Contrasting Fake News in Oncology: The First Declaration of Good Communication.

PURPOSE: Nowadays, websites, online journals, and social media give access to an extraordinary amount of medical information. Misleading news are often disseminated generating false expectations, exaggerated anxiety, and confusion; in oncology setting, disinformation is perhaps more deleterious than in other fields, with a considerable impact on single patients as well as on families and, more in general, on Public Health. We aimed to promote a better interaction between the health care and the world of communication. MATERIALS AND METHODS: A regional technical table was established with the aim of drafting a shared document through the consensus conference method in the RAND/University of California Los Angeles variant, identifying strategies to overcome barriers between communication and health care as well as to propose common criteria for an effective dissemination of medical information. RESULTS: Sixteen articles met the inclusion criteria, from which 72 recommendations were drawn to the communication and health field (40 related to specific issues and 32 transversal to all the specific topics). Following an evaluation of relevance by the panel of experts, it was found that 57 recommendations scored more than 7, 13 between 4 and 6.9, and 2 below 4. CONCLUSION: This consensus and the drawn up document represent a concrete attempt to find a renewed and strategic alliance between key figures in health care and communication operators. As the American Declaration of Independence, our Declaration of Good Communication has identified high-impact recommendations for the best management of patients, providing simple but fundamental concepts and recommendations about effectiveness especially in oncology setting.

Utilization of Formal and Informal Care by Community-Living People with Dementia: A Comparative Study between Sweden and Italy.

Background: Dementia is a public health priority with a dramatic social and economic impact on people with dementia (PwD), their caregivers and societies. The aim of this study was to contribute to the knowledge on how utilization of formal and informal care varies between Sweden and Italy. Methods: Data were retrieved from two trials: TECH@HOME (Sweden) and UP-TECH (Italy). The sample consisted of 89 Swedish and 317 Italian dyads (PwD and caregivers). Using bivariate analysis, we compared demographic characteristics and informal resource utilization. Multiple linear regression was performed to analyze factors associated with time spent on care by the informal caregivers. Results: Swedish participants utilized more frequently health care and social services. Informal caregivers in Italy spent more time in caregiving than the Swedish ones (6.3 and 3.7 h per day, respectively). Factors associated with an increased time were country of origin, PwD level of dependency, living situation, use of formal care services and occupation. Conclusions: Care and service utilization significantly varies between Sweden and Italy. The level of formal care support received by the caregivers has a significant impact on time spent on informal care. Knowledge on the factors triggering formal care resources utilization by PwD and their caregivers might further support care services planning and delivery across different countries.

Pathophysiology of dyslipidemia in Cushing's syndrome.

Dyslipidemia seems to be less frequent than other metabolic comorbidities in human Cushing's syndrome. Nevertheless, it plays an important role in determining the global cardiovascular risk in overt and subclinical Cushing's syndrome. In Cushing's syndrome, there is an increase of triglyceride and total cholesterol levels whereas HDL can be at variable levels. Overt and subclinical Cushing's syndrome share many features with metabolic syndrome including insulin resistance, abnormal fasting glucose levels, hypertension, obesity and dyslipidemia. The pathogenetic mechanisms are multifactorial, including direct and indirect cortisol action on lipolysis, free fatty acid production and turnover, very-low-density lipoprotein synthesis and fatty accumulation in the liver. AMP-activated protein kinase mediates many of glucocorticoid-induced metabolic changes. Insulin resistance plays a key role in determining lipid abnormalities. Other hormonal changes are involved including growth hormone, testosterone in men and estrogen in women, catecholamines and cytokines. In vitro, cortisol increases lipoprotein lipase in adipose tissues and particularly in visceral fat where lipolysis is activated, resulting in the release of free fatty acids into the circulation. The increase of free fatty acids may enhance the accumulation of hepatic lipids reducing glucose uptake and activating various serine kinases which results in decreased insulin signaling. Moreover, mice with a liver-specific disruption of the glucocorticoid receptor had diminished hepatic triglycerides levels. In humans, a high prevalence (up to 20%) of hepatic steatosis was also reported in patients with Cushing's syndrome. Genetic variations in the glucocorticoid receptors may also affect the activity of cortisol, lipid metabolism and cardiovascular risk.