2,138 research outputs found

    CONTINUITA' OSPEDALE TERRITORIO

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    L’Italia ha una percentuale di popolazione ultrasessantacinquenne che supera il 20%, e che dovrebbe salire a oltre il 35% nel 2050. Circa 2 milioni di persone anziane non sono autonome. La prevalenza di disabilità è più alta nelle regioni meridionali del paese. L'età avanzata è un fattore di rischio indipendente per le fratture da fragilità che a lungo termine comportano un maggiore e considerevole rischio di disabilità. L’impatto delle fratture di femore è particolarmente grave negli anziani fragili. I casi più gravi di disabilità (più concentrati negli ultraottantenni) sono aumentati drammaticamente nelle ultime decade. Di conseguenza, il bisogno dei servizi di cure continuative territoriali in grado di gestire questa crescente fetta della popolazione, cioè, anziani con patologie multiple e/o con disabilità grave, spesso come conseguenza delle fratture da fragilità, è in continuo aumento. La cura a lungo termine di queste persone, con un carico sociale complesso e oneri di assistenza gravosi pongono seri problemi sia agli operatori sanitari che all'intero sistema di welfare. Da sottolineare che nei pazienti istituzionalizzati la incidenza di fratture di femore è circa 2-3 volte maggiore rispetto alle persone che vivono in comunità, comportando ancora un ulteriore rischio di disabilità, costi sociali e finanziari. Pertanto, negli anziani istituzionalizzati è di fondamentale importanza l’attuazione di programmi di prevenzione delle fratture da fragilità e soprattutto del rischio di ulteriori fratture. Le cure continuative territoriali in Italia sono contraddistinte da una bassa quota di finanziamenti pubblici e di un basso numero di prestazione se paragonate con la situazione in altri paesi del centro-nord europeo. Ad esempio, nell’anno 2007 la spesa pubblica per le cure domiciliari e residenziali (long term care – LTC) è stata del 1,13% del PIL e gli utenti di questi servizi erano soltanto circa il 5% del totale della popolazione ultrasessantacinquenne. Il sistema pubblico di cure continuative italiano si basa su due forme parallele di intervento: il primo, e più rilevante (50% del totale delle spese pubbliche per le cure continuative), consiste in programmi di erogazioni monetarie ("indennità di accompagnamento"), il secondo è dato dai programmi sociali e sanitari, compresa la erogazione di assistenza residenziale e domiciliare. La responsabilità delle cure è in gran parte delegata alle famiglie anche se la tradizionale capacità assistenziale delle famiglie italiane si è ridotta notevolmente nell'ultimo decennio a causa, al meno in parte, del continuo aumento del tasso di occupazione femminile. Le tendenze demografiche minacciano la sostenibilità del sistema di welfare italiano esistente, in particolare nei servizi di cure croniche territoriali, per i quali la domanda è in gran parte aumentata e si prevede che continuerà ad aumentare nei prossimi decenni

    High-accuracy determination of the neutron flux in the new experimental area n_TOF-EAR2 at CERN

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    A new high flux experimental area has recently become operational at the n_TOF facility at CERN. This new measuring station, n_TOF-EAR2, is placed at the end of a vertical beam line at a distance of approximately 20m from the spallation target. The characterization of the neutron beam, in terms of flux, spatial profile and resolution function, is of crucial importance for the feasibility study and data analysis of all measurements to be performed in the new area. In this paper, the measurement of the neutron flux, performed with different solid-state and gaseous detection systems, and using three neutron-converting reactions considered standard in different energy regions is reported. The results of the various measurements have been combined, yielding an evaluated neutron energy distribution in a wide energy range, from 2meV to 100MeV, with an accuracy ranging from 2%, at low energy, to 6% in the high-energy region. In addition, an absolute normalization of the n_TOF-EAR2 neutron flux has been obtained by means of an activation measurement performed with 197Au foils in the beam.Comisión Europea FP7/2007-2011 No.605203Centro Nacional de Ciencias de Polonia UMO- 2012/04/M/ST2/00700Centro Nacional de Ciencias de Polonia UMO-2016/22/M/ST2/00183Fundación de Ciencia Croata No. 168

    FRAGILITY FRACTURES IN OLDER PERSONS WITH ALTERED THYROID FUNCTION

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    Gli ormoni tiroidei sono peptidi che svolgono molteplici e complesse funzioni nell\u2019organismo umano. Lo sche-letro \ue8 uno dei tessuti bersaglio degli ormoni tiroidei, ed una loro carenza o un loro eccesso ha importanti conseguenze sul tessuto osseo soprattutto nel periodo dello sviluppo e durante l\u2019invecchiamento. I disturbi a carico della tiroide si osservano con maggior frequenza nei soggetti in et\ue0 avanzata rispetto ai giovani. La tire-otossicosi \ue8 una causa nota di osteoporosi secondaria. L\u2019ipertiroidismo conclamato e l\u2019ipertiroidismo iatrogeno dovuto ad un eccesso nel dosaggio della terapia sostitutiva con ormoni tiroidei sono possibili cause di fratture ossee da fragilit\ue0. L\u2019ipertiroidismo subclinico da cause endogene o esogene si associa ad una riduzione della densit\ue0 minerale ossea (BMD), soprattutto a livello dell\u2019osso corticale nelle donne in et\ue0 avanzata. Il rischio di sviluppo di fratture da fragilit\ue0 sembra essere strettamente correlato al grado di soppressione dell\u2019ormone stimolante la tiroide (TSH) e alla presenza di altri fattori di rischio, inclusa l\u2019et\ue0 avanzata. Nelle persone anziane, l\u2019ipertiroidismo conclamato e l\u2019ipertiroidismo subclinico endogeno dovrebbero essere trattati al fine di ridurre il rischio di sviluppo di fratture da fragilit\ue0 e di fibrillazione atriale, e la mortalit\ue0 associata a tali patologie. Il rischio di fratture da fragilit\ue0 nei soggetti in et\ue0 avanzata, specialmente nelle donne nel periodo post-menopausale, che devono assumere dosaggi soppressivi di levotiroxina per il trattamento di un carcinoma della tiroide, pu\uf2 essere ridotto adottando una terapia a base di levotiroxina con la minima dose efficace e/o, se indicato, ag-giungendo una terapia con farmaci antiriassorbitivi o che favoriscano la formazione ossea. La terapia sostitu-tiva con levotiroxina nell\u2019ipotiroidismo conclamato dovrebbe essere regolarmente monitorata e aggiustata per evitare la soppressione dei livelli di TSH e il conseguente aumento del rischio di fratture da fragilit\ue0.Thyroid hormones are pleiotropic peptides with complex action on the human economy. The skeleton is a target tissue for thyroid hormone\u2019s action, which is illustrated by the consequences of thyroid hormone excess and deficiency during development and during aging. Thyroid disorders are more frequently observed in older than in younger persons. Thyrotoxicosis is an established cause of secondary osteoporosis. Overt hyper-thyroidism and iatrogenic hyperthyroidism due to over-replacement of thyroid hormone may result in fragility fractures. Endogenous or exogenous subclinical hyperthyroidism is associated with reduced bone density, especially in cortical bone in older women. Fragility fracture risk seems to be closely related to the degree of thyroid-stimulating hormone suppression and to other risk factors, including older age. Overt hyperthyroidism and endogenous subclinical hyperthyroidism in older persons should be treated to reduce the risk for fragility fractures, atrial fibrillation and related mortality risk. The risk for fragility fractures in older people, especially in postmenopausal women, taking suppressive doses of levothyroxine for thyroid cancer can be diminished by treatment with the minimal effective suppressive dose and in some cases, by adding an antiresorptive or bone forming therapy where indicated. Replacement therapy for overt hypothyroidism should be regularly adjusted to avoid TSH suppression and consequent increased risk of fragility fractures

    Testing Embedded Memories in Telecommunication Systems

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    Extensive system testing is mandatory nowadays to achieve high product quality. Telecommunication systems are particularly sensitive to such a requirement; to maintain market competitiveness, manufacturers need to combine reduced costs, shorter life cycles, advanced technologies, and high quality. Moreover, strict reliability constraints usually impose very low fault latencies and a high degree of fault detection for both permanent and transient faults. This article analyzes major problems related to testing complex telecommunication systems, with particular emphasis on their memory modules, often so critical from the reliability point of view. In particular, advanced BIST-based solutions are analyzed, and two significant industrial case studies presente

    MAGNESIUM AND TYPE 2 DIABETES: AN UPDATE

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    The link between magnesium (Mg) deficiency and type 2 diabetes mellitus is well known. Type 2 diabetes is frequently associated with both extracellular and intracellular Mg deficits. A chronic latent Mg deficit or an overt clinical hypomagnesaemia is common in subjects with type 2 diabetes, especially in those with poorly controlled glycemic profiles. Insulin and glucose are important regulators of Mg metabolism. Intracellular Mg plays a key role in regulating insulin action, insulin-mediated-glucose-uptake and vascular tone. Reduced intracellular Mg concentrations result in a defective tyrosine-kinase activity, postreceptorial impairment in insulin action and worsening of insulin resistance in diabetic patients. A low Mg intake and an increased Mg urinary loss appear the most important mechanisms that may favor Mg depletion in patients with type 2 diabetes. Low dietary Mg intake has been related to the development of type 2 diabetes and metabolic syndrome. Benefits of Mg supplementation on metabolic profile in diabetic subjects have been found in most, but not all clinical studies and larger prospective studies are needed to support the potential role of dietary Mg supplementation as a possible public health strategy in diabetes risk. The objective of this review is to revise current evidences on the mechanisms of Mg deficiency in diabetes mellitus type 2 and on the possible role of Mg supplementation in the prevention and management of the disease

    Dietary Approaches and Supplements in the Prevention of Cognitive Decline and Alzheimer's Disease

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    Age-associated cognitive decline and dementia are conditions in which there is deterioration in memory, thinking, and behavior, with profound effects on the ability to perform everyday activities and well-being. Even if dementia mainly affects older persons, it is not a normal part of aging. Alzheimer's disease accounts for 60-75% of dementia cases. The number of persons affected will increase in the next decades in parallel with aging of the world population. Hence, unless some approach is found to reduce age-related deterioration of cognitive functions, health care costs will continue to rise exponentially. There is a wealth of epidemiological evidence supporting a relationship between diet and Alzheimer's disease, and suggesting that the risk of cognitive decline may be reduced by dietary interventions. It has been proposed that adopting a healthy diet and lifestyle that improves cardiovascular function may help delaying the onset of Alzheimer's disease due to its potential association with vascular disease. Several nutrients, dietary components, supplements and dietary patterns have been reported in relation to their association with cognition and with the development of cognitive decline and Alzheimer's disease. The possible effect of diet on the prevention of dementia is of tremendous scientific and general interest, because hitherto there is no definitive evidence of any effective pharmacological treatment for dementia. The aim of this review is to evaluate the evidence for the effects of some dietary components, supplements, and dietary patterns as neuroprotective, with potential to delay cognitive decline and the onset of dementia

    Short-Term Neurodevelopmental Outcome in Term Neonates Treated with Phenobarbital versus Levetiracetam: A Single-Center Experience

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    BACKGROUND: Phenobarbital (PB) has been traditionally used as the first-line treatment for neonatal seizures. More recently, levetiracetam (LEV) has been increasingly used as a promising newer antiepileptic medication for treatment of seizures in neonates. OBJECTIVES: The aim of our study was to compare the effect of PB vs. LEV on short-term neurodevelopmental outcome in infants treated for neonatal seizures. METHOD: This randomized, one-blind prospective study was conducted on term neonates admitted to the Neonatal Intensive Care Unit of S. Bambino Hospital, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy, from February 2016 to February 2018. Thirty term neonates with seizures were randomized to receive PB or LEV; the Hammersmith Neonatal Neurological Examination (HNNE) was used at baseline (T0) and again one month after the initial treatment (T1). RESULTS: We found a significantly positive HNNE score for the developmental outcomes, specifically tone and posture, in neonates treated with LEV. There was no significant improvement in the HNNE score at T1 in the neonates treated with PB. CONCLUSION: This study suggests a positive effect of levetiracetam on tone and posture in term newborns treated for neonatal seizures. If future randomized-controlled studies also show better efficacy of LEV in the treatment of neonatal seizures, LEV might potentially be considered as the first-line anticonvulsant in this age grou

    Celiac disease in older persons: A case of seronegative disease

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    A 68-year-old man with a history of smoking (former smoker of 40 cigarettes per day), euthyroid goiter, deep vein thrombosis and depression, came to our attention for weakness, cachexia, abdominal bloating and diarrhea lasting for almost six months. Furthermore, he had lost about 25 kilograms of weight in the last year and was bedridden for three months. Combining the results of serological, histopathological and genetic tests, he was diagnosed with a seronegative celiac disease. Gluten-free diet, combined with nutritional supplements and physical therapy, improved his clinical condition and allowed the recovery of weight and the walking ability. Celiac disease might be suspected in elderly patients with diarrhea, malabsorption, malnutrition and cachexia, but also with other symptoms such as anemia, micronutrients' deiciency, fragility fractures and neurological symptoms
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