Chagas disease at the crossroad of international migration and public health policies: why a national screening might not be enough

n/

Postural counseling represents a novel option in pain management of fibromyalgia patients

Background: Chronic pain is a key symptom in fibromyalgia (FM), and its management is still challenging for rheumatologists in daily practice. FM patients show psychological and psychiatric manifestations, going from mood and emotional disorders to depression and alexithymia that negatively impact their quality of life, limiting their daily activities. Since pharmacological strategies have a limited efficacy in FM pain, alternative or complementary non-pharmacological approaches have been introduced in the clinical management of FM. Patients and methods: This is a retrospective study on FM patients (n=52) treated with a novel integrated postural counseling (PC) rehabilitation program carried out by a counselor physiotherapist. The clinical impact of PC was evaluated by 1) a semi-structured interview using an ad hoc modified questionnaire McGill Illness Narrative Interview (MINI) 1 to obtain data on pain management by highlighting everyday experience of living with pain and 2) an FM impact questionnaire (FIQ) total score. Results: Two main structures of narrative emplotment of FM illness were recognized: 1) the cumulative life narrative structure (46.15%) and 2) the broken life (53.85%) narrative structure. Baseline FIQ score was 77.38±7.77, and it was significantly reduced after PC to 39.12±13.27 (P<0.0001). Although well-being still requires further definition as outcome in pain management, it is important for FM patients, dealing with pain-related sensations, thoughts and feelings and limiting their daily activities. In our study, 87.5% of interviewed FM patients reported an improvement in their well-being after PC. Conclusion: Our data suggest that an integrated PC program positively impacts chronic pain and fatigue based on self-management strategies. PC allows FM patients to resume their own life and regenerate their own image. Finally, we propose the introduction of the evaluation of the ability to resume daily activities as the target of rehabilitation programs in FM

Seroprevalence of five neglected parasitic diseases among immigrants accessing five infectious and tropical diseases units in Italy: a cross-sectional study.

: This multicentre cross-sectional study aims to estimate the prevalence of five neglected tropical diseases (Chagas disease, filariasis, schistosomiasis, strongyloidiasis, toxocariasis) among immigrants accessing health care facilities in five Italian cities (Bologna, Brescia, Florence, Rome, Verona). : Individuals underwent a different set of serological tests, according to country of origin and presence of eosinophilia. Seropositive patients were treated and further followed up. : A total of 930 adult immigrants were enrolled: 477 men (51.3%), 445 women (47.9%), 8 transgender (0.8%); median age was 37.81 years (range 18-80). Most of them were coming from the African continent (405/930, 43.5%), the rest from East Europe, South America and Asia. A portion of 9.6% (89/930) were diagnosed with at least one of the infections under study. Seroprevalence of each specific infection varied from 3.9% (7/180) for Chagas diseases to 9.7% (11/113) for toxocariasis. Seropositive people were more likely to be 35 to 40 years-old male and to come from South East Asia, Sub-Saharan Africa or South America. : The results of our study confirm that neglected tropical diseases represent a substantial health problem among immigrants and highlight the need for addressing this emerging public health issue.<br/

Engaging clinicians to identify and prioritize disinvestment opportunities in the treatment of neurodegenerative diseases: a qualitative study

Introduction. The overuse of health care interventions is a problem which has clinical and economic implications. On a clinical level this means that ineffective interventions or effective interventions in inappropriate clinical indications are used. On an economic level it refers to allocative inefficiency which implies that these resources could possibly be used for interventions of major clinical utility. The contribution of health professionals in the context of reallocation disinvestment policies is still little investigated. This study involved 25 neurologists in the process of identifying low value interventions in the management of stroke, dementia, Parkinson’s disease, amyotrophic lateral sclerosis and multiple sclerosis. Methods. The Nominal Group Technique was applied in the context of 5 Focus Groups (FG) in order to reach a consensus to identify and prioritize disinvestment opportunities in the treatment of the 5 neurodegenerative diseases. Qualitative data were coded, categorised, and analysed, applying the six-phase approach to thematic analysis, with the support of Atlas Ti7. Results. Within 5 categories of “low value intervention”, 25 clinical interventions were identified: 6 pharmacological, 16 diagnostic, 3 clinical-therapeutic. FG findings describe: how clinicians view the issue of disinvestment, both in absolute and relative terms; the factors which contribute to the use of low-value interventions; the explicit link between the disinvestment process and the reallocation of resources. Discussion. This study revealed that factors that hinder the disinvestment of inappropriate practices involve elements that are not only technical or clinical, but also relational and care-related contexts

Appunti per una ricerca \u201cin salute\u201d: presupposti teorici ed esperienze concrete per una funzione politica e trasformativa della produzione di conoscenza

As Centre for International Health, we intend to contribute to the current debate on the public, applied and socially committed forms of anthropology by elaborating on the social impact and utility of research, and on the mechanisms of knowledge generation that are considered to be \u201cscientific\u201d. We argue that, in order to redefine (anthropological) research as a transformative process, there needs to be a methodological change towards collective and participatory research practices. The proposed reflection originates from the challenges that we face as a research centre, addressing on the one side the ethics and politics of research, and on the other one the constraints of the labour market. To illustrate these challenges, and the practices we developed to address them, we present three field experiences (that involve social cooperatives, civil society organisations and public services, and social movements) grounded in the approaches of participatory action-research and training-intervention. The theoretical and methodological contribution of these approaches opens the way for collaborative research practices that are inclusive from the planning to the evaluation, transforming research itself in a field for a possible change in society towards a greater self-determination of subjects and their emancipation from oppression. However, the challenge of how to sustain a research activity that is deeply political remains, and can probably be addressed only through a broad, collective and systemic engagement

Migra\ue7\ue3o, Sa\ufade e participa\ue7\ue3o: um abordagem multidisciplinar entres universidade, servi\ue7os de sa\ufade e territ\uf3rio

Occuparsi di salute e di servizi sanitari oggi, in un contesto caratterizzato da processi di globalizzazione, di migrazione e dal progressivo inasprimento delle disuguaglianze sociali e in salute, rende sempre pi\uf9 necessario l'utilizzo di approcci teorici e di strumenti metodologici integrati, orientati alla comprensione profonda delle diverse dimensioni della malattia e della cura. In tal senso, alleanze disciplinari con le scienze sociali e umane permettono di ampliare lo sguardo sui processi di salute e malattia sia da un punto di vista macroscopico che microscopico. Il caso della malattia di Chagas nel contesto di immigrazione italiano svela in modo emblematico tali processi. Il mal de Chagas, malattia \u201cdimenticata\u201d endemica in America Latina, si configura come fenomeno complesso e di difficile inquadramento; un approccio multidisciplinalre mette in luce quanto a \u201cdimenticanza\u201d sia in primo luogo politica ed economica e si contrapponga all\u2019\u201cemergenzialit\ue0\u201d con cui il medesimo fenomeno si sta configurando in alcuni paesi di accoglienza (es. Europa), dove si sta dibattendo sui costi/benefici di strategie sanitarie incentrate pi\uf9 sulla retorica del \u201crischio\u201d per la popolazione locale, che sulla volont\ue0 di garantire la salute degli interessati, migranti in questo caso. Questa cornice va a intersecarsi con i vissuti e le esperienze migratorie delle singole persone e con la gestione dell\u2019immigrazione da parte delle politiche locali, laddove spesso rispetto all'\u201cimmigrato\u201d vengono prodotti ulteriori \u201cdiscorsi\u201d e azioni altrettanto stigmatizzanti e marginalizzanti. Dal 2009 a Bologna, il Centro Studi e Ricerche in Salute Internazionale e Interculturale (CSI) dell\u2019Universit\ue0 di Bologna, in collaborazione con l\u2019Azienda Ospedaliera Universitaria locale e con alcune associazioni di migranti latinoamericani, ha implementato un progetto di ricerca-azione partecipativa con l\u2019obiettivo di analizzare, attraverso un approccio di epidemiologia sociale, la presenza, l'entit\ue0 e le percezioni relative alla malattia di Chagas in tale contesto. Si \ue8 scelto di operare sui diversi livelli della malattia in una prospettiva bio-psico-sociale. Coerentemente sono stati coinvolti in modo attivo e partecipativo tutti gli attori sociali interessati: la popolazione, gli operatori sanitari e i decisori politici, sia nella co-costruzione dei significati e dei bisogni che nella elaborazione delle possibili strategie d\u2019azione