Integrated Care for Chronic Diseases – State of the Art

Chronic diseases represent a high cost for healthcare systems, for individuals, families, businesses and governments. The World Health Organization (WHO) estimates that an increase of 10% of chronic diseases is associated with a reduction of 0.5% of annual economic growth. Primary care has proven to ensure high levels of efficiency, effectiveness, equity, safety, timely and centrality of the patient achieving better health outcomes and lower costs. The Chronic Care Model (CCM) proposes a proactive approach in assisting the empowerment of patients and their community. The CCM contributes to improving the quality of care and health outcomes and the reduction of inequalities (e.g., ethnicity, social status) too

Monte Carlo evaluation of the external gamma, neutron and muon induced background sources in the CUORE experiment

CUORE is a 1 ton scale cryogenic experiment aiming at the measurement of the Majorana mass of the electron neutrino. The detector is an array of 988 TeO2 bolometers used for a calorimetric detection of the two electrons emitted in the BB0n of 130Te. The sensitivity of the experiment to the lowest Majorana mass is determined by the rate of background events that can mimic a BB0n. In this paper we investigate the contribution of external sources i.e. environmental gammas, neutrons and cosmic ray muons to the CUORE background and show that the shielding setup designed for CUORE guarantees a reduction of this external background down to a level <1.0E-02 c/keV/kg/y at the Q-value, as required by the physical goal of the experiment.Comment: 14 pages, 7 figure

Large area Si low-temperature light detectors with Neganov-Luke effect

Next generation calorimetric experiments for the search of rare events rely on the detection of tiny amounts of light (of the order of 20 optical photons) to discriminate and reduce background sources and improve sensitivity. Calorimetric detectors are the simplest solution for photon detection at cryogenic (mK) temperatures. The development of silicon based light detectors with enhanced performance thanks to the use of the Neganov-Luke effect is described. The aim of this research line is the production of high performance detectors with industrial-grade reproducibility and reliability.Comment: 4 pages, 2 figure

Genome-Wide snp analysis of southern african populations provides new insights into the dispersal of bantu-Speaking groups

The expansion of Bantu-speaking agropastoralist populations had a great impact on the genetic, linguistic, and cultural variation of sub-Saharan Africa. It isgenerally accepted that Bantulanguages originated inanarea around thepresent borderbetweenCameroon and Nigeria approximately 5,000 years ago, from where they spread South and East becoming the largest African linguistic branch. The demic consequences of this event are reflected in the relatively high genetic homogeneity observed acrossmost of sub-Saharan Africapopulations. Inthiswork, weexploredgenome-wide singlenucleotidepolymorphismdata from28populations to characterize the genetic components present in sub-Saharan African populations. Combining novel data from four SouthernAfrican populations withpreviouslypublishedresults,we reject the hypothesis that the" non-Bantu" geneticcomponent reported inSouth-Eastern Africa (Mozambique) reflects extensive gene flow between incoming agriculturalist and resident hunter-gatherer communities.We alternatively suggest that this novel component is the result of demographic dynamics associated with the Bantu dispersal

Complex ancient genetic structure and cultural transitions in Southern African populations

The characterization of the structure of southern African populations has been the subject of numerous genetic, medical, linguistic, archaeological, and anthropological investigations. Current diversity in the subcontinent is the result of complex events of genetic admixture and cultural contact between early inhabitants and migrants that arrived in the region over the last 2000 years. Here, we analyze 1856 individuals from 91 populations, comprising novel and published genotype data, to characterize the genetic ancestry profiles of 631 individuals from 51 southern African populations. Combining both local ancestry and allele frequency based analyses, we identify a tripartite, ancient, Khoesan-related genetic structure. This structure correlates neither with linguistic affiliation nor subsistence strategy, but with geography, revealing the importance of isolation-by-distance dynamics in the area. Fine-mapping of these components in southern African populations reveals admixture and cultural reversion involving several Khoesan groups, and highlights that Bantu speakers and Coloured individuals have different mixtures of these ancient ancestries

Long term effectiveness on prescribing of two multifaceted educational interventions: Results of two large scale randomized cluster trials

Introduction: Information on benefits and risks of drugs is a key element affecting doctors' prescribing decisions. Outreach visits promoting independent information have proved moderately effective in changing prescribing behaviours. Objectives: Testing the short and long-term effectiveness on general practitioners' prescribing of small groups meetings led by pharmacists. Methods: Two cluster open randomised controlled trials (RCTs) were carried out in a large scale NHS setting. Ad hoc prepared evidence based material were used considering a therapeutic area approach - TEA, with information materials on osteoporosis or prostatic hyperplasia - and a single drug oriented approach - SIDRO, with information materials on me-too drugs of 2 different classes: barnidipine or prulifloxacin. In each study, all 115 Primary Care Groups in a Northern Italy area (2.2 million inhabitants, 1737 general practitioners) were randomised to educational small groups meetings, in which available evidence was provided together with drug utilization data and clinical scenarios. Main outcomes were changes in the six-months prescription of targeted drugs. Longer term results (24 and 48 months) were also evaluated. Results: In the TEA trial, one of the four primary outcomes showed a reduction (prescription of alfuzosin compared to tamsulosin and terazosin in benign prostatic hyperplasia: prescribing ratio -8.5%, p = 0.03). Another primary outcome (prescription of risedronate) showed a reduction at 24 and 48 months (-7.6%, p = 0.02; and -9,8%, p = 0.03), but not at six months (-5.1%, p = 0.36). In the SIDRO trial both primary outcomes showed a statistically significant reduction (prescription of barnidipine -9.8%, p = 0.02; prescription of prulifloxacin -11.1%, p = 0.04), which persisted or increased over time. Interpretation: These two cluster RCTs showed the large scale feasibility of a complex educational program in a NHS setting, and its potentially relevant long-term impact on prescribing habits, in particular when focusing on a single drug. National Health systems should invest in independent drug information programs. Trial Registration: Controlled-Trials.com ISRCTN05866587

Characterization of ZnSe scintillating bolometers for Double Beta Decay

ZnSe scintillating bolometers are good candidates for future Double Beta Decay searches, because of the 82Se high Q-value and thanks to the possibility of alpha background rejection on the basis of the scintillation signal. In this paper we report the characteristics and the anomalies observed in an extensive study of these devices. Among them, an unexpected high emission from alpha particles, accompanied with an unusual pattern of the light vs. heat scatter plot. The perspectives for the application of this kind of detectors to search for the Neutrinoless Double Beta Decay of 82Se are presented.Comment: 12 pages, 10 figure