From the bench to practice - Field integration of community-based services for older citizens with different levels of functional limitation across European Regions

The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe. The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report. All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens' individual social, economic and human resources. Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery. The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach

Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases

Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity

Corpi inclusi e sindromi talassemiche

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Encefalopatia Epatica Iniziale. Un approccio terapeutico semplice ed efficace

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Emolisi all'Ultramicroscopia

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SCANNING ELECTRON-MICROSCOPY (SEM) IN HEMOLYSIS

Fixation procedures (Bessis and Weed, 1972) ] for the SEM observation of erythrocytes nowadays prove reliable, so that most artifacts are prevented from occurring. Thus SEM results in a useful method for examining normal and haemolytic patterns. Normal reticulocytes are polylobulate since they undergo through the splenic slits shape remodeling and foreign body extrusion. In premature infants the latter may occur spontaneously throughout the circulation owing to spleen immaturity. Spherocytosis is due to ATP depletion in the oldest cells and thus represents the normal pre-lytic stage. Such deformation is present in most erythrocytes during the haemolytic bouts of hereditary spherocytosis and in most defects of anaerobic glycolysis. Like hereditary spherocytosis, also elliptocytosis is caused by protein n~mbrane defects. The hallmark of thalassaemias is anisopoikilocytosis, due to increased membrane-haemoglobin content ratio. To overlapping unbalance of the globin chain synthesis ratio, more marked surface deformations in alpha- than in beta-thalassaemia correspond. In Hb H disease chain excess precipitates peripherally, in Cooley's anaemia centrally as large clusters. This is due to the more hydrophylic conditions of beta chains (Zavagli et al., 1982) 2 . Thalassaemia may be associated with other abnormal haemoglobins, such as Hb S. Haemolysis may also be due to physical agents, namely shearing stress caused by (a) fibrin deposition throughout the microcirculation, such as in Moschkowitz and Gasser syndromes, (b) prosthetic heart valves, and (c) march haemoglobinuria. IgG-caused haemolytic anaemia may or mav not be associated with complement involvement: early stages may occur intravascularly, but lysis is completed in the spleen and liver through phagocytic receptors. Conversely paroxysmal noctural haemoglobinuria (PNH) is exclusively complement-mediated owing to the characteristic red cell susceptibility to such lytic system. Scanning can reliably distinguish PNH II from PNH III cells (Zavagli et al., 1978)

ERYTHROCYTES AND VINCA-ROSEA ALKALOIDS - AN INVITRO STUDY

The reported stereoscan images have proved that overtherapeutic amounts of vincristine induce in normal red cells the same effects as vinblastine, i.e. the onset of spherocytosis (in about 30% of the cells) and spherostomatocytosis (in the remainder) associated with distinct smaller vacuoles surrounding the larger cavity. The lowest deformation-inducing doses have been found to be twice as high for vincristine as for vinblastine (0.6mM); this is probably due to the greater interaction of the latter drug (because of its methyl group) with the bilayer phospholipids. Unlike previous reports, the present findings have revealed that the onset of red cell deformation is energy independent, since the same aspects have been recorded in both young and old erythrocytes. Therefore, such deformations must be considered the morphological consequence of a drug-induced mechanical derangement of the membrane subunits. In drug-incubated normal erythrocytes it was found that (a) neither drug exerts any influence on the intraglobular energy production and/or utilization, (b) osmotic fragility is enhanced, and (c) potassium leak is increased. These findings may be considered convincingly consistent with the assumption of a drug-induced mechanical derangement of the bilayer components