Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine

Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of eHealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the "chronic care management" challenge in both traditional and mHealth settings

Civiltà della Campania. Anno II, n. 3 (agosto-ottobre 1975)

A. II, n.3 (agosto-ottobre 1975): Il messaggio dell’Assessore Emilio de Feo, P. 3 ; M. Parrilli, Continuità nel turismo regionale, P. 3 ; Napoli nei secoli, P. 5 ; G. Galasso, Tumulti ed elezioni del ’600, P. 6 ; N. Cilento, Nella città medioevale, P. 18 ; B. Gatta, Capri tra Napoleone e Murat, P. 24 ; R. Causa, Gioacchino Toma a Napoli, P. 30 ; A. Assante, Napoli e il suo porto, P. 34 ; G. Grimaldi, Messaggio di fede dell’Anno Santo, P. 40 ; R. Vlad, Musica all’aperto, P. 50 ; M. Stefanile, Viaggio nella storia di Amalfi, P. 52 ; D. Rea, Mappa minore, P. 60 ; M. Prisco , Incontro con la Badia, P. 68 ; P. Amos e A. Gambardella, Il villaggio di Albori, P. 74 ; R. Virtuoso, Giovanni Cuomo ritorna tra i giovani, P. 76 ; V. Panebianco, Il turismo venuto dalla storia, P. 80 ; A.P. Carbone, Le grotte di Pertosa, P. 84 ; F. de Ciuceis, Il mare di Caserta, P. 88 ; E. Tirone, Riti settennali a Guardia Sanframondi, P. 92 ; F. Calabro, Turismo e cultura a Capri, P. 98 ; F. de Ciuceis, Settembre al Borgo, P. 102 ; I. Santoro, Teggiano citta museo, P. 104 ; Notiziario, P. 108

Civiltà della Campania. Anno II, n. 2 (febbraio-marzo 1975)

A. II, n. 2 (febbraio-marzo 1975): M. Parrilli, All’Unesco Ravello e Castellabate, P. 3 ; L’anno santo in Campania, P. 7; B. Gatta, Videre Petrum, P. 8; B. Lucrezi, Gli itinerari sacri, P. 12 ; Il Duomo di Salerno: novecento anni di fede e storia », P. 24 ; R. Causa, Santuari nel Nocerino, P. 26 ; G. Giordano, Pacem in maribus, P. 32 ; R. Virtuoso, L’ambiente e il ruolo del turismo, P. 40 ; S. Pavia, I centri storici, P. 32 ; R. Di Stefano, Villa Campolieto, P. 48 ; R. De Simone, Feste popolari, P. 56 ; E. Corsi, II riassetto di Ischia, P. 60 ; C. Nazzaro, Rosmarino col pomodoro, P. 65 ; G. Doria, Il napoletano che cammina, P. 66 ; M. Stefanile, Raffaele Viviani, P. 68 ; A. Fratta, Amedeo Maiuri: una vita per l’archeologia, P. 80 ; E. Fiore, Gli Incontri del Cinema, P. 86 ; G. Blasi, Petrosino l’antipadrino, P. 90 ; I. Santoro, Il mistero di Velia di, P. 93 ; R. Senatore, La rinascita del Borgo Scacciaventi di, P. 97 ; P. Andria, Salerno: S. Pietro a Corte, P. 100 ; U. Abundo, Amalfi sempre di, P. 102 ; V. Gramignazzi Serrone, S. Agata dei Goti, P. 106 ; Attività congressuali in Campania, P. 108 ; Notiziario, P. 10

Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry

Abstract BACKGROUND: Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). METHODS: In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster. RESULTS: Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters. CONCLUSIONS: Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs

Memoria y Patrimonio la huella del carbón en Chile : parque patrimonial de Lota, Plaza de Lota : Antesala e infraestructuta Turística - Cultural.

Tesis (Arquitecto)RESUMEN: En la presente memoria, se hace una pequeña introducción al tema de la memoria y el patrimonio y como la tradición minera y en específico, los asentamientos mineros son parte inexorable del patrimonio cultural chileno. En primera parte se estudiará y presentará cuales son los elementos de estructuración y valorización del paisaje, lo que ha permitido determinar, a que llamamos paisajes culturales. Como estos han sido expuestos y enfrentados en Estados Unidos y en algunas partes de Europa y, como han ayudado en estos casos a tomar decisiones de fondo, decisiones para determinar a qué tipo de patrimonio se han enfrentando, y que tipo de decisiones de proyecto se han tomado. Todo esto a fin de determinar y zanjar el tema del patrimonio cultural y, en específico, el tema de los parques patrimoniales para zonas industriales obsoletas a fin de estructurar de manera correcta y lograr la revalorización de un territorio. Territorio, que para este caso sería Lota alto y sus instalaciones industriales. Patrimonio industrial minero que deja en evidencia la tradición minera chilena y como los asentamientos mineros se han hecho parte de la memoria y del patrimonio de nuestro país, patrimonio que en su mayoría ha quedado obsoleto, sin ser reconocidos como bienes culturales, y porque Lota es un caso ejemplar. En la segunda parte se hace una presentación del contexto del caso, para poder determinar, tras el estudio realizado previamente, que decisiones tomar a fin de poder otorgar a Lota alto mediante conceptos de reutilización y reconstrucción del paisaje, un desarrollo y una nueva forma de entender el patrimonio y como este pretende Preservar e interpretar sus recursos históricos y culturales; Proporcionar y aumentar las oportunidades recreativas, (parques; rutas y recorridos, paseos en barcaza, pesca deportiva, conservación de la fauna, etc.); y Fomentar el desarrollo económico, a fin de revitalizar este territorio que han sufrido el proceso de desindustrialización y de desvalorización de la memoria y el patrimonio. Cabe resaltar que se han dejado fuera referentes nacionales, como Humberstone, Santa Laura y Sewell. Ya que se presentan como museos de sitios que han permitido la restauración del patrimonio industrial, pero que no tienen relación con un contexto urbano inmediato, que obligue a poner en jaque esta obsolescencia, con la vida permanente y creciente de zonas urbanas

Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial.

Background: Diagnostic hysteroscopy has not yet been generally accepted as a well-tolerated office procedure. The aim of our study was to verify compliance, side-effects and haemodynamic variations when a mini-hysteroscope is used. Methods: A prospective randomized trial on office hysteroscopy was performed by comparing the use of a traditional 5 mm hysteroscope (group A) and of a 3.3 mm mini-hysteroscope (group B). Two patient groups (A and B), each comprising 100 cases, were formed on the basis of a randomized computer-generated list. Results: A marked reduction in the mean (+/-SD) pelvic pain score during office hysteroscopy was seen in group B (2.3+/-2.1) as compared with group A (4.6+/-2.2) (P<0.0001, Mann-Whitney test). This result was also confirmed when using an alternative approach: four classes of pelvic pain at the visual analogue score (VAS). A significant reduction was observed in the incidence of moderate and severe pelvic pain in group B at the end of the examination (P=0.001) and 5-10 min later (P<0.05). Conclusions: The use of mini-hysteroscopes (3.3 mm with diagnostic sheath) lowers considerably the level of pelvic pain the patients feel: it is halved in comparison with traditional calibre hysteroscopes (2.3+/-2.1, on a 0-10 VAS). Furthermore the outpatient hysteroscopy failure rate is less than half (2%) with the mini-hysteroscope compared with the traditional 5 mm hysteroscope (5%). As for side-effects and haemodynamic parameters, no differences were observed except for an increase (P<0.05) in bradycardia in group B. The advantage of this technique is self-evident, if the patients' compliance is taken into account: in many cases the introduction or withdrawal of the vaginal speculum was reported as the greatest discomfort

Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device

To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as a pain control method during office hysteroscopy. A prospective, randomized study. Centre for Minimally Invasive Surgery, Department of Gynecological Science and Perinatology, "La Sapienza" University, Rome, Italy. One hundred forty-two patients undergoing office hysteroscopy. Application of a TENS device on the patient's abdomen before and during office hysteroscopy. The level of pain experienced by the patients was assessed using a 10 cm visual analog scale; the side effects and changes in the hemodynamic parameters were evaluated. The patients treated with TENS during hysteroscopy (group A, n = 71) were compared with a control group (group B, n = 71) on whom the TENS device was not used. The women in the TENS group experienced a significantly lower level of pain during hysteroscopy. No differences in side effects were observed between both group. TENS is a simple, efficient, and safe method of relieve pain during office hysteroscopy

Hysteroscopic findings in postmenopausal abnormal uterine bleeding: a comparison between HRT users and non-users

The aim of our study was to investigate hysteroscopic findings in a sample of 410 menopausal women (hormonal replacement therapy, HRT users n = 219 and HRT non-users n = 191) and to evaluate the relationship between the presence of intrauterine disease, the use of HRT and the presence of AUB. Two hundred and nineteen women on HRT underwent standard office hysteroscopy by means of the Hamou hysteroscope (in 94 cases for abnormal uterine bleeding (AUB) and in 125 cases for periodic endometrium monitoring). One hundred and ninety-one women who had never received HRT were submitted to office hysteroscopy (154 for AUB and 37 for other reasons). Intrauterine diseases are more frequent in patients who do not use HRT (P = 0.02). Endometrial polyps is a frequent disease present in 30% of the sample (23.7% of HRT users and 30.8% of HRT non-users). Myomas were present in 8.7% of all patients examined (6.8% of HRT users and 11% of HRT non-users). Irregular bleeding in menopause is often associated with endouterine abnormalities: in symptomatic patients the frequency of endouterine diseases was 41% while in asymptomatic patients was 28% (P = 0.003). In patients taking HRT (n = 219) endouterine disease is demonstrated in 37% with AUB and in 26% without AUB (P = 0.07). Benign intrauterine diseases (endometrial polyps and submucous myomas) are more frequent in postmenopausal women who do not use HRT. In patients taking HRT irregular bleeding is associated with intrauterine diseases; however, the absence of AUB does not exclude the presence of endometrial polyps or myomas. Copyright 2002 Published by Elsevier Science Ireland Ltd

Hysteroscopic Findings in Women With Menorrhagia

Study Objective: To describe the hysteroscopic findings in patients complaining of menorrhagia to establish any significant association between menorrhagia and benign/malignant intrauterine disorders. Design: Prospective cohort study (Canadian Task Force classification II). Setting: University La Sapienza, Rome, Italy. Patients: One hundred eighteen premenopausal women undergoing office hysteroscopy for menorrhagia (group A) and 344 premenopausal patients undergoing office hysteroscopy for other indications (noncyclic abnormal uterine bleeding, infertility, ultrasonographic abnormalities, etc) (group B). Interventions: Office hysteroscopy. Measurement and Main Results: Data on the prevalence of hysteroscopic findings (cervical polyps, endometrial polyps, submucous myomas, low-grade hyperplasia and high-grade hyperplasia/endometrial carcinoma) were compared between group A and group B. The total prevalence, as well as the prevalence of type 0 and type I myomas (totally or >50% intracavitary, respectively), and the mean number per patients with submucous myomas was significantly higher in group A compared with group B (p = .0001, p = .024, and p = .017, respectively). Multivariable logistic regression analysis showed a statistically significant association between age (odds ratio 4.15, 95% confidence interval 1.55-11.1 in the 40- to 49-year age group), presence of submucous myomas (odds ratio 2.76, 95% confidence interval 1.52-5.00), and menorrhagia. Conclusions: Menorrhagia seems to be associated with aging, the presence and number of submucous myomas, and with the degree of their intracavitary development. Journal of Minimally Invasive Gynecology (2013) 20, 209-214 (C) 2013 AAGL. All rights reserved

Trend of FEV1 in Cystic Fibrosis patients: A telehomecare experience

Since 2001, in the Cystic Fibrosis Center of the Pediatric Hospital Bambino Ges\uf9 in Rome, we use telemedicine for monitoring of our patients. While in our first published works reporting this experience, we showed statistically significant reduction in hospital admissions and a tendency over time towards a better stability of the respiratory function for telehomecare (THC) patients, here we focus on the trend of the Forced Expiratory Volume in the first second (FEV1). In particular, we investigate the evolution of the clinical trend of the FEV1 index, by monitoring the activities of home patients from 2011 to 2014. THC is applied in addition to the standard therapeutic protocol by following 16 Cystic Fibrosis (CF) patients with specialized doctors. Our results show that THC patients improve their FEV1 values with a trend which can be considered significantly better than the one reported by the control group