Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

How do You Feel in Virtual Environments? The Role of Emotions and Openness Trait over Creative Performance

none4noIn the Dynamic Creativity Framework creativity is defined as a context-embedded phenomenon requiring potential originality and effectiveness. This definition indicates that the environmental conditions embedding the creative process have fundamental impact on the process itself and its outcomes. In particular, Virtual environments (VEs) are emerging as everyday contexts for a large part of the world population, affecting behaviors and feelings. VEs have been demonstrated to affect creative performance in several ways, even if the psychological mechanisms at the basis of the different modifications in the creative behavior are far from being completely explained. The aim of this study was to explore the influence of different types of VEs on creative performance, with a specific focus on participants' emotional reactions and on their individual differences in the Openness personality trait. a total of 22 participants were exposed to four different types of environments: a real room environment (RE), a control virtual environment (CVE) resembling the physical characteristics of the RE, a positive virtual environment (PVE) and a negative virtual environment (NVE). Participants were free to explore each environment for two minutes, then they were asked to perform an alternative Uses Task for five minutes, to measure divergent thinking performance. Openness and affective reactions in each environment were measured in all participants. Results showed that Openness was associated with higher originality of responses and that this effect was particularly significant in PVE. Importantly, the type of environment interacted significantly with participants' affective reactions in explaining their creative performance, revealing that an increase of ideas originality was associated with an increase of positive affect, emerging as a consequence of experiencing a PVE. affective reactions to VEs, in combination with individual differences in term of Openness, thus emerge as one of the possible explicatory mechanisms of the impact of virtual reality on creative performance.openAgnoli S.; Zenari S.; Mastria S.; Corazza G.E.Agnoli S.; Zenari S.; Mastria S.; Corazza G.E

Increased pulse pressure independently predicts incident atrial fibrillation in patients with type 2 diabetes.

OBJECTIVEdTo examine whether baseline pulse pressure (PP), a marker of arterial stiffness,is associated with subsequent development of atrial fibrillation (AF) in type 2 diabetes.RESEARCH DESIGN AND METHODSdA total of 350 type 2 diabetic patients, whowere free from AF at baseline, were followed for 10 years. A standard electrocardiogram wasperformed annually and a diagnosis of incident AF was confirmed in affected participants by asingle cardiologist.RESULTSdDuring the follow-up, 32 patients (9.1% of total) developed incident AF. Afteradjustments for age, sex, BMI, diabetes duration, presence of left ventricular hypertrophy, hypertensiontreatment, kidney dysfunction, and pre-existing history of coronary heart disease,heart failure, and mild valvular disease, baseline PP was associated with an increased incidence ofAF (adjusted odds ratio 1.76 for each SD increment [95% CI 1.1\u20132.8]; P , 0.01).CONCLUSIONSdOur findings suggest that increased PP independently predicts incidentAF in patients with type 2 diabetes