Functional health literacy of asylum seekers and refugees. A pilot study in italy

Literature shows how some groups of populations, among which are people seeking international protection and refugees, find it difficult to access services in national health systems. Usually, asylum seekers have limited Health Literacy (HL), which makes understanding the appropriate health information difficult. The objective of this research is to consider the relationship between how people requesting international protection and refugees approach the Italian Health System to request health services and their level of Functional Health Literacy (FHL). These relationships are examined through mixed methods. Data were obtained using several tools: a self-administered questionnaire in which the subjects revealed social and demographic data and a face-to-face interview together with the S-FHL Scale fulfilment in order to identify the functional level of HL. Twenty-one subjects were interviewed in two Centers of Protection System for Asylum Seekers and Refugees (SPRAR). Results show a picture of the actual situation. Data report a problematic or insufficient FHL level. Some factors, such as gender, age and health perceptions, play a role in the FHL levels. Some racial prejudices were reported. Language barriers had the most impact on the communication gap. Nevertheless, none of the subjects were denied health services. In conclusion, although this study is a pilot, we have experienced difficulty in obtaining asylum seekers’ trust to be open about their experience. This explains the number of the sample that should be more indicated for a qualitative study. Our results are in accordance with literature for inadequate level of FHL and lack of knowledge of the Italian Health System. This study highlighted several other issues to be taken into consideration for future research on the subject

Vitamin D3 as possible diagnostic marker of Eating Disorders

Abstract Purpose Eating Disorders (EDs) refer to a group of psychiatric conditions in which disorderly food intake results in impaired psychological functioning or physical health. Nowadays, these disorders represent an increasing problem in modern society. There are no universally validated clinical parameters to confirm, disprove or simply help to identify EDs except for diagnostic criteria on psychiatric basis. The aim of this study was the assessment of Vitamin D3 level in patients with EDs to understand if it might be a valid clinical biochemistry parameter useful as prognostic marker. Methods The sample consists of 28 female patients, who suffer from EDs. Blood samples were examined in terms of blood count, glucose, cholesterol and Vitamin D3 levels. The other clinical biochemistry parameters were analysed to understand if the Vitamin D3 was the only altered parameter. Results The parameters that appear altered are glycemia, cholesterol and, in particular, Vitamin D3. Significant results were obtained comparing controls with restrictive-type anorexia nervosa (p value= 0,003) and with purging-type anorexia nervosa (p value= 0,007). Conclusion There are currently no universally validated and diagnostic reliable clinical biochemistry parameters for EDs but, in the light of the findings, but our research indicates the potential use of Vitamin D3 as a biomarker for anorexia nervosa. Level of evidence Level III: Evidence obtained from a single-center cohort study

Efficacy and safety of emapalumab in macrophage activation syndrome

OBJECTIVES: Macrophage activation syndrome (MAS) is a severe, life-threatening complication of systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD). The objective of this study was to confirm the adequacy of an emapalumab dosing regimen in relation to interferon-γ (IFNγ) activity by assessing efficacy and safety. The efficacy outcome was MAS remission by week 8, based on clinical and laboratory criteria. METHODS: We studied emapalumab, a human anti-IFNγ antibody, administered with background glucocorticoids, in a prospective single-arm trial involving patients who had MAS secondary to sJIA or AOSD and had previously failed high-dose glucocorticoids, with or without anakinra and/or ciclosporin. The study foresaw 4-week treatment that could be shortened or prolonged based on investigator's assessment of response. Patients entered a long-term (12 months) follow-up study. RESULTS: Fourteen patients received emapalumab. All patients completed the trial, entered the long-term follow-up and were alive at the end of follow-up. The investigated dosing regimen, based on an initial loading dose followed by maintenance doses, was appropriate, as shown by rapid neutralisation of IFNγ activity, demonstrated by a prompt decrease in serum C-X-C motif chemokine ligand 9 (CXCL9) levels. By week 8, MAS remission was achieved in 13 of the 14 patients at a median time of 25 days. Viral infections and positive viral tests were observed. CONCLUSIONS: Neutralisation of IFNγ with emapalumab was efficacious in inducing remission of MAS secondary to sJIA or AOSD in patients who had failed high-dose glucocorticoids. Screening for viral infections should be performed, particularly for cytomegalovirus. TRIAL REGISTRATION NUMBER: NCT02069899 and NCT03311854

ANCA-associated vasculitis in childhood: Recent advances

Abstract Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides are rare systemic diseases that usually occur in adulthood. They comprise granulomatosis with polyangiitis (GPA, Wegener’s), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome). Their clinical presentation is often heterogeneous, with frequent involvement of the respiratory tract, the kidney, the skin and the joints. ANCA-associated vasculitis is rare in childhood but North-American and European cohort studies performed during the last decade have clarified their phenotype, patterns of renal involvement and their prognostic implications, and outcome. Herein, we review the main clinical and therapeutic aspects of childhood-onset ANCA-associated vasculitis, and provide preliminary data on demographic characteristics and organ manifestations of an Italian multicentre cohort

Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

BACKGROUND: As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. METHODS: Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. RESULTS: Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients 64aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446). CONCLUSIONS: The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged 6470 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor

25th annual computational neuroscience meeting: CNS-2016

The same neuron may play different functional roles in the neural circuits to which it belongs. For example, neurons in the Tritonia pedal ganglia may participate in variable phases of the swim motor rhythms [1]. While such neuronal functional variability is likely to play a major role the delivery of the functionality of neural systems, it is difficult to study it in most nervous systems. We work on the pyloric rhythm network of the crustacean stomatogastric ganglion (STG) [2]. Typically network models of the STG treat neurons of the same functional type as a single model neuron (e.g. PD neurons), assuming the same conductance parameters for these neurons and implying their synchronous firing [3, 4]. However, simultaneous recording of PD neurons shows differences between the timings of spikes of these neurons. This may indicate functional variability of these neurons. Here we modelled separately the two PD neurons of the STG in a multi-neuron model of the pyloric network. Our neuron models comply with known correlations between conductance parameters of ionic currents. Our results reproduce the experimental finding of increasing spike time distance between spikes originating from the two model PD neurons during their synchronised burst phase. The PD neuron with the larger calcium conductance generates its spikes before the other PD neuron. Larger potassium conductance values in the follower neuron imply longer delays between spikes, see Fig. 17.Neuromodulators change the conductance parameters of neurons and maintain the ratios of these parameters [5]. Our results show that such changes may shift the individual contribution of two PD neurons to the PD-phase of the pyloric rhythm altering their functionality within this rhythm. Our work paves the way towards an accessible experimental and computational framework for the analysis of the mechanisms and impact of functional variability of neurons within the neural circuits to which they belong

Therapeutische Vertreter und Vertreterinnen von Menschen mit Demenz im Entscheidungskonflikt bezüglich Ernährungsoptionen am Ende des Lebens unterstützen

Darstellung des Themas: Die Literatur zeigt, dass die Demenzprävalenz zunimmt. Im fortgeschrittenen Stadium der Krankheit kommt es zur Urteilsunfähigkeit. Oftmals muss bei Menschen mit Demenz (MMD) am Lebensende eine Entscheidung bezüglich künstlicher Ernährung und Hydratation getroffen werden. Diese Entscheidung muss bei fehlender Patientenverfügung von therapeutischen Vertretern und Vertreterinnen (TV) getroffen werden. Diese Entscheidung stellt TV von MMD vor eine Herausforderung. Grund dafür sind Wissensmangel und ungenügende Vorbereitung auf die Rolle als stellvertretende Entscheidungstragende. Fragestellung: Welche Unterstützung bedürfen TV von MMD im ambulanten und stationären Setting in der Entscheidungsfindung bezüglich der künstlichen Ernährung und Hydratation am Lebensende von Pflegefachpersonen? Methode: Es fand eine systematisierte Literaturrecherche statt. Daraus wurden vier quantitative Studien zur Bearbeitung dieser Thesis verwendet. Erkenntnisse für die Praxis wurden mithilfe des Modells von Rycroft-Malone et al. (2004) erläutert. Relevante Ergebnisse: Frühzeitige Wissensvermittlung an TV über Krankheitsverlauf und Ernährungsoptionen mithilfe von Instrumenten zur Wissensvermittlung und «Advance Care Planning» reduzieren den Entscheidungskonflikt bezüglich Ernährungsoptionen bei MMD am Lebensende. Schlussfolgerung: Zur Unterstützung der Entscheidungsfindung müssen Pflegefachpersonen TV von MMD auf ihre Rolle als stellvertretende Entscheidungstragende vorbereiten. Dies beinhaltet frühzeitige Edukation über Krankheitsverlauf und mögliche Ernährungsoptionen am Lebensende sowie regelmässige Gesprächsführung

Functional health literacy of asylum seekers and refugees. A pilot study in Italy

Context: literature shows how some groups of population, among which are the people seeking International Protection and the Refugees, find difficult to access services in National Health Systems. Usually, Asylum Seekers have limited Health Literacy (HL) that makes understanding the appropriate health information difficult. The objective is to consider the relationship between how people requesting International Protection and Refugees approach the Italian Health System to request health services and their level of Functional Health Literacy (FHL). The Method used is a mixed approach. Data were obtained using several tools: a self-administered questionnaire in which the subjects revealed social and demographic data and a face to face interview together with the S-FHL Scale fulfilment in order to identify the functional level of HL. 21 subjects were interviewed in two centers of Protection System for Asylum Seekers and Refugees (SPRAR). Results show a picture of the actual situation. Data report a problematic or insufficient FHL level. Some factors, such as gender, age and health perceptions, play a role in the FHL levels. Some racial prejudices were reported. Language barrier had the most impact on the communication gap. Nevertheless, none of the subjects were denied health services. In conclusion, although this study is a pilot, we have experienced difficulty in obtaining Asylum Seekers trust to be open about their experience. Our results are in accordance with literature for inadequate level of FHL and lack of knowledge of the Italian Health System. This study highlighted several other issues to be taken into consideration for future research on the team

Anorexia Nervosa and Comorbid Psychopathology

There is great interest, supported by clinical experience, in the relationship between Eating Disorders (EDs) and psychiatric symptoms and diseases. The psychopathology of EDs is also referred to many risk and protective factors, and there is some evidence in the literature, also about genetic and neurobiological factors involved. EDs are often associated with pre-morbid psychiatric disorders, personality disorders, substance abuse, mood and anxiety disorders. The great amount of scientific articles dealing with the relationship between EDs and psychopathology confirms the complexity of these problems and the difficulties in diagnosis and treatment. The aim of this review is to examine and synthesize the recent scientific literature on this topic, in particular the complex relationship between Anorexia Nervosa (AN) and Neuropsychiatric Disorders