Gender health and policies: the state of the art from exposure to solutions

Objective. To synthesize the determinants of gender inequalities through a narrative review that: (i) describes gender related var- iables that can create different levels of health; (ii) describes key points that may assist in policy development and its reorientation towards gender differences; (iii) debates potential approaches in understanding gender issues. Methods. Review of the international literature through online databases (Pubmed), search engines, publications and documents from ?grey literature?. Inclusion criteria: publications from 1997, English language; keywords used: gender based analysis; gender and public policy; women?s health; gender differences; health policy; gender impact assessment. Among the 300 papers retrieved, 55 were selected for relevance. Results. We performed a narrative synthesis of the included literature, regarding: (i) gender differences and their determi-nants; (ii) elements for the changing; (iii) possible approaches; (iv) gender influences the pursuit of health and health care access through specific variables; (v) health policies can modify these variables only by a minimal percentage. These interventions should guarantee equity and allow efficient resources allocation. The gap between political announce- ments and real policy implementation remains unchanged. (vi) Standard approaches to the topic are not feasible due to the scarcity of a specific literature and the numerous cultural differences. Conclusions. Gender analysis of policies suggests they can dif- ferently affect women in comparison to men. However, reforms, strategies and interventions introduced in the last two decades, have achieved a limited success towards better gender equality in health. The main aim is to attack the structural sources of gender inequity in the society

Over 1200 drugs-related deaths and 190,000 opiate-user-years of follow-up : relative risks by sex and age-group

Heroin users/injectors' risk of drugs-related death by sex and current age is weakly estimated both in individual cohorts of under 1000 clients, 5000 person-years or 50 drugs-related deaths and when using cross-sectional data. A workshop in Cambridge analysed six cohorts who were recruited according to a common European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) protocol from drug treatment agencies in Barcelona, Denmark, Dublin, Lisbon, Rome and Vienna in the 1990s; and, as external reference, opiate-user arrestees in France and hepatitis C diagnosed ever-injectors in Scotland in 1993-2001, both followed by database linkage to December 2001. EMCDDA cohorts recorded approximately equal numbers of drugs-related deaths (864) and deaths from other non-HIV causes (865) during 106,152 person-years of follow-up. External cohorts contributed 376 drugs-related deaths (Scotland 195, France 181) and 418 deaths from non-HIV causes (Scotland 221, France 197) during 86,417 person-years of follow-up (Scotland 22,670, France 63,747). EMCDDA cohorts reported 707 drugs-related deaths in 81,367 man-years {8.7 per 1000 person-years, 95% CI: 8.1 to 9.4} but only 157 in 24,785 person-years for females {6.3 per 1000 person-years, 95% CI: 5.4 to 7.4}. Except in external cohorts, relative risks by current age-group were not particularly strong, and more modest in Poisson regression than in cross-sectional analyses: relative risk was 1.2 (95% CI: 1.0-1.4) for 35-44 year olds compared to 15-24 year 3 olds, but 1.4 for males (95%CI: 1.2-1.6), and dramatically lower at 0.44 after the first year of follow-up (95% CI: 0.37-0.52)

Climatic Feedbacks and Desertification: The Mediterranean Model

Abstract Mesometeorological information obtained in several research projects in southern Europe has been used to analyze perceived changes in the western Mediterranean summer storm regime. A procedure was developed to disaggregate daily precipitation data into three main components: frontal precipitation, summer storms, and Mediterranean cyclogenesis. Working hypotheses were derived on the likely processes involved. The results indicate that the precipitation regime in this Mediterranean region is very sensitive to variations in surface airmass temperature and moisture. Land-use perturbations that accumulated over historical time and greatly accelerated in the last 30 yr may have induced changes from an open, monsoon-type regime with frequent summer storms over the mountains inland to one dominated by closed vertical recirculations where feedback mechanisms favor the loss of storms over the coastal mountains and additional heating of the sea surface temperature during summer. This, in turn, favors Mediterranean cyclogenesis and torrential rains in autumn–winter. Because these intense rains and floods can occur anywhere in the basin, perturbations to the hydrological cycle in any part of the basin can propagate to the whole basin and adjacent regions. Furthermore, present levels of air pollutants can produce greenhouse heating, amplifying the perturbations and pushing the system over critical threshold levels. The questions raised are relevant for the new European Union (EU) water policies in southern Europe and for other regions dominated by monsoon-type weather systems

A follow-up study of heroin addicts (VEdeTTE2): study design and protocol

BACKGROUND: In Italy, a large cohort study (VEdeTTE1) was conducted between 1998–2001 to evaluate the effectiveness of treatments in reducing mortality and increasing treatment retention among heroin addicts. The follow-up of this cohort (VEdeTTE2) was designed to evaluate the effectiveness of treatments on long-term outcomes, such as rehabilitation and social re-integration. The purpose of this paper is to describe the protocol of the VEdeTTE2 study, and to present the results of the pilot study carried out to assess the feasibility of the study and to improve study procedures. METHODS: The source population for the VEdeTTE2 study was the VEdeTTE1 cohort, from which a sample of 2,200 patients, traced two or more years after enrolment in the cohort, were asked to participate. An interview investigates drug use; overdose; family and social re-integration. Illegal activity are investigated separately in a questionnaire completed by the patient. Patients are also asked to provide a hair sample to test for heroin and cocaine use. Information on treatments and HIV, HBV and HCV morbidity are obtained from clinical records. A pilot phase was planned and carried out on 60 patients. RESULTS: The results of the pilot phase pointed out the validity of the procedures designed to limit attrition: the number of traced subjects was satisfactory (88%). Moreover, the pilot phase was very useful in identifying possible causes of delays and attrition, and flaws in the instruments. Improvements to the procedures and the instruments were subsequently implemented. Sensitivity of the biological test was quite good for heroin (78%) but lower for cocaine (42.3%), highlighting the need to obtain a hair sample from all patients. CONCLUSION: In drug addiction research, studies investigating health status and social re-integration of subjects at long-term follow-up are lacking. The VEdeTTE2 study aims to investigate these outcomes at long-term follow-up. Results of the pilot phase underline the importance of the pilot phase when planning a follow-up study

Altered Error Processing following Vascular Thalamic Damage: Evidence from an Antisaccade Task

Event-related potentials (ERP) research has identified a negative deflection within about 100 to 150 ms after an erroneous response – the error-related negativity (ERN) - as a correlate of awareness-independent error processing. The short latency suggests an internal error monitoring system acting rapidly based on central information such as an efference copy signal. Studies on monkeys and humans have identified the thalamus as an important relay station for efference copy signals of ongoing saccades. The present study investigated error processing on an antisaccade task with ERPs in six patients with focal vascular damage to the thalamus and 28 control subjects. ERN amplitudes were significantly reduced in the patients, with the strongest ERN attenuation being observed in two patients with right mediodorsal and ventrolateral and bilateral ventrolateral damage, respectively. Although the number of errors was significantly higher in the thalamic lesion patients, the degree of ERN attenuation did not correlate with the error rate in the patients. The present data underline the role of the thalamus for the online monitoring of saccadic eye movements, albeit not providing unequivocal evidence in favour of an exclusive role of a particular thalamic site being involved in performance monitoring. By relaying saccade-related efference copy signals, the thalamus appears to enable fast error processing. Furthermore early error processing based on internal information may contribute to error awareness which was reduced in the patients

Visual Stability and the Motion Aftereffect: A Psychophysical Study Revealing Spatial Updating

Eye movements create an ever-changing image of the world on the retina. In particular, frequent saccades call for a compensatory mechanism to transform the changing visual information into a stable percept. To this end, the brain presumably uses internal copies of motor commands. Electrophysiological recordings of visual neurons in the primate lateral intraparietal cortex, the frontal eye fields, and the superior colliculus suggest that the receptive fields (RFs) of special neurons shift towards their post-saccadic positions before the onset of a saccade. However, the perceptual consequences of these shifts remain controversial. We wanted to test in humans whether a remapping of motion adaptation occurs in visual perception

Outcomes of pregnancies after kidney transplantation: lessons learned from CKD. A comparison of transplanted, nontransplanted chronic kidney disease patients and low-risk pregnancies: a multicenter nationwide analysis.

BACKGROUND: Kidney transplantation (KT) may restore fertility in CKD. The reasons why materno-foetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling.Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of non-transplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium. METHODS: We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD and 1418 low-risk controls recruited in 2 large Italian Units, in the same period (2000-2014). The following outcomes were considered: maternal and foetal death; malformations; preterm delivery; small for gestational age baby (SGA); need for the neonatal intensive care unit (NICU); doubling of serum creatinine or increase in CKD stage. Data were analysed according to kidney diseases, renal function (staging according to CKD-EPI), hypertension, maternal age, partity, ethnicity. RESULTS: Materno-foetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. KT patients with e-GFR >90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ('progressive CKD') are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 versus 1: RR 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient. CONCLUSIONS: The materno-foetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney diseas

A PC based method for clinical evaluation of saccadic eye movements

A program is presented which computes saccade parameters and evaluates the amplitude/duration and amplitude/peak velocity relationships, the latency, and precision and symmetry as a function of target offset. Based on statistical methods, it gives a judgement of normality. Data were collected from a population of 76 normal subjects whose ages ranged from 10 to 80 years. Subjects were divided, according to their age, into 7 groups. Several statistical methods were used to find the most significant method to be used for patient comparison. Once the statistical method was tested on patients, an automatic computer program was developed which, based on these statistical methods, gives the examiner the results of the comparison in a simple, comprehensive way that can be easily understood, even by people not familiar with statistical problems. The program is implemented on a MS-DOS personal computer equipped with an input/output device for online acquisition of eye movements