The issue of dementia in migrants and ethnic minorities: the perspective of National Dementia Plans.

BACKGROUND: The occurrence of dementia among individuals with a migration background and composing ethnic minorities is being recognized as a global public health issue. AIMS: In the present study, we sought to explore if and how this phenomenon is mentioned and addressed by the existing National Dementia Plans (NDPs). METHODS: The 32 NDPs listed on the Alzheimer's Disease International (ADI)'s website were considered for the present analysis. First, the plans mentioning the issue of dementia among migrants and/or ethnic minorities were identified. Subsequently, the sections addressing this topic and the pertaining proposed actions were analyzed and their contents were unbundled in descriptive categories. RESULTS: Overall, nine NDPs (28.1% of the total), namely those promulgated by Australia, Austria, England, Israel, Norway, Switzerland, Taiwan, United States, and Wales, mentioned the issue of dementia among migrants and/or ethnic minorities and only eight proposed targeted actions to tackle this issue. With few exceptions, the proposed strategies were only marginally dashed within NDPs and crucial information on their objectives, timeline, conduction, and monitoring was missing. DISCUSSION AND CONCLUSIONS: To our knowledge, this is the first attempt to describe and discuss how the issue of dementia among migrants and ethnic minority groups is addressed within NDPs. The issue of dementia in migrants and ethnic minorities is assuming a growing relevance under a of global health perspective. The timely identification and implementation of dedicated policies at the national and international level are fundamental to limit its future clinical and socioeconomic burden.

A systematic review on the epidemiology of normal pressure hydrocephalus.

BACKGROUND: The aim of this systematic review is to gather all available studies reporting prevalence and incidence rates of iNPH and to assess their methodological quality and consistency. METHODS: All available studies published up to June 2019 were retrieved searching the databases PubMed, ISI Web of Science, and the Cochrane Database of Systematic Reviews. All included studies were qualitatively assessed by two independent reviewers using the MORE Checklist for Observational Studies of Incidence and Prevalence. KEY RESULTS: Bibliographic searches and other sources yielded 659 records. A total of 28 studies were selected and applied the predefined inclusion and exclusion criteria. Fourteen studies were further excluded, and 14 studies (10 on prevalence and 6 on incidence) were included in the qualitative analysis. Results from the prevalence studies reported crude overall rates ranging from 10/100 000 to 22/100 000 for probable iNPH and 29/100 000 for possible iNPH, and age-specific rates ranging from 3.3/100 000 in people aged 50-59 to 5.9% in people aged ≥ 80 years. Results from incidence studies reported overall crude rates ranging from 1.8/100 000 to 7.3/100 000 per year, and age-specific rates ranging from 0.07/100 000/year in people aged < 60 years to 1.2/1000/year in people aged ≥ 70 years. CONCLUSIONS & INFERENCES: The high methodological and clinical heterogeneity of included studies does not allow drawing adequate conclusions on the epidemiology of iNPH. Further, high-quality, population-based studies should be carried out to allow for a better understanding of the epidemiology of this condition. Moreover, the implementation in current clinical practice of guidelines on the diagnosis and management of iNPH should also be endorsed.

Integrated care pathways on dementia in Italy: a survey testing the compliance with a national guidance.

Dementias are chronic, degenerative neurological disorders with a complex management that require the cooperation of different healthcare professionals. The Italian Ministry of Health produced the document "Guidance on Integrated Care pathway for People with Dementia" (GICPD) with the specific objective of providing a standardized framework for the definition, development, and implementation of integrated care pathways (ICP) dedicated to people with dementia. We searched all available Italian territorial ICPs. Two raters assessed the retrieved ICPs with a 2-point scale on a 43-item checklist based on the GICPD. Only 5 out of 21 regions and 5 out of 101 local health authorities had an ICP, with most ICPs having a moderate compliance to the GICPD, in particular for the items referring to the development and implementation of the care pathways. A low to moderate inter-rater agreement was observed, mainly due to a lack of standardized models to describe ICPs for dementias. Results suggest that policy- and decision-makers should pay more attention to the GICPD when producing ICPs. The direct communication with clinicians, and the implementation of more precise and appropriate clinical outcomes, could increase the involvement of clinicians, whose participation is crucial to guarantee that ICPs meet needs of patients and their carers.

The Efficacy of Cocoa Polyphenols in the Treatment of Mild Cognitive Impairment: A Retrospective Study.

Background: Mild cognitive impairment (MCI) is characterized by cognition impairment that does not interfere with the usual activities of daily living. It is considered to be a transitional stage between normal aging and dementia. No treatment is available for MCI. Methods: This retrospective cohort study included 55 patients (29 males and 26 females, aged 56-75 years) with a diagnosis of amnestic MCI who attended the Center for Cognitive Disorder and Dementia of the IRCCS Centro Neurolesi Bonino Pulejo (Messina, Italy) between January and December of 2017. As we aimed to evaluate the effect of cocoa polyphenols on cognition, the study population was separated into two groups depending on the change in their Mini-Mental State Examination (MMSE) score at a one-year follow-up. Results: Compared to G2 (i.e., patients with a worsening in cognitive functions), the rate of polyphenol intake was significantly higher in patients without a worsening in cognition (i.e., G1) (χ2 = 13.79, df = 1, p-value < 0.001). By subdividing G1 patients based on whether they improved or were stable at follow-up, we found that 46.2% of those who had improved were treated with polyphenols. Conclusions: Dietary supplementation of cocoa flavonoids seems to reduce the progression of MCI to dementia. Further prospective studies with larger sample volumes are required to confirm these promising findings.

[Epidemics of Hepatitis A and opportunities for vaccination: a focus on the category of men who practice sex with men (MSM)]. / Epidemie di Epatite A e opportunità della vaccinazione: un focus sulla categoria degli uomini che praticano sesso con uomini (MSM).

Hepatitis A is an infectious disease caused by a virus (HAV), which is highly contagious and widespread all over the world. In industrialized countries, Hepatitis A is commonly considered a disease with an important socio-economic impact, as the clinical disease affects mostly young adults. After the development of a specific anti-HAV vaccine, a reduction in the incidence of Hepatitis A was observed, with a subsequent change in the prevalence of HAV. HAV spreads mainly in children and risk categories, whose work or activities or medical conditions lead to a close contact with the virus. In particular, in Men who have sex with Men (MSM) many outbreaks have been reported in the last five years. Aim of this paper is an evaluation of the recent literature about HAV infection in MSM in order to update the current guidelines on HAV procedures for MSM.

[The progressive patient care program as a model of field training of public health practitioners: the experience of the Roman Public Health Academy]. / L'ospedale ad Intensità di cura come modello di formazione condivisa sul campo: l'esperienza dell'Accademia Romana di Sanità Pubblica.

The management of healthcare facilities has become increasingly complex in recent years, leading to a greater demand for public health physicians in Italy. Public Health physicians are responsible for evaluating community needs, with particular attention to health determinants and, at the same time, to final user feedback. During their training, they must acquire the competencies to manage a wide range of problems. The Roman Public Health Academy (ARSP) was developed to motivate young residents in Public Health to acquire the knowhow, skills and abilities required of a public health practitioner. It therefore implemented a special training program offering different educational opportunities for residents. In particular, the program offers a team of three young residents field training opportunities, allowing them to become engaged in solving complex technical and management problems. In this paper we describe the methods through which, following a specific request by the director of a hospital in Rome, the team supported a project involving the reorganization of several hospital wards. The aim of the reorganization was to enhance the performance and efficiency of the wards, according to the Progressive Patients Care program.

[Rare adverse events following immunization: coincidence]. / Eventi avversi rari successivi a vaccinazione: casualità o causalità?

The high standards of safety and effectiveness of vaccines have allowed them to get a prominent role in disease prevention and health protection. However, like any other intervention, vaccination is not free from risks. Rare adverse events occur after immunization in less than one in a thousand individuals and can be linked to vaccination by causality or coincidence. These events are reported on the SmPC (Summary of Product Characteristics). We have first divided the rare adverse events in local and generalized, and then we have analyzed them according to the type of vaccine linked to the event. Communication of the benefits of vaccines, that are surely greater than their risks, must take place in a conscious and scientific way, in order to avoid vaccinations being perceived as an imposition, instead of the great opportunity for everyone that they are.

[Universal vaccination for Rotavirus infection control]. / Vaccinazione universale per il controllo delle infezione da Rotavirus.

Rotaviruses are the most common etiological cause for pediatric acute gastroenteritis, particularly in children under 5 years of age or immunocompromised. Since 2008, vaccination program has determined a decrease in Rotavirus-related hospitalization, outpatient's visits, emergency department visits and mortality. These indicators of illness for Rotaviruses diseases remain high in those countries where there is no access to rehydrating therapies. In Italy vaccine coverage is very low, even if the burden of RV disease is well known, and at present vaccination is offered free of charge in a single region.

[Relationship between pharmaceutical industry and public health in vaccination]. / Il rapporto tra industria farmaceutica e Sanità Pubblica nell'ambito della vaccinazione.

Vaccines play the main role in primary prevention in Public Health as they allow the control of many infectious diseases progression, reducing complications, morbidity and mortality. Pharmaceutical industry has spread worldwide the production and distribution of vaccines; moreover, research and new technological approaches inside industry make possible new formulations and preparations with an increasing safety. In spite of these positive aspects, lack of confidence in the utility of vaccination as well as in the real role of the pharmaceutical industry has grown in importance in recent decades. Aim of the study was to analyze these issues, with regards to cost and timing of vaccine production, and complex vaccine planning, related to efficacy, safety and tolerability assessment. Relationship between pharmaceutical industry and Public Health was finally considered; in particular, the role of Public Health as mediator between the pharmaceutical industry and the general population.

Is hydrokinesitherapy effective on gait and balance in patients with stroke? A clinical and baropodometric investigation.

BACKGROUND: Patients with stroke present an asymmetric posture, severe balance dysfunction with delayed and disrupted equilibrium reactions, exaggerated postural sway and abnormal gait with an increased risk of falling. The aim of this study is to evaluate the efficacy of hydrokinesytherapy on stance, balance and gait in individuals after stroke. METHODS: In this single-blinded randomized controlled trial, patients with stroke were divided into two groups: an experimental one (G1), performing hydrokinesytherapy (3 times/week) in addition to a conventional physical therapy (3 times/week) and a control one (G2), performing only a conventional physical therapy (6 times/week). All of the participants underwent a proper clinical and baropodometric evaluation before and after 8 weeks of treatment. RESULTS: The two groups presented similar clinical and instrumental features at enrolment (mean modified Rankin Scale of 3, and a disease duration of 6.3 ± 1.4 months). After treatment, the patients undergoing hydrokinesytherapy showed a significantly greater improvement than those undergoing traditional training. CONCLUSIONS: Hydrokinesytherapy may be considered a promising treatment in improving gait and balance in individuals following stroke.

Central neuropathic pain: an unusual case of painful ejaculation responding to topiramate.

INTRODUCTION: Painful ejaculation (PE) is an uncommon condition and it is usually associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, ejaculatory duct obstruction, radical prostatectomy, and prostate radiation. Topiramate (TPM) is a new antiepileptic drug with recognized efficacy in neuropathic pain. AIM: The study is aimed to evaluate TPM efficacy in ejaculation pain. METHODS: Following a spinal cord injury, a 53-year-old man was referred to our institute for persistent PE. Neurological examination showed mild hypoesthesia of the genital area. Urogenital examination, neurophysiological tools, and computed tomography of the dorso-lumbar spine were normal. MAIN OUTCOME MEASURES: The main outcome measure was the visual analogue scale. RESULTS: Since pain was refractory to conventional neuropathic pharmacological therapies, TPM was introduced up to 150 mg daily with a dramatic improvement of PE. CONCLUSIONS: TPM may be considered as a valid therapeutic option for the treatment of PE.

Single tonic-clonic seizure after energy drink abuse.

Energy drinks are soft beverages especially marketed for adolescents in order to obtain a heightened sense of awareness. Concerns about the safety of these drinks are raised based on our observation of potentially serious adverse effects. Caffeine and taurine are psychoactive agents highly present in energy drinks, which may lead to modification of neurotransmission. We herein report the case of a 20-year-old man presenting with a generalized epileptic seizure after energy drink consumption.

Can interaction between atrial septal abnormalities and genetic prothrombotic polymorphisms play a role in cryptogenic ischemic stroke? Description of a family.

Ischemic stroke is a complex multifactorial disorder whose incidence increases as a function of the number of inherited and acquired risk factors. It has been recently suggested that several susceptibility "stroke alleles" act individually, together or in combination with environmental factors in stroke pathogenesis. Patent foramen ovale is considered an independent risk factor for cerebral infarct in young adult with cryptogenic stroke. Paradoxical embolism, from peripheral venous system, embolization from thrombi formed within the atrial septum, and the formation of thrombus as a result of transient atrial arrhythmias, have been advocated as potential pathogenetic mechanisms. Herein is reported a family with cryptogenic strokes probably due to the interaction between prothrombotic genetic polymorphism and atrial septal defects.

Does HLA Class II haplotype play a role in adult acute disseminated encephalomyelitis? Preliminary findings from a Southern Italy hospital-based study.

Acute Disseminated Encephalomyelitis (ADEM) is an acute, multifocal, monophasic, inflammatory demyelinating disease of the central nervous system that affects predominantly children. Aim of the study was to evaluate the distribution of Human Leukocyte Antigen (HLA) class II haplotype in adult ADEM patients, in order to better characterize this rare clinical entity. Six patients (3 males and 3 females; median age 50 years) with ADEM were retrospectively studied in our Neurology Unit; 29 healthy subjects (8 males and 21 females, mean age 43.4±14.3) were the control group. All the study subjects were molecularly typed for HLA class II haplotype. The frequencies of HLA-DRB1*16 (17% vs 3% in control group; Py=0.02) and HLA-DQB1*05 (42% against 24% in the control group; Py=0.010), as well as the association HLA-DRB1*16/HLA-DQB1*05 were significantly increased in ADEM population compared to the control group. The frequencies of allelic association between 13-04 (P < 0.01) and homozygosis 14 (P < 0.05) alleles at HLA-DRB1* locus and 05-02 (P < 0.05) alleles at HLA-DQB* locus also were increased in ADEM patients. Our preliminary data provide further evidence that the HLA-DR/DQ haplotypes may be involved in susceptibility to immunomediate demyelinating diseases of central nervous system in the Caucasian population.

Postthalamic stroke dystonic choreoathetosis responsive to tetrabenazine.

OBJECTIVE: To describe the case of a woman with poststroke choreoathetosis whose symptoms improved after treatment with tetrabenazine. CASE SUMMARY: A 48-year-old left-handed woman developed progressive involuntary dystonic choreoathetoid movements of her arm following a cerebrovascular event. Involuntary abnormal movements (IAMs) were treated with haloperidol, but they worsened 6 months later, also involving her mouth, tongue, and perioral area. Because of the suspected occurrence of drug-induced tardive dyskinesia, treatment was switched to tetrabenazine (titration up to 100 mg/daily), with rapid remission of the involuntary abnormal movements (Abnormal Involuntary Movement Scale score switching from 20 to 1). One month later, following discontinuation of tetrabenazine, the dystonic choreoathetoid movements rapidly reappeared. Subsequent rechallenge with tetrabenazine caused remission of her symptoms. DISCUSSION: Poststroke IAMs are rare, and lesions involving the basal ganglia and/or thalamus seem to be particularly implicated in such disorders. The exact pathogenic mechanism has not been clarified; however, it has been postulated that a central dopaminergic overactivity might play an important role in the IAM occurrence. Thus, antipsychotics are the main treatment option, but they are often associated with therapeutic failure or adverse effects, including extrapyramidal symptoms and metabolic complications. Interestingly, when our patient was treated with tetrabenazine for haloperidol-induced tardive dyskinesia, she demonstrated substantial improvement in the dystonic choreoathetoid movements of her left upper limb. CONCLUSIONS: The improved response of this case to tetrabenazine monotherapy suggests that tetrabenazine may be a pharmacologic alternative for patients with poststroke choreoathetosis that is intolerant or unresponsive to antipsychotic agents. Further studies are needed to better define the risk versus benefit profile of tetrabenazine.

Male sexual disorders following stroke: an overview.

Stroke is one of the leading causes of death and disability throughout the world. Although physical and cognitive impairments after stroke have been well studied, little information is known about one of the crucial aspect of the quality of life of stroke patients, namely, sexual functioning and satisfaction. Poststroke sexual dysfunctions seem to be very common since in men affected by stroke, a decline in libido and poor or tailed erection and ejaculation are frequently observed. Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic (i.e., lesion localization, premorbid medical conditions, and medications) and psychosocial (i.e., fear of recurrences, loss of self-esteem, role changes, anxiety, and depression). Thus, exploration in sexual dysfunctions and sexual counseling by trained professionals should be a part of stroke rehabilitation. The aim of this review is to evaluate the burden of stroke on sexual function taking into account the complex interaction between neurological, psychological, and relational factors.

Misdiagnosed chronic pelvic pain: pudendal neuralgia responding to a novel use of palmitoylethanolamide.

BACKGROUND: Pudendal neuralgia is a cause of chronic, disabling, and often intractable perineal pain presenting as burning, tearing, sharp shooting, foreign body sensation, and it is often associated with multiple, perplexing functional symptoms. CASE REPORT: We report a case of a 40-year-old man presenting with chronic pelvic pain due to pudendal nerve entrapment and successfully treated with palmitoylethanolamide (PEA). CONCLUSION: PEA may induce relief of neuropathic pain through an action upon receptors located on the nociceptive pathway as well as a more direct action on mast cells via an ALIA (autocoid local injury antagonism) mechanism. As recently demonstrated in animal models, the present case suggests that PEA could be a valuable pharmacological alternative to the most common drugs (anti-epileptics and antidepressants) used in the treatment of neuropathic pain.

Meralgia Paresthetica Successfully Treated with Palmithoylethanolamide.

Meralgia paresthetica (MP) is an uncommon entrapment mononeuropathy that is characterized by a sudden onset of paresthesia and numbness in the anterolateral surface of the thigh. Palmithoylethanolamide (PEA) is commonly used in the treatment of chronic pelvic pain and compressive neuropathies. Herein, we describe an otherwise healthy 28-year-old patient affected by posttraumatic MP for three months who was successfully treated with PEA (1200mg/day). Further studies are needed to better investigate the potential use of PEA as therapeutic drug in peripheral neuropathies, including MP, to avoid or delay more invasive surgical treatments.

Seasonal influenza vaccination among health-care workers: the impact of different tailored programs in four University hospitals in Rome.

Seasonal influenza vaccination (SIV) of health-care workers (HCWs) is recommended in most countries to protect them and their patients from infection. Although SIV can reduce the risk of influenza complications among vulnerable patients, vaccination uptake is generally unsatisfactory. The present study aimed to assess the impact of different programs in promoting SIV uptake among HCWs during the season 2017/2018 in four teaching hospitals in Rome. A multicentric cross-sectional study was carried out, in order to describe the four different campaigns and to assess their impact by identifying and developing a set of indicators that provide information about the vaccination services, the percentage of invited HCWs, the vaccinators' workforce and the vaccination coverage rates.The hospitals organized different strategies: Hospital 1, 3 and 4 organized educational courses for HCWs and actively invited every single HCW through e-mail. All the hospitals organized a dedicated unit for influenza vaccination, and Hospital 1 added on-site vaccination sessions that required a large number of staff. Hospital 1 and hospital 4 registered a comparable vaccination coverage rate, 12.97% and 12.76%, respectively, while it was 6.88% in Hospital 2 and 4.23% in Hospital 3. Our indicators demonstrated to be effective and useful for analyzing the different SIV campaigns. The results suggest that the best practice to promote SIV among HCWs should include multiple approaches. Among those, an easy access to the vaccination site seems to play a key role in determining a higher vaccination coverage.

A Systematic Review of the Microbiome in Children With Neurodevelopmental Disorders.

Background and Purpose: A relationship between gut microbiome and central nervous system (CNS), have been suggested. The human microbiome may have an influence on brain's development, thus implying that dysbiosis may contribute in the etiology and progression of some neurological/neuropsychiatric disorders. The objective of this systematic review was to identify evidence on the characterization and potential distinctive traits of the microbiome of children with neurodevelopmental disorders, as compared to healthy children. Methods: The review was performed following the methodology described in the Cochrane handbook for systematic reviews, and was reported based on the PRISMA statement for reporting systematic reviews and meta-analyses. All literature published up to April 2019 was retrieved searching the databases PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews. Only observational studies, published in English and reporting data on the characterization of the microbiome in humans aged 0-18 years with a neurodevelopmental disorder were included. Neurodevelopmental disorders were categorized according to the definition included in the Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5). Results: Bibliographic searches yielded 9,237 records. One study was identified through other data sources. A total of 16 studies were selected based on their relevance and pertinence to the topic of the review, and were then applied the predefined inclusion and exclusion criteria. A total of 10 case-control studies met the inclusion criteria, and were thus included in the qualitative analysis and applied the NOS score. Two studies reported data on the gut microbiome of children with ADHD, while 8 reported data on either the gut (n = 6) or the oral microbiome (n = 2) of children with ASD. Conclusions: All the 10 studies included in this review showed a high heterogeneity in terms of sample size, gender, clinical issues, and type of controls. This high heterogeneity, along with the small sample size of the included studies, strongly limited the external validity of results. The quality assessment performed using the NOS score showed an overall low to moderate methodological quality of the included studies. To better clarify the potential role of microbiome in patients with neurodevelopmental disorders, further high-quality observational (specifically cohort) studies are needed.