GAP: Gioco d'azzardo Patologico. Un modello di progetto di prevenzione al GAP e di educazione al gioco responsabile per gli adolescenti.

Il mercato dei “giochi d'azzardo”, negli ultimi anni, sta presentando un'ampia e crescente offerta di gioco, in relazione ai tipi di gioco, ai luoghi in cui giocare e alle occasioni per farlo. La ricerca epidemiologica, in questo campo, si è consolidata a partire dalla fine degli anni '90 e risulta essere un ambito ancora non del tutto esplorato (Vetere, 2003); inoltre, i dati disponibili, si riferiscono ai soli giochi legali, mentre non si hanno dati attendibili sui video-poker e sul gioco on-line (Croce, 2001). Ciò che tuttavia risulta evidente, è che il gioco d'azzardo è evoluto, e sta evolvendo tuttora, verso aspetti più complessi e problematici, in linea con la società odierna, a sua volta soggetta a rapide trasformazioni riguardanti gli stili di vita, i valori, la cultura, la tecnologia e il lavoro (Mannari e Guidi, 2013). Quando il giocatore non è più in grado di controllare l'impulso a giocare, il gioco perde la sua connotazione originaria di divertimento e assume un carattere patologico, comportando ripercussioni negative in vari ambiti della vita del soggetto. La forte espansione di questo fenomeno, ha reso necessario riconsiderare quello che un tempo veniva chiamato “vizio del gioco”, come una vera e propria dipendenza patologica. Questa tesi offre una rassegna della letteratura riguardante il gioco d'azzardo patologico (sebbene la dicitura utilizzata nel DSM-5 sia “Disturbo da Gioco d'Azzardo”, nel linguaggio comune si utilizza ancora “Gioco d'Azzardo Patologico” o GAP), in riferimento alla definizione e all'inquadramento diagnostico del GAP, che si è evoluto nel corso degli anni, passando da un disturbo del controllo degli impulsi, ad una vera e propria dipendenza (American Psychiatric Association, 2013); alle potenziali comorbilità, sia con la dipendenza da sostanze stupefacenti/alcol, che con altri disturbi psichiatrici; ai fattori eziopatogenetici, possibili predittori del rischio di sviluppare un comportamento di gioco patologico; ai dati epidemiologici disponibili; agli strumenti di screening e di valutazione disponibili, validi per una valutazione iniziale del GAP o per confermare un'ipotesi diagnostica emersa dai criteri del DSM; alle basi neurobiologiche e genetiche del disturbo; alle distorsioni cognitive tipiche del giocatore patologico; ai trattamenti utilizzati, da quelli psicoterapeutici ai tentativi psicofarmacologici; infine, un'attenzione particolare viene riservata al preoccupante aumento della diffusione del GAP tra gli adolescenti. A questo proposito, al termine dell'elaborato, viene fornito un modello di intervento preventivo indirizzato a questa fascia della popolazione considerata più vulnerabile, attraverso un progetto mirato ad educare al gioco responsabile, da presentare agli alunni delle scuole medie superiori

Inquinamento microbiologico delle sale operatorie: analisi critica di due decenni di sorveglianza

Obiettivo dello studio è stato quello di analizzare i risultati delle campagne di monitoraggio microbiologico delle sale operatorie effettuate negli ultimi due decenni presso il Policlinico di Roma, al fine di descrivere l’andamento nel tempo dei livelli di contaminazione riscontrati e di valutare eventuali cambiamenti significativi. Sono stati presi in esame i campionamenti microbiologici dell’aria effettuati all’interno di 14 blocchi operatori tra il 1992 ed il 2010. I risultati dei campionamenti sono stati aggregati in quattro periodi di tempo (1992-1996; 1996-2000; 2001-2005; 2006-2010) ed è stato analizzata la distribuzione nel tempo dei risultati dei campionamenti rispetto al limite proposto all'ISPESL per le sale at-rest (≤35 UFC/mc). La stessa analisi è stata ripetuta dopo la stratificazione per livello di rischio delle sale operatorie (AR e BR). Al fine di verificare il livello di significatività delle variazioni temporali nelle distribuzioni dei risultati si è fatto ricorso al test del x2 per il trend. Si è osservato un significativo trend in diminuzione del numero di sale con livelli di contaminazione superiori a quello indicato (x2 per trend=8,94; p<0,025). Tale riduzione ha riguardato soprattutto le sale operatorie AR (x2 per trend=7,33; p<0,05). I risultati ottenuti fanno ritenere che le misure adottate nelle sale ad AR siano risultate efficaci. Una maggiore attenzione dovrà essere posta alle sale operatorie a BR

Microwave Ablation in Intermediate Hepatocellular Carcinoma in Cirrhosis: An Italian Multicenter Prospective Study

Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone. Methods: This multicenter study included 215 cirrhotics (age range: 67-84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoembolization. Among the patient population, 109 had a single nodule (Ø 5.3-8 cm) [group A], 70 had 2 nodules (Ø 3-6 cm) [group B] and 36 had 3-5 nodules (Ø 1.5-6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS). Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5-3.5 cm nodules. In nodules >3.5-5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5-8 cm, ablation was up to 92%. Overall, 1-, 3- and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years. The cumulative OS rate of group B was 88%, 60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival. Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Preablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome

SARS-CoV-2 RNA Recovery from Air Sampled on Quartz Fiber Filters: A Matter of Sample Preservation?

The airborne route of transmission of SARS-CoV-2 was confirmed by the World Health Organization in April 2021. There is an urge to establish standardized protocols for assessing the concentration of SARS-CoV-2 RNA in air samples to support risk assessment, especially in indoor environments. Debates on the airborne transmission route of SARS-CoV-2 have been complicated because, among the studies testing the presence of the virus in the air, the percentage of positive samples has often been very low. In the present study, we report preliminary results on a study for the evaluation of parameters that can influence SARS-CoV-2 RNA recovery from quartz fiber filters spotted either by standard single-stranded SARS-CoV-2 RNA or by inactivated SARS-CoV-2 virions. The analytes were spiked on filters and underwent an active or passive sampling; then, they were preserved at −80 °C for different numbers of days (0 to 54) before extraction and analysis. We found a mean recovery of 2.43%, except for the sample not preserved (0 days) that showed a recovery of 13.51%. We found a relationship between the number of days and the recovery percentage. The results presented show a possible issue that relates to the quartz matrix and SARS-CoV-2 RNA recovery. The results are in accordance with the already published studies that described similar methods for SARS-CoV-2 RNA field sampling and that reported non-detectable concentrations of RNA. These outcomes could be false negatives due to sample preservation conditions. Thus, until further investigation, we suggest, as possible alternatives, to keep the filters: (i) in a sealed container for preservation at 4 °C; and (ii) in a viral transport medium for preservation at a temperature below 0 °C.This research was funded by University of Trieste Atheneum Fund for scientific research (2021) and IRCCS Burlo Garofolo (RC47/20)

Microperimetric evaluation and predictive factors of visual recovery after successful inverted internal limiting membrane-flap technique for macular hole in high myopic eyes

IntroductionInverted Internal Limiting Membrane (ILM)-flap technique demonstrated its effectiveness, in terms of anatomical closure rate and visual acuity recovery for high myopic macular holes. We evaluated macular function after a successful inverted ILM-flap for macular holes in high myopic eyes (hMMH) using microperimetry to predict visual prognosis.MethodsA retrospective study on 23 eyes of 23 patients after surgical closure of hMMH, was performed. All patients underwent inverted ILM-flap and gas tamponade. Cataract surgery was performed in phakic eyes. Study outcomes including best-corrected visual acuity (BCVA), retinal sensitivity (RS) at central 12°, central retinal sensitivity (CRS) at central 4° and mean deviation (MD), and fixation behavior as bivariate contour ellipse area (BCEA, degrees2) measured by microperimetry, were evaluated over 6 months. A mixed-effects model was used to evaluate and compare the repeated measurements of outcomes between phakic and pseudophakic eyes. A regression model was performed to assess the relationship between BCVA at 6 months and independent variables.ResultsOverall mean BCVA improved from 0.98 ± 0.21 logMAR at baseline to 0.47 ± 0.31 logMAR at the last follow-up (p < 0.001). Over 6 months, overall sensitivity measurements improved (RS, p = 0.001; CRS, p < 0.0001; MD, p = 0.03), and the BCEA decreased in dimension, although not significantly (p ≥ 0.05). The mixed model revealed a significantly better effect of inverted ILM-flap combined with cataract surgery on BCVA and CRS in phakic eyes than inverted ILM-flap alone in pseudophakic ones. The regression model revealed a relationship of 6-month BCVA with pre-operative BCVA (β = 0.60, p = 0.02) and RS (β = −0.03, p = 0.01).ConclusionThe inverted ILM-flap technique significantly improved visual acuity and retinal sensitivity after the hMMH closure, particularly when combined with cataract extraction. Pre-operative visual acuity and retinal sensitivity at central 12° may predict post-surgical visual acuity

Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study

Objectives To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. Methods Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database. Results We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. Conclusions Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures

Online marketing of tourist destinations: Analysis of the tourist image of Southern Italy

[ESP] La fuerte competencia que se ha generado en los últimos años en el sector turístico ha llevado a los destinos a intensificar las acciones de diferenciación. El papel de Internet resulta clave para entender el fuerte impulso del sector. En este trabajo hemos analizado cuáles son los factores que influyen en la decisión del turista a la hora de elegir donde pasará su tiempo libre. En concreto nos hemos centrado en comparar las páginas web oficiales del turismo de las Regiones del Sur de Italia, así como sus perfiles en la red social Facebook y la implicación que los seguidores tienen con dichos perfiles. [ENG] Because of the strong competition that has been generated in the last years in the tourist sector, destinations have intensified their actions of differentiation. The Internet has a key role to understand the strong growth of the sector. In this final degree project we have analyzed which are the factors that influence the choice of tourists about their holiday’sdestination. In particular we have focused on comparing the official websites of the Southern Regions of Italy, as well as their Facebook pages and the involvement of the followers in these pages.Facultad de Ciencias de la EmpresaUniversidad Politécnica de Cartagen