Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

L'Italia come modello per l'Europa e per il mondo nelle politiche sanitarie per il trattamento dell'epatite cronica da HCV

The World Health Organization foresees the elimination of HCV infection by 2030. In light of this and the curre nt, nearly worldwide, restriction in direct-acting agents (DAA) accessibility due to their high price, we aimed to evaluate the cost-effectiveness of two alternative DAA treatment policies: Policy 1 (universal): treat all patients, regardless of the fibrosis stage; Policy 2 (prioritized): treat only priori tized patients and delay treatment of the remaining patients until reaching stage F3. T he model was based on patient’s data from the PITER cohort. We demonstrated that extending HC V treatment of patients in any fibrosis stage improves health outcomes and is cost-effective

La transformación de las noticias: Walter Lippmann y la opinión pública.

Tras la Primera Guerra Mundial, Walter Lippmann analiza los inconvenientes de las estrategias de comunicación de masas impulsadas por el periodismo, enfocándose en la transformación de los patrones simbólicos de las narraciones públicas. Su análisis se inspira en la complejidad de la situación política derivada del Tratado de Versalles y definida por los catorce puntos de Thomas Woodrow Wilson, en consonancia con el debate más amplio concerniente a la yuxtaposición de ganadores/ perdedores. El impacto social de los periódicos revela no sólo los rápidos cambios funcionales de la opinión pública dentro de las zonas urbanas, sino también la transformación de la información colectiva en una época caracterizada por estereotipos arraigados, por símbolos nacionalistas y por mitos populares. Lippman demostró que no deberían subestimarse los estereotipos, los símbolos y los mitos en los años que anuncian el desarrollo del totalitarismo, especialmente si estos se refieren a técnicas de propaganda y persuasión informativa. La construcción del consenso de masas depende de los patrones retóricos que inspiran el discurso periodístico, como subraya Lippmann: “Los hombres dominan menos palabras que ideas para expresar, y el lenguaje [...] es un diccionario de metáforas desvaídas”. De ahí el análisis certero del impacto social de los reporteros y agentes de prensa ante la lluvia eléctrica de las últimas décadas, con el propósito de sondear la “naturaleza de las noticias” y fomentar "la detección de estereotipos" que influyen en la opinión pública y en el comportamiento colectivo

Per la formazione degli insegnanti di ginnastica in Italia: le Scuole Magistrali (1879-1882) e i Corsi autunnali per i maestri elementari (1878-1883)

This paper analyses the laws, rules and education principles which regulated and ensured the establishment of courses to qualify as a gymnastics teacher in Italy in the second half of the 19th century. The aim of the research is to point out teaching and learning approaches applied in teachers’ schools (so-called Scuole Magistrali) and special qualifying courses (i.e. Corsi autunnali), in order to provide a better understanding of teacher professionalism. Findings regarding Italian teacher training are compared with those collected in other European states in order to highlight the extent to which teacher education programs developed according to similar paths when gymnastics became a compulsory subject in European schools

MODELS, INFERENCES, AND REPRESENTATIONS IN SCIENTIFIC INQUIRY

The research project is proposed by a PRIN group of Italian teams formed in the 1990s, under the leadership of Lorenzo Magnani of the PAVIA Unit, in the framework of intensive international collaborations. The project involves 10 units, representative of Italian Philosophy of Science, and forms a consistent group, involving a cross participation of its members. The program is coherently linked to the activities of the Italian Society for Logic and Philosophy of Sciences (SILFS) - http://www.silfs.it the local coordinator of the BOLOGNA unit is the president of this Society. The connecting thread of the past research work realized by the group has been the role of models and simulations in the rational reconstruction of scientific inquiry. The title proposed this year, although a continuation of this fundamental research line, aims at further extending - especially by strengthening the interdisciplinary aspects - the basic subject of models in science with three goals that are shared by all the local teams: a) the analysis of explanatory and creative inferential/representational strategies from a cognitive, epistemological, and computational perspective, also involving the computational modeling of concepts and the development of experimental studies; b) the refinement of the logical and mathematical tools required to develop the basic ideas and to better analyze the concepts of inference and representation; c) the analysis of modeling with respect to the notions of foundations, multilevel explanation, and emergence in the naturalistic perspective of empirical science including physics - a naturalized model of metaphysical knowledge \u2013 biology, and contemporary brain sciences. The project's units of the University of Macerata will focus on the following subject-matter: -MACERATA: Multilevel explanation in science and ontology. Here the others interrelated subject-matters of the other project's units: -PAVIA: Scientific models, representations, and abductive inferences in the light of a new \u201ceco-cognitive epistemology\u201d -BOLOGNA: Reasoning and non-classical inferences: proof theory, semantics and applications -ROME 3: Physical models of the world and naturalism -MILAN: Emergence and fundamentality -PISA: Decision under risk and uncertainty: a logical and epistemological analysis -TRIESTE: Confirmation, verisimilitude, and realism: issues in the logic and epistemology of scientific change -CHIETI/PESCARA Frames of reasoning and limitations of rational behaviour: theoretical and experimental research from the cognitive, social and cultural point of view -CAGLIARI: From models to logic: structures, logification and equivalence between logics -SASSARI: Properties: fundamental, intrinsic, involved in truth-making, grounding causal power

New data from the Italian National Register of Congenital Coagulopathies, 2016 Annual Survey

In Italy, the National Register of Congenital Coagulopathies (NRCC) collects epidemiological and therapeutic data from patients affected by haemophilia A (HA), haemophilia B (HB), von Willebrand's disease (vWD) and other rare coagulation disorders. Here we present data from the 2016 annual survey

Efficacy of Long-Term Treatment of Autosomal Recessive Hypercholesterolemia With Lomitapide: A Subanalysis of the Pan-European Lomitapide Study

Background and aim: Autosomal recessive hypercholesterolemia (ARH) is a rare autosomal recessive disorder of low-density lipoprotein (LDL) metabolism caused by pathogenic variants in the LDLRAP1 gene. Like homozygous familial hypercholesterolemia, ARH is resistant to conventional LDL-lowering medications and causes a high risk of atherosclerotic cardiovascular diseases (ASCVDs) and aortic valve stenosis. Lomitapide is emerging as an efficacious therapy in classical HoFH, but few data are available for ARH.Results: This is a subanalysis carried out on nine ARH patients included in the Pan-European Lomitapide Study. The age at starting lomitapide was 46 (interquartile range (IQR), 39.0-65.5) years, with a median treatment duration of 31.0 (IQR 14.0-40.5) months. At baseline, four (44.4%) patients had hypertension, one (11.1%) had diabetes mellitus, two (22.2%) were active smokers, and five (55.5%) reported ASCVD. The baseline LDL-C was 257.0 (IQR, 165.3-309.2) mg/dL. All patients were on statins plus ezetimibe, three were receiving Lipoprotein apheresis (LA), and one was also receiving proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). The addition of lomitapide (mean dose, 10 mg) resulted in the achievement of a median on-treatment LDL-C of 101.7 mg/dL (IQR, 71.3-138.3; 60.4% reduction from baseline), with a best LDL-C value of 68.0 mg/dL (IQR, 43.7-86.7; 73.5% reduction from baseline). During follow-up, one patient stopped both PCSK9i and LA. Recurrence of ASCVD events was reported in one patient. The median on-treatment aspartate transaminase and alanine transaminase values were 31.1 (IQR, 22.6-48.3) U/L and 31.1 (IQR, 27.2-53.8) U/L, respectively. Among six ARH patients with available fibroscan examination, liver stiffness values recorded at the last visit were within the normal range (median, 4.7 KPa; IQR, 3.6-5.3 KPa).Conclusion: Lomitapide is effective and safe in ARH therapy as well as in classical HoFH