La gestión del aborto voluntario en los servicios de orientación familiar. Estudio cualitativo sobre el papel de los trabajadores sociales en Italia

Introduction. Elective abortion has always been considered taboo. The event can sometimes be experienced as traumatic, as the woman finds herself struggling against a range of emotions: fear, shame, ambivalence, and a sense of guilt. Multidisciplinary support is therefore fundamental to guide women during this complex phase, and social workers usually play a key role in the process. The present study aimed therefore to explore the experiences and perspectives of social workers who worked with women who decided to have abortions, focusing on the strongest and weakest aspects of their support process. Methodology. The study involved 10 social workers working in family counselling services in Italy. All of them were female, with a mean age of 47 years, and a mean of 16.7 years of experience in the field. The study followed a qualitative approach, based on semi-structured interviews that were studied following the principles of thematic analysis. Results. Three fundamental themes emerged from the data analysis: «Limits of the family counselling procedures and organization»; «The emotional dimension of elective abortion»; and «The issue of conscientious objectors». Discussion. The study highlighted how family counselling services are facing a crisis due to the lack of resources, personnel, and projects allowing for women’s proper sexual education and support. It also showed how the social worker’s role, which is fundamental, has instead been reduced, especially regarding elective abortions. Moreover, there was a lack of social and sanitary contexts integration and professional training that would provide the operators with specific skills and make them feel prepared to address such delicate situations. Conclusions. The need has emerged for a new, multidisciplinary perspective on the issue of voluntary interruption of pregnancy and social workers play a major role. However, the support system still presents many shortcomings for the women in need of assistance. The present study offers innovative and practical suggestions to properly fill these gaps.Introducción. El aborto voluntario siempre ha sido considerado tabú, y es una experiencia que a veces puede resultar traumática para la mujer, que se enfrenta a emociones cargadas de muchos matices: miedo, vergüenza, ambivalencia y un sentido de culpa. Por este motivo, es fundamental que, en este momento complejo, exista un apoyo multidisciplinar para guiar a la mujer, y los trabajadores sociales suelen desempeñar un papel fundamental en él. Por ello, el presente estudio tiene por objeto explorar las experiencias y perspectivas de los trabajadores sociales que trabajaron con mujeres que decidieron someterse a abortos voluntarios, centrándose en los aspectos más fuertes y débiles del proceso de apoyo que ofrecieron a estas mujeres. Metodología. En el estudio participaron 10 trabajadoras sociales que trabajaban en servicios de orientación familiar en Italia. Todos ellos eran mujeres, con una edad media de 47 años y una media de 16,7 años de experiencia en el campo. El estudio se basó en un enfoque cualitativo, a través de entrevistas semiestructuradas que se han analizado siguiendo los principios del análisis temático. Resultados. A partir del análisis de los datos, han identificado tres áreas temáticas fundamentales: «límites de los procedimientos y de la organización del asesoramiento familiar», «dimensión emocional del aborto electivo» y «la cuestión de los objetores de conciencia». Discusión. El estudio destacó el hecho de que los servicios de orientación familiar se enfrentan a una crisis debido a la falta de recursos, personal y proyectos destinados a asegurar una buena educación sexual y a apoyar adecuadamente a las mujeres; que el papel del trabajador social, que es fundamental, se ha vuelto más débil, especialmente con respecto a este procedimiento; y que son insuficientes la integración entre los contextos sociales y sanitarios así como una formación profesional capaz de ofrecer a los operadores unas habilidades específicas, que les ayuden a sentirse preparados en una situación tan delicada y difícil. Conclusiones. Ha surgido la necesidad de una nueva perspectiva multidisciplinaria sobre la cuestión de la interrupción voluntaria del embarazo, y la importancia del papel de los trabajadores sociales. Sin embargo, todavía existen muchas deficiencias en el sistema de apoyo para las mujeres que lo necesitan. La presente investigación ofrece algunas sugerencias prácticas e innovadoras para llenar adecuadamente esas lagunas

Clinical trial units and clinical research coordinators: a system facing crisis?

We are currently witnessing an increase in procedural and managerial complexities within the field of clinical research, which require greater human and infrastructural resources as well as imply the need for a greater skill set and expertise on the part of professionals. Within this frame of reference clinical trial units and clinical research coordinators play a vital role in the design and conduct of clinical trials in Italy. There is a current recruitment and retention crisis for this specialist role due to a complex set of factors, most likely to have come to a head due to the lack of recognition at the Italian institutional level, that lead to precarious work contracts, lack of identity, and excessive turnover at experimental sites. This article, led by the Italian Group of Clinical Research Coordinator (GIDMcrc), presents some of the issues and ways in which national stakeholders may be able to address this

FoxA and LIPG endothelial lipase control the uptake of extracellular lipids for breast cancer growth

The mechanisms that allow breast cancer (BCa) cells to metabolically sustain rapid growth are poorly understood. Here we report that BCa cells are dependent on a mechanism to supply precursors for intracellular lipid production derived from extracellular sources and that the endothelial lipase (LIPG) fulfils this function. LIPG expression allows the import of lipid precursors, thereby contributing to BCa proliferation. LIPG stands out as an essential component of the lipid metabolic adaptations that BCa cells, and not normal tissue, must undergo to support high proliferation rates. LIPG is ubiquitously and highly expressed under the control of FoxA1 or FoxA2 in all BCa subtypes. The downregulation of either LIPG or FoxA in transformed cells results in decreased proliferation and impaired synthesis of intracellular lipids

UM SOM, UM SENTIMENTO

A música está presente em nosso mundo desde a pré-história. Ela está em todo lugar, nas escolas, no trabalho, na televisão, no supermercado, nas lojas de roupas. Pode possuir vários sons, batidas, sentidos, timbres, ritmos, letras distintas e gêneros devido ao fato de que cada um tem seus gostos e uma sensibilidade diferente diante dos sons emitidos pela música. Tendo isso em mente, nosso trabalho teve como finalidade mostrar como a música pode ser um meio de protesto, qual a sensação que os diferentes gêneros trazem nas pessoas e mostrar o quão importante ela é para a manifestação dos sentimentos dos indivíduos. Para conseguirmos os resultados que queríamos, utilizamos nossa criatividade para criar músicas que intriguem as pessoas, com letras de protesto e de sentimento. Nossa pesquisa, por sua vez, englobou a história da música, os gêneros musicais, o processo de criação da música e sua influência na sociedade. Nosso resultado foi uma música com clipe impactante, que representa situações de homens e mulheres espalhados pelo mundo, tendo como base a opressão da sociedade perante essas pessoas. Também expomos o processo de formação e elaboração da música, a influência na sociedade e a criação dos gêneros. Apresentaremos, dentro de dez minutos, a importância da música no contexto social na forma de apresentação oral, além disso, pretendemos apresentar os resultados práticos do projeto, os clipes, com o auxílio de um projetor e as músicas produzidas pelos integrantes do grupo como performance ao vivo. Concluímos esse trabalho entendendo que o ser humano utiliza a música como refúgio, que ela pode carregar sentimentos e, inclusive, mudar o humor, trazendo conteúdos e ideais que podem ser aceitos, ou não, pela sociedade. Palavras-chave: Música. Sentimento. Preconceito. Ser humano. Expressão. Sociedade.

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Catharsis through cinema: an italian qualitative study on watching tragedies to mitigate the fear of covid-19

Background: Among different ways of coping with the unsettling situation of the COVID-19 pandemic, a very peculiar one has been identified: a more frequent request, by the general population, of movies or TV series related to the very theme of viruses, contagions, and epidemics. Objectives: The aim of the present study was to explore this peculiar phenomenon, in order to identify people's emotions and cognitions during and after the process, and to better understand the possible psychological function cinema can have during moments of intense and generalized crisis like the present COVID-19 pandemic. Participants: Fifteen Italian adults took part in the study – eight women and seven men (average age = 30 years, SD = 10.54). Participants were recruited through social media via a specific announcement, and subsequently, through a “snowball sampling.” Method: For the present study a qualitative approach was adopted, and more specifically, the principles of Interpretative Phenomenological Analysis (IPA) have been followed. Semi-structured interviews were conducted by telephone or through online meeting platforms (Zoom or Skype). The written texts obtained from the transcription of each interview were analyzed using thematic analysis with the support of the software Atlas.ti, in order to highlight their fundamental contents. Results: From the data analysis, four main areas of thematic prevalence emerged, which reflected the participants' condition during the pandemic that actually led them to watch epidemic-themed movies or TV series: the need to document themselves concerning the theme of epidemics, the need to exorcize contagion anxiety, the desire to find a character with which they could identify, and the casual condition of finding a peculiar movie related to the theme of pandemics and being interested in it because of the striking resemblance with real life. Conclusions: The findings suggest that cinema could indeed represent a powerful tool to help people face the intense uncertainty of the new COVID-19 epidemic, since it allows spectators to both obtain more insight into the current situation, and to project their fears and uncertainties into the movie or TV series, thus reaching a sort of cathartic liberation that offers them hope toward the future