The Development and Running of an Italian Birth Cohort for an In-Depth Evaluation of Child Health Status and Health Care Utilization in the First Years of Life

Background: The first 1,000 days of life are a unique period for the brain architecture. The development of perceptual, sensorimotor, social and language systems depend crucially on environmental stimulation. Multiple factors influence the acquisition of competencies, including health, nutrition, security and safety, responsive caregiving, and early learning. All are necessary for nurturing care and evolve through bi-directional interactions. Following children from born since adulthood researchers can identify individual trajectories through the different stages of growth that develop in function of the social and the historical context. Aim: The thesis aims to describe the development and running of a national birth cohort aiming to understand how the influences of environmental and nurture factors, that include also the social context, can affect child health. Methods: We performed an extensive review aiming for the identification of all the European Birth Cohorts focusing on those that started data collection at birth. All the information gathered from this review has been essential to defining and running NASCITA (NAscere e CREscere in ITAlia) a national birth cohort officially started on the 1st of April 2019. In this thesis, I will present the protocol, the management and the organization of this birth cohort and some preliminary results. Results: The enrollment of newborns began on April 1st, 2019. After six months from the start, the number of participating pediatricians was 160 and the number of children enrolled 2264. Most of the mothers (84%) were born in Italy and had a healthy pregnancy. The anthropometric measures of the newborns were showing an average of 3792 grams at birth and 59% of them were also breastfed at 6 months. Discussion: The only way to understand the epidemiology of diseases and to address related needs is through large epidemiological studies. In NASCITA we aim to perform an in-depth study of child development and health and the impact on them of nurturing care

A liberdade no pensamento ocidental: uma reflexão a partir de Amartya Sen

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências Jurídicas, Programa de Pós-Graduação em Direito, Florianópolis, 2015.Que significa a liberdade? Em todos os contextos históricos, este termo de extenso caráter semântico esteve presente como um dos principais temas da política, da filosofia e do direito. Quando se fala em liberdade, toca-se no aspecto subjetivo dos homens e, em especial, em suas relações com a coletividade. Seu desenvolvimento é ínsito à existência da própria sociedade. Neste limiar de século XXI, em que se cotejam todas as mudanças pelas quais os Estados fundados no modelo liberal-democrático têm passado, a questão do significado da liberdade continua atual. A presente tese investiga o modo como a liberdade foi concebida por diversos autores ocidentais ao longo dos períodos históricos, desde a Grécia em seu período clássico até a contemporaneidade, com especial enfoque na obra do economista indiano Amartya Sen. A pesquisa tem como perspectiva a sua obra no que tange, principalmente, ao desenvolvimento das liberdades como fatores instrumentais ao desenvolvimento político e humano. O trabalho defende a relação de simultaneidade entre a atuação estatal e o fortalecimento da condição de agente dos indivíduos como elo fundamental para o aprimoramento dos regimes democráticos.Abstract : What freedom means? In every historic contexts, this word with a lot of meanings is present like one of the most significant topic of discussion for politics, philosophy and also for the law. The issue of freedom touches on subjective outlook of men, but specially in your relations with others. The freedom?s development is intrinsic in the human society. On the threshold of 21st century, when the occidental world collates all changes whereby nations founded on liberal and democratic systems experienced, the debate on freedom?s meaning remains relevant. This thesis investigates how freedom was conceived by thought of many occidental political philosophers and thinkers, since Ancient Greece until now, with special focus on work of Indian economist Amartya Sen. By his work, the perspective of the thesis turns to freedom?s development as a way to human and social effectiveness. This work advocates the concurrent relation between government intervention and expansion of individual initiative as a fundamental link to improve democratic regimes

Direito e Filosofia Política em Platão e Aristóteles

This article is meant to examine some recurrent political issues to the philosophers classical Greece, with special focus in political think of Plato and Aristotle, whose paradigmatic discussions are still legitimate even in the contemporary context. Through literature review of these authors and some of his best readers, the text develops the themes of freedom, justice and forms of government, strengthening the actuality of these philosophies in the daily legal and political States.O presente artigo tem por intuito analisar alguns temas políticos recorrentes aos pensadores da Grécia clássica, tendo como enfoque a filosofia política de Platão e Aristóteles, cujas paradigmáticas discussões ainda são legítimas no contexto estatal contemporâneo. Através da revisão bibliográfica destes autores e de alguns de seus intérpretes, o texto desenvolve os temas da liberdade, justiça e formas de governo, fortalecendo a atualidade destas filosofias no cotidiano jurídico e político dos Estados

DESINFORMAÇÃO, PÓS-VERDADE E DEMOCRACIA: UMA ANÁLISE NO CONTEXTO DO ESTADO DEMOCRÁTICO DE DIREITO

Objetivo: Com as novas formas de comunicação possibilitadas com a internet, a desinformação se apresenta como uma nova realidade cada vez mais presente na sociedade de diversos países, constatando-se um período de pós-verdade que reflete nos contextos democráticos de diversas maneiras. Assim, o presente artigo tem o objetivo de traçar um panorama a respeito da forma como a desinformação nos tempos atuais traz reflexos no Estado Democrático de Direito, notadamente à moderação de conteúdo em plataformas digitais.Metodologia: Por meio do método de abordagem dedutivo e técnica de pesquisa bibliográfica.Resultados: Conclui-se que é preciso traçar estratégias jurídicas para conviver nesta nova realidade posta e, ainda, que a imprecisão do termo fake news não traduz o problema da pós-verdade.Contribuições: Refletir sobre as formas de moderação dos conteúdos de desinformação no contexto de pós-verdade e os reflexos disto no Estado Democrático de Direito.Palavras-chave: desinformação; fake news; pós-verdade; democracia. ABSTRACTObjective: With the new forms of communication made possible with the internet, misinformation presents itself as a new reality that is increasingly present in society in different countries, revealing a period of post-truth that reflects on democratic contexts in different ways. Thus, this article aims to draw an overview of how misinformation in current times, reflections on the Democratic Rule of Law, notably the moderation of content on digital platforms.Methodology: Through the method of deductive approach and bibliographic research technique.Results: It is concluded that it is necessary to trace legal strategies to live in this new reality, and also that the imprecision of the term fake news does not reflect the problem of post-truth.Contributions: To reflect on the ways of moderating disinformation content in the context of post-truth and its reflexes on the Democratic Rule of Law.Keywords: disinformation; fake news; post-truth; democracy.

0254: Updated reference levels for radiation doses to patients undergoing coronary angiography and coronary percutaneous interventions: the RAY’ACT2 study

PurposeThe RAY’ACT project is a nationwide, multicentre survey program aimed at evaluating patient radiation protection (RP) during coronary angiography (CA) and percutaneous coronary interventions (PCI) in French non-university public hospitals, which represent>30% of the national activity for PCIs, and 60% of the emergency cases. We present the updated reference levels based on the results of the second survey conducted in 2013 (RAY’ACT2).MethodsRP parameters from 48,547 CAs and 40,026 PCIs performed at 61 centres during 2013 and routinely registered in professional software were extracted and analysed retrospectively. Kerma-area product (KAP), fluoroscopy time (FT), number of acquired frames (Nb F) and runs (NR), and total Air Kerma at interventional reference point (KA, r) were analysed separately for CAs and PCIs (elective and ad hoc pooled). All procedures of the year were included.ResultsThe table shows the medians (Q1-Q3) of the RP parameters, updated RLs based on the 75th percentiles of the values for CA and PCI (bold), and previous RLs (RAY’ACT1, 2010).ConclusionsBetween 2010 and 2013, a 20 to 30% decrease was observed in medians and Reference Levels (Q3) for main RP parameters, including KAP and total Air Kerma.Abstract 0254 – Table: Results2013 (RAY’ACT2) 61 centres2010 (RAY’ACT1) 44 centresCAN=48,547N=31,066KAP (Gy.cm²)20.9 (11.8-35.7)27.2 (15.5-45.2)FT (min)3.3 (2.1-5.7)3.7 (2.3-6.3)Nb Frames404 (284-566)553 (388-769)KA,r (mGy)294 (164-498)421 (240-695)PCIN=40,026N=25,356KAP (Gy.cm²)45.2 (25.6-77.6)56.8 (32.8-94.6)FT (min)9.8 (6.3-15.4)10.3 (6.7-16.2)Nb Frames676 (465-960)837 (578-1193)KA,r (mGy)747 (421-1285)1052 (589-1788

Main approaches to malocclusions and orthognathic surgery in facial aesthetic: an integrative review

Introduction: In the scenario of orthodontic corrections, orthognathic surgery makes it possible to restore the functional and aesthetic patterns of the face, and non-surgical or minimally invasive procedures have optimized the results of ortho-surgical facial treatments. Objective: the present study aimed to perform a systematic review of the main information about orthognathic surgery in malocclusions, as well as to present the aesthetic importance. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 107 articles were found involving "malocclusions and orthognathic surgery". A total of 47 articles were evaluated in full, and 33 were included and discussed in this study. Aesthetic/functional rehabilitation is necessary until the eruption of permanent successor teeth occurs. A practical option to obtain this rehabilitation is through the installation of aesthetic or functional space maintainers. These are orthodontic devices that replace one or more deciduous teeth and are used to preserve the space destined for the permanent tooth successor, preventing it from suffering deviations during its eruption. The facial typology seeks to redefine the relationships between deleterious habits and malocclusions, through the valuation of individual morphological characteristics, which will lead to craniofacial growth and development to assume certain facial types. Therefore, due to the aging of the stomatognathic apparatus the orofacial functions can be modified, such as malocclusion, therefore for greater effectiveness and longevity of the final result of the orthodontic treatment, the indefinite use of fixed inferior containment should be established and accompanied by the professional

039: Platelet reactivity predicts both ischemic and bleeding events at one year follow-up in acute coronary syndome patients receiving prasugrel

There are evidences of a link between platelet reactivity inhibition and thrombotic and bleeding events. We have previously demonstrated that PR after prasugrel loading dose (LD) predicts short-term thrombotic events. We aimed to further investigate the relationship between PR under prasugrel and one-year thrombotic and bleeding events.MethodPatients were prospectively included in this multicentre study if they had a successful PCI for an acute coronary syndrome (ACS) and received prasugrel. Vasodilator-Stimulated Phosphoprotein (VASP index) was measured after prasugrel LD. Endpoint included the rate of thrombotic events (cardiovascular death, myocardial infarction and stent thrombosis) and bleeding events (TIMI) at one year.ResultsThree hundreds and one patients were enrolled. Nine patients (3%) were lost to follow-up at one year. The rates of thrombotic and bleeding events at one year were 7.5 and 6.8% respectively. The mean VASP index after a 60mg LD of prasugrel was 34}23% and 76 patients (25%) were considered as having high on-treatment platelet reactivity (HTPR). Patients with HTPR had a higher rate of thrombotic events compared to good responders (19.7 vs 3.1%;p<0.001). Patients with a minor or major non-CABG related TIMI bleeding had lower PR compared to patients with no bleeding events (21}18 vs 35}23%;p=0.008). In multivariate analysis, the VASP index predicted both thrombotic and bleeding events (OR: 1.44 (95% CI: 1.2–1.72; p<0.001 and 0.75 (95% CI: 0.59–0.96;p=0.024 (respectively, per 10% increase)).ConclusionPlatelet reactivity measurement after prasugrel LD predicts both ischemic and bleedings events at one year follow-up for ACS patients undergoing PCI

Mapping of Data-Sharing Repositories for Paediatric Clinical Research—A Rapid Review

The re-use of paediatric individual patient data (IPD) from clinical trials (CTs) is essential to overcome specific ethical, regulatory, methodological, and economic issues that hinder the progress of paediatric research. Sharing data through repositories enables the aggregation and dissemination of clinical information, fosters collaboration between researchers, and promotes transparency. This work aims to identify and describe existing data-sharing repositories (DSRs) developed to store, share and re-use paediatric IPD from CTs. A desk review of platforms providing access to electronic DSRs was conducted. A two-stage process was used to characterize DSRs: a first step of identification, followed by a second step of suitability assessment using a set of eight purpose-built indicators. From an initial set of forty-five publicly available DSRs, twenty-one DSRs were identified as meeting the eligibility criteria. Only two DSRs were found to be totally focused on the paediatric population. Despite an increased awareness of the importance of data-sharing, the results of this study show that paediatrics remains an area in which targeted efforts are still needed. Promoting initiatives to raise awareness of these DSRs and creating ad-hoc measures and common standards for the sharing of paediatric CTs data could help to bridge this gap in paediatric research

Use of biologics for the management of Crohn's disease: IG-IBD clinical guidelines based on the GRADE methodology

A cure for Crohn's disease (CD), a chronic inflammatory disease of the gastrointestinal tract of unknown etiology, is not available, so patients require lifelong management to keep inflammation under control. The therapeutic armamentarium has expanded with approval of several biological drugs, including in-fliximab, adalimumab, vedolizumab and ustekinumab - monoclonal antibodies that target different in-flammatory pathways - and darvadstrocel, a suspension of expanded human allogeneic, adipose-derived, mesenchymal stromal cells for the treatment of refractory complex perianal fistula. Notwithstanding ex-isting practice guidelines on medical therapy for CD, the Italian Group for the Study of Inflammatory Bowel Disease felt the need to issue new guidelines focused on the use of biologics for managing the intestinal manifestations of CD and based on the GRADE methodology. This document presents recom-mendations regarding six clinical settings, from the induction to the maintenance of clinical remission, and from optimization and de-escalation of treatments to dealing with perianal CD and post-operative recurrence. The 19 evidence-based statements are supported by information on the quality of the evi-dence, agreement rate among panel members, and panel comments mainly based on evidence from real world studies