54 research outputs found
Comuni-care in comunità per minori
No full textQuesto volume cerca di fornire un’alternativa alla solitudine e alla denigrazione
di cui sono oggetto le comunità per minori fornendo una diversa prospettiva:
un’esperienza possibile di formazione/supervisione a matrice relazionale
con uno scambio comunicativo intenso e regolare tra decine di
professionisti dell’intero territorio italiano per un anno si sono confrontati
quotidianamente sulle tematiche centrali dell’intervento di comunità sulla piattaforma on line del Master “Tutela,
diritti e protezione dei minori” dell’Università di Ferrara.
Comuni_care in comunità per minori è l’espressione di una nuova dimensione didattica, formativa e di supervisione che
supera i vincoli di spazi e tempi, senza rinunciare a un ambiente relazionale autenticamente connotato, che è principio
fondante di ogni comunità.
Alla presentazione di un modello di formazione/supervisione a matrice relazionale fa seguito l’approfondimento, attraverso
l’accurata disamina di dilemmi educativi, di narrazioni di casi presi in carico, di riflessioni sul proprio operato in
comunità, degli aspetti centrali di un intervento di comunità che non vuole rinunciare al suo mandato di accoglienza e
cura individualizzata. Nella seconda parte del volume vengono presentate tre diverse metodologie che consentono di
operare - con la mediazione del linguaggio cinematografico, tramite la narrativa per ragazzi e attraverso la co-costruzione
di un personale progetto educativo - in vista della costruzione di alleanze di lavoro con i ragazzi e le ragazze delle
comunità non rinunciando mai a considerarli/e innanzitutto persone uniche e destinatarie di specifici progetti di vita
OUP accepted manuscript
No full textThe story of heart failure (HF) traces a path from the oldest records of human healing
practices several millennia ago, winding through various changing models of
physiology, sickness and health. It passes through today’s landscape of neurohormonal
modulation, device therapy, and assist devices, towards a future of therapies,
some in development today, some as-yet unimagined, based on pathophysiological
insights yet to come. This review attempts to follow the path and notes the traces
left by earlier travellers, as well as the therapeutic improvements made possible by
the developments in our understanding of HF that followed from their successes and
failures. As we focus on pathophysiology, transplantation and mechanical assist devices
will be treated more cursorily. Likewise, as this is a history of the development
of modern (sometimes ‘Western’ although more properly ‘global’ or ‘scientific’)
medicine, alternative therapies are not discussed in this paper
Plasma soluble HLA-G levels in a cohort of heart failure patients exposed to chemicals
No full textHeart failure (HF) is a syndrome caused by structural and/or functional cardiac abnormalities, resulting in a reduced cardiac output and/or elevated intracardiac pressures. Several studies reported a crucial role of immune activation and inflammation in the chronic heart failure (HF) pathogenesis, suggesting that pro-inflammatory and anti-inflammatory mediators could be predictive markers of the HF development and/or progression. Human Leukocyte Antigen-G (HLA-G), a tolerogenic and anti-inflammatory class I non-classical major histocompatibility complex molecule, was reported to be upregulated in patients diagnosed with HF, suggesting a tentative to regulate the inflammatory condition. We evaluated soluble (s)HLA-G plasmatic levels in patients with stable chronic heart failure at baseline visit and after 6 and 12 months. The 14 bp Insertion/Deletion polymorphisms of the HLA-G gene was also analyzed. We showed that in HF subjects, sHLA-G levels were higher in NYHA class II and III subjects (mild-severe symptoms) (6.11 ± 1.15 ng/ml; 8.25 ± 2.27 ng/ml, respectively) in comparison with NYHA class I subjects (no symptoms) (2.35 ± 0.43 ng/ml) (I vs II: p = 0.0156; I vs III: p = 0.0122). Moreover, the exposure to chemicals seems to affect sHLA-G levels, with higher sHLA-G levels in exposed patients (3.36 ± 5.12 ng/ml) in comparison with unexposed subjects (2.01 ± 2.84 ng/ml). The HLA-G 3'UTR 14 bp INS/DEL polymorphism correlated with sHLA-G, with the 14 bp INS/INS genotype associated with higher sHLA-G levels during the 12 months follow-up in unexposed subjects (p = 0.008). In conclusion, these results support a correlation between sHLA-G levels, genetics and HF disease in presence of work chemical exposition
Incremental exercise using progressive versus constant pedaling rates: A study in cardlac patients
No full textPURPOSE: Cardiopulmonary exercise testing is widely used in clinical
assessment and exercise prescription. However, significant differences
in physiological responses can occur depending on testing protocol.
The aim of this study was to evaluate the cardiopulmonary responses
to different incremental cycle pedaling cadences in cardiac patients.
■ METHODS: Eleven men with coronary artery disease (CAD) and 12 men
with chronic heart failure (CHF) performed 2 maximal cycle tests at
constant cadence (60-70 rpm, at fixed cadence) and at progressive
cadence. Peak values for oxygen uptake (VO2peak), workload (Wpeak),
and heart rate (HRpeak); ventilatory threshold (VT); and the oxygen
uptake (VO2) per unit work rate (WR) increment (VO2/WR) obtained
using 2 protocols were determined.
■ RESULTS: Vo2peak and Wpeak, respectively, were higher during increasing
cadence (INCR) compared with fixed cadence (FIX) protocol both in
patients with CAD (32.7 5.4 vs 28.1 7.0 mL ̇ kg1 ̇ min1, P .01;
214 42 vs 150 28 W, P .001) and in patients with CHF (20.3 7.4
vs 17.2 5.5 mL ̇ kg1 ̇ min1, P .006; 133 45 vs 104 33 W,
P .005). No differences were seen in HRpeak. Both in patients with CAD
and in patients with CHF, O2 (21.7 5.5 vs 16.8 5.3 and 12.3 7.4
vs 9.3 2.8 mL ̇ kg1 ̇ min1) and HR (114 14 vs 98 13 and 92
17 vs 80 17 bpm) at VT were significantly higher in INCR than in FIX
protocol. No differences were seen in workload at VT. Vo2/WR during
INCR protocol were higher in patients with CAD (13.4 1.8 vs 9.5
2.6 mL ̇ kg1 ̇ W1, P .006) and patients with CHF (13.6 4.1 vs
8.7 1.9 mL ̇ kg1 ̇ W1, P .006).
■ DISCUSSION: These findings indicate that in tests at fixed cadence, there
occurs an earlier activation of the anaerobic mechanisms leading to a premature
exhaustion before a cardiopulmonary endpoint has been achieved.PURPOSE: Cardiopulmonary exercise testing is widely used in clinical assessment and exercise prescription. However, significant differences in physiological responses can occur depending on testing protocol. The aim of this study was to evaluate the cardiopulmonary responses to different incremental cycle pedaling cadences in cardiac patients.METHODS: Eleven men with coronary artery disease (CAD) and 12 men with chronic heart failure (CHF) performed 2 maximal cycle tests at constant cadence (60-70 rpm, at fixed cadence) and at progressive cadence. Peak values for oxygen uptake (VO(2peak)), workload (W(peak)), and heart rate (HR(peak)); ventilatory threshold (VT); and the oxygen uptake (VO(2)) per unit work rate (WR) increment (Delta VO(2)/Delta WR) obtained using 2 protocols were determined.RESULTS: Vo(2peak) and W(peak), respectively, were higher during increasing cadence (INCR) compared with fixed cadence (FIX) protocol both in patients with CAD (32.7 +/- 5.4 vs 28.1 +/- 7.0 mL . kg(-1) . min(-1), P = .01; 214 +/- 42 vs 150 +/- 28 W, P = .001) and in patients with CHF (20.3 +/- 7.4 vs 17.2 +/- 5.5 mL . kg(-1) . min(-1), P = .006; 133 +/- 45 vs 104 +/- 33 W, P = .005). No differences were seen in HR(peak). Both in patients with CAD and in patients with CHF, VO(2) (21.7 +/- 5.5 vs 16.8 +/- 5.3 and 12.3 +/- 7.4 vs 9.3 +/- 2.8 mL . kg(-1). min(-1)) and HR (114 +/- 14 vs 98 +/- 13 and 92 +/- 17 vs 80 +/- 17 bpm) at VT were significantly higher in INCR than in FIX protocol. No differences were seen in workload at VT.Delta Vo(2)/Delta WR during INCR protocol were higher in patients with CAD (13.4 +/- 1.8 vs 9.5 +/- 2.6 mL . kg(-1). W(-1), P = .006) and patients with CHF (13.6 +/- 4.1 vs 8.7 +/- 1.9 mL . kg(-1) . W(-1), P = .006).DISCUSSION: These findings indicate that in tests at fixed cadence, there occurs an earlier activation of the anaerobic mechanisms leading to a premature exhaustion before a cardiopulmonary endpoint has been achieved
In Vitro Endothelial Cell Proliferation Assay Reveals Distinct Levels of Proangiogenic Cytokines Characterizing Sera of Healthy Subjects and of Patients with Heart Failure
No full textAlthough myocardial angiogenesis is thought to play an important role in heart failure (HF), the involvement of circulating proinflammatory and proangiogenic cytokines in the pathogenesis and/or prognosis of HF has not been deeply investigated. By using a highly standardized proliferation assay with human endothelial cells, we first demonstrated that sera from older (mean age 52±7.6 years; n=46) healthy donors promoted endothelial cell proliferation to a significantly higher extent compared to sera obtained from younger healthy donors (mean age 29±8.6 years; n=20). The promotion of endothelial cell proliferation was accompanied by high serum levels of several proangiogenic cytokines. When we assessed endothelial cell proliferation in response to HF patients’ sera, we observed that a subset of sera (n=11) promoted cell proliferation to a significantly lesser extent compared to the majority of sera (n=18). Also, in this case, the difference between the patient groups in the ability to induce endothelial cell proliferation correlated to significant (P<0.05) differences in serum proangiogenic cytokine levels. Unexpectedly, HF patients associated to the highest endothelial proliferation index showed the worst prognosis as evaluated in terms of subsequent cardiovascular events in the follow-up, suggesting that high levels of circulating proangiogenic cytokines might be related to a worse prognosis
The prospective impact of chronic obstructive pulmonary disease on short-term prognosis of patients with chronic heart failure
No full textEchocardiographic Evaluation of Left Ventricular Output in Patients with Heart Failure: A Per-Beat or Per-Minute Approach?
No full textLeft ventricular (LV) output is a predictor of adverse outcome in patients with heart failure. It can be evaluated using a per-beat approach, measuring stroke volume index (SVI), or a per-minute approach, calculating cardiac index (CI). However, the prognostic value of these two approaches has never been compared
Attualità e nuove prospettive in tema di cardiogenetica
No full textIn recent years, cardiogenetics is emerging as a major discipline for the study of many pathologies, with immediate clinical effects for patients who were previously managed by the cardiologist alone. Recent acquisitions have allowed significant improvements in terms of diagnostic characterization, prognostic stratification and guidance for treatment for both patients with genetic disease and their family members. At present, cardiogenetics has an important role for the clinical management of patients with cardiomyopathies and channelopathies. We present an updated review of the literature and a proposal of organizational model
Predicting return to work after acute myocardial infarction: Socio-occupational factors overcome clinical conditions
No full textObjectivesReturn to work after acute myocardial infarction (AMI), a leading cause of death globally, is a multidimensional process influenced by clinical, psychological, social and occupational factors, the single impact of which, however, is still not well defined. The objective of this study was to investigate these 4 factors on return to work (RTW) within 365 days after AMI in a homogeneous cohort of patients who had undergone an urgent coronary angioplasty.ParticipantsWe studied 102 patients, in employment at the time of AMI (88.24% of men), admitted to the Department of Cardiology of the University-Hospital of Ferrara between March 2015 to December 2016. Demographical and clinical characteristics were obtained from the cardiological records. After completing an interview on social and occupational variables and the Hospital Anxiety and Depression (HADS) questionnaire, patients underwent exercise capacity measurement and spirometry.ResultsOf the 102 patients, only 12 (12.76%) held a university degree, 68.63% were employees and 31.37% self-employed. The median number of sick-leave days was 44 (IQR 33–88). At day 30, 78.5% of all subjects had not returned to work, at day 60, 40.8% and at day 365 only 7.3% had not resumed working. At univariate analyses, educational degree (p = 0.026), self-employment status (p = 0.0005), white collar professional category (p = 0.020) and HADS depression score were significant for earlier return to work. The multivariate analysis confirms that having a university degree, being self-employed and presenting a lower value of HADS depression score increase the probability of a quicker return to work.ConclusionsThese findings suggest that the strongest predictors of returning to work within 1 year after discharge for an acute myocardial infarction are related more to socio-occupational than to clinical parameters.</div
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