Consensus communication strategies to improve doctor-patient relationship in paediatric severe asthma

Background: Asthma is a chronic inflammatory disease that is very common among youth worldwide. The burden of this illness is very high not only considering financial costs but also on emotional and social functioning. Guidelines and many researches recommend to develop a good communication between physicians and children/caregiver and their parents. Nevertheless, a previous Italian project showed some criticalities in paediatric severe asthma management. The consensus gathered together experts in paediatric asthma management, experts in narrative medicine and patient associations with the aim of identify simple recommendation to improve communication strategies. Methods: Participants to the consensus received the results of the project and a selection of narratives two weeks before the meeting. The meeting was structured in plenary session and in three working groups discussing respectively about communication strategies with children, adolescents and parents. The task of each working group was to identify the most effective (DO) and least effective practices (DON' T) for 5 phases of the visit: welcome, comprehension of the context, emotions management, duration and end of the visit and endurance of the relationship. Results: Participants agreed that good relationships translate into positive outcomes and reached consensus on communication strategies to implement in the different phase of relationships. Conclusions: The future challenges identified by the participants are the dissemination of this Consensus document and the implementation of effective communication strategies to improve the management of pediatric asthma

Geophysical monitoring of Stromboli volcano: insight into recent volcanic activity

Stromboli is an open conduit strato-volcano of the Aeolian archipelago (Italy), characterized by typical Strom-bolian explosive activity, lasting for several centuries, and by the emission of huge amounts of gas. The normalactivity of Stromboli is characterized by some hundreds of moderate explosions per day. Major explosions, whichlaunch scoria up to hundreds of meters from the craters, lava flows and paroxysmal explosions, which producelarge ballistic blocks, sometimes take place. During the effusive eruption in 2002 - 2003, which caused a tsunamiwith waves of about 10 meters high along the coasts of the Island, the monitoring system was enhanced. In 2006INGV has added two Sacks-Evertson borehole volumetric dilatometers to the surveillance system, in order to mon-itor changes in the local strain field by measuring areal strain. Today we have a large amount of geophysical dataand observations that allow us to better understand how this volcano works. After a period of low explosive activitystarted in mid-2014, Stromboli has shown a more intense explosive activity in the last few months. During the re-cent phase of increased activity, the geophysical monitoring system detected four major explosions occurred on 26July, 23 October, 1 November and 1 December 2017, respectively. The current phase of reawakening of Strombolivolcano has led the Italian civil protection authorities to decree the "attention" alert level (yellow) on the Island.PublishedVienna, Austria1IT. Reti di monitoraggio e sorveglianz

Polygenic prediction of educational attainment within and between families from genome-wide association analyses in 3 million individuals

We conduct a genome-wide association study (GWAS) of educational attainment (EA) in a sample of ~3 million individuals and identify 3,952 approximately uncorrelated genome-wide-significant single-nucleotide polymorphisms (SNPs). A genome-wide polygenic predictor, or polygenic index (PGI), explains 12-16% of EA variance and contributes to risk prediction for ten diseases. Direct effects (i.e., controlling for parental PGIs) explain roughly half the PGI's magnitude of association with EA and other phenotypes. The correlation between mate-pair PGIs is far too large to be consistent with phenotypic assortment alone, implying additional assortment on PGI-associated factors. In an additional GWAS of dominance deviations from the additive model, we identify no genome-wide-significant SNPs, and a separate X-chromosome additive GWAS identifies 57

Genome-wide association study identifies 74 loci associated with educational attainment

Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20% of the variation across individuals1. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample1,2 of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases

The biodynamic stress hypothesis Towards an evolutionary psychology paradigm

In recent decades, stress has played a prominent role in terms of how the individual views the world and in the sphere of public health policies. Expressions such as “being stressed”, “reducing stress” and so on abound in individual communication. Recently, the World Health Organization, with the ICD 11, formally recognized stress as a central contributor to the “burn out syndrome”. Despite these advances, scientific discussion on stress has made little progress due to a significant number of issues related to its definition, the nature of normal or pathological responses and its neurobiological basis, each of which must be kept quite separate from those related to psychiatric and medical disorders related to stress. In this article we shall try to a) define stress in a scientifically adequate and rigorous manner; b) describe stress (and stress response) in its normal individual phenomenology, including behavioral and biological changes during a response to a stressful event; c) formulate some hypotheses on the psychobiological basis of stress in the light of the biodynamic stress hypothesis; d) analyze the consequences of stress at an early age; e) detect implications for the development of new IC technologies

Living with Chronic Spontaneous Urticaria in Italy: A Narrative Medicine Project to Improve the Pathway of Patient Care

Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness