements in single cells. Our data revealed that strong ligands drove more efficient and uniform activation than did weak ligands, but all activated cells were fully cytolytic. Notably, activation followed the same transcriptional pathways regardless of ligand potency. Thus, stimulation strength did not intrinsically dictate the T cell-activation route or phenotype; instead, it controlled how rapidly and simultaneously the cells initiated activation, allowing limited machinery to elicit wide-ranging responses

EFFETTI DI UN PERCORSO CLINICO- STRUMENTALE MULTIDISCIPLINARE PER LA RIABILITAZIONE DELLA DISFAGIA NELL\u2019ICTUS CEREBRALE: STUDIO SU 1391 PAZIENTI

Introduzione. I disturbi della deglutizione rappresentano una frequente conseguenza dell\u2019ictus cerebrale con ricadute negative sulla gestione della fase acuta, sui tempi di degenza e sull\u2019esito (morbosit\ue0 e mortalit\ue0). Lo scopo del presente lavoro \ue8 valutare l\u2019efficacia di un percorso multidisciplinare, clinico e strumentale, specifico per l\u2019individuazione precoce e la riabilitazione del disturbo disfagico in pazienti con ictus cerebrale. Materiali e metodi. Sono stati analizzati 1391 pazienti con ictus cerebrale. Sono stati inclusi nello studio pazienti con et\ue0 compresa tra 18-80 anni e con disfagia neurogena. Sono stati esclusi pazienti affetti da disfagia antecedente l\u2019ictus, demenza o grave decadimento cognitivo. Per ogni paziente sono stati raccolti tutti i dati clinici tra cui (misure di outcome principali) tipo di nutrizione al momento del ricovero e alla dimissione, comparsa di complicanze broncopolmonari, terapie antibiotiche (monoterapia o in associazione) e mortalit\ue0. \uc8 stata effettuata un\u2019analisi per valutare l\u2019efficacia di un percorso clinico-strumentale multidisciplinare per la riabilitazione della disfagia sul recupero della disfagia, sulle complicanze polmonari e sull\u2019esito in pazienti con ictus cerebrale. Risultati. Sono stati inclusi nello studio 193 pazienti di cui 58 avevano eseguito il percorso clinico-strumentale specifico per disfagia. I risultati hanno mostrato che l\u2019effettuazione di percorso clinico-strumentale multidisciplinare per la riabilitazione della disfagia ha permesso di migliorare il recupero dei disturbi deglutitori, ridurre la necessit\ue0 di terapia antibiotica in associazione e ridurre la percentuale di decessi. Conclusioni. Un percorso clinico multidisciplinare specifico per la diagnosi e trattamento della disfagia pu\uf2 migliorare il recupero delle funzioni deglutitorie e diminuire le complicanze correlate

Effect of Global Postural Rehabilitation program on spatiotemporal gait parameters of parkinsonian patients: a three-dimensional motion analysis study

The aim of the present study was to evaluate the effects of a Global Postural Rehabilitation (GPR) program on motor symptoms and gait parameters of patients with Parkinson’s disease (PD) by means of three-dimensional motion analysis study. Ten subjects with clinical diagnosis of PD were enrolled (study group). Age-, sexand disease duration-matched PD patients were recruited as a control group (no treatment). Three-dimensional motion analysis was conducted by means of a stereophotogrammetric system. After basal evaluation, the study group underwent a specific rehabilitation program consisting of individual 40 min GPR daily sessions, 3 days a week for 4 consecutive weeks. Neurological status and spatiotemporalgait parameters of the two groups were evaluated at study entry (t0), at 4 weeks (t1, end of rehabilitation protocol) and at 8 and 12 weeks (t2 and t3, follow-up evaluation). At baseline evaluation, the two groups did not differ in clinical features and gait parameters. At the end of rehabilitation protocol (t1) and at follow-up evaluation (t2 and t3), a significant improvement in temporal gait parameters and UPDRS scores was observed in all treated patients as compared to baseline and controls. Our preliminary findings showed that significant improvements in mobility and gait parameters of PD patients can be obtained through GPR treatment, with a parallel improvement in clinical status. Quantitative analysis of gait pattern can be considered a useful tool to assess the efficacy of rehabilitation interventions in patients affected by PD