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The presence of panic disorder (PD) [1,2,3] is associated with numerous of cardiovascular, respiratory, gastroenterologic and neuro-otologic symptoms. PD is an anxiety disorder with a good outcome and prognosis, but if it isn't recognized cause a worse quality of life and a reduction of global functioning. The aim of our study is to put the attention on this delayed form of PD that are very good treated with duloxetine.
GV, a 29-year-old caucasian woman affected by PD with agoraphobia referred for recurrent gastroenteric symptoms (heartburn, chest tightness). PA, a 64-year-old caucasian woman affected by PD without agoraphobia referred for recurrent gastroenteric symptoms (heartburn). TB, a 45-year-old caucasian man affected by PD without agoraphobia referred for recurrent gastroenteric symptoms (heartburn, tightness, eructation). All patients are evaluated by gastroenterologist to excluded fisical gastroenterological problems. After 6 months all patients treated with duloxetine 60 mg/day, showed a complete remission of gastric and panic related symptoms.
Three case report positive treated with duloxetine, without particular adverse effects and litterature review.
Discussion and conclusion
Others authors hypothesized the duloxetine, a serotonin-norepinephrine inhibitor that has greater initial noradrenergic effects than venlafaxine, would have broad efficacy for individuals with PD. Descending serotonin and norepinephrine pathways are modulators of pain perception, and duloxetine have an analgesic effect on painful physical symptoms. Further research is warranted to replicate our clinical observations.
Our world is becoming more urban. More than fifty percent of the global population now lives in cities, which poses new challenges for sustainable development. This book integrates theory and methods of sustainability assessment with concepts from systems science to provide guidelines for assessing the sustainability of urban systems. It discusses different aspects of urban sustainability, from energy and housing, to mobility and health, covering social, economic and environmental factors, as well as the various stakeholders and actors involved. The book argues for the need to find models and solutions in order to design sustainable cities of the future in light of the complexity of urban social life. Including diverse case studies from the developed and developing world, this book provides a useful reference for researchers and students from a broad range of disciplines working in the field of sustainability, as well as for environmental consultants and policy makers.
Sustainability as a key principle that guides the development of our societies requires fundamental transitions if we are to attain a more liveable planet. Concomitantly, the question of how to assess sustainability not only with respect to specific system states, but also regarding transition processes as a whole, has gained greater importance. In this chapter, we propose to extend established sustainability assessment practices with an approach informed by resilience thinking. In particular, we apply a systemic angle to develop three analytical perspectives which focus on the progress, the stability, as well as the adaptability of transition processes. These perspectives make it possible to reflect on the history, current state, and (potential) future development of the system in transition. We illustrate how these analytical perspectives can complement existing sustainability assessment approaches with regard to the description, interpretation, and evaluation of the transition process.
The sustainability of urban systems is a pressing topic now, and will be even more so in the future. Currently, more that 50 percent of the world’s population (74 percent in the EU) lives in cities, and this share is expected to keep increasing, posing new challenges for sustainable development. Although cities only cover 3 percent of the earth’s surface, they account for 75 percent of global CO2 emissions, and consume about 75 percent of resources and produce 50 percent of the waste worldwide. However, cities also provide income (80 percent of global GDP) and education, and are hotspots for innovation (Acuto & Panel 2016; Wigginton, et al., 2016). The ambiguous role of cities poses large challenges and renders it necessary to develop tools to assess urban strategies and developments from a sustainability perspective.
The conceptualisation of urban systems is a crucial step in their assessment. It not only involves identifying the constituent parts of an urban system, but also directly influences the definition of appropriate measurement tools, evaluation criteria, and stakeholders for the assessment. Choices related to conceptualisation therefore have strong normative implications. Hence, there is a need to develop ways to analyse and compare different approaches in terms of their relative emphases, strengths, and weaknesses. The purpose of this chapter is to respond to this need by developing analytical tools that build on four contrasting metaphors commonly used for describing cities. The set of four metaphors (machine, organism, network, and melting pot) used for this purpose were selected based their ability to capture different existing scientific perspectives on cities. Through elaborating the implications that each of the four metaphors carries for the different aspects of an urban system, our work produced two frameworks, one for analysing approaches to conceptualising urban systems in general, and another directed more specifically at analysing approaches to the assessment of urban systems. In addition to their analytical functions, these frameworks can also provide the language that enables communication between different scientific approaches to urban systems.
Due to the growing interest in the role of dietary patterns (DPs) on chronic diseases, we assessed the association between a posteriori identified DPs in the Seguimiento Universidad de Navarra (SUN) Project – a prospective cohort study in a Mediterranean country – and breast cancer (BC) risk.
DPs were ascertained through a principal component analysis based on 31 predefined food groups. BC cases were initially identified through self-report or, if deceased, from death certificates or by notification by the next kin. Women reporting BC were asked to provide a copy of their medical report and diagnoses for confirmation purposes. We fitted Cox regression models to assess the association between adherence to the identified DPs and BC risk.
Spanish university graduates.
We included 10 713 young and middle-aged – mainly premenopausal – women.
After a median follow-up of 10·3 years, we identified 100 confirmed and 168 probable incident BC cases. We described two major DPs: ‘Western dietary pattern’ (WDP) and ‘Mediterranean dietary pattern’ (MDP). A higher adherence to a WDP was associated with an increased risk of overall BC (multivariable-adjusted HR for confirmed BC Q4 v. Q1 1·70; 95 % CI 0·93, 3·12; P for trend = 0·045). Contrarily, adherence to a MDP was inversely associated with premenopausal BC (multivariable-adjusted HR Q4 v. Q1 0·33; 95 % CI 0·12, 0·91). No significant associations were observed for postmenopausal BC.
Whereas a higher adherence to the WDP may increase the risk of BC, a higher adherence to the MDP may decrease the risk of premenopausal BC.