Risultati per: Anamnesi alimentare short e counselling sulla nutrizione smart per il medico di medicina generale

Measles cases worldwide rose by 20% in a single year—from about 8.6 million in 2022 to 10.3 million in 2023, which the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) attributed to insufficient immunization coverage.

Objective
The purpose of the study was to examine the association between short-acting beta agonist (SABA), antibiotic and oral corticosteroid (OCS) use and mortality and cardiopulmonary outcomes in chronic obstructive pulmonary disease (COPD).

Design
Retrospective cohort study using administrative health data from 1 April 2011 to 31 March 2020.

Setting
Alberta, Canada.

Participants
Patients ≥35 years old with COPD were identified using diagnostic codes.

Primary and secondary outcome measures
Patient characteristics included age, sex, geographical zone and comorbidities (as defined by the Charlson Comorbidity Index). Outcome variables included all-cause and COPD-related mortality. Outcomes were assessed in consecutive 90-day intervals, starting from cohort entry, paired with time-varying COPD-related medication history in the 1 year preceding each interval. Associations were modelled between mortality and SABA, antibiotic and OCS history, and between major adverse cardiac events (MACE) and cardiovascular disease (CVD) death and SABA history.

Results
Among 188 969 patients, dose–response effects were observed. Adjusting for covariates, rates were higher for patients with 6+ (vs 1) SABA dispenses (all-cause mortality HR: 1.20, 95% CI 1.16 to 1.24, p

Bartoletti,attenzione a sottobosco professionisti ‘improvvisati’

I trattamenti mirano a contrastare gli effetti collaterali delle terapie

Mi chiamo Federica Aimeri, sono un medico di medicina generale che lavora in un piccolo paese di campagna del nord Italia, in provincia di Cuneo. Sono anche una lettrice del…

Introduction
Individuals with higher neurological levels of spinal cord injury (SCI) at or above the sixth thoracic segment (≥T6), exhibit impaired resting cardiovascular control and responses during upper-body exercise. Over time, impaired cardiovascular control predisposes individuals to lower cardiorespiratory fitness and thus a greater risk for cardiovascular disease and mortality. Non-invasive transcutaneous spinal cord stimulation (TSCS) has been shown to modulate cardiovascular responses at rest in individuals with SCI, yet its effectiveness to enhance exercise performance acutely, or promote superior physiological adaptations to exercise following an intervention, in an adequately powered cohort is unknown. Therefore, this study aims to explore the efficacy of acute TSCS for restoring autonomic function at rest and during arm-crank exercise to exhaustion (AIM 1) and investigate its longer-term impact on cardiorespiratory fitness and its concomitant benefits on cardiometabolic health and health-related quality of life (HRQoL) outcomes following an 8-week exercise intervention (AIM 2).

Methods and analysis
Sixteen individuals aged ≥16 years with a chronic, motor-complete SCI between the fifth cervical and sixth thoracic segments will undergo a baseline TSCS mapping session followed by an autonomic nervous system (ANS) stress test battery, with and without cardiovascular-optimised TSCS (CV-TSCS). Participants will then perform acute, single-session arm-crank exercise (ACE) trials to exhaustion with CV-TSCS or sham TSCS (SHAM-TSCS) in a randomised order. Twelve healthy, age- and sex-matched non-injured control participants will be recruited and will undergo the same ANS tests and exercise trials but without TSCS. Thereafter, the SCI cohort will be randomly assigned to an experimental (CV-TSCS+ACE) or control (SHAM-TSCS+ACE) group. All participants will perform 48 min of ACE twice per week (at workloads corresponding to 73–79% peak oxygen uptake), over a period of 8 weeks, either with (CV-TSCS) or without (SHAM-TSCS) cardiovascular-optimised stimulation. The primary outcomes are time to exhaustion (AIM 1) and cardiorespiratory fitness (AIM 2). Secondary outcomes for AIM 1 include arterial blood pressure, respiratory function, cerebral blood velocity, skeletal muscle tissue oxygenation, along with concentrations of catecholamines, brain-derived neurotrophic factor and immune cell dynamics via venous blood sampling pre, post and 90 min post-exercise. Secondary outcomes for AIM 2 include cardiometabolic health biomarkers, cardiac function, arterial stiffness, 24-hour blood pressure lability, energy expenditure, respiratory function, neural drive to respiratory muscles, seated balance and HRQoL (eg, bowel, bladder and sexual function). Outcome measures will be assessed at baseline, pre-intervention, post-intervention and after a 6-week follow-up period (HRQoL questionnaires only).

Ethics and dissemination
Ethical approval has been obtained from the Wales Research Ethics Committee 7 (23/WA/0284; 03/11/2024). The recruitment process began in February 2024, with the first enrolment in July 2024. Recruitment is expected to be completed by January 2026. The results will be presented at international SCI and sport-medicine conferences and will be submitted for publication in peer-reviewed journals.

Trial registration number
ISRCTN17856698.

Società Italiana Nutrizione Umana, obiettivi più sani per 60%

I trattamenti mirano a contrastare effetti collaterali terapie

Dall’anno accademico 2025/26, esclusivamente in lingua inglese

At the well-controlled HbA1c of the participants, previous literature shows current diabetes treatments have similar HbA1c decreases, so the HbA1c mean difference of long half-life PDE5 inhibitors may indeed be clinically relevant. This suggests future investigation into PDE5 inhibitors as part of combination therapy or as therapy for high HbA1c individuals is needed, especially because of variable risk of biases, homogeneity, and sample sizes in our study.

Insulti dai no vax, ‘sono terrorizzato’

Insulti dai no vax, ‘sono terrorizzato’

Objective
Dose-response analysis of the effect of each additional contact where family planning (FP) was discussed during antenatal, delivery, postnatal or immunisation visits on the uptake of postpartum family planning (PPFP) within 12 months.

Design
A cohort where pregnant women were enrolled and reinterviewed approximately 12 months postpartum. Life table analyses examined differentials in probabilities of adopting contraception over 12 months postpartum by level of exposure to FP counselling. Competing risks regression analysis examined the dose effects in HRs by the number of maternal, newborn or child health (MNCH) contacts where FP was discussed, adjusted for confounding covariates.

Setting
Two Arsi zone woredas: Oromia and Ethiopia.

Participants and measures
722 pregnant women enrolled, and 706 successfully reinterviewed 12 months postpartum about each MNCH contact during pregnancy, delivery and later visits, whether these included any PPFP counselling and PPFP use.

Main results
Two-thirds of the cohort delivered at home. The average number of MNCH contacts women received was 7.6, while the average number where FP was discussed was 2.8. The cumulative probability of PPFP uptake was higher for women who received FP information during at least one MNCH contact, regardless of place of delivery. Each additional MNCH contact where FP was discussed increased the likelihood of PPFP uptake by 14% (95% CI 8% to 20%) or 9% (95% CI 5% to 13%), depending on place of birth. PPFP did not increase with additional contacts without FP information.

Conclusions
While PPFP conversations immediately after a facility birth generated the greatest chance of affecting use, integrating at every visit in the continuum had more impact.

Trial registration number
ClinicalTrials.gov, NCT03585361.

Glepaglutide is a long-acting GLP-2 analog developed to improve intestinal absorption in short bowel syndrome (SBS) patients. We conducted a trial to establish efficacy and safety of glepaglutide in reducing parenteral support (PS) needs in SBS patients with intestinal failure (IF).

Ordinaria di Medicina interna a Perugia, si insedierà nel 2028

Objective
To analyse the effects of tracheostomy timing on COVID-19 outcomes by comparing mortality rates at different time points (7, 10 and 14 days).

Design
Systematic review and meta-analysis.

Data sources
PubMed, Embase, Cochrane Library, Web of Science and Scopus were searched from 31 August 2023 to 6 September 2023.

Primary and secondary outcomes measures
The primary outcome was short-term mortality, defined as intensive care unit (ICU) mortality, hospital mortality and 28-day or 30-day mortality. The secondary outcomes included mechanical ventilation duration, ICU and hospital days.

Results
Among 3465 patients from 12 studies, the 10-day subgroup analysis revealed higher mortality for earlier tracheostomy than for later tracheostomy (49.7% vs 32.6%, OR 1.91, 95% CI 1.37–2.65). No significant differences were observed at 7- and 14-day marks. Earlier tracheostomy was associated with shorter mechanical ventilation (mean difference=–7.35 days, 95% CI –11.63 to –0.38) and ICU stays (mean difference=–11.24 days, 95% CI –18.50 to –3.97) compared with later tracheostomy. Regarding hospital stay, the later tracheostomy group exhibited a trend towards longer-term inpatients, with no significant difference.

Conclusions
No significant difference in short-term mortality was observed between patients undergoing tracheostomy at 7 and 14 days; however, at 10 days, later tracheostomy resulted in a lower mortality rate. Accordingly, subtle timing differences may impact short-term results in COVID-19 patients. Considering that the later tracheostomy group had longer mechanical ventilation and ICU stays, additional research is required to determine an optimal timing that reduces mortality cost-effectively.