Dati preliminari dello studio multicentrico caso-controllo "Grave danno epatico acuto indotto da farmaci"

Il danno epatico indotto dall'assunzione di farmaci viene comunemente indicato con il termine inglese DILI (Drug-Induced Liver Injury). Il paracetamolo rappresenta la causa più comune di DILI, seguito da antibiotici, FANS e farmaci antitubercolari. In particolare, i FANS sono una delle classi di farmaci maggiormente impiegate in terapia. Numerosi case report descrivono pazienti che hanno sviluppato danno epatico fatale durante il trattamento con FANS; molti di questi farmaci sono stati ritirati dal commercio in seguito a gravi reazioni avverse a carico del fegato. L'ultimo segnale di epatotossicità indotto da FANS è associato alla nimesulide; in alcuni paesi europei come la Finlandia, la Spagna e l'Irlanda, la nimesulide è stata sospesa dalla commercializzazione perché associata ad un'alta frequenza di epatotossicità. Sulla base dei dati disponibili fino a questo momento, l'Agenzia Europea dei Medicinali (EMA) ha recentemente concluso che i benefici del farmaco superano i rischi; un possibile aumento del rischio di epatotossicità associato a nimesulide rimane tuttavia una discussione aperta di cui ancora molto si dibatte. Tra le altre classi di farmaci che possono causare danno epatico acuto la cui incidenza tuttavia non è sempre ben definita sono gli antibiotici, quali amoxicillina e macrolidi, le statine e gli antidepressivi.Obiettivo dello studio è stato quello di determinare il rischio relativo di danno epatico indotto da farmaci con una prevalenza d'uso nella popolazione italiana maggiore o uguale al 6%. E’ stato disegnato uno studio caso controllo sviluppato intervistando pazienti ricoverati in reparti di diversi ospedali d’Italia. Il nostro studio ha messo in evidenza che il danno epatico da farmaci riguarda numerose classi farmacologiche e che la segnalazione di tali reazioni risulta essere statisticamente significativa per numerosi principi attivi. I dati preliminari hanno mostrato un valore di odds ratio significativo statisticamente per la nimesulide, i FANS, alcuni antibiotici come i macrolidi e il paracetamolo.

The genetic history of Italians: new-insights from uniparentally-inherited markers

Genetic differences among human groups can be ascribed both to the broad-scale extents of pre-historical and historical migrations and to the fine-scale impacts of socio-cultural and geographic heterogeneity. In this thesis, the genetic information provided by uniparental markers were exploited to address different aspects of the Italian population history, by combining macro- and micro-geographic investigations at different spatial and temporal scales. To firstly assess the overall Italian variability, Y-chromosome and mtDNA markers were deeply typed in ~900 individuals from continental Italy, Sicily and Sardinia. Sex-biased patterns and contrasting demographic histories were observed for males and females. Differential European and Mediterranean contributions were invoked to explain the paternal genetic sub-structure observed in peninsular Italy, compared to the homogeneous maternal genetic landscape. If Neolithic showed to be one principal determinant of the detected paternal structure, local insights into specific Italian regional contexts highlighted the importance of Post-Neolithic contributions. Among them, migrations from the Balkans (particularly Greece) during late Metal Ages, played a relevant role in the cultural and genetic transitions occurred in Sicily and Southern Italy. On a finer geographic and temporal perspective, the more recent layers of Italian genetic history and some aspects of the gene-culture interaction were assessed by exploring the genetic variability within two “marginal populations���: Arbereshe of Southern Italy and Partecipanza in Northern Italy. The Arbereshe are Albanian-speaking communities settled in Sicily and Calabria since the end of Middle Ages. Despite sharing common genetic and cultural backgrounds, these groups revealed diverging micro-evolutionary histories, implying different founding events and different patterns of cultural isolation and local admixture. Partecipanza is an idiosyncratic institution of Medieval origin aimed at sharing and devolving collective lands. This case-study exemplified that socio-economic stratification within the same population may induce sex-biased genetic structuring and the maintenance of otherwise hidden historical genetic traces.

"Il carceriere di s�� medesimo" di Lodovico Adimari e Alessandro Melani, Firenze 1681. Dalla «comedia» di Pedro Calderón de la Barca al «drama per musica» italiano di fine Seicento

Questo lavoro è imperniato sullo studio di uno dei melodrammi più interessanti della fine del XVII secolo: “Il carceriere di s�� medesimo” di Lodovico Adimari (1644-1708) e Alessandro Melani (1639-1703), allestito per la prima volta a Firenze nel 1681, e ripreso nel giro di una ventina d’anni a Reggio (1684), a Bologna (1697) e a Vienna (1702). L’opera vanta un’origine drammatica di spicco: risale infatti alla commedia “Guardarse a s�� mismo” di Pedro Calderón de la Barca (1600-1681) mediata dal “Geôlier de soi-mesme” di Thomas Corneille (1625-1709), e presenta qualità poetiche e musicali evidenti, assicurate dai nomi del poeta Lodovico Adimari e del compositore Alessandro Melani. A ciò si aggiungano una tradizione articolata in quattro allestimenti, nonché un elevato numero di testimoni superstiti: cinque edizioni del libretto (testimoniate da numerosi esemplari) e il numero fortunatissimo di tre partiture manoscritte, conservate a Parigi, Bologna e Modena. La tesi contiene l’edizione critica del “Carceriere di s�� medesimo” di Adimari con tutte le varianti accumulatesi nella riedizione del libretto e nella copiatura della partitura, l’analisi del dramma, a partire dal confronto tra i testi di Calderón, Corneille e Adimari, e lo studio delle sue componenti drammatiche, formali e contenutistiche. Si aggiunge uno studio sul contesto storico-musicale degli allestimenti di Firenze, Reggio, Bologna e Vienna, nonché l’edizione dei restanti tre drammi di Adimari: la commedia “Le gare dell’amore e dell’amicizia” (1679), e il dramma per musica “L’amante di sua figlia” (1684).

Il giudice tributario come giudice europeo

Questo lavoro, tramite un'analisi attenta ed accurata dello sviluppo delle pronunce della Corte di Giustizia in materia tributaria, ha lo scopo di mettere in evidenza i canoni interpretativi utilizzati dalla Corte, tenendo presente gli effetti che tali pronunce hanno prodotto nei singoli stati ed in particolare sul ruolo del giudice tributario come giudice europeo. Assistiamo infatti oggi ad una vera e propria europeizzazione della produzione giuridica in grado di aprire nuovi spiragli alla tutela del cittadino anche nei confronti dell'amministrazione finanziaria. L'interazione, per molti aspetti problematica, tra gli organi di giustizia tributaria dei singoli ordinamenti ed il giudice comunitario sono diventate vera e propria fucina di un diritto tributario europeo, nell'ambito del quale a svolgere un ruolo di estrema rilevanza è il giudice interno. Le sentenze del giudice tributario nazionale infatti rappresentano lo strumento più efficace di chiarificazione del diritto comunitario. Il presente lavoro si propone quindi di esaminare nel dettaglio il rapporto complementare e funzionalista che si estrinseca nella peculiare funzione attribuita al giudice tributario nazionale che gli fa assumere le vesti di "giudice europeo" nonché la funzione attribuita alla Corte di Giustizia che assume i caratteri sempre più marcati di "giudice tributario sovranazionale". Partendo dalla disamina delle figure dei giudici tributari di Germania, Francia ed Italia, si passerà poi ad evidenziare i ruoli che hanno avuto le Corti nazionali nell'applicazione del diritto comunitario, evidenziando come nei vari casi le sentenze si sono affiancate alla preminenza gerarchica della norma europea.

Raccontare la storia al tempo delle crisi

La ricerca analizza il tema della relazione tra storia e narrazione nella letteratura degli ultimi quindici anni in tre contesti nazionali: Italia, Spagna e Portogalo. Per indagare un campo cos�� vasto si sono identificate tre direttrici principali connesse tra loro, coincidenti con tre "crisi": la crisi del rapporto tra letteratura e mercato, la crisi del concetto di verità e la crisi dello stato nazione. Attraverso le riflessioni sul postmoderno (Lyotard, Jameson Hutcheon) e l’analisi di Bourdieu si indaga il rapporto tra mercato e autore letterario, facendo particolare riferimento ai percorsi letterari di Rafael Chirbes, Mia Couto e Wu Ming. Il tema della forma letteraria è invece letto atttraverso le analisi di Hutcheon e analizzando i testi di Helder Macedo (Pedro e Paula), Isaac Rosa (¡Otra maldita novela sobre la guerra civil!) e Tommaso De Lorenzis-Guido Favale (L’aspra stagione). La crisi del concetto di verità viene analizzata alla luce del dibattito sulla storiografia nella seconda metà del Novecento. In particolare si evidenzia la tensione tra Hayden White e Carlo Ginzuburg. Per evidenziare come le relazioni di potere influenzino la narrazione della storia si fa inoltre riferimento alle analisi di Michel Foucault, Michel de Certeau, Stephen Greenbaltt e Gayatri Spivak. Si analizzano quindi Anatomía de un instante, di Javier Cercas, Romanzo criminale, di Giancarlo de Cataldo e As três vidas, di João Tordo. Infine ci si riferisce alla crisi dello stato-nazione individuando una tensione tra le analisi di György Lukács e Franco Moretti, e allargando la riflessione agli studi sociologici di Immanuel Wallerstein e Saskia Sassen. Inoltre, attraverso i testi di Benedict Anderson, Homi B. Bhabha, Jos�� Saramao e Eduardo Lourenço si articola una riflessione sull’immaginario politico nazionale. I testi analizzati sono Victus, di Albert S��nchez Piñol, Pro Patria, di Ascanio Celestini e A voz da terra di Miguel Real.

Sprachpolitische Subsidiarität: ein Blick auf S��dtirol

With its economically and politically advantageous autonomy, the province of South-Tyrol (northern Italy) has developed a society in which multilingualism plays an ever more important role. As suggested in the present contribution, a solution to some still current problems and barriers that exist between the different linguistic groups can, and indeed should, be found in the principle of subsidiarity, applied consciously, and not only encouraging and accomplishing a simple improvement of the situation. Thanks to subsidiarity, we could think about eliminating existing deficits and inequality. It is precisely with this concept in mind that, half a century ago, in an evening school for young workers and later in his parish school in Barbiana, the Italian priest Don Milani established his school for “children without a school”, an experiment which gained a wide reputation in the whole of Italy and which inspired the reform of scuola media emphasising the concept of language education.

Italia: La chiusura della Casa dell’Emigrante come spunto riflessione sui rientri degli emigrati italiani

In the literature on migration, as well as in social policies regarding this phenomenon, the situation of returning emigrants receives scant attention. This essay establishes an intricate connection between attitudes and policies that prevail in a country regarding emigration and those concerning immigration. The case of Italy provides a prime example for this as it once was a classical country of emigration, only to turn, in recent decades, into a country that appears highly attractive (and relatively accessible) to immigrants. The essay traces the pervasive ambiguity that characterizes this country’s attitudes towards emigration from the beginning of mass emigration shortly after the unification of Italy in 1868 to the emigration policies of the fascist regime of Mussolini and the post-World War II waves of emigration right through to the corresponding ambiguity concerning the status of immigrants in contemporary society, including the indifferent treatment of returning Italian emigrants who constitute a considerable numerical phenomenon. These reflections take their origin from the impending closure of a reception centre in Lazio, the Casa dell’Emigrante near Sant’Elia Fiumerapido, Province of Frosinone, ostensibly for financial reasons. This centre had been the only one of its kind in the whole of Italy dealing officially with the needs of repatriated Italians. It had assisted returning emigrants both with practical matters, such as negotiating the labyrinth of Italian bureaucracy , and with psychological implications of a return, which are often considerable given the time lag of experiences with current social realities and the frequently unrealistic expectations associated with the return. Questions of identity become highly acute in those circumstances. The threatened closure of the centre illustrates the unwillingness of the state to face up to the factual prevalence of migratory experiences in the country as a whole and as a core element of national history, experiences of migration in both directions. The statistics speak for themselves: of the 4.660.427 persons who left Italy between 1880 and 1950, 2.322.451 have returned, almost exactly 50%. To those have to be added 3.628.430 returnees of the 5.109.860 emigrants who left Italy between the end of World War II and 1976 for Europe alone. Attitudes towards people leaving changed ostensibly over time. In the first two decades after Unification parliament on the one hand wanted to show some concern over the fate of its citizens, not wanting to abandon those newly created citizens entirely to their own destiny, while on the other portraying their decisions to emigrate as expressions of individual liberty and responsibility and not necessitated by want and poverty. Emigrants had to prove, paradoxically that they had the requisite means to emigrate when in fact poverty was largely driving them to emigrate. To admit that publicly would have amounted to admission of economic and political failure made evident through emigration. In contrast to that Mussolini’s emigration policies not only enforced large population movements within the territory of Italy to balance unemployment between regions and particularly between North and South, but also declared it citizen’s duty to be ready to move also to the colonies, thereby ‘turning emigration as a sign of social crisis into a sign of national strength and the success of the country’s political agenda’ (Gaspari 2001, p. 34). The duplicity continued even after World War II when secret deals were done with the USA to allow a continuous flow of Italian immigrants and EU membership obviously further facilitated the departure of unemployed, impoverished Italians. With the growing prosperity of Italy the reversal of the direction of migration became more obvious. On the basis of empirical research conducted by one of the author on returning emigrants four types of motives for returning can be distinguished: 1. Return as a result of failure – particularly the emigrants who left during the 1950-1970 period usually had no linguistic preparation, and in any case the gap between the spoken and the written language is enormous with the latter often being insurmountable. This gives rise to nostalgic sentiments which motivates a return into an environment where language is familiar 2. Return as a means of preserving an identity – the life of emigrants often takes place within ghetto-like conditions where familiarity is being reproduced but under restricted conditions and hence not entirely authentic. The necessity for saving money permits only a partial entry into the host society and at the same time any accumulating savings add to the desire to return home where life can be lived fully again – or so it seems. 3. Return of investment – the impossibility to become fully part of another society often motivates migrants to accumulate not so much material wealth but new experiences and competences which they then aim to reinvest in their home country. 4. Return to retire – for many emigrants returning home becomes acute once they leave a productive occupation and feelings of estrangement build up, in conjunction with the efforts of having invested in building a house back home. All those motives are associated with a variety of difficulties on the actual return home because, above all, time in relation to the country of origin has been suspended for the emigrant and the encounter with the reality of that country reveals constant discrepancies and requires constant readjustment. This is where the need for assistance to returning emigrants arises. The fact that such an important centre of assistance has been closed is further confirmation of the still prevailing politics of ambiguity which nominally demand integration from nationals and non-nationals alike but deny the means of achieving this. Citizenship is not a natural result of nationality but requires the means for active participation in society. Furthermore, the experiences of returning immigrants provide important cues for the double ambivalence in which immigrants to Italy live between the demands made on them to integrate, the simultaneous threats of repatriation and the alienation from the immigrants��� home country which grows inexorably during the absence. The state can only regain its credibility by putting an end to this ambiguity and provide to returning emigrants, and immigrants alike, the means of reconstructing strong communal identities.

A Research Roadmap for Complementary and Alternative Medicine – What We Need to Know by 2020

Background: The CAMbrella coordination action was funded within the Framework Programme 7. Its aim is to provide a research roadmap for clinical and epidemiological research for complementary and alternative medicine (CAM) that is appropriate for the health needs of European citizens and acceptable to their national research institutes and healthcare providers in both public and private sectors. One major issue in the European research agenda is the demographic change and its impact on health care. Our vision for 2020 is that there is an evidence base that enables European citizens to make informed decisions about CAM, both positive and negative. This roadmap proposes a strategic research agenda for the field of CAM designed to address future European health care challenges. This roadmap is based on the results of CAMbrella’s several work packages, literature reviews and expert discussions including a consensus meeting. Methods: We first conducted a systematic literature review on key issues in clinical and epidemiological research in CAM to identify the general concepts, methods and the strengths and weaknesses of current CAM research. These findings were discussed in a workshop (Castellaro, Italy, September 7–9th 2011) with international CAM experts and strategic and methodological recommendations were defined in order to improve the rigor and relevance of CAM research. These recommendations provide the basis for the research roadmap, which was subsequently discussed in a consensus conference (Järna, Sweden, May 9–11th 2012) with all CAMbrella members and the CAMbrella advisory board. The roadmap was revised after this discussion in CAMbrella Work Package (WP) 7 and finally approved by CAMbrella’s scientific steering committee on September 26th 2012. Results: Our main findings show that CAM is very heterogenous in terms of definitions and legal regulations between the European countries. In addition, citizens��� needs and attitudes towards CAM as well as the use and provision of CAM differ significantly between countries. In terms of research methodology, there was consensus that CAM researchers should make use of all the commonly accepted scientific research methods and employ those with utmost diligence combined in a mixed methods framework. Conclusions: We propose 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions. These are: Research into the prevalence of CAM in Europe: Reviews show that we do not know enough about the circumstances in which CAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance. Research into differences regarding citizens��� attitudes and needs towards CAM: Citizens are the driver for CAM utilization. Their needs and views on CAM are a key priority, and their interests must be investigated and addressed in future CAM research. Research into safety of CAM: Safety is a key issue for European citizens. CAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of CAM. Research into the comparative effectiveness of CAM: Everybody needs to know in what situation CAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of CAM as an additional or alternative treatment strategy in real-world settings. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of CAM treatments must be investigated; it is likely that they are significant. Research into different models of CAM health care integration: There are different models of CAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of CAM provision in health care systems should be one focus for CAM research. We also propose a methodological framework for CAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research. Furthermore, structural and sufficient financial support for research into CAM is needed to strengthen CAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing CAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of CAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of CAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data. Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using CAM in apparently increasing numbers. We propose that the EU actively supports an EUwide strategic approach that facilitates the development of CAM research. This could be achieved in the first instance through funding a European CAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field. With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens.

Italo-Swiss "Chalk and blackboard interactive 2-day workshop"-participants feedback

Ten "chalk and blackboard interactive workshops" have taken place between 2011 and 2015 in Southern Switzerland or Italy. Students, residents and expert pediatricians meet during 2 days and discuss 10-15 cases. Pediatricians promote reasoning, provide supporting information and correct statements. Emphasis is placed on history taking and examination, and on all participants being involved in a stimulating atmosphere. Thirty-seven participants were asked, ≥3 months after workshop-completion, to evaluate the workshop and a recent teaching session. Thirty answered and scored the workshop as excellent (N = 24) or above average (N = 6). The scores assigned to the workshop were higher (P < 0.001) than those assigned to the lecture-based teaching.