Short-term efficacy of high intensity group and individual education in patients with type 2 diabetes: a randomized single-center trial.

PURPOSE: The aim of this randomized study was to examine the efficacy of two high intensity educational programs: the conversation maps-based (CM™) education and the individual education (IE), compared to usual care (UC) in a cohort of type 2 diabetic (T2DM) patients. METHODS: Ninety T2DM outpatients (30 per group) were randomized and 79 finished the study and were analyzed. The CM™ and IE groups received four educational sessions at 0, 4, 8 and 12 weeks, while the UC group received two brief individual sessions at 0 and 12 weeks. We evaluated glycemic control (HbA1c), diabetes treatment, body mass index (BMI) and carried out a questionnaire survey at three time points (before intervention, at 12 and at 32 weeks) to assess patients' satisfaction, attitudes toward diabetes and dietary knowledge. RESULTS: All the three groups showed a significant and comparable reduction of both HbA1c and BMI. Diabetes therapy needed to be reinforced in a higher percentage of cases (39.3%) among UC patients compared to the IE (14.8%; p = 0.04) and the CM™ (8.3%; p = 0.01) groups. At 32 weeks Diabetes Treatment Satisfaction (DTSQ Q1 + Q4-8) significantly improved in the CM™ group (25.8 ± 4.5 vs. 22.4 ± 6.0; p < 0.01) and attitudes toward diabetes (ATT19) significantly improved in the IE group (58.0 ± 4.7 vs. 55.3 ± 5.1; p = 0.02). CONCLUSIONS: Our trial provides preliminary data regarding the efficacy of structured group and individual education on achieving better glyco-metabolic control without drug therapy reinforcement and with positive effects on patients' attitude and treatment satisfaction.

Clinically applicable optical imaging technology for body size and shape analysis: comparison of systems differing in design.

BACKGROUND/OBJECTIVES: Recent advances have extended anthropometry beyond flexible tape measurements to automated three-dimensional optical devices that rapidly acquire hundreds of body surface dimensions. Three new devices were recently introduced that share in common inexpensive optical cameras. The design, and thus potential clinical applicability, of these systems differ substantially leading us to critically evaluate their accuracy and precision. SUBJECTS/METHODS: 113 adult subjects completed evaluations by the three optical devices (KX-16 (16 stationary cameras), Proscanner (1 vertically oscillating camera), and Styku scanner (1 stationary camera)), air displacement plethysmography (ADP), dual-energy X-ray absorptiometry (DXA) and a flexible tape measure. Optical measurements were compared to reference method estimates that included results acquired by flexible tape, DXA and ADP. RESULTS: Optical devices provided respective circumference and regional volume estimates that overall were well-correlated with those obtained from flexible tape measurements (for example, hip circumference: R2, 0.91, 0.90, 0.96 for the KX-16, Proscanner, and Styku scanner, respectively) and DXA (for example, trunk volume: R2, 0.97, 0.97, and 0.98). Total body volumes measured by the optical devices were highly correlated with those from the ADP system (all R2s, 0.99). Coefficient of variations obtained from duplicate measurements (n, 55) were larger in optical than in reference measurements and significant (P<0.05) bias was present for some optical measurements relative to reference method estimates. CONCLUSIONS: Overall, the evaluated optical imaging systems differing in design provided body surface measurements that compared favorably with corresponding reference methods. However, our evaluations uncovered system measurement limitations, such as discrepancies in landmarking, that with correction have the potential to improve future developed devices.

Genetic and Environmental Determinants of Otitis Media in an Indigenous Filipino Population.

OBJECTIVE: To identify genetic and environmental risk factors for otitis media in an indigenous Filipino population. STUDY DESIGN: Cross-sectional study. SETTING: Indigenous Filipino community. SUBJECTS AND METHODS: Clinical history and information on breastfeeding, tobacco smoke exposure, and swimming were obtained from community members. Heads of households were interviewed for family history and personal beliefs on ear health. Height and weight were measured. Otoscopic findings were described for the presence and character of perforation or discharge. An A2ML1 duplication variant that confers otitis media susceptibility was Sanger sequenced in all DNA samples. Co-occurrence of middle ear bacteria detected by 16S rRNA gene sequencing was determined according to A2ML1 genotype and social cluster. RESULTS: The indigenous Filipino population has a ~50% prevalence of otitis media. Young age was associated with otitis media (4 age strata; P = .004); however, age was nonsignificant as a bistratal or continuous variable. There was no association between otitis media and sex, body mass index, breastfeeding, tobacco exposure, or deep swimming. In multivariate analyses, A2ML1 genotype is the strongest predictor of otitis media, with an odds ratio of 3.7 (95% confidence interval: 1.3-10.8; P = .005). When otitis media diagnoses were plotted across ages, otitis media was observed within the first year of life, and chronic otitis media persisted up to adulthood, particularly in A2ML1-variant carriers. CONCLUSION: Among indigenous Filipinos, A2ML1 genotype is the primary risk factor for otitis media and main determinant of disease progression, although age, the middle ear microbiome, and social clusters might modulate the effect of the A2ML1 genotype.

Influence of early-life and parental factors on childhood overweight and obesity.

PURPOSE: We recently reported that a high BMI and high waist circumference prevalence is present in Sicilian children and that the male gender is associated with a significant risk of obesity. Early-life and parent-related risk factors were investigated 1521 Sicilian children (752 females and 769 males, aged 9.0-14.0 years) to identify biological and environmental factors that can contribute to obesity onset. METHODS: Anthropometric measurements of children, their urban vs rural area provenience, birth weight and neonatal feeding were collected. In addition, the BMI and educational level of their parents and the perception of their child weight status were investigated. RESULTS: In the study cohort, the prevalence of overweight and obesity was 27.2 and 14.1 %, respectively, significantly (p < 0.05) higher in males than in females. Breastfeeding emerged as a protective factor (OR 0.64; p < 0.0005), while risk factors for developing childhood obesity were a birth weight ≥4.0 kg (OR 1.83; p < 0.05), an overweight or obese mother (OR 2.33; p < 0.0001) or father (OR 1.68; p < 0.0001) and a mother with a low/medium education level (OR 1.72; p < 0.005). CONCLUSION: Understanding risk factors for pediatric obesity is a prerequisite to identify children at highly risk of being obese and to predispose early intervention strategies.

Changing patterns in the surgical management of renal masses.

OBJECTIVE: To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision. MATERIALS AND METHODS: A total of 646 patients were treated by surgery for clinically localised renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN. RESULTS: During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011-2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011-2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all P<.05). CONCLUSIONS: At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen.

Accuracy evaluation of the Kinect v2 sensor during dynamic movements in a rehabilitation scenario.

In this paper, the accuracy evaluation of the Kinect v2 sensor is investigated in a rehabilitation scenario. The accuracy analysis is provided in terms of joint positions and angles during dynamic postures used in low-back pain rehabilitation. Although other studies have focused on the validation of the accuracy in terms of joint angles and positions, they present results only considering static postures whereas the rehabilitation exercise monitoring involves to consider dynamic movements with a wide range of motion and issues related to the joints tracking. In this work, joint positions and angles represent clinical features, chosen by medical staff, used to evaluate the subject's movements. The spatial and temporal accuracy is investigated with respect to the gold standard, represented by a stereophotogrammetric system, characterized by 6 infrared cameras. The results provide salient information for evaluating the reliability of Kinect v2 sensor for dynamic postures.

A tool for home-based rehabilitation allowing for clinical evaluation in a visual markerless scenario.

This work deals with the design of an interactive monitoring tool for home-based physical rehabilitation. The software platform includes a video processing stage and the exercise performance evaluation. Image features are extracted by a Kinect v2 sensor and elaborated to return the exercises score. Furthermore the tool provides to physiotherapists a quantitative exercise evaluation of subject's performances. The proposed tool for home rehabilitation has been tested on 5 subjects and 5 different exercises and results are presented. In particular both exercises and relative evaluation indexes were selected by specialists in neurorehabilitation.

Nanowire-based field effect transistors for terahertz detection and imaging systems.

The development of self-assembled nanostructure technologies has recently opened the way towards a wide class of semiconductor integrated devices, with progressively optimized performances and the potential for a widespread range of electronic and photonic applications. Here we report on the development of field effect transistors (FETs) based on semiconductor nanowires (NWs) as highly-sensitive room-temperature plasma-wave broadband terahertz (THz) detectors. The electromagnetic radiation at 0.3 THz is funneled onto a broadband bow-tie antenna, whose lobes are connected to the source and gate FET electrodes. The oscillating electric field experienced by the channel electrons, combined with the charge density modulation by the gate electrode, results in a source-drain signal rectification, which can be read as a DC signal output. We investigated the influence of Se-doping concentration of InAs NWs on the detection performances, reaching responsivity values higher than 100 V W⁻¹, with noise-equivalent-power of ∼10⁻9 W Hz(⁻½). Transmission imaging experiments at 0.3 THz show the good reliability and sensitivity of the devices in a real practical application.

[Mental disorders related to persistent negative working conditions]. / Disturbi psichici associabili a condizioni di lavoro negative persistenti.

BACKGROUND: Mental disorders are common in our industrialised society and inevitably affect the working population. Over the last few years greater attention has been focussed on work-related psychopathologies due to an increasing number of studies regarding workplace bullying. OBJECTIVES: This study reports our observations on patients with mental disorders who came to our Occupational Health Centre because they perceived themselves to be victims of negative working conditions. An indepth analysis of their working conditions led us to the conclusion that many of these disorders were to be attributed to the workplace. METHODS: Between 2004 and 2010, 449 workers attended our Occupational Health Centre, most suffering from mental disorders which they ascribed to negative working conditions. All patients had an initial consultation session with an occupational physician which focused on the environmental and relational characteristics of their place of work. Thereafter, patients underwent a second clinical evaluation with a psychologist including several psychological tests. At the end of diagnostic process, the occupational physician and the clinical psychologist drew their clinical conclusions and defined the possible relationship with the working condition. RESULTS: For 379 out of 449 patients/workers, a positive and causal relationship between medical disorders and working conditions was established. The mental disorders observed in these groups of workers were: mixed anxiety and depressive disorder (53.6%), depressive disorder (16.2%), adaptation disorder (15.9%), anxiety disorder (13%) and only 1.3% post-traumatic stress disorder. The working conditions favouring the mental disorders were: workplace bullying, such as person-related bullying (30.1%) and task-related bullying (14.8%), adverse situations causing work distress (38.2%) or non-specific work discomfort (16,9%). CONCLUSIONS: Our experience showed that not only workplace bullying can cause different psychiatric disorders but also adverse situations that favour work distress and non-specific work discomfort often give raise to the same disorders. Negative working conditions can play a significant role in the development of psychological-psychiatric disorders: such disorders related to occupational conditions are on the increase in many industrialised countries.

[Occupational risk by the pine processionary moth Thaumetopoea pityocampa in the forestry workers of Verona]. / Rischio professionale da processionaria del pino nero (Thaumetopoea pityocampa) nei forestali di Verona.

Pine processionary moth (Thaumetopoea pityocampa) is a lepidopteran living in the Mediterranean countries whose mature larvae have microscopic hairs that can be released and carried far from the source. The hairs are responsible of urticating symptoms on the exposed areas although systemic manifestation might be involved. The study involved 94 forestry workers (92 M, 2 F) of the Regional Forest Service of Verona and the objective was to determine the prevalence of skin and respiratory disorders due to exposure to this insect. 21 chainsaw operators and 2 labourers experienced symptoms on exposed skin areas; 3 of them reported also ocular and respiratory symptoms. The chainsaw operators resulted most at risk whereas individual already suffering from others allergies do not seem to be affected. The results highlight the importance of risk assessment to Thaumetopoea pityocampa in forestry workers and the need for instruments to assess the allergic sensitization in medical surveillance.

[Work-related stress and psychological distress assessment in urban and suburban public transportation companies]. / Valutazione del rischio stress lavero correlato e del distress psichico in aziende di trasporto pubblico urbane ed extraurbano.

The risk of work-related stress has been determined in bus drivers and workers employed in the service department of two urban and suburban public transportation companies. The INAIL evaluation method (Check list and HSE indicator tool) was used. The GHQ-12 questionnaire, which is widely used to assess the level of psychological distress, was also employed. 81.9% of workers involved in the survey answered both the HSE indicator tool and the GHQ-12 questionnaire. The Check list evaluation showed an increase in quantifiable company stress indicators while close examination using the HSE indicator tool demonstrated critical situations for all the subscales, with the control subscales more problematic in bus drivers. The demand, manager's support, relationships and change subscales were most associated with psychological distress in bus drivers, while relationships, role, change and demand subscales were negatively related in workers of the service department.

Xenobiotic action on steroid hormone synthesis and sulfonation the example of lead and polychlorinated biphenyls.

OBJECTIVES: In the present study, the metabolism of steroid hormones has been investigated to determine whether and how xenobiotics like lead (Pb) and polychlorinated biphenyls (PCBs) interfere with steroid hormone biotransformation in humans. METHODS: Three groups of subjects were tested for concentration of urinary total steroids, 17-ketosteroids (n = 5), pregnane derivates (n = 6), 17-hydroxycorticosteroids (n = 11) and their sulfonated compounds: 14 workers exposed to lead, with a mean Pb blood concentration (PbB) of 29.21 microg/dl; 15 subjects exposed to PCBs, with a mean PCB blood concentration (PCBB) of 61.69 microg/l; a control group (n = 25). RESULTS: The urinary concentrations of 17-ketosteroids and 17-hydroxycorticosteroids were significantly lower in the PCB-exposed groups. There were significantly fewer sulfonated 17-hydroxycorticosteroids in the subjects exposed to PCBs as compared to the controls, while the percentage of sulfonated steroids was lower for both 17-ketosteroids and 17-hydroxycorticosteroids in the PCB-exposed subjects, but only for the 17-hydroxycorticosteroids in the group of subjects exposed to Pb (P < 0.05). Pregnane derivate urinary concentrations did not differ between the three groups. CONCLUSION: Our results suggest that PCBs and Pb act on steroid hormone metabolism with different effects and only partially using the same hormone pathways; they may cause changes in endogenous hormone homeostasis and interfere with the xenobiotic phase II of detoxification. PCBs interfere on a larger number of steroids and cause more significant effects than Pb. It is likely that different mechanisms are involved in steroid hormone metabolism interference.

Post-transcriptional regulation of HSP70 expression following oxidative stress in SH-SY5Y cells: the potential involvement of the RNA-binding protein HuR.

Brain aging is associated with a progressive imbalance between intracellular concentration of Reactive Oxygen Species (ROS) and cells ability to activate defensive genes. Heat Shock Protein 70 (HSP70) has been shown to act as a fundamental defensive mechanism for neurons exposed to an oxidant challenge, and its expression decreases during senescence. In the present report we show that the RNA-binding protein ELAV/HuR can affect, post-transcriptionally, the fate of HSP70 mRNA following H(2)O(2)-mediated oxidative stress in SH-SY5Y human neuroblastoma cells. As a consequence of H(2)O(2) treatment (1mM for 30 minutes), HSP70 mRNA accumulates in the ribosomes associated to the cytoskeleton, where parallel Western blotting experiments reveal statistically significant increase for both HuR and HSP70 protein levels. We also confirm the capability of HuR to bind to HSP70 mRNA, and describe how the biological effect of this ELAV protein on the HSP70 mRNA could be due to a direct phosphorylation in serine/threonine residues of HuR itself by the early (10 minutes) H(2)O(2)-mediated activation of PKC alpha. Our findings shed light on the post-transcriptional regulation of HSP70 expression, suggesting the existence of a new molecular cascade -involving PKC/HuR/HSP70- that possibly represents an early event in the cellular response to H(2)O(2)-mediated oxidative stress in SH-SY5Y human neuroblastoma cells. The present results lead us to speculate that an impairment in this regulatory mechanism might directly contribute to the defective cellular response to oxidative stress, thus helping to dissect a potential tool useful to counteract some aspects associated to cerebral senescence.

Interethnic differences at the thermometric response to cold test: functional disorders of blood circulation in hand fingers and exposure to hand-arm vibration.

OBJECTIVES: To report some notable aspects regarding thermometric response to cold test in black African subjects compared with Caucasians: both groups comprised persons exposed to hand-arm vibration and controls. METHODS: An overall sample of 48 workers was examined in order to study their blood circulation in hand fingers: a control group of 12 healthy Caucasian workers never exposed before to hand-arm vibration; 12 Caucasian workers exposed for several years to vibrating tools and affected by occupational Raynaud's phenomenon; 12 healthy black African workers exposed to hand-arm vibration for almost 3 years; and 12 healthy black African workers never exposed to hand-arm vibration. Computerized skin thermometry was performed and thermometric curves were analyzed according to thermometric interpretation criteria such as the area-over-curve (AOC), the fifth minute of recovery/baseline temperature ratio (5REC/BT) and the temperature at the tenth minute of recovery (10REC) after cold test. RESULTS: Thermometric parameters in Caucasian subjects confirmed the basis of the existing literature in controls (basal finger temperature higher than 32 degrees C and complete recovery to the initial temperature after the cold test) and also in patients with Raynaud's phenomenon (basal temperature often lower than control subjects and slow recovery of finger temperature after cold test). Statistically significant difference was found between healthy Caucasians and healthy black subjects in all the parameters tested: healthy black subjects showed values of AOC and 10REC suggesting almost constantly lower finger temperatures during the thermometry test. Black people, both exposed and non-exposed to hand-arm vibration showed thermometric parameters suggesting poor blood microcirculation, which seems even poorer than in Caucasian people complaining Raynaud's phenomenon. CONCLUSIONS: Our chronothermometric tests suggest some significant interethnic differences in peripheral microcirculation, which seems rather poor in black African subjects in comparison with Caucasians.

Cost structure of a postcombustion CO2 capture system using CaO.

This paper presents the basic economics of an emerging concept for CO2 capture from flue gases in power plants. The complete system includes three key cost components: a full combustion power plant, a second power plant working as an oxy-fired fluidized bed calciner, and a fluidized bed carbonator interconnected with the calciner and capturing CO2 from the combustion power plant. The simplicity in the economic analysis is possible because the key cost data for the two major first components are well established in the open literature. It is shown that there is clear scope for a breakthrough in capture cost to around 15 $/t of CO2 avoided with this system. This is mainly because the capture system is generating additional power (from the additional coal fed to the calciner) and because the avoided CO2 comes from the capture of the CO2 generated by the coal fed to the calciner and the CO2 captured (as CaCO3) from the flue gases of the existing power plant, that is also released in the calciner.

[Follow up of person-related bullying and work-related bullying: evaluation of effectiveness of interventions]. / Follow up di lavoratori vittime di molestie morali protratte e costrittività organizzativa: valutazione dell'efficacia degli interventi messi in atto.

Person-related bullying is regarded as a form of stress capable of cause negative effects on workers' health, potentially leading to psycho-physical symptoms, alterations of mood and personality, psychiatric disorders such as anxiety-depression disorder, chronic adjustment disorder and posttraumatic stress disorder. At the Centre for the study of psychosocial risks and pathologies at work of Verona the health state of victims of person-related bullying and work-related bullying and their working conditions are periodically evaluated. On a regular bases these workers receive psychological support and, if necessary, psychiatric treatment; at the same time interventions on working environment are undertaken when possible. Verification of effectiveness is then carried out by means of interviews starting six months after the first consultation. Two questionnaires are used; a specific one for the assessment of working environment and health conditions, and Goldberg's General Health Questionnaire--G.H.Q-12. Improvement of health state related to better working conditions was obtained in general.

Polyostotic giant enostoses with strongly positive radionuclide bone scan.

For nearly three quarters of a century bone islands (enostoses) were considered scintigraphically inactive, hence, easily differentiated radiologically from clinically more significant primary or metastatic intraosseous lesions. However, enostoses' clinical significance has changed considerably since the first report of a case with increased radioactive uptake on bone scan in 1976. Consequently, any radiotracer-positive skeletal lesion, regardless of radiographic appearance and clinical presentation, is now generally viewed with some caution. A 23-year-old woman presented with polyostotic enostoses discovered incidentally during pelvic radiographic examination. Both scintiscan and skeletal survey identified one or three fairly large densely radiopaque lesions in many bones, the largest measuring 7 x 4 cm. Except for a few departures from characteristic radiologic and scintigraphic changes, such as lesional border alterations and considerable increase in size and number of lesions involving many bones (polyostotic), the clinical findings and radiographic appearance of every bone island seem typical. Absent definitive roentgenologic diagnosis, both needle and open biopsies were performed. We found no previous report of a polyostotic enostoses with or without positive radionuclide bone scans reported in the literature. Distinctions from osteopoikilosis and osteopathia striata are briefly discussed.

Langerhans cell histiocytosis involving epiphysis of a long bone.

Eosinophilic granulomas of long tubular bones, a form of Langerhans cell histiocytosis, occurs in metaphyses and diaphyses with equal frequency. Epiphyseal location is unusual, with only 13 cases previously reported in the literature. The present case involves the epiphysis of the upper end of the left femur in a 12-year-old boy with pain and limp in the affected area. Radiographic findings were an oval, radiolucent rarefaction with nonsclerotic border, measuring approximately 3.5 x 3.0 cm. Microscopic examination identified aggregates of histiocytes, multinucleated giant cells, scattered eosinophils, and few plasma cells and lymphocytes. Ultrastructural studies demonstrated Birbeck granules within cytoplasm of histiocytes diagnostic of Langerhans cell histiocytosis. Whether Langerhans cell histiocytosis is a neoplastic disorder or a reactive process remains controversial. The true nature of the Langerhans cell, the proliferating cells and hallmark of this disease, is likewise under scrutiny.

[Scleroderma and occupational risk factors: a case-control study]. / Sclerodermia e fattori di rischio occupazionali: uno studio caso-controllo.

In a hospital-based case-referent study of systemic sclerosis (SSc) and occupational risk factors (55 cases and 171 referents), an excess risk for SSc was observed in men with previous occupational exposure to solvents and certain chemicals (vinyl chloride, formaldehyde). SSc was associated, even though not significantly, with occupational exposure to solvents and silica among women. The possible role of occupational exposures in the etiology of SSc, as well as the methodological limitations of the present study, are discussed.