CONTINUITA' OSPEDALE TERRITORIO

L’Italia ha una percentuale di popolazione ultrasessantacinquenne che supera il 20%, e che dovrebbe salire a oltre il 35% nel 2050. Circa 2 milioni di persone anziane non sono autonome. La prevalenza di disabilità è più alta nelle regioni meridionali del paese. L'età avanzata è un fattore di rischio indipendente per le fratture da fragilità che a lungo termine comportano un maggiore e considerevole rischio di disabilità. L’impatto delle fratture di femore è particolarmente grave negli anziani fragili. I casi più gravi di disabilità (più concentrati negli ultraottantenni) sono aumentati drammaticamente nelle ultime decade. Di conseguenza, il bisogno dei servizi di cure continuative territoriali in grado di gestire questa crescente fetta della popolazione, cioè, anziani con patologie multiple e/o con disabilità grave, spesso come conseguenza delle fratture da fragilità, è in continuo aumento. La cura a lungo termine di queste persone, con un carico sociale complesso e oneri di assistenza gravosi pongono seri problemi sia agli operatori sanitari che all'intero sistema di welfare. Da sottolineare che nei pazienti istituzionalizzati la incidenza di fratture di femore è circa 2-3 volte maggiore rispetto alle persone che vivono in comunità, comportando ancora un ulteriore rischio di disabilità, costi sociali e finanziari. Pertanto, negli anziani istituzionalizzati è di fondamentale importanza l’attuazione di programmi di prevenzione delle fratture da fragilità e soprattutto del rischio di ulteriori fratture. Le cure continuative territoriali in Italia sono contraddistinte da una bassa quota di finanziamenti pubblici e di un basso numero di prestazione se paragonate con la situazione in altri paesi del centro-nord europeo. Ad esempio, nell’anno 2007 la spesa pubblica per le cure domiciliari e residenziali (long term care – LTC) è stata del 1,13% del PIL e gli utenti di questi servizi erano soltanto circa il 5% del totale della popolazione ultrasessantacinquenne. Il sistema pubblico di cure continuative italiano si basa su due forme parallele di intervento: il primo, e più rilevante (50% del totale delle spese pubbliche per le cure continuative), consiste in programmi di erogazioni monetarie ("indennità di accompagnamento"), il secondo è dato dai programmi sociali e sanitari, compresa la erogazione di assistenza residenziale e domiciliare. La responsabilità delle cure è in gran parte delegata alle famiglie anche se la tradizionale capacità assistenziale delle famiglie italiane si è ridotta notevolmente nell'ultimo decennio a causa, al meno in parte, del continuo aumento del tasso di occupazione femminile. Le tendenze demografiche minacciano la sostenibilità del sistema di welfare italiano esistente, in particolare nei servizi di cure croniche territoriali, per i quali la domanda è in gran parte aumentata e si prevede che continuerà ad aumentare nei prossimi decenni

Celiac disease in older persons: A case of seronegative disease

A 68-year-old man with a history of smoking (former smoker of 40 cigarettes per day), euthyroid goiter, deep vein thrombosis and depression, came to our attention for weakness, cachexia, abdominal bloating and diarrhea lasting for almost six months. Furthermore, he had lost about 25 kilograms of weight in the last year and was bedridden for three months. Combining the results of serological, histopathological and genetic tests, he was diagnosed with a seronegative celiac disease. Gluten-free diet, combined with nutritional supplements and physical therapy, improved his clinical condition and allowed the recovery of weight and the walking ability. Celiac disease might be suspected in elderly patients with diarrhea, malabsorption, malnutrition and cachexia, but also with other symptoms such as anemia, micronutrients' deiciency, fragility fractures and neurological symptoms

B meson decay constants f(Bc), f(Bs) and f(B) from QCD sum rules

Finite energy QCD sum rules with Legendre polynomial integration kernels are used to determine the heavy meson decay constant f(Bc), and revisit f(B) and f(Bs). Results exhibit excellent stability in a wide range of values of the integration radius in the complex squared energy plane, and of the order of the Legendre polynomial. Results are f(Bc) = 528 +/- 19 MeV, f(B) = 186 +/- 14 MeV, and f(Bs) = 222 +/- 12 MeV

Steady-state modulation of voltage-gated K+ channels in rat arterial smooth muscle by cyclic AMP-dependent protein kinase and protein phosphatase 2B

Voltage-gated potassium channels (Kv) are important regulators of membrane potential in vascular smooth muscle cells, which is integral to controlling intracellular Ca2+ concentration and regulating vascular tone. Previous work indicates that Kv channels can be modulated by receptor-driven alterations of cyclic AMP-dependent protein kinase (PKA) activity. Here, we demonstrate that Kv channel activity is maintained by tonic activity of PKA. Whole-cell recording was used to assess the effect of manipulating PKA signalling on Kv and ATP-dependent K+ channels of rat mesenteric artery smooth muscle cells. Application of PKA inhibitors, KT5720 or H89, caused a significant inhibition of Kv currents. Tonic PKA-mediated activation of Kv appears maximal as application of isoprenaline (a β-adrenoceptor agonist) or dibutyryl-cAMP failed to enhance Kv currents. We also show that this modulation of Kv by PKA can be reversed by protein phosphatase 2B/calcineurin (PP2B). PKA-dependent inhibition of Kv by KT5720 can be abrogated by pre-treatment with the PP2B inhibitor cyclosporin A, or inclusion of a PP2B auto-inhibitory peptide in the pipette solution. Finally, we demonstrate that tonic PKA-mediated modulation of Kv requires intact caveolae. Pre-treatment of the cells with methyl-β-cyclodextrin to deplete cellular cholesterol, or adding caveolin-scaffolding domain peptide to the pipette solution to disrupt caveolae-dependent signalling each attenuated PKA-mediated modulation of the Kv current. These findings highlight a novel, caveolae-dependent, tonic modulatory role of PKA on Kv channels providing new insight into mechanisms and the potential for pharmacological manipulation of vascular tone

The MRN complex is transcriptionally regulated by MYCN during neural cell proliferation to control replication stress

The MRE11/RAD50/NBS1 (MRN) complex is a major sensor of DNA double strand breaks, whose role in controlling faithful DNA replication and preventing replication stress is also emerging. Inactivation of the MRN complex invariably leads to developmental and/or degenerative neuronal defects, the pathogenesis of which still remains poorly understood. In particular, NBS1 gene mutations are associated with microcephaly and strongly impaired cerebellar development, both in humans and in the mouse model. These phenotypes strikingly overlap those induced by inactivation of MYCN, an essential promoter of the expansion of neuronal stem and progenitor cells, suggesting that MYCN and the MRN complex might be connected on a unique pathway essential for the safe expansion of neuronal cells. Here, we show that MYCN transcriptionally controls the expression of each component of the MRN complex. By genetic and pharmacological inhibition of the MRN complex in a MYCN overexpression model and in the more physiological context of the Hedgehog-dependent expansion of primary cerebellar granule progenitor cells, we also show that the MRN complex is required for MYCN-dependent proliferation. Indeed, its inhibition resulted in DNA damage, activation of a DNA damage response, and cell death in a MYCN- and replication-dependent manner. Our data indicate the MRN complex is essential to restrain MYCN-induced replication stress during neural cell proliferation and support the hypothesis that replication-born DNA damage is responsible for the neuronal defects associated with MRN dysfunctions.Cell Death and Differentiation advance online publication, 12 June 2015; doi:10.1038/cdd.2015.81

Sexual expression and cognitive function: gender-divergent associations in older adults

Prior research demonstrates a positive association between sexual activity and cognitive function in later life. However, the relationship between the type of sexual activity and cognitive function in older adulthood remains unclear. This study explores the associations between the frequency of engaging in different types of sexual activities (intercourse, masturbation, and kissing/petting/fondling) and cognitive function in older women and men. Using data from Wave 6 of the English Longitudinal Study of Ageing (ELSA), 1915 women and 2195 men (age range 50-89 years; n = 4110) reporting any type of sexual activity over the past 12 months, were included in the study. Multiple regression controlling for age, education, satisfaction with sex life, cohabiting, wealth, general health, physical activity, depression and loneliness, was used to explore the associations between the frequency of engagement in intercourse, masturbation and kissing/petting/fondling, and two measures of cognitive function; word recall and number sequencing. For women, masturbation was linked to better word recall (p = .008), whilst for men, kissing/petting/fondling was associated with better number sequencing (p = .035). In women (p = .016) and men (p = .018), dissatisfaction with sex life was associated with better number sequencing. The results point to gendered links between sexual activity and cognitive function. These gender-related divergences may reflect differences in biological/neurological mechanisms, or in cognitive lifestyle factors that could influence cognitive reserve in later life. This novel study underscores the need to delineate the underlying mechanisms of the association between sex and cognition in men and women

Extra-uterine (abdominal) full term foetus in a 15-day pregnant rabbit

[EN] Background: While ectopic pregnancies account for 1-2% of all pregnancies, abdominal pregnancy is extremely rare, accounting for approximately 1% of ectopic pregnancies. Extrauterine abdominal pregnancy is defined as the implantation and development of an embryo in the peritoneal cavity. The present report is the first of an incidental case of abdominal pregnancy within four full-term foetus simultaneously with 2 weeks of physiological gestation in a healthy doe rabbit. Case presentation: The doe was born on November 3, 2014 and the first partum took place on May 18, 2015. The doe had previously delivered and weaned an average of 12.0 +/- 1.41 live kits at birth (no stillbirths were recorded) during 5 consecutive pregnancies. The last mating was on December 18, 2015 and the detection of pregnancy failure post breeding (by abdominal palpation) on December 31, 2015. Then, the doe was artificially inseminated on January 27, 2016, diagnosed pregnant on February 11, 2016 and subsequently euthanized to recover the foetus. A ventral midline incision revealed a reproductive tract with 12 implantation sites with 15 days old foetus and 4 term foetus in abdominal cavity. There were two foetus floating on either side of the abdominal cavity and two suspended near the greater curvature of the stomach. They were attached to internal organs by means of one or 2 thread-like blood vessels that linked them to the abdominal surfaces. Conclusions: In our opinion a systematic monitoring of rabbit breeding should be included to fully understand and enhance current knowledge of this phenomenon of abdominal pregnancy.This work was supported by Spanish Research Project AGL2014-53405-C2-1-P (Interministerial Commission on Science and Technology).Marco-Jiménez, F.; Garcia-Dominguez, X.; Valdes-Hernández, J.; Vicente Antón, JS. (2017). Extra-uterine (abdominal) full term foetus in a 15-day pregnant rabbit. BMC Veterinary Research. 13:1-4. https://doi.org/10.1186/s12917-017-1229-7S1413Petracci M, Bianchi M, Cavani C. Development of rabbit meat products fortified with n-3 polyunsaturated fatty acids. Nutrients. 2009;1:111–8.FAOSTAT (Food and Agriculture Organization of the United Nations, authors). Available online: http://faostat.fao.org/site/569/DesktopDefault.aspx?PageID=569#ancor . Accessed Sept 2012.Segura Gil P, Peris Palau B, Martínez Martínez J, Ortega Porcel J, Corpa Arenas JM. Abdominal pregnancies in farm rabbits. Theriogenology. 2004;62:642–51.Rosell JM, de la Fuente LF. Culling and mortality in breeding rabbits. Prev Vet Med. 2009;88:120–7.Tena-Betancourt E, Tena-Betancourt CA, Zúniga-Muñoz AM, Hernández-Godínez B, Ibáñez-Contreras A, Graullera-Rivera V. Multiple extrauterine pregnancy with early and near full-term mummified foetuses in a New Zealand white rabbit (Oryctolagus Cuniculus). J Am Assoc Lab Anim Sci. 2014;53:204–7.Sánchez JP, Theilgaard P, Mínguez C, Baselga M. Constitution and evaluation of a long-lived productive rabbit line. J Anim Sci. 2008;86:515–25.Savietto D, Friggens NC, Pascual JJ. Reproductive robustness differs between generalist and specialist maternal rabbit lines: the role of acquisition and allocation of resources. Genet Sel Evol. 2015;47:2.Viudes-de-Castro MP, Vicente JS. Effect of sperm count on the fertility and prolificity rates of meat rabbits. Anim Reprod Sci. 1997;46:313–9.Marco-Jiménez F, Garcia-Dominguez X, Jimenez-Trigos E, Vera-Donoso CD, Vicente JS. Vitrification of kidney precursors as a new source for organ transplantation. Cryobiology. 2015;70:278–82.Garcia-Dominguez X, Vera-Donoso CD, Jimenez-Trigos E, Vicente JS, Marco-Jimenez. First steps towards organ banks: vitrification of renal primordial. Cryo Letters. 2016;37:47–52.Arvidsson A. Extra-uterine pregnancy in a rabbit. Vet Rec. 1998;142:176.Glišić A, Radunović N, Atanacković J. Methotrexate and fallopian tubes in ectopic pregnancy. Acta veterinaria. 2006;56:375–82.Nwobodo EI. Abdominal pregnancy. A case report. Ann Afr Med. 2004;3:195–6.Nassali MN, Benti TM, Bandani-Ntsabele M, Musinguzi E. A case report of an asymptomatic late term abdominal pregnancy with a live birth at 41 weeks of gestation. BMC Res Notes. 2016;9:31.Baffoe P, Fofie C, Gandau BN. Term abdominal pregnancy with healthy new-born: a case report. Ghana Med J. 2011;45:81–3.Eleje GU, Adewae O, Osuagwu IK, Obianika CE. Post-date extra-uterine abdominal pregnancy in a rhesus negative Nullipara with successful outcome: a case report. J Women's Health. 2013;6:2.Hong CC, Armstrong ML. Ectopic pregnancy in 2 guinea-pigs. Lab Anim. 1978;12:243–4.Peters LJ. Abdominal pregnancy in a golden hamster (Mesocricetus Auratus). Lab Anim Sci. 1982;32:392–3.Xiccato G, Trocino A, Boiti C, Brecchia G. Reproductive rhythm and litter weaning age as they affect rabbit doe performance and body energy balance. Anim Sci. 2005;81:289–96.Fortun-Lamothe L, De Rochambeau H, Lebas F, Tudela F. Influence of the number of suckling young on reproductive performance in intensively reared rabbits does. In: Blasco A, editor. Proceedings of the 7th world rabbit congress; 2002. p. 125–32

Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed

Health Services Utilization, Work Absenteeism and Costs of Pandemic Influenza A (H1N1) 2009 in Spain: A Multicenter-Longitudinal Study

Background: The aim of this study was to estimate healthcare resource utilization, work absenteeism and cost per patient with pandemic influenza (H1N1)2009, from its beginning to March 2010, in Spain. We also estimated the economic impact on healthcare services. Methods and Findings: Longitudinal, descriptive,multicenter study of in- and outpatients with confirmed diagnosis of influenza A (H1N1) in Spain. Temporal distribution of cases was comparable to that in Spain. Information of healthcare and social resources used from one week before admission (inpatient) or index-medical visit (outpatient) until recovery was gathered. Unit cost was imputed to utilization frequency for the monetary valuation of use. Mean cost per patient was calculated. A sensitivity analysis was conducted, and variables correlated with cost per patient were identified. Economic impact on the healthcare system was estimated using healthcare costs per patient and both, the reported number of confirmed and clinical cases in Spain. 172 inpatients and 224 outpatients were included. Less than 10% were over 65 years old and more than 50% had previous comorbidities. 12.8% of inpatients were admitted to the Intensive Care Unit. Mean length of hospital stay of patients not requiring critical care was 5 days (SD =4.4). All working-inpatients and 91.7% working-outpatients went on sick leave. On average, work absenteeism was 30.5 days (SD=20.7) for the first ones and 9 days (SD= 6.3) for the latest. Caregivers of 21.7% of inpatients and 8.5% of outpatients also had work absenteeism during 10.7 and 4.1 days on average respectively. Mean cost was J6,236/inpatient (CI95%=1,384-14,623) and J940/outpatient (CI95% =66-3,064). The healthcare economic burden of patients with confirmed influenza was J144,773,577 (IC95% 13,753,043-383,467,535). More than 86% of expenditures were a result of outpatients" utilization. Conclusion: Cost per H1N1-patient did not defer much from seasonal influenza estimates. Hospitalizations and work absenteeism represented the highest cost per patient