Invited review: Human, cow, and donkey milk comparison: Focus on metabolic effects.

Milk is an important food of the daily diet. Many countries include it in their dietary recommendations due to its content in several important nutrients that exert beneficial effects on human health. Human milk is a newborn's first food and plays an important role in the growth, development, and future health of every individual. Cow milk is the type of milk most consumed in the world. However, its relatively high content of saturated fats raises concerns about potential adverse effects on human health, although epidemiological studies have disproved this association. Indeed, dairy consumption appear to be linked to a lower risk of mortality and major cardiovascular disease events. In the last few years many researchers have begun to focus their attention on both the production and quality of cow milk as well as the analysis of milk from other animal species to evaluate their effect on human health. The need to investigate the composition and metabolic effects of milk from other animal species arises from the adverse reactions of individuals in several groups to certain components of cow milk. It has emerged that donkey milk compared with that of other animal species, is the nearest to human milk and an excellent substitute for it. Milk from various animal species shows substantial differences in nutritional composition and distinct metabolic effects. In this review, we discussed the main compositional features and metabolic effects of 3 types of milk: human, cow, and donkey milk.

Implicit mechanisms of body image alterations: The covert attention exposure effect.

Visual exposure to extreme-sized bodies elicits explicit self-body image variations. Several features of such modulation remain to be clarified. In this study we explored whether this effect: (i) acts on implicit mechanisms in modifying one's body-size perception, (ii) is body-exposure-specific also at the implicit level, and (iii) is modulated by interoceptive sensibility. We assigned a covert attention task to 100 women, exposing them to extreme-sized bodies (thin and fat) or extreme-sized objects (thin and fat bottles). Before and after the attentional exposure, we tested the association between the "self/others" and "thin/fat" concepts using an Implicit Association Test. We also collected a measure of interoceptive sensibility by means of a self-report questionnaire. Results showed that participants exposed to fat bodies implicitly presented a stronger association between the "self" and "thin" concepts. This association was significantly weaker in the group exposed to thin bodies. This effect was absent after exposure to thin and fat bottles. Notably, participants with a higher tolerance of negative bodily interoceptive signals were less susceptible to the malleability of body image exerted by the exposure attentional task. Our findings shed new light on the relationship between the perception of internal (e.g., visceral) and external (e.g., visual) signals in the representation of our body.

Chagas disease knocks on our door: a cross-sectional study among Latin American immigrants in Milan, Italy.

OBJECTIVES: We aimed to assess the prevalence and risk factors for Chagas disease (CD) in Latin American immigrants and to evaluate the accuracy of diagnostic tests. Moreover, we offered to all positive subjects a complete free-of-charge clinical/instrumental evaluation as well as benznidazole treatment in order to stage the disease and verify drug tolerability. METHODS: A cross-sectional survey of CD among Latin Americans living in Milan and its metropolitan area was conducted between July 2013 and July 2014. Blood samples were tested for serologic evidence of CD together with a questionnaire covering demographic and clinical-epidemiological information. RESULTS: Forty-eight (9.6%) of the 501 tested subjects were conclusively diagnosed as having CD. The highest prevalence of CD was among those from Bolivia (43/169, 25.4%) and El Salvador (4/68, 5.9%). Older age (adjusted odds ratio (aOR)] 1.05, p =0.004), a Bolivian origin (aOR 8.80; p =0.003), being born in the department of Santa Cruz (aOR 3.72, p =0.047), having lived in mud houses (aOR 2.68; p =0.019), and having an affected relative (aOR 12.77, p =0.001) were independently associated with CD. The ARCHITECT Chagas test showed the highest sensitivity (100%) and specificity (99.8%). Twenty-nine of the subjects with CD (60.4%) underwent disease staging, 10 of whom (35.7%) showed cardiac and/or digestive involvement. Benznidazole treatment was associated with high frequency of adverse reactions (19/27, 70.4%) and permanent discontinuation (8/27, 29.6%). CONCLUSIONS: CD is highly prevalent among Bolivians and Salvadorans living in Milan. Regions with a large Latin American immigrant population should implement programmes of active detection and treatment.

A Hedonism Hub in the Human Brain.

Human values are abstract ideals that motivate behavior. The motivational nature of human values raises the possibility that they might be underpinned by brain structures that are particularly involved in motivated behavior and reward processing. We hypothesized that variation in subcortical hubs of the reward system and their main connecting pathway, the superolateral medial forebrain bundle (slMFB) is associated with individual value orientation. We conducted Pearson's correlation between the scores of 10 human values and the volumes of 14 subcortical structures and microstructural properties of the medial forebrain bundle in a sample of 87 participants, correcting for multiple comparisons (i.e.,190). We found a positive association between the value that people attach to hedonism and the volume of the left globus pallidus (GP).We then tested whether microstructural parameters (i.e., fractional anisotropy and myelin volume fraction) of the slMFB, which connects with the GP, are also associated to hedonism and found a significant, albeit in an uncorrected level, positive association between the myelin volume fraction within the left slMFB and hedonism scores. This is the first study to elucidate the relationship between the importance people attach to the human value of hedonism and structural variation in reward-related subcortical brain regions.

["I do the right thing only against payment": A critique of pay for performance in psychiatry]. / "Ich tue das Richtige nur gegen Belohnung" : Eine Kritik an Pay-for-Performance in der Psychiatrie.

This paper takes a critical look at pay for performance (P4P) as a model for introducing new incentives in psychiatry. This model is to be seen as a tool of commercialism, and such a restructuring of psychiatry represents a wide-reaching political maneuver which actively introduces economical parameters into the field and will have a great impact on psychiatry. P4P starts with the false premise that medicine has to be structured like industry. This premise is false because psychiatry has to do with relationships to patients, and not with the production of a product. Therefore, it is essential to reflect critically upon the premises and consequences of P4P for psychiatry. Only this critical reflection can help psychiatry to keep its identity as a humane service for suffering people.

[When letting-be is more important than actions. Plea for a new culture of dying]. / Wenn das Annehmen wichtiger wird als das Machen. Plädoyer für eine neue Kultur des Sterbens.

The fact of "being mortal" and mortality are of an existential meaning for every human being. The knowledge of death and the imagination of a finiteness of life have a crucial impact on the whole life. Today it has become a common approach to plan death, to organize and to regulate it. We tend to reduce death to a duty of management. With this rationalization of death we try to get within distance of it. Active euthanasia and assisted suicide seem to be the adequate answers to this approach but is death really well understood if we only try to handle it this way? Is autonomy really the only relevant principle to respect the concerns of dying individuals or desperate people who want to die? This contribution pleads for an emphasis on a new ethics of caring, because a truly human medicine is not possible without caring. It shows that care does not necessarily get in conflict with autonomy but that it is the prerequisite for autonomy.

Medicine and the holistic understanding of the human being: ultrasound examination as dialog.

Ultrasound can capture the living nature of a person. This capturing of life depends greatly on experience as well as sense of touch, intuition, sense of speech, and not least a sense for the distinctiveness of every person. Performing ultrasound is not simply the application of a technique but rather a merging of man and technology in the framework of an interpersonal encounter. Therefore, as much should be invested in the interpersonal nature of the encounter as in the development of the technical principles of the ultrasound probe. To effectively perform ultrasound, it is necessary to avoid viewing ultrasound from a purely technical view and to always remember the importance of the relationship to the patient, particularly during the technical examination.

Empirical standard mass equation for Salmo marmoratus.

Total length (L(T)) (range 24-1000 mm; mean ±S.E. = 170.21 ± 0.36 mm) and mass (W) (range 0.10-9590 g; mean ±S.E. = 76.03 ± 0.87 g) of 36,460 specimens of marble trout Salmo marmoratus were used to compute a standard mass (W(s)) equation for this species by means of the empirical percentile (EmP) method. The EmP W(s) equation calculated was: log(10) W(s) = -5.208 + 3.202 log(10) L(T) - 0.046 (log(10) L(T))(2) (L(T) range 90-570 mm) and it is valid throughout the species' area of distribution across Europe.

[Helping as a matter of expedience? Ethical objections against prioritization in medicine]. / Helfen nach Berechnung? Ethische Einwände gegen die Priorisierung in der Medizin.

The paper discusses the question whether it could be ethically appropriate to "resolve" the problem of scarce resources in health care via priority lists. It is argued that such a schematical priority list could only be undisputed in ethical respects if it represented a broad consensus on the question what a good life would be. Priority lists are always implicit decisions about specific concepts of the good life. Using a priority list only in consideration of a mere cost-benefit ratio means to accept a mere utilitarian way of defining good life. Such a definition goes with neglect of the interests of people with chronic diseases, of patients with incurable diseases, of patients with a limited life expectancy. To neglect the interests of these patients means to abandon the core of medical identity, because medicine has the mission to help those above all who are most in need and those who cannot help themselves. And so we have to realize that for medicine there are some values which are more important than economic considerations. The physician is a person who gives a promise, the promise to be there for the patient. If the physician now is becoming a businessman, this promise is no longer valid. The businessman doesn't give any other promise than not to act against the contract. But the main need of the patient, his longing for a human person whom he can trust, cannot become part of a contract. Especially in our time medicine has to fight for the core of its identity.

Proposed standard mass equations for European chub Leuciscus cephalus in Italy.

Total length (L(T)) and mass measurements of 28,596 specimens of European chub Leuciscus cephalus, collected from a variety of waterways across Italy, were used to compute standard mass (W(s)) equations by both empirical percentile (EmP) and regression line percentile (RLP) methods. The use of the EmP W(s) equation [log(10) W(s) = -4·79 + 2·68log(10) L(T) + 0·10(log(10) L(T))(2)] to compute relative mass (W(r)) of L. cephalus in Italy is suggested, as it was not influenced by length-related bias (L(T) range of application = 70-470 mm).

The experience of implementing a 'TB village' for a pastoralist population in Cherrati, Ethiopia.

SETTING: In Cherrati District, Somali Regional State (SRS), Ethiopia, despite a high burden of tuberculosis (TB), TB control activities are virtually absent. The majority of the population is pastoralist with a mobile lifestyle. TB care and treatment were offered using a 'TB village' approach that included traditional style residential care, community empowerment and awareness raising, provision of essential social amenities and essential food and non-food items. OBJECTIVE: To describe 1) key aspects of the implementation of the TB village approach, 2) TB treatment outcomes and 3) the lessons learnt during implementation. DESIGN: Descriptive study. RESULTS: A total of 297 patients entered the TB village between September 2006 and October 2008; 271 (91%) patients were treated successfully, nine (3%) defaulted and 13 (4%) died. CONCLUSIONS: For pastoralist populations, a TB village approach may be effective for improving access to TB care, ensuring proper adherence to treatment and achieving good overall TB outcomes. The successes and challenges of this approach are discussed.

[Ethical insolvency?]. / Ethische Insolvenz?

The current DRG system has not only changed the economic structure of clinical medicine but also has profound effects on its original mission. In the present paper we discuss the fundamental limits of the DRG system and make a case for placing more emphasis on time and communication in health care.

[Options, limits and ethics of pharmacological neuroenhancement]. / Möglichkeiten und Grenzen des pharmakologischen Neuroenhancements.

Pharmacological neuroenhancement is an attempt to increase cognitive performance in healthy humans. Learning and memory, attention and vigilance or mood and social interaction are targeted by a modulation of brain plasticity. Firstly, an analysis of the current state of research shows that, until now, clinical trials of neuroenhancing drugs have demonstrated only limited efficacy and long-term side effects remain largely unexplored. Secondly, we argue that, from an ethical perspective, neuroenhancement differs from socially mediated methods of learning. Pharmacological neuroenhancement is based on notions of efficacy and control that threaten to undermine other important aspects of mental capacities.

Prevalence of occupational voice disorders in teachers.

INTRODUCTION: In Italy the number of teachers among private and public schools is around one million. Voice disorders are thought to be one of the major occupational hazards of school teaching; in fact the teachers often use their voice with high-intensity, in noisy classes, for a long time and without suitable breaks. The aim of the study was to assess the prevalence of voice problems in teachers of Naples district, identifying risk factors for developing voice pathology. METHODS: In this study we evaluated 504 teachers (322 F-182 M) with an age ranging between 24 and 62 years, randomly choiced in 28 schools of the district of Naples submitted to a questionnaire to determine the prevalence of voice disorders. In our study we have also introduced a comparison group of not-teachers workers of 402 subjects (244 F-158 M); they were in the same age range as the teacher sample (range: 22-65 years). The control group was also submitted to a questionnaire regarding sociodemographic characteristics, smoking and alcohol use, a self-report of voice problems, voice symptoms, frequency of acute and chronic voice problems, absenteeism due to voice problems. RESULTS: The prevalence of reporting a current voice problem was significantly greater in teachers compared with not-teachers (8.7% vs 2.9%), as the prevalence of voice disorders during their lifetime too (51.4% vs 25.9%), chi2 = 86.672, p < 0.001. Women, compared with men had a higher lifetime prevalence of voice disorders. An other important data evidenced, is that 116 workers of the teachers group (23.01%) have been forced, during their professional activity, to miss job for problems related to voice; only 22 subjects of control group (5.47%) instead, missed job for voice troubles. DISCUSSION AND CONCLUSIONS: This study confirms that teachers have a higher rate of self-reported voice problems than subjects working in other occupations. Teachers, compared with not-teachers, were significantly more likely to have experienced multiple voice symptoms including hoarseness, discomfort while using their voice, difficulty projecting their voice and tiring or change in voice quality after short use. Large proportion of these problems may be preventable and prevention programs need to be developed and evaluated. Italian teachers do not receive any preventive voice training; that, in combination with poor hygienic work conditions, could increase health problems. Thus, voice training of teachers and teacher college students in some cases should be considered as a useful tool to prevent voice disorders.

[What's an ideal physician? Ethical reflections on the transformation of medical practice today]. / Was ist ein guter Arzt?--Ethische Uberlegungen zur ärztlichen Identität in ihrem modernen Wandel.

Today the physician is often reduced to a mere technician who is fulfilling the wish of the patient. Such a concept is lacking the aspect of care which is essential for the identity of the physician and which is important for patients in need. It is suggested to understand care as a prerequisite to respect autonomy. Autonomy without care is not medicine.