Conversion to secondary progressive multiple sclerosis: patient awareness and needs. results from an online survey in Italy and Germany

Background: Few studies have investigated the experiences of patients around the conversion to secondary progressive multiple sclerosis (SPMS). ManTra is a mixed-method, co-production research project conducted in Italy and Germany to develop an intervention for newly-diagnosed SPMS patients. In previous project actions, we identified the needs and experiences of patients converting to SPMS via literature review and qualitative research which involved key stakeholders.Aims: The online patient survey aimed to assess, on a larger and independent sample of recently-diagnosed SPMS patients: (a) the characteristics associated to patient awareness of SPMS conversion; (b) the experience of conversion; (c) importance and prioritization of the needs previously identified.Methods: Participants were consenting adults with SPMS since <= 5 years. The survey consisted of three sections: on general and clinical characteristics; on experience of SPMS diagnosis disclosure (aware participants only); and on importance and prioritization of 33 pre-specified needs.Results: Of 215 participants, those aware of their SPMS diagnosis were 57% in Italy vs. 77% in Germany (p = 0.004). In both countries, over 80% of aware participants received a SPMS diagnosis from the neurologist; satisfaction with SPMS disclosure was moderate to high. Nevertheless, 28-35% obtained second opinions, and 48-56% reported they did not receive any information on SPMS. Participants actively seeking further information were 63% in Germany vs. 31% in Italy (p < 0.001).Variables independently associated to patient awareness were geographic area (odds ratio, OR 0.32, 95% CI 0.13-0.78 for Central Italy; OR 0.21, 95% CI 0.08-0.58 for Southern Italy [vs. Germany]) and activity limitations (OR 7.80, 95% CI 1.47-41.37 for dependent vs. autonomous patients).All pre-specified needs were scored a lot or extremely important, and two prioritized needs were shared by Italian and German patients: "physiotherapy" and "active patient care involvement." The other two differed across countries: "an individualized health care plan" and "information on social rights and policies" in Italy, and "psychological support" and "cognitive rehabilitation" in Germany.Conclusions: Around 40% of SPMS patients were not aware of their disease form indicating a need to improve patient-physician communication. Physiotherapy and active patient care involvement were prioritized in both countries

Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry

Abstract BACKGROUND: Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). METHODS: In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster. RESULTS: Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters. CONCLUSIONS: Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Una formazione multidisciplinare e continua: l’esperienza del corso EMTASK

Uno degli assi prioritari del Sendai Framework riguarda la diffusione di conoscenze – attraverso la prevenzione e la preparazione degli individui, delle comunità e delle organizzazioni – che possono mitigare gli effetti dei disastri naturali e ridurre, dove possibile, il rischio che si verifichino. In Italia una simile formazione non è ancora disponibile in modo adeguato per rispondere a una domanda crescente, già attiva da parte delle amministrazioni pubbliche e del volontariato. A Modena, in seguito agli eventi calamitosi degli ultimi anni, l’Università, insieme al Comune, all’Esercito italiano e all’Agenzia regionale di prevenzione ambientale, ha organizzato un corso sulle emergenze territoriali, ambientali e sanitarie (emtask). Questa esperienza formativa fornisce spunti in merito a contenuti e metodi, all’organizzazione delle attività didattiche e al partenariato che si è mobilitato per definire obiettivi e modalità di realizzazione del corso: elementi rilevanti per avviare una progettazione modulare e “scalabile”

Analysing methodological issues in short-term monitoring of rare European beech forests restoration

Monitoring restoration effectiveness implies that restoration measures should be evaluated using multi-scale analysis and modelling approaches. In this way, the scale-dependent nature of ecosystem processes and dynamics can be adequately described. Here we evaluated how grain size (i.e. the dimension of sampling units) and type of data (abundance vs. presence/absence) impact the analysis of the response to restoration management activities aiming at halting the loss of European beech forests with Abies alba in the cCentral Apennines (Italy). The proposed analysis relies on forests sampled in three Sites of Community Importance (SCIs) located in Ccentral Italy. For each described treatment (reference, control and impact), randomly located multi-scale plots were selected. The total number of plots was 35, grouped as follows: 18 plots in Pigelleto SCI (9 reference and 9 impact, Before/After-Reference/Impact design); 9 plots in Badia Prataglia SCI (5 reference and 4 impact, Before/After - Reference/Impact design), and 8 plots in Valle della Corte SCI (4 control and 4 impact, Before/After Control-Impact design). Vascular plant occurrences were recorded twice in every plot during summer 2010 or 2011 (before restoration) and in 2013 or 2014 (after restoration). Analysis of species abundances , recorded at the largest grain size available (20x20m plot), showed a significant change in plant species composition, in restored sites just after two years from the restoration management. These changes referred oninvolved tree species composition, object of thinning or removal, but also toon herbaceous species that are typical of the understory vegetation of deciduous woodlands as well as on synanthropic species, these latter showing an increase in their presence in managed plots. When presence/absence data were used, however, previous results were less visible for all the examined grains in two out of the three sites where restoration measure were carried out, also suggesting a site-dependent response. In conclusion our results suggest that the type of data determines the ability to discriminate control/reference and impact areas better than the grain size alone, since most of the observed differences are related to the variation in species abundances

Magnetic resonance butterfly coils: Design and application for hyperpolarized 13C studies

Hyperpolarized 13C magnetic resonance spectroscopy in pig models enables cardiac metabolism assessment and provides a powerful tool for heart physiology studies, although the low molar concentration of derivate metabolites gives rise to technological limitations in terms of data quality. The design of dedicated coils capable of providing large field of view with high Signal-to-Noise Ratio (SNR) data is of fundamental importance. This work presents magnetostatic simulations and tests of two butterfly coils with different geometries, both designed for 13C hyperpolarized studies of pig heart with a clinical 3T scanner. In particular, the paper provides details of the design, modeling, construction and application of the butterfly style coils. While both coils could be successfully employed in single configuration (linear mode), the second prototype was used to design a quadrature surface coil constituted by the butterfly and a circular loop both in receive (RX) mode while using a birdcage coil as transmitter (TX). The performance of this coils configuration was compared with the single TX/RX birdcage coil, in order to verify the advantage of the proposed configuration over the volume coil throughout the volume of interest for cardiac imaging in pig. Experimental SNR-vs-depth profiles, extracted from the [1-13C]acetate phantom chemical shift image (CSI), permitted to highlight the performance of the proposed coils configuration. © 2013 Elsevier Ltd. All rights reserved

Ceramide Analogues in Apoptosis: A New Strategy for Anticancer Drug Development

A survey on the role played by ceramide within the sphingolmyelin pathway is here reported, taking into account its importance as an intracellular effector molecule in apoptosis. Recently, several analogs of ceramide, able to pass the cell membrane and then to induce apoptosis, have been developed as a new potential approach in anticancer therapy

Severe warm autoimmune haemolytic anaemia due to anti-Jk(a) autoantibody associated with Parvovirus B19 infection in a child

We referred an unusual and interesting association of B19 infection with warm AIHA showing a rare specificity of the autoantibodies. The authors recommend identification of antibody specificities in AIHA since this will play an important role in the appropriate transfusion therapy