Care manager to control cardiovascular risk factors in primary care: the Raffaello cluster randomized trial.

BACKGROUND AND AIM: This cluster randomized trial evaluated the efficacy of a disease and care management (D&CM) model in cardiovascular (CVD) prevention in primary care. METHODS AND RESULTS: Eligible subjects had ≥ 1 among: blood pressure ≥ 140/90 mmHg; glycated hemoglobin ≥ 7%; LDL-cholesterol ≥ 160 or ≥ 100 mg/dL (primary or secondary prevention, respectively); BMI ≥ 30; current smoking. The D&CM intervention included a teamwork including nurses as care managers for the implementation of tailored care plans. Control group was allocated to usual-care. The main outcome was the proportion of subjects achieving recommended clinical targets for ≥ 1 of uncontrolled CVD risk factors at 12-month. During 2008-2009 we enrolled 920 subjects in the Abruzzo/Marche regions, Italy. Following the exclusion of L'Aquila due to 2009 earthquake, final analyses included 762 subjects. The primary outcome was achieved by 39.1% (95%CI: 34.2-44.2) and 25.2% (95%CI: 20.9-29.9) of subjects in the intervention and usual-care group, respectively (p < 0.001). The D&CM intervention significantly increased the proportion of subjects who achieved clinical targets for both diabetes and hypertension, with no differences in hypercholesterolemia, smoking status and obesity. CONCLUSIONS: The D&CM intervention was effective in controlling cardiovascular risk factors, in particular hypertension and diabetes. Numbers needed to treat were small. Such intervention may deserve further consideration in clinical practice. REGISTRATION NUMBER: ACTRN12611000813987.

Socioeconomic studies of high-level nuclear waste disposal.

The socioeconomic investigations of possible impacts of the proposed repository for high-level nuclear waste at Yucca Mountain, Nevada, have been unprecedented in several respects. They bear on the public decision that sooner or later will be made as to where and how to dispose permanently of the waste presently at military weapons installations and that continues to accumulate at nuclear power stations. No final decision has yet been made. There is no clear precedent from other countries. The organization of state and federal studies is unique. The state studies involve more disciplines than any previous efforts. They have been carried out in parallel to federal studies and have pioneered in defining some problems and appropriate research methods. A recent annotated bibliography provides interested scientists with a compact guide to the 178 published reports, as well as to relevant journal articles and related documents.

Immunization of mice with antibiotic treated Escherichia coli.

The hypothesis of a different immunogenicity between untreated and antibiotic-treated Escherichia coli was investigated in vivo. Groups of mice were injected weekly for eight weeks with formalin-killed E. coli ATCC 25922 either exposed or not to 0.1 x MIC of aztreonam. A group of mice injected with sterile saline only served as control. IgG production towards whole bacteria was clearly enhanced in the group immunized with antibiotic-treated E. coli as shown in ELISA assays. In the same group, the appearance of additional bands of reactivity in the region of major outer membrane proteins was observed in immunoblot experiments as well as an enhanced protection towards a challenge of 10 x LD50 of live E. coli. These findings seem to support the hypothesis that sub-MICs of antibiotics modify the bacterial surface influencing host-parasite relationships.

Periventricular hypodensity in hydrocephalus: a clinico-radiological and mathematial analysis using computed tomography.

The computed tomography (CT) scans carried out in hydrocephalic patients before and after surgical treatment [cerebrospinal fluid (CSF) shunting] were assessed by analysis of the densities. The numerical data were compared to the pictorial record on the display console. The periventricular hypodensity was correlated to the clinical parameters and to the time lapse after surgical treatment. The subependymal hypodensity shows good direct correlation to the transit of CSF from the ventricles to the white matter, and to the clinical status of the patients. The mathematical analysis supplies objective data and comparable indices. It constitutes the starting point for an automatic evaluation of the CT images of the process of transependymal CSF resorption in non-treated and treated hydrocephalus.