La metamorfosi del personaggio nei romanzi neostorici di Roberto Pazzi

This is the first of three essays on Roberto Pazzi's narrative. A second article will focus on Vangelo di Giuda, and a final article will examine the author's non-historical narratives. This essay examines the novels which portray historical themes, from ancient Rome (La stanza sull'acqua) to the RussianRevolution (Cercando l'Imperatore), in order to show how the author attempts to find a transcendental value in reality. Such a revelation is only possiblethrough art, which, by manipulating characters and events, enables them to move from being contingent to being permanent, granting them a presencebased on mythical parameters. There ensues a symbolic narrative construction, given both by the intellectual rhythm of the narrative, based on a utopic return to myth, and by the psychoanalytic inquiry and the spatio-temporal determinants, which in turn become metaphors for a-temporal existential moments.Article text in Italia

I labirinti narrativi Di marcella cioni

In Marcella Cioni’s narrative, a competitive psychological tension prevails between the limits imposed by official culture and the desire for free and complete expression of the “I”. Her characters are all in search of their own identity and, after having discovered its coordinates, they make desperate attempts to give form to their profound feelings. Her women characters seem more able and more willing to take risks than the men, indeed they sometimes display an extreme, irrational desire for self-affirmation. The male characters are more conditioned by their socio-historical roles and their journeys are more complicated and more intellectual. Cioni’s ambitious narrative project is given germane expression by the intelligent, linguistically and structurally elaborate plots devised by this new Italian writer

Febre Q: uma zoonose de distribuição mundial.

A febre Q é uma zoonose de distribuição mundial causada pelo patógeno Coxiella burnetii, uma bactéria que, além de apresentar resistência e estabilidade ambiental, é um dos agentes mais infecciosos ao ser humano. Sua principal forma de transmissão à população humana ocorre através da inalação de aerossóis contaminados com produtos de animais infectados, principalmente bovinos, caprinos e ovinos. A infecção em humanos apresenta um amplo espectro de manifestações, desde casos assintomáticos até complicações graves e fatais

Q fever: characteristics and reports ofanimportant neglected zoonosisin Brazil.

ABSTRACT - The Q fever is a zoonotic disease neglected in many countries all over the world. This zoonosis is caused by the bacteria Coxiella burnetii, a pathogen that presents stability and environmental resistance with high capacity to cause human infection, which could be fatal. This literature review study aims to describe the general aspects of Q fever, presenting the main cases occurred in Brazil and discussing ways to avoid this zoonosis negligence and underreporting in Brazil. The Q fever is still a disease unknown by the larger part of healthcare professionals in Brazil. In addition, the disease in humans presents a clinical picture similar to that of other acute feverish diseases. Therefore, cases of Q fever cannot be diagnosed and their treatment can be erroneous, which can increase the chances of chronic Q fever occurrence. The inclusion of Q fever as a disease of mandatory notification in humans and the utilization of the "One Health" approach are essential for the confrontation of the disease. Moreover, measures for the control, investigation, and prevention of Q fever will contribribute to avoid the occurrence of outbreaks and possible worsening resulting from this zoonosis. RESUMO - A febre Q é uma doença zoonótica negligenciada em muitos países do mundo. Essa zoonose é causada pela bactéria Coxiella burnetii, um patógeno que apresenta estabilidade e resistência ambiental com alta capacidade de causar infecção em humanos, podendo ser fatal. Este estudo de revisão da literatura tem como objetivo descrever os aspectos gerais da febre Q, apresentar os principais casos ocorridos no Brasil e discutir formas para que essa zoonose deixe de ser negligenciada e subnotificada no Brasil. A febre Q ainda é uma doença desconhecida por grande parte dos profissionais de saúde no Brasil. Aliado a isso, a doença em humanos apresenta um quadro clínico similar ao de outras doenças febris agudas. Dessa forma, casos de febre Q podem não estar sendo diagnosticados e sendo tratados de forma equivocada, o que pode aumentar as chances de ocorrência da febre Q crônica. A inclusão da febre Q como uma doença de notificação compulsória em humanos e a utilização da abordagem "One Health" são fundamentais para o enfrentamento da doença. Ademais, medidas de controle, de investigação e de prevenção da febre Q contribuirão para evitar a ocorrência de surtos e possíveis agravamentos decorrentes dessa zoonose

Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study

<p>Abstract</p> <p>Background</p> <p>Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure.</p> <p>The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region.</p> <p>Methods</p> <p>Population-based (n=206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4months and when patients withdrew more than 80% of the packs required.</p> <p>Results</p> <p>5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives=3months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42).</p> <p>Conclusions</p> <p>In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.</p

Impact of an educational intervention in the management of individuals with uncontrolled type 2 diabetes mellitus using insulin therapy.

Objective: To investigate the effects of problematizing intervention in the treatment of individuals with type 2 diabetes mellitus. Methodology: A randomized clinical trial was conducted in 41 patients ages 18 to 64 with type 2 diabetes who were treated with insulin and had glycosylated hemoglobin greater than 7.0%. The mean age of participants was 55.9 (SD = 5.49). A high percentage of patients had comorbidities such as hypertension (92.7%), dyslipidemia (68.3%), overweight (95%), retinopathy (41%), and neuropathy (39%). The patients in the intervention group participated in 6 educational groups using problematization methodology, whereas the patients in the control group attended only routine consultations. Sociodemographic, clinical, behavioral, and lifestyle variables were assessed. Results: After 6 months of follow-up, no statistically significant difference in glycemic control and anthropometric parameters was observed between participants in either study group. The intervention group showed an increase in knowledge about the disease, and an improvement in total cholesterol and uric acid levels. Conclusion: The use of a problematizing intervention provided an improvement in behavioral as well as specific clinical parameters, compared to routine diabetes care. However, longer follow-up time for these patients could bring benefits regarding glycemic control

The other side of recovery: validation of the Portuguese version of the subjective experiences of psychosis scale.

BACKGROUND: The aim of this study was to develop and validate a Portuguese version of The Subjective Experiences of Psychosis Scale (SEPS) for use in Portuguese-speaking populations in order to provide a self-report instrument to assess and monitor dimensions of psychotic experiences, translating patient's perspective and experience in terms of recovery from psychosis. METHODS: The sample consisted of 30 participants with psychotic disorders who had recently experienced delusions or hallucinations. The SEPS was completed along with other observer-based assessments and self-report questionnaires, such as the Brief Psychiatric Rating Scale, the Insight and Treatment Attitudes Questionnaire and the Function Assessment Short Test. RESULTS: Two main factors representing the positive and negative components of each subscale were identified. We obtained good internal consistency and test-retest reliability for the positive and negative components of all subscales. The subscales of SEPS correlated with observer-based assessments and self-report questionnaires. CONCLUSIONS: The Portuguese version of the SEPS is a useful tool in the assessment and monitoring of psychotic symptoms

The challenges of transferring chronic illness patients to adult care: reflections from pediatric and adult rheumatology at a US academic center

<p>Abstract</p> <p>Background</p> <p>Little is known about the transfer of care process from pediatric to adult rheumatology for patients with chronic rheumatic disease. The purpose of this study is to examine changes in disease status, treatment and health care utilization among adolescents transferring to adult care at the University of California San Francisco (UCSF).</p> <p>Methods</p> <p>We identified 31 eligible subjects who transferred from pediatric to adult rheumatology care at UCSF between 1995–2005. Subject demographics, disease characteristics, disease activity and health care utilization were compared between the year prior to and the year following transfer of care.</p> <p>Results</p> <p>The mean age at the last pediatric rheumatology visit was 19.5 years (17.4–22.0). Subject diagnoses included systemic lupus erythematosus (52%), mixed connective tissue disease (16%), juvenile idiopathic arthritis (16%), antiphospholipid antibody syndrome (13%) and vasculitis (3%). Nearly 30% of subjects were hospitalized for disease treatment or management of flares in the year prior to transfer, and 58% had active disease at the time of transfer. In the post-transfer period, almost 30% of subjects had an increase in disease activity. One patient died in the post-transfer period. The median transfer time between the last pediatric and first adult rheumatology visit was 7.1 months (range 0.7–33.6 months). Missed appointments were common in the both the pre and post transfer period.</p> <p>Conclusion</p> <p>A significant percentage of patients who transfer from pediatric to adult rheumatology care at our center are likely to have active disease at the time of transfer, and disease flares are common during the transfer period. These findings highlight the importance of a seamless transfer of care between rheumatology providers.</p

Impaired Growth and Force Production in Skeletal Muscles of Young Partially Pancreatectomized Rats: A Model of Adolescent Type 1 Diabetic Myopathy?

This present study investigated the temporal effects of type 1 diabetes mellitus (T1DM) on adolescent skeletal muscle growth, morphology and contractile properties using a 90% partial pancreatecomy (Px) model of the disease. Four week-old male Sprague-Dawley rats were randomly assigned to Px (n = 25) or Sham (n = 24) surgery groups and euthanized at 4 or 8 weeks following an in situ assessment of muscle force production. Compared to Shams, Px were hyperglycemic (>15 mM) and displayed attenuated body mass gains by days 2 and 4, respectively (both P<0.05). Absolute maximal force production of the gastrocnemius plantaris soleus complex (GPS) was 30% and 50% lower in Px vs. Shams at 4 and 8 weeks, respectively (P<0.01). GP mass was 35% lower in Px vs Shams at 4 weeks (1.24±0.06 g vs. 1.93±0.03 g, P<0.05) and 45% lower at 8 weeks (1.57±0.12 vs. 2.80±0.06, P<0.05). GP fiber area was 15–20% lower in Px vs. Shams at 4 weeks in all fiber types. At 8 weeks, GP type I and II fiber areas were ∼25% and 40% less, respectively, in Px vs. Shams (group by fiber type interactions, P<0.05). Phosphorylation states of 4E-BP1 and S6K1 following leucine gavage increased 2.0- and 3.5-fold, respectively, in Shams but not in Px. Px rats also had impaired rates of muscle protein synthesis in the basal state and in response to gavage. Taken together, these data indicate that exposure of growing skeletal muscle to uncontrolled T1DM significantly impairs muscle growth and function largely as a result of impaired protein synthesis in type II fibers

The management of diabetic ketoacidosis in children

The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort