Social Design. Design e bene comune.

Per questo primo doppio numero della rivista, Social Design. Design e "bene comune", curato da Marinella Ferrara, Francesco E. Guida, Mario Piazza, Paola Proverbio e Raimonda Riccini, quasi come una sfida, si è provato a rompere l’ortodossia di un approccio lineare alla storia. In questo orientamento, che tende a portare più vicino a noi i temi storici, il Social Design si offre in modo calzante per il suo essere questione contemporanea e complessa, ampia e ambigua financo controversa, anche solo dal punto di vista delle diverse espressioni sinonimiche con cui si presenta: design etico, design umanitario, design per la collettività, design di pubblica utilità, design per l’utenza ampliata, design per la sostenibilità, ... Il numero ha ricevuto la Menzione d'Onore alla XXVII edizione del Compasso d'Oro (giugno 2022), ed è stato segnalato nell'ADI Design Index 2021 (promosso da ADI, Associazione per il Disegno Industriale) nella sezione "Ricerca teorica, storica, critica e progetti editoriali"

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted

Geografie relazionali nella storia del design

Con il tema delle “geografie relazionali” l'intenzione di questo numero è di valorizzare studi e ricerche che assumono approcci tipici delle scienze sociali per la comprensione e la spiegazione del design. Questo, infatti, oltre ad essere fatto di “cose”, strutture materializzate (come la nazione o la comunità), individui e meccanismi, è composto soprattutto di reti e fatti sociali: un insieme intricato e complesso di intersecazioni, rete di flussi e di relazioni..

Certainties fading away: β-blockers do not worsen chronic obstructive pulmonary disease

For many years, β-blockers have been considered contraindicated in patients with heart failure (HF) and in those with bronchial asthma or even chronic obstructive pulmonary disease (COPD) although without clear evidence of asthma. Today, despite overwhelming evidence of the usefulness of β-blockers, especially in HF with reduced left ventricular ejection fraction (HFrEF), and in ischaemic heart disease, some reluctance persists in using these drugs when COPD coexists. Such resistance is due to the fear that a possible worsening of bronchospasm induced by β-blockers could induce negative effects greater than the benefits. The Guidelines of the European Society of Cardiology clearly suggest that: (i) implantation of a cardiac defibrillator (ICD) are not contraindicated in COPD without clear evidence of bronchial asthma; (ii) β-blockers are only 'relatively' contraindicated when there is certainty of bronchial asthma with a documented bronchodilator response to the β2 stimulant. Therefore, bronchial asthma is not an absolute contraindication to β-blockers. The cardiologist should not limit the diagnosis of COPD to clinical suspicion, but should rely on a spirometry examination associated with any bronchodilation tests. In any case, selective β1 blockers are preferred, starting at a basic dose, which ensure a better dilator response to bronchodilators and in any case cause less bronchospasm than non-selective β-blockers. Unfortunately, there is still some reluctance to the use of β-blockers in patients with COPD associated with HF, which should be eliminated

Menzione d'onore XXVII Compasso d'Oro - AIS/Design Journal. Storia e ricerche, V. 7 N. 12-13 (2020): Social Design. Design e “bene comune”

La rivista, online e open-access, l’unica rivista scientifica esclusivamente dedicata alla storia del design italiano e internazionale, ha dedicato un numero monografico a “Social Design. Design e bene comune”. Affronta dal punto di vista storico un argomento vivo nelle pratiche attuali del design e oggetto di studi e teorizzazioni, che però non è stato mai approfondito attraverso ricerche storiche puntuali. Dai saggi presentati nel numero della rivista emerge come questo ambito abbia solide radici nella seconda metà del Novecento e come il design italiano abbia dato propri e significativi contributi sia in termini di pensiero teorico, critico e metodologico, sia dal punto di vista progettuale e di buone pratiche

Unattended compared to traditional blood pressure measurement in patients with rheumatoid arthritis: a randomised cross-over study

Background: Hypertension is characterised by a high prevalence, low awareness and poor control among rheumatoid arthritis (RA) patients. Correct blood pressure (BP) measurement is highly important in these subjects. The “unattended” BP measurement aims to reduce the “white-coat effect,” a phenomenon associated with cardiovascular risk. Data on “unattended” BP measurement in RA and its impact on hypertensive organ damage are very limited. Methods: BP was measured in the same patient both traditionally (“attended” BP) and by the “unattended” protocol (3 automated office BP measurements, at 1-min intervals, after 5 min of rest, with patient left alone) by a randomised cross-over design. Patients underwent clinical examination, 12-lead electrocardiography and trans-thoracic echocardiography to evaluate cardiac damage. Results: Sixty-two RA patients (mean age 67 ± 9 years, 87% women) were enrolled. Hypertension was diagnosed in 79% and 66% of patients according to ACC/AHA and ESC/ESH criteria, respectively. Concordance correlation coefficients between the two techniques were 0.55 (95%, CI 0.38–0.68) for systolic BP and 0.73 (95%, CI 0.60–0.82) for diastolic BP. “Unattended” (121.7/68.6 mmHg) was lower than “attended” BP (130.5/72.8 mmHg) for systolic and diastolic BP (both p <.0001). Among the two techniques, only “unattended” systolic BP showed a significant association with left ventricular mass (r = 0.11; p =.40 for “attended” BP; r = 0.27; p =.036 for unattended BP; difference between slopes: z = 3.92; p =.0001). Conclusions: In RA patients, “unattended” BP is lower than traditional (“attended”) BP and more closely associated with LV mass. In these patients, the “unattended” automated BP measurement is a promising tool which requires further evaluation.KEY MESSAGES “Unattended” automated blood pressure registration, aimed to reduce the “white-coat effect” is lower than “attended” value in rheumatoid arthritis patients. “Unattended” blood pressure is more closely associated with left ventricular mass than “attende” registration

Soluble CD40 ligand and outcome in patients with coronary artery disease undergoing percutaneous coronary intervention

CD40 ligand (CD40L), a transmembrane glycoprotein belonging to the tumor necrosis factor family and expressed by a variety of cells, is involved in the basic mechanisms of inflammation, atherosclerosis and thrombosis. Some studies suggest that the soluble form of CD40L (sCD40L) is a predictor of major cardiovascular events and mortality in a variety of clinical settings, but data from literature are conflicting. We studied consecutive patients with acute (ACS) or chronic (CCS) coronary syndrome who underwent percutaneous coronary artery intervention (PCI). Blood samples for sCD40L dosage were taken at baseline immediately before PCI. We tested the relation between sCD40L and pre-specified outcome measures consisting of new ACS, clinical restenosis and all-cause mortality. We recruited 3,841 patients (mean age 64 ± 11 years, 79% men) with ACS (n=2,383) or CCS (n=1,458). During a mean follow-up of two years (±0.6 years), 642 patients developed ACS, 409 developed restenosis (≥70% of at least one of the previously treated coronary segments) and 175 died. For each 1-standard deviation increase in sCD40L (0.80 ng/mL), the hazard ratios (HRs) for ACS, restenosis, and mortality were 1.11 (95% confidence interval [CI]: 1.05 to 1.18, p<0.0001), 1.10 (95% CI: 1.02 to 1.19, p=0.010), and 1.00 (95% CI: 0.86 to 1.16, p=0.983), respectively. In multivariable Cox regression models with adjustment for several potential confounders including age, acute or chronic coronary syndrome, multi-vessel disease, stent placement, diabetes, previous coronary events and dyslipidemia, sCD40L remained an independent predictor of ACS and coronary restenosis. There were no interactions between sCD40L and acute or chronic coronary syndrome or stent placement. Among patients with ACS or CCS who undergo PCI, higher levels of sCD40L predict an increased risk of acute coronary events and coronary restenosis, but not of mortality