Il dolore oncologico come malattia nella malattia. Una ricerca nazionale sulle donne con tumore al seno

L’ipotesi di fondo su cui si basa l’intero lavoro è che il dolore oncologico debba essere riconosciuto come “malattia nella malattia”: non si può considerare tale dolore mero “sintomo” del cancro ma esperienza totale che coinvolge l’intera persona. Il dolore oncologico è carico di valenze e significati personali, è associato a rappresentazioni sociali e, come ogni malattia, è disease, illness e sickness. Partendo da questo presupposto, la dissertazione si è posta come obiettivo generale quello di studiare il dolore oncologico tra le donne con tumore al seno, le sue componenti sociali, psicologiche, individuali oltre che fisiche; si è voluto inoltre studiare la specificità del vissuto e dei significati associati all’esperienza dolorosa. Il lavoro è articolato in due parti fondamentali, una teorica ed una empirica. La prima presenta un inquadramento dei principali concetti della sociologia della salute riguardanti il dolore. Per quanto riguarda la parte empirica, si è fatto ricorso ad una ricerca mista, fatta di metodi misti e fondata su un approccio metodologico di natura integrativa che si avvale di tecniche quantitative e qualitative. La parte quantitativa si basa su una parte dei dati della ricerca nazionale ESOPO - Epidemiological Study of Pain in Oncology. Dall’intero campione sono state isolate le sole donne con tumore al seno (n=846). Si è proceduto quindi allo studio di tale campione, alle elaborazioni statistiche con il programma SPSS e all’interpretazione dei risultati. Per quanto riguarda la parte qualitativa, invece, è stata condotta un’analisi delle fonti che si è avvalsa di un approccio netnografico: è stata condotta un’osservazione non intrusiva di 12 blog scritti da donne con tumore al seno, con lo scopo di indagare le narrazioni di malattia, i vissuti personali, i significati di dolore e malattia e le loro ripercussioni sulla vita quotidiana.

From fall-risk assessment to fall detection: inertial sensors in the clinical routine and daily life

Falls are caused by complex interaction between multiple risk factors which may be modified by age, disease and environment. A variety of methods and tools for fall risk assessment have been proposed, but none of which is universally accepted. Existing tools are generally not capable of providing a quantitative predictive assessment of fall risk. The need for objective, cost-effective and clinically applicable methods would enable quantitative assessment of fall risk on a subject-specific basis. Tracking objectively falls risk could provide timely feedback about the effectiveness of administered interventions enabling intervention strategies to be modified or changed if found to be ineffective. Moreover, some of the fundamental factors leading to falls and what actually happens during a fall remain unclear. Objectively documented and measured falls are needed to improve knowledge of fall in order to develop more effective prevention strategies and prolong independent living. In the last decade, several research groups have developed sensor-based automatic or semi-automatic fall risk assessment tools using wearable inertial sensors. This approach may also serve to detect falls. At the moment, i) several fall-risk assessment studies based on inertial sensors, even if promising, lack of a biomechanical model-based approach which could provide accurate and more detailed measurements of interests (e.g., joint moments, forces) and ii) the number of published real-world fall data of older people in a real-world environment is minimal since most authors have used simulations with healthy volunteers as a surrogate for real-world falls. With these limitations in mind, this thesis aims i) to suggest a novel method for the kinematics and dynamics evaluation of functional motor tasks, often used in clinics for the fall-risk evaluation, through a body sensor network and a biomechanical approach and ii) to define the guidelines for a fall detection algorithm based on a real-world fall database availability.

Assessment of Daily Life Mobility Levels using Wearable Inertial Sensors and Minimun Measured Input Models

Tracking activities during daily life and assessing movement parameters is essential for complementing the information gathered in confined environments such as clinical and physical activity laboratories for the assessment of mobility. Inertial measurement units (IMUs) are used as to monitor the motion of human movement for prolonged periods of time and without space limitations. The focus in this study was to provide a robust, low-cost and an unobtrusive solution for evaluating human motion using a single IMU. First part of the study focused on monitoring and classification of the daily life activities. A simple method that analyses the variations in signal was developed to distinguish two types of activity intervals: active and inactive. Neural classifier was used to classify active intervals; the angle with respect to gravity was used to classify inactive intervals. Second part of the study focused on extraction of gait parameters using a single inertial measurement unit (IMU) attached to the pelvis. Two complementary methods were proposed for gait parameters estimation. First method was a wavelet based method developed for the estimation of gait events. Second method was developed for estimating step and stride length during level walking using the estimations of the previous method. A special integration algorithm was extended to operate on each gait cycle using a specially designed Kalman filter. The developed methods were also applied on various scenarios. Activity monitoring method was used in a PRIN’07 project to assess the mobility levels of individuals living in a urban area. The same method was applied on volleyball players to analyze the fitness levels of them by monitoring their daily life activities. The methods proposed in these studies provided a simple, unobtrusive and low-cost solution for monitoring and assessing activities outside of controlled environments.

Multi-pollutants impact on modern cement built heritage

It is well known that the deposition of gaseous pollutants and aerosols plays a major role in causing the deterioration of monuments and built cultural heritage in European cities. Despite of many studies dedicated to the environmental damage of cultural heritage, in case of cement mortars, commonly used in the 20th century architecture, the deterioration due to air multipollutants impact, especially the formation of black crusts, is still not well explored making this issue a challenging area of research. This work centers on cement mortars – environment interactions, focusing on the diagnosis of the damage on the modern built heritage due to air multi-pollutants. For this purpose three sites, exposed to different urban areas in Europe, were selected for sampling and subsequent laboratory analyses: Centennial Hall, Wroclaw (Poland), Chiesa dell'Autostrada del Sole, Florence (Italy), Casa Galleria Vichi, Florence (Italy). The sampling sessions were performed taking into account the height from the ground level and protection from rain run off (sheltered, partly sheltered and exposed areas). The complete characterization of collected damage layer and underlying materials was performed using a range of analytical techniques: optical and scanning electron microscopy, X ray diffractometry, differential and gravimetric thermal analysis, ion chromatography, flash combustion/gas chromatographic analysis, inductively coupled plasma-optical emission spectrometer. The data were elaborated using statistical methods (i.e. principal components analyses) and enrichment factor for cement mortars was calculated for the first time. The results obtained from the experimental activity performed on the damage layers indicate that gypsum, due to the deposition of atmospheric sulphur compounds, is the main damage product at surfaces sheltered from rain run-off at Centennial Hall and Casa Galleria Vichi. By contrast, gypsum has not been identified in the samples collected at Chiesa dell'Autostrada del Sole. This is connected to the restoration works, particularly surface cleaning, regularly performed for the maintenance of the building. Moreover, the results obtained demonstrated the correlation between the location of the building and the composition of the damage layer: Centennial Hall is mainly undergoing to the impact of pollutants emitted from the close coal power stations, whilst Casa Galleria Vichi is principally affected by pollutants from vehicular exhaust in front of the building.

Quantitative evaluation of household nutrition patterns: an econometric assessment of the UK 5-a-day impact on fruit and vegetable consumption

The present work provides an ex-post assessment of the UK 5-a-day information campaign where the positive effects of information on consumption levels are disentangled from the potentially conflicting price dynamics. A model-based estimate of the counterfactual (no-intervention) scenario is computed using data from the Expenditure and Food Survey between 2002 and 2006. For this purpose fruit and vegetable demand is modelled employing Quadratic Almost Ideal Demand System (QUAIDS) specification with demographic effects and controlling for potential endogeneity of prices and total food expenditure.

Synthesis of Modified Amino Acids and Insertion in Peptides and Mimetics. Structural Aspects and Impact on Biological Activity.

I studied the effects exerted by the modifications on structures and biological activities of the compounds so obtained. I prepared peptide analogues containing unusual amino acids such as halogenated, alkylated (S)- or (R)-tryptophans, useful for the synthesis of mimetics of the endogenous opioid peptide endomorphin-1, or 2-oxo-1,3-oxazolidine-4-carboxylic acids, utilized as pseudo-prolines having a clear all-trans configuration of the preceding peptide bond. The latter gave access to a series of constrained peptidomimetics with potential interest in medicinal chemistry and in the field of the foldamers. In particular, I have dedicated much efforts to the preparation of cyclopentapeptides containing D-configured, alfa-, or beta-aminoacids, and also of cyclotetrapeptides including the retro-inverso modification. The conformational analyses confirmed that these cyclic compounds can be utilized as rigid scaffolds mimicking gamma- or beta-turns, allowing to generate new molecular and 3D diversity. Much work has been dedicated to the structural analysis in solution and in the receptor-bound state, fundamental for giving a rationale to the experimentally determined bioactivity, as well as for predicting the activity of virtual compounds (in silico pre-screen). The conformational analyses in solution has been done mostly by NMR (2D gCosy, Roesy, VT, molecular dynamics, etc.). A special section is dedicated to the prediction of plausible poses of the ligands when bound to the receptors by Molecular Docking. This computational method proved to be a powerful tool for the investigation of ligand-receptor interactions, and for the design of selective agonists and antagonists. Another practical use of cyclic peptidomimetics was the synthesis and biological evaluation of cyclic analogues of endomorphin-1 lacking in a protonable amino group. The studies revealed that a inverse type II beta-turn on D-Trp-Phe constituted the bioactive conformation.

Analysis of the Slow Food movement impact on the farmers and rural areas’ sustainable development

The evaluation of the farmers’ communities’ approach to the Slow Food vision, their perception of the Slow Food role in supporting their activity and their appreciation and expectations from participating in the event of Mother Earth were studied. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was adopted in an agro-food sector context. A survey was conducted, 120 questionnaires from farmers attending the Mother Earth in Turin in 2010 were collected. The descriptive statistical analysis showed that both Slow Food membership and participation to Mother Earth Meeting were much appreciated for the support provided to their business and the contribution to a more sustainable and fair development. A positive social, environmental and psychological impact on farmers also resulted. Results showed also an interesting perspective on the possible universality of the Slow Food and Mother Earth values. Farmers declared that Slow Food is supporting them by preserving the biodiversity and orienting them to the use of local resources and reducing the chemical inputs. Many farmers mentioned the language/culture and administration/bureaucratic issues as an obstacle to be a member in the movement and to participate to the event. Participation to Mother Earth gives an opportunity to exchange information with other farmers’ communities and to participate to seminars and debates, helpful for their business development. The absolute majority of positive answers associated to the farmers’ willingness to relate to Slow Food and participate to the next Mother Earth editions negatively influenced the UTAUT model results. A factor analysis showed that the variables associated to the UTAUT model constructs Performance Expectancy and Effort Expectancy were consistent, able to explain the construct variability, and their measurement reliable. Their inclusion in a simplest Technology Acceptance Model could be considered in future researches.

Maternal Smoking Impact on the Delivery Cost: a population-based study in the Emilia-Romagna region

This doctoral thesis is devoted to the study of the causal effects of the maternal smoking on the delivery cost. The interest of economic consequences of smoking in pregnancy have been studied fairly extensively in the USA, and very little is known in European context. To identify the causal relation between different maternal smoking status and the delivery cost in the Emilia-Romagna region two distinct methods were used. The first - geometric multidimensional - is mainly based on the multivariate approach and involves computing and testing the global imbalance, classifying cases in order to generate well-matched comparison groups, and then computing treatment effects. The second - structural modelling - refers to a general methodological account of model-building and model-testing. The main idea of this approach is to decompose the global mechanism into sub-mechanisms though a recursive decomposition of a multivariate distribution.

Sublethal effects of a common neonicotinoid pesticide, thiamethoxam, on honey bees: impact on locomotion and thermoregulation

Neonicotinoids have been pointed to as a factor responsible for the increased honey bee colony losses in the last decades. Many studies have investigated the effects of the first marketed neonicotinoid, imidacloprid, while fewer have focused on thiamethoxam. One recent study showed that sublethal doses of thiamethoxam lead to colony failure by decreasing forager homing flight success. We thus decided to investigate the mechanism which caused this phenomenon. Our hypothesis was that this effect was caused by impairment of forager locomotion abilities. Therefore we tested the effects of sublethal acute and chronic exposures to thiamethoxam on forager walking (Chapter 2) and flight (Chapter 3) performances. The acute treatment (1.34 ng/bee) affected walking locomotion firstly triggering hyperactivity (30 min post-treatment) and then impairing motor functioning (60 min post-treatment). 2-day continuous exposures to thiamethoxam (32.5, 45 ppb) elicited fewer effects on walking locomotion, however both exposure modes elicited an increased positive phototaxis. Similarly, in flight experiments, the single dose (1.34 ng/bee) elicited hyperactivity shortly after intoxication (increased flight duration and distance), while longer and continuous exposures (32.5, 45 ppb) impaired forager motor functions (decreased flight duration, distance, velocity). It is known that flight muscles temperature needs to be precisely regulated by bees during flight. Therefore, we further hypothesized that the impaired flight performances of neonicotinoid intoxicated bees were caused also by thermoregulation anomalies. We tested the effects that acute thiamethoxam exposures (0.2, 1, 2 ng/bee) elicit on forager thorax temperature (Chapter 4). Foragers treated with high doses exhibited hyperthermia or hypothermia when respectively exposed to high or low environmental temperatures. In summary, we show that sublethal doses of thiamethoxam affected forager walking and flight locomotion, phototaxis and thermoregulation. We also display the intricate mode of action of thiamethoxam which triggered, at different extents, inverse sublethal effects in relation to time and dose.