The Frailty of the Invincible

The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very "democratic", its consequences aren't. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and "financialisation". In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake

From the bench to practice - Field integration of community-based services for older citizens with different levels of functional limitation across European Regions

The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe. The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report. All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens' individual social, economic and human resources. Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery. The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach

Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases

Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity

Co-regolazione diadica madre-bambino, qualit\ue0 affettiva e sviluppo comunicativo-linguistico a 12 mesi in bambini nati estremamente pretermine

Coregolazione diadica madre-bambino, qualit\ue0 affettiva e sviluppo comunicativo-linguistico a 12 mesi in bambini nati estremamente pretermine Alessandra Sansavini, Annalisa Guarini, Silvia Savini, Veronica Zavagli Dipartimento di Psicologia, Universit\ue0 di Bologna e-mail: [email protected] Introduzione. Diverse ricerche hanno mostrato che le interazioni madri-bambino (M-B) pretermine nei primi mesi di vita sono caratterizzate da minore sincronia e affettivit\ue0 positiva rispetto alle diadi M-B a termine (Bozzette, 2007). La qualit\ue0 delle interazioni diadiche nella seconda met\ue0 del primo anno \ue8 stata meno indagata e con risultati di pi\uf9 complessa interpretazione (Forcada-Guex et al., 2006; Salerni et al. 2007); poco indagata \ue8 anche la relazione tra modalit\ue0 interattive e sviluppo comunicativo-linguistico nello stesso periodo. \uc8 stata rilevata difficolt\ue0 nei bambini pretermine a coorientare lo sguardo verso uno stimolo guardato dall\u2019adulto (De Schuymer et al., 2011); d\u2019altra parte, la strategia materna di mantenere l\u2019attenzione del bambino su un focus condiviso \ue8 risultata supportiva dello sviluppo linguistico e cognitivo (Landry, 1996). Tuttavia, mancano studi sulla relazione tra modalit\ue0 di coregolazione diadica e sviluppo comunicativo-linguistico, in particolare, nei nati con et\ue0 gestazionale estremamente bassa (ELGA) che presentano rischio elevato per ritardi linguistici, cognitivi, motori, percettivi e attentivi (Sansavini et al. 2011). Obiettivi. Questo studio si \ue8 proposto di esaminare la qualit\ue0 della coregolazione diadica a 12 mesi in diadi M-B ELGA confrontate con diadi M-B a termine (NT), tenendo conto degli aspetti qualitativi di condivisione dell\u2019attenzione e della qualit\ue0 affettiva dei partner. Si \ue8 fatto riferimento al modello di Fogel (1993, 2003) che considera la coregolazione diadica come un mutuo e continuo adattamento tra i due partner, che implica capacit\ue0 di mantenere l\u2019attenzione su un focus condiviso, responsivit\ue0 ai segnali del partner e innovazione. Lo studio ha inoltre inteso esaminare la relazione tra modalit\ue0 di coregolazione e sviluppo comunicativo-linguistico, motorio e cognitivo. Si \ue8 ipotizzato che la nascita estremamente pretermine costituisca un fattore di rischio per tale sviluppo, ma che questo sia modulato dalle modalit\ue0 di coregolazione diadica, in particolare, dalla capacit\ue0 di mantenere un focus condiviso di attenzione e da una qualit\ue0 affettiva positiva nell\u2019interazione. Metodo. Partecipanti: 27 diadi M-B di lingua italiana, di cui 16 ELGA (EG media = 25.7 settimane), esenti da danni cerebrali, e 11 NT (EG media = 39.2 settimane), comparabili per caratteristiche socio-demografiche, osservate a 12 mesi (et\ue0 corretta per gli ELGA). Procedura. Le diadi sono state videoregistrate durante un\u2019interazione di gioco con oggetti in laboratorio. La modalit\ue0 di coregolazione M-B \ue8 stata codificata mediante il Revised Relational Coding System (Fogel et al. 2003) in categorie diadiche mutualmente esclusive, definite sulla base di focus di attenzione, livello di coinvolgimento dei partner e funzione comunicativa. La qualit\ue0 affettiva della madre e del bambino \ue8 stata codificata mediante il sistema di codifica di Lunkenheimer et al. (2011) in categorie mutualmente esclusive, definite da qualit\ue0 e intensit\ue0 affettiva. Lo sviluppo comunicativo-linguistico \ue8 stato valutato con il questionario \u201cIl Primo Vocabolario del Bambino\u201d-PVB- (Caselli e Casadio, 1995) per comprensione e produzione lessicale e produzione gestuale, e le Scale Bayley-III (2006), utilizzate anche per esaminare le competenze motorie e cognitive. Risultati. La modalit\ue0 di coregolazione pi\uf9 frequente in entrambi i campioni \ue8 risultata quella unilaterale, ma con lievi differenze tra i due gruppi, con una frequenza pi\uf9 elevata della modalit\ue0 simmetrica nelle diadi M-B NT (p = .048) e della modalit\ue0 unilaterale nelle diadi M-B ELGA (p = .057, tendenza). La qualit\ue0 affettiva materna prevalente in entrambi i campioni \ue8 risultata quella positiva bassa. Differenze significative (p = .001) sono state rilevate nella qualit\ue0 affettiva del bambino, pi\uf9 frequentemente neutra negli ELGA, positiva bassa nei NT. Punteggi significativamente pi\uf9 bassi (p < .01) sono stati riscontrati nei bambini ELGA rispetto ai NT nelle competenze linguistiche globali, recettive, fine-motorie e cognitive delle Scale Bayley III e nella produzione gestuale del PVB. Correlazioni positive significative (p < .05) sono emerse nel campione totale tra modalit\ue0 di coregolazione simmetrica e competenze linguistiche (globali: rho = .411; recettive: rho = .456; comprensione di frasi: rho = .396; produzione di parole: rho = .445; produzione gestuale: rho = .400) e fine-motorie (rho = .421). Conclusioni. I bambini estremamente pretermine mostrano, rispetto ai nati a termine, differenze rilevanti nello sviluppo comunicativo-linguistico, motorio e cognitivo, pi\uf9 sfumate nella qualit\ue0 affettiva e nelle modalit\ue0 di coregolazione diadica. La capacit\ue0 di mantenere un focus di attenzione condiviso con coinvolgimento di entrambi i partner mostra una relazione positiva con lo sviluppo comunicativo-linguistico e fine-motorio, evidenziando l\u2019importanza di supportare tale modalit\ue0 di coregolazione in particolare nelle diadi con bambini estremamente pretermine

Dyadic co-regulation, affective intensity and maternal communicative style at 12 months: a comparison among extremely preterm and full-term dyads.

Previous research has found that mother\u2013preterm infant face-to-face interactions in the first months of life are less synchronous and preterm infants express less positive emotions than full-terms (Feldman and Eidelman, 2007; Bozzette, 2007). However, little is known about the quality of dyadic processes and its relationships with affective intensity and communicative style in mother-infant preterm dyads at the end of the first year when infants are building language through interactions. For this reason, our thinking was framed with reference to Fogel\u2019s (2003) model of interaction as a continuous adjustment between partners. Our study aimed at investigating the quality of mother\u2013infant co-regulation in preterm compared to full-term infant\u2013mother dyads at 12 months, taking into account affective intensity of both partners and mothers\u2019 communicative style. Method. Twenty-seven monolingual Italian mother\u2013infant dyads, including 16 extremely low gestational age preterms (mean GA: 25.7 weeks) without major cerebral damage, and 11 full-terms comparable for gender and socio-economical background, were videotaped at 12-month-old (corrected age for preterms) during a spontaneous play interaction. Quality and degree of dyadic co-regulation (Fogel et al., 2003), mothers\u2019 and infants\u2019 affective intensity (Lunkenheimer et al., 2011) and maternal communicative style (Longobardi, 1992) were coded. Results. Unilateral-following co-regulation prevailed in both samples with mothers observing their infant playing, followed by unilateral-initiating by mothers in preterm dyads, while sequential-symmetrical in full-term dyads. Neutral and low negative affective intensity prevailed significantly in preterms, while low positive in full terms. Preterms\u2019 mothers showed similarly to their infants significantly higher neutral affective intensity. Maternal communicative style\u2019s analyses will allow to further understand the characteristics of communicative exchanges in the two groups. Conclusions. Search for co-regulation was observed in both samples at 12 months, but with less symmetric and positive engagement in preterm with respect to full term dyads. The implications of these findings for communication and language development in preterm dyads will be discussed

Early lexical processes and the role of early mother-infant interaction in extremely preterm infants

Early lexical processes and the role of early mother-infant interaction in extremely preterm infants Alessandra Sansavini, Annalisa Guarini, Silvia Savini, Veronica Zavagli Department of Psychology, University of Bologna (Italy) Recent studies have shown that lexical development can be affected by preterm birth with delays with respect to typically developing children. However, preterm children\u2019s early lexical processes have not been enough investigated as well as the role of early mother-infant interaction in building infants\u2019 lexicon. We addressed this issue by examining extremely preterm infants\u2019 communicative and linguistic abilities, as well as the dynamics of mother-infant interaction and communicative style, compared to those of typically developing (TD) children. Seventeen monolingual Italian extremely preterms without severe cerebral damages and neurosensorial impairments (GA <=28 weeks) were compared to 11 monolingual Italian full-terms. At 12 months infants\u2019 observational measures of communicative and linguistic abilities, quality of dyadic coregulation and maternal communicative function as well as direct (Bayley-III) and indirect (MB-CDI) measures of infants\u2019 linguistic and cognitive development were employed. At 24 months the same direct and indirect measures and a lexical test (Picture Naming Game) were administered. Linguistic and cognitive difficulties were found in extremely preterm infants through direct and indirect tools and observational measures already at 12 months, becoming more evident at 24 months. The role of early positive and coregulated mother-infant interaction in relation to lexical production at 24 months as well as the dynamic process of lexical building through multimodal communication will be discussed. The methodological implications of this approach will also be considered

Life-threatening hyponatremia caused by vinblastine

Some days after the administration of a third bolus of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) a patient affected by immunoblastic lymphoma underwent a neurotoxic crisis. The episode lasted 1 week and was followed by a dramatic fall in plasma sodium (104 mEq I-1), associated with a proportionally lesser decrease in plasma chloride and phosphate. Despite the lowest plasma osmolality, detectable levels of circulating ADH were present. After 36 h the hyponatremic episode improved after the infusion of hypertonic sodium chloride. Nevertheless the patient lapsed into a hypotonic coma. The urinary concentrations of the main tubular enzymes (gamma-glutamyltranspeptidase, N-acetyl-glucosaminidase, alpha-glucosidase) proved very high and successively decreased slowly. The most likely cause of such hyponatremic episode is vinblastine. The drug acted through: (a) an already known inappropriate release of ADH, and (b) a hitherto unreported tubular lesion, which impaired the reabsorption of sodium and other coupled solutes

Oil Spill Detection from SAR Images by Deep Learning

Oil spills, caused by accidents or by ships cleaning their tanks, represent big threats for maritime and coastal ecosystems health. A very effective detection of oil spills can be performed using satellite synthetic aperture radar (SAR) systems, operating regardless of cloud coverage and sunlight and capable of discriminating oil from regular sea surface. However, discriminating between real oil spills and lookalikes (such as natural oils and seepages, often occurring in upwelling sea areas), although well performed by expert SAR image interpreters, poses a great challenge for automatic processes. In addition, a visual check performed by human operators on a great number of images would be too expensive. Therefore, many solutions for automatic detection have been tried in the last few years, using probabilistic models and, more recently, machine learning. This work presents an innovative solution based on image-to-image translation using convolutional neural networks (CNNs) trained with an adversarial loss function. The proposed approach has been tested, with very promising results, using Radarsat-2 and Sentinel-1 SAR data over the Mediterranean Sea and some areas of the Atlantic Ocean and the North Sea