La nave dei folli: la modifica dello stereotipo del malato mentale nell’adolescente

L’intervento si colloca in due ambiti: 1) la riabilitazione psichiatrica; 2) l’educazione alla diversità. Si è affrontato il problema della modifica dello stereotipo del malato mentale presso un gruppo di adolescenti frequentanti l’ultimo anno di un istituto superiore della periferia di Roma. Il problema è nato proprio dalla presenza degli utenti del Centro diurno nella scuola con richiesta da parte del personale docente di non fare incontrare studenti e utenti. Il rischio evidente del perdurare dell’ emarginazione si è trasformato, grazie all’aiuto del preside, in un’ occasione di incontro tra utenti e studenti conformemente con la “Mission” del centro diurno e l’ottica di educazione alla diversità per la scuola. L’intervento si poggia sulla concezione di riabilitazione proposta dall’APA. La riabilitazione si propone di conseguire anche una meta culturale caratterizzata dalla accettazione e dal riconoscimento dei più deboli attraverso una azione sul tessuto sociale che contrasti sia l’atteggiamento pietistico che quello emarginante. A questo livello si pone la specificità pedagogica dell’intervento che vede.1) la riabilitazione porsi entro il raggio d’azione di una pedagogia per l’inclusione che vede la scuola come microcosmo sociale all’interno del quale attuare la formazione di una piccola comunità competente. 2) La scuola sensibile al progetto di apertura alla diversità vede nell’avvicinamento alla radicale alterità della follia, una necessità fondamentale e un obbligo a favore della conoscenza e comprensione dell’altro diverso da sé per assicurargli pari dignità di cittadinanza. Si è voluto preparare un incontro tra due “culture”: quello dei “sani” e quello dei “folli” che rappresentasse un’esperienza di crescita reciproca e di annullamento di barriere fra i due gruppi, con una particolare attenzione ai processi intrapsichici che sono alla base del processo di emarginazione. Il costrutto mentale che si è inteso modificare era la costruzione dello stereotipo che per sua natura si presenta rigido, difficilmente modificabile e basato su pochi elementi. L’istruzione (dare informazioni) e la crescita empatica (modificazione degli aspetti emotivi) sono stati il focus della formazione orientata ad accrescere la curiosità piuttosto che la paura nei confronti della malattia mentale, attraverso la conoscenza della complessità e drammaticità dei vissuti dei malati, che ridimensionasse, esplicitandoli, gli atteggiamenti di paura e rifiuto. L’ipotesi formulata prevedeva che questi elementi avrebbero modificato lo stereotipo, nel senso di un allargamento-arricchimento degli attributi e di una maggiore elasticità-indeterminatezza attraverso una modificazione cognitiva e degli aspetti emotivi. Rivolta a quest’ultimo aspetto è stata l’organizzazione di un cineforum. Tale metodologia costituisce tuttora una delle attività formative più collaudate all’interno della scuola. Gli strumenti per la rilevazione dei dati sono stati: un tema a carattere fantastico sulla malattia mentale i cui contenuti sono stati analizzati con il software SPSS: questo strumento mirava a suscitare gli aspetti fantasmatici dell’incontro con il folle e a valutare gli atteggiamenti in merito a: emozioni, atteggiamenti cognitivi e tendenza all’azione: ad integrazione di questo strumento per sua natura poco strutturato, ma utilizzato perché inserito nella quotidianità della vita scolastica, e quindi accettato dai ragazzi, è stata affiancata la somministrazione di una Adjective check list (Acl) avente come stimolo il malato mentale. La metodologia ha visto due somministrazioni prima e dopo l’intervento formativo. I risultati hanno confermato gli esiti ipotizzati.Among the most invisible, of exclusions, are the mentally ill. This form of exclusion varies from society to society. In this cultural and historical context, the mentally ill emerge as “loser”. The question becomes how to minimize the cultural and social stigmata of mentally illness. This study illustrates a small investigation to educate the sensibility of young people by introducing them to the problems of perception which they hold by stereotyping the mentally ill. Internationally, similar results emphasise the importance of giving correct information which in itself tends to change stereotypes. The form which this research took was to arrange that a group of young people met the clients of public rehabilitation centre in Rome. The first step in the research was to prepare the young people to meet members of this centre who were all schizophrenics. This preparation was by showing films about mental disease; by discussing the interpretation of the films; and by offering to the young people precise, and correct, information on hallucination and delirium. Two instruments were used to measure the change in stereotypes. The first , was an Adjective Check List, and the second was the analysis of essays written by the young people. These essays were subjected to a content analysis. The results were clear. They will be indicated in the full paper

Dormant Mycobacterium tuberculosis fails to block phagosome maturation and shows unexpected capacity to stimulate specific human T lymphocytes

Dormancy is defined as a stable but reversible nonreplicating state of Mycobacterium tuberculosis. It is currently thought that dormant M. tuberculosis (D-Mtb) is responsible for latent tuberculosis (TB) infection. Recently, D-Mtb was also shown in sputa of patients with active TB, but the capacity of D-Mtb to stimulate specific immune responses was not investigated. We observed that purified protein derivative-specific human CD4(+) T lymphocytes recognize mycobacterial Ags more efficiently when macrophages are infected with D-Mtb instead of replicating M. tuberculosis (R-Mtb). The different Ag recognition occurs even when the two forms of mycobacteria equally infect and stimulate macrophages, which secrete the same cytokine pattern and express MHC class I and II molecules at the same levels. However, D-Mtb but not R-Mtb colocalizes with mature phagolysosome marker LAMP-1 and with vacuolar proton ATPase in macrophages. D-Mtb, unlike R-Mtb, is unable to interfere with phagosome pH and does not inhibit the proteolytic efficiency of macrophages. We show that D-Mtb downmodulates the gene Rv3875 encoding for ESAT-6, which is required by R-Mtb to block phagosome maturation together with Rv3310 gene product SapM, previously shown to be downregulated in D-Mtb. Thus, our results indicate that D-Mtb cannot escape MHC class II Ag-processing pathway because it lacks the expression of genes required to block the phagosome maturation. Data suggest that switching to dormancy not only represents a mechanism of survival in latent TB infection, but also a M. tuberculosis strategy to modulate the immune response in different stages of TB

TM9SF4 is a novel V-ATPase-interacting protein that modulates tumor pH alterations associated with drug resistance and invasiveness of colon cancer cells

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Cannibalism of Live Lymphocytes by Human Metastatic but Not Primary Melanoma Cells

The phenomenon of cell cannibalism, which generally refers to the engulfment of cells within other cells, was described in malignant tumors, but its biological significance is still largely unknown. In the present study, we investigated the occurrence, the in vivo relevance, and the underlying mechanisms of cannibalism in human melanoma. As first evidence, we observed that tumor cannibalism was clearly detectable in vivo in metastatic lesions of melanoma and often involved T cells, which could be found in a degraded state within tumor cells. Then, in vitro experiments confirmed that cannibalism of T cells was a property of metastatic melanoma cells but not of primary melanoma cells. In particular, morphologic analyses, including time-lapse cinematography and electron microscopy, revealed a sequence of events, in which metastatic melanoma cells were able to engulf and digest live autologous melanoma-specific CD8+ T cells. Importantly, this cannibalistic activity significantly increased metastatic melanoma cell survival, particularly under starvation condition, supporting the evidence that tumor cells may use the eating of live lymphocytes as a way to ‘‘feed’’ in condition of low nutrient supply. The mechanism underlying cannibalism involved a complex framework, including lysosomal protease cathepsin B activity, caveolae formation, and ezrin cytoskeleton integrity and function. In conclusion, our study shows that human metastatic melanoma cells may eat live T cells, which are instead programmed to kill them, suggesting a novel mechanism of tumor immune escape. Moreover, our data suggest that cannibalism may represent a sort of ‘‘feeding’’ activity aimed at sustaining survival and progression of malignant tumor cells in an unfavorable microenvironment. (Cancer Res 2006; 66(7): 3629-38

Randomized clinical trial to evaluate the effect of fecal microbiota transplant for initial Clostridium difficile infection in intestinal microbiome

Objective The aim of this study was to evaluate the impact of fecal donor-unrelated donor mix (FMT-FURM) transplantation as first-line therapy for C. difficile infection (CDI) in intestinal microbiome. Methods We designed an open, two-arm pilot study with oral vancomycin (250mg every 6 h for 10–14 days) or FMT-FURM as treatments for the first CDI episode in hospitalized adult patients in Hospital Universitario “Dr. Jose Eleuterio Gonzalez”. Patients were randomized by a closed envelope method in a 1: 1 ratio to either oral vancomycin or FMT-FURM. CDI resolution was considered when there was a reduction on the Bristol scale of at least 2 points, a reduction of at least 50% in the number of bowel movements, absence of fever, and resolution of abdominal pain (at least two criteria). From each patient, a fecal sample was obtained at days 0, 3, and 7 after treatment. Specimens were cultured to isolate C. difficile, and isolates were characterized by PCR. Susceptibility testing of isolates was performed using the agar dilution method. Fecal samples and FMT-FURM were analyzed by 16S rRNA sequencing. Results We included 19 patients; 10 in the vancomycin arm and 9 in the FMT-FURM arm. However, one of the patients in the vancomycin arm and two patients in the FMT-FURM arm were eliminated. Symptoms resolved in 8/9 patients (88.9%) in the vancomycin group, while symptoms resolved in 4/7 patients (57.1%) after the first FMT-FURM dose (P = 0.26) and in 5/7 patients (71.4%) after the second dose (P = 0.55). During the study, no adverse effects attributable to FMT-FURM were observed in patients. Twelve isolates were recovered, most isolates carried tcdB, tcdA, cdtA, and cdtB, with an 18-bp deletion in tcdC. All isolates were resistant to ciprofloxacin and moxifloxacin but susceptible to metronidazole, linezolid, fidaxomicin, and tetracycline. In the FMT-FURM group, the bacterial composition was dominated by Firmicutes, Bacteroidetes, and Proteobacteria at all-time points and the microbiota were remarkably stable over time. The vancomycin group showed a very different pattern of the microbial composition when comparing to the FMT-FURM group over time. Conclusion The results of this preliminary study showed that FMT-FURM for initial CDI is associated with specific bacterial communities that do not resemble the donors’ sample.Peer reviewedFinal Published versio

Analisi della salute organizzativa e burnout fra gli infermieri di area chirurgica, medica e pediatrica

Nell’attuale scenario sociale la progressiva centralità dei servizi alle persone appare come un fenomeno complesso, con vantaggi e limiti legati al rischio che la società e le organizzazioni possano non adeguatamente governarne le dinamiche proprie della persona che lavora. Le organizzazioni hanno il ruolo di mediare tra le caratteristiche dell’essere umano (motivazioni, obiettivi, bisogni) e quelle dell’ambiente, cercando di creare un equilibrio. Quando non riescono in questo compito, l’ambiente diviene campo utile per l’insorgere delle patologie organizzative, quali ad esempio il burnout.In today's social scenary the progressive centrality of personal services appears as a complex phenomenon, with advantages and limitations related to the risk that companies and organizations can not adequately govern the internal dynamics of working people. Organizations have the role to mediate between characteristics of the human beings (motivations, goals, needs) and those of the environment, trying to create a balance. When they fail in this task, the environment becomes useful field for the onset of organizational pathologies, such as burnout

Episodic memory and learning rates in amyotrophic lateral sclerosis without dementia

In amyotrophic lateral sclerosis (ALS), memory deficits may be primary or secondary to executive dysfunction. We assessed episodic memory and executive function of nondemented ALS patients, comparing episodic memory profiles and learning rates of ALS patients with those of mild cognitive impairment (MCI) subjects and cognitively healthy controls (HC). In a multidisciplinary tertiary centre for motor neuron disease, 72 nondemented ALS patients, 57 amnestic MCI (aMCI), 89 single non amnestic MCI with compromised executive functions (dysexecutive MCI), and 190 HC were enrolled. They were screened using the Frontal Assessment Battery and Mini Mental State Examination. Episodic memory performances and learning rates were tested using the Rey Auditory Verbal Learning Test (RAVLT). Episodic memory dysfunction (immediate recall) was found in 14 ALS patients (19.4%). The ALS group had lower performance than HC on immediate recall, without differences in learning rate, and better performance than aMCI subjects on all RAVLT measures. Compared to dysexecutive MCI subjects, ALS patients had only better verbal learning abilities. ALS patients with executive dysfunction had a lower score on immediate and delayed recalls, verbal learning, and primacy effect than ALS patients without executive dysfunction. The immediate recall among couples of diagnostic groups differed in a statistically significant way except for the ALS/dysexecutive MCI groups. In ALS patients, episodic memory performances and learning rates appeared to be better than in aMCI subjects and similar to those with dysexecutive MCI, suggesting also a secondary functional damage due to executive impairment