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1.
Artículo en Inglés | MEDLINE | ID: mdl-33158223

RESUMEN

Decision makers are used to consider Out-of-Pocket Expenditure (OOPE) within a health technology assessment framework in order to account for an indicator relying on the level of fairness and on the quality of care of a health system. In this paper, we provide estimates on the determinants of OOPE in Italy by using data coming from an observational cross-sectional study that enrolled a sample of 2526 patients suffering from inflammatory bowel diseases. We explore the association between OOPE and: (1) geographical location; (2) income effects; (3) performances in delivering healthcare. A regression model was used. Individuals' age were in the range of 18-88 (mean 44 ± 14.55). Forty-six percent were females, 54% were married and 19% held a bachelor degree. Ninety-six percent of respondents declared an OOPE >0 whose mean value was €960 ± €950. Individuals belonging to low-income and low-performance regions were more likely to declare an OOPE >0 (99%). Regression findings suggest that increases in OOPE could be considered as a response from patients aiming to compensate for lacks and inefficiencies in the public healthcare offers. Policymakers should consider increases in OOPE in patients with Inflammatory Bowel Diseases (IBDs) as an indicator of poor quality of care and poor fairness.

2.
Thorac Cancer ; 2020 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-33219738

RESUMEN

BACKGROUND: Non-small cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimated the direct costs of care for patients with NSCLC by stage at diagnosis, and management phase of pathway recommended in local and international guidelines. METHODS: Based on the most up-to-date guidelines, we developed a very detailed "whole-disease" model listing the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. We assigned a cost to each procedure, and obtained an estimate of the total and average per-patient costs of each stage of the disease and phase of its management. RESULTS: The mean expected cost of a patient with NSCLC is 21,328 € (95% C.I. -20 897-22 322). This cost is 16 291 € in stage I, 19530 € in stage II, 21938 € in stage III, 22175 € in stage IV, and 28 711 € for a Pancoast tumor. In the early stages of the disease, the main cost is incurred by surgery, whereas in the more advanced stages radiotherapy, medical therapy, treatment for progressions, and supportive care become variously more important. CONCLUSIONS: An estimation of the direct costs of care for NSCLC is fundamental in order to predict the burden of new oncological therapies and treatments on healthcare services, and thus orient the decisions of policy-makers regarding the allocation of resources. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: The high costs of surgery make the early stages of the disease no less expensive than the advanced stages. WHAT THIS STUDY ADDS: An estimation of the direct costs of care is fundamental in order to orient the decisions of policy-makers regarding the allocation of resources.

3.
J Cosmet Dermatol ; 2020 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-33090687

RESUMEN

BACKGROUND: In esthetic medicine, different techniques have been used against the aging of the human skin especially in the facial area. Hyaluronic acid is used for improving the quantity of water and extracellular matrix molecule. The aim of this study is a clinical and histological evaluation of the effect of low-molecular-weight hyaluronic acid fragments mixed with amino acid (HAAM) on the rejuvenation the face skin treated with intradermal microinjections. METHODS: Twenty women with mean age 45 range from 35 to 64 were studied, thereof 8 in menopause and 12 of childbearing age. The patients were treated with the HAAM products by mesotherapy technique; before and after 3 months of the therapeutic procedure, each patient underwent small biopsies with a circular punch biopsy. RESULTS: The clinical results of the present study showed that the administration of the dermal filler containing fragments of hyaluronic acid between 20 and 38 monomers and amino acid via dermis injection technique produces an esthetic improvement in the faces of the treated patients, while the histological evaluation shows an increased fibroblast activity with the production of type III reticular collagen and increased number of vessels and epidermis thickness. CONCLUSIONS: The clinical and histological assessment showed that subcutaneous HAAM infiltration has a significant impact on the dermis and clinical aspects of the face.

4.
Artículo en Inglés | MEDLINE | ID: mdl-33114587

RESUMEN

Aim: In this article, we aim to present a tool for the early assessment of medical technologies. This evaluation system was designed and implemented by the National Centre for HTA and the National Centre for Innovative Technologies of the Istituto Superiore di Sanita, Italy, in order to respond to an institutional commitment within the "Health Technologies Assessment Team" that was established to face the huge demand for the evaluation of Health Technologies during the pandemic event caused by COVID-19, with a smart and easy-to-use framework. Methods: Horizon scanning was conducted through a brief assessment carried out according to the multicriteria decision analysis methodology. Each HTA domain was attributed a score according to a pros/cons and opportunities/threats system, derived from evidence in the literature. Scores were weighted according to different perspectives. Scores were presented in a Cartesian graph showing the positioning according to the potential value and the perceived risk associated with the technology. Results: Two case studies regarding the early assessment were reported, concerning two specific technologies: an individual protection device and a contact tracking system.


Asunto(s)
Infecciones por Coronavirus , Técnicas de Apoyo para la Decisión , Pandemias , Neumonía Viral , Evaluación de la Tecnología Biomédica , Betacoronavirus , Humanos , Italia , Riesgo
5.
Food Nutr Res ; 632019.
Artículo en Inglés | MEDLINE | ID: mdl-31645850

RESUMEN

Background: The onset of some types of obesity may correlate with specific familial relational patterns, and expressed emotion (EE), the family life's 'emotional temperature', may play a role in obesity treatment compliance and outcome. Objective: The aim of this study is to address the current gap in the literature about EE and obesity, assessing EE in a sample of patients with overweight or obesity and their relatives. A further objective is to assess patients' weight loss, patients' and relatives' anxiety, perceived stress and their possible correlation with EE and diet compliance. Design: A total of 220 patients with overweight or obesity and 126 relatives were recruited; their socio-demographic and clinical features were collected; and Level of Expressed Emotion Scale (LEE), State-Trait Anxiety Inventory 1 and 2 (STAI-Y1 and STAI-Y2) and Paykel Scale of Stressful Life Events were administered. Results: Patients' baseline body mass index (BMI) was negatively correlated with educational level, but we failed to find any correlation between BMI and the other variables assessed. We found a positive correlation between EE median and stressful life events, as well as between median EE and state and trait anxiety. Conclusions: Our results seem to suggest that other factors than the psychological ones we investigated may play a role in treatment adherence and outcome in patients with overweight and obesity.

6.
BMC Psychiatry ; 19(1): 235, 2019 07 30.
Artículo en Inglés | MEDLINE | ID: mdl-31362720

RESUMEN

BACKGROUND: The amount of research about orthorexic attitudes and behaviours has increased in the last five years, but is still mainly based on descriptive and anecdotal data, yielding a variety of prevalence data and inconsistent results. The interplay between socio-cultural context and orthorexia has been poorly investigated and is still far from being understood. METHOD: Multicentre, cross-sectional study involving Italian (N = 216), Polish (N = 206) and Spanish (N = 242) university students, assessed through a protocol including informed consent, socio-demographic and anamnestic data sheet and self-administered questionnaires (ORTO-15, Eating Attitudes Test- 26 [EAT-26], Temperament and Character Inventory [TCI]). RESULTS: Higher prevalence of orthorexia (as described by the ORTO-15 cutoff) was found in Poland. Female gender, Body Mass Index (BMI), current Eating Disorder, dieting, EAT-26 score ≥ 20 and low/medium Persistence were associated with orthorexia in the whole sample. The cross-cultural comparison showed several differences among the three subgroups of students. CONCLUSIONS: The associations found between orthorexic attitudes, self-reported current eating disorder, BMI and adherence to a dieting need to be supported by further research. The differences among students from the three countries seem to suggest a possible rolve for cultural elements in the construct of orthorexia.


Asunto(s)
Actitud Frente a la Salud/etnología , Conducta Alimentaria/etnología , Trastornos de Alimentación y de la Ingestión de Alimentos/etnología , Personalidad , Estudiantes/psicología , Adolescente , Adulto , Índice de Masa Corporal , Comparación Transcultural , Estudios Transversales , Conducta Alimentaria/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Femenino , Humanos , Italia/epidemiología , Italia/etnología , Masculino , Inventario de Personalidad , Polonia/epidemiología , Polonia/etnología , Prevalencia , España/epidemiología , España/etnología , Encuestas y Cuestionarios , Universidades , Adulto Joven
7.
Oxid Med Cell Longev ; 2019: 4683723, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31354906

RESUMEN

Introduction: Inflammation is associated with obesity condition and plays a pivotal role in the onset and progression of many chronic diseases. Among several nutraceutical foods, hazelnuts (Corylus avellana L.) are considered an excellent anti-inflammatory and hypolipidemic food being the second richest source of monounsaturated fatty acids among nuts and because they are rich in vitamins, minerals, and phenolic compounds. Materials and Methods: A prospective pilot clinical trial on 24 healthy volunteers who consumed daily, as a snack, 40 g of hazelnuts (261.99 kcal/1096.17 kJ) for six weeks was conducted. Anthropometric measurements, body composition analysis, and nutrigenomic analysis on 12 anti-inflammatory and antioxidant genes were evaluated at baseline (T0) and after hazelnut intervention (T1). Results: No significant changes were detected on body composition analysis after hazelnut consumption. Conversely, significant upregulation was detected for SOD1 (2-ΔΔCt = 2.42), CAT (2-ΔΔCt = 2.41), MIF (2-ΔΔCt = 4.12), PPARγ (2-ΔΔCt = 5.89), VDR (2-ΔΔCt = 3.61), MTHFR (2-ΔΔCt = 2.40), and ACE (2-ΔΔCt = 2.16) at the end of the study. Conclusions: According to emerging evidences, hazelnut consumption does not lead to weight gain probably due to the improvement of the body's antioxidant capacity by the upregulation of genes implied in oxidant reactions and inflammation.


Asunto(s)
Corylus/química , Expresión Génica/genética , Inflamación/dietoterapia , Obesidad/dietoterapia , Estrés Oxidativo/efectos de los fármacos , Voluntarios Sanos , Humanos , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos
8.
Nutrients ; 11(7)2019 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-31277506

RESUMEN

The reversion of diabetes and the treatment of long-term obesity are difficult challenges. The failure mechanisms of rapid weight loss are mainly related to the wasting of lean mass. This single-arm study aims to evaluate the effects of a very low-calorie ketogenic diet (VLCKD) on body composition and resting energy expenditure in the short term reversal of diabetes mellitus Type 2. For eight weeks, subjects were administered a personalized VLCKD with protein intake based on lean mass and synthetic amino acidic protein supplementation. Each subject was assessed by anthropometry, Dual-energy X-ray Absorptiometry(DXA), bioimpedentiometric analysis (BIA), indirect calorimetry, and biochemical analysis. The main findings were the saving of lean mass, the reduction of abdominal fat mass, restored metabolic flexibility, the maintenance of resting energy expenditure, and the reversion of diabetes. These results highlight how the application of preventive, predictive, personalized, and participative medicine to nutrition may be promising for the prevention of diabetes and enhancement of obesity treatment.


Asunto(s)
Grasa Abdominal/fisiopatología , Adiposidad , Restricción Calórica , Diabetes Mellitus Tipo 2/dietoterapia , Dieta para Diabéticos , Dieta Cetogénica , Metabolismo Energético , Grasa Abdominal/diagnóstico por imagen , Adulto , Anciano , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Ingestión de Energía , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Pérdida de Peso
9.
Methods Protoc ; 2(2)2019 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-31226732

RESUMEN

Modern optics offers several label-free microscopic and spectroscopic solutions which are useful for both imaging and pathological assessments of biological tissues. The possibility to obtain similar morphological and biochemical information with fast and label-free techniques is highly desirable, but no single optical modality is capable of obtaining all of the information provided by histological and immunohistochemical analyses. Integrated multimodal imaging offers the possibility of integrating morphological with functional-chemical information in a label-free modality, complementing the simple observation with multiple specific contrast mechanisms. Here, we developed a custom laser-scanning microscopic platform that combines confocal Raman spectroscopy with multimodal non-linear imaging, including Coherent Anti-Stokes Raman Scattering, Second-Harmonic Generation, Two-Photon Excited Fluorescence, and Fluorescence Lifetime Imaging Microscopy. The experimental apparatus is capable of high-resolution morphological imaging of the specimen, while also providing specific information about molecular organization, functional behavior, and molecular fingerprint. The system was successfully tested in the analysis of ex vivo tissues affected by urothelial carcinoma and by atherosclerosis, allowing us to multimodally characterize of the investigated specimen. Our results show a proof-of-principle demonstrating the potential of the presented multimodal approach, which could serve in a wide range of biological and biomedical applications.

10.
Dev Cell ; 49(4): 574-589.e5, 2019 05 20.
Artículo en Inglés | MEDLINE | ID: mdl-31006650

RESUMEN

The effect of intracellular vesicle trafficking on stem-cell behavior is largely unexplored. We screened the Drosophila sorting nexins (SNXs) and discovered that one, SH3PX1, profoundly affects gut homeostasis and lifespan. SH3PX1 restrains intestinal stem cell (ISC) division through an endocytosis-autophagy network that includes Dynamin, Rab5, Rab7, Atg1, 5, 6, 7, 8a, 9, 12, 16, and Syx17. Blockages in this network stabilize ligand-activated EGFRs, recycling them via Rab11-dependent endosomes to the plasma membrane. This hyperactivated ERK, calcium signaling, and ER stress, autonomously stimulating ISC proliferation. The excess divisions induced epithelial stress, Yki activity, and Upd3 and Rhomboid production in enterocytes, catalyzing feedforward ISC hyperplasia. Similarly, blocking autophagy increased ERK activity in human cells. Many endocytosis-autophagy genes are mutated in cancers, most notably those enriched in microsatellite instable-high and KRAS-wild-type colorectal cancers. Disruptions in endocytosis and autophagy may provide an alternative route to RAS-ERK activation, resulting in EGFR-dependent cancers.


Asunto(s)
Proteínas de Drosophila/metabolismo , Drosophila melanogaster/citología , Receptores ErbB/metabolismo , Mucosa Intestinal/citología , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Sistema de Señalización de MAP Quinasas , Receptores de Péptidos de Invertebrados/metabolismo , Células Madre/citología , Animales , Autofagia/fisiología , Proteínas Relacionadas con la Autofagia/metabolismo , Diferenciación Celular/fisiología , Membrana Celular/metabolismo , Proliferación Celular/fisiología , Drosophila melanogaster/metabolismo , Endocitosis , Endosomas/metabolismo , Mucosa Intestinal/metabolismo , Transporte de Proteínas , ARN Polimerasa II/genética , ARN Polimerasa II/metabolismo , Transducción de Señal/fisiología , Nexinas de Clasificación/metabolismo , Células Madre/metabolismo , Proteínas de Unión al GTP rab/metabolismo
11.
J Colloid Interface Sci ; 538: 449-461, 2019 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-30537658

RESUMEN

Major obstacles to the successful treatment of gliolastoma multiforme are mostly related to the acquired resistance to chemotherapy drugs and, after surgery, to the cancer recurrence in correspondence of residual microscopic foci. As innovative anticancer approach, low-intensity electric stimulation represents a physical treatment able to reduce multidrug resistance of cancer and to induce remarkable anti-proliferative effects by interfering with Ca2+ and K+ homeostasis and by affecting the organization of the mitotic spindles. However, to preserve healthy cells, it is utterly important to direct the electric stimuli only to malignant cells. In this work, we propose a nanotechnological approach based on ultrasound-sensitive piezoelectric nanoparticles to remotely deliver electric stimulations to glioblastoma cells. Barium titanate nanoparticles (BTNPs) have been functionalized with an antibody against the transferrin receptor (TfR) in order to obtain the dual targeting of blood-brain barrier and of glioblastoma cells. The remote ultrasound-mediated piezo-stimulation allowed to significantly reduce in vitro the proliferation of glioblastoma cells and, when combined with a sub-toxic concentration of temozolomide, induced an increased sensitivity to the chemotherapy treatment and remarkable anti-proliferative and pro-apoptotic effects.


Asunto(s)
Antineoplásicos Alquilantes/farmacología , Compuestos de Bario/química , Neoplasias Encefálicas/tratamiento farmacológico , Glioblastoma/tratamiento farmacológico , Nanopartículas/química , Temozolomida/farmacología , Titanio/química , Antineoplásicos Alquilantes/química , Apoptosis/efectos de los fármacos , Barrera Hematoencefálica/efectos de los fármacos , Neoplasias Encefálicas/patología , Proliferación Celular/efectos de los fármacos , Ensayos de Selección de Medicamentos Antitumorales , Glioblastoma/patología , Humanos , Nanotecnología , Temozolomida/química , Células Tumorales Cultivadas
12.
J Crit Care ; 50: 169-176, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30553184

RESUMEN

PURPOSE: To assess risk factors for 28-day mortality and cost implications in intensive care unit (ICU) patients with complicated intra-abdominal infections (cIAIs). METHODS: Single-center retrospective cohort study of prospectively collected data analysing ICU patients with a microbiologically confirmed complicated intra-abdominal infections. RESULTS: 137 complicated intra-abdominal infections were included and stratified according to the adequacy of antimicrobial therapy (initial inadequate antimicrobial therapy [IIAT], n = 44; initial adequate antimicrobial therapy [IAAT], n = 93). The empirical use of enterococci/methicillin-resistant Staphylococcus aureus active agents and of carbapenems was associated with a higher rate of therapeutic adequacy (p = 0.016 and p = 0.01, respectively) while empirical double gram-negative and antifungal therapy did not. IAAT showed significantly lower mortality at 28 and 90 days and increased clinical cure and microbiological eradication (p < 0.01). In the logistic and Cox-regression models, IIAT and inadequate source control were the unique predictors of 28-day mortality. No costs differences were related to the adequacy of empirical therapy and source control. The empirical double gram-negative and antifungal therapy (p = 0.03, p = 0.04) as well as the isolation of multidrug-resistant (MDR) bacteria and the microbiological failure after targeted therapy were drivers of increased costs (p = 0.004, p = 0.04). CONCLUSIONS: IIAT and inadequate source control are confirmed predictors of mortality in ICU patients with complicated intra-abdominal infections. Empirical antimicrobial strategies and MDR may drive hospital costs.


Asunto(s)
Enfermedad Crítica/terapia , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Infecciones Intraabdominales/microbiología , Staphylococcus aureus Resistente a Meticilina , Anciano , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Cuidados Críticos/economía , Cuidados Críticos/métodos , Femenino , Costos de la Atención en Salud , Humanos , Unidades de Cuidados Intensivos , Infecciones Intraabdominales/complicaciones , Masculino , Persona de Mediana Edad , Análisis Multivariante , Probabilidad , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
13.
Int J Technol Assess Health Care ; 34(5): 527-534, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30322414

RESUMEN

OBJECTIVES: The emergence of new medical technologies and budget restrictions has led to a substantial increase in the use of hospital-based health technology assessment (HB-HTA). This qualitative study explores whether there is a possibility and interest to realize the collection and dissemination of HB-HTA reports on an international scale by exploring the opinions from HB-HTA experts. METHODS: A survey was designed and sent to an international group of experts knowledgeable in HB-HTA from eighteen different countries. The survey contained questions about their opinions on the collection and distribution of HB-HTA information, and about the meaningful dimensions, barriers and values about a database. The data obtained were analyzed through the method of content analysis. RESULTS: A total of thirty-six experts (response rate of 18.3 percent) responded to the survey. The obtained data shows that all respondents agree that the collection of HB-HTA reports is useful. Moreover, 41.7 percent of respondents that are in the position of sharing HB-HTA reports (n = 24) mentioned that full HB-HTA reports can be shared. Many other respondents reported that confidentiality (45.7 percent) and investment into a database (40.0 percent) are important barriers for the dissemination of HB-HTA reports. CONCLUSIONS: There seem to be enough demand and willingness to share all or most reports by a large community of HB-HTA producers. Therefore, there is a need for a well-designed database with regular maintenance and complete, comparable, and qualitative HB-HTA reports. The database of the AdHopHTA project could potentially facilitate this process.


Asunto(s)
Hospitales , Difusión de la Información , Internacionalidad , Participación de los Interesados , Evaluación de la Tecnología Biomédica , Estudios Transversales , Toma de Decisiones , Investigación Cualitativa , Encuestas y Cuestionarios
14.
Ecology ; 99(12): 2874, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30187464

RESUMEN

The use of database technologies as a tool for implementing data for quantitative ecological studies and biodiversity conservation planning has recently attracted the attention of the biological community. Despite the fact that the number of biodiversity data sets is quickly rising, online databases of small mammals are still scarce, especially for Mediterranean ecosystems. We implemented the first standardized and accessible georeferenced European database of small mammal occurrences, abundances, and functional traits. Data derived from owl pellets was obtained from different sources, including original field surveys, publications, gray literature, existing databases, and museum collections. The OpenMICE database covers the years 1972 to 2017 and includes nearly 50,000 individuals from 23 species (13 Rodentia and 10 Eulipotyphla) at 190 sites in south-central Italy. Our specific goals in compiling this data set were as follows: (1) to make data that is usually accessible to a restricted audience widely available; (2) to identify the gaps in knowledge about small mammal communities and guide future sampling and conservation efforts; and (3) to gain a first insight into small mammal diversity and abundance in the study area. The potential applications of our spatial relational database are many, from individual-based to community-based models as potential indicators of environmental changes at different geographical scales. Given the long-term support for data storage, the OpenMICE database could be further expanded to include other geographical contexts and implemented with new information and traits. We would appreciate that researchers cite this paper if using all or part of the data set. We also request that researchers and teachers inform us of how they are using the data. We intend to keep it up to date as novel studies become available (see Data Availability).

15.
Recenti Prog Med ; 109(5): 272-293, 2018 May.
Artículo en Italiano | MEDLINE | ID: mdl-29771250

RESUMEN

In the first article in this series we described the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision (EtD) frameworks and their rationale for different types of decisions. In this second article, we describe the use of EtD frameworks for clinical recommendations and how it can help clinicians and patients who use those recommendations. EtD frameworks for clinical practice recommendations provide a structured and transparent approach for guideline panels. The framework helps ensure consideration of key criteria that determine whether an intervention should be recommended and that judgments are informed by the best available evidence. Frameworks are also a way for panels to make guideline users aware of the rationale (justification) for their recommendations.


Asunto(s)
Toma de Decisiones , Prestación de Atención de Salud/organización & administración , Guías de Práctica Clínica como Asunto , Conducta de Elección , Humanos
16.
Int J Technol Assess Health Care ; 34(2): 205-211, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29656722

RESUMEN

OBJECTIVES: Hospital-based health technology assessment (HB-HTA) is becoming increasingly relevant because of its role in managing the introduction and withdrawal of health technologies. The organizational arrangement in which HB-HTA activities are conducted depends on several contextual factors, although the dominant models have several similarities. The aims of this study were to explore, describe, interpret, and explain seven cases of the application of HB-HTA logic and to propose a classification for HB-HTA organizational models which may be beneficial for policy makers and HTA professionals. METHODS: The study was part of the AdHopHTA Project, granted under the European 7th Framework Research Programme. A case study methodology was applied to analyze seven HB-HTA initiatives in seven countries, with collection of qualitative and quantitative data. Cross-case analysis was performed within the framework of contingent organizational theory. RESULTS: Evidence showed that some organizational or "structural" variables, namely the level of procedure formalization/structuration and the level of integration with other HTA bodies at the national, regional, and provincial levels, predominantly shape the HB-HTA approach, determining a contingency model of HB-HTA. Crossing the two variables, four options have emerged: integrated specialized HTA unit, stand-alone HTA unit, integrated-essential HTA, independent group unit. CONCLUSIONS: No one-best-way approach can be used for HTA at the hospital level. Rather, the characteristics of HTA models depend on many contextual factors. Such conceptualization may aid the diffusion of HB-HTA to inform managerial decision making and clinical practice.


Asunto(s)
Toma de Decisiones , Administración Hospitalaria , Evaluación de la Tecnología Biomédica/organización & administración , Europa (Continente) , Humanos , Liderazgo , Administración de Personal en Hospitales
17.
Dev Cell ; 43(5): 603-617.e5, 2017 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-29207260

RESUMEN

The Hippo/Yki and RB/E2F pathways both regulate tissue growth by affecting cell proliferation and survival, but interactions between these parallel control systems are poorly defined. In this study, we demonstrate that interaction between Drosophila E2F1 and Sd disrupts Yki/Sd complex formation and thereby suppresses Yki target gene expression. RBF modifies these effects by reducing E2F1/Sd interaction. This regulation has significant effects on apoptosis, organ size, and progenitor cell proliferation. Using a combination of DamID-seq and RNA-seq, we identified a set of Yki targets that play a diversity of roles during development and are suppressed by E2F1. Further, we found that human E2F1 competes with YAP for TEAD1 binding, affecting YAP activity, indicating that this mode of cross-regulation is conserved. In sum, our study uncovers a previously unknown mechanism in which RBF and E2F1 modify Hippo signaling responses to modulate apoptosis, organ growth, and homeostasis.


Asunto(s)
Proteínas de Drosophila/metabolismo , Drosophila melanogaster/metabolismo , Factor de Transcripción E2F1/metabolismo , Regulación del Desarrollo de la Expresión Génica/fisiología , Proteínas Nucleares/metabolismo , Transducción de Señal/fisiología , Transactivadores/metabolismo , Factores de Transcripción/metabolismo , Animales , Núcleo Celular/metabolismo , Proliferación Celular/fisiología , Supervivencia Celular , Drosophila melanogaster/citología , Humanos , Tamaño de los Órganos , Transcripción Genética/genética
18.
Naturwissenschaften ; 104(9-10): 80, 2017 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-28900670

RESUMEN

Many small terrestrial vertebrates exhibit limited spatial movement and are considerably exposed to changes in local environmental variables. Among such vertebrates, amphibians at present experience a dramatic decline due to their limited resilience to environmental change. Since the local survival and abundance of amphibians is intrinsically related to the availability of shelters, conservation plans need to take microhabitat requirements into account. In order to gain insight into the terrestrial ecology of the spectacled salamander Salamandrina perspicillata and to identify appropriate forest management strategies, we investigated the salamander's seasonal variability in habitat use of trees as shelters in relation to tree features (size, buttresses, basal holes) and environmental variables in a beech forest in Italy. We used the occupancy approach to assess tree suitability on a non-conventional spatial scale. Our approach provides fine-grained parameters of microhabitat suitability and elucidates many aspects of the salamander's terrestrial ecology. Occupancy changed with the annual life cycle and was higher in autumn than in spring, when females were found closer to the stream in the study area. Salamanders showed a seasonal pattern regarding the trees they occupied and a clear preference for trees with a larger diameter and more burrows. With respect to forest management, we suggest maintaining a suitable number of trees with a trunk diameter exceeding 30 cm. A practice of selective logging along the banks of streams could help maintain an adequate quantity of the appropriate microhabitat. Furthermore, in areas with a presence of salamanders, a good forest management plan requires leaving an adequate buffer zone around streams, which should be wider in autumn than in spring.


Asunto(s)
Urodelos , Animales , Femenino , Bosques , Italia , Árboles
19.
J Environ Manage ; 201: 129-137, 2017 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-28651222

RESUMEN

The conservation of species and habitats is increasingly threatened by anthropogenic impacts, particularly land use change, from local to global scales. Although many efforts have been carried out so far to halt or at least reduce the biodiversity loss (e.g., the establishment of protected areas' networks), there are still both knowledge and policy gaps slowing the conservation of species and habitats in complex environments, such as the Mediterranean region. In particular, the human-driven impacts and threats on biodiversity need more careful analysis. Accordingly, this paper aims to assess the habitat quality and degradation in Italy in relation with the spatial pattern of the current protected areas' network, mainly to identify priority areas of intervention, thus supporting large-scale conservation strategies. A survey of experts was conducted to identify the main threats for biodiversity from different land uses at the national scale. The InVEST software was then applied to assess and map habitat quality and degradation with a high spatial resolution (20 m). The relationship between habitat quality and degradation as well as their hotspots, and alternative PA categories were also explored. Results indicate that: (i) habitat quality and degradation depend on the location and intensity of the anthropogenic impacts and are sensitive to different protection levels; (ii) the combination of the survey of experts and the spatially-explicit assessment of habitat quality and degradation is useful to highlight variations of the current conditions of biodiversity and habitats; and (iii) the identification of hotspots allows one to identify priority areas for conservation. Accordingly, the proposed approach may be used to strengthen the conservation efforts in similar contexts, and thus support the implementation of the biodiversity-related policies over the long term.


Asunto(s)
Conservación de los Recursos Naturales , Ecosistema , Biodiversidad , Humanos , Italia , Región Mediterránea
20.
Int J Technol Assess Health Care ; 32(4): 292-299, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27745567

RESUMEN

OBJECTIVES: Health technology assessment (HTA) yields information that can be ideally used to address deficiencies in health systems and to create a wider understanding of the impact of different policy considerations around technology reimbursement and use. The structure of HTA programs varies across different jurisdictions according to decision-maker needs. Moreover, conducting HTA requires specialized skills. Effective decision making should include multiple criteria (medical, economic, technical, ethical, social, legal, and cultural) and requires multi-disciplinary teams of experts working together to produce these assessments. A workshop explored the multi-disciplinary skills and competencies required to build an effective and efficient HTA team, with a focus on low- and middle-income settings. METHODS: This proceeding summarizes main points from a workshop on capacity building, drawing on presentations and group discussions among attendees including different points of view. RESULTS AND CONCLUSIONS: The workshop and thus this study would have benefited from a larger variety of stakeholders. Therefore, the conclusions arising from the workshop are not the opinion of a representative sample of HTA professionals. Nonetheless, organizations and speakers were carefully selected to provide a valuable approach to this theme. Thus, these proceedings highlight some of the gaps and needs in the education and training programs offered worldwide and calls for further investigation.


Asunto(s)
Creación de Capacidad/organización & administración , Eficiencia Organizacional , Evaluación de la Tecnología Biomédica/organización & administración , Creación de Capacidad/economía , Comunicación , Cultura , Procesos de Grupo , Humanos , Gestión del Conocimiento , Competencia Profesional , Evaluación de la Tecnología Biomédica/economía
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