La relazione tra medici nell'ambito ospedaliero: tra autonomia decisionale e collaborazione interdisciplinare

vengono descritte le problematiche medico legali relative alla responsabilit\ue0 dei vari membri di un equip\ue9 medica multidisciplinare e le modalit\ue0 per relaizzare un governo clinico mediante accreditamento di eccellenz

Individualized Breakfast Programs or Glycogen Super-Compensation: Which Is the Better Performing Strategy? Insights from an Italian Soccer Referees Cohort

The role of soccer referees has grown in importance in the last decades, as has attention to their performance, which may be influenced and improved with specific and evolved training programs. Today, multiple specialists are working as a team in order to develop effective training programs. Moreover, for athletes, it is becoming more and more important to be attentive to nutrition. By considering such items, in this study, we aimed to investigate the nutritional habits of a group of referees belonging to the Italian Soccer Referees' Association (on behalf of AIA-FIGC). Our main aim was to spread a "culture of nutrition" in refereeing, starting with a survey on referees' breakfast attitudes and in order to disseminate such a "culture", we chose top-level elite referees who were younger subjects (despite the average 4 years' experience). Therefore, we enrolled 31 subjects (aged 22.74 \ub1 1.79, BMI 22.30 \ub1 1.53) and asked them about their breakfast habits. Then, for measuring their performance, we used the conventional fitness test named Yo-Yo (YYiR1), performed in three different sessions (test 1, test 2, test 3). Test 1 was carried out without any nutritional indications, test 2 was given after individualized breakfast suggestions by a designed dietician, and test 3 after an individualized glycogen super-compensation strategy. The Wilcoxon statistical analysis indicates that following an individualized breakfast strategy may enhance referees' performance (p < 0.0001), whereas no significant effects were observed with the glycogen super-compensation option. However, further studies will be necessary to better address this topic and clarify whether high-carbohydrates (high-CHO) intake may be useful in other sports

Igiene orale in soggetti istituzionalizzati affetti da ritardo mentale

The aim of this study is to compare the condition of oral hygiene of thirty institutionalized subjects afflicted with mental retardation already in care near the Dental Service, and seventy ones not yet in, in order to value both the efficaciousness of carried out prevention programs and willingness of the operators responsible for oral hygiene in undertaking a valid formation pattern for the task. Private data, mental retardation level, patient collaboration grade and autonomy in daily oral hygiene level, in addition to caries experience (DFMT) and simplified oral hygiene index (OHI), are all parameters that have been recorded. The results underline a lower DMFT in those subjects of the group who have already been submitted to prevention measures. Also OHI presents very different values between the groups unfavourably to those subjects not yet included in dental specific program. Data about the group of subjects already in cure put in evidence the efficaciousness of educational and motivational measures, founded upon dailyness and friendly individualized approach, adopted by the \ue9quipe of Dental Service. In the same time, data about the other group let the necessity of educational programs for those subjects who the role of daily oral hygiene is destined to emerge

Analisi descrittiva di una popolazione di anziani afferenti a un Centro Diurno Integrato (CDI) dell'hinterland milanese

Tutti i soggetti assistiti dal 2002 al 2007 sono stati sottoposti a valutazione multidimensionale mediante somministrazione di scale validate. E' stato individuato il vero caregiver di ogni ospite. Questo studio ha evidenziato che avere un caregiver anziano \ue8 l'unico fattore di rischio per la successiva istituzionalizzazione degli utenti afferenti

Motivazione lavorativa e stress del caregiver formale in RSA

Il benessere del caregiver ha un notevol impatto nella gestione del soggetto anziano ricoverato in strutture di lungodegenza.Un questionario anonimo somministrato 51 caregiver formali valutando il livello di stress. I risultati permetternno di valutare quali problematiche possono ridurre lo stress e miglirare l'assistenzaObjective. Well-being of professional caregivers has a profound impact on the management of elderly patients in nursing homes. Aim of this paper is to investigate how potentially stressful situations affect workers of facilities for dependent patients. Methods. Fifty-one professional caregivers (15 SRN and 36 NA), of three small institutions of the Fondazione Istituto Sacra Famiglia in Cesano Boscone (MI) Italy, were involved in the study. Data were collected according to the privacy norms and using an anonymous questionnaire including socio-demographic information, the Nursing Stress Scale and the Rosemberg' Self-esteem Scale. Work loads were quantified using the Barthel Index and the NeuroPsychiatric Inventory. Student's t-test, ANOVA and Bonferroni's post hoc test were used for statistical analysis. Results. The average level of perceived stress is not high (NSS mean score 37,5 \ub1 13,4), and is directly related to work loads, to death management and to lack of support; the highest stress levels are registered in the Alzheimers' Unit. Self-esteem score is rather high (RSS score 57,1 \ub1 8,6), but significantly lower in the group working with mentally impaired patients (p < 0,001). Professional caregi-vers with children show a lower vulnerability to stress and towards conflicts in the working environment, paralleled by a higher self-esteem compared to their colleagues without children. Conclusions. The knowledge of stress determinants can help planning preventive interventions and strategies in order to avoid stress and promote better living conditions for both caregivers and patients in nursing homes

Valutazione dell'efficacia di un programma di attivit\ue0 fisica adattata (APA) in una popolazione di anziani istituzionalizzati affetti da ritardo mentale

Questo studio evidenzia che in questi soggetti l'esercizio fisico continuativo \ue8 risultato essere un elemento fondamentale per garantire benessere psico fisco nall'anziano istituzionalizzato. La performance fisica (WT6' e TUG) e la mobilit\ue0 del cingolo scapolo omerale sono migliorate in modo significativo

Why Treat Patients with a Major Orthopaedic Surgery Only to Send Them Back to the Vulnerable Conditions That Made Them Sick in the First Place? A Conceptual Scenario to Improve Patient’s Journey

Individuals with severe cartilage degeneration of the hip or knee or collapsed vertebrae that cause spine deformities can suffer from joint and neuropathic pain in the back, disuse of the affected limb, and restriction of movements. Surgical intervention is the most widespread and successful solution to date. There is a general belief that eating healthy and staying physically and mentally active might have a preventive role against musculoskeletal disease occurrence, while instead, we are more certain of the benefits deriving from a healthy diet and exercise therapy after major orthopaedic procedures. These aspects are in fact vital components in enhanced recovery after surgery programmes. However, they are applied in hospital settings, are often centre-dependent, and lack primary and tertiary preventive efficacy since end once the patient is discharged. There is the lack of initiatives at the territorial level that ensure a continuum in the patient?s journey towards orthopaedic surgery, home transition, and a healthy and long-lasting life. The expert panel advocates the integration of an intermediate lifestyle clinic that promotes healthy eating, physical activity, and sleep hygiene. In this facility directed by professionals in enhancing recovery after surgery, patients can be referred after the surgical indication and before home discharge. Surgery is in fact a moment when individuals are more curious to do their best to heal and stay healthy, representing a timepoint and opportunity for educating patients on how lifestyle changes may optimise not only their surgical recovery but also long-term future health state

Presence of Legionella spp. in human dental plaque

Aims. The aim of this research is to verify the presence of Legionella in human dental plaque. Methods. 65 adult patients not treated with systemic or local antibiotics at least 2 months before the time of sample collection were enrolled for plaque collection between September 2015 and December 2016. A brief questionnaire about lifestyle and health risks was administered. Legionella spp. detection has been executed by semi- nested PCR. Results. 8 out of 65 plaque samples (12.3%) were positive for Legionella spp. As regards health risks and lifestyle aspects, no relevant difference was observed between patients involved in our study, except for two positive patients who have reported a COPD ongoing and a pneumonia in the past. Conclusions. This study represents a step forward in the knowledge of reservoirs of the microorganism and richness of oral microbiot

Attivit\ue0 fisica adattata (APA) in anziani istituzionalizzati affetti da ritardo mentale: un possibile approccio con evidenza di efficacia

I benefici dell\u2019attivit\ue0 fisica sono notori ma l\u2019effettiva sistematica attuazione nella popolazione \ue8 la scommessa del futuro. E\u2019 necessario oggi verificare le metodologie e gli approcci per massimizzare l\u2019efficacia dei programmi di avvicinamento all\u2019attivit\ue0 fisica adattata mirati a segmenti particolari della popolazione con rilevanti comorbilit\ue0 e disabilit\ue0 relazionali. A tal fine lo scopo di questo studio \ue8 stato valutare alcuni indicatori funzionali per dimostrare l\u2019efficacia di un programma di APA (adapted physical activity) in gruppo di anziani disabili istituzionalizzati dell\u2019hinterland milanese nel migliorare la performance fisica, la massa muscolare e la mobilit\ue0 di alcuni distretti corporei. Vengono riportati i risultati di tre studi realizzati dal 2002 al 2011 nei quali sono stati reclutati complessivamente 58 soggetti disabili anziani affetti da ritardo mentale residenti presso la Fondazione Istituto Sacra Famiglia-ONLUS, omogenei per abitudini di vita. I soggetti reclutati sono stati sottoposti a diversi periodi di allenamento. Per ogni soggetto sono state misurate:la circonferenza brachiale, addominale, del quadricipite e del polpaccio; la mobilit\ue0 scapolo-omerale (test del bastone millimetrato, goniometro); e nell\u2019ultimo studio anche la forza dei flessori del braccio con dinamometro. Tutti gli anziani sono stati sottoposti inoltre a Walking Test (WT6\u2019) ed al Time Up and Go Test (TUG). Tutte le misure sono state eseguite garantendo il doppio cieco. I soggetti arruolati hanno svolto il programma motorio due/tre volte alla settimana per novanta/centoventi minuti. Per ciascun ospite \ue8 stata realizzata una scheda di lavoro personalizzata comprendente anche le indicazioni per l\u2019operatore. Per l\u2019analisi statistica \ue8 stato utilizzato il test T di Student. la compliance all\u2019APA \ue8 stata elevata, mai nessun soggetto \ue8 stato assente per tre volte consecutive. Tra i soggetti reclutati non si sono verificati decessi, cadute o eventi condizionanti ricoveri o giorni di immobilizzazione. I drop out sono stati determinati da motivi indipendenti dall\u2019attivit\ue0. Tutti i parametri sottoposti ad analisi hanno evidenziato una differenza statisticamente significativa tra il t0 e il t1 (p<0,05), con un miglioramento di tutti i parametri misurati. Questi studi evidenziano che l\u2019esercizio fisico continuativo risulta essere efficace nel migliorare i parametri di performance fisica dei partecipanti anche ma anche di essere un elemento fondamentale per garantire benessere psico-fisico all\u2019anziano istituzionalizzato. L\u2019APA pu\uf2 quindi essere adottata per soggetti anziani con disabilit\ue0 intellettivo-relazionale anche nelle residenze protette adattando il setting alla struttura

Prevalence of HSV1/2 Congenital Infection Assessed Through Genome Detection on Dried Blood Spot in Individuals with Autism Spectrum Disorders

Background/Aim: Etiopathogenesis of autism spectrum disorders (ASD) remains to be elucidated. Congenital infections, particularly viral infections, have repeatedly been associated with the onset of such disorders. Our study aimed at assessing the prevalence of herpes simplex type 1 and 2 (HSV1/2) congenital infections in patients with ASD. Materials and Methods: In our case-control study, a total of 38 children with ASD were compared to 44 age- and sex-matched controls regarding the presence of HSV1/2 infection though viral DNA polymerase chain reaction performed on dried blood spots collected at birth. Results: No HSV congenital infection was detected in either group. Conclusion: Our negative finding is in agreement with other studies that failed to demonstrate a definitive role of HSV on the onset of ASD. Further investigation of congenital HSV prevalence in larger and more powerful studies is needed to undeniably discard a role of such virus in the etiopathogenesis of ASD