Need for Cardiovascular Risk Reduction in Persons With Serious Mental Illness: Design of a Comprehensive Intervention

Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US. Potentially modifiable CVD risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly elevated in persons with SMI. Evaluations of programs implementing integrated medical care into specialty mental health settings have not shown meaningful effects on CVD risk factor reduction. Rigorously tested, innovative interventions are needed to address the large burden of CVD risk in populations with SMI. In this article, we describe the design of a comprehensive 18-month intervention to decrease CVD risk that we are studying in a randomized clinical trial in a community mental health organization with psychiatric rehabilitation programs. The individual-level intervention incorporated health behavior coaching and care coordination/care management to address all seven CVD risk behaviors and risk factors, and is delivered by a health coach and nurse. If successful, the intervention could be adopted within current integrated care models and significantly improve the physical health of persons with SMI

Microclimate monitoring of Ariadne's house (Pompeii, Italy) for preventive conservation of fresco paintings

Background: Ariadne's house, located at the city center of ancient Pompeii, is of great archaeological value due to the fresco paintings decorating several rooms. In order to assess the risks for long-term conservation affecting the valuable mural paintings, 26 temperature data-loggers and 26 relative humidity data-loggers were located in four rooms of the house for the monitoring of ambient conditions. Results: Data recorded during 372 days were analyzed by means of graphical descriptive methods and analysis of variance (ANOVA). Results revealed an effect of the roof type and number of walls of the room. Excessive temperatures were observed during the summer in rooms covered with transparent roofs, and corrective actions were taken. Moreover, higher humidity values were recorded by sensors on the floor level. Conclusions: The present work provides guidelines about the type, number, calibration and position of thermohygrometric sensors recommended for the microclimate monitoring of mural paintings in outdoor or semi-confined environments. © 2012 Merello et al.; licensee Chemistry Central Ltd.This work was partially supported by the Spanish Government (Ministerio de Ciencia e Innovacion) under projects HAR2010-21944-C02-01 and HAR2010-21944-C02-02.Merello Giménez, P.; García Diego, FJ.; Zarzo Castelló, M. (2012). Microclimate monitoring of Ariadne's house (Pompeii, Italy) for preventive conservation of fresco paintings. Chemistry Central Journal. 6:145-161. https://doi.org/10.1186/1752-153X-6-145S1451616Ribera A, Olcina M, Ballester C: Pompeya Bajo Pompeya, las Excavaciones en la Casa de Ariadna. Valencia: Fundación MARQ; 2007.World Monuments Fund: World Monuments Watch: 100 Most Endangered Sites. New York: World Monuments Fund; 1996.Anter KF: Colours in Pompeiian cityscape: Adding pieces to the puzzle. Color Res Appl 2006,31(4):331–340.Harris J: Protecting Pompeii and the Italian heritage in 2012. http://www.i-italy.org/bloggers/18935/protecting-pompeii-and-italian-heritage-2012Augusti S: La Tecnica Dell’antica Pittura Parietale Pompeiana. Napoli: Gaetano Macchiaroli Editore; 1950.Miriello D, Barca D, Bloise A, Ciarallo A, Crisci GM, De Rose T, Gattuso C, Gazineo F, La Russa MF: Characterisation of archaeological mortars from Pompeii (Campania, Italy) and identification of construction phases by compositional data analysis. J Arch Sci 2010, 37:2207–2223.Castriota M, Cosco V, Barone T, De Santo G, Carafa P, Cazzanelli E: Micro-Raman characterizations of Pompei’s mortars. J Raman Spectrosc 2008,39(2):295–301.Maguregui M, Knuutinen U, Castro K, Madariaga JM: Raman spectroscopy as a tool to diagnose the impact and conservation state of Pompeian second and fourth style wall paintings exposed to diverse environments (House of Marcus Lucretius). J Raman Spectrosc 2010,41(11):1400–1409.Genestar C, Pons C, Más A: Analytical characterisation of ancient mortars from the archaeological Roman city of Pollentia (Balearic Islands, Spain). Anal Chim Acta 2006, 557:373–379.Duran A, Perez-Maqueda LA, Poyato J, Perez-Rodriguez JL: A thermal study approach to roman age wall painting mortars. J Therm Anal Calorim 2010,99(3):803–809.Pérez MC, García Diego F-J, Merello P, D’Antoni P, Fernández Navajas A, Ribera Lacomba A, Ferrazza L, Pérez Miralles J, Baró JL, Merce P, D’Antoni H, Curiel Esparza J: Ariadne’s house (Pompeii, Italy) wall paintings: a multidisciplinary study of its present state focused on a future restoration and preventive conservation. 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Indoor Air 2004,14(Suppl 7):168–174.Loupa G, Charpantidou E, Kioutsioukis I, Rapsomanikis S: Indoor microclimate, ozone and nitrogen oxides in two medieval churches in Cyprus. Atmos Environ 2006, 40:7457–7466.Vuerich E, Malaspina F, Barazutti M, Georgiadis T, Nardino M: Indoor measurements of microclimate variables and ozone in the church of San Vincenzo (Monastery of Bassano Romano – Italy): a pilot study. Microchem J 2008, 88:218–223.García-Diego F-J, Zarzo M: Microclimate monitoring by multivariate statistical control: the renaissance frescoes of the cathedral of valencia (Spain). J Cult Herit 2010,11(3):339–344.Zarzo M, Fernández-Navajas A, García-Diego F-J: Long-term monitoring of fresco paintings in the Cathedral of Valencia (Spain) through humidity and temperature sensors in various locations for preventive conservation. Sensors 2011,11(9):8685–8710.Maekawa S, Lambert F, Meyer J: Environmental monitoring at Tiwanaku. Mater Res Soc Symp Proc 1995, 352:885–892.Lillie M, Smith R, Reed J, Inglis R: Southwest Scottish Crannogs: using in situ studies to assess preservation in wetland archaeological contexts. J Archaeol Sci 2008,35(7):1886–1900.Verdecchia F, Zoccatelli C, Norelli E, Miandro R: Integrated monitoring network for surface deformation in Capo Colonna archaeological area, Crotone. Italy. IAHS-AISH P 2010, 339:345–351.Nava S, Becherini F, Bernardi A, Bonazza A, Chiari M, García-Orellana I, Lucarelli F, Ludwig N, Migliori A, Sabbioni C, Udisti R, Valli G, Vecchi R: An integrated approach to assess air pollution threats to cultural heritage in a semi-confined environment: the case study of Michelozzo’s Courtyard in Florence (Italy). Sci Total Environ 2010,408(6):1403–1413.Hygrochron Temperature/Humidity Logger iButton with 8KB Data-Log Memory. Maxim Integrated Products. http://datasheets.maxim-ic.com/en/ds/DS1923.pdfTemperature Logger iButton with 8KB Data-Log Memory. 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Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial

<p>Abstract</p> <p>Background</p> <p>Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group.</p> <p>Methods/Design</p> <p>A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m²) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months.</p> <p>Discussion</p> <p>Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.</p> <p>Trial Registration</p> <p>Clinical Trials.gov NCT00902694</p

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

On the architectural and energy classification of existing buildings: a case study of a district in the city of Palermo

Town Administrations are increasingly facing the challenge to identify smart planning actions to reduce the cities' energy demand by improving the efficiency of the urban energy systems. Buildings play an important role in this regarding both the demand and supply energy. In this scenario, the neighborhood or district scale seems to be the most appropriate to implement a multi-disciplinary approach on which smart planning relies. This paper shows the application, to a district of the city of Palermo (Sicily, Italy), of a methodology for architectural-energy classification of existing buildings. Such methodology provides, regarding the building sector, an easy tool that can support smart planning at district scale using data available to the municipalities. The work also shows a first experimental approach for the neighborhoods' characterization. The basic idea guiding this work is to identify possible features and subsequent intervention actions for energy refurbishment in neighborhoods clusters

Cronaca istituzionale dalla Lombardia, tra referendum "per" l'autonomia e leggi "per" la persona

lo scritto prende in esame le principali leggi lombarde in materia di tutela della salute adottate nel corso del 2017 ponendo in evidenza i principali indirizzi (maggiore efficienza organizzativa, "cultura" della prevenzione, approccio più "laico" per la gestione della questione del "fin di vita") e le principali modifiche rispetto alla normativa pregressa