The transformative potential of health as a Commons

Italy was a participating country in the People’s Health Movement multi-centred action-research project (Civil Society Engagement for Health for All). The Italian team, a collective named Grup-pa, undertook several participatory action-research activities including, in a first phase, a mapping of groups active in fields linked to the social determination of health and health promotion, through individual and collective interviews. In a second phase, three public workshops, structured around the exchange of practices, focused on key themes emerged from phase one. A major construct originated from this work, centred around the co-construction of experiential knowledge on health as a commons, has been named ‘health commons practices’. The focus on practices is not merely strategic (producing synergies and alliances), but inherently political (conceiving participation as a value) and connected to health and staying healthy (as individuals; as a community). The construct of ‘health commons practices’ is meant to make visible an area of ongoing transformations in new spaces created by movements and in more traditional actions in defence of existing public services, addressing health as a socio-political issue. In this essay, we sketch the reflection around six keywords that are central to it: commons, care, technology, efficacy, sustainability, institution

Salute (e) politica: una ricerca-azione partecipata

Ricerca-azione partecipata applicata alla (promozione della) salute

L’equità nel diritto alla salute: una ricerca-azione multimetodologica e interdisciplinare per il contrasto alle disuguaglianze nella città di Bologna

Descrizione dell'approccio metodologico e del processo di ricerca-azione nell'ambito di un progetto cittadino di analisi e contrasto delle disuguaglianze in salute

Prolonged slow expiration technique: has new chest physiotherapy a role in the treatment of bronchiolitis?

Bronchiolitis is an acute lower respiratory tract disease caused by a viral infection. It affects infants and often requires hospitalization. Treatment is based on supportive care1. Although all current guidelines do not recommend chest physiotherapy in the treatment of bronchiolitis, its role is still controversial and challenging 1,2. Two different respiratory physiotherapy techniques are known in the treatment of bronchiolitis: conventional Chest Physiotherapy (cCPT), which includes vibration, percussion, postural drainage and forced expiratory maneuvers, and new Chest Physiotherapy (nCPT), based on prolonged slow expiration techniques2. While most studies have demonstrated ineffectiveness and risk of associated adverse events for cCPT1, nCPT has showed some benefits improving bronchial airway obstruction and Wang score in hospitalized infants with bronchiolitis3. Nevertheless, lack of homogeneity of the studies in literature makes the interpretation of the results less reliable. Although nCPT seems to show fair results in terms of clinical effectiveness and safety, it is rarely used in the treatment of bronchiolitis. Further research is needed in order to enhance and confirm preliminary positive results of nCPT in the management of bronchiolitis

Active pharmacovigilance program in patients affected by psoriasis and inflammatory bowel diseases\u2029

Objective: To help identify adverse events (AEs) in new biologic therapies and to spread the culture of pharmaceutical surveillance among patients affected by psoriasis or inflammatory bowel disease (IBD). Materials and methods: This active pharmacovigilance program provided all patients with telephone follow-ups (FU), carried out by a clinical pharmacologist for a total duration of 1 year. Collected AEs were classified according to the MedDRA dictionary. Results: 21 patients with psoriasis and 10 patients with IBD were enrolled. In our sample, the AEs reported were frequent but mild, underlining the crucial role of active pharmacovigilance in detecting minor AEs rarely spontaneously reported by the patients. Conclusion: According to our experience, a multidisciplinary team is recommended to manage complex therapies improving AE reporting and promoting greater therapeutic adherence

La comunit\ue0 che cura: una ricerca azione partecipata per promuovere salute nella zona di Pescarola.

Ricerca-azione partecipata e promozione della salute nella zona di Pescarola (Bologna)

Subclinical impairment of coronary flow velocity reserve assessed by transthoracic echocardiography in young renal transplant recipients

BACKGROUND: In renal transplant recipients (RTR) an increased risk to develop cardiovascular injury is present. Transthoracic Doppler echocardiographic assessment of coronary flow velocity reserve (CFVR), a sensitive and minimally invasive technique, was recently employed to detect both macrovascular and microvascular coronary artery disease (CAD) in different clinical settings. The prevalence of coronary involvement in young adult RTR is still unknown. The aim of the study was to investigate the presence of early cardiovascular damage in asymptomatic young adult RTR. METHODS: Transthoracic Doppler echocardiographic-derived CFVR and common carotid intima-media thickness (IMT) were assessed in 25 asymptomatic young adult RTR (mean age 25.7+/-7.0 years; range 17.3-43.9) without CAD and 25 healthy controls. RESULTS: CFVR was lower in young adult RTR compared to controls (2.8+/-0.6 vs. 3.5+/-0.8; P<0.001), meanwhile left ventricular wall motion and common carotid IMT were comparable in both groups. We found a negative correlation between CFVR and age (r=-0.50; P=0.018) and months on dialysis (r=-0.54; P<0.01). CONCLUSIONS: Young adult RTR showed a reduced CFVR reflecting an impaired coronary microcirculation, which is significantly related to the age and duration of dialysis; coronary microvascular damage is detectable in the absence of changes in common carotid IMT. Non-invasive evaluation of CFVR by transthoracic stress echocardiography could be a reliable method for identification of early coronary microvascular involvement in young adult RTR

Positron Emission Tomography with [18 F]-DPA-714 Unveils a Smoldering Component in Most Multiple Sclerosis Lesions which Drives Disease Progression

Objective: To determine the prognostic value of persisting neuroinflammation in multiple sclerosis (MS) lesions, we developed a 18 kDa-translocator-protein-positron emission tomography (PET) -based classification of each lesion according to innate immune cell content and localization. We assessed the respective predictive value of lesion phenotype and diffuse inflammation on atrophy and disability progression over 2 years.Methods: Thirty-six people with MS (disease duration 9 +/- 6 years; 12 with relapsing-remitting, 13 with secondary-progressive, and 11 with primary-progressive) and 19 healthy controls (HCs) underwent a dynamic [F-18]-DPA-714-PET. At baseline and after 2 years, the patients also underwent a magnetic resonance imaging (MRI) and neurological examination. Based on a threshold of significant inflammation defined by a comparison of [F-18]-DPA-714 binding between patients with MS and HCs, white matter lesions were classified as homogeneously active (active center), rim-active (inactive center and active periphery), or nonactive. Longitudinal cortical atrophy was measured using Jacobian integration.Results: Patients with MS had higher innate inflammation in normal-appearing white matter (NAWM) and cortex than HCs (respective standardized effect size = 1.15, 0.89, p = 0.003 and < 0.001). Out of 1,335 non-gadolinium-enhancing lesions, 53% were classified as homogeneously-active (median = 17 per patient with MS), 6% rim-active (median = 1 per patient with MS), and 41% non-active (median = 14 per patient with MS). The number of homogenously-active lesions was the strongest predictor of longitudinal changes, associating with cortical atrophy (beta = 0.49, p = 0.023) and Expanded Disability Status Scale (EDSS) changes (beta = 0.35, p = 0.023) over 2 years. NAWM and cortical binding were not associated to volumetric and clinical changes.Interpretation: The [F-18]-DPA-714-PET revealed that an unexpectedly high proportion of MS lesions have a smoldering component, which predicts atrophy and clinical progression. This suggests that following the acute phase, most lesions develop a chronic inflammatory component, promoting neurodegeneration and clinical progression

Methodological Comparison of Different Projects

In order to compare the methodological aspects of the different projects, while also placing them within a common framework, a form was specially drafted. This form was filled out in May 2019 by one or more members of each work group (Ascoli Piceno, Bologna, Milano, Roma, Trieste). The form was divided into three different sections (“Context characterisation methods”; “Community involvement methods”; “Networking methods”). Each section was created in order to highlight multidisciplinary aspects, the collaboration among different roles, and the problems and limitations the could have been faced. The sections differ in their design, although a common scheme was used in nearly all parts: narrative description, players, actions, instruments and sources. Consequently, all projects were therefore analysed according to the following matrix. Considering the specificity of the Recovery-Net project, this project was analysed solely for context characterisation methods