An Approach to Prevent Frailty in Community Dwelling Older Adults: a pilot study performed in Campania region in the framework of the PERSSILAA project.

We developed and tested an innovative physical training method in older adults that embeds the gym program into everyday life in the most conservative way possible. Physical training was included in the activities of local parishes where older women from Southern Italy spend most of their free time and was delivered by trained physical therapists with the support of an ICT tool known as CoCo. 113 older women (aged 72.0 [69.0-75.0] years) noncompliant to conventional exercise programs participated to the study. 57 of them underwent the final anthropometric assessment and 50 the final physical tests. In study completers handgrip strength and physical performance evaluated with the chair-stand, the two minutes step and the chair-sit and -reach tests significantly improved. Quality of life as evaluated with the EuroQol-5dimension (EQ-5D) questionnaire improved as well. In conclusion, a training program designed to minimally impact on life habits of older people is effective in improving fitness in patients noncompliant to other to physical exercise programs.

Health tourism: an opportunity for sustainable development.

In February 2017, the "Programma Mattone Internazionale Salute" (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "Age-Friendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities.

Innovative Approaches to Active and Healthy Ageing: Campania Experience to Improve the Adoption of Innovative Good Practices.

The demographic projections on the European population predict that people aged over 60 will increase by about two million/year in the next decades. Since 2012, the Campania Reference Site of the European Innovation Partnership on Active and Healthy Ageing supports the innovation of the Regional Health System, to face up demographic changes and sustainability. Campania Reference Site provides the opportunity to connect loco-regional stakeholders in social and health care services (universities, healthcare providers, social services, local communities and municipalities), with international organizations, in order to adopt and scale up innovative solutions and approaches. This paper describes the building process of Campania Reference Site and the main results achieved, that have been allowing it to become a hub for open innovation in the field of active and healthy aging at regional, national and international level.

[Diagnosis, therapy, and follow up in synchronous colorectal cancer of the colon]. / Diagnosi, terapia e follow-up dei cancri colorettali (CCR) sincroni del colon.

The authors report their experience with synchronous colorectal cancers (CRC). They underline the role of pre-operative diagnosis to improve surgical results and overall survival. The endoscopic surveillance allows the identification of neoplasms missed at previous examinations. In selected cases intraoperative colonoscopy may prove to be helpful.

Single-step treatment of gallbladder and bile duct stones: a combined endoscopic-laparoscopic technique.

BACKGROUND: The introduction of laparoscopic cholecystectomy has given rise to a debate as to whether endoscopic retrograde cholangiopancreatography (ERCP) should be performed before or after cholecystectomy in patients with bile duct stones. METHODS: This study evaluated the efficacy of treatment of cholecystocholedocholithiasis in a single step by performing ERCP during surgery in 52 patients (35 women, 17 men; mean age 57.0 years; age range 20 to 89 years). Laparoscopic intraoperative cholangiography via the cystic duct was carried out to confirm the presence of duct stones. A soft-tipped guidewire was passed through the cystic duct and papilla into the duodenum. A papillotome was inserted endoscopically over the guidewire. Endoscopic sphincterectomy was performed and the stones removed with balloon and basket catheters. RESULTS: Endoscopic stone removal was successful in 94% of cases without complications related to ERCP or surgery. Although operative time was lengthened by about 20 minutes, the hospital stay was as short and equal to that for simple laparoscopic cholecystectomy (3 days on average). CONCLUSIONS: The single-step combined endoscopic-laparoscopic technique is safe and effective for treatment of patients with gallbladder and bile duct stones.

Speed of information processing in traumatic brain injury: modality-specific factors.

OBJECTIVE: To assess speed of information processing by two serial addition tests (one visual, one auditory) in individuals with moderate-to-severe traumatic brain injuries (TBIs) and in a healthy, normal control group (NC). The tasks were designed to equate and control for accuracy of performance across the TBI and NC groups, thus allowing for quantification of information processing speed. DESIGN: Performance across groups and tasks were compared using 2 x 2 repeated measure analyses of variance (ANOVAs). In addition, each individual's processing speed was used to adjust rate of stimulus presentation on a subsequent "rehabilitation" trial to determine further whether this adjustment equated accuracy of performance. SETTING: Rehabilitation hospital. PATIENTS: 22 outpatients with moderate-to-severe TBI (6 women, 16 men; mean age = 34.6 years; duration of loss of consciousness = 22.6 days) and 20 age- and education-matched healthy controls. RESULTS: Processing speed was slower in TBI subjects, relative to controls and was significantly related to measures of executive functioning for those with TBI. Relative to controls, speed of processing in the TBI group was disproportionately slower when information was presented in the auditory, relative to the visual, modality. CONCLUSIONS: Speed of information processing is a major impairment in those with TBI when unconfounded by performance accuracy. The modality-specific impairment observed in the TBI group may, in part, be due to a greater within-modality interference effect created by the auditory version of the task. By manipulating information at a pace customized for an individual through compensatory strategies and environmental modifications, information-processing performance of TBI participants can be enhanced significantly.

Seasonal dependence of cadmium accumulation and Cd-binding proteins in Mytilus galloprovincialis exposed to cadmium.

At different periods of the year specimens of Mytilus galloprovincialis were exposed to 0.5 microg Cd/ml seawater for 7 days. Concentrations of trace elements (Cd, Zn, Cu and Fe) and Cd-binding proteins in gills, viscera, muscle and mantle were determined after 1 weeks exposure. Cadmium accumulation was higher in May and June and was tissue dependent; it was highest in the gills and decreased in the order: gills > viscera > mantle and adductor muscle. Significant seasonal variations of zinc, copper and iron, were also found, in both exposed and control molluscs. The percentage of Cd distribution between cytosol and pellet changed during the year; a clear shift from the particulate fractions to the cytosolic fractions was measured during May and June, especially in the gills. Metallothionein (MT) was the main ligand responsible for Cd accumulation, and this protein reached a maximum between May and June. Inclusion of mercaptoethanol during the purification procedure was found to improve MT isolation by gel chromatography. In the absence of mercaptoethanol, MT showed polymerization patterns which were season dependent and temperature independent, whereas its concentration was increased in mussels kept at higher temperature.

Primary carcinoma of the vagina. Case report.

An unusual case of Primary Carcinoma of the vagina was recently observed. The patient was treated surgically in 1981 for squamous cervical carcinoma in situ (CIN 3); eight years later the same patient was treated for squamous carcinoma of the vagina that involved the upper, median and lower tract. She was treated with radical colpectomy and VBP chemotherapy for three courses. The pathology, natural history and treatment are discussed.

[Schönlein-Henoch syndrome. Clinico-statistical analysis of 60 cases (1978-1984)]. / Sindrome di Schonlein-Henoch. Analisi clinico-statistica su 60 casi (1978-1984).

Schonlein-Henoch purpura is a systemic, immunocomplex-mediated vasculitis which involves skin, joints, gastrointestinal and urinary system. This is a retrospective study on 60 S.H.S. admitted in our Division from 1978 to 1984. The most affected age range seems to be included between 2 and 7 years, with a maximum at 6. The Male/Female ratio is 35/25. Clinically we found skin (100%), joint (63%), abdominal (48%), and renal (25%) manifestations. Laboratory data are not characteristic: C3 and C4 are always in the normal range. 27% showed an elevation of IgA, 81% a rise of sedimentation rate and 45% a rise of Anti-O-Streptolysin Title. The main problem to face is prevention of glomerulonephritis. Salicylates, piridamol and cyproheptadine have been suggested to be effective. Prednisone is recommended in all cases with abdominal pain in order to prevent surgical complications. In our experience we could not demonstrate any difference between treated and not treated cases. It is important anyway to perform a correct follow-up of these children to early show a possible relapse or a renal complication.