SPATIAL AND TEMPORAL DYNAMICS OF PESTIVIRUS, CRIMEAN-CONGO HEMORRHAGIC FEVER AND HEPATITIS E VIRUS: A PHYLOGENETIC APPROACH

The general aim of the PhD project was to apply phylogenetic analysis to viral sequences obtained in different geographic areas at different times, in order to reconstruct the most probable places of origin and pathways of dispersion of infections. Viral population growth and evolution leave a measurable imprint on the genome of viruses over the course of years, months or even days and occur simultaneously with geographic dispersal (Holmes, 2008; Pybus & Rambaut, 2009). This interaction characterizes a spatial phylodynamic process that can be recovered from genomic data using phylogeographic analyses (Faria et al., 2011). The research activity has been focused on Pestivirus genus, that includes pathogens of livestock (Bovine viral diarrhea virus - BDV) and wildlife (Border disease virus - BDV), and on zoonotic emerging diseases, involving in their epidemiological cycle both livestock and wildlife (Crimean-Congo hemorrhagic fever - CCHF, Hepatitis E virus- HEV). Concerning BDV, since 2001 several outbreaks of disease have been reported in Pyrenean chamois in Spain, France and Andorra. These outbreaks have decimated several Pyrenean chamois populations, with mortalities ranging from 40% to 85%. The infection has become endemic in the Central and Eastern Pyrenees. The aim of this study was to clarify the origin and dispersion of the Pyrenean chamois BDV genetic variant by reconstructing the spatial and temporal dynamics of BDV 5\u2019 UTR sequences of Pyrenean chamois, 10 novel sequences and 41 retrieved from public databases and Sheep BDV sequences (n=44) from Spain and France were also retrieved. The phylogenetic analysis was performed using a Bayesian Markov chain Monte Carlo (MCMC) method implemented in the BEAST v.1.74 package. The chamois clade originated from sheep BDV genotype 4, generating a founder effect due to intra-species spread and spatial dispersion. The time of the most recent common ancestor estimates for the chamois clade dated back to a time span between 1974 and 1996, with a mean estimation falling in 1988. The pathway of dispersion of isolates suggests a complex exchange between neighboring Pyrenean chamois populations, still going on such as Western direction. Genetic typing of bovine viral diarrhea virus (BVDV) has distinguished BVDV-1 and BVDV-2 species and an emerging putative third species (HoBi-like virus), recently detected in southern Italy, signaling the occurrence of natural infection in Europe. Recognizing the need to update the data on BVDV genetic variability in Italy for mounting local and European alerts, a wide collection of 5\u2019 UTR sequences (n = 371) was selected to identify the frequency of genotypes and subtypes at the herd level. BVDV-1 had the highest frequency, followed by sporadic BVDV-2. No novel HoBi-like viruses were identified. Four distribution patterns of BVDV-1 subtypes were observed: highly prevalent subtypes with a wide temporal-spatial distribution (1b and 1e), low prevalent subtypes with a widespread geographic distribution (1a, 1d, 1g, 1h, and 1k) or a restricted geographic distribution (1f), and sporadic subtypes detected only in single herds (1c, 1j, and 1l). BVDV-1c, k, and l are reported for the first time in Italy. Italy is one of the countries with the highest genetic diversity of BVDV worldwide. Northern Italy ranked first for BVDV introduction, prevalence, and dispersion. Nevertheless, the presence of sporadic variants in other restricted areas suggests the risk of different routes of BVDV introduction. CCHF is a zoonosis mainly transmitted by ticks that causes sporadic cases and severe hemorrhagic fever of acute human disease with a mortality rate of 5-60% and it has recently emerged in the Balkans and eastern Mediterranean areas. In order to reconstruct the origin and pathway of the worldwide dispersion of the virus at global and regional (eastern European) level, we investigated the phylogeography of the infection by analysing 121 publicly available CCHFV S gene sequences including two recently characterised Albanian isolates. The spatial and temporal phylogeny was reconstructed using a Bayesian Markov chain Monte Carlo approach. CCHFV phylogeographic reconstruction suggests that the disease originated about one thousand years ago from a common ancestor probably located in Africa. The virus then spread to Asia in the XV century and entered Europe on at least two occasions: the first in the early 1800s and the second in the early 1900s. The most probable location for the origin of the European clade was Russia, but Turkey played a central role in spreading the virus throughout Europe. Our data suggest that the movement of wild and domestic ungulates from endemic areas probably represent the main cause of virus dissemination in Eastern Europe. Hepatitis E virus is classified into four genotypes that have different geographical and host distributions. The main cause of sporadic autochthonous type E acute hepatitis in developed countries is genotype 3, which has a worldwide distribution and widely infects pigs. The aim of this study was to make hypotheses concerning the origin and global dispersion routes of this genotype by reconstructing the spatial and temporal dynamics of 208 HEV genotype 3 ORF-2 sequences (retrieved from public databases) isolated in different geographical areas. The evolutionary rates, time of the most recent common ancestors (tMRCAs), epidemic growth and phylogeography of HEV-3 were co-estimated using a MCMC Bayesian method. On the basis of time-scaled phylogeographical reconstruction, we hypothesise that HEV-3, after originating in the early 1800s in Europe, reached Asia in the first decades of 1900, and then moved to America probably in the 1970s-1980s. Analysis of the skyline plot showed a sharp increase of the number of infections between the 1980s and 2005, suggesting the intervention of new and highly efficient routes of transmission, possibly related to changes in the pig industry

La prevenzione del reato nella coppia disfunzionale: dalla presa in carico individuale a quella relazionale

The crimes occurring in dysfunctional couples are usually of a violent kind and include psychological abuses, sexual assault, personal wounds, attempted murder, to murder itself. Generally, it comes to crimes that are repeated through time, although it is very difficult to define their chronological course on the whole, since the number of such deeds remains very often obscure. This is due to the lack of a valid communication not only between the two partners of a dysfunctional couple, but also between the couple itself and its social environment, particularly between the victim and those agencies in charge of social assistance, which could give psychological aid and legal protection. As a result, it is difficult to attempt a realistic evaluation of this phenomenon, because a very high number of cases are not reported by the victims, and this is also an obstacle to the achievement of valid precautionary approaches. Crime prevention in the dysfunctional couple means therefore psychologicalsocial assistance of the couple, rather than just of only one partner. In fact, while first prevention works at a general level, meaning a series of psychological- social-educational activities focused on risk factors, second prevention is at an individual level, monitoring some specific markers with the purpose of preventing a certain situation from occurring; the third prevention aims at preventing a relapse. Preventing a crime (usually a violent one) in dysfunctional couples means focusing on the kind of relationship and on the way the couple works; in fact, an intervention addressed at only one partner cannot solve the problem: on the contrary, it makes it sometimes worse. Likewise, a mere penal intervention isn’t successful neither at the level of second prevention, nor - least of all - at the level of first prevention. Having considered all that, we think that crime prevention in dysfunctional couples can be achieved through a double intervention: motivating the victims to communicate, and training those social and institutional operators who might get in touch with them. In other words, prevention is then possible, but only if we motivate to communication on one side and on the other one if operators are trained to understand in a right way the meaning of implicit distress signals coming from dysfunctional behaviours.I reati che si consumano nelle coppie disfunzionali sono, in genere, di tipo violento e comprendono maltrattamenti psicologici, violenza sessuale, lesioni personali, tentativi di omicidio, fino all’omicidio vero e proprio. In genere, si tratta di crimini che si ripetono nel tempo, anche se risulta molto difficile stabilirne l’andamento cronologico complessivo, dal momento che il numero oscuro per tali fattispecie è molto alto. Questo aspetto è dovuto al fatto che, nelle coppie disfunzionali, manca una valida comunicazione non solo tra i due partner, ma anche tra la coppia e l’ambiente sociale, e soprattutto tra la vittima e quelle agenzie di controllo sociale che potenzialmente potrebbero fornirle aiuto psicologico e tutela giuridica. Per tale ragione, l’elevatissimo numero di casi che non viene denunciato dalle vittime stesse non solo rende molto difficoltosa una corretta stima del fenomeno, ma impedisce anche la realizzazione di valide strategie preventive. La prevenzione del reato all’interno della coppia disfunzionale implica quindi una “presa in carico” di tipo psico-sociale della coppia stessa, più che del singolo partner. Infatti, se la “prevenzione primaria” si colloca su di un piano “generale”, consistendo in una serie di iniziative di natura psico-socio-educativa volte ad agire sui fattori di rischio, quella “secondaria” si pone ad un livello “individuale” e mira ad impedire l’insorgenza di una determinata situazione partendo da precisi indicatori; mentre quella “terziaria” si propone di prevenire la “recidiva”. Prevenire un reato, in genere violento, nelle coppie disfunzionali, comporta di porre attenzione specialmente alla tipologia di rapporto ed alle modalità di funzionamento della coppia, perché un intervento centrato soltanto su un partner non risolve il problema, anzi, talora lo aggrava; se poi l’intervento avviene solo a livello penale non risulta efficace, né sul piano della prevenzione secondaria, né tantomeno su quello della prevenzione primaria. Tenuto conto di tutto ciò, si è perciò del parere che la prevenzione del reato nelle coppie disfunzionali possa essere realizzata attraverso una duplice opera: di motivazione delle vittime alla comunicazione e di formazione degli operatori sociali ed istituzionali che possono venire in contatto con le medesime. Prevenire è dunque possibile, ma solo a patto di motivare, da un lato, a comunicare e, dall’altro, a recepire correttamente il significato di richieste di aiuto implicite a condotte disfunzionali

Spatial and temporal phylogeny of border disease virus in pyrenean chamois (Rupicapra p. Pyrenaica)

Border disease virus (BDV) affects a wide range of ruminants worldwide, mainly domestic sheep and goat. Since 2001 several outbreaks of disease associated to BDV infection have been described in Pyrenean chamois (Rupicapra pyrenaica pyrenaica) in Spain, France and Andorra. In order to reconstruct the most probable places of origin and pathways of dispersion of BDV among Pyrenean chamois, a phylogenetic analysis of 95 BDV 5'untranslated sequences has been performed on chamois and domestic ungulates, including novel sequences and retrieved from public databases, using a Bayesian Markov Chain Monte Carlo method. Discrete and continuous space phylogeography have been applied on chamois sequences dataset, using centroid positions and latitude and longitude coordinates of the animals, respectively. The estimated mean evolutionary rate of BDV sequences was 2.9x10(-3) subs/site/year (95% HPD: 1.5-4.6x10(-3)). All the Pyrenean chamois isolates clustered in a unique highly significant clade, that originated from BDV-4a ovine clade. The introduction from sheep (dated back to the early 90s) generated a founder effect on the chamois population and the most probable place of origin of Pyrenean chamois BDV was estimated at coordinates 42.42 N and 1.9 E. The pathways of virus dispersion showed two main routes: the first started on the early 90s of the past century with a westward direction and the second arise in Central Pyrenees. The virus spread westward for more than 125 km and southward for about 50km and the estimated epidemic diffusion rate was about 13.1 km/year (95% HPD 5.2-21.4 km/year). The strong spatial structure, with strains from a single locality segregating together in homogeneous groups, and the significant pathways of viral dispersion among the areas, allowed to reconstruct both events of infection in a single area and of migrations, occurring between neighboring areas

Effect of allogeneic intraoperative blood transfusion on survival in patients treated with radical cystectomy for nonmetastatic bladder cancer: Results from a single high-volume institution

Transfusion has been related to poor survival after surgery in several cancers. Recently, timing of transfusion has been proposed as crucial in the determination of poor survival expectanies after surgery, in fact, intra- operative but not postoperative transfusion were found to be related. We confirmed these findings in patients who underwent radical cystectomy because of bladder cancer; physicians should avoid use of transfusion intraoperatively. Background: Previous studies have demonstrated that perioperative blood transfusion (BT) is associated with a significantly increased risk of cancer recurrence and mortality after radical cystectomy (RC). Recently, it was shown for the first time that intraoperative transfusion has a detrimental effect on cancer survival. The aim of the current study was to validate this finding in a single European institution. Patients and Methods: The study focused on 1490 consecutive nonmetastatic bladder cancer patients treated with RC at a single tertiary care referral center between January 1990 and August 2013. KaplaneMeier analyses and Cox regression analyses were used to assess the effect of timing of BT administration (no transfusion vs. intraoperative transfusion vs. postoperative transfusion vs. intra- operative and postoperative transfusion) on cancer-specific mortality (CSM), overall mortality (OM), and disease recurrence. Results: Mean age at the time of RC was 67 years. Overall, 322 (21.6%) patients received intraoperative BT and 97 (6.5%) received postoperative BT. At a mean follow-up time of 125 months (median, 110 months), the 5- and 10-year CSM rate was 846 (58%) and 715 (48%), respectively. In multivariable analyses patients who received intraoperative BT had greater risk of disease recurrence (hazard ratio [HR], 1.24; P .2). Conclusion: Our study confirms that intraoperative, but not postoperative BT, are related to a detrimental effect on survival after RC. These results should be take into account by physicians to administer BT using the correct timing

Restrizione della libertà ed espiazione della colpa. La riabilitazione anche come presa in carico del reato

We hereby aim at determining how influent a period of freedom restriction in Judicial Psychiatric Hospitals might be upon an elaboration process of the guilt, concerning women who committed a symbiotic homicide. Given that by “symbiosis” we mean a situation pertaining those early developmental phases, in which there is no psychic differentiation between a mother and her baby, we remark that leaving this psycho-developmental problem unsolved until adulthood might cause heavy consequences upon an individual’s both mental health and emotional behaviour. A “symbiotic crime” is usually a violent kind of murder, caused by a fusional state of mind involving both the victim and the aggressor. On one side, this kind of crime tries to solve the symbiosis between a victim and her/his aggressor, whereas on the other side it may bring a sense of guilt of persecutorial origin, which prevents the aggressor from elaborating the separation caused by the emotional loss and often implies his/her suicide following to the homicide. We have here reported a record of occurrences from Judicial Psychiatric Hospitals concerning inpatient women, who had murdered a descendant or a parent and committed suicide once discharged, since the elaboration process of their sense of guilt and of its hidden fusional factor had not been completed. In this regard, we refer to the body of works about symbiosis and guilt and to all related sorts of murder, such as matricide and filicide. In fact, though we acknowledge that not every single matricide or filicide case seems to be caused by a mental disease having strongly influenced the murderer in committing the crime, or by an unresolved fusional situation between victim and aggressor, the record of crimes we reported proved to be caused by such diseases. A real understanding of these sort of crimes is necessarily linked to the study of the generational interactions and the family background where the symbiotic couple was born and had been living. In fact, it is at this level that some crime originating and crime triggering elements come to light, which can be relevant not only to a judicial psychiatric valuation (about both crime attribution and the aggressor’s social danger), but also to his/her treatment course. Moreover, the latter doesn’t have to be just the chemical and psychological therapy of the individual’s mental disease: it also means taking charge of the intrapsychic effects caused in the aggressor by his/her crime, because, in the case they aren’t faced in the right way, they can bring about really serious damage, such as the suicide of the patient. We therefore underline the need for Judicial Psychiatric Hospitals to become not only the place where criminals can begin to face their own pathology, but also the place where they can begin to elaborate the crime related to it and the sense of guilt caused by the crime itself. This course must nevertheless be improved and completed, when it is possible, in those local facilities cooperating with Judicial Psychiatric Hospitals. In this perspective, a symbiotic crime calls for an organized net of intervention, so that a restriction of freedom in Judicial Psychiatric Hospitals is just the first step of a course, which must be necessarily carried out elsewhere and by other professionals, the whole of them being particularly careful to that process which, from the initial symbiosis and following to homicide, leads to a sense of guilt, which can turn into suicide. And this proving again that homicide and suicide are “two extremes which often touch” (Tantalo, 1988).Il presente contributo intende valutare il significato che può assumere un periodo di restrizione della libertà in OPG nel percorso di elaborazione della colpa in donne autrici di un omicidio a matrice simbiotica. Premesso che con il termine di simbiosi si fa riferimento ad una situazione delle fasi precoci dello sviluppo infantile nella quale manca la differenziazione intrapsichica del neonato dalla madre, si evidenzia come la mancata risoluzione in età adulta di questa problematica psico-evolutiva possa provocare gravi conseguenze sulla salute psichica del soggetto e sul suo comportamento affettivo. Si qualifica come “reato simbiotico” un delitto, in genere violento, che viene motivato da uno stato mentale di tipo fusionale esistente tra la vittima ed il suo aggressore. Questa tipologia criminosa, da un lato, tenta di risolvere la simbiosi tra la prima ed il secondo, mentre, dall’altro, può innescare in quest’ultimo una colpa di natura persecutoria che gli impedisce di elaborare il distacco conseguente alla perdita affettiva e sottendo spesso il suo suicidio in epoca cronologicamente successiva all’omicidio. A titolo esemplificativo, si riporta una casistica di donne degenti in O.P.G. per un omicidio commesso nei confronti di ascendenti e discendenti, le quali, rimesse in libertà, in mancanza di sufficiente elaborazione della colpa e della sottostante fusionalità, si sono suicidate dopo essere ritornate libere. In proposito, si richiamano i contributi della letteratura sui temi della simbiosi e della colpa, nonché di quei tipi di delitti, come il matricidio ed il figlicidio, ad esse ricollegabili. Infatti, pur dando atto che non tutti i casi di matricidio e di figlicidio appaiono motivati da un disturbo mentale presente nell’autore di reato e rilevante nella commissione del medesimo, oppure da una situazione fusionale irrisolta tra la vittima ed il carnefice, i crimini della casistica presentata riconoscono prodromi e dinamiche di tal genere. La comprensione di queste tipologie di reato, quindi, implica necessariamente lo studio delle interazioni inter-generazionali e dell’ambiente familiare nel quale si è formata ed ha vissuto la coppia simbiotica. Infatti, proprio a tale livello, emergono quegli aspetti crimino-genetici e crimino-dinamici che possono assumere rilevanza non solo nella valutazione psichiatrico-forense dell’imputabilità e della pericolosità sociale del reo, ma anche nel suo percorso di trattamento. Questo, del resto, deve consistere non solo nella cura farmacologica e psicologica del suo disturbo mentale, ma anche nella presa in carico continuativa degli effetti intrapsichici prodotti in lui dal reato commesso, perché, se essi non vengono adeguatamente affrontati, sono in grado di provocare conseguenze molto negative, come il suicidio del soggetto. In questi casi, perciò, si sottolinea l’esigenza che l’O.P.G. diventi il luogo nel quale il reo possa iniziare non solo ad affrontare la sua patologia, ma anche ad elaborare il crimine ad essa connesso e la colpa innescata dal delitto, anche se tale percorso deve necessariamente perfezionarsi e completarsi, laddove sia possibile, in quelle strutture territoriali che lavorano in collaborazione con lo stesso O.P.G. In tale prospettiva, un reato di tipo simbiotico pone più che mai il problema di strutturare interventi in rete, per cui la restrizione della libertà in O.P.G. rappresenta il primo momento di un processo che inevitabilmente deve proseguire in altri luoghi e con altri operatori, tutti però attenti a quella dinamica che dalla simbiosi iniziale, attraverso l’omicidio, porta ad una colpa che può tradursi in suicidio, a riprova che l’omicidio ed il suicidio rappresentano “due estremi che spesso si toccano” (Tantalo, 1988)

Problemi etici della predizione. Prevenzione della delinquenza precoce

The prevision and the prevention of criminal and abnormal behaviour are very debated topics in criminology. Actually, since the concept of prevention implies in theory the use of any useful mean for trying to reduce the amount of crimes in any age group, the question is which strategies could in fact bring about such an effect. From a historical point of view, this thought requires being aware both of the limits, and of the consequences of the crime prophylaxis itself. It requires being aware of the limits, because every hypothetical prevision can be denied by a high number of variables, which in any moment can modify the course of human behaviour. One should as well be aware of consequences, because, in case a prognosis turned out to be wrong, those behaviours which one wanted to prevent, might paradoxically be reinforced through processes of marginalization and labelling. On the other hand, a preventing and predictive judgement has implications of different kinds: 1) technical, because it results in interventions more or less focused on specific problems (preventing a bank robbery is different from preventing a familiar/domestic crime); 2) prescriptive, which is essential, since the life of a social group could never do without shared and followed rules (a penalty may even have a deterrent effect, if the leading group complies with the rules); 3) ethical, necessarily linked to a principle of benefit (who will enjoy benefits from preventing certain crimes? where is the advantage?). This discussion becomes even more complicated, if referred to those adolescent behaviours which are not only problematical (since they express a developmental discomfort, which can sometimes have even a psychopathological meaning), but also dysfunctional, and therefore antisocial, because they damage the respect of the “other”, required and imposed by the rule, in order to grant social harmony. In this sense, we also talk of “ premature delinquency” meaning a criminal behaviour acted by a minor who is under 14.The question about it is whether, in this age group, the prediction of a possible developmental path in a psychopathological and/or abnormal and/or criminal sense might meet the need either of social control (moreover necessary, at least within certain limits), or of healthcare of the individual, who, in such phase, often acts antisocial behaviours due to psychodevelopmental reasons, in addition to social ones. Everybody knows about the risks and the damages caused by a merely “oracular” work; this is why we cannot leave them aside, particularly when it comes to the building of the personal identity, which could irreparably become a negative identity, just because of a wrong or anyway abnormal prognosis. On the other hand, we have to consider the psychic potential of under 14 subjects, which is available also in a developmental perspective, and even when they are abnormal subjects: a prevention avoiding stigma and aiming at repairing or reinforcing the personal identity seems to meet the need of preserving both the interests of the community (by neutralizing the risk of repeating offence by the same individual) and of individual psychophysical wellness (through a project which enables the individual to rebuild himself by interiorizing positive values). Human existence is necessarily oriented towards a future, which one can be more or less aware of, which is nevertheless inescapable.Therefore, giving growth paths and indicating developmental routes to antisocial under 14 subjects could be a way of preventive intervention, based on an ethical ground, which would lead to an adequate balance between the limits of a merely stigmatizing basis and the need of encouraging respect and improvement of the others.In criminologia, la predizione e la prevenzione delle condotte delittuose e devianti sono argomenti molto dibattuti. Infatti, se il concetto di prevenzione, a livello teorico, presuppone il ricorso ad ogni mezzo utile per tentare di ridurre il numero dei crimini in ogni fascia di età, pare opportuno chiedersi attraverso quali strategie possa verosimilmente ottenersi un simile risultato. Storicamente, tale riflessione presuppone la consapevolezza sia dei limiti, sia delle conseguenze della stessa profilassi criminologia: limiti perché ogni previsione teorica può essere smentita da un numero di variabili molto ampio che, in ogni momento, può modificare il decorso del comportamento umano; e conseguenze perchè, se la prognosi si rivela errata, possono paradossalmente essere rafforzate, attraverso processi di marginalizzazione ed etichettamento, proprio quelle condotte che si intendevano evitare. D’altra parte, un giudizio preventivo e predittivo presenta implicazioni di diversa natura: tecnica, perché si traduce in interventi più o mirati sui singoli problemi (prevenire un furto in banca è un’evenienza diversa dal prevenire un reato intrafamiliare); normativa, imprescindibile nella misura in cui la vita di un gruppo sociale non può mai fare a meno di regole comunque condivise ed osservate (la sanzione può anche fungere da deterrente se il gruppo dominante vi obbedisce); etica, necessariamente correlata ad un principio di beneficialità (chi ci guadagna a prevenire certi reati? dove sta il vantaggio?). Questo discorso risulta ancor più complesso se riferito a quelle condotte adolescenziali non solo problematiche, poiché espressive di un disagio evolutivo che talora, può assumere un valore anche psicopatologici, ma anche disfunzionali e, perciò, antisociali, perché lesive di quel rispetto dell’altro che la norma richiede ed al contempo impone per garantire la civile convivenza. In questo senso, si parla anche di “delinquenza precoce”, con riferimento ad un comportamento criminoso agito da un minore al di sotto dei 14 anni. Al riguardo, ci si domanda se, in questa fascia di età,“predire” un possibile percorso evolutivo in senso psicopatologico e/o deviante e/o criminoso possa rispondere ad un’esigenza di controllo sociale, peraltro necessario almeno entro certi limiti, oppure ad un bisogno di tutela della salute dell’individuo, che, in tale fase, pone in essere condotte antisociali spesso per ragioni di ordine psico-evolutivo, oltre che sociale. I rischi e i danni di un’opera meramente “oracolare” sono noti e, perciò, non possono trascurarsi, soprattutto laddove è in gioco la formazione della stessa identità personale, che può diventare un’identità irrimediabilmente negativa proprio per una prognosi errata, o comunque abnorme. D’altro canto, considerando il potenziale psichico presente nei soggetti infra-quattordicenni, seppur devianti, ed utilizzabile anche in prospettiva evolutiva, una prevenzione che evitasse lo stigma e mirasse ad una riparazione, o ad un rinforzo, dell’identità personale, parrebbe rispondere ad un’esigenza di contemporanea salvaguardia degli interessi della collettività (tramite la neutralizzazione del rischio di recidiva criminale dei singoli) e del benessere psicofisico individuale (mediante un progetto nel quale l’individuo si ricostruisce interiorizzando valori positivi). Se infatti l’esistenza umana è necessariamente proiettata verso un futuro, del quale si può essere più o meno consapevoli, ma dal quale non si può prescindere, fornire traiettorie di crescita ed indicare percorsi di sviluppo a soggetti infra-quattordicenni antisociali potrebbe rappresentare una forma di intervento preventivo all’origine del quale la dimensione etica permetterebbe di trovare un adeguato equilibrio tra le limitazioni di un’impostazione meramente stigmatizzante e la necessità di promuovere il rispetto e la valorizzazione degli altri

La relazione nelle coppie perverse come matrice di violenza coniugale: considerazioni criminologiche su una casistica

This work aims at studying the meaning of the alterations of personal relationships recognized as the origin of crimes committed within a couple in cases with abnormal affective and sexual relation, even prolonged in time. This type of relations can be better defined as “going to perversion”, rather than “perverse”, as in the affective and sexual dynamics paraphilia appears functional to the mainteinance of the relation itself. By “couple” it is meant an over-individual system characterized by a series of needs and dynamics implying different ways of functioning, so that the “couple” is very different from the sum of its parts. This implies an adequate affective investment and a sufficient emotional involvement between the partners, because such an exchange makes easier the expression of the intimacy and stability that has already been experienced by each of them in their relationship with their parents and has then been transferred in the adult relation with the other. So there is not “being” a couple, but rather “becoming” a couple, where the relation is of a kind that allows the growth of its members and their adaptation to the environment and its changes. In this perspective being “with” and “for” the other consists in giving value and sense to the personal and the other’s existence. In the disfunctional couple, the relation does not promote the wellbeing of its members. This couple works on the bases of misunderstandings, coertions and exploitations, so that it becomes pathogenic. It gets to crossroads: it becomes collusive (and is based on silence and unsaid) or accumulates aggressiveness and destructivness, sooner or later expressed through and with crimes. In these kinds of couples the relation is so various that it makes it necessary to define the difference between the concept of episodic perverse conduct (occasional defence strategy) and stable perverse structure; moreover, the difference between perversion (well structured deviation of sexual instinct, in which sexual act has nothing to do with a real alter-egoic communication) and perversity, in which the psychic object does not form or is formed only partially, and others do not have their own individuality. In these subjects (the so called perverse personalities), particularly destructive components are expressed, and the sexual act represents a corollary. In the so called perverse couples there is a consistency between the organization of individual personality and the paraphilic conduct; the perverse conduct is functional to the interpersonal relation, because this kind of relation allows partners to follow their unfinished functioning and psychic organization levels. One becomes instrument of the other and never becomes subject. In order to understand the criminogenesis and criminodynamics of violent conduct in the so called perverse couple, it is necessary to analyze not only the single subjects, but in particular the typology of their relation. We have examined seven couples in a period of nine years, which have come to observation for criminal behaviour emerged during separation. The relation had been about five years long and all couples revealed an apparently sufficient integration in the social tissue. They all displayed a paraphlic behaviour (mostly sadomasochism, but also wife-swappering, transvestism, exhibitionism, voyeurism). The type of couple was defined on the basis of the predominant behaviour model, although some of the couples have showed more paraphilic kinds of conduct. These types of behaviour, carried out by couples seeming well-estabilished on the family level and well integrated on the social level, are often interpreted, within the so called “new perversions”, as situations at the “borderline” between slavery and freedom, or as an antidote against boredom. The Authors, although refusing such a superficial interpretation, which turns out to be disclaimed by the cases in object, that point out a disorganized personality structure in both members of the couple, as well as an unfinished personal identity and an essential inability to affective investment, that prevent them from a true object relation. The paraphilic conduct, on one side, is correlated to the personality structure of the subjects, whereas, on the other side, it justifies interpersonal dynamics characterized by constant aggresivity and reification of the partner. In such highly dysfunctional couples the absence of an adequate object for investment recalls necessarily a personal identity that - on the psychoevolutive level - was formed without a real alter-egoic comparison. The inborn destructivness in these kinds of relationship refers to the lack of the “other”, conceived as both a “matrix” of the Self and the “limit” according to which the affective erotic relation is organized. The relational approach to paraphilia, especially if acted in the context of “going to” perversion couples, allows to identify premonitory signs and dynamics of inborn aggressivity of such relations. Furthermore, these relationships - after a growing tension and a conflict phase that destabilize the apparent balance and its corresponding egosintonic paraphilia - end up with the destruction of the couple itself. The denounced offences, such as personal injury, attempted murder, sexual violence, induction to prostitution, etc., are the most evident aspect of aggressiveness subtended to the interpersonal dynamics of the couple.Il lavoro intende approfondire il significato di quelle alterazioni della relazione interpersonale che vengono riconosciute all’origine dei reati commessi all’interno della coppia, soprattutto nei casi in cui esiste un rapporto affettivo e sessuale abnorme, anche se protratto nel tempo. Questo tipo di relazione può essere meglio definita come “perversificato”, anziché "perverso”, perché nella dinamica affettiva, prima e oltre che sessuale, la parafilia appare funzionale al mantenimento del rapporto stesso. Per “coppia” si intende un sistema sovra-individuale, caratterizzato da una serie di bisogni e di dinamiche che implicano diverse modalità di funzionamento, per cui la stessa rappresenta una realtà ben diversa dalla semplice somma delle parti che la compongono. Questo comporta un adeguato investimento affettivo ed un sufficiente coinvolgimento emotivo tra i partner, perché questo scambio agevola l’espressione di quell’intimità e di quella stabilità che sono già state vissute dai singoli nel rapporto con i genitori e vengono trasferite poi nella relazione adulta con l’altro. Non si “è” dunque coppia, ma “si diventa”coppia laddove la relazione è tale da permettere l’integrazione e la crescita dei suoi membri, nonché un adattamento funzionale all’ambiente ed ai suoi mutamenti. In questa prospettiva essere “con” e “per” l’altro consiste nel dare valore e senso alla propria ed all’altrui esistenza. Nella coppia disfunzionale, la relazione non favorisce il benessere dei suoi membri. Essa funziona sulla base di fraintendimenti, coartazione e strumentalizzazione, così da diventare patogena. Essa raggiunge presto un bivio: o diventa collusiva (e si fonda sul silenzio e sul non detto), o accumula aggressività e distruttività, prima o poi destinata a manifestarsi nel e con il reato. In siffatte coppie, il rapporto erotico è quanto mai variegato, al punto da rendere necessario delineare la differenza tra i concetti di condotta perversa episodica (intesa come occasionale strategia difensiva) e struttura perversa stabile; nonché tra perversione (intesa come deviazione ben strutturata dell’istinto sessuale, nella quale l’atto sessuale prescinde da una reale comunicazione alter-egoica) e perversità, nella quale l’oggetto psichico non si forma, o si forma in modo parziale, e gli altri non possiedono una propria individualità. In questi soggetti (c.d. anche perversi caratteriali), si manifestano soprattutto le componenti distruttive, nelle quali il rapporto sessuale rappresenta un corollario. Nelle coppie c.d. perverse vi è congruenza tra organizzazione di personalità individuale e condotta parafilica: infatti, la condotta perversa è funzionale alla relazione interpersonale, perché questo tipo di rapporto permette ai partner di vivere secondo i propri incompiuti livelli di funzionamento e di organizzazione psichica. L’uno diviene strumento dell’altro e non diventa mai soggetto. Per comprendere la criminogenesi e la criminodinamica della condotta violenta nella coppia c.d.perversa, è necessario pertanto analizzare non solo i singoli, ma soprattutto la tipologia della loro relazione. La casistica è costituita da sette coppie, esaminate in un periodo di nove anni e giunte all’osservazione peritale per comportamenti criminosi emersi in sede di separazione. Il rapporto dura mediamente quasi cinque anni e tutte le coppie apparentemente rivelano sufficiente integrazione nel tessuto sociale. Tutte agiscono una condotta parafilica (prevalentemente sado-masochismo, ma anche scambismo, travestitismo, esibizionismo, voyeurismo). Il tipo di coppia è stata definita in base al modello di condotta prevalente, anche se alcune coppie hanno dichiarato di agire diverse tipologie di comportamenti parafilici. Tali comportamenti, attuati da coppie apparentemente consolidate a livello familiare ed integrate sul piano sociale, sono spesso interpretati, all’interno delle c.d. “nuove perversioni”, come situazioni “al limite” tra la schiavitù e la libertà, o come antidoto contro la noia. Gli AA., tuttavia, rifiutano tale lettura semplicistica, che sembra smentita dalla casistica esaminata, nella quale si evidenziano in tutti i membri delle coppie una struttura di personalità disorganizzata, un’identità personale incompiuta ed una sostanziale incapacità di investimento affettivo, che impedisce loro una relazione oggettuale autentica. La condotta parafilica, da un lato, si correla alla struttura di personalità dei soggetti, mentre, dall’altro, motiva una dinamica interpersonale connotata da costante aggressività e reificazione del partner. Si tratta di coppie altamente disfunzionali, nelle quali l’assenza di un adeguato investimento oggettuale chiama necessariamente in causa un’identità personale che, sul piano psico-evolutivo, si è formata senza un vero e proprio confronto alter-egoico. La distruttività insita in queste relazioni rinvia quindi alla mancanza dell’“altro”, concepito sia come “matrice”del Sé, sia come “limite” rispetto al quale articolare la relazione affettiva ed erotica. L’approccio relazionale alla parafilia, specialmente se questa viene agita nel contesto di rapporti di coppia perversificati, permette di cogliere i prodromi e le dinamiche dell’aggressività insita in tali rapporti. Questi, del resto, dopo un crescendo di tensioni e conflitti che destabilizzano l’apparente equilibrio perverso e la relativa egosintonicità parafilica, si concludono con la distruzione della coppia stessa. I reati denunciati, costituiti da lesioni personali, tentato omicidio, violenza sessuale, induzione alla prostituzione, etc., rappresentano quindi l’aspetto più eclatante e manifesto di un’aggressività pur sempre sottesa alle dinamiche interpersonali presenti in queste coppie

Il comportamento aggressivo in psichiatria: un approccio ermeneutico come chiave di prevenzione del rischio e di valutazione della responsabilità professionale

Diagnostic and clinical case histories in psychiatry are manifold and they range from schizophrenic forms to personality disorders, from mood to anxiety disorders, from sexual dysfunctions to paraphilias, from posttraumatic stress to adjustment disorders, to the organically determined mental disorders. Each one of the cited cases has a different intrinsic potentiality to act aggressive behaviours, anticipated and expressed by different symptoms and signs. Furthermore, we also have to consider the subject’s personality, culture and actual situation, in addition to the personal response to therapy and to operator. There is no doubt that the onset of a violent behaviour is an emergency clinical situation, but the management of aggressivity requires an intervention protocol, which is to include both an analysis of the patient’s resources and of the environmental means, and a precise close examination of the risk, and an accurate search for a risk-benefit counterbalance in every therapeutic option, in the wider perspective of taking the patient properly in charge all through the various phases of diagnosis, therapy, prognosis and rehabilitation. We hereby aim at propose a hermeneutic approach to the psychiatric management of aggressive behaviour, because it may become a necessary therapeutic mean in the doctor-patient relationship, and also because it may give, even later on, a key for evaluating the particulars of a possible professional liability of the medical professional. In fact, psychopathological states are likely to turn into a violent acting out, be it against self or against others, which must be prevented as much as possible with the aim of safeguarding the patient right to his own healthcare, and also to avoid a professional liability of the therapist. The latter, in fact, is in charge not only of the task of diagnosis, but also of prognosis and prevention, in the wider perspective of the taking in charge of the patient, and this in order to grant him the already mentioned right (sanctioned by the Italian Constitution, Art. 32), and even to protect the medical operators, and the possible third parties, in case of destructive behaviour performed by the patient. A hermeneutic approach is intrinsically addressed to the interpretation of phenomena and thereby to the search of their meaning, that’s to say to the explicitation of their implicit significants. This kind of approach may be really important in a prevention perspective: when the therapist relating with his patient searches for the sense of the latter’s aggressivity, he has even the chance to see whether there’s a risk of an acting out. In this way, the professional has enough time to adopt proper prevention measures, with the only aim of the patient’s healthcare. At the same time, this would give the professional a way of recognizing those elements which make it necessary for him to act in compliance with the obligatory means, while evaluating the predictability and the prevention of the illicit event. We also wish to remark the important influence of hermeneutics on other scientific disciplines, such as psychoanalysis (sharing with it the same attention to the symbol, to the language, and to the content of the patients’ clinical histories and to what lies beneath inexpressible) and psychotherapy, since in every clinical dialogue we can build up meanings in common, which can be recognized when put in a context where the different pieces fit together thanks to the whole of the discussion. In this perspective, a hermeneutic approach in the therapist-patient relationship can give valid knowledge for a well grounded prognosis, but also for starting an effective prevention, which may even be able to protect both the patient acting an aggressive behaviour (and the possibly involved third parties), and the specialist from the possible particulars causing a professional liability.In psichiatria i quadri diagnostico-clinici sono molteplici: dalle forme schizofreniche ai disturbi di personalità, dai disturbi dell’umore a quelli d’ansia, dalle disfunzioni sessuali alle parafilie, dai disturbi post-traumatici a quelli dell’adattamento fino ai disturbi mentali su base organica. In ciascuna di queste fattispecie, vi è una differente ed intrinseca potenzialità ad agire comportamenti aggressivi, preceduti ed accompagnati da sintomi e segni diversi; inoltre, tale eventualità chiama in causa anche la personalità del soggetto, la sua cultura e la situazione contingente, oltre alla compliance individuale rispetto alla terapia ed all’operatore. La comparsa di un comportamento violento rappresenta senza dubbio una situazione di emergenza in ambito clinico, ma la gestione dell’aggressività si inscrive in un protocollo di intervento che implica sia la valutazione delle risorse del paziente e dell’ambiente, sia una puntuale disamina del rischio, sia un attento bilanciamento tra rischi e benefici di ogni scelta terapeutica, nel contesto più generale di una corretta presa in carico del soggetto nelle varie fasi della diagnosi, della terapia, della prognosi e della riabilitazione. La finalità del presente contributo è quella di proporre un approccio di tipo ermeneutico alla condotta aggressiva in ambito psichiatrico, sia perché esso può diventare un indispensabile strumento terapeutico nel rapporto medico-paziente, sia perché può fornire, anche a posteriori, una chiave di lettura per valutare gli estremi di un’eventuale responsabilità professionale del sanitario. In sede psicopatologica, infatti, un agito violento, auto- e/o eterodiretto, rappresenta non solo un’eventualità più che verosimile, da prevenire quanto più possibile nell’ottica della salvaguardia del diritto del paziente alla tutela della sua salute, ma anche una più che plausibile causa di responsabilità professionale per il terapeuta. Questo, infatti, si trova ad essere investito di compiti non solo di diagnosi, ma anche di prognosi e di prevenzione nell’ambito più ampio della presa in carico e della cura del paziente, sia per garantire al medesimo il predetto diritto sancito dall’art. 32 della Costituzione, sia per tutelare gli operatori stessi, o eventuali terzi, in caso di condotte distruttive agite dal malato. Un’impostazione ermeneutica, per sua natura finalizzata all’interpretazione dei fenomeni e, di conseguenza, alla ricerca del loro significato, cioè all’esplicitazione dei loro impliciti significanti, può essere molto importante in una prospettiva preventiva, poiché, quando il terapeuta, nel suo rapporto con il paziente, cerca il senso dell’aggressività di quest’ultimo, può anche coglierne l’entità del rischio di passaggio all’atto; il che, da un lato, consente allo specialista di attivare per tempo adeguate misure preventive, nell’esclusivo interesse della salute del malato, mentre, dall’altro, permette al consulente tecnico di ravvisare quegli elementi di conferma, o meno, dell’ottemperanza ad un’obbligatorietà di mezzi da parte del sanitario, nella valutazione della prevedibilità e prevenibilità dell’evento illecito. In proposito, si ricorda che i contributi dell’ermeneutica hanno avuto importanti influssi su altre discipline scientifiche, come la psicanalisi, con la quale condivide la riflessione sul simbolo, sul linguaggio e sui contenuti delle storie cliniche dei pazienti e su quanto di non esprimibile vi è comunque celato; oppure come la psicoterapia, dato che, in ogni colloquio clinico, è possibile costruire significati condivisi, che possono ravvisarsi se collocati in una dimensione nella quale è sempre la totalità del discorso ad armonizzare i diversi frammenti.In tale ottica, impostare il rapporto terapeuta-paziente in senso ermeneutico può fornire valide conoscenze non solo per stilare un fondato giudizio prognostico, ma anche per avviare una valida attività preventiva, al punto da proteggere sia il paziente che agisce una condotta aggressiva, sia terze persone eventualmente coinvolte in essa, sia lo specialista stesso dagli estremi di un’eventuale responsabilità professionale

Mechanism of ferritin iron uptake: activity of the H-chain and deletion mapping of the ferro-oxidase site. A study of iron uptake and ferro-oxidase activity of human liver, recombinant H-chain ferritins, and of two H-chain deletion mutants.

To study the functional differences between human ferritin H- and L-chains and the role of the protein shell in the formation and growth of the ferritin iron core, we have compared the kinetics of iron oxidation and uptake of ferritin purified from human liver (90% L) and of the H-chain homopolymer overproduced in Escherichia coli (100% H). As a control for iron autocatalytic activity, we analyzed the effect of Fe(III) on the iron uptake reaction. The results show that the H-chain homopolymer has faster rates of iron uptake and iron oxidation than liver ferritin in all the conditions analyzed and that the difference is reduced in the conditions in which iron autocatalysis in high: i.e. at pH 7 and in presence of iron core. We have also analyzed the properties of two engineered H-chains, one lacking the last 22 amino acids at the carboxyl terminus and the other missing the first 13 residues at the amino terminus. These mutant proteins assemble in ferritin-like proteins and maintain the ability to catalyze iron oxidation. The deletion at the carboxyl terminus, however, prevents the formation of a stable iron core. It is concluded that the ferritin H-chain has an iron oxidation site which is separated from the sites of iron transfer and hydrolysis and that either the integrity of the molecule or the presence of the amino acid sequences forming the hydrophobic channel is necessary for iron core formation