[Emerging ethical issues in clinical practice: a regional survey]. / Questioni etiche emergenti nella pratica clinica: risultati di un'indagine regionale.

. Emerging ethical issues in clinical practice: a regional survey. INTRODUCTION: In 2016, the Friuli Venezia Giulia Region established the Clinical Ethics Committees in every health agency of the Region. To initiate a proactive way of "doing ethics" giving voice to those who face clinical-ethical problems, a survey was carried out in six health agencies. AIM: To identify the most relevant ethical issues. METHODS: Survey through self-administered questionnaires, which explore: a) the ethical dimension of work in health care; b) situations of potential moral conflict; c) death and dying; (d) how ethical issues are handled and the role of ethic committees. RESULTS: 2.774 questionnaires were collected. Almost all respondents (97%) consider ethics an integral dimension of the health profession; 35% report a lack of education on bioethic issues. Behaviors that generated moral suffering (lack of respect of patients as persons 43%; aggressive medical treatment 29%). End-of-life ethical issues were the most controversial wellas the discharge of not self-sufficient patients without a social network. Restraints use was a source of conflict; receive education on; 60% of health professionals did receive education on death and dying death and dying; 51% felt inadequate in dealing with these issues. Only 8% referred to use ethical advice. CONCLUSIONS: Ethical Committees could play a role in fostering debate, proposing methods for detecting, describing and analysing ethical dilemmas, to supporting professionals in difficult clinical choices.

Intracellular bacteria can cause EAE in SJL mice or modify self-specific T cell repertoire.

Environment and genetic are both relevant in determining development of Multiple Sclerosis. Many epidemiological observations converge on indicating EBV infection and Vitamin D levels as major players among the environmental factors. Bacteria and bacterial products are however potent triggers of immune responses, and recent work from several laboratories indicates that the microbiota plays a prominent role in "priming" or protecting individuals for development of experimental autoimmune diseases. Here we report our recent work dealing with the role of non-pathogenic mycobacteria and their innate receptors in relapsing-remitting experimental autoimmune encephalomyelitis in the SJL mouse and in mobilization of CNS-reactive T cells. We finally discuss how bacteria are likely involved in the pathogenesis of Multiple Sclerosis, expecially with regard to their role in driving the recurring acute episodes of disease.