Normare la vita. Biocontrollo e nuove tecnologie

Questa ricerca, suddivisa in due parti, si concentra sulle problematiche connesse alla normazione della vita e dei corpi delle donne al tempo delle biotecnologie. La Parte I è una genealogia filosofico-politica che ripercorre le tappe analitico-concettuali del dibattito intorno a biopolitica e tecnoscienza, a partire dai contributi teorici di poststrutturalismo e femminismo neomaterialista, e risponde alle domande: Cosa sono diventati i corpi nell’attuale società bio-info-modificata? Qual'è il ruolo delle scienze nelle metamorfosi che interessano soggettività e rapporti di potere? La Parte II è una cartografia dei modi in cui le biotecnologie, riguardanti i corpi delle donne, si sono sviluppate e diffuse. Essa indaga in modo transdisciplinare come in Italia, e più in generale in Europa, sono state normate le tecniche di interruzione volontaria di gravidanza e fecondazione in vitro. Ampio spazio è dedicato ai modi in cui gli attori della bioetica, istituzionale e non, i medici, laici e cattolici, e le case farmaceutiche hanno affrontato questi temi e quello della contraccezione ormonale maschile. Medicina riproduttiva e rigenerativa sono tematizzate sempre in relazione al quadro normativo, per mostrare in che modo esso influenzi l’accesso ai diritti alla salute e all’autodeterminazione delle donne. Il quadro normativo è analizzato, a sua volta, alla luce dei fatti storici più rilevanti e delle culture più diffuse. L’obiettivo della ricerca è duplice: da un lato essa ha il fine di mostrare il modo in cui i corpi delle donne, e la relativa potenza generatrice, siano diventati uno snodo fondamentale nell’articolazione del biocontrollo e nell'apertura dei nuovi mercati legati a medicina riproduttiva e rigenerativa; dall’altro si propone di argomentare come un biodiritto flessibile, a contenuto storico variabile, condiviso e partecipato, sia un’ipotesi praticabile e virtuosa, utile all'eliminazione del gender gap ancora esistente in materia di diritti riproduttivi e sessuali.

Foetal heart rate recording: analysis and comparison of different methodologies

Monitoring foetal health is a very important task in clinical practice to appropriately plan pregnancy management and delivery. In the third trimester of pregnancy, ultrasound cardiotocography is the most employed diagnostic technique: foetal heart rate and uterine contractions signals are simultaneously recorded and analysed in order to ascertain foetal health. Because ultrasound cardiotocography interpretation still lacks of complete reliability, new parameters and methods of interpretation, or alternative methodologies, are necessary to further support physicians’ decisions. To this aim, in this thesis, foetal phonocardiography and electrocardiography are considered as different techniques. Further, variability of foetal heart rate is thoroughly studied. Frequency components and their modifications can be analysed by applying a time-frequency approach, for a distinct understanding of the spectral components and their change over time related to foetal reactions to internal and external stimuli (such as uterine contractions). Such modifications of the power spectrum can be a sign of autonomic nervous system reactions and therefore represent additional, objective information about foetal reactivity and health. However, some limits of ultrasonic cardiotocography still remain, such as in long-term foetal surveillance, which is often recommendable mainly in risky pregnancies. In these cases, the fully non-invasive acoustic recording, foetal phonocardiography, through maternal abdomen, represents a valuable alternative to the ultrasonic cardiotocography. Unfortunately, the so recorded foetal heart sound signal is heavily loaded by noise, thus the determination of the foetal heart rate raises serious signal processing issues. A new algorithm for foetal heart rate estimation from foetal phonocardiographic recordings is presented in this thesis. Different filtering and enhancement techniques, to enhance the first foetal heart sounds, were applied, so that different signal processing techniques were implemented, evaluated and compared, by identifying the strategy characterized on average by the best results. In particular, phonocardiographic signals were recorded simultaneously to ultrasonic cardiotocographic signals in order to compare the two foetal heart rate series (the one estimated by the developed algorithm and the other provided by cardiotocographic device). The algorithm performances were tested on phonocardiographic signals recorded on pregnant women, showing reliable foetal heart rate signals, very close to the ultrasound cardiotocographic recordings, considered as reference. The algorithm was also tested by using a foetal phonocardiographic recording simulator developed and presented in this research thesis. The target was to provide a software for simulating recordings relative to different foetal conditions and recordings situations and to use it as a test tool for comparing and assessing different foetal heart rate extraction algorithms. Since there are few studies about foetal heart sounds time characteristics and frequency content and the available literature is poor and not rigorous in this area, a data collection pilot study was also conducted with the purpose of specifically characterising both foetal and maternal heart sounds. Finally, in this thesis, the use of foetal phonocardiographic and electrocardiographic methodology and their combination, are presented in order to detect foetal heart rate and other functioning anomalies. The developed methodologies, suitable for longer-term assessment, were able to detect heart beat events correctly, such as first and second heart sounds and QRS waves. The detection of such events provides reliable measures of foetal heart rate, potentially information about measurement of the systolic time intervals and foetus circulatory impedance.

Country-of-Origin Labeling for Processed Foods

The country-of-origin is the “nationality” of a food when it goes through customs in a foreign country, and is a “brand” when the food is for sale in a foreign market. My research on country-of-origin labeling (COOL) started from a case study on the extra virgin olive oil exported from Italy to China; the result shows that asymmetric and imperfect origin information may lead to market inefficiency, even market failure in emerging countries. Then, I used the Delphi method to conduct qualitative and systematic research on COOL; the panel of experts in food labeling and food policy was composed of 19 members in 13 countries; the most important consensus is that multiple countries of origin marking can provide accurate information about the origin of a food produced by two or more countries, avoiding misinformation for consumers. Moreover, I enhanced the research on COOL by analyzing the rules of origin and drafting a guideline for the standardization of origin marking. Finally, from the perspective of information economics I estimated the potential effect of the multiple countries of origin labeling on the business models of international trade, and analyzed the regulatory options for mandatory or voluntary COOL of main ingredients. This research provides valuable insights for the formulation of COOL policy.

Antiepileptic drugs and pregnancy. Population based pharmaco-epidemiological study on prescription patterns, pregnancy outcome and foetal health

Aims of the study: To assess the prevalence of Antiepileptic Drug (AED) exposure in pregnant women with or without epilepsy and the comparative risk of terminations of pregnancy (TOPs), spontaneous abortions, stillbirth, major congenital malformations (MCMs) and foetal growth retardation (FGR) following intrauterine AED exposure in the Emilia Romagna region (RER), Northern Italy (4 million inhabitants). Methods: Data were obtained from official regional registries: Certificate of Delivery Assistance, Hospital Discharge Card, reimbursed prescription databases and Registry of Congenital Malformations. We identified all the deliveries, hospitalized abortions and MCMs occurred between January 2009 and December 2011. Results: We identified 145,243 pregnancies: 111,284 deliveries (112,845 live births and 279 stillbirths), 16408 spontaneous abortions and 17551 TOPs. Six hundred and eleven pregnancies (0.42% 95% Cl: 0.39-0.46) were exposed to AEDs. Twenty-one per cent of pregnancies ended in TOP in the AED group vs 12% in the non-exposed (OR:2.24; CI 1.41-3.56). The rate of spontaneous abortions and stillbirth was comparable in the two groups. Three hundred fifty-three babies (0.31%, 95% CI: 0.28-0.35) were exposed to AEDs during the first trimester. The rate of MCMs was 2.3% in the AED group (2.2% in babies exposed to monotherapy and 3.1% in babies exposed to polytherapy) vs 2.0% in the non-exposed. The risk of FGR was 12.7 % in the exposed group compared to 10% in the non-exposed. Discussion and Conclusion: The prevalence of AED exposure in pregnancy in the RER was 0.42%. The rate of MCMs in children exposed to AEDs in utero was almost superimposable to the one of the non-exposed, however polytherapy carried a slightly increased risk . The rate of TOPs was significantly higher in the exposed women. Further studies are needed to clarify whether this high rate reflects a higher rate of MCMs detected prenatally or other more elusive reasons.