1,721,213 research outputs found
Migrant health: a value for public health
Full text linkAccording to United Nations estimates, 120 million of the approximately 175 million migrants worldwide are migrant workers and their families. Legal and illegal workers have a different status and, therefore, varying levels of access to social and health services.
According to WHO statements, the collective health needs and implications of this sizeable population are considerable and different health determinants and levels of vulnerability could impact on their health. The health matters associated with migration are crucial public health challenges faced by governments and societies.
The main public health goal is to avoid disparities in health status and access to health services between migrants and the host population. The second, closely associated, principle is to ensure migrants’ health rights, as stated during the 4th Conference on Migrant and Ethnic Minority Health in Europe which took place from 21st to 23rd June 2012 in Milan, where Migrants and ethnic minorities were confirmed a benefit to society.
This special issue of the Italian Journal of Public Health include each theme related to the main migrant health concerns such as mental health, women and child health, infectious diseases and workers health and safety. Other important issues are represented by Migrant Healthcare Policies and Inequalities in the Access to Social and Health Services.
In specific, Marceca, Geraci and Baglio (Italian Society of Migration Medicine), present a review of political, institutional and social aspects regulating immigrants’ health protection at international and Italian level, highlighting the importance of a cultural effort, even prior to the organizational one, for identifying instruments for equal policies for health without exclusions.
Domnich, Panatto, Gasparini and Amicizia, (department of Genoa University Health Sciences) discuss about the existence of “healthy immigrant” effect in Europe and present contrasting experiences, underlining how the “healthy immigrant” effect diminishes as the time since immigration increases. In order to limit this decline, it is important to try to reduce socio-sanitary disparities (healthcare access, unprotected working conditions).
Falzon, Zignol, Migliori and Raviglione (Stop TB Department - World Health Organization-) discuss the main associations between TB and migration based on data from recent publications on surveillance, policy and practice. Reports from different high-income countries with well-performing screening and treatment systems have shown that foreign-born TB patients do not contribute importantly to TB transmission in the native population.
Aragona, Pucci, Mazzetti and Geraci (Invisible Wounds” Project Caritas Health Service Network -Rome-) focus on post-migration living difficulties that significantly increase the risk of post-traumatic stress disorder in primary care “ordinary” migrants. Their hypothesis is that there is a re-traumatizing effect on individuals who are already vulnerable and with a low capacity to handle resettlement stress due to their previous traumatic history.
Fransen and colleagues, (Erasmus Medical Centre -Rotterdam-), explore to what extent midwives experience barriers in providing information about prenatal screening for Down syndrome to women from diverse ethnic backgrounds, and to assess their competences to overcome these barriers. They emphasize, in order to enable all pregnant women to make an informed decision whether or not to participate in prenatal screening, that midwives’ competences to address language barriers should be increased.
Four contributions address then aspects relating to health protection in a very susceptible age group: children and adolescents.
Buchegger-Traxler and Sirsch (University of Vienna) investigate how do adolescents cope with the consequences of living as migrants or refugees, how do they compare with their peers in the host country of refuge and if there are differences between males and females, in Austrian context. Their research leads to a better understanding of factors determining the well-being of adolescents and contributes to finding new approaches to prevent or cope with mental health problems of young immigrants.
Sisto, Gargiullo, Ranno and Valentini (Catholic University –Rome-), discuss that despite of the existing laws and a favourable resolution emanated by the European Parliament in 2011, full recognition of irregularly immigrated minors rights is bound in Europe to each State and in Italy to the legislation of every Region, thus nowadays still separating health rights for regular immigrated minors and for irregular ones.
Valentini, Gargiullo, Ceccareli and Ranno present a “Health check-in” for internationally adopted children as a model for all immigrant children validate by National Working Group for Immigrant Children, to check internationally adopted children at their entry to Italy, in order to assess their health status, often poorly documented; they show the data resulting from their experience using this “ad hoc” protocol.
Pfarwaller, (University Hospital -Geneva-), presents a review aimed at identifying risk and protective factors serving as a base for health promotion of young recent migrants in primary care.
Young migrants’ health was considered good at arrival, but deteriorated with length of stay due to factors linked to migration. Social support and family cohesion were identified as protective factors.
Finally Di Pietro, Teleman and Faggioni present the aspects related to classification, motivations and health consequences of the Female Genital Mutilation (FGM), the ethical aspects, the legislative measures and information campaigns brought forth by several organizations working to obtain, within the year 2012, an United Nations General Assembly Resolution that universally and explicitly bans all forms of FGM.
This edition, which collects the works of many Authors, offers to our readers some aspects of Migrant Health topics. The issues are all very complex and we thank the Author for the effort and the clarity of their contributions, coming from their competence and experience
University Teaching and Global Health
No full textGlobal health is a challenge to define, and even more of a challenge to improve. A broad definition of global health is given by the United States Institute of Medicine as health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions (1).
Most medical and post graduate students in rich countries think that there should be more teaching on global health issues, and many have led the way in calling for global health to be included in their curriculum. Little is known, however, a prosal is given. A broad understanding of health throughout the world, for diverse populations, is essential if doctors are to be seen as experts in health. If health professionals are to have a strong voice in discussions on health, they must grasp the international dimensions of their subject
Extracellular vesicles: emerging therapeutic agents for liver fibrosis
Full text linkLiver fibrosis is a progressive condition characterized by excessive scar tissue buildup, leading to impaired liver
function and potentially cirrhosis. Despite advancements in treatment strategies, effective anti-fibrotic therapies
remain an urgent unmet need. Recent research has identified extracellular vesicles (EVs) as promising therapeutic
agents due to their ability to mediate intercellular communication and regulate key fibrotic pathways. This review
aims to provide a comprehensive overview of the therapeutic potential of EVs in different in vitro and in vivo models
of hepatic fibrosis, focusing on their natural effects and recent advancements in their engineering for enhanced
efficacy. EVs can be derived from various cellular sources, including mesenchymal stromal cells (MSCs) and liverresident
cells. Biological materials, including serum, breast milk, bacteria, and plants, also serve as EV sources.
Among these, MSC-EVs stand out for their therapeutic potential, which can be significantly enhanced through
preconditioning with inflammatory signals, pharmacological agents, or genetic engineering to improve EV quality
and efficacy. Engineering techniques have further expanded EV applications, enabling their use as precise and
effective drug-delivery vehicles. Approaches such as loading EVs with pharmacological compounds, designing
customized EVs, and creating EV-liposome hybrids enable targeted delivery to activated hepatic stellate cells
(HSCs), central drivers of fibrosis progression. These strategies enhance the efficacy of EV-based treatments. Both
natural and engineered EVs regulate critical pathways of liver fibrosis development, including activation of HSCs,
modulation of pro-fibrotic genes, extracellular matrix deposition, and programmed cell death. Additionally, EVs
modulate immune responses, fostering a liver microenvironment conducive to repair and regeneration. Combining
the natural regenerative properties of EVs with innovative engineering strategies provides highly targeted, effective
treatment approaches to restore liver function and address the urgent unmet need for chronic liver disease therapies
Medicina globale e medicina globalizzata. La formazione dei nuovi professionisti della salute.
No full textPer avviare un percorso di vero sviluppo umano si deve partire inderogabilmente dalla salute. La salute incrocia fattori diversi e decisivi in tutte le fasi dell’esistenza: educazione, lavoro, equilibrio di genere, distribuzione delle ricchezze e accesso alle risorse, protezione sociale, capacità di autodeterminazione e qualità di una democrazia. La salute richiede di mettere in atto politiche intersettoriali e di verificare il grado di integrazione tra settori. La salute è un rilevatore dell’andamento di altri indicatori, e l’equità in salute misura la qualità e l’estensione della titolarità di cittadinanza attribuita agli individui in una società.
Ma le scuole di medicina sono in grado di formare professionisti capaci di rispondere ai bisogni di salute delle persone e delle comunità che andranno a servire? Come rispondono alle sfide che l’epoca della globalizzazione e della complessità pone? Come affrontano il tema della responsabilità sociale?
Nel 2010 la rivista «The Lancet» decise di costituire una Commissione con lo scopo di analizzare lo stato della formazione dei professionisti sanitari nel mondo e di fornire raccomandazioni per il futuro. L’iniziativa, dal titolo Education on health professionals for the 21st century: a global independent commission, coinvolse venti esperti provenienti da ogni parte del mondo: furono evidenziate clamorose diseguaglianze nella salute all’interno dei paesi e tra paesi, confermando il fallimento collettivo nel distribuire in maniera equa gli straordinari progressi della medicina. Ci troviamo inoltre a fronteggiare le nuove sfide della globalizzazione che includono nuove infezioni, rischi ambientali e comportamentali, insieme alla rapida transizione demografica ed epidemiologica. In tutto il mondo i sistemi sanitari faticano a restare al passo e diventano sempre più complessi e costosi, richiedendo un impegno sempre maggiore agli operatori sanitari.
Ma la formazione dei professionisti, in tutto il mondo, sembra aver sottovalutato tutto ciò: i programmi didattici delle università rimangono ancora fortemente ancorati ad una visione bio-medica e riduzionista e non abbracciano un approccio sistemico. Non vengono promossi lavori di gruppo, la stratificazione di genere è ancora ingiustificatamente mantenuta, si focalizza su problemi tecnici senza valutare il più ampio contesto, ci si concentra sui singoli episodi e si tralascia la continuità delle cure, si prediligono le cure ospedaliere a scapito delle cure primarie.
Negli ultimi anni è cresciuta la consapevolezza di questi limiti e non sono mancati i tentativi di innovare i piani di studi, che si sono però tradotti in iniziative marginali rispetto al nucleo centrale della formazione medica. A fronte delle riforme del sistema sanitario che si sono succedute, non si è pensato di fare una riforma non tanto della facoltà di medicina ma dei suoi paradigmi formativi.
Fare formazione in salute globale non vuol dire integrare i curricula universitari con tematiche specifiche, ma introdurre un nuovo modo di pensare e agire la salute per generare reali cambiamenti sia nella comunità sia nell’intera società. Riforme curriculari hanno aumentato e diminuito il numero degli esami, armonizzato e standardizzato alcuni parametri, non entrando nel merito dell’innovazione dell’approccio, dei contenuti e delle metodologie formative. Risulta invece cogente produrre dei cambiamenti nelle attitudini dei medici nei riguardi dei determinanti della salute, nell’assistenza sanitaria e nel sistema sociale,
In ambito formativo è importante introdurre gli studenti già nelle fasi iniziali della loro carriera di studi ai i determinanti sociali di salute perché ciò li aiuterà a migliorare la salute della società. La formazione sui determinanti sociali di salute dovrebbe essere inclusa tout court anche nelle discipline cliniche, dove la discussione sulle cause di una malattia dovrebbe tener conto del contesto familiare del paziente, del suo ambiente di vita e di lavoro. I problemi riguardanti le diseguaglianze nella salute e dei determinanti sociali di salute dovrebbero essere inseriti in tutte la parti del curriculum degli studi e nella formazione pratica.
Agli studenti inoltre dovrebbe essere fornita l’opportunità di fare esperienze in ambito sociale, a contatto con operatori sociali, gruppi comunitari, organizzazioni di volontariato.
La formazione dei professionisti sanitari ha bisogno di una riforma che produca due fondamentali risultati: l’apprendimento trasformativo e l’interdipendenza nell’educazione.
L’apprendimento trasformativo ha il compito di aiutare lo sviluppo della leadership e trasformare i professionisti in attori del cambiamento. L’interdipendenza è un elemento chiave in un approccio sistemico perché mette in evidenza il modo in cui varie componenti interagiscono l’una con l’altra, senza presupporre che queste debbano essere uguali. Come risultato finale l’interdipendenza nell’educazione produce alcuni passaggi importanti: da un’educazione isolata ad una armonizzata all’interno del sistema sanitario; da istituzioni autosufficienti a reti, alleanze, consorzi; da assetti istituzionali autoreferenziali a un patrimonio comune di flussi globali di contenuti educativi, risorse pedagogiche e innovazioni
Narrative review of in vitro experimental models of hepatic fibrogenesis
Full text linkBackground and Objective: Hepatic fibrosis is a pathological condition affecting millions of people worldwide that results from an improper tissue repair process, following liver injury or inflammation. Since progressive liver fibrosis can evolve into end-stage liver diseases, it is becoming increasingly important to develop efficient experimental models for evaluating new anti-fibrotic therapies. An important role in the onset and progression of hepatic fibrosis is played by hepatic stellate cells (HSCs), perisinusoidal vitamin A-storing cells that, in the presence of pro-fibrogenic stimuli, acquire a myofibroblast-like phenotype with an increased ability to produce extracellular matrix (ECM) components. In this review, we provide an overview of the traditional two-dimensional (2D) systems and of the innovative bioengineered three-dimensional (3D) models that allow for the screening of novel anti-fibrotic therapies.
Methods: Data presented in this narrative review were retrieved from scientific literature by searching the computerized database PubMed and MEDLINE for original and review papers describing different in vitro 2D and 3D culture systems that mimic hepatic fibrosis.
Key Content and Findings: Over the past years, most in vitro studies have focused on the mechanisms underlying HSC activation, using liver cells cultured in traditional 2D systems. The development of 3D in vitro models allowed studying the complex interactions between HSCs and the surrounding parenchymal and non-parenchymal cells, and between liver cells and ECM, thus improving the mimicking of the situation in vivo. Advanced bioengineered 3D models can replace in vivo models reducing the ethical concerns and biological issues.
Conclusions: Traditional and innovative in vitro cell culture systems represent a valid alternative to in vivo animal models in the investigation of the complex mechanisms involved in fibrosis development and in the discovery of new anti-fibrogenic compounds for the treatment of hepatic fibrosis
Anti-fibrotic and anti-inflammatory effect of mesenchymal stromal cell-derived extracellular vesicles in chronic kidney disease
Full text linkRenal fibrosis and inflammation are common pathological features of chronic kidney disease (CKD). Since currently available treatments can only delay the progression of CKD, the outcome of patients with CKD is still poor. One therapeutic option for the prevention of CKD-related complications could be the use of mesenchymal stromal cells (MSCs), which have shown beneficial effects in tissue fibrosis and regeneration after damage. However, safety issues, such as cellular rejection and carcinogenicity, limit their clinical application. Among the bioactive factors secreted by MSCs, extracellular vesicles (EVs) have shown the same beneficial effect of MSCs, without any notable side effects. This heterogeneous population of membranous nano-sized particles can deliver genetic material and functional proteins to injured cells, prompting tissue regeneration. Here we describe the anti-fibrotic and anti-inflammatory properties of MSC-derived EVs in CKD preclinical models and summarize the potential molecular mechanisms involved in the regulation of renal fibrosis and inflammation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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