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Infodemiology and Infoveillance of Multiple Sclerosis in Italy  [PDF]
Nicola Luigi Bragazzi
Multiple Sclerosis International , 2013, DOI: 10.1155/2013/924029
Abstract: Multiple Sclerosis (MS) is a chronic debilitating disease of probable autoimmune inflammatory nature, whose aetiology is not fully understood, despite the many efforts and investigations. In this manuscript, we review the concept of “Multiple Sclerosis 2.0”, that is to say the Internet usage by MS patients, for seeking health and disease-related material for self-care and self-management purposes, and we introduce a Google Trends-based approach for monitoring MS-related Google queries and searches, called MS infodemiology and infoveillance. Google Trends has already proven to be reliable for infectious diseases monitoring, and here we extend its application and potentiality in the field of neurological disorders. 1. Introduction 1.1. Multiple Sclerosis 2.0 Multiple Sclerosis (MS) is a chronic debilitating disease of probable autoimmune inflammatory nature, whose aetiology is not fully understood, despite the many efforts and investigations carried out [1, 2]. Being a chronic disorder, MS has a tremendous psycho-social burden [3, 4], and recently the concept of a Web-based aid for MS patients has emerged, collecting MS-related information and at the same time trying to reduce the stressors, enhancing the self-management of the disease, facilitating the interactions between the patients and the medical team, and accurately reporting to the physician the patients’ symptoms after their online registration [5]. Gunther Eysenbach coined the terms “infodemiology” and “infoveillance”, describing a new emerging approach for public health [6, 7], based on large-scale monitoring and data mining, within the conceptual framework of e-health and health Web 2.0 [8, 9]. Even if with some limitations and concerns, the Internet and the medical informatics are paving the way for new directions in the field of the epidemiological research, indicating new trends and strategies [10]. In the shift from a paternalistic medicine (P0 model) to a patient-centered approach (P6 model, where the six Ps stay personalized, preventive, predictive, participatory, psycho cognitive, and public) [11–13], patients tend to use Internet as a source of relevant health-related information, even if not all properly validated or reliable, for health education, for finding suggestions, for coping strategies, and for self-managing their disease [14]. The Internet has blurred geographical boundaries and other barriers, making it available to lay people a wealth of medical material which was rather difficult to reach before that [15]. This material could help the patients in the process of decision
A seasonal periodicity in relapses of multiple sclerosis? A single-center, population-based, preliminary study conducted in Bologna, Italy
Fabrizio Salvi, Ilaria Bartolomei, Michael H Smolensky, Angelo Lorusso, Elena Barbarossa, Anna Malagoni, Paolo Zamboni, Roberto Manfredini
BMC Neurology , 2010, DOI: 10.1186/1471-2377-10-105
Abstract: We considered 96 consecutive patients with severe MS relapse (29 men, 67 women, mean age 38.5 ± 8.8 years), referred to the Multiple Sclerosis Center, Bellaria Hospital, Bologna, Italy, between January 1, 2007 and December 31, 2008. Overall, we analyzed 164 relapses (56 in men, 108 in women; 115 in patients aged < 40 years, 49 in patients ≥40 years). Relapses were more frequent in May and June (12.2% each) and the least frequent in September (3.7%). Chronobiological analysis showed a biphasic pattern (major peak in May-June, secondary peak in November-December, p = 0.030). Analysis of monthly mean meteorological data showed a significant seasonal pattern in ambient temperature (peak in July, p < 0.001), relative humidity (peak in January, p < 0.001), and wind speed (peak in June, p = 0.011).In this Italian setting, we found a biphasic pattern (peaks in spring and autumn) in severe MS relapses requiring medical consultation by doctors of the MS specialty center, apparently unrelated to meteorological variables. Confirmations of the findings on larger multi-center populations residing in different climatic conditions are needed to further explore the potential seasonality of MS relapses and associated environmental triggers.Several medical conditions, in particular acute cardiovascular and cerebrovascular ones, exhibit prominent temporal patterns, i.e., 24-hour, weekly, and seasonal patterns in exacerbation and mortality. For example, a seasonal pattern, characterized by an autumn-winter excess of onset, has been recently confirmed in the Emilia-Romagna region of Italy for acute myocardial infarction [1], aortic diseases [2], and transient ischemich attack [3]. Little is known, however, about the seasonality of many other types of diseases, especially neurological ones, including multiple sclerosis (MS) and its relapses, particularly in Italy. Thus, we investigated, by means of a validated chronobiological statistical method, whether severe relapses of MS display seas
Adherence to monthly online self-assessments for short-term monitoring: a 1-year study in relapsing-remitting multiple sclerosis patients after start of disease modifying treatment
Jongen PJ,Sanders E,Zwanikken C,Koeman J
Patient Preference and Adherence , 2013,
Abstract: Peter Joseph Jongen,1 Evert Sanders,2 Cees Zwanikken,3 Jan Koeman,4 Leo H Visser,5 Petra Koopmans,6 Dirk Lehnick,7 OPTIVIT study group 1MS4 Research Institute, Nijmegen, 2Amphia Ziekenhuis, Breda, 3Maxima Medisch Centrum, Eindhoven, 4Admiraal de Ruyter Ziekenhuis, Vlissingen, 5St Elisabeth Ziekenhuis, Tilburg, 6Signidat, Groningen, The Netherlands; 7Nuvisan GmbH, Neu-Ulm, Germany Background: The participation of neurologists and patients in studies on the effectiveness and safety of newly authorized drugs in multiple sclerosis (MS) is insufficient. Monthly online self-assessments using patient-reported outcomes may help in short-term monitoring of neurological changes and side effects. Objective: Investigate in relapsing-remitting (RR) MS patients the adherence to monthly online self-assessments after the start of disease modifying treatment. Methods: Observational study in 39 neurological departments in The Netherlands. Patients starting glatiramer acetate treatment were instructed to complete online the Modified Fatigue Impact Scale 5-item version and the 8-item Leeds Multiple Sclerosis Quality of Life scale every month during 1 year (T0 toT12). Results: Sixty-three investigators included 163 analyzable patients. At T3, 148 (90.8%) patients had completed all questionnaires; at T6, 142 (87.1%); at T9, 133 (81.6%); and at T12, 123 (75.5%). Eight (4.9%) patients did not complete any questionnaire. Median values for inter-assessment intervals ranged from 32 to 34 days (first quartile [Q1] 30 days, third quartile [Q3] 41 days), and the final assessment was at 417 days (median: Q1 385 days, Q3 480 days). Forty-three (26.3%) patients completed the questionnaires at all time points (completion adherent) with their final assessment within 30 days after the scheduled T12 (interval adherent). Eighty (49.1%) patients were completion adherent, but not interval adherent. Forty (24.5%) patients were not completion adherent, as they discontinued assessments prematurely. Men were more interval adherent than women (47.5% vs 20.0%; P = 0.001). Conclusion: The observation that three out of four (75.5%) RRMS patients completed two short questionnaires at all monthly time points during 1 year after the start of disease modifying treatment suggests that intensive online monitoring in this patient group is feasible. As only one in five (19.6%) patients adhered to the time intervals between self-assessments, measures are needed that improve the timely completion of questionnaires. Keywords: effectiveness, glatiramer acetate, fatigue, health-related quality of life, MFIS-5, LM
Vascular Neurology Nurse Practitioner Provision of Telemedicine Consultations  [PDF]
Bart M. Demaerschalk,Terri-Ellen J. Kiernan,STARR Investigators
International Journal of Telemedicine and Applications , 2010, DOI: 10.1155/2010/507071
Abstract: Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was minutes, which included the vascular neurologist supervisory evaluation time of minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider. 1. Introduction The purpose of this preliminary study was to define, demonstrate, and evaluate a role for the vascular neurology nurse practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist in the context of an established hub and spoke stroke telemedicine network. NPs, physician assistants (PAs), and other physician extenders are no longer being relegated to subservient roles in health-care delivery. They are assuming an ever-increasing level of responsibility in patient care. With technological enablers, such as telemedicine, physician extenders’ future roles as specialty caregivers in rural communities will grow. Examples of physician—NP telemedicine partnerships already exist in rural emergency medicine, but none describe the potential role of a VN-NP telemedicine provider responding to cases of acute stroke. Physician extenders and midlevel providers have practiced emergency medicine for 25 years or more [1]. In the United States, it is estimated that NP and
A crítica literária na Itália napole nica: avalia es e contribui es de Ugo Foscolo The literary criticism in Napoleonic Italy: assessments and contributions of Ugo Foscolo  [cached]
Karine Simoni
Signótica , 2010, DOI: 10.5216/sig.v22i1.12728
Abstract: O artigo analisa as ideias do autor italiano Ugo Foscolo (1778-1827) sobre a crítica literária presente nos seus ensaios sobre literatura, e demonstra como a metodologia proposta pelo autor contribuiu para a renova o da crítica literária na Itália entre os séculos XVIII e XIX. This paper analyses the ideas of the Italian author Ugo Foscolo (1778-1827) about the literary criticism contained in his essays about literature, and demonstrates how the metodology proposed by the author contributed to the renewal of the literary criticism in Italy between the eighteenth and nineteenth centuries.
Urban freight consultations in the Paris region
Laetitia Dablanc,Diana Diziain,Hervé Levifve
European Transport Research Review , 2011, DOI: 10.1007/s12544-011-0049-2
Abstract: We analyse the difficulties encountered when conducting negotiations with the freight and logistics sectors in a complex urban environment. We describe the relationships between local and regional processes, showing how they have benefited from and sometimes overlapped with one another. Conditions for success are suggested, and a few guidelines are proposed.The Paris case leads to three conclusions. First of all, with regard to freight issues, specific consultations need to be implemented, because regular consultationsneglect freight transport issues. Secondly, freight consultations are of little use at the local and municipal levels. They need to be combined with metropolitan or region-wide consultation, because freight movement in urban areas is logistically connected to regional and national supply chains. Finally, it is important that consultation outcomes translate into effective changes in policies and behaviours. If not, well-intentioned freight companies willing to improve their urban operations will be discouraged from doing so and the very purpose of freight consultations, which is to promote more efficient and sustainable urban supply chains based on voluntary commitments, will be lost.
The mesenchymal stem cells in multiple sclerosis (MSCIMS) trial protocol and baseline cohort characteristics: an open-label pre-test: post-test study with blinded outcome assessments
Peter Connick, Madhan Kolappan, Rickie Patani, Michael A Scott, Charles Crawley, Xiao-Ling He, Karen Richardson, Kelly Barber, Daniel J Webber, Claudia AM Wheeler-Kingshott, Daniel J Tozer, Rebecca S Samson, David L Thomas, Ming-Qing Du, Shi L Luan, Andrew W Michell, Daniel R Altmann, Alan J Thompson, David H Miller, Alastair Compston, Siddharthan Chandran
Trials , 2011, DOI: 10.1186/1745-6215-12-62
Abstract: MSCIMS is a phase IIA study of autologous mesenchymal stem cells (MSCs) in secondary progressive MS. A pre-test : post-test design is used with healthy controls providing normative data for inter-session variability. Complementary eligibility criteria and outcomes are used to select participants with disease affecting the anterior visual pathway.Ten participants with MS and eight healthy controls were recruited between October 2008 and March 2009. Mesenchymal stem cells were successfully isolated, expanded and characterised in vitro for all participants in the treatment arm.In addition to determining the safety and feasibility of the intervention and informing design of future studies to address efficacy, MSCIMS adopts a novel strategy for testing neuroprotective agents in MS - the sentinel lesion approach - serving as proof of principle for its future wider applicability.ClinicalTrials.gov (NCT00395200).Multiple sclerosis (MS) is the commonest neurological cause of disability in young adults, affecting over 1.3 million people worldwide. It is a chronic multifocal and multiphasic immune mediated disorder characterised pathologically by inflammatory demyelination, axonal injury and partial remyelination [1]. Although recent evidence suggests that conventional disease modifying approaches can mitigate demyelination and secondary axonal loss resulting from focal inflammation if given during a narrow therapeutic-window in nascent RR-MS,[2,3] there are currently no therapies that slow, stop, or reverse progressive axonal loss in established disease. Mesenchymal stem cells (MSCs) are recognised as a candidate in this respect due to evidence that they promote oligodendrogenesis both in vitro and in vivo,[4,5] result in functional improvement in animal models of MS,[6,7] and confer benefit in non-neurological T-cell driven autoimmune human disease [8].Trial design for the assessment of putative neuroprotective agents in MS presents a range of challenges including the need t
Patients' and Observers' Perceptions of Involvement Differ. Validation Study on Inter-Relating Measures for Shared Decision Making  [PDF]
Jürgen Kasper, Christoph Heesen, Sascha K?pke, Gary Fulcher, Friedemann Geiger
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026255
Abstract: Objective Patient involvement into medical decisions as conceived in the shared decision making method (SDM) is essential in evidence based medicine. However, it is not conclusively evident how best to define, realize and evaluate involvement to enable patients making informed choices. We aimed at investigating the ability of four measures to indicate patient involvement. While use and reporting of these instruments might imply wide overlap regarding the addressed constructs this assumption seems questionable with respect to the diversity of the perspectives from which the assessments are administered. Methods The study investigated a nested cohort (N = 79) of a randomized trial evaluating a patient decision aid on immunotherapy for multiple sclerosis. Convergent validities were calculated between observer ratings of videotaped physician-patient consultations (OPTION) and patients' perceptions of the communication (Shared Decision Making Questionnaire, Control Preference Scale & Decisional Conflict Scale). Results OPTION reliability was high to excellent. Communication performance was low according to OPTION and high according to the three patient administered measures. No correlations were found between observer and patient judges, neither for means nor for single items. Patient report measures showed some moderate correlations. Conclusion Existing SDM measures do not refer to a single construct. A gold standard is missing to decide whether any of these measures has the potential to indicate patient involvement. Practice Implications Pronounced heterogeneity of the underpinning constructs implies difficulties regarding the interpretation of existing evidence on the efficacy of SDM. Consideration of communication theory and basic definitions of SDM would recommend an inter-subjective focus of measurement. Trial Registration Controlled-Trials.com ISRCTN25267500.
Tsunami risk assessments in Messina, Sicily – Italy  [PDF]
A. Grezio,P. Gasparini,W. Marzocchi,A. Patera
Natural Hazards and Earth System Sciences (NHESS) & Discussions (NHESSD) , 2012, DOI: 10.5194/nhess-12-151-2012
Abstract: We present a first detailed tsunami risk assessment for the city of Messina where one of the most destructive tsunami inundations of the last centuries occurred in 1908. In the tsunami hazard evaluation, probabilities are calculated through a new general modular Bayesian tool for Probability Tsunami Hazard Assessment. The estimation of losses of persons and buildings takes into account data collected directly or supplied by: (i) the Italian National Institute of Statistics that provides information on the population, on buildings and on many relevant social aspects; (ii) the Italian National Territory Agency that provides updated economic values of the buildings on the basis of their typology (residential, commercial, industrial) and location (streets); and (iii) the Train and Port Authorities. For human beings, a factor of time exposition is introduced and calculated in terms of hours per day in different places (private and public) and in terms of seasons, considering that some factors like the number of tourists can vary by one order of magnitude from January to August. Since the tsunami risk is a function of the run-up levels along the coast, a variable tsunami risk zone is defined as the area along the Messina coast where tsunami inundations may occur.
Is entanglement observer-dependent?  [PDF]
Italo Vecchi
Physics , 2001,
Abstract: The properties of quantum entanglement are examined and the role of the observer is pointed out.
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