La classificazione internazionale del funzionamento (ICF) e le dipendenze: verso un inquadramento "dinamico"

Among professionals involved in the care of addictions is emerging the need to develop interventions aimed at activation of personal and social skills as well as prevention of disabilities related to addiction. The approaches based only on medical care seem to be insufficient: it is appropriate to adopt a broader perspective about the addiction disorders, which is able to consider the person in the totality of his condition of life and health, and in synchronous way pursues the cure of addiction and the psycho-social rehabilitation. An important aspect of this process is the definition of tools that allow an objective assessment of skills and the definition of personalized programs. The ICF allows to describe the condition of each individual through a series of domains, that include all aspects of life, from those biological to psychological and social factors. In the Department of Addiction of Local Health Agency 13 (Veneto, Italy) is in progress a research that involves the application of a core set of codes of component of the ICF called Activities and Participation in a group of patients, through which it defines a "functioning profile" built on the interaction between the performance of the subject and the environmental factors. This profile provides support in the definition of individualized rehabilitation paths and of improvement targets, with the involvement of patient

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Educatori nel riabilitare storie di dipendenza

L'articolo presenta l'evoluzione del ruolo degli educatori professionali nell'ambito dei percorsi di riabilitazione delle dipendenze patologiche. Si tratta dell'esperienza che ha portato alla definizione del set di strumenti denominato "ICF-Dipendenze", pubblicati sul libro omonimo

Validation of the name Centaurea ×forsythiana Levier (Asteraceae)

3 p., 1 fot.Two individuals morphologically intermediate between Centaurea horrida Badarò (1824: 367) and C. filiformis Viviani (1825: 6) were collected by Charles Immanuel Forsyth Major on 26 May 1885 at Tavolara Islet, Italy (FI!): these samples were published by Fiori (1904) and later reported in Arrigoni (1972) as two different hybrids: “C. superfiliformis × horrida Levier” and “C. superhorrida × filiformis Levier”. As annotated on the label by Emile Levier, the material deposited in FI shows that the morphology of the two hybrids is very different and only the one named by Fiori as “C. superfiliformis × horrida Levier” was labelled as C. forsythiana Levier (Fig. 1). This sample is morphologically similar to the individuals of a hybrid population we discovered in the same site in the Tavolara Islet (Timone), on limestone, as reported by Fiori (1904). The hybrid named “C. superhorrida × filiformis Levier” by Fiori (1904) was collected by Forsyth Major in a different site (Bocchetta) on granite, and has never been recollected afterwards. For the matter of this note, this is not a problem since, according to Article H.4.1 of the International Code of Nomenclature (McNeill et al. 2012), all the hybrid variants originated from the same parental species, as far as considered nothotaxa (Art. H.3.1), should bear the same name.This study was supported by the Regione Autonoma della Sardegna, LR 7/2007–PO Sardegna FSE 2007–2013, with the grant no. CRP2 474 for all authors and no. CRP3 188 for SP.Peer reviewe

A prospective cohort analysis of the prevalence and predictive factors of delayed discharge after laparoscopic cholecystectomy in Italy: the DeDiLaCo Study

Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC. Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units. Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P <0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours. Conclusions: The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele