Assistere l’utenza straniera: quale bisogno formativo per gli operatori sanitari dell’Azienda Città della Salute e della Scienza di Torino?

 Introduzione. Il fenomeno immigratorio è in continuo aumento e anche in sanità è ormai forte la presenza di utenza immigrata che richiede un riorientamento dei servizi e la necessità di un approccio terapeutico-assistenziale multiculturale. Scopo: Obiettivo del presente studio è indagare il bisogno formativo degli operatori dell’Azienda Città della Salute e della Scienza di Torino nell’assistenza all’utenza straniera. Metodo: E’ stato costruito un questionario ad hoc, rivolto a medici, infermieri, logopedisti e personale di supporto del Dipartimento “Capo e Collo”, articolato in quattro sezioni: conoscenze, atteggiamenti e percezioni; vissuto e formazione; miglioramento della competenza culturale; dati anagrafici. E’ strutturato sotto forma di domande a risposta dicotomica sì/no, chiusa e aperta breve. Risultati: Hanno risposto 176/235 operatori (75%). Meno del 20% conosce la normativa che regolamenta l’utilizzo dei servizi sanitari da parte degli immigrati; le patologie indicate come più frequenti negli stranieri sono tubercolosi, malattie veneree e AIDS. Sesso femminile (p=0.008) e profilo professionale non medico (trend con p=0.051) sono associati in modo significativo all’importanza percepita di conoscere i valori dell’assistito, mentre una precedente formazione è associata al bisogno di approfondirli (p=0.0002). Gli aspetti di maggior bisogno formativo sono: significato di malattia e cura, senso della prevenzione, igiene e cura di sé e percezione delle pratiche di cura. Tra le strategie più efficaci: lezione e discussione, lavori di gruppo e filmografia. Conclusioni: L’analisi ha evidenziato le aree tematiche principalmente carenti e le strategie formative che gli operatori considerano più efficaci.Parole chiave: Valutazione del bisogno, Educazione continua, Educazione professionale delle salute pubblica, Educazione professionale, Nursing transculturale ABSTRACTIntrodution. Immigration is growing and immigrants’ presence is important also in the health care system, thereby services reorientation and a multicultural approach are needed. Objective: To explore health care professionals’ training needs of Turin Azienda Città della Salute e della Scienza in taking care of foreign users. Methods: An ad hoc 4-sections questionnaire was built: (1) Knowledge, attitudes and perceptions; (2) Lived and Training; (3) Improvement in cultural competence; (4) Socio-demographic data. Questions were dichotomous (yes/no), closed and short open. Doctors, nurses, speech therapists and support staff of the “Head and Neck” Department were involved. Results: One hundred seventy-six operators answered (75%). Less than 20% (n = 34) knew the normative concerning immigrants’ health services use; tubercolosis, venereal diseases and AIDS were believed to be the most frequent diseases in foreign users. Female sex (p = 0.008) and allied health care profile (trend p = 0051) were significantly associated to consider clients’ values important, while a previous training was associated to the need of improving their knowledge (p = 0.0002). The most important training needs were: meaning of illness and care, perception of prevention, hygiene and self-care practices and perception of care. Among the most effective strategies: lecture and discussion, group work and filmography. Conclusion: The analysis shows the main needing education areas and the training strategies which operators considered more effective.Keywords: Need Assessment, Education Continuing, Education Public Health Professional, Education Professional, Transcultural Nursin

Current Options for Visualization of Local Deformation in Modern Shape Analysis Applied to Paleobiological Case Studies

In modern shape analysis, deformation is quantified in different ways depending on the algorithms used and on the scale at which it is evaluated. While global affine and non-affine deformation components can be decoupled and computed using a variety of methods, the very local deformation can be considered, infinitesimally, as an affine deformation. The deformation gradient tensor F can be computed locally using a direct calculation by exploiting triangulation or tetrahedralization structures or by locally evaluating the first derivative of an appropriate interpolation function mapping the global deformation from the undeformed to the deformed state. A suitable function is represented by the thin plate spline (TPS) that separates affine from non-affine deformation components. F, also known as Jacobian matrix, encodes both the locally affine deformation and local rotation. This implies that it should be used for visualizing primary strain directions (PSDs) and deformation ellipses and ellipsoids on the target configuration. Using C = FTF allows, instead, one to compute PSD and to visualize them on the source configuration. Moreover, C allows the computation of the strain energy that can be evaluated and mapped locally at any point of a body using an interpolation function. In addition, it is possible, by exploiting the second-order Jacobian, to calculate the amount of the non-affine deformation in the neighborhood of the evaluation point by computing the body bending energy density encoded in the deformation. In this contribution, we present (i) the main computational methods for evaluating local deformation metrics, (ii) a number of different strategies to visualize them on both undeformed and deformed configurations, and (iii) the potential pitfalls in ignoring the actual three-dimensional nature of F when it is evaluated along a surface identified by a triangulation in three dimensions

Root inoculation with Azotobacter chroococcum 76A enhances tomato plants adaptation to salt stress under low N conditions

Background: The emerging roles of rhizobacteria in improving plant nutrition and stress protection have great potential for sustainable use in saline soils. We evaluated the function of the salt-tolerant strain Azotobacter chroococcum 76A as stress protectant in an important horticultural crop, tomato. Specifically we hypothesized that treatment of tomato plants with A. chroococcum 76A could improve plant performance under salinity stress and sub-optimal nutrient regimen. Results: Inoculation of Micro Tom tomato plants with A. chroococcum 76A increased numerous growth parameters and also conferred protective effects under both moderate (50 mM NaCl) and severe (100 mM NaCl) salt stresses. These benefits were mostly observed under reduced nutrient regimen and were less appreciable in optimal nitrogen conditions. Therefore, the efficiency of A. chroococcum 76A was found to be dependent on the nutrient status of the rhizosphere. The expression profiles of LEA genes indicated that A. chroococcum 76A treated plants were more responsive to stress stimuli when compared to untreated controls. However, transcript levels of key nitrogen assimilation genes revealed that the optimal nitrogen regimen, in combination with the strain A. chroococcum 76A, may have saturated plant’s ability to assimilate nitrogen. Conclusions: Roots inoculation with A. chroococcum 76A tomato promoted tomato plant growth, stress tolerance and nutrient assimilation efficiency under moderate and severe salinity. Inoculation with beneficial bacteria such as A. chroococcum 76A may be an ideal solution for low-input systems, where environmental constraints and limited chemical fertilization may affect the potential yield

Effects of methacrilyc thermosets coated with Silver-polysaccharide nanocomposite on HGFs adhesion in a S. mitis co-culture system

Silver based medical products have been proven to be effective in retarding and preventing bacterial growth, being silver reported to control infections since ancient times (1). In the field of dentistry, the use of silver ions/nanoparticles has been explored to counteract bacteria in resins and implants, as silver can destroy bacterial cell walls by reacting with the thiol groups (–SH) of proteins exposed to the extracellular portion of the bacterial membrane. Conversely, eukaryotic cells lack these exterior binding sites, so nanoparticles are supposed to interact with them only upon metal internalization (2). To reduce both bacterial adhesion to dental devices and cytotoxicity against eukaryotic cells, we coated BisGMA/TEGDMA methacrylic thermosets with a new material, Chitlac-nAg, formed by stabilized silver nanoparticles with a polyelectrolyte solution containing Chitlac. Here we analyzed the proliferative and adhesive ability of human gingival fibroblasts (HGFs) on BisGMA/TEGDMA thermosets uncoated and coated with AgNPs in a co-culture model system with Streptococcus mitis. After 48 h, HGFs well adhered onto both surfaces, while S. mitis cytotoxic response was higher in the presence of AgNPs coated thermosets. After 24 h thermosets coated with Chitlac as well as those coated with Chitlac-nAg exerted a minimal cytotoxic effect on HGFs, while after 48 h LDH release rised up to 20%. Moreover, the presence of S. mitis reduced this release mainly when HGFs adhered to Chitlac-nAg coated thermosets. The reduced secretion of collagen type I was significant in the presence of both surfaces even more when saliva is added. Integrin β1 localized closely to cell membranes onto Chitlac-nAg thermosets and PKC α translocated into nuclei. These data confirm that Chitlac-nAg thermosets have a promising utilization in the field of restorative dentistry exerting their antimicrobial activity due to AgNPs without cytotoxicity for eukaryotic cells.This work was supported by grants from MIUR FIRB 2010 and MIUR PRIN-2009

From traumatic childhood to cocaine abuse: the critical function of the immune system

Background: Experiencing traumatic childhood is a risk factor for developing substance use disorder (SUD), but the mechanisms that underlie this relationship have not been determined. Adverse childhood experiences affect the immune system and the immune system mediates the effects of psychostimulants. However, whether this system is involved in the etiology of SUD in individuals who have experience early life stress is unknown. Methods:In this study, we performed a series of ex vivo and in vivo experiments in mice and humans to define the function of the immune system in the early-life stress-induced susceptibility to the neurobehavioral effects of cocaine. Results: We provide evidence that exposure to social-stress (S-S) at an early age permanently sensitizes the peripheral (splenocytes) and brain (microglia) immune responses to cocaine in mice. In the brain, microglial activation in the ventral tegmental area (VTA) of S-S mice was associated with functional alterations in dopaminergic neurotransmission, as measured by whole-cell voltage clamp recordings in dopamine (DA) neurons. Notably, preventing immune activation during the S-S exposure reverted the effects of DA in the VTA and the cocaine-induced behavioral phenotype to control levels. In humans, cocaine modulated Toll-like receptor 4-mediated innate immunity, an effect that was enhanced in cocaine addicts who had experienced a difficult childhood. Conclusions Collectively, our findings demonstrate that sensitization to cocaine in early-life-stressed individuals involves brain and peripheral immune responses and that this mechanism is shared between mice and humans

Iron capture through CD71 drives perinatal and tumor-associated Treg expansion

: Beside suppressing immune responses, regulatory T cells (Tregs) maintain tissue homeostasis and control systemic metabolism. Whether iron is involved in Treg-mediated tolerance is completely unknown. Here, we showed that the transferrin receptor CD71 was upregulated on activated Tregs infiltrating human liver cancer. Mice with a Treg-restricted CD71 deficiency spontaneously developed a scurfy-like disease, caused by impaired perinatal Treg expansion. CD71-null Tregs displayed decreased proliferation and tissue-Treg signature loss. In perinatal life, CD71 deficiency in Tregs triggered hepatic iron overload response, characterized by increased hepcidin transcription and iron accumulation in macrophages. Lower bacterial diversity, and reduction of beneficial species, were detected in the fecal microbiota of CD71 conditional knock-out neonates. Our findings indicate that CD71-mediated iron absorption is required for Treg perinatal expansion and related to systemic iron homeostasis and bacterial gut colonization. Therefore, we hypothesize that Tregs establish nutritional tolerance through competition for iron during bacterial colonization after birth

E-cigarettes fluids trigger molecular and morphological response in oral fibroblasts

Electronic-cigarettes (e-cigarettes) have been recently advertised as a safe alternative to the traditional ones and a possible smoking cessation tool. This electronic device was designed to transform a solution of variable compounds (some of them approved as food additives), in an inhalable aerosol. However, their safety is still not fully know (Lerner et al. 2016). The cytotoxicity of the fluids on human gingival fibroblasts (HGFs) was demonstrated on a previous study by Sancilio et al. (2016) where the occurrence of oxidative stress and apoptosis was found following the exposure to nicotine containing fluids. The aim of this study was to investigate the HGF biological response to e-cigarettes liquids (with and without nicotine) and to clarify the molecular mechanisms driving the cytotoxicity exerted by fluids themselves. To this purpose, cells were treated with e-cigarette fluids containing nicotine (final concentration 1mg/mL) and the equivalent volume of a fluid without nicotine, for times up to 48 h. Lactate Dehydrogenase Assay (LDH), electronic microscopy analysis, collagen I production, flow cytometry lysosome compartment evaluation and western blotting LC3 (microtubule-associated protein 1A/1B-light chain 3) expression were performed. Fluids containing nicotine exerted cytotoxicity as demonstrated by the increased levels of LDH, in parallel to the formation of numerous vacuoles in the cytoplasm, as well as a decrease in collagen I production and an augmented LC3 II expression which characterized autophagy occurrence In conclusion E-cigarette fluids (with and without nicotine) trigger modification ultrastructure, collagen production and lysosomal compartment in HGFs, suggesting an involvement in the pathogenesis of oral diseases

Escape from cell death through authophagy in Human Gingival Fibroblast/Streptococcus mitis co-culture treated with Chitlac n-Ag

Since ancient times, silver has been extensively used to control infections. Silver based medical products have been proved to be effective in retarding and preventing bacterial infections (Chen et al., 2007). In order to prevent silver nanoparticles aggregation a lactose-modified chitosan was shown to be effective in stabilizing colloidal solutions of silver nanoparticles: “Chitlac-nAg” (Travan et al., 2009). Silver ions and nanoparticle are capable to destroy the bacterial cell wall by reacting with sulfhydryl groups on membrane proteins (Kruszewski et al., 2003). Since the cells are capable of internalizing nanoparticles there is the risk of a massive uptake by eukaryotic cells, which eventually leads to their death through oxidative DNA damage (Li et al. 2013) In the present work we investigated the effects of Chitlac-nAg on primary human gingival fibroblast (HGFs) co-cultured with Streptococcus mitis in the presence of saliva. HGFs were obtained from fragments of healty marginal gingival tissue, co-cultured with the clinical strain of S. mitis and treated for 24-48h with Chitlac or Chitlac-nAg. Cytotoxicity evaluated by LDH assay showed an increment in LDH release in co-culture in the presence of Chitlac n-Ag and saliva. Oxidative stress detected by means of Reactive Oxygen Species formation highlighted an early ROS presence in samples with Chitlac-nAg and saliva, but this value was similar to control after 48h; apoptotic and necrotic cells were detected by means of Annexin V/PI showing an increase in cell death in HGFs treated with Ag and saliva after 24h, and returned to basal levels after 48h; the uptake of nanoparticles by cells was determined by optical and electronic microscopy revealing the Ag uptake in vesicles. The presence of lysosomes and autophagosomes was verified by Lysotracker and by LC3 respectively. In vitro results showed that in our co-culture model, which mimics the microenvironment of the oral cavity, chitlac n-Ag does not exert cytotoxic effect towards HGFs that are able to execute a homeostasis mechanism through autophagy promoting cell survival