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Aspetti giuridici e bioetici dell’Intelligenza Artificiale con particolare riferimento alla relazione medico-paziente. La prospettiva comunitaria nel recente Regolamento Europeo.
No full textL’Intelligenza Artificiale (IA) è ormai una realtà fortemente pervasiva in tutti gli ambiti sociali, scientifici, culturali. L’impatto sui sistemi sanitari è emerso ancor più durante la recente esperienza pandemica, garantendo un supporto concreto all’avanzamento della ricerca scientifica e alla modalità di assistenza ai pazienti e si sta sviluppando semprepiù in ambito neurologico. Sul retro della medaglia, in particolare in campo biomedico, devono essere identificate e valutate le ricadute nell’ambito della relazione medico-paziente, che da alleanza terapeutica diadica potrebbe evolversi in una relazione triadica in cui l’IA potrebbe introdurre nuove e inesplorate criticità. Le implicazioni in tema di generazione e tutela dell’enorme mole di dati, nonché sui possibili rischi in termini di violazione dei diritti umani e dei principi bioetici sono inquadrate nel contesto comunitario, alla luce del recente Regolamento europeo (AI ACT)
Sleep apnea, sleep disturbance, and fasting glucose variability: a pilot study
No full textBackground: Disturbed sleep and nocturnal altered breathing are related to disturbances of glucose metabolism. The present uncontrolled observational study explores the role of these factors on the variability of fasting glycemia. Methods: The number and duration of nocturnal awakenings and the fasting glycemia of 97 patients with type 2 diabetes treated with diet, metformin, or gliptins were recorded over seven consecutive days. During the same time period, the main respiratory indexes - oxygen disturbance index, apnea/hypopnea index, and respiratory disturbance index - were recorded for one night. Results: The three respiratory indexes and the number of nocturnal awakenings are highly correlated with the coefficient of variation of the fasting blood glucose recorded over the 7-day period at p < .005 level. A multiple regression analysis showed that the variables in the model explained 86% of the variability. Discussion: Respiratory/sleep disturbances appear to be modulators superimposed on blood glucose levels determined by other factors. © Diabetes Technology Society
Different prevalence of metabolic control and chronic complication rate according to the time of referral to a diabetes care unit in the elderly
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Acta Diabetologica
Volume 51, Issue 3, June 2014, Pages 447-453
Different prevalence of metabolic control and chronic complication rate according to the time of referral to a diabetes care unit in the elderly (Article)
Strollo, F.a ,
Guarino, G.b,
Marino, G.b,
Paolisso, G.c,
Gentile, S.b
a Endocrine-Metabolic Unit, INRCA, Rome, Italy
b Department of Clinical and Experimental Medicine, 2nd University of Naples, Naples, Italy
c Department of Geriatrics and Metabolic Diseases, 2nd University of Naples, Naples, Italy
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Abstract
The time of diagnosis is crucial for type 2 diabetes mellitus (T2DM) in terms of disease severity and chronic complications, as initial glycated haemoglobin (HbA1c) predicts 5-year cardiovascularmortality. The Italian health-care system relies on about 650 diabetes care units (DCU) interfacing with a large number of general practitioners (GPs). It may thus reach the goal of preventing complications easier than others by adopting a more comprehensive multifactorial approach. To assess whether the interval between diagnosis and referral to the DCU might influence the course of the disease in terms of HbA1c, associated cardiovascular risk factors, drug utilisation, and chronic complications in the elderly, the electronic records of 313 elderly T2DM patients (74.6 ± 4.9 years) followed by their GPs until referral to our DCU were retrospectively analysed for the above-mentioned parameters and divided into an early referral (ER) group (diagnosed within 12 months, n = 111) and a late referral (LR) group (diagnosed>12 months before, n = 202). A further set of 200 patients routinely taken care by our DCU, matched with the LR group for age, gender, and disease duration, was classified as "long-standing follow-up" (LSF) and compared to the others to rule out any confounding effects of long-standing disease per se on the clinical outcomes investigated in our study. About 35% of T2DM patients referred to our DCU within 12 months of diagnosis; the rest did so some 5 years after diagnosis. LR patients displayed worse HbA1c levels (10.8 vs. 7.7%, p < 0.01), used more drugs, and had more than twice as high complication rates as their ER counterparts. Almost all risk factors and complications were lower in the LSF (0.001 < p < 0.05) and ER groups than in the LR group. In both the ER and the LSF groups, we observed a lower burden of diabetes than in the LR group. This rules out the possibility that disease duration might play a major role per se in the burden of the disease in the elderly as opposed to the thoughtful patient care attitude exhibited by the DCU. A better and more efficient organisation has to be developed, including a strong interaction among GPs, diabetes specialists, and elderly people with T2DM allowing the latter to take charge of their own disease management through a sustained empowerment policy
Insulin-induced lipohypertrophy and factors affecting it in children and adolescents with type 1 diabetes mellitus: Review of the literature from the past 12 years: An appraisal and extension to adult subjects
Get PDFOur research group has dealt with injection-induced lip hypertrophy (IILH) in insulin-treated subjects for over a decade, focusing on causes and consequences, education, prevention and treatment, comorbidities, and related complications. Stimulated by an excellent Review that recently appeared on the pages of this Journal, we want to contribute insight into IILH. This brief Commentary underlines some key concepts on how to identify, prevent and cure them, pointing out salient aspects derived from our research to provide the scientific community with an as complete as possible overview of evidence-based knowledge and highlight the need for further experimental insights
Mental Rotation Task in a Pilot During and After Pregnancy
No full textIntroduction: Discordant findings have been reported about the change in pregnant women’s cognitive test performance. Visuo-spatial abilities, which are crucial in terrestrial/flight navigation, could be influ- enced by hormonal variations. Case report: A 32-yr-old Italian Air Force pilot underwent a 2-D Mental Rotation Task (MRT) and hormonal assess- ment in the second trimester of pregnancy and 1 yr after delivery. Her performance was compared with that of two nonpregnant groups of women: one with flying experience and the other without. Estradiol and progesterone were significantly higher in pregnancy compared with postpartum, while testosterone was almost unchanged. During preg- nancy, we observed a significant difference in the subject’s response time compared with pilots (she was slower) and nonpilots (she was faster). One year after delivery, her performance was still better than the nonpilot group and was almost the same as the pilot group. Discussion: Our data are consistent with an effect of pregnancy on visuo-spatial abil- ity that can last for some time after delivery, even with the early recovery of the hormonal levels. MRT smoothly changed in our subject, support- ing previous findings that women who are experts in flight navigation are less sensitive to hormonal fluctuations. Conclusion: In this case, visuo- spatial ability requiring effortful processing underwent variations during pregnancy and postpartum. Further studies are needed in order to con- firm our observations in a wider population
Metabolic consequences of incorrect insulin administration techniques in aging subjects with diabetes
No full textOnly few insulin-treated (IT) people with diabetes
mellitus (DM) reach the target due to poor compliance
and/or to sedentary lifestyle and/or to inadequate
treatment regimen. The latter may be also brought about by
often overlooked factors including insulin injection into
altered skin areas, often brought about by incorrect habits,
namely needle reutilization or poor compliance to the
suggestion to continuously rotate skin injection areas. The
aim of our study was to evaluate the rate of skin lesions
within the sites commonly used for insulin injection in our
IT DM patients and to verify whether a short-acting insulin
analogue yielded different metabolic effects when injected
in altered vs. normal skin areas. One hundred and eighty
well-trained IT people with type 1 and type 2 DM
(64 ± 15 years of age) consecutively referring to our unit
underwent a standard clinical examination involving an
accurate skin inspection protocol meant at looking for any
alterations eventually affecting all possible injection sites,
including bruising, multiple needle pricks and lipodystrophic
nodules (LN). They were also tested for HPLC
HbA1c determination and asked to fill in a standard
questionnaire on injection habits. Furthermore, seven male,
T1DM glulisine–glargine basal-bolus-treated patients in
this group were randomly injected 10 IU glulisine into
either normal skin (NS) or an LN by a nurse before a
standard, 405 kcal breakfast, for blood glucose and free
insulin determination at 0, 30, 45, 60, 75, 90, 120 and
150 min. More lesions were found in people over sixty
(P\0.01) and in women (P\0.05). A higher prevalence
of HbA1c[7.5% was found in patients with lesions (with
an O.R. of 3.74) and further confirmed by data obtained
from head-to-head comparison of insulin injection into an
LN and NS. In fact, injection into an LN proved to impair
and slow down insulin absorption, resulting in a higher
absolute value and a larger variability of blood glucose
levels than those observed by utilizing NS. This suggests us
to pay more attention to all aspects of patient–team relationship
to try and obtain good metabolic control in all
people with diabetes and even more in the elderly
Deficits in visuo-spatial but not in topographical memory during pregnancy and the postpartum state in an expert military pilot: a case report
No full textBackground: It is well known that cognitive and emotional changes occur during pregnancy, but little is known
about their magnitude or their time of occurrence and recovery. During pregnancy memory is one of the most
impaired cognitive functions. Although long-term aspects of memory have been investigated, other aspects of
memory have not yet been explored (i.e., navigational memory and reaching memory).
Case presentation: Here we describe the changes in reaching and walking memory that occurred during
pregnancy and one year after delivery in an Italian female military pilot (Case 1) with high spatial ability. In memory
tests she showed a classical dissociation between performance in reaching and walking distance, which indicated a
failure of working memory, learning, and storage in reaching space. This suggests that her expertise served as a
protective factor mitigating her low walking memory performance, and saving the topographical component.
We compared her performance with that of two non-pregnant control groups (i.e., women pilots and non-pilots)
and found that Case 1’s reaching memory performance was significantly worse than that of the control groups.
Even one year postpartum, Case 1’s performance was not yet the same as that of the other pilots.
Conclusions: These findings contribute to our knowledge of the specific, as yet unexplored, aspects of memory
deficits in women pilots during pregnancy and postpartum and suggest the need for better neuropsychological
assessment before these women return to work in operational environments
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
Get PDF“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
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