Therapeutic innovation in high-prevalence chronic diseases: Challenges and opportunities for specialist care models.

Therapeutic innovation is expected to change if not disrupt present care models for several chronic diseases in the coming years, as suggested by recent clinical trials. New drugs that anticipate and possibly delay the full expression of a disease will likely face some common challenges, such as the need of designing and implementing large scale interventions; the necessary engagement of multiple specialties for both diagnosis and treatment; the shift from specialist to non-specialist interventions and secondary prevention. Building on the case of HCV and other innovation in hepatology, we discuss common challenges caused by disruptive change that other chronic conditions faced in the past.

Relations among motivation, behaviour, and performance in writing: A multiple-group structural equation modeling study.

Background: Writing is a particularly demanding activity, which poses unique motivational challenges for students. Despite the wealth of research on the relation between writing motivation and writing performance, little is known about the role of students' writing frequency in writing motivation and writing performance.

Aims: We aimed to: (1) examine structural relations among two motivational variables (i.

Measuring Value in Health Care: A Comparative Analysis of Value-based Frameworks.

Purpose: This paper presents a comparative analysis of value-based frameworks (VBFs) developed in the United States and Europe for both drugs and medical devices.

Methods: The authors relied on a comprehensive literature review to identify relevant dimensions of analysis and available VBFs. Compared to previous studies on this topic, this study focused on the roles and strategic objectives of different institutions and organizations currently orchestrating the debate and development of VBFs and value-based initiatives.

What type of clinical evidence is needed to assess medical devices?

The objective of this mini-review is to discuss the role of real-world studies as a source of clinical evidence when experimental studies, such as randomised controlled trials (RCTs), are not available. Waiting for RCT evidence when the technology is diffusing could be anti-economical, inefficient from the policy perspective and methodologically questionable.We explain how real-world studies could provide relevant evidence to decision makers.

Real-world cost effectiveness of MitraClip combined with Medical Therapy Versus Medical therapy alone in patients with moderate or severe mitral regurgitation.

Background: We evaluated the real-world cost-effectiveness of the MitraClip system (Abbott Vascular Inc., Menlo Park, CA) plus medical therapy for patients with moderate/severe mitral regurgitation, as compared with medical therapy (MT) alone.

Methods: Clinical records of patients with moderate to severe functional mitral regurgitation treated with MitraClip (N=232) or with MT (N=151) were collected and outcome analyzed with propensity score adjustment to reduce selection bias.

Comparative effectiveness of Mitraclip plus medical therapy versus medical therapy alone in high-risk surgical patients: a comprehensive review.

In recent years, Mitraclip has become available as a treatment option for mitral regurgitation in high-risk surgical patients. Focusing on the incremental effectiveness of Mitraclip versus the current standard of care, this article provides a comparative review of the evidence on Mitraclip and standard medical therapy (MT) in high-risk mitral regurgitation patients. Evidence was retrieved from seven major databases.

Blood pressure changes and polycyclic aromatic hydrocarbons in outdoor workers.

Objectives: Everyday outdoor workers are exposed to chemicals including the polycyclic aromatic hydrocarbons (PAHs). The aim of the study is to evaluate the relationship between hydroxypyrene and blood pressure in outdoor workers.

Materials And Methods: 374 subjects of both sexes entered the study.

[Innovation in the ergonomic procedures for evaluating risk in building activities of the Abruzzo region (Italy)].

After the earthquake of L'Aquila, INAIL further stimulated the local Universities to train specialists in the prevention of occupational risks on construction sites. Since 2005 the University of Chieti-Pescara evaluated occupational stress (through the Karasek's JCQ) as well as perception of occupational risk of the building workers. Moreover, procedures (including planning) in the field of building technology were analyzed.

Perception of occupational risk by rural workers in an area of central Italy.

The aim of this study is to analyze the subjective perception of risks for rural workers in Abruzzo, an area of central Italy. A group of 273 workers were asked to fill in a questionnaire which included, apart from general information, questions relative to six different types of risks normally found in the field of agriculture. The types of risks considered were: falling from a height, manually moving loads, overturning/accident whilst driving an agricultural tractor, noise and vibration, use of pesticides, the risk of being cut/injured.

Occupational stress and biomechanical risk in a high fashion clothing company.

Psychosocial discomfort may amplify job-related risk factors. The aim of this study is to evaluate job stress in a high fashion clothing company with upper limb biomechanical overload due to repetitive and forceful manual activities. Biomechanical risk was analyzed and in part reduced using the OCRA Check list.

Job strain in different types of employment affects the immune response.

The immune system, in cooperation with neuroendocrine functions, defends from cancer and infections mainly by the activity of blood natural killer (NK) cells. Blood NK activity may be influenced by the type of employment since work is the central part of life; moreover, job stress is a situation affecting both neuroendocrine and immune systems. This study examines anxiety (by STAI 1 and 2), job strain (by the Karasek's JCQ) and blood NK activity (by an in vitro radio-isotopic method) of 134 male workers.

Daily intake of Lactobacillus casei Shirota increases natural killer cell activity in smokers.

Dietary probiotics supplementation exerts beneficial health effects. Since cigarette smoking reduces natural killer (NK) activity, we evaluated the effect of Lactobacillus casei Shirota (LcS) intake on NK cytotoxic activity in male smokers. The double-blind, placebo-controlled, randomised study was conducted on seventy-two healthy Italian blue-collar male smokers randomly divided for daily intake of LcS powder or placebo.

Analysis of occupational stress in a high fashion clothing factory with upper limb biomechanical overload.

Purpose: To study job stress and upper limb biomechanical overload due to repetitive and forceful manual activities in a factory producing high fashion clothing.

Methods: A total of 518 workers (433 women and 85 men) were investigated to determine anxiety, occupational stress (using the Italian version of the Karasek Job Content Questionnaire) and perception of symptoms (using the Italian version of the Somatization scale of Symptom Checklist SCL-90). Biomechanical overload was analyzed using the OCRA Check list.

Effects of palladium nanoparticles on the cytokine release from peripheral blood mononuclear cells of palladium-sensitized women.

Objective: To investigate the effects of palladium (Pd) nanoparticles on cytokine release from peripheral blood mononuclear cells (PBMCs) of control or Pd-sensitized nonatopic women.

Methods: TNF-α, IL-5, IL-10 and IFN-γ release and/or expression from PBMCs incubated in presence of 5 to 10 nm Pd nanoparticles or Pd salt (potassium hexachloropalladate) were determined by enzyme-linked immunosorbent assay and reverse transcription-polymerase chain reaction analysis. Transmission electronmicroscopy was performed.

Immunotoxicity of nanoparticles.

The interaction between NPs and immune system has been demonstrated, however, the data available are limited. Among all traits, i.s.

Work stress and innate immune response.

Several reports highlight the relationship between blood NK cytotoxic activity and life style. Easy life style, including physical activity, healthy dietary habits as well as good mental health are characterized by an efficient immune response. Life style is related to the type of occupational activity since work has a central part in life either as source of income or contributing to represent the social identity.

[In vitro study on the immune effects of the exposure to palladium nanoparticles].

Pd allergic contact dermatitis is increasing in the general population; aim of this preliminary study was to determine, in women with Pd sensitization, the cytokine release from PBMC exposed to Pd nanoparticles similar to those emitted from catalytic converters. PBMC of 8 non-atopic and of 5 Pd sensitized women were incubated with LPS stimulation in presence of Pd nanoparticles (5-10 nm) or potassium hexa-chloropalladate 10(-5) and 10(-6) M. This Pd salt inhibited IFN-gamma, TNF-alpha, IL-10 and IL-17 release from PBMC of non-atopic women, whereas Pd nanoparticles enhanced the release of IFN-gamma and inhibited that of TNF-alpha and IL-17.

[The development of organizational comfort: organizational training as strategic instrument for changing].

The organizational comfort has been defined as the relationship between people and work environment. The supervisor's functions imply organizing and relation competences, listening and observation, communication and negotiation. Unfortunately, the reality is quite different: there are often situations of communication disorder between the supervisor and the worker, where the first, unaware of his role and responsibility, doesn't understand the worker's needs, doesn't communicate rightly the risk, doesn't develop any emphatic attitude and organize work without thinking to individual inclinations and limitations.

Effects of palladium nanoparticles on the cytokine release from peripheral blood mononuclear cells of non-atopic women.

The object of this study is to determine the cytokine release from PBMCs exposed to Pd model nanoparticles emitted from catalytic converters. PBMCs of 8 healthy non-atopic women were incubated in the presence of Pd nanoparticles (5-10 nm) or salt (potassium hexa-chloropalladate) 10-5 and 10-6 M. Release of cytokines in supernatant of PBMCs was then determined.

[Comparison of the training schemes of the specialization schools of the public health area: a rational basis for a proposal of a core curriculum for the university training programme contained in article 38 of Legislative Decree (D.Lgs) 81/2008].

A document by the B. Ramazzini College of University Teachers of Occupational Medicine of the Italian Society of Occupational Health and Industrial Hygiene (S.I.

[Effects of occupational stress and job insecurity on the immune response].

The immune system responds to environmental signals. High blood NK activity characterizes individuals with a good life style and mental health condition or those exerting physical activity. Mental instability, depression and a poor life style exert opposite effects.

Occupational stress, job insecurity and perception of the health status in Italian teachers with stable or temporary employment.

The object of this study is to analyse job stress and insecurity and the perception of symptoms (health status) of 374 teachers (30 women and 74 men) with stable or temporary employment in schools in Pescara, a town in Central Italy. Job strain and job insecurity were analysed by an Italian version of the Karasek?s questionnaire, the perception of the health status by a 12 item test, and state and trait anxiety by STAI I and STAI II. There were no significant differences depending on the type of school.

Chlamydia pneumoniae and atherosclerosis: the role of mast cells.

Chlamydia pneumoniae (C. pneumoniae), a respiratory pathogen, has been implicated in the pathogenesis of atherosclerosis, an inflammatory progressive disease, characterized by the formation of atherosclerotic plaques. Among several types of inflammatory cells involved in the atherogenesis process, recently particular attention has been directed toward the mast cells.