The Barthel index: italian translation, adaptation and validation

The Barthel Index (BI) is widely used to measure disability also in Italy, although a validated and culturally adapted Italian version of BI has not been produced yet. This article describes the translation and cultural adaptation into Italian of the original 10-item version of BI, and reports the procedures for testing its validity and reliability. The cultural adaptation and validation process was based on data from a cohort of disabled patients from two different Rehabilitation Centers in Rome, Italy. Forward and backward translation method was adopted by qualified linguist and independent native English official translators. The scale obtained was reviewed by 20 experts in psychometric sciences. The Italian adapted version of the BI was then produced and validated. A total number of 180 patients were submitted to the adapted scale for testing its acceptability and internal consistency. The total time of compilation was 5 ± 2,6 minutes (range 3-10). Validation of the scale was performed by 7 trained professional therapists that submitted both the translated and the adapted versions to a group of 62 clinically stable patients (T-test=-2.051 p=0.05). The internal consistency by Cronbach’s alpha resulted equal to 0.96. Test – retest intra – rater reliability was evaluated on 35 cases; at test-retest was ICC=0.983 (95%IC: 0.967-0.992). This is the first study that reports translation, adaptation and validation of the BI in Italian language. It provides a new tool for professionals to measure functional disability when appraising Italian speaking disable patients in health and social care settings along the continuum of care

L-CARNITINE SUPPLEMENTATION ATTENUATES NAFLD PROGRESSION AND COMPLICATIONS IN A METHIONINE AND CHOLINE DEFICIENT DIET MOUSE MODEL

Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and become one of the most common causes of chronic liver disease over the last decade in developed countries. The general prevalence of NAFLD is reported ranging between 20\u201330 % and 87 % in obese people. It is commonly associated with visceral obesity, type 2 diabetes mellitus, dyslipidemia and hypertension, all components of the metabolic syndrome, so that NAFLD might be considered an additional component of metabolic syndrome itself. As the rate of obesity, diabetes, and metabolic syndrome continue to increase, NAFLD will bring a tremendous impact on health care in the upcoming years. The underlying causes of the disease progression in NAFLD are unclear. Recent evidences suggest the development of lipid droplets (steatosis), subsequent generation of reactive oxygen species (ROS) and fibrosis deposition in the progression to non-alcoholic steatohepatitis (NASH). Moreover, continued elucidation has needed to understand fibrosis progression and regression. The paradigm of hepatic stellate cell (HSCs) activation remains the foundation for defining key translational challenges in order to accelerate the development of new therapies for patients with chronic liver disease. L-Carnitine (LCARN) is an essential nutrient that converts fat into energy in mitochondria. LCARN plays an important role in lipid metabolism; it acts as an essential cofactor for the \u3b2-oxidation of fatty acids. Very recently, LCARN has been proposed for the treatment of various diseases, including liver injury and several studies have shown that LCARN administration can ameliorate or prevent liver damage of various etiologies. We investigated the potential antioxidant and antifibrotic role of LCARN supplementation on methionine choline deficient (MCD)-diet-induced NAFLD in C57BL/6 mice. Mice were divided into three groups of CONTR (normal diet without any treatment), MCDD (MCD diet only), MCDD+LCARN 200 mg/kg/die group. Liver and heart weight, histological changes and fibrosis progression were assessed after 6 weeks of experiments. The MCD-diet induced severe hepatic fatty accumulation, but the fatty change was reduced in the MCDD+LCARN group. LCARN supplementation showed a role in controlling liver ROS generation and consequently coordinating the HSCs activation. Additionally, the same antioxidant and antifibrotic effect was observed in the myocardium. In conclusion, our findings indicate that LCARN has a potential role in control NAFLD progression to NASH. Therefore, our data suggest that LCARN may acts as a novel and potent supplementation agent against NAFLD cardiac complications

Uterine artery Doppler in predicting pregnancy outcome in women with connective tissue disorders

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Measuring the health impact of human rights violations related to Australian asylum policies and practices: A mixed methods study

This article has been made available through the Brunel Open Access Publishing Fund - Copyright @ 2009 Johnston et al.BACKGROUND: Human rights violations have adverse consequences for health. However, to date, there remains little empirical evidence documenting this association, beyond the obvious physical and psychological effects of torture. The primary aim of this study was to investigate whether Australian asylum policies and practices, which arguably violate human rights, are associated with adverse health outcomes. METHODS: We designed a mixed methods study to address the study aim. A cross-sectional survey was conducted with 71 Iraqi Temporary Protection Visa (TPV) refugees and 60 Iraqi Permanent Humanitarian Visa (PHV) refugees, residing in Melbourne, Australia. Prior to a recent policy amendment, TPV refugees were only given temporary residency status and had restricted access to a range of government funded benefits and services that permanent refugees are automatically entitled to. The quantitative results were triangulated with semi-structured interviews with TPV refugees and service providers. The main outcome measures were self-reported physical and psychological health. Standardised self-report instruments, validated in an Arabic population, were used to measure health and wellbeing outcomes. RESULTS: Forty-six percent of TPV refugees compared with 25% of PHV refugees reported symptoms consistent with a diagnosis of clinical depression (p = 0.003). After controlling for the effects of age, gender and marital status, TPV status made a statistically significant contribution to psychological distress (B = 0.5, 95% CI 0.3 to 0.71, p </= 0.001) amongst Iraqi refugees. Qualitative data revealed that TPV refugees generally felt socially isolated and lacking in control over their life circumstances, because of their experiences in detention and on a temporary visa. This sense of powerlessness and, for some, an implicit awareness they were being denied basic human rights, culminated in a strong sense of injustice. CONCLUSION: Government asylum policies and practices violating human rights norms are associated with demonstrable psychological health impacts. This link between policy, rights violations and health outcomes offers a framework for addressing the impact of socio-political structures on health.This research was supported by an Australian National and Medical Research Council PhD Scholarship (N. 251782) and a Victorian Health Promotion Foundation research grant (No. 2002-0280)

Pathologic Complete Response in Urothelial Carcinoma Patients Receiving Neoadjuvant Immune Checkpoint Inhibitors: A Meta-Analysis

Background. Immune checkpoint inhibitors (ICIs) have been evaluated as neoadjuvant treatment in urothelial carcinoma (UC) patients, with these agents reporting encouraging pathologic complete response (pCR) rates. Herein, we performed a systematic review and meta-analysis aimed at evaluating the incidence of pCR in UC patients treated with neoadjuvant ICI. Moreover, we investigated the impact of PD-L1 expression in this patient population, exploring the possible role of PD-L1 status as predictive biomarker. Materials and Methods. We retrieved all the relevant trials through PubMed/Medline, Cochrane Library and EMBASE; moreover, proceedings of the main international oncological meetings were also searched for relevant abstracts. Eligible trials assessed pre-operative ICI in UC patients. Results. Our meta-analysis has highlighted a pooled pCR rate of 36.6% in the overall population; interestingly, pCR was higher in PD-L1 positive compared with PD-L1 negative UCs (49.5% versus 35.1%, respectively). Conclusions. Positive signals emanating from neoadjuvant immunotherapy should encourage the scientific community to persist in the long road toward finding more effective treatments for UC patients

Effect of a high forage: Concentrate ratio on milk yield, blood parameters and oxidative status in lactating cows

A feeding strategy that requires a forage: concentrate ratio equal to 70: 30, with at least five different herbs in the forage and the use of silages prohibited, has recently been introduced in Italy. Despite the benefits in terms of human health (lower ω6: ω3 ratio, higher conjugated linoleic acid level) of the obtained milk, little information regarding the possible effects on cows' health is available. The aim of this study was to evaluate the effects of such a feeding strategy in dairy cows (90 days in milk at the beginning of the trial) on milk yield and composition, and blood metabolic profile, including the evaluation of oxidative stress. The proposed feeding strategy, compared with a semi-intensive strategy, resulted in an improvement of animal oxidative status (lower levels of reactive oxygen metabolites, higher levels of antioxidant potential and anti-reactive oxygen metabolites) and a significant increase of milk urea only in the first part of the trial. No differences in milk yield and composition were detected throughout the trial

Renal Toxicities in Cancer Patients Receiving Immune-Checkpoint Inhibitors: A Meta-Analysis

Aim: We performed a meta-analysis of the available clinical trials of immune-checkpoint inhibitors to assess risk differences and relative risks of renal toxicity. Methods: 17 randomized phase III studies were selected, including 10,252 patients. Results: The administration of immune-checkpoint inhibitors resulted in an overall low-grade, high-grade and all-grade renal toxicity Risk Difference of: 0.746% (95% CI 0.629% to 1.15%, p &lt; 0.001—random), 0.61% (95% CI, 0.292–0.929%, p &lt; 0.001—fixed) and 1.2% (95% CI, 0.601–1.85%—random), respectively. The pooled Relative Risk of low-grade, high-grade and all-grade renal toxicity was: 2.185 (95% CI 1.515–3.152—fixed), 2.610 (95% CI, 1.409–4.833, p = 0.002—fixed) and 2.473 (95% CI, 1.782–3.431, p &lt; 0.001—fixed), respectively. An increased risk of renal toxicity was evident in some subgroups more than others. Conclusion: Immune-checkpoint inhibitors are associated with an increased risk of renal toxicity