Functional impairment is associated with an increased risk of mortality in patients on chronic hemodialysis

Background: Functional impairment is associated with adverse outcomes in older people, as well as in patients on chronic hemodialysis. The aim of the present study was to determine the characteristics associated with functional impairment in chronic hemodialysis, and to evaluate if functional impairment represents a risk factor for reduced survival in chronic hemodialysis. Methods: All 132 chronic hemodialysis referring to the Hemodialysis Service of the Catholic University, Rome, Italy between November 2007 and May 2015 were included. All patients underwent comprehensive geriatric assessment; functional ability was estimated using two questionnaires exploring independency in bathing, dressing, toileting, transferring, continence, feeding (ADLs), and independency in using the telephone, shopping, food preparation, housekeeping, laundering, traveling, taking medications, and handling finances (IADLs). Functional impairment was diagnosed in presence of dependence in one or more ADLs/IADLs. Mood was assessed using the 30-item Geriatric Depression Scale. Logistic regression was used to evaluate factors associated with functional impairment. The association between functional impairment and survival was assessed by Cox regression. Results: ADLs impairment was present in 34 (26 %) participants, while IADLs impairment was detected in 64 (48 %) subjects. After a follow up of 90 months, 55 (42 %) patients died. In logistic regression, depressive symptoms were associated with ADLs and IADLs impairment (OR 1.12; 95 % CI = 1.02-1.23; OR 1.16; 95 % CI = 1.02-1.33; respectively). In Cox regression, ADLs impairment was associated with mortality (HR 2.47; 95 % CI-1.07-5.67) while IADLs impairment was not associated with reduced survival (HR .80; 95 % CI-.36-1.76). Conclusions: Functional impairment is associated with depressive symptoms; also, impairment in the ADLs represents a risk factor of reduced survival in chronic hemodialysis. These associations and their potential implication should be assessed in dedicated studies

Il delicato equilibrio dell’accessibilità tra esigenze specifiche e universalità. il caso delle persone sorde

Negli ultimi anni termini e concetti quali quello di accessibilità, universal design, inclusione - che ha di fatto sostituito integrazione - si sono affermati nella letteratura che si occupa di disabilità, nei tavoli tecnici dedicati all’eliminazione delle barriere, nelle norme e in certa misura anche nell’opinione pubblica. Le Istituzioni, soprattutto musei, luoghi d’arte e cultura sono divenuti più sensibili al tema dell’accessibilità, un concetto entrato a far parte di norme internazionali e italiane nello specifico, in cui si parla di turismo sociale e sostenibile, abbattimento di barriere, società inclusive. Se da un lato il concetto di design universale sembra avere dei vantaggi rispetto alla frammentarietà di soluzioni sviluppate per ciascuna esigenza specifica e il coinvolgimento degli utenti, nella definizione di percorsi e prodotti accessibili, è maggiore rispetto al passato (Greco 2018) si rende necessaria una riflessione sulla effettiva aderenza di tali cambiamenti alle esigenze degli utenti, nel nostro caso le persone sorde. La specificità di alcune soluzioni non sempre sono funzionali al design for all e il coinvolgimento nella co-progettazione di spazi, servizi e percorsi accessibili rimane più un’intenzione, per diversi motivi, che una prassi effettiva. Il presente contributo intende portare alcune riflessioni sulla complessità dei contesti in cui si opera, delle risorse e strategie da mettere in atto, delle modalità di comunicazione e promozione di cui occorre tenere conto nella realizzazione di percorsi inclusivi. Verranno presentate esperienze maturate nell’ambito della partecipazione a tavoli tecnici istituzionali e progetti dedicati all’accessibilità (es. Gallerie d’Italia, Cappella San Severo, progetti MAPS e AccessibItaly).In recent years, terms and concepts such as accessibility, universal design, inclusion - which has in fact replaced integration - have established themselves in the literature dealing with disabilities, in the technical tables dedicated to the elimination of barriers, in the standards and to a certain extent even in public opinion. Institutions, especially museums, places of art and culture, have become more sensitive to the issue of accessibility, a concept that has become part of international and Italian standards, widely referring to social and sustainable tourism, removal of barriers, inclusive societies. If on the one hand the concept of universal design seems to have advantages with respect to the fragmented nature of solutions developed for each specific need, while the involvement of users and stakeholders in the definition of accessible paths and products is greater than in the past (Greco 2018), a reflection is needed on the effective adherence of these changes to the expectations of users, in our case deaf people. The specificity of some solutions are not always functional to design for all and the involvement in the co-design of accessible spaces, services and paths remains more an intention, for various reasons, than an effective practice. This contribution intends to bring some reflections on the complexity of the contexts in which we operate, the resources and strategies to be implemented, the methods of communication and promotion which must be taken into account in the creation of inclusive paths. Experiences gained in the context of participation in institutional technical task-forces and projects dedicated to accessibility will be presented (e.g. Gallerie d'Italia, Cappella San Severo, MAPS and AccessibItaly ENS projects)

Verso un approccio integrato alla sordità

L’articolo si inserisce nell’ambito di un numero monotematico della rivista dedicato alla Lingua dei Segni e ai pregiudizi che la circondano, con l’obiettivo dei curatori di “superare sterili contrapposizioni ideologiche e discutere insieme le più recenti evidenze scientifiche su questo tema in una prospettiva multidisciplinare”. L’articolo quindi tenta di fornire una serie di risposte in un’ottica inclusiva che parta dalla sordità come questione complessa, evidenziando come l’utilizzo della LIS non sia una soluzione univoca e per tutti ma innegabilmente diritto alla libertà di scelta della comunicazione e potente strumento di inclusion

Letter by Gronda et al Regarding Article, “Effect of Empagliflozin on Worsening Heart Failure Events in Patients With Heart Failure and Preserved Ejection Fraction: EMPEROR-Preserved Trial”

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5° Convegno Nazionale sulla Lingua dei Segni Italiana

Dopo gli storici convegni nazionali sulla Lingua dei Segni Italiana (LIS) tenutisi a Trieste (1995), Genova (1998), Verona (2007), Roma (2018) l’Università della Calabria e l’Ente Nazionale Sordi organizzano il 5° Convegno Nazionale sulla Lingua dei Segni Italiana. Il tema del #5ConvegnoLIS sarà“La LIS: patrimonio culturale o capitale umano?”. Obiettivo del Convegno è delineare il quadro attuale degli studi narrandolo mediante diverse prospettive e approcci interdisciplinari e costituire ulteriore dimensione di visibilità e consapevolezza del prezioso patrimonio linguistico della comunità sorda italiana e non solo. Infatti, come si legge sull’Enciclopedia Treccani alla voce “Lingua e Dialetti” scritta dal grande linguista Federico Albano Leoni, “il repertorio linguistico italiano comprende ormai anche la LIS, che ha visto riconosciuto il suo status di lingua di recente”

Randomised trial of impact of model of integrated care and case management for older people living in the community

Objective: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. Design: Randomised study with 1 year follow up. Setting: Town in northern Italy (Rovereto). Subjects: 200 older people already receiving conventional community care services. Intervention: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care. Main outcome measures: Admission to an institution, use and costs of health services, variations in functional status. Results: Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of £1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05). Conclusion: Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community

Quantitative analysis of cerebrospinal fluid dynamics at phase contrast cine-MRI: predictivity of neurosurgical "Shunt" responsiveness in patients with idiopathic normal pressure hydrocephalus

BACKGROUND: Aqueductal stroke volume (ACSV) measured by phase-contrast cine (PCC)-MRI has been proposed with controversy as a tool for the selection of patients with normal pressure hydrocephalus (NPH) as candidates for shunt-surgery. The aim of this study was to assess if PCC-MRI scan measurements of ACSV could select properly these patients. METHODS: We retrospectively reviewed charts and MRI of 38 shunted patients (72,16 \ub16,16 years). ACSV measurements were performed 7-30 days before shunt and at the first and sixth months after surgery. Normally distributed variables were compared in the two groups (improved/unimproved) by T-test for baseline values and with repeated measures analysis of variance. RESULTS: 26 patients (68,4 %) improved after VPS (mean time of symptom onset was 8,15 \ub17,19 months). Mean preoperative ACSV value was 271,85 \ub1 143,03, which decreased by 21,6 % (mean 213 \ub1 125,14 ) at the first month and 40,3% sixth months after VPS (mean 162,15 \ub1 91,5). 12 patients (31,6 %) did not improve (mean time of symptom onset was 29 \ub1 5,62 months). Mean preoperative ACSV value was 79,83 \ub1 31,24, decreased to 8,7 % (mean 72,83 \ub128,66 ) at first month after VPS, 21,2% (mean 62,83 \ub1 31,12 ) after six months. We found statistical difference between preoperative ACSV of improved and unimproved patients (p<0,01), onset time of symptoms (p<0,01) and the changes in ACSV after one and six months in both groups (p<0,001). CONCLUSIONS: ACSV is useful to stratify patients with NPH after surgery (improved /not improved) suggesting to proceed with serial ACSV measurements before deciding treatment

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Intradialytic hypotension (IDH) is common in patients on chronic hemodialysis, but knowledge on determinants is still unclear. The present study aims at evaluating the association between IDH and dialytic age (DA) in patients on chronic hemodialysis