SOPRAVVIVENZA AL TUMORE AL SENO IN DONNE IN FASE DI FOLLOW UP DA 1A 5ANNI

La presente ricerca ha avuto lo scopo di analizzare cosa accade a livello personale, familiare e di coppia in donne sopravvissute a un tumore al seno che realizzano i controlli di follow up a 1, 2, 3, 4 e 5 anni, nonché le possibili influenze della relazione paziente/medico-ospedale sullo stato di benessere. La ricerca si è sviluppata tra Italia e Argentina, due paesi accomunati da molte tradizioni e costumi, grazie al grande numero di italiani emigrati in Argentina, in particolare tra la fine del 1800 e la prima metà del 1900, ma allo stesso tempo anche molto diversi dal punto di vista socio-culturale ed economico. Queste differenze socio-economiche sono apparse interessanti ai fini della comprensione dell’influenza dei fattori socio-economici e culturali sulla percezione del benessere e la rappresentazione della malattia nelle pazienti. Per tali ragioni la tesi è stata condotta in co-tutela tra l’Università degli Studi di Napoli Federico II e l’Universidad Nacional de Tucuman. La ricerca è suddivisa in due parti, una teorica e la seconda empirica. Nella prima parte viene inquadrato il contesto storico e teorico riguardante gli aspetti statistici del cancro, in generale, e del cancro alla mammella in particolare. Nel primo capitolo vengono presentati i dati relativi al tumore al seno in Italia: incidenza, prevalenza e la sopravvivenza; la sopravvivenza a 5 anni e dati circa la lungo-sopravvivenza, oltre a presentare brevemente alcuni numeri relativi al cancro in Italia e in Europa. Il secondo capitolo affronta le questioni connesse al concetto di “survivor” e di “Follow Up”, la sopravvivenza al tumore al seno e l’impatto sulla femminilità e sul benessere, la Sessualità e vita di coppia, le dinamiche e i modelli familiari. La seconda parte del lavoro è dedicata alla ricerca empirica. Il terzo capitolo, dal titolo“Cancer survivor: aspectos psicosociales en pacientes sobrevivientes de cáncer”, presenta i risultati di uno studio qualitativo condotto attraverso il metodo dell’osservazione etnografica presso l’Ospedale Pascale di Napoli e in collaborazione con l’Università di Tucuman U.N.T. Argentina. Il quarto capitolo presenta uno studio qualitativo realizzato in Italia in collaborazione con il servizio di psico-oncologia dell’Istituto dei tumori di Napoli, INT G. Pascale, condotto con donne sopravvissute a un tumore al seno nel periodo di controllo di follow up a 1, 2, 3, 4 e 5 anni. Sono state somministrate interviste focalizzate (Arcidiacono, 2012). Il materiale testuale raccolto è stato analizzato mediante l’utilizzo del software ATLAS.ti 7.0, seguendo le indicazioni della Grounded Theory Methodology (GTM). Nel quinto capitolo, infine, è presentato uno studio qualitativo realizzato a Tucuman, Argentina, con la collaborazione del “Hospital Padilla” rivolto a donne sopravvissute a un tumore al seno nel periodo di controllo di follow up a 1, 2, 3, 4 e 5 anni. Sono state somministrate interviste focalizzate (Arcidiacono, 2012) il cui materiale testuale raccolto è stato analizzato mediante l’utilizzo del software ATLAS.ti 7.0, seguendo le indicazioni della Grounded Theory Methodology (GTM)

Psychological Lockdown Experiences: Downtime or an Unexpected Time For Being?

The spread of COVID-19 in Italy resulted in the implementation of a lockdown that obligated the first time the general populace to remain at home for approximately two months. This lockdown interrupted citizens’ professional and educational activities, in addition to closing shops, offices and educational institutions. The resulting changes in people’s daily routines and activities induced unexpected changes in their thoughts, feelings and attitudes, in addition to altering their life perceptions. Consequently, the present study explores how young adults perceived their lives under lockdown during the final week of March 2020, when the reported number of daily coronavirus infections reached its peak in Italy. The research was carried out among 293 university students (234 women and 59 men) with an average age of 20.85 years old (SD = 3.23). The researchers asked participants to describe the emotions, thoughts and experiences that characterized their time under lockdown. The study analyzed specific narratives related to time and space using grounded theory methodology, which was applied using Atlas 8 software, leading to the creation of 68 codes. The study organized these codes into three specific categories: confined in the present, confined in the past, and striving toward one’s goals. Finally, the researchers also created a core-category labeled “continuity of being.” The results showed that the closure of open spaces caused a division in participants’ perceptions of time continuity, with many viewing themselves as feeling fragmented and as living the present in a static and fixed way. Additionally, participants also saw the present as being discontinuous from the past, while, simultaneously, projecting toward the future and the changes it might bring. Finally, this study examined further implications surrounding individual projecting among young people in greater depth

Bienvenida sonrisa : Parte II

La Facultad de Odontología de la Universidad Nacional de La Plata, desde el año 1997, desarrolla un Programa de Salud Bucal en la ciudad de La Plata y sus alrededores, a través de la Asignatura Odontología Preventiva y Social. Esto ha permitido obtener datos estadísticos y de relevamiento de zonas, que impulsa la formulación de nuevas iniciativas en poblaciones vulnerables donde el índice de incidencia de enfermedades bucodentales, es elevado. Entendemos a la salud bucal como un valor que no debe ser considerado como un privilegio, sino como un derecho de todas las personas, reforzando el trabajo multidisciplinario de manera de que la salud recuperada, se mantenga a lo largo del tiempo, con el objetivo de disminuir las desigualdades en salud y con el propósito de brindar atención a poblaciones de difícil acceso, por este motivo, creemos que es fundamental la gestión del Trabajo Social , trabajando de forma efectiva con la comunidad, colaborando en la promoción de la salud y prevención de la enfermedad. Teniendo conocimiento de que la escuela es un espacio privilegiado y del encuentro con el otro, enfocamos nuestros esfuerzos en colaborar para modificar la realidad que se presenta.Este Proyecto surge debido a la necesidad de la Comunidad Educativa perteneciente a la Escuela Nº 45 “Manuel Rocha” del barrio El Mondongo de la Ciudad de La Plata, quienes manifiestan la carencia de información y atención de la comunidad educativa en cuanto a acciones preventivas. Este proyecto se lleva a cabo desde fines del 2019, atravesando el contexto de Pandemia por el virus causante de la enfermedad Covid-19, reacondicionando nuestras actividades.Facultad de Odontologí

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.status: publishe

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

Purpose To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed

Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Purpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome