[Nutritional status of elderly institutionalized subjects in a health district in Frosinone (Italy)]

In recent years there has been a constant increase in the number of elderly people being admitted to nursing homes. Elderly nursing home residents seem to have a higher risk of malnutrition with respect to the community dwelling elderly population. A study was therefore performed to evaluate the nutritional status of elderly subjects living in 8 nursing homes in the "D" health district in Frosinone (Italy). Subjects aged over 65 years living in one of the selected nursing homes since at least two months were invited to participate. Nutritional status was evaluated by anthropometric measurements to calculate the Body Mass Index and by data collected through the Mini Nutritional Assessment. Additional data regarding the subject's educational level, social life, family ties, length of stay in the facility, physical activity, medical conditions, frequency of diarrhoeal episodes and eating habits, were collected through a questionnaire. Statistical analysis of data was performed with Epi Info software version 3.3 One hundred eighty four subjects participated in the study, 69.4% of which had been admitted to the nursing home following a request by their family, mainly for health reasons or because the family could no longer take care of them. Approximately 38% of subjects admitted having a moderate decrease in functional independence. The mean BMI was found to be 27.3 while the mean MNA was 20.6, with no sex- or age-related differences. The prevalence of underweight based on BMI threshold values was 6.3%; 30.8% of subjects were normal weight. On the other hand, MNA results revealed that 13% of study subjects were malnourished and 66.1% were at risk for malnutrition. These results indicate that assessment of nutritional status in elderly subjects should not be based on BMI alone and that MNA is a more appropriate tool in the elderly as it allows for a dynamic evaluation of the risk of malnutrition in this population. The results of this study also show a high risk of malnutrition in the study sample, and confirm the need for increased surveillance of nutritional status among residents of nursing homes.

Prevalence of stress, anxiety and depression in with Alzheimer caregivers

BACKGROUND

Alzheimer's disease presents a social and public health problem affecting millions of Italians. Those affected receive home care from caregivers, subjected to risk of stress.The present investigation focuses on stress, anxiety and depression in caregivers.

METHODS

Data on 200 caregivers and their patients were collected using a specific form to assess cognitive, behavioural, functional patient (MMSE, and ADL-IAD) and caregiver stress (CBI). The relationship between stress, depression and disease has been assessed by means of a linear regression, logistic analysis which reveals the relationship between anxiety, stress and depression and cognitive problems, age, the patient's income.

RESULTS

The caregivers are usually female (64%), mean age of 56.1 years, daughters (70.5%), pensioners and housewives (30%), who care for the sick at home (79%). Of these, 53% had little time for themselves, 55% observed worsening of health, 56% are tired, 51% are not getting enough sleep. Overall, 55% have problems with the patient's family and/or their own family, 57% at work. Furthermore, 29% feel they are failing to cope with the situation as they wish to move away from home. The increase in the degree of anxiety and depression is directly proportional to the severity of the illness, affecting the patient (r = 0.3 stress and depression r = 0.4 related to CBI score). The memory disorders (OR = 8.4), engine problems (OR = 2.6), perception disorders (OR = 1.9) sick of the patient with Alzheimer's disease are predictive of caregiver stress, depression is associated with the presence of other disorders, mainly behavioural (OR = 5.2), low income (OR = 3.4), patients < 65 years of age (OR = 2.9).

CONCLUSION

The quality of life of caregivers is correlated with the severity of behavioural disorders and duration of the Alzheimer's disease. The severity of the disease plays an important role in reorganization of the family environment in families caring for patients not institutionalised. It is important to promote measures to soften the impact that the patient has on the caregiver, and that, at the same time, improves the quality of life of the patient.

What is the biopsychosocial role of human immunodeficiency virus positivity in patients with end-stage liver disease who undergo orthotopic liver transplantation?

INTRODUCTION

Since 2003 the National Research Program for Solid Organ Transplantation in patients with human immunodeficiency virus (HIV) is active at our liver transplantation center. Patients with HIV who enter this protocol are assessed by the Consultation Liaison Psychiatry Service. The aim of the present study was to evaluate their psychiatric comorbidity.

METHODS

An observational prospective study was conducted comparing end-stage liver disease (ESLD) patients with and without HIV. After the assessment, the psychiatrist compiled the Transplant Evaluation Rating Scale (TERS) and the Montgomery Asberg Depression Rating Scale (MADRS). Baseline evaluation was made before inclusion on the OLT waiting list and the follow-up evaluation was made 12 months later.

RESULTS

From January 2003 to December 2006 we assessed 553 patients: 39 (6%) with HIV and 361 (94%) without HIV. The 2 groups were homogeneous for gender (75% of male patients; P=not significant [NS]) but not for age (46+/-5 vs 56+/-9; P=NS). Psychiatric history was negative in 176 (49%) patients without HIV and in 6 (15%) patients with HIV (P< .001). At baseline psychiatric comorbidity was present in 33 HIV patients (85%) and in 148 non-HIV patients (41%; P< .001). At follow-up MADRS highlighted an improvement in all of the items for HIV patients. In the non-HIV group, the variation was as follows: baseline, 7.10; follow-up, 8.15. In the HIV group, the variation was as follows: baseline, 10.20; follow-up, 4.09 (P< .001). The average score at TERS was higher among patients with HIV (43+/-9 vs 35+/-9; P=NS).

CONCLUSIONS

At baseline HIV patients with ESLD showed a higher rate of psychopathology, but they improved at follow-up; the contrary happened in the non-HIV group.

Formulating policies for the welfare of animals during long distance transportation

Long distance transportation of animals creates much public concern in the European Union (EU) and elsewhere, partly because of its visibility to the general public. The protection of animals during transport is thus a key element of EU policy for farm animal welfare. At the same time, animal transport has been vital to the structure of the food chain in Europe since the beginning of the Common Agricultural Policy. The authors describe the formulation of EU policy on long distance transportation. Initiatives are based on scientific risk assessment and considerations of international guidelines. The two main objectives of EU policy are to reduce long distance transportation as far as possible and to upgrade standards for transported animals. The extent of detail in regulations depends on the ability of the sector concerned to address issues and on continual upgrading of the awareness and knowledge of transport operators on animal welfare which is universally important for progress. The economic impact of legislative measures must be evaluated as part of the policy process, noting that proper animal welfare standards can generate direct and indirect economic advantages. Awareness of these welfare advantages in all sectors is essential for raising the quality of enforcement. Finally, policy goals should be monitored to verify the extent of their fulfilment. Efforts from competent authorities and transport companies in Europe are improving the situation. However, a strong legislative framework is likely to remain the best option for the coming years to ensure that the welfare of transported animals is more than just a minimum.

[Indoor air quality in school facilities in Cassino (Italy)]

This study evaluated the indoor air quality of 26 classrooms of secondary schools in the city of Cassino (Italy). Two types of school buildings were assessed: buildings specifically designed as schools, and former dwellings converted to schools. Measurements were taken in both winter and spring months, before students entered the classrooms and while the classrooms were occupied. Lower thermal comfort levels were observed during the winter months; in fact, during the winter, ideal temperature, humidity and air speed parameters were found in only a small percentage of classrooms and students were found to experience thermal discomfort as a result. Air velocity was often found to be inadequate both in winter and spring months and in both types of school buildings evaluated. Illumination levels measured during the winter months with both natural daylight and mixed illumination, were found to be below 200 lux, the minimum recommended level recommended by the ministerial decree 18.12.1975. Noise levels above the maximum level recommended by the ministerial decree 01.03.1991 were also frequently observed. The symptoms most frequently reported by students were headache, difficulties in concentrating, cough, and unusual tiredness. The various discomfort situations observed in both types of school buildings point toward a need for greater attention toward indoor air quality of schools as this can have affect students' attention, concentration, productivity and comfort.

Neurophysiological effects of mobile phone electromagnetic fields on humans: a comprehensive review

In recent years a growing number of people have begun to use mobile phone technology. This phenomenon has raised questions and doubts about possible effects on users' brains. This literature review focuses on the human electrophysiological and neuro-metabolic effects of mobile phone (MP)-related electromagnetic fields (EMFs) published in the last 10 years. To this end, all relevant papers have been reported and, subsequently, a literature selection has been carried out by taking several criteria into account, such as: blind techniques, randomization or counter-balancing of conditions and subjects, detail of exposure characteristics and the statistical analyses used. As a result, only the studies meeting the selection criteria have been described, evaluated and discussed further. The main goal of this review is to provide a clear scenario of the most reliable experiments carried out over the last decade and to offer a critical point of view in their evaluation. It is concluded that MP-EMFs may influence normal physiology through changes in cortical excitability and that in future research particular care should be dedicated to both methodological and statistical control, the most relevant criteria in this research field.

Preventable infectious diseases using vaccination in developmental age in the province of Frosinone, Italy

INTRODUCTION

A study has been made of the behaviour of preventable infectious diseases by means of vaccination in the developmental age, reported between 1995 and 2003, in the area of Frosinone and Province, Italy.

RESULTS

. Analysis of the distribution of the 185 cases of hepatitis B notified, demonstrates that the mean age has increased from 26.5 to 41.1 years. Notifications of invasive diseases due to haemophilus influenzae type b (Hib) refer exclusively to 13 cases of meningitis. As far as concerns pertussis, 119 cases have been reported (median age 4.0 years, mode 1.0). Overall 850 cases of measles were reported (median age 7.0 years, mode 5.0), the highest number being recorded in 1997 (349 cases: median age 7.0 years, mode 5.0) and 2002 (199 cases: median age 8.0 years, mode 8.0). Rubella occurred in 411 cases (median age 12.0 years, mode 11.0), with 53.3% involving females. As far as concerns mumps, the last peak of the epidemic occurred in 2001 (median age 7.0 years, mode 6.0) with 137 cases.

DISCUSSION AND CONCLUSION

Results emerging from the study demonstrate a reduction in time in the number of notifications for almost all the diseases under consideration. The distribution of the cases of rubella infertile females, in 2002, stresses the need to promote campaigns in order to recuperate still-susceptible women of childbearing age. The cases of hepatitis B, pertussis and meningitis due to Hib confirm the high rate of protection resulting from vaccination. The incidence rates of measles, mumps, rubella and pertussis when compared with those of the paediatric sentinel surveillance system (SPES) clearly demonstrate not only that these are underestimated but also reveal controversial findings with respect to data provided by Infectious Diseases Italian Surveillance System (SIMI).

Newborn hearing screening project using transient evoked otoacoustic emissions: Western Sicily experience

OBJECTIVE

To study the incidence of congenital sensorineural hearing loss in all newborns introducing a screen test with a protocol no expensive, with a good "screen sensitivity" that could let an earlier identification of hearing impairment beginning early intervention by 2 months of age and increasing the probability of having language development within the normal range of development.

METHODS

The study was conducted in Sciacca hospital from the beginning of 2003 to our days and was carried out with transient evoked otoacoustic emission using the criteria for PASS or RETEST and considering eventual prenatal and perinatal risk factors. All the newborns were divided into four groups each one with its personal secondary step program.

RESULTS

In the years 2003-2004 the number of the newborns in Sciacca hospital was: 538 for 2003, 653 for 2004 with a total of 1191; all these infants were divided in three groups: resident in Sciacca, resident in the Sciacca borderlands and resident out of the district of Sciacca. The coverage (percentage of the target population who undergo the screen) was of 90% in the 2003 (483 newborns) and of 90% in the 2004 (585 newborns) with two cases of congenital sensorineural hearing loss identified. The incidence of sensorineural hearing loss, in the District of Sciacca, was estimated to be 2.07/1000 in 2003 and 1.70/1000 in 2004.

CONCLUSIONS

The higher incidence of sensorineural hearing loss in our study is due to a high prevalence of consanguineous marriage in Sicily that was shown to be linked with hearing impairment. The "sensitivity value" was 95% at the first step but became 99% after the second step with a few number of false positive (0.74%). All the infants with a diagnosis of sensorineural hearing loss began a rehabilitation program before the age of 5 months and they have a good speech development and speech intelligibility.

Frontal lobe syndrome or adolescent-onset schizophrenia? A case report

OBJECTIVE

To highlight the difficulties that abound in making a clinical distinction between early-onset schizophrenia (EOS) and juvenile frontal dementia early in the course of illness.

METHOD

Clinical information and data from investigations in single case was collated and reviewed.

RESULTS

A 15-year-old girl was admitted to our psychiatric unit because of cognitive decline and formal thought disorder with echopraxia, echolalia and palilalia, and a lack of flexibility in the use of cognitive and motor strategies that culminated in psychosis. A single photon emission computerized tomography scan showed marked frontal lobe hypoperfusion; however, on proton spectroscopy there was no differential in N-acetyl aspartate levels.

CONCLUSION

Hypofrontality in EOS is well established and the association of frontal functional alterations, neuropsychological impairment and psychotic symptomatology is suggestive of frontal lobe prodrome that precedes the onset of psychosis.

Nipple sparing subcutaneous mastectomy: sixty-six months follow-up

AIM

Validation of oncological and reconstructive efficacy of nipple sparing subcutaneous mastectomy.

METHODS

We enrolled 50 patients on behalf of Humanitas Centro Catanese di Oncologia fulfilling appropriate reconstructive and oncological criteria to undergo nipple sparing subcutaneous mastectomy. We preferably selected women with medium size-small breast affected by early stage breast cancer peripherally located with intra-operative negative frozen section of the major ducts.

RESULTS

fourty-six patients were alive after a mean follow-up of 5.5 years. We observed a single case of local recurrence in the nipple successfully treated with local excision. Five patients presented metastatic disease. One is currently alive, 4 died because of progressive disease.

CONCLUSIONS

Our study supports other findings regarding safety and efficacy of nipple sparing subcutaneous mastectomy for selected patients.

Side effects of corticosteroid therapy in children with chronic idiopathic thrombocytopenic purpura

In 29 symptomatic children of both sexes with chronic idiopathic thrombocytopenic purpura (CITP) with platelet counts < or = 30,000/mm3, of mean age 7.2 +/- 1.3 years, the side effects of long-term glucocorticoid therapy were evaluated. Patients were divided into three groups based on the different glucocorticoid protocols they were receiving. Baseline measurements (t0) of height (H) as standard deviation score (SDS), body mass index (BMI) as kg/m2 and bone mineral density (BMD) at the femoral neck (FBMD) and lumbar spine L2-L4 (LBMD) by a dual energy X-ray absorption technique, expressed as Z score, with follow-up measurements at 1 (t1) and 2 (t2) years were assessed. Group I patients (10 pts) treated with oral prednisone (2 mg/kg/die-for one month for 2 cycles) showed significantly different HSDS, BMI, FBMD and LBMD at t1 and t2 (P < 0.005) than other groups treated respectively with pulsed high doses of dexamethasone (24 mg/m2 over 4 days/months for 6 cycles) and methylprednisolone (9 mg/kg/die for 5 days for 3-4 months). These findings suggest that pulsed high doses of glucocorticoid lead to fewer side effects than oral prednisone therapy.

Alter Ego. Drug and brain--information to prevent. Compared analysis of opinions, knowledge and habits among a multicentric sample of secondary school students about drug addiction

Repression and control have been shown to be inadequate for drug addiction issues. Recent history, however has proved that information is one of the most effective measures against the spread of drugs. The wide range of drug circulation and the need for the spread of correct information on the effects of drugs in man, especially his brain, have led the Center for Scientific Culture Diffusion of Cassino University, to widen the scope of "Alter Ego. Drugs and the brain", a touring educational exhibition, which opened in 1994, by dedicating more attention to socially accepted drugs, such as alcohol and tobacco, and to new substances like ecstasy and similar drugs. Concurrently with the Alter Ego touring exhibition, a study was undertaken to obtain information on public awareness of the dangers of psychotropic drug abuse and to assess the effectiveness of the exhibition as an instrument of scientific information about drug addiction among its visitors, during its tour of over 60 Italian towns.

Impact of excess weight and estrogen receptor gene polymorphisms on clinical course of homozygous beta thalassemia

In homozygous beta thalassemic patients we examined the role played by the interaction of ER gene polymorphisms with adverse environmental factors. A total of 108 homozygous beta thalassemic patients, 60 prepubertal mean age 9,5 +/- 3,7 years (27 M, 33 F) and 48 pubertal mean age 22,2 +/- 5,4 years (21 M, 27 F), regularly treated with red cell transfusion and iron chelation therapy were segregated on the basis of their XbaI and PvuII ER gene polymorphisms. Body mass index (BMI), lipidic pattern and blood pressure values were evaluated in each group. No significant differences were observed between patients segregated by their PvuII ER genotypes. Prepubertal and pubertal patients of both sexes lacking XbaI site showed BMI, HDL, LDL cholesterol significantly different than the other patients. In addition, triglyceride levels and blood pressure values were significantly higher in pubertal patients of both sexes lacking XbaI site than in other patients. ER XbaI polymorphism appear to influence nutritional factors, metabolic status and blood pressure and could be considered additional risk factors for later cardiac involvement in beta thalassemic patients.

Is the brain influenced by a phone call?

We recorded the resting electroencephalogram of 20 healthy subjects in order to investigate the effect of electromagnetic field (EMF) exposure on EEG waking activity and its temporal development. The subjects were randomly assigned to two groups and exposed, in double-blind conditions, to a typical mobile phone signal (902.40 MHz, modulated at 217 Hz, with an average power of 0.25 W) before or during the EEG recording session. The results show that, under real exposure as compared to baseline and sham conditions, EEG spectral power was influenced in some bins of the alpha band. This effect was greater when the EMF was on during the EEG recording session than before it. The present data lend further support to the idea that pulsed high-frequency electromagnetic fields can affect normal brain functioning, also if no conclusions can be drawn about the possible health effects.

Dysmorphism of the middle ear: case report

Although there are numerous publications in the literature describing the wide range of diagnosis, classifications and treatment of malformations of the hearing apparatus, even more variations can be found in clinical practice. Indeed, each individual case is unique as far as concerns pathogenesis, clinical course and treatment. The case reported herein describes a 12-year-old boy affected by cranio-facial dysmorphism and monolateral conductive hearing loss in the right ear: followed from radiological diagnosis--carried out to study a malformation of the ear pinna--to surgical treatment.

[Economic management of institutional pharmacies of the city of Rosario. Quality indicators proposal]

OBJECTIVE

To compare structures, procedures and results of the pharmaceutical management of institutional pharmacies in the city of Rosario (Argentina), to define the current situation and thus recommend changes.

METHOD

Descriptive study, using a questionnaire and quality indicators of an Accreditation Program of Hospital Pharmacies. Evaluated dimensions: selection, acquisition, reception, storage and stock control of drugs and medical devices. Data was collected for a one-year-period in order to obtain indicators. After tabulation, data was discussed in meetings with all the pharmacists that participate in this study, in order to evaluate the situation and propose changes for the Pharmacies, as well as to evaluate the Program based on usefulness of these indicators.

RESULTS

The general results illustrate how each institution has different health policies. 43.2% of indicators were answered, 67.6% reached standard values.

CONCLUSIONS

This work allowed for an exhaustive analysis of the current situation. The pharmacists made proposals and unified criteria in order to obtain an improved use of the economic resources of each institution.

Time-course of electromagnetic field effects on human performance and tympanic temperature

The study aimed to investigate the time-course of electromagnetic field (EMF)-induced effects on human cognitive and behavioral performance and on tympanic temperature. Subjects were randomly assigned to two groups, exposed to a 902.40 MHz EMF before the testing session, or to the same signal during the data collecting session. Following a double-blind paradigm, subjects were tested on four performance tasks: an acoustic simple-reaction time task, a visual search task, an arithmetic descending subtraction task and an acoustic choice-reaction time task. Moreover, tympanic temperature was collected five times during each session. Results indicated an improvement of both simple- and choice-reaction times and an increase of local temperature on the exposed region under the active exposure. There was a clear time-course of the reaction time and temperature data, indicating that performance and physiological measures need a minimum of 25 min of EMF exposure to show appreciable changes.

Reduced sympathetic outflow and adrenal secretory activity during a 40-day stay in the Antarctic

Human adaptation to unknown and extreme environments requires changes in the psychological and physical homeostasis. We previously reported a significant decrease of anterior pituitary and adrenal hormonal levels and a significant modification of psychophysiological correlates of stress, such as galvanic skin response, after exposure to Antarctica, suggesting a possible decrease of individual arousal. The latter was hypothesized to be correlated with a modification of autonomic balance, mainly represented by a possible reduction of adrenergic output. The aim of the present study was to assess the patterns of hormonal circadian rhythms and the autonomic nervous system balance by means of spectral analysis of heart rate variability (HRV). These parameters were evaluated during 3 sessions (baseline, session 1 and session 2), before, at the beginning and after a 40-day stay in Antarctica (Station of Terra Nova Bay; average temperature in the study period: -11 degrees C, 24 h of light, sea level). In each of the sessions, 6 healthy male subjects underwent a 24-h electrocardiogram and blood sampling (08.00, 12.00, 16.00, 20.00, 24.00 and 08.00 h) for hormonal determinations. The data showed a remarkable decrease of hormonal levels without significant changes in circadian rhythms. Spectral analysis of HRV showed an imbalance of the autonomic nervous system with a relative significant decrease of the low frequency band (0.1 Hz) in session 1 and 2 compared to baseline, which can be functionally interpreted as a relative decrement of the sympathetic component. In conclusion, the exposure to a cold and extreme environment seems to affect autonomic balance over a 40-day period. This is followed by a significant reduction of the anterior pituitary and adrenal hormonal secretory patterns with preserved hormonal circadian rhythms (within the same time period of 40 days). This pattern is suggestive of a trophotropic neurovegetative adaptive process.