RESUMEN
Most of the difficulties when trying to realize the proposal to prescribe physical activity for transplantation patients come from patient attitudes and cultural beliefs that ignore the benefits of exercise, but there also are organizational aspects arising from the difficulties that these patients face in accessing supervised exercise facilities. To address these difficulties, the Italian study project "Transplant and Now Sport" was developed based on a model of cooperation among transplantation specialists, sports physicians, and exercise specialists organized as a team combining their specific skills to effectively actuate the physical exercise programs. This preliminary report is based on 26 patients (16 male, 10 female; 47.8±10.0 years old; 21 kidney and 5 liver transplantations; time from transplantation 2.3±1.4 years) who performed prescribed and supervised exercises consisting of 3 sessions per week of aerobic and strengthening exercises for 1 year. Preliminary results show a significant decrease in body mass index (t=1.966; P<.05) and a significant increase in peak aerobic power (t=4.535; P<.01) and maximum workload (t=4.665; P<.01) on the incremental cycling test. Also maximum strength of knee extensors (t=2.933; P<.05) and elbow flexors (t=2.450; P<.05) and countermovement jump performance (t=2.303; P<.05) significantly increased. Creatinine and proteinuria tended to decrease, but the differences were not significant. In health-related quality of life assessed by the SF-36 questionnaire, the Bodily Pain, General Health, Vitality, Social Functioning, and Role Emotional scale scores showed a significant improvement (P<.05). Preliminary results of the study protocol "Transplant and Now Sport" show the positive effects of the model based on cooperation among transplantation centers, sports medicine centers, and gyms in the administration of a supervised exercise prescription. These data should be considered a contribution to developing and promoting further detailed exercise protocols and to fostering improved posttransplantation health and survival, helping to ensure that physical activity becomes a safe routine medical treatment plan of patient management.
Asunto(s)
Ejercicio Físico , Receptores de Trasplantes , Índice de Masa Corporal , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Fuerza Muscular , Grupo de Atención al Paciente , Calidad de VidaRESUMEN
OBJECTIVES: Following a Chikungunya (CHIKV) outbreak in Italy, a cohort study was conducted to describe the infection long-term clinical course and outcome. METHODS: Persons identified through active and passive surveillance as confirmed or possible CHIKV cases during the outbreak were enrolled and interviewed by trained public health nurses, between 4-5 and 12-13 months following the acute stage. Patients reporting persistent clinical symptoms were evaluated by rheumatologists. Serum samples were obtained and anti-CHIKV specific IgG and IgM immune responses detected. Only confirmed cases who completed the follow-up were analysed. RESULTS: Out of 250 patients, 66.5% still reported myalgia, asthenia or arthralgia (most frequent sign) after 12 months. Functional ability, measured by the ROAD index, was more impaired for lower extremities (3.75; Inter Quartile Range - IQR 4.4), and the activities of daily living (average 4.2; IQR 5). Variables independently associated with the presence of joint pain at 12-13 months were increasing age, and history of rheumatologic diseases). Elderly, females, and persons with history of rheumatologic diseases had higher anti-CHIKV IgG titres at 12-13 months. CONCLUSIONS: This study confirms, in an unselected population, that the long-lasting burden of CHIKV infection is significant.
Asunto(s)
Infecciones por Alphavirus/epidemiología , Infecciones por Alphavirus/patología , Brotes de Enfermedades , Actividades Cotidianas , Adolescente , Adulto , Anciano , Anticuerpos Antivirales/sangre , Artralgia/epidemiología , Fiebre Chikungunya , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Persona de Mediana Edad , Dolor/epidemiología , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
Dengue is a significant mosquito-borne infection in humans, and its worldwide prevalence is rapidly increasing. In 2010, 83 serum samples from febrile travellers returning from dengue-endemic countries to a region in north-eastern Italy, densely infested with Aedes albopictus, were analysed for dengue virus (DENV). DENV RNA was detected in 20.5% of patients. By RT-PCR, DENV serotypes 1 and 3 were the most common. DENV must be identified early in symptomatic travellers returning from high-risk countries, to prevent outbreaks where potential vectors exist.
Asunto(s)
Virus del Dengue/aislamiento & purificación , Dengue/epidemiología , Adolescente , Adulto , Animales , Anticuerpos Antivirales/sangre , Niño , Chlorocebus aethiops , Dengue/transmisión , Dengue/virología , Virus del Dengue/genética , Virus del Dengue/inmunología , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Vigilancia de la Población , ARN Viral , Reacción en Cadena en Tiempo Real de la Polimerasa , Viaje , Células Vero , Proteínas no Estructurales Virales/genéticaRESUMEN
Following a large West Nile virus (WNV) epidemic in northeastern Italy in 2008, human and animal surveillance activities were implemented in Emilia Romagna. Human surveillance was performed by serology or genome detection on blood and cerebrospinal fluid for all suspected cases suffering from acute meningoencephalitis in the regional territory. Animal surveillance consisted of passive and active surveillance of horses and active surveillance of wild birds and mosquitoes. Between 15 June and 31 October 2009, nine of 78 possible cases of West Nile neuroinvasive disease were confirmed (three fatal). From May to October, 26 cases of neurological West Nile disease were confirmed among 46 horses. The overall incidence of seroconversion among horses in 2009 was 13%. In 2009, 44 of 1,218 wild birds yielded positive PCR results for WNV infection. The planned veterinary and entomological surveillance actions detected WNV activity from the end of July 2009, about 2-3 weeks before the onset of the first human neurological case. Passive surveillance of horses seems to be an early and suitable tool for the detection of WNV activity, but it will be less sensitive in the future, because an intensive programme of horse vaccination started in June 2009.
Asunto(s)
Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Vigilancia de la Población/métodos , Medición de Riesgo/métodos , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/prevención & control , Virus del Nilo Occidental/aislamiento & purificación , Humanos , Incidencia , Italia/epidemiología , Factores de RiesgoRESUMEN
In 2007, the first chikungunya outbreak ever occurring in a temperate area of the Northern Hemisphere was reported in Emilia-Romagna, Italy. The present study aims to evaluate knowledge, attitudes and practices regarding chikungunya infection. Information was collected by standardised telephone questionnaire, administered to 325 people during a seroprevalence survey performed in the outbreak area. Most people (61%) knew that Chikungunya virus is transmitted through mosquito bites. A significant proportion of respondents perceived chikungunya infection as a high-risk disease (49.8%) and declared their intention to use mosquito repellents in the future (47.4%). Willingness to use skin repellents was more often declared by women, residents in households with children and people who knew infection transmission routes, while perception of high risk related to Chikungunya did not influence claimed future behaviour. Knowledge of the mechanisms of infection transmission was inversely related to risk perception: elderly people were less likely to know the disease than young people, but ranked the risk highest compared to younger age groups. Less educated residents were much more likely to perceive a high risk. After a chikungunya infection outbreak in a temperate area, where mosquito-borne infections have not been previously reported, only half of the study participants declared their intention to use individual protection in the future. Anticipated behaviour was not explained by the level of risk perception, but was associated with knowledge of the disease and demographic characteristics.
RESUMEN
In 2009, to date 16 human cases of West Nile neuroinvasive disease (WNND) have been reported in Italy, in three regions: Veneto, Emilia-Romagna and Lombardia. The number of cases is higher compared with last year when nine cases were identified (eight cases of WNND and one case of West Nile fever) and the geographical distribution indicates spread from east to west.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/transmisión , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Vigilancia de la Población , Medición de Riesgo/métodos , Factores de RiesgoAsunto(s)
Enfermedades de los Caballos/diagnóstico , Caballos/microbiología , Fiebre del Nilo Occidental/diagnóstico , Fiebre del Nilo Occidental/veterinaria , Animales , Vectores de Enfermedades , Enfermedades de los Caballos/epidemiología , Enfermedades de los Caballos/virología , Italia/epidemiología , Control de Mosquitos , Vigilancia de la Población , Fiebre del Nilo Occidental/epidemiologíaRESUMEN
During summer 2007, an outbreak due to the local transmission of CHIKV by Aedes albopictus mosquitoes occurred moreover in Italy, Emilia-Romagna Region, in the areas of Ravenna, Forli-Cesena, Rimini and Bologna cities. The original outbreak developed in Castiglione di Cervia and Castiglione di Ravenna, two small villages divided by a river. The first case was recorded on August 9th the epidemic outbreak then spread out, thus giving rise to smaller secondary outbreaks and further sporadic cases in the same area, for a total of 337 suspected cases, 217 of which confirmed by blood analysis. CHIKV has been isolated and characterized on both blood and mosquito samples.
Asunto(s)
Infecciones por Alphavirus/epidemiología , Virus Chikungunya/aislamiento & purificación , Brotes de Enfermedades , Aedes/virología , Anciano , Infecciones por Alphavirus/virología , Animales , Femenino , Humanos , Insectos Vectores/virología , Italia/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
Following the outbreak of Chikungunya virus fever occurred in the summer 2007 in Emila Romagna (an administrative region located along the Adriatic (East) coast of Italy) a regional plan for Aedes albopicus control has been implemented. The major items of the plan are here reported and discussed.
Asunto(s)
Aedes , Insectos Vectores , Control de Mosquitos/organización & administración , Aedes/virología , Animales , Virus Chikungunya , Virus del Dengue , Insectos Vectores/virología , ItaliaRESUMEN
OBJECTIVES: To identify clinical and economic indicators of pharmacoutilization of antihypertensive drugs. PATIENTS AND METHODS: 4614 subjects receiving a first prescription for amlodipine, atenolol, fosinopril, indapamide, or losartan were included in the study. All prescriptions filled during the study period from January 1, 1997 to December 31, 1998 were considered. A retrospective analysis was carried out on information recorded in the drug database. The percentage of patients continuing, discontinuing, and switching the initial treatment, duration of treatment, and doses used were calculated together with total costs. RESULTS: A large proportion of patients (65.1%) discontinued the treatment. From the analysis of the mean daily dose taken by patients who continued the treatment, it was found that many subjects took a drug dosage which was below the therapeutic dose range, whereas the administration of doses above the therapeutic range occurred only occasionally. Continuation of treatment accounted for 48.1% of total costs, switching accounted for 20.8%, and discontinuation represented 31.1% of total expenditures. CONCLUSIONS: With adequate markers, helpful data can be collected for monitoring the quality of antihypertensive drug prescriptions and the rational usage of resources in the general practice setting.
Asunto(s)
Antihipertensivos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Antihipertensivos/economía , Costos y Análisis de Costo , Bases de Datos Factuales , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Farmacoepidemiología , Estudios RetrospectivosRESUMEN
Increased plasma total homocysteine (tHcy) levels are a known risk factor for vascular disease and have been reported in association with cognitive impairment of old age. Alternatively, however, increased tHcy levels may simply be an indicator of B vitamin deficiency. We evaluated the relationship between plasma tHcy levels, serum vitamin B12 and folate levels, and the scores at a battery of neuropsychological tests in 54 healthy cognitively normal subjects aged 65 years and over. Hyperhomocysteinemia prevalence (plasma tHcy>15 micromol/L) was about 24%. In univariate analysis, vitamin B12 levels were associated with both verbal memory and visuo-spatial skills, whereas no association was found between psychometric test scores and folate levels or tHcy levels. However, none of the univariate associations of neuropsychological test scores and serum B12 vitamin levels was confirmed when adjusting for age, education and other confounding variables. In conclusion, although a relationship between homocysteine, B vitamins and poor cognitive skills in the elderly is plausible, this study does not suggests that such relationship is biologically important.
Asunto(s)
Cognición/fisiología , Demencia/sangre , Ácido Fólico/sangre , Homocisteína/sangre , Hiperhomocisteinemia/sangre , Vitamina B 12/sangre , Anciano , Anciano de 80 o más Años , Envejecimiento/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/complicaciones , Demencia/epidemiología , Demencia/etiología , Femenino , Humanos , Hiperhomocisteinemia/epidemiología , Hiperhomocisteinemia/etiología , Masculino , Factores de RiesgoRESUMEN
So far, one of the major obstacles to the development of special purpose MRI imaging apparatus has been the lack of a magnetic technology that could cater to the need for a light, compact and efficient magnet, capable of providing the required field uniformity at a reasonable cost. Today, recent advances in magnet design permit attaining, with the use solely of ferrite, low-cost, small-scale scanners, which can open up new areas of application of MRI, in both medical and industrial fields. A novel apparatus (ARTOSCAN) is described and some examples of applications in different fields are shown. The apparatus has been designed specifically for the imaging of extremities, but possible applications on the industrial side are numerous and not yet all identified. Such a device could be used, for example, in the agricultural, food, and oil industries, where some of the needs for nondestructive quality-control devices could be fulfilled. Some tests have been performed that demonstrate the potential of the apparatus in the study of rock properties, of the drying process of pasta and wood, and to display flaws that could be present in ceramic materials before firing.