The Complexity of Frailty: Psychological Mechanism and Therapeutic Interventions in Old People - A Narrative Review

Aging is a complex and dynamic process. Senses become less sophisticated and negative life events increase. These factors combined with medical conditions contribute to develop a degenerative functional autonomy of the elderly. This clinical condition is known as frailty. However, there is a difference in the way people live their silver years in terms of happiness and their sense of autonomy. Both being and feeling frail represent two different drives of cognitive representations concerning how the elderly live their lives. In addition, other factors such as cognitive stimulation, assistive technology and physical activity can support frail people to achieve independence. This chapter aims to provide an overview on how the psychological environment may affect frailty, suggesting a possible role of new technology’s solutions and physical activity as therapeutic interventions

Unconventional approach for prevention of environmental and related social risks: a geoethic mission

sem InformaçãoSome natural events are considered catastrophic for their damaging effects on society, however, many of these effects are due more to inappropriate management of the environment rather than the event itself. In order to prevent the continuation of the occ82119sem Informaçãosem Informaçãosem Informaçã

The geological characterization of landscape in majjor TV Series: a suggested approach to involve the public in the geological heritage promotion.

The characterization of natural and cultural heritage using popular entertainment, such as TV movies and series, can become an effective and original way to involve society in protecting territory and enhancing local development, thanks to the dissemination of knowledge. The aim is to make the complex aspects of landscape related to its geological and ecological assessment understandable to the public. The tools here proposed are the episodes of the TV series “Inspector Montalbano” filmed in Sicily. The stories, written by Andrea Camilleri, are located in Sicily (the biggest Italian island in the southern Mediterranean Sea), in particular with some World Heritage Sites. The natural and cultural landscapes, which provide fascinating scenery to the films, represent a meaning in the representation of the plot. At the same time, if recognized and understood, they become part of the cultural heritage of each component of the local community and of society. The cognitive process activates a virtuous circle revitalizing the links between humanity and environment. Moreover, it promotes a creative participation of the public in new policies, oriented towards sustainable development, and tourism—especially geotourism and ecotourism—becomes an important resource, especially in these times of crisis

Old Age and Women’s Identity

Female identity is a dynamic concept, and it has been a very discussed issue by contemporary cultural critic. How does old age affect identity construction and perception in elderly woman? Has feminine gender an impact in subjective well-being? Psychological changes of midlife women have been as conflicting as the idea that society has about them. Personality changes after young adulthood in women is a controversial matter. Erikson proposed that women might not develop identities in early adulthood as men do. In fact, he argued that women develop them later, in the context of an intimate relationship. Moreover, identity development appears to have important consequences for midlife well-being. For example, Vandewater et al. found that women’s midlife well-being was facilitated by earlier attainment of a well-articulated identity. In these situations accomplishment of developmentally earlier tasks (identity formation) sets the stage for later psychological health. Our work sheds additional light on how women live this period of life in terms of happiness and purpose of life

Virtual Round care model in a Covid-19 Geriatric sub intensive unit

Introduction. Telepresence provides clinicians the ability to monitor patients as well to communicate with all the members of the healthcare staff.  Covid-19 Units cope with high complexity in providing care and an integration amount the care team and the patients’ relatives should be carried out to obtained successful outcomes and preventing complication. Virtual rounding (VR) has been successfully applied to cope with this task in the last 2000 years in medical units.  Covid-19 patients due to safety rules may be prone to isolation and lack of communication with their family. Purpose. The aim of our study was to evaluate the effect of structured virtual round protocol in a geriatric Covid-19 unit on anxiety and depression for the patients and their relatives. Methodology. All the patients admitted to the geriatric Covid-19 unit from 1 February 2021 to 30 April were studied. Inclusion criteria to the study were the followings: no severe cognitive impairment (MMSE =>24) or neuro sensorial deficits; informed consent to participate to the study. Forty-nine 49 (75% of patients) met the inclusion criteria. All the subject who were found to be eligible to the study underwent a VR standard protocol of care. VR was consisted with: 1) a video call with a tablet device conducted by a psychologist that established a cooperative communication between the health care staff (nurses and MD, their relatives) at the bed sides; 2) a video call with the patient’s relatives in which it was clearly explained the standard care and the role of each healthcare member was also included. Anxiety and depression levels were assessed for the patients at baseline after the end of the protocol by the Hospital Anxiety and Depression Scale (HADS). Patients’ relatives were investigated for depression at baseline and after the end of the protocol by the Beck Depression Inventory- Primary Care (BDI-PC). The Beck Depression Inventory for primary care has seven items with each item rated on a 4-point scale (0–3). It is scored by summing ratings for each item (range 0–21). Items are symptoms of sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal thoughts and wishes. The Hospital Anxiety and Depression Scale (HADS) is a self- assessment scale found to be a reliable instrument for detecting states of depression and anxiety. The anxiety and depressive sub-scales are also valid measures of severity of the emotional disorder. The questionnaire comprises seven questions for anxiety and seven questions for depression, and takes 2–5min to complete. For both scales, scores less than 7 indicate non- cases, 8-10 mild, 11-14 moderate, 15-21 severe. JMP software by SAS (v.16) was used for the statistical analysis. Results. The present study included forty-nine 49 patients (67% male), mean age of 69.9 ±14.7 years with one relative for each patient. The average mean of the hospitalization for each patients was 17.6 ± 5.7 days The mean VR duration time was 60±5.5 minutes. VR showed a significant decrease in both Anxiety and depression for patients: (HADS Depression baseline 10.6 ±3.1 vs 6.9 ±2.7 end p<0.01) (HADS Anxiety baseline 10.2 ±3.4 vs 6.8 ±3.0 end p<0.01). VR has also reduced depression in the relatives of patients (BDI-PC 3.6 ±2.4 vs 1.9 ±1.9 p<0.01). Discussion. VR has reduced anxiety and depression in patients hospitalized in a sub-intensive COVID 19 unit and it also has been found to be effective in decreasing depression in the relatives of these patients Limitation. However, the study has some possible limitations considering its small size and that it was mono centric Conclusions. Our data confirm the efficacy of VR in the sub-intensive care setting. This evidence supports the key role of a multidisciplinary team, focusing on the importance of social and psychological support during the hospital stay.   More studies will be consequently necessary to better validate the importance of VR as a standard care tool in intensive/sub- intensive care units for the elderly patient

Minimally invasive intraoral approach to submandibular lodge

The purpose of this study is to describe the Minimally Invasive Intraoral Approach (MIIA) performed on selected cases of abscesses and neck phlegmons of odontogenic origin when the infection has not spread beyond the inferior mandibular margin. This technique allows us to avoid cervicotomy by a direct approach to the abscess, draining it through the oral cavity. If the limits have already been crossed, then cervicotomy is necessary. The aim of the study is to show the surgical outcomes that we have achieved during a time span of two years, and to show the effectiveness of the MIIA and its results. We selected 66 patients with abscesses and neck phlegmons, from January 2018 to June 2020. Among these cases, five patients were excluded as it was not possible to recover medical records from database. The MIIA technique has been performed on 16 patients (26.2%) when a successful dental extraction and drainage of the submandibular lodge were accomplished. The patients who underwent the MIIA surgery have all perfectly healed and did not suffer from relapses during the follow-up. The results show the achievement of excellent healing, underlining the lower impact required by MIIA when compared to a more traditional approach through cervicotomy

COVID-19 in rheumatic diseases in Italy: first results from the Italian registry of the Italian Society for Rheumatology (CONTROL-19)

OBJECTIVES: Italy was one of the first countries significantly affected by the coronavirus disease 2019 (COVID-19) epidemic. The Italian Society for Rheumatology promptly launched a retrospective and anonymised data collection to monitor COVID-19 in patients with rheumatic and musculoskeletal diseases (RMDs), the CONTROL-19 surveillance database, which is part of the COVID-19 Global Rheumatology Alliance. METHODS: CONTROL-19 includes patients with RMDs and proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) updated until May 3rd 2020. In this analysis, only molecular diagnoses were included. The data collection covered demographic data, medical history (general and RMD-related), treatments and COVID-19 related features, treatments, and outcome. In this paper, we report the first descriptive data from the CONTROL-19 registry. RESULTS: The population of the first 232 patients (36% males) consisted mainly of elderly patients (mean age 62.2 years), who used corticosteroids (51.7%), and suffered from multi-morbidity (median comorbidities 2). Rheumatoid arthritis was the most frequent disease (34.1%), followed by spondyloarthritis (26.3%), connective tissue disease (21.1%) and vasculitis (11.2%). Most cases had an active disease (69.4%). Clinical presentation of COVID-19 was typical, with systemic symptoms (fever and asthenia) and respiratory symptoms. The overall outcome was severe, with high frequencies of hospitalisation (69.8%), respiratory support oxygen (55.7%), non-invasive ventilation (20.9%) or mechanical ventilation (7.5%), and 19% of deaths. Male patients typically manifested a worse prognosis. Immunomodulatory treatments were not significantly associated with an increased risk of intensive care unit admission/mechanical ventilation/death. CONCLUSIONS: Although the report mainly includes the most severe cases, its temporal and spatial trend supports the validity of the national surveillance system. More complete data are being acquired in order to both test the hypothesis that RMD patients may have a different outcome from that of the general population and determine the safety of immunomodulatory treatments

Carcinomi cutanei in pazienti portatori di leucosi croniche

associazioni che possono esistere tra i tumori di origine epiteliali e le neoplasie maligne di origine ematologico e in particolar modo le forme leucemiche. Negli ultimi: tempi infatti le osservazioni di associazioni di queste forme tumorali sono sempre più frequenti sia per l'aumentata età media di sopravvivenza dei pazienti portatori di forme neoplastiche ematologiche, sia per una migliore diagnostica nel campo dei tumori cutanei. Gli Autori dopo aver eseguito una revisione della letteratura e di aver analizzato alcuni casi pervenuti alla loro osservazione, considerano: 1) le possibili interrelazioni tra le due forme neoplastiche, 2) il trattamento dell'epitelioma cutaneo; 3) la prognosi

Unconventional Approach for Prevention of Environmental and Related Social Risks: A Geoethic Mission

Some natural events are considered catastrophic for their damaging effects on society; however, many of these effects are due more to inappropriate management of the environment rather than the event itself. In order to prevent the continuation of the occurrence of such pernicious situations, it is necessary to spread the knowledge of natural mechanisms so that the general public becomes aware of the dynamics that characterize our planet’s balance. To this aim, we argue it is indispensable to find, create and test new methods of communication in order to reach a wide audience in an understandable way. We believe in science popularization as an ethic mission: the proposal is dedicated to those Outdoor Sports that take place in the landscape, considered as an ideal vector of information, as people develop curiosity and motivation to learn about natural history. Our study focuses particularly on cycling because of its popularity as well as for its close ties to the environment