Beneficial effects of DAAs on cardiac function and structure in hepatitis C patients with low-moderate liver fibrosis.

Hepatitis C virus (HCV)-related chronic infection has been associated with a higher incidence of cardiovascular diseases. An altered morphology and function of both left and right heart have been described in HCV patients; however, the causality of the association is still debated. Ninety-eight nonobese and nondiabetic HCV patients (59.5 ± 12.0 years; males 52%) with Fibroscan-Transient Elastography assessed low-moderate liver fibrosis that achieved sustained viral response at 12 and 24 weeks after DAAs (direct-acting antivirals) participated. 56 were matched with 52 control subjects for age, sex and cardiovascular risk factors at baseline. A trans-thoracic echocardiography was performed in each subject at baseline (T0) and repeated in all HCV patients after eradication (6 months later eligibility, T1). TNF-α and IL-10 were measured at baseline and at T1. A concentric remodelling of the left heart in HCV participants was identified, whereas tricuspidal annular plane systolic excursion, right indexed atrial volume, right basal ventricular diameter, inferior vena cava diameter and pulmonary arterial pressure were higher in HCV participants compared to matched controls. After virus eradication, left indexed atrial volume and all right cardiac chambers measures were lower than baseline. A significant reduction of TNF-α was shown at T1, while IL-10 did not change. This study shows a concentric remodelling of the left ventricle and structural modifications in the right sections in HCV patients compared to controls. Virus eradication with DAAs was associated with a reduction of the main right atrioventricular parameters indicating a direct involvement of the HCV in cardiac changes.

Individual fatty acids in erythrocyte membranes are associated with several features of the metabolic syndrome in obese children.

PURPOSE: Obesity leads to the clustering of cardiovascular (CV) risk factors and the metabolic syndrome (MetS) also in children and is often accompanied by non-alcoholic fatty liver disease. Quality of dietary fat, beyond the quantity, can influence CV risk profile and, in particular, omega-3 fatty acids (FA) have been proposed as beneficial in this setting. The aim of the study was to evaluate the associations of individual CV risk factors, characterizing the MetS, with erythrocyte membrane FA, markers of average intake, in a group of 70 overweight/obese children. METHODS: We conducted an observational study. Erythrocyte membrane FA were measured by gas chromatography. Spearman correlation coefficients (rS) were calculated to evaluate associations between FA and features of the MetS. RESULTS: Mean content of Omega-3 FA was low (Omega-3 Index = 4.7 ± 0.8%). Not omega-3 FA but some omega-6 FA, especially arachidonic acid (AA), were inversely associated with several features of the MetS: AA resulted inversely correlated with waist circumference (rS = - 0.352), triglycerides (rS = - 0.379), fasting insulin (rS = - 0.337) and 24-h SBP (rS = - 0.313). Total amount of saturated FA (SFA) and specifically palmitic acid, correlated positively with waist circumference (rS = 0.354), triglycerides (rS = 0.400) and fasting insulin (rS = 0.287). Fatty Liver Index (FLI), a predictive score of steatosis based on GGT, triglycerides and anthropometric indexes, was positively correlated to palmitic acid (rS = 0.515) and inversely to AA (rS = - 0.472). CONCLUSIONS: Our data suggest that omega-6 FA, and especially AA, could be protective toward CV risk factors featuring the MetS and also to indexes of hepatic steatosis in obese children, whereas SFA seems to exert opposite effects.

Analysis of occupational stress in a high fashion clothing factory with upper limb biomechanical overload.

PURPOSE: To study job stress and upper limb biomechanical overload due to repetitive and forceful manual activities in a factory producing high fashion clothing. METHODS: A total of 518 workers (433 women and 85 men) were investigated to determine anxiety, occupational stress (using the Italian version of the Karasek Job Content Questionnaire) and perception of symptoms (using the Italian version of the Somatization scale of Symptom Checklist SCL-90). Biomechanical overload was analyzed using the OCRA Check list. RESULTS: Biomechanical assessment did not reveal high-risk jobs, except for cutting. Although the perception of anxiety and job insecurity was within the normal range, all the workers showed a high level of job strain (correlated with the perception of symptoms) due to very low decision latitude. CONCLUSION: Occupational stress resulted partially in line with biomechanical risk factors; however, the perception of low decision latitude seems to play a major role in determining job strain. Interactions between physical and psychological factors cannot be demonstrated. Anyway, simultaneous long-term monitoring of occupational stress features and biomechanical overload could guide workplace interventions aimed at reducing the risk of adverse health effects.

Blood natural killer activity is reduced in men with occupational stress and job insecurity working in a university.

PURPOSE: To examine the immune response to job strain and insecurity of 88 men working in a university, divided according to age and type of employment. METHODS: Anxiety, job strain, job insecurity and subjective symptoms were measured by questionnaires. Blood NK cytotoxic activity was determined by an in vitro method and lymphocyte subpopulations by flow-cytometry analysis. RESULTS: Employees (over 40 years old) in a library showed higher values of job strain, anxiety and subjective symptoms and lower blood NK activity than the controls. The young employees with temporary employment showed high job insecurity and reduced blood NK activity, while the young sanitary staff with temporary position showed normal immune response. NK cytotoxic activity of the recruited men was negatively correlated with anxiety, work load and job insecurity. CONCLUSIONS: Not only anxiety and depression but also high levels of job strain and/or insecurity may affect the health status by reducing blood NK activity.

Prevalence and Comorbidities of Resistant Hypertension: A Collaborative Population-Based Observational Study.

BACKGROUND: Resistant hypertension, is a clinical condition that may confer high cardiovascular risk. Aim of the observational study was to evaluate the prevalence of resistant hypertension, and the association with cardiovascular risk factors or diseases in the Verona urban area. DESIGN AND METHODS: Eleven family doctors retrieved anonymised data concerning blood pressure, diagnosis of hypertension and treatments from a population of 17,502 adult subjects. The prevalence of resistant hypertension was estimated considering patients who had been consecutively treated with at least four antihypertensive medications, regardless of blood pressure values. Further search concerning the clinical characteristics associated with resistant hypertension was performed in a random subsample of 55 patients. RESULTS: The prevalence of hypertension was 21.9%, that of resistant hypertension was 2.1%, approximately 10% of the whole hypertensive population. High prevalence of diabetes mellitus (53%) and hyperlipidemia (83%) was found in association with resistant hypertension. As for end organ damage, high prevalence of carotid artery stenosis (45%), ischemic heart disease (43%) and left ventricular hypertrophy (40%) was observed in patients with resistant hypertension. Blood pressure was higher than 140/90 mmHg in 58% of patients in spite of treatment with four or more different antihypertensive drugs. The average age, systolic and pulse pressure were significantly higher in the subgroup of patients with resistant hypertension. CONCLUSIONS: Patients with resistant hypertension are characterised by a higher systolic and pulse pressure and a very high attributable cardiovascular risk, due to high prevalence of cardiovascular risk factors and overt organ damage and cardiovascular disease.

Job strain in different types of employment affects the immune response.

The immune system, in cooperation with neuroendocrine functions, defends from cancer and infections mainly by the activity of blood natural killer (NK) cells. Blood NK activity may be influenced by the type of employment since work is the central part of life; moreover, job stress is a situation affecting both neuroendocrine and immune systems. This study examines anxiety (by STAI 1 and 2), job strain (by the Karasek's JCQ) and blood NK activity (by an in vitro radio-isotopic method) of 134 male workers. These men, over 38 years old with stable employment, were working in factories, in construction yards, in offices, as hospital attendants or as self-employed craftsmen. Workers in factories and in construction yards, with high job strain, showed lower NK activity, while office employees, with low job demand, and craftsmen with low anxiety and elevated decision latitude, showed higher NK activity; the level of NK activity of the hospital attendants was between the other groups. In conclusion, this study confirms that the type of employment, related to job stress, affects blood NK activity. Moreover, blood NK activity may be used in the bio-monitoring of workers at high risk.

Occupational stress and biomechanical risk in a high fashion clothing company.

Psychosocial discomfort may amplify job-related risk factors. The aim of this study is to evaluate job stress in a high fashion clothing company with upper limb biomechanical overload due to repetitive and forceful manual activities. Biomechanical risk was analyzed and in part reduced using the OCRA Check list. A total of 518 workers (433 females and 85 males) were investigated to determine anxiety (by STAI 1 and 2), occupational stress (using the Italian version of the Karasek Job Content Questionnaire) and perception of symptoms. Final biomechanical assessment did not reveal high risk jobs, except for cutting. Although the perception of anxiety and job insecurity was within the normal range, all the workers showed a high level of job strain (correlated with the perception of symptoms) due, probably, to very low decision latitude. It was suggested that job strain may increase the perception of symptoms. Moreover, the result of this study indicates that musculoskeletal overload has to be further analyzed since its low level is not in agreement with the level of discomfort due to the repetitive tasks.

Pesquisa realizada no Pronto Socorro do Hospital Psiquiátrico do Água Funda pela equipe técnica do Hospital Dia do Distrito de Saúde Jabaquara / Research conducted in the Emergency Room of Água Funda Psychiatric Hospital by the technical team of the Health District Hospital Day Jabaquara

Este levantamento parcial da situação da Saúde Mental no Distrito de saúde do Jabaquara, faz parte de um processo mais amplo da discussão neste distrito, que teve lugar a partir de / Junho de 1991, com base nas discussões sobre territorialização trazidas á Secretaria Municipal da Saúde pelos membros da Cooperação Italiana. Entende-se por territorialização uma estratégia de gerenciamento dos Sistemas Locais de Sáude, Silos. Na área da Saúde Mental ainda não havia sido realizada nenhuma coleta de dados vinculada á questão do território. Integradas á proposta, a equipe técnica que compõe o Hospital-Dia desse Distrito propôs realizar a participação e integração efetiva da Saúde mental no processo mais geral da territorialização....