The Luigi Sacco Hospital VAS-COG stroke care pathway: A five-year experience

Background

Psycho-cognitive consequences are a frequent cause of disability in stroke survivors but are often underdiagnosed also because of lack of services dedicated to these aspects. We started assessing systematically cognitive and behavioral functions in acute stroke patients and to follow them up. Here, we report a retrospective analysis of the organization of the Sacco VAS-COG stroke care pathway and the refinements implemented during 5 years of activity.

Methods

The protocol includes baseline collection of clinical history, general and neurologic examinations, functional, neuropsychological, and neuroimaging assessment. At follow-up, a diagnosis of cognitive decline was made based on best clinical judgment in the first period (January 2018 to May 2019, namely VAS-COG protocol 1.0) and then based on an extensive neuropsychological battery (May 2019 to January 2023, namely VASCOG protocol 2.0); psychiatric and behavioral disturbances are investigated through suitable scales.

Results

From January 2018 to December 2022, 834 patients (mean age 76±13.6 years; 46.6 % females) with acute cerebrovascular events were admitted to the stroke unit, mostly (80 %) for ischemic strokes. Pre-event cognitive impairment was not assessable in 78 patients (9.3 %) because no reliable informant was present and was reported in 327/756 (43 %) patients. During follow-up, post-stroke cognitive impairment was detected in 124/217 (57.1 %) patients in VAS-COG protocol 1.0 and in 137/201(68.2 %) patients in VAS-COG protocol 2.0, while 95/218 (43.2 %) patients were found to be depressed and patients presented on average 2.5 neuropsychiatric symptoms on Neuropsychiatric Inventory-questionnaire.

Conclusions

The VAS-COG stroke care pathway represents a model for patients and for their families.

Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study

Background

Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies.

Objective

The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity.

Methods

After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app.

Results

Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet.

Conclusions

The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project.

Titania supported on silica as an efficient catalyst for deep oxidative desulfurization of a model fuel with exceptionally diluted H2O2

The continuous ODS of a model fuel, catalyzed by titanium nanocrystals dispersed onto silica, was performed with <1% aqueous H₂O₂.

Electrophilic activation of allenenes and allenynes: analogies and differences between Brønsted and Lewis acid activation

This review focuses on electrophilic activation of allenes by an acid. Key mechanistic features are presented together with recent synthetic applications.

Rapid screening of DOM's metal-binding ability using a fluorescence-based microplate assay

This note describes the development of a method to rapidly quantify the metal-binding ability of low-volume DOM samples based on their fluorescence properties. The method uses 96-well microplates to screen the fluorescence quenching observed when increasing concentrations of various metals are added to the pH-buffered DOM sample. Only 1.6 mL of DOM sample is required to quantify the binding affinity for each metal and the result is obtained in a few minutes. This study presents results for a surface soil DOM sample for which binding was assessed for Cu2+, Fe2+, Ni2+ at pH 5 and 9.

On the deposition of unipolarly charged particles in the human respiratory tract

The effect of unipolar electrostatic charges on the total deposition efficiency in the human respiratory tract has been investigated. Monodisperse carnauba wax particles of diameter between 0.3 and 1.1 micron were charged, in a corona discharge apparatus, with a number of elementary charges ranging from about 30 to 110 per particle, with a narrow distribution. The experiments were performed with volunteers breathing through the mouth at 12 resp/min at constant flow rate, without pauses. The increase in deposition was of the order of 15 to 30% relative to neutral but otherwise unchanged monodisperse aerosol. The increase depended on the charges carried by each particle, but was independent of the concentration. Therefore it may be concluded that the variation can be ascribed to the effect of electrostatic attraction between the particle charge and the image charge on the airway wall.