Annali dell'Istituto Superiore di Sanità
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The Italian reference sites of the European innovation partnership on active and healthy ageing: Progetto Mattone Internazionale as an enabling factor
Get PDFBackground. Ageing population implies an increasing demand for health care services and resources, unsustainable according to current previsions. The European Commis-sion is tackling this challenge throughout initiatives such as the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), where all the efforts are aligned to the common goal of adding two active and healthy years to the life of European Union (EU) citizens. Method. We presented the collaborative efforts of Italian Reference Site Collaborative Network 2012-2015. Results. Italian regions joined forces through the “Progetto Mattone Internazionale” of the Ministry of Health developing several national and international collaborations. Activities from all five Italian reference sites are presented with different good practices and scale-up approaches for improving health in ageing population.Discussion. The simultaneous development of these activities allowed the strengthening of the coordination of Italian stakeholders in the European arena fostering collaboration and supporting the streamlining of the Italian regions still outside these projects
Sustainable public health systems for rare diseases
Get PDFIn the framework of the Joint Action for Rare Diseases (RD-ACTION), a specific task was defined to identify mechanisms influencing sustainability, equity and resilience of health systems for rare diseases (RDs).Method: literature narrative review on health systems sustainability and resilience for RDs. Years: 2000-2015. Databases: PubMed, Scopus, EBSCOHost, EMBAL, PASCAL, EMBASE, STN International and GoogleScholar. Analysis: interpretive synthesis concept and thematic analysis (Dixon-Wood et al.)Results: 97 papers and 4 grey literature publications were identified. Two main topics stand out: economic evaluation and networks. The first topic did not identify widely accepted criterion to assign more weight to individuals with greater health needs. Healthcare network are identified as increasingly important for sustainability and resilience, in all of their aspects: professional (‘expertise’), ‘experience’ networks of users and carers; policy, learning, and interest networks.In conclusion, possible mechanisms for ensuring sustainability can be identified in networking, patients’ empowerment and reorienting healthcare towards integrated community and home care
P4 Medicine versus Hippocrates
Get PDFHippocrates was the first to raise awareness of medicine as a science. He asserted the body being a unified whole and emphasized the importance of preventive and predictive medicine, spurring physicians to foster patient collaboration. Recent achievements today have permitted a new approach - ‛P4 medicine’ - Predictive, Preventive, Personalized and Participatory – with the aim of depicting an individual’s health history and molecular profile in determining the best medical intervention in maintaining or restoring wellbeing. This report highlights the link between Hippocrates and P4 Medicine. Moreover, it will discuss how P4 Medicine may help to refine the knowledge of Rare Diseases and define new procedures for faster diagnosis and better therapies. Additionally, it will reveal how Patient advocacy groups and the management of Rare Disease Registries already echo the P4 premises and purposes, underlining the social impact of the new diagnostic and therapeutic protocols
Organ transplantation from marginal and non-standard risk donors: ethical requisites for consent from recipients
No full textIn order to close the gap between available organs and patients needing transplants, the selection criteria for donors have gradually become more relaxed and many countries have defined expanded criteria for donor variables. However, the use of non-standard risk organs poses considerable ethical issues. The acceptability of the risk/benefit ratio depends primarily on a clinical assessment, and information given to the recipient and his/her eventual consent are crucial. Some of the requisites concerning information and consent are mandatory. Once these requisites have been defined in binding regulations, adequate margins must be allowed for their personalisation and to account for the unique nature of each physician/patient relationship. Each decision should be specific for a particular person, and it must be accepted that similar clinical situations may give rise to differing solutions that are nonetheless agreed by the physician and the patient
Sex-driven vulnerability in stress and drug abuse
Get PDFA growing body of literature shows that a link exists between substance abuse and stress and that the crosstalk of sex hormones with the neuroendocrine system might differently prime vulnerability to drug addiction in male and female subjects. Thus, understanding the neurobiological mechanisms of addiction and the identification of sex-driven determinants in vulnerability to drug abuse may help to better devise and/or implement strategic (pharmacological, behavioural, social) interventions to prevent or face the issue of addiction. Differences between sexes can be found at all stages of life (in both the animal model and human studies) and may account for genetic, epigenetic and environmental/ hormonal factors that in turn affect the functionality of the whole organism leading also to a sex-driven differential vulnerability or resilience to non-communicable pathologies. These include the onset and precipitation of stress-related psychiatric disorders as well as “substance-related and addictive disorders” (as defined in the DSM-V). This paper reviews the scientific literature highlighting significant differences in male and female subjects in stress and neuroendocrine function and the implications for sex-dependent differential vulnerability to drug addiction
Gender issues on occupational safety and health
Get PDFThe increasing proportion of women in the workforce raises a range of gender-related questions about the different effects of work-related risks on men and women. Few studies have characterized gender differences across occupations and industries, although at this time, the gender sensitive approach is starting to acquire relevance in the field of human preventive medicine. The European Agency for Safety and Health at Work has encouraged a policy of gender equality in all European member states. Italy has adopted European provisions with new specific legislation that integrates the previous laws and introduces the gender differences into the workplace. Despite the fact that gender equal legislation opportunities have been enacted in Italy, their application is delayed by some difficulties. This review examines some of these critical aspects
The gender perspective in cancer research and therapy: novel insights and on-going hypotheses
Get PDFCancer represents a leading cause of death whose incidence is steadily increasing worldwide due to the population aging. The Global Health Observatory of the World Health Organization reported that approximately 13% of all deaths are caused by cancer. In the 2012 the estimated total number of cancer deaths was 1.75 million, 56% in men and 44% in women. Gender is recognized to play a role in cancer incidence, progression and response to therapy. Besides anatomical and hormonal disparities, genetic differences should be considered when assessing the effects of gender on cancer. Accumulating evidence also support the existence of sex-driven differences in immune responses. Until today clinical trials and research in animal models have been gender unbalanced. In consideration of the differences between sexes observed in cancer, sex should represent an important stratification factor to be included in all randomized clinical trials for a better understanding of biological differences between men and women, which may yield improved targeted therapies