Use of the universal pain assessment tool for evaluating pain associated with TMD in youngsters with an intellectual disability

The Universal Pain Assessment Tool (UPAT) was used to assess the level of pain in people with limited communication skills. The UPAT enables clinicians to consult a specialized pain management team more often and lead to earlier interventions. The purpose of this study was to determine, whether the UPAT could be used as an extra tool to collect data on functional TMJ pain and to assess orofacial pain levels related to temporomandibular disorder(s) (TMD) in people with intellectual disabilities (ID). Non-down syndrome ID Athletes were screened during the Special Olympics European games in 2014. The clinical scores of possible functional jaw pain were collected using the UPAT, to indicate pain severity on a visual scale during different jaw movements (opening, closing and lateral). Two hundred and four youngsters were screened by calibrated dentists. The majority (65%) of participants were male (133 male and 71 female athletes); age distribution ranged from 15 to 23 years (mean 19.25 ± 2.53). The results of the UPAT have shown the existence of functional TMJ pain in 32% (n=65) of the athletes without significant prevalence (P > 0.05) in this survey group. According to the results of the present study, the UPAT demonstrated that it could be a useful tool to detect the existence of functional jaw pain possibly associated with TMD and also a valid instrument to score pain intensity associated with TMD in people with ID

Sex differences in the effect of type 2 diabetes on major cardiovascular diseases: results from a population-based study in Italy.

The aim of the study is to assess sex difference in association between type 2 diabetes and incidence of major cardiovascular events, that is, myocardial infarction, stroke, and heart failure, using information retrieved by diabetes register. The inhabitants of Reggio Emilia (Italy) aged 30\u201384 were followed during 2012\u20132014. Incidence rate ratios and 95% confidence intervals were calculated using multivariate Poisson model. The age- and sex-specific event rates were graphed. Subjects with type 2 diabetes had an excess risk compared to their counterparts without diabetes for all the three major cardiovascular events. The excess risk is similar in women and men for stroke (1.8 times) and heart failure (2.7 times), while for myocardial infarction, the excess risk in women is greater than the one observed in men (IRR 2.58, 95% CI 2.22\u20133.00 and IRR 1.78, 95% CI 1.60\u20132.00, resp.; P of interaction < 0.0001). Women had always a lesser risk than men, but in case of myocardial infarction, the women with type 2 diabetes lost part of advantage gained by women free of diabetes (IRR 0.61, 95% CI 0.53\u20130.72 and IRR 0.36, 95% CI 0.33\u20130.39, resp.). In women with type 2 diabetes, the risk of major cardiovascular events is anticipated by 20\u201330 years, while in men it is by 15\u201320

Importancia del enfoque ecosistémico en las pesquerías de Georgia

The economic downturn in the 1990s and early 2000s associated with the break-up of the Soviet Union had a negative impact on Georgian fisheries. Both marine and freshwater fisheries and aquaculture suffered considerable decline. The Georgian fishing fleet deteriorated. The role of state institutions in fisheries management weakened and funding of scientific research diminished. Economic and institutional problems had a negative effect on the state of aquatic bio-resources. The excessive and relentless use of living resources, use of illegal fishing gear and degradation of coastal ecosystems led to a considerable reduction in fish stocks, while the number of vulnerable and endangered species increased. Starting from the new millennium the attitude has changed. In 2004-2005 the 15-year plan for the development of the ecosystem approach to fisheries in Georgia was initiated with support from the FAO. A Georgian law on fisheries and aquaculture has been introduced. Discussions on responsible fisheries and an aquaculture code have also started, but are still pending. On the other hand, the fisheries department of the Ministry of Agriculture was abolished and the single fisheries research institute met a similar fate. Fisheries regulation came under the authority of the ministry of environment. There is still a lot to be done in order to establish an ecosystem approach to fisheries in Georgia. First of all, the legislative base must be addressed, including the Georgian law on fisheries, which would consider such issues as long-term sustainable development of fisheries, a responsible code of conduct for fishermen, monitoring and management structures at the national level, allocation of resources and application of scientific approaches in development of fisheries, aquaculture and mariculture.La crisis económica del la década de 1990 y principios de 2000 asociada a la caída de la Unión Soviética tuvo un impacto negativo sobre las pesquerías de Georgia. Tanto la pesca de agua dulce como la acuicultura marina sufrieron un importante descenso. La flota pesquera de Georgia se deterioró. Se debilitó el papel de las instituciones estatales en las pesquerías y la financiación de la investigación científica disminuyó considerablemente. Los problemas económicos e institucionales tuvieron un efecto negativo en el estado de los recursos biológicos acuáticos. El uso excesivo de los recursos vivos, el uso de artes de pesca ilegal y la degradación de los ecosistemas costeros, provocó una considerable reducción de las poblaciones de peces, al tiempo que aumentó el número de especies vulnerables y en peligro de extinción. A partir del nuevo milenio la actitud ha cambiado. En el período 2004-2005, con el apoyo de la FAO, se inició el plan de 15 años de duración para el desarrollo del enfoque ecosistémico de la pesca en Georgia. Se introdujo una nueva ley sobre pesca y acuicultura. Sin embargo, las deliberaciones sobre el Código de Conducta para la pesca responsable siguen todavía pendientes. Por otro lado, se eliminó el departamento de pesca del Ministerio de Agricultura y algo similar le ocurrió al instituto de investigación de pesquerías. La regulación de la pesca pasó a manos del Ministerio de Medio Ambiente. Todavía hay mucho por hacer a fin de establecer un enfóque ecosistémico de la pesca en Georgia. En primer lugar, debe aplicarse una base legislativa, e incluir la ley de pesquerías de Georgia en ella. Debe considerar cuestiones, tales como el desarrollo sostenible a largo plazo de las pesquerías, el Código de Conducta para la Pesca Responsable para los pescadores, vigilancia y estructuras de gestión a nivel nacional, asignación de recursos y aplicación de criterios científicos en el desarrollo de la pesca, acuicultura

Pharmacokinetics of tramadol and its major metabolite after intramuscular administration in piglets

Tramadol (T) is a centrally acting atypical opioid used for treatment of dogs. Piglets might experience pain following castration, tooth clipping and tail docking and experimental procedures. The aim of this study was to assess the pharmacokinetics of T and its active metabolite M1 in male piglets after a single intramuscular injection. Six healthy male piglets were administered T (5 mg/kg) intramuscularly. Blood was sampled at scheduled time intervals and drug plasma concentrations evaluated by a validated HPLC method. T plasma concentration was quantitatively detectable from 0.083 to 8 h. M1 was quantified over a shorter time period (0.083–6 h) with a Tmax at 0.821 h. The study demonstrated that piglets produce a larger amount of M1 compared with dogs, horses and goats. The human minimum effective concentration of M1 (40 ng/mL) was exceeded for over 3 h in piglets. If it is assumed to also apply to piglets, it could be speculated that the drug efficacy might exert its action over 3 h or longer. This assumption has to be confirmed by further specific pharmacokinetic/pharmacodynamic studies

Experimental Characterization and Acoustic Correction of a Multipurpose Performance Hall: The Italian Theatre “Cavallino Bianco”

This study presents the retrofit acoustic dq1esign of the Italian theatre "Cavallino Bianco". In its historical configuration, the hall had a curved roof with a pressed-plant fiber ceiling, which was demolished and replaced with a wooden roof without a false ceiling, leading to an increase in volume and a worsening of the reverberation time. This study proposed the realization of a wave ceiling and the application of sound-absorbing and reflecting panels on the walls, which have already been implemented. These modifications have affected the acoustic characterization of the theatre, as shown both through on-site measurements during the main construction phases and through numerical simulations. The reverberation time, clarity index, and speech transmission index (STI) are evaluated considering all the variations in the hall over different construction times, and the optimal solution is identified with regard to different specific uses. The final configuration with the new roof, by reducing the volume of the hall and using sound-absorbing materials, significantly reduces the reverberation time (e.g., at 2000 Hz, this reduction is from 2.33 to 1.47). In addition, the hall at full capacity with chairs and people shows evident improvement in terms of the clarity index, allowing the theatre to be used for a wide range of musical genres such as instrumental, symphonic, and opera performances. As regards the Combos 00 (concrete roof without vertical sound acoustic panels) and 01-a/b/c (wooden roof with draped curtains), the STI values are never lower than 0.42 and never higher than 0.70; therefore, the room never experiences poor or excellent conditions at any point. The Combos 01-a and 01-b, which have a non-performing C80, have a good STI index, confirming the difficulty of achieving a configuration that can be optimal a variety of uses. Combo 01 (wooden roof without vertical sound acoustic panels and no draped curtains), which has a good C80 value, presents a lower STI value, with an average performance. The STI values of Combo 02-a (characterized by wave false ceiling and vertical sound acoustic panels) are never lower than 0.52 and never higher than 0.60; therefore, neither poor nor excellent conditions are experienced in the room, but there is still a slight improvement over the combos 00 and 01

A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students

The medical students' well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students' clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The "Interpretive Description" approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students' subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students

Determinants of inappropriate setting allocation in the care of patients with type 2 diabetes: A population-based study in Reggio Emilia province

The study aims to describe the distribution of patients with type 2 diabetes (T2D) by care plan and to highlight determinants of underuse and overuse of integrated care (IC). This cross-sectional study included all T2D patients resident in Reggio Emilia on 31/12/2015 based on the population-based diabetes registry. Eligibility for IC requires good glycaemic control, no rapid insulin, no kidney failure and no diabetes complications. We calculated the proportion of IC underuse and overuse and adjusted prevalence estimate using multivariate logistic regression. Determinants were age, sex, citizenship, district of residence and time since diagnosis. Of 29,776 patients, 15,364 (51.6%) were in diabetes clinic plan, 9851 (33.1%) in IC plan and 4561 (15.3%) not in any care plan (i.e., in Other group). There were 10,906 (36.6%) patients eligible for IC, of whom 1000 in Other group. When we adjusted for all covariates and restricted the analysis to patients included in care plans, the proportion of those eligible for IC plan but cared for in diabetes clinic plan (i.e. underuse of IC) was 28% (n = 3028/9906; 95%CI 27–29). Similarly, the proportion of those not eligible for IC but cared for in IC plan (i.e. overuse of IC) was 11% (n = 1720/11,896; 95%CI 10–11).The main determinant of both IC underuse and overuse was the district of residence. Foreign status was associated with underuse (37%; 95%CI 33–43), while old age (≥80 years) with both underuse (36%; 95%CI 0.33–0.38) and overuse (23%; 95%CI 22–25). The criterion for suspension of IC plan most frequently found was renal failure, followed by hospitalization for diabetes-related complications. Patients are more often allocated to more specialized settings than not. Healthcare provider-related factors are the main determinants of inappropriate setting allocation

Effectiveness of integrated care model for type 2 diabetes: A population-based study in Reggio Emilia (Italy)

Aims To compare the effectiveness of integrated care with that of the diabetes clinic care model in terms of mortality and hospitalisation of type 2 diabetes patients with low risk of complications. Methods Out of 27234 people with type 2 diabetes residing in the province of Reggio Emilia on 31/12/2011, 3071 were included in this cohort study as eligible for integrated care (i.e., low risk of complications) and cared for with the same care model for at least two years. These patients were followed up from 2012 to 2016, for all-cause and diabetes-related mortality and hospital admissions. We performed a Poisson regression model, using the proportion of eligible patients included in the integrated care model for each general practitioner as an instrumental variable. Results 1700 patients were cared for by integrated care and 1371 by diabetes clinics. Mortality rate ratios were 0.83 (95%CI 0.60-1.13) and 0.95 (95%CI 0.54-1.70) for all-cause and cardiovascular mortality, respectively, and incidence rate ratios were 0.90 (95%CI 0.76-1.06) and 0.91 (95%CI 0.69-1.20) for all-cause and cardiovascular disease hospitalisation, respectively. Conclusion For low risk patients with type 2 diabetes, the integrated care model involving both general practitioner and diabetes clinic professionals showed similar mortality and hospitalisation as a model with higher use of specialized care in an exclusively diabetes clinic setting

Effects of Tail Pinch on BDNF and trkB Expression in the Hippocampus of Roman Low- (RLA) and High-Avoidance (RHA) Rats

In this article, we describe the effects of tail pinch (TP), a mild acute stressor, on the levels of brain-derived neurotrophic factor (BDNF) and its tyrosine kinase receptor B (trkB) proteins in the hippocampus (HC) of the outbred Roman High- (RHA) and Low-Avoidance (RLA) rats, one of the most validated genetic models for the study of fear/anxiety- and stress-related behaviors. Using Western blot (WB) and immunohistochemistry assays, we show for the first time that TP induces distinct changes in the levels of BDNF and trkB proteins in the dorsal (dHC) and ventral (vHC) HC of RHA and RLA rats. The WB assays showed that TP increases BDNF and trkB levels in the dHC of both lines but induces opposite changes in the vHC, decreasing BDNF levels in RHA rats and trkB levels in RLA rats. These results suggest that TP may enhance plastic events in the dHC and hinder them in the vHC. Immunohistochemical assays, carried out in parallel to assess the location of changes revealed by the WB, showed that, in the dHC, TP increases BDNF-like immunoreactivity (LI) in the CA2 sector of the Ammon's horn of both Roman lines and in the CA3 sector of the Ammon's horn of RLA rats while, in the dentate gyrus (DG), TP increases trkB-LI in RHA rats. In contrast, in the vHC, TP elicits only a few changes, represented by decreases of BDNF- and trkB-LI in the CA1 sector of the Ammon's horn of RHA rats. These results support the view that the genotypic/phenotypic features of the experimental subjects influence the effects of an acute stressor, even as mild as TP, on the basal BDNF/trkB signaling, leading to different changes in the dorsal and ventral subdivisions of the HC

Development and validation of a case-finding algorithm for the identification of non-small cell lung cancers in a region-wide Italian pathology registry

PurposeTo develop and validate a case-finding algorithm for the identification of Non-Small Cell Lung Cancer (NSCLC) cases in a region-wide Italian pathology registry (PR).Materials and methodsData collected between 2009 and 2017 in the PR and the Pharmacy Database of the University Hospital of Siena and the PR of Tuscany region were used. A NSCLC-identification algorithm based on free-text keywords and SNOMED morphology and topography codes was designed and tested on data from Siena: indication for drug use (i.e. NSCLC) was the reference standard for sensitivity (SE); positive predictive value (PPV) was estimated through manual review. Algorithm modifications were then tested to improve algorithm performance: PPV was calculated against validated dataset from PR of Siena; a range of SE [min-max] was estimated in PR of Tuscany using analytical formulae that assumed NSCLC incidence equal either to 80% or 90% of overall lung cancer incidence recorded in Tuscany. The algorithm modification with the best performance was chosen as the final version of the algorithm. A random sample of 200 cases was extracted from the PR of Tuscany for manual review.ResultsThe first version of the algorithm showed a PPV of 74.7% and SE of 79% in PR of Siena. The final version of the algorithm had a SE in PR of Tuscany that grew with calendar time (2009 = [24.7%-28%]; 2017 = [57.9%-65.1%]) and a PPV of 93%.ConclusionsThe final NSCLC-finding algorithm showed with very high PPV. SE was in line with the expected contribution of PR to overall cases captured in the regional Cancer Registry, with a trend of increase over calendar time. Given the promising algorithm validity and the wide use of SNOMED terminology in electronic pathology records, the proposed algorithm is expected to be easily adapted to other electronic databases for (pharmaco)epidemiology purposes