Co-Occurring Psychiatric and Substance Use Disorders: Clinical Survey Among a Rural Cohort of Italian Patients

Purpose: Dual diagnosis (DD) is the co-occurrence of both a mental illness and a substance use disorder (SUD). Lots of studies have analysed the integrated clinical approach, which involves both psychiatry and toxicology medical experts. The purpose of this study is to analyse the socio-demographic characteristics and treatment strategies of patients with DD in a rural area of Italy. Patients and Methods: Clinical data of 750 patients were collected in 2016 through the analysis of health plan records. Results: The rate of co-occurring disorders is highly variable among people with SUD. In the considered area, patients with DD are 24%, of these only 46.1% have been treated with an integrated clinical program. Moreover, this percentage is further reduced (35.8%) if only patients with heroin use disorder are considered. Conclusion: A comprehensive revision of DD treatment is needed, especially for people suffering from heroin use disorder and living in remote areas. Meticulous data analysis from other addiction health services of rural areas could be necessary to identify a science-based clinical intervention

Physical exercise in major depression: Reducing the mortality gap while improving clinical outcomes

Major depression shortens life while the effectiveness of frontline treatments remains modest. Exercise has been shown to be effective both in reducing mortality and in treating symptoms of major depression, but it is still underutilized in clinical practice, possibly due to prevalent misperceptions. For instance, a common misperception is that exercise is beneficial for depression mostly because of its positive effects on the body (\u201cfrom the neck down\u201d), whereas its effectiveness in treating core features of depression (\u201cfrom the neck up\u201d) is underappreciated. Other long-held misperceptions are that patients suffering from depression will not engage in exercise even if physicians prescribe it, and that only vigorous exercise is effective. Lastly, a false assumption is that exercise may be more harmful than beneficial in old age, and therefore should only be recommended to younger patients. This narrative review summarizes relevant literature to address the aforementioned misperceptions and to provide practical recommendations for prescribing exercise to individuals with major depression

Plasma levels of matrix metalloproteinase-2, -3, -10, and tissue inhibitor of metalloproteinase-1 are associated with vascular complications in patients with type 1 diabetes: The EURODIAB Prospective Complications Study

Impaired regulation of extracellular matrix remodeling by matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase (TIMP) may contribute to vascular complications in patients with type 1 diabetes. We investigated associations between plasma MMP-1, -2, -3, -9, -10 and TIMP-1, and cardiovascular disease (CVD) or microvascular complications in type 1 diabetic patients. We also evaluated to which extent these associations could be explained by low-grade inflammation (LGI) or endothelial dysfunction (ED). Methods: 493 type 1 diabetes patients (39.5 ± 9.9 years old, 51% men) from the EURODIAB Prospective Complications Study were included. Linear regression analysis was applied to investigate differences in plasma levels of MMP-1, -2, -3, -9, -10, and TIMP-1 between patients with and without CVD, albuminuria or retinopathy. All analyses were adjusted for age, sex, duration of diabetes, Hba1c and additionally for other cardiovascular risk factors including LGI and ED. Results: Patients with CVD (n = 118) showed significantly higher levels of TIMP-1 [β = 0.32 SD (95%CI: 0.12; 0.52)], but not of MMPs, than patients without CVD (n = 375). Higher plasma levels of MMP-2, MMP-3, MMP-10 and TIMP-1 were associated with higher levels of albuminuria (p-trends were 0.028, 0.004, 0.005 and 0.001, respectively). Severity of retinopathy was significantly associated with higher levels of MMP-2 (p-trend = 0.017). These associations remained significant after further adjustment for markers of LGI and ED. Conclusions: These data support the hypothesis that impaired regulation of matrix remodeling by actions of MMP-2, -3 and-10 and TIMP-1 contributes to the pathogenesis of vascular complications in type 1 diabetes

Villes et urbanités au Maghreb

Le fait urbain est au cœur des mutations que vit le Maghreb. En quelques décennies l’urbanisation a été massive, rapide et parfois brutale tant les bouleversements dans les modes de vie et les structures sociales ont été profonds. Produit des transformations de la société, la ville est elle-même génératrice d’importantes mutations sociales. De tels processus interpellent la recherche urbaine, dont le dynamisme reflète toute l’acuité des problèmes posés par la transition en cours. Pour saisir cette complexité, les coordonnateurs de ce dossier et la rédaction de L’Année du Maghreb ont opté pour une entrée « par le bas », à l’échelle de ceux qui vivent la ville au quotidien. Les contributions portent sur les processus de production de l’urbain, du bâti et des espaces, les modes de vie, les pratiques et les représentations sociales induites par la ville, la construction des territoires urbains, le rapport entre l’espace voulu et l’espace vécu, la question de la gestion des cadres de vie, l’interaction enfin entre les politiques publiques et l’action collective. L’univers des signes par lesquels se disent et se lisent les villes est aussi le lieu où s’exprime l’exigence de nouvelles citoyennetés, déclinées du quartier à l’espace mondialisé, en passant par toutes les échelles de l’accès au politique

Villes et urbanitès au Maghreb

Le fait urbain est au cœur des mutations que vit le Maghreb. En quelques décennies l’urbanisation a été massive, rapide et parfois brutale tant les bouleversements dans les modes de vie et les structures sociales ont été profonds. Produit des transformations de la société, l’urbanisation est elle-même génératrice d’importantes mutations sociales. Pour autant, les villes du Maghreb ne sont pas homogènes. De grandes diversités les caractérisent : entre les pays maghrébins, à l’intérieur des pay..