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Essence of fundamental rights – Article 52(1) of the Charter – Court of Justice of the EU – Methodology for determination of interference with essence – EU values – Proportionality – Balancing – Absolute and relative theory – Absolute rights – Interest theory of rights – Choice theory of rights – Hohfeld’s theory of rights – ‘Newtonian’ conception of rights – Case law on Article 52(1) of the Charter.
Dengue virus can affect the heart, with complications as bradycardia, arrhythmias, and death. We present a case of a 15-year-old patient, diagnosed 4 years before with severe idiopathic pulmonary hypertension, confirmed by catheterism, with continuous follow up. At that time, she was living in Bogotá (2640 m above sea level). Sildenafil and Macitentan were started. She was recommended to live at low altitude and she moved. The patient was transferred back to Bogota, from that place, due to flu-like symptoms and fever. Immunoglobulin M for dengue was confirmed and second-degree atrioventricular block Mobitz I with bradycardia (40 beats/minute) was documented throughout the clinical course. She recovered.
Since the beginning of 2020, the COVID-19 pandemic has dramatically influenced almost every aspect of human life. Activities requiring human gatherings have either been postponed, cancelled, or held completely virtually. To supplement lack of in-person contact, people have increasingly turned to virtual settings on-line, advantages of which include increased inclusivity and accessibility and reduction of carbon footprint. However, emerging online technologies cannot fully replace, in-person scientific events. In-person meetings are not susceptible to poor internet connectivity problems, and they provide novel opportunities for socialization, creating new collaborations, and sharing ideas. To continue such activities, a hybrid model for scientific events could be a solution offering both in-person and virtual components. While participants can freely choose the mode of their participation, virtual meetings would most benefit those who cannot attend in-person due to the limitations. In-person portions of meetings should be organized with full consideration of prevention and safety strategies including risk assessment and mitigation, venue and environmental sanitation, participant protection and disease prevention, and promoting the hybrid model. This new way of interaction between scholars can be considered as a part of a resilience system which was neglected previously and should become a part of routine practice in scientific community.
Pharmacological intervention is an important component of patient care. However, drugs are often inappropriately used. It is necessary for countries to implement strategies to improve the rational use of drugs, including independent information for healthcare professionals and the public, which must be supported by well-trained staff. The primary objectives of the EDU.RE.DRUG (Effectiveness of informative and/or educational interventions aimed at improving the appropriate use of drugs designed for general practitioners and their patients) study are the retrospective evaluation of rates of appropriate prescribing indicators (APIs) and the assessment of the effectiveness of informative and/or educational interventions addressed to general practitioners (GPs) and their patients, aimed at improving prescribing quality and promoting proper drug use.
Methods and analysis:
This is a prospective, multicentre, open-label, parallel-arm, controlled, pragmatic trial directed to GPs and their patients in two Italian regions (Campania and Lombardy). The study data are retrieved from administrative databases (Demographic, Pharmacy-refill, and Hospitalization databases) containing healthcare information of all beneficiaries of the National Health Service in the Local Health Units (LHUs) involved. According to LHU, the GPs/patients will be assigned to one of the following four intervention arms: (1) intervention on GPs and patients; (2) intervention on GPs; (3) intervention on patients; and (4) no intervention (control). The intervention designed for GPs consists of reports regarding the status of their patients according to the APIs determined at baseline and in two on-line Continuous Medical Education (CME) courses. The intervention designed for patients consists in flyers and posters distributed in GPs ambulatories and community pharmacies, focusing on correct drug use.
A set of indicators (such as potential drug–drug interactions, unnecessary duplicate prescriptions, and inappropriate prescriptions in the elderly), adapted to the Italian setting, has been defined to determine inappropriate prescription at baseline and after the intervention phase. The primary outcome was a composite API.
Ethics and dissemination:
The study was approved by the Ethics Committee of the University of Milan on 7th June 2017 (code 15/17). The investigators will communicate trial results to stakeholders, collaborators, and participants via appropriate presentations and publications.
Registration details: NCT04030468. EudraCT number 2017-002622-21
Prenatal glucocorticoid overexposure has been shown to programme adult cardiovascular function in a range of species, but much less is known about the long-term effects of neonatal glucocorticoid overexposure. In horses, prenatal maturation of the hypothalamus–pituitary–adrenal axis and the normal prepartum surge in fetal cortisol occur late in gestation compared to other precocious species. Cortisol levels continue to rise in the hours after birth of full-term foals and increase further in the subsequent days in premature, dysmature and maladapted foals. Thus, this study examined the adult cardiovascular consequences of neonatal cortisol overexposure induced by adrenocorticotropic hormone administration to full-term male and female pony foals. After catheterisation at 2–3 years of age, basal arterial blood pressures (BP) and heart rate were measured together with the responses to phenylephrine (PE) and sodium nitroprusside (SNP). These data were used to assess cardiac baroreflex sensitivity. Neonatal cortisol overexposure reduced both the pressor and bradycardic responses to PE in the young adult males, but not females. It also enhanced the initial hypotensive response to SNP, slowed recovery of BP after infusion and reduced the gain of the cardiac baroreflex in the females, but not males. Basal diastolic pressure and cardiac baroreflex sensitivity also differed with sex, irrespective of neonatal treatment. The results show that there is a window of susceptibility for glucocorticoid programming during the immediate neonatal period that alters cardiovascular function in young adult horses in a sex-linked manner.
To construct and test the validity of a new psychometric questionnaire to assess psychological impact of facial lipoatrophy (ABCD-F), that is the most stigmatizing feature of HIV-related lipodystrophy.
Methods
Construction: The development went through Focus groups and Content Validity, Item reduction and Exploratory Factor Analysis.
Validation: ABCD-F questionnaire was administered together with ABCD and MOS HIV questionnaires. The Cronbach's Alfa was used to test internal consistency, while convergent validity and divergent validity were analyzed by the correlations with MOS, ABCD items and BMI and CD4 counts respectively.
Results
42 HIV+ people participated to focus groups. In the EFA the 17 Items were aggregated around psychological distress and role functioning domains.
ABCD-F showed high internal consistency (Chronbach's alpha = 0.95). Both convergent and divergent validity were confirmed. ABCD-F scores were highly correlated to Physical Health Summary (B 0.59; 95% [CI] 0.35; 0.84; p< 0.0001), Mental Health Summary (B-1.54; 95% [CI] 1.15; 1.93; p< 0.0001), and weakly correlated to CD4 count (B-0.02; 95% [CI] -0.01; 0.06; p=0.54) and HIV viral load (B-0.004; 95% [CI] -2.69; 2.69; p=1.00).
Conclusions
ABCD-F is a valid and reliable questionnaire to assess psychological impact of facial lipoatrophy (FLA).
ABCD-F may result as a useful tool both in clinical and research settings: it's able to identify people experiencing greater psychological impact due to FLA. It may become an objective instrument to evaluate priority and efficacy of plastic surgery to treat lipodystrophy. In research setting may be used to compare different populations or different treatments of FLA.
Empathy is the human ability to understand and share other people's feelings through knowledge, observation and memory. Lower levels of empathy lead to poor social functioning, like in Major Depressive Disorder (MDD), Schizophrenia and Autism. Until today, very few studies have focused on empathic deficits in depressed patients.
Aims:
Our aim was to evaluate whether MDD causes variations in empathy levels.
Objectives:
We wanted to assess cognitive and affective components of Empathy in a sample of women with MDD, and relate them to clinical issues. We compared these results to a control sample.
Methods:
Our sample included 20 female patients with MDD and a control group, homogeneous for age and gender. We used the Hamilton scale for depression (HAM- D) to evaluate depression severity, the Interpersonal Reactivity Index (IRI) to evaluate cognitive and affective empathy, the Faux pas test to assess cognitive empathy; Pearson and Mann tests for statistic analysis.
Results:
In general, patients showed mild depression levels (HAM- D: 14, 41± 6, 07). Severity of symptoms and empathy levels were inversely related with Faux Pas and IRI results (R: −0, 5805; R: −0, 5145), with patients being worse than the control group. Patients showed deficits in personal distress and perspective taking IRI subscales.
Conclusions:
Our study shows that in depressed patients both components of Empathy are modified; in particular, personal distress increases, while perspective taking decreases. Additional studies and higher numbers of patients will be necessary to further investigate whether empathic deficits are trait- or state-depending MDD characteristics.
Obesity has been associated with cognitive impairment. However, it is not clear whether cognitive impairment may depend on concomitant psychopathology, since several psychiatric conditions, e.g. schizophrenia, include cognitive deficits among their manifestations.
Objectives:
To assess cognitive performances and psychopathology in obese patients, and to compare cognitive alterations in obese patients with those in schizophrenics and controls.
Aims:
To compare cognitive performances in obese patients to normal percentiles. To provide an analysis of correlation with specific psychopathological domains. To evaluate whether cognitive performances in very obese patients were different from those in schizophrenia patients and non-affected controls.
Methods:
88 obese patients were included. Exclusion criteria were: axis I and II diagnosis; severe medical, neurological, or endocrinology conditions. Patients underwent an extensive battery of cognitive tests and completed the Toronto Alexithymia Scale (TAS-20), the Barratt Impulsiveness Scale (BIS-11), the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI). In the second part of the study, very obese patients (BMI>40; n=16) were compared for cognitive performances to schizophrenia patients (n=16) and non-affected controls (n=17).
Results:
Obese patients performed at low percentiles (<15) on the Problem Solving and the Social Cognition tasks. Mean scores on psychopathology rating scales did not reach abnormal values. No correlation was found with psychopathology. When compared to schizophrenics, no significant differences were found in performances on spatial working memory.
Discussion:
Obese patients show cognitive alterations even in the absence of abnormal psychopathology. Very obese patients share cognitive alterations with schizophrenia patients, which may imply common neurobiological basis.
The internalized stigma of mental illness leads to negative outcomes (low self-esteem, demoralization, lower compliance to the treatment, unemployment). Previous studies have shown that the prevalence in psychotic patients is about 64%; furthermore, patients with non-psychotic disorders exhibit high prevalence, as well.
Aim:
Our aim is to study internalized stigma, insight and social functioning in psychotic patients.
Objective:
Through the investigation of low insight patients, we sought to verify the insight paradox theory and the impact stigma has on social functioning. We also investigated ISMI subscales (alienation, discrimination, stigma resistance, stereotype endorsement, social withdrawal) and the correlation between those elements.
Methods:
Our sample included 19 psychotic patients: 11 with bipolar disorder; 3 with schizoaffective disorder; 5 with NOS psychosis. Patients were assessed with the following tests: SAI to evaluate insight; PANSS for clinical and psychopathological evaluation; GAF for social functioning; ISMI for the assessment of internalized stigma.
Results:
13 patients with mild or complete lack of insight reported low stigma, confirming the Insight Paradox theory. There is a positive correlation, measured with the Pearson correlation analysis, between insight and social functioning (R=0,752*) and between stigma and insight (R=0,024) while stigma and social functioning correlate negatively (R= -0,491*).
Conclusions:
Results showed that lower levels of insight are related to higher stigma resistance and higher stigma leads to poorer functioning in social contexts. Higher sample numbers are necessary for further investigations on the subject.
During weaning-to-estrus interval (WEI), the sows are usually fed with high feed level to improve the reproductive performance. However, the WEI has been reduced over the years which may reduce the impact of feed level on performance in the modern genetic lines. The aim of this study was to evaluate the effect of two feeding levels (moderate feeding level (MFL): 2.7 kg/day and high feeding level (HFL): 4.3 kg/day) and two diet types (gestation: 13.67 MJ/kg of metabolizable energy (ME) and 0.62% of standard ileal digestible lysine (SID Lys) and lactation: 14.34 MJ ME/kg and 1.20% of SID Lys) offered during the WEI on reproductive performance. In total, 19.0% of sows were excluded from the analysis due to feed intake below 75% (9.6% and 28.5% in MFL and HFL groups, respectively), remaining 254 primiparous and 806 multiparous sows. Follicular size and change in BW were measured in subsamples of 180 and 227 females, respectively. Data were analyzed considering the sow as the experimental unit. Feeding level, diet type, parity and their interactions were included as fixed effects, whereas the day of weaning was considered as a random effect. The feed intake of MFL and HFL groups averaged 2.5 ± 0.02 and 3.8 ± 0.02 kg/day, respectively. There was an interaction between feeding level and parity for daily feed intake. Within HFL, multiparous sows consumed 181 g/day more than primiparous sows (P < 0.01), but no difference was observed within MFL (P > 0.05). Both primiparous and multiparous sows lost proportionally less weight when fed HFL than MFL gestation diet during WEI. The percentage of weight loss was lower in HFL than in the MFL group in multiparous sows fed the lactation diet. The WEI was not affected by feeding level, diet type or its interaction (P > 0.05), but it was longer in primiparous than in multiparous sows (P = 0.001). There was no effect of feeding level, diet type, parity or their interactions on anestrus and farrowing rates. Multiparous sows showed greater follicular size, and greater numbers of total born and born alive piglets in the subsequent cycle than primiparous sows (P < 0.05). In conclusion, feeding weaned primiparous and multiparous sows with 4.3 kg/day of a gestation (58.78 MJ ME and 26.66 g SID Lys) or a lactation diet (61.66 MJ ME and 51.60 g SID Lys) does not improve follicular size and reproductive performance in the subsequent cycle.
Aggression and violence are common phenomena, potentially experienced by everyone.
Objectives
To demonstrate that coping patterns to face aggression and violence may exhibit differential group features.
Aims
To find differences in coping styles during moments of high aggression in psychiatric patients compared to non-affected controls.
Methods
We evaluated 34 outpatients from the section of psychiatry of university Federico II of Naples by two psychometric scales: AQ to evaluate aggression levels and Brief-COPE for coping patterns. Outcomes were compared with that of 34 non-affected controls, recruited from the university student population. Pearson's correlation was used to find relationships between aggression levels and coping skills in these two groups.
Results
We found significant differences between groups in multiple scale items and in the correlation measures, e.g. the use of expression was completely reversed in this two samples according to aggression levels.
Conclusions
These results show that aggression is experienced differentially and with different coping styles by psychiatric patients compared to non-affected controls.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Previous studies about young people in conflict with the law (YPCL) have a tendency to focus on the risk factors that contribute to trigger antisocial criminal behavior. Instead, this study aims to research the social determinants that encourage the criminal desistance: understood as a gradual process taking place in the periods of absence of crime and desire to abandon the criminal activity.
Objectives
From a sample that is made up of 100 YPCL, the main objective is to deduce the social determinants, which encourage the criminal desistance in YPCL, it means young people who commit crimes.
Aims
To infer the social determinants (circumstances in which people are born, grow, live, including the health system) which foster the desistance in YPCL.
Methods
The results of a sample of 100 YPCL were assessed with three profiles as follows: I: DSM-IV personality disorders (PD T-Scores). II: swap personality syndromes (Q-Factor T-Scores). III. factor T-scores.
Results
This research shows the prevalence of the following social determinants associated with the desistance: (1) integrated families. (2) Educational and cultural opportunities (3) academic progress. (4) Healthy relationships that support and help. (5) Stable living arrangements (6) social conditions preserved the use of psychoactive substances and alcohol abuse.
Conclusions
It is possible to identify the prevalence of social determinants which encourage the desistance in YPCL. Those allows them to transform their risk path in another that shows a positive development, associated with individual transformations that take them away from the criminal life and reintegrate into the community.
Dielectrics are electrical insulator materials, polarizable by opposite displacement of positive and negative ionized atoms via electric fields across the material’s thickness. Dielectrics are used in energy-storage capacitors, as key components in modern micro-/nanoelectronics, high-frequency and mobile communication devices, and life-saving microchips and other devices such as defibrillators and pacemakers implantable in humans. A key dielectric parameter is the dielectric constant (k), which largely controls the capacitance in capacitors with nanoscale area and dielectric layer thickness. Extremely high dielectric constants (k ≥1000) were observed in oxides (e.g., La1.8Sr0.12NiO4) with relaxor/ferroelectric materials and in combined semiconducting bulk properties with highly resistive grain boundaries. Giant dielectric constant films have also been demonstrated, based on integrating relatively low-dielectric-constant oxides into nanolaminate structures (e.g., TiOx/Al2O3; TiO2/HfO2) with tailored sublayer thicknesses, interfaces, and oxygen atom distributions. This overview article addresses the science and technology of high-dielectric-constant oxide materials with different compositions and structures.
Learning Health Systems (LHS) iteratively implement and evaluate health improvement projects. Dissemination and implementation (D&I) science is the study of evidence-based practices in real-world settings, a critical tool for LHS. This paper explores intersections between LHS and D&I science in Clinical and Translational Science Awards (CTSAs) institutions and identifies critical components of collaboration. We conducted website scans of 34 CTSAs and their home institutions that had Dissemination, Implementation, and Knowledge Translation (DIKT) Workgroup members. We identified linkages between CTSAs and their institutions’ LHS. We interviewed six CTSA leaders experienced in LHS and D&I sciences. Nearly half of CTSAs identified an LHS structure on their websites, but only one-third indicates CTSA involvement in these efforts. Interviewees identified key components for successful integration of LHS and D&I sciences: leadership, infrastructure, balance between rigor and efficiency, and aligned incentives. The need for research integration in LHS, to improve evaluation and increase knowledge, is an emerging opportunity for D&I scientists and CTSAs. CTSAs that are engaged in D&I science can introduce and/or expand the role of D&I science in LHS. Collaboration between CTSAs and clinical leaders could result in strengthened relationships between clinical and research enterprises, effective and efficient health care delivery, and improved health.
Burnout is present at a high rate in emergency medicine. The ambulance driver-rescuers, who furnish first aid to the victims, are the non-medical part of the Italian 118-service staff. There is a lack of research on burnout risk in Italian Emergency Medical Services and, particularly, for this category of workers. The two Italian studies, including a little group of ambulance driver-rescuers, reported inconsistent findings.
Hypothesis:
This survey investigated for the first time the prevalence and exact profile of burnout in a large sample of Italian driver-rescuers. As a secondary aim, the study described how the items of the Italian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) cluster in components in this sample.
Methods:
This cross-sectional census survey was conducted from June 2015 through May 2016 and involved all the driver-rescuers operating in Sicily, the biggest and most southern region of Italy. The subjects received a classification according to different profiles of burnout by using the Italian version of the MBI-HSS (burnout, engagement, disengagement, over-extension, and work-inefficacy). In order to explore the existence of independent factors, a Principal Component Analysis (PCA) was conducted on the survey to obtain eigenvalues >one for each component in the data.
Results:
The final sample comprised 2,361 responders (96.6% of the initial sample). Of them, 29.8% were in burnout (95% confidence interval [CI], 27.8% to 31.8%) and 1.7% presented a severe form (95% CI, 1.1% to 2.3%); 30.0% were engaged in their work (95% CI, 21.0% to 34.8%), 24.7% of responders were disengaged (95% CI, 22.9% to 26.5%), 1.2% presented an over-extension profile (95% CI, 0.8% to 1.7%), and 12.6% felt work-inefficacy (95% CI, 11.3% to 14.1%). The factors loaded into a five-factor solution at PCA, explaining 48.1% of the variance and partially replicating the three-factor structure. The Emotional Exhaustion (EE) component was confirmed. New dimensions from Personal Accomplishment (PA) and Depersonalization (DP) sub-scales described empathy and disengagement with patients, respectively, and were responsible for the increased risk of burnout.
Conclusions:
These results endorse the importance of screening and psychological interventions for this population of emergency workers, where burnout could manifest itself more insidiously. It is also possible to speculate that sub-optimal empathy skills could be related to the disengagement and work-inefficacy feelings registered.
We consider a multilinear kernel operator between Banach function spaces over finite measures and suitable order continuity properties, namely
$T:X_{1}(\,\unicode[STIX]{x1D707}_{1})\times \cdots \times X_{n}(\,\unicode[STIX]{x1D707}_{n})\rightarrow Y(\,\unicode[STIX]{x1D707}_{0})$
. Then we define, via duality, a class of linear operators associated to the
$j$
-transpose operators. We show that, under certain conditions of
$p$
th power factorability of such operators, there exist vector measures
$m_{j}$
for
$j=0,1,\ldots ,n$
so that
$T$
factors through a multilinear operator
$\widetilde{T}:L^{p_{1}}(m_{1})\times \cdots \times L^{p_{n}}(m_{n})\rightarrow L^{p_{0}^{\prime }}(m_{0})^{\ast }$
, provided that
$1/p_{0}=1/p_{1}+\cdots +1/p_{n}$
. We apply this scheme to the study of the class of multilinear Calderón–Zygmund operators and provide some concrete examples for the homogeneous polynomial and multilinear Volterra and Laplace operators.
A balanced diet is a fundamental component of athletes' health, training and performance. WHO dietary guidelines highlight the importance of maintaining a normal BMI, limiting the intake of sugars (especially sweetened foods and beverages), eating at least 5 portions of fruits and vegetables per day, drink lots of clean water (at least 2 L per day for children older than 13 and for adults). HBSC-Italy study reveals that children have frequently bad eating habits, such as consuming sweetened drinks and not enough fruits and vegetables. Indeed, 21.3% of Italian children are overweight and 9.3% are obese. The purpose of this study is to evaluate nutritional and health status of a population of Northern Italy children and adolescents practicing Athletics, investigating for both endurance and not endurance disciplines. Data obtained are a starting point for focused food education interventions aimed at improving health and sport performance.
Materials and Methods:
A cohort of 125 athletes (12–25 years, 42.4% male, 57.6% female). Two groups were created: children (12–17 years) and adults (18–25 years). Weight, height, waist circumference, triceps and subscapularis skinfolds were measured in order to calculate BMI, Waist-to-Height ratio (WtHr), body adiposity and muscle mass. At baseline and after 1 year (follow-up) from a nutritional educational intervention, the anthropometric measures and dietary habits were tested with a validated dietary screening survey, considering food quality, portions and frequencies of consumption, were taken.
Results:
At Baseline, more than 85% of athletes were found to be normal weight with WHtR < 0.5. All the athletes showed body adiposity in the normal range. Regarding food habits, most athletes do not take the recommended daily fruit and vegetable servings follow Italian trend. Only about 20% of children athletes assumes the water daily intake. On the contrary, about 50% of athletes in every group drink sweetened beverages every day. The data collection after the personalized food education meetings will be collected in May 2019.
Discussion:
The athletes of cohort shows a good health status but nutritional habits present critical issue. For this reasons, there is a need of nutritional education for improving healthy eating habits in young athletes in order to impact positively on future health status and on sport performance.