Servizi Sociali Territoriali e Università: Esempi di Sinergie Possibili per un Percorso di Qualità

Although – or because – social work education in Italy has for some 15 years now been exclusively in the domain of the university the relationship between the academic world and that of practice has been highly tenuous. Research is indeed being conducted by universities, but rarely on issues that are of immediate practice relevance. This means that forms of practice develop and become established habitually which are not checked against rigorous standards of research and that the creation of knowledge at academic level pays scant attention to the practice implications of social changes. This situation has been made even worse by the dwindling resources both in social services and at the level of the universities which means that bureaucratic procedures or imports of specialisations from other disciplines frequently dominate the development of practice instead of a theory-based approach to methodology. This development does not do justice to the actual requirements of Italian society faced with ever increasing post-modern complexity which is reflected also in the nature of social problems because it implies a continuation of a faith in modernity with its idea of technical, clear-cut solutions while social relations have decidedly moved beyond that belief. This discrepancy puts even greater strain on the personnel of welfare agencies and does ultimately not satisfy the ever increasing demands for quality and accountability of services on the part of users and the general public. Social workers badly lack fundamental theoretical reference points which could guide them in their difficult work to arrive at autonomous, situation-specific methodological answers not based on procedures but on analytical knowledge. Thirty years ago, in 1977, a Presidential Decree created the legal basis for the establishment of social service departments at the level of municipalities which created opportunities for the direct involvement of the community in the fight against exclusion. For this potential to be fully utilized it would have required the bringing together of three dimensions, the organizational structure, the opportunities for learning and research in the territory and the contribution by the professional community. As this did not occur social services in Italy still often retain the character of charity which does not concern itself with the actual causes of poverty and exclusion. This in turn affects the relationship with citizens in general who cannot develop trust in those services. Through uncritical processes of interaction Edgar Morin’s dictum manifests itself which is that without resorting to critical reflection on complexity interventions can often have an effect that totally the opposite to the original intention. An important element in setting up a dynamic interchange between academia and practice is the placement on professional social work courses. Here the looping of theory to practice and back to theory etc. can actually take place under the right organizational and conceptual conditions, more so than in abstract, and for practitioners often useless debates about the theory-practice connection. Furthermore, research projects at the University of Florence Social Work Department for instance aim at fostering theoretical reflection at the level of and with the involvement of municipal social service agencies. With a general constructive disposition towards research and some financial investment students were facilitated to undertake social service practice related research for their degree theses for instance in the city of Pistoia. In this way it was also possible to strengthen the confidence and professional identity of social workers as they became aware of the contribution their own discipline can make to practice-relevant research instead of having to move over to disciplines like psychology for those purposes. Examples of this fruitful collaboration were presented at a conference in Pistoia on 25 June 2007. One example is a thesis entitled ‘The object of social work’ and examines the difficult development of definitions of social work and comes to the conclusion that ‘nothing is more practical than a theory’. Another is on coping abilities as a necessary precondition for the utilization of resources supplied by social services in exceptional circumstances. Others deal with the actual sequence of interventions in crisis situations, and one very interestingly looks at time and how it is being constructed often differently by professionals and clients. At the same time as this collaboration on research gathers momentum in the Toscana, supervision is also being demanded more forcefully as complementary to research and with the same aim of profiling more strongly the professional identity of social work. Collaboration between university and social service filed is for mutual benefit. At a time when professional practice is under threat of being defined from the outside through bureaucratic prescriptions a sound grounding in theory is a necessary precondition for competent practice.

Experience and attitudes towards CAM--a survey of internal and psychosomatic patients in a German university hospital

Complementary and alternative medicine (CAM) is popular in Germany. In a consecutive survey the experiences with CAM and the need for a CAM consultation among inpatients of the departments of cardiology (CL), gastroenterology (GE), oncology (OL) and psychosomatics (PS) of the University Hospital Freiburg (FUH) were questionned. Exclusion criteria were inability to understand the questions or a Karnofsky Index < 30%. Four hundred thirty-five patients were included. Three hundred and fifty patients, 100 each in the departments of CL, GE and OL, and 50 in PS answered the questionnaires. Eighty-five patients (20%) refused. Among the 350 patients 26% had previously visited a CAM physician and 19% had visited a CAM therapist (Heilpraktiker). Information about CAM was obtained mainly by television, radio and family members. Frequently used therapies for the current disease were physical training (21%), diet (19%), massage (19%), vitamins/trace elements (19%), herbs (13%), acupuncture (10%) and homeopathy (7%). The highest frequency of CAM use had PS patients, followed by GE, OL and CL patients. High effectivity (> or = 70%) for the current disease, rated on a scale of 4 degrees, had for CL patients physical exercise and massage, for GE patients herbal treatment and for OL patients diet. Physical exercise, diet, massage and herbal treatment generally had better ratings than homeopathy, acupuncture and vitamins. 65% would welcome a CAM center and 53% asked for a consultation about CAM at FUH. OL and GE patients had the strongest (58%), PS patients a lower (52%) and patients with cardiovascular diseases the lowest (43%) interest in a CAM consultation. Twenty-five percent believed, that CAM can help to cope better with their disease. Predictors for a positive attitude towards CAM were young age, aversion to chemical medications (Spearman correlation r = 0.22), desire to participate in therapeutic decisions (r = 0.29), motivation to change, if recommended, the life style (r = 0.31) and desire for a holistic treatment (r = 0.37).

A complementary radiographic projection of the equine temporomandibular joint

The complexity of the equine skull makes the temporomandibular joint a difficult area to evaluate radiographically. The goal of this study was to determine the optimal angle for a complementary radiographic projection of the equine temporomandibular joint based on a computed tomography (CT) cadaver study. CT was performed on six equine cadaver heads of horses that were euthanized for other reasons than temporomandibular joint disease. After the CT examination, 3D reconstruction of the equine skull was performed to subjectively determine the angle for a complementary radiographic projection of the temporomandibular joint. The angle was measured on the left and right temporomandibular joint of each head. Based on the measurements obtained from the CT images, a radiographic projection of the temporomandibular joint in a rostra-145 degrees ventral-caudodorsal oblique (R45 degrees V-CdDO) direction was developed by placing the X-ray unit 30 degrees laterally, maintaining at the same time the R45 degrees V-CdDO angle (R45 degrees V30 degrees L-CdDLO). This radiographic projection was applied to all cadaver heads and on six live horses. In three of the live horses abnormal findings associated with the temporomandibular joint were detected. We conclude that this new radiographic projection of the temporomandibular joint provides superior visualization of the temporomandibular joint space and the articular surface of the mandibular condyle.

Altered expression of the PTR/NRT1 homologue OsPTR9 affects nitrogen utilization efficiency, growth and grain yield in rice

The plant PTR/NRT1 (peptide transporter/nitrate transporter 1) gene family comprises di/tripeptide and low-affinity nitrate transporters; some members also recognize other substrates such as carboxylates, phytohormones (auxin and abscisic acid), or defence compounds (glucosinolates). Little is known about the members of this gene family in rice (Oryza sativa L.). Here, we report the influence of altered OsPTR9 expression on nitrogen utilization efficiency, growth, and grain yield. OsPTR9 expression is regulated by exogenous nitrogen and by the day-night cycle. Elevated expression of OsPTR9 in transgenic rice plants resulted in enhanced ammonium uptake, promotion of lateral root formation and increased grain yield. On the other hand, down-regulation of OsPTR9 in a T-DNA insertion line (osptr9) and in OsPTR9-RNAi rice plants had the opposite effect. These results suggest that OsPTR9 might hold potential for improving nitrogen utilization efficiency and grain yield in rice breeding.

Evaluation of Hay-Type and Grazing Tolerant Alfalfa Hybrids in Season-Long or Complementary Rotational Stocking Systems for Beef Cows

Pastures containing hay-type and grazing tolerant alfalfa hybrids were grazed in a season-long or complementary rotational stocking system with Nfertilized smooth bromegrass. The pastures were stocked at a seasonal density of .8 cow-calf pairs per acre for 120 days in 1998 and 141 days in 1999. Pastures were intensively managed by daily stripstocking with the assumptions that 50% of live forage was available and daily live dry matter consumption of each cow-calf pair was 3.5% of the cow’s body weight. First-cutting forage was harvested as hay from 40% of the pasture acres to remove excess forage growth early in the grazing season. Grazing occurred on the remaining 60% of each pasture for the first 44 and 54 days and 100% of each pasture after days 45 and 55 in 1998 and 1999, respectively. Proportions of ‘Amerigraze’ and ‘Affinity’ alfalfa in the live forage dry matter decreased by 70% and 55% in pastures stocked season-long and by 60% and 42% in pastures used for complementary stocking (alfalfa type, p<.05; grazing management, p<.05) in 1998, but decreased by a mean of 72% and was unaffected by hybrid or stocking system in 1999. Cows grazing either alfalfa hybrid by either grazing system had greater weight gains during the breeding and overall grazing seasons and greater increases in body condition score pre-breeding and during the breeding season than the cows that grazed smooth bromegrass for the entire season in 1998. Also, cows grazing either alfalfa hybrid in the season-long system had greater breeding season increases in body condition score than cows grazing alfalfa in the complementary system with smooth bromegrass in 1998. Cows grazing in the season-long alfalfa system had greater prebreeding season weight (p<.10) increases and condition score (p<.05) increases than cows grazing alfalfa in the complementary system in 1999. Daily and seasonal body weight gains of calves were not affected (p>.10) by the presence of alfalfa in 1998 or by alfalfa type and grazing management in 1998 and 1999. Total animal production (cow and calf) in 1998 was greater (p<.10) from the season-long alfalfa pastures compared with the complementary stocked pastures. Total (p<.10) and live (p<.05) forage masses, estimated by monthly clippings, were greater in September of 1998 from the season-long alfalfa pastures than pastures using alfalfa for complementary stocking. Total (p<.10) and live (p<.05) forage masses were greater in August of 1999 from season-long alfalfa pastures than pastures using alfalfa for complementary stocking.

Evaluation of Hay-Type and Grazing Tolerant Alfalfa Hybrids in Season-Long or Complementary Rotational Stocking Systems for Beef Cows

Pastures containing hay-type and grazing tolerant alfalfa hybrids were grazed in a season-long or complimentary rotational stocking system with Nfertilized smooth bromegrass. The pastures were stocked at a seasonal density of .8 cow-calf pairs per acre for 120 days. Pastures were intensively managed by daily strip-stocking with the assumptions that 50% of live forage was available and daily live dry matter consumption of each cow-calf pair was 3.5% of the cow’s body weight. First-cutting forage was harvested as hay from 40% of pasture acres to remove excess forage growth early in the grazing season. Forage was grazed from the remaining 60% of each pasture for the first 44 days of the experiment and then from the entire pasture thereafter. Live forage yields, estimated by monthly clippings, were greater in May and September on the season-long alfalfa pastures compared with the complementary pastures and on the alfalfa pastures compared with the N-fertilized smooth bromegrass pastures. The proportions of legumes in the live dry matter in pastures with grazing tolerant and hay-type alfalfas in the season-long grazing systems declined by 70% and 50%, respectively, in the 120 day trial. The proportions of legumes in the live dry matter in pastures with grazing tolerant and the hay-type alfalfas in the complementary grazing system declined 60% and 42%, respectively, in the 120 day trial. Cows grazing either alfalfa hybrid by either management system had greater weight gains during the breeding and grazing seasons and greater increases in body condition score prebreeding and during the breeding season than the cows that grazed N-fertilized smooth bromegrass for the entire season. Also, cows grazing either alfalfa in the season-long system had greater breeding season increases in body condition score than cows grazing alfalfa in the complementary system with N-fertilized smooth bromegrass. Daily gains and seasonal gains of calves from cows grazing the alfalfa pastures tended to be greater than those grazing N-fertilized smooth bromegrass. Within alfalfa treatments, calves of cows grazing alfalfa pastures in the season-long system tended to produce more pounds per acre than those of cows grazing alfalfa in the complementary systems.

Impact of recommendation updates in well-controlled patients on nonrecommended antiretroviral therapies: the Swiss HIV cohort study

BACKGROUND HIV treatment recommendations are updated as clinical trials are published. Whether recommendations drive clinicians to change antiretroviral therapy in well-controlled patients is unexplored. METHODS We selected patients with undetectable viral loads (VLs) on nonrecommended regimens containing double-boosted protease inhibitors (DBPIs), triple-nucleoside reverse transcriptase inhibitors (NRTIs), or didanosine (ddI) plus stavudine (d4T) at publication of the 2006 International AIDS Society recommendations. We compared demographic and clinical characteristics with those of control patients with undetectable VL not on these regimens and examined clinical outcome and reasons for treatment modification. RESULTS At inclusion, 104 patients were in the DBPI group, 436 in the triple-NRTI group, and 19 in the ddI/d4T group. By 2010, 28 (29%), 204 (52%), and 1 (5%) patient were still on DBPIs, triple-NRTIs, and ddI plus d4T, respectively. 'Physician decision,' excluding toxicity/virological failure, drove 30% of treatment changes. Predictors of recommendation nonobservance included female sex [adjusted odds ratio (aOR) 2.69, 95% confidence interval (CI) 1 to 7.26; P = 0.01] for DPBIs, and undetectable VL (aOR 3.53, 95% CI 1.6 to 7.8; P = 0.002) and lack of cardiovascular events (aOR 2.93, 95% CI 1.23 to 6.97; P = 0.02) for triple-NRTIs. All patients on DBPIs with documented diabetes or a cardiovascular event changed treatment. Recommendation observance resulted in lower cholesterol values in the DBPI group (P = 0.06), and more patients having undetectable VL (P = 0.02) in the triple-NRTI group. CONCLUSION The physician's decision is the main factor driving change from nonrecommended to recommended regimens, whereas virological suppression is associated with not switching. Positive clinical outcomes observed postswitch underline the importance of observing recommendations, even in well-controlled patients.

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study

PURPOSE We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. METHODS Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. RESULTS We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. CONCLUSIONS Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.

A 6'-Fluoro-Substituent in Bicyclo-DNA Increases Affinity to Complementary RNA Presumably by CF-HC Pseudohydrogen Bonds

The synthesis of a novel bicyclic thymidine analogue carrying a β-fluoro substituent at C6' (6'F-bcT) has been achieved. Key steps of the synthesis were an electrophilic fluorination/stereospecific hydrogenation sequence of a bicyclo sugar intermediate, followed by an N-iodo-succinimide-induced stereoselective nucleosidation. A corresponding phosphoramidite building block was then prepared and used for oligonucleotide synthesis. Tm measurements of oligonucleotides with single and double incorporations showed a remarkable stabilization of duplex formation particularly with RNA as complement without compromising pairing selectivity. Increases in Tm were in the range of +1-2 °C compared to thymidine and +1-3 °C compared to a standard bc-T residue. Structural investigations of the 6'F-bcT nucleoside by X-ray crystallography showed an in-line arrangement of the fluorine substituent with H6 of thymine, however, with a distance that is relatively long for a nonclassical CF-HC hydrogen bond. In contrast, structural investigations in solution by (1)H and (13)C NMR clearly showed scalar coupling of fluorine with H6 and C6 of the nucleobase, indicating the existence of at least weak electrostatic interactions. On the basis of these results, we put forward the hypothesis that these weak CF-HC6 electrostatic interactions increase duplex stability by orienting and partially freezing torsion angle χ of the 6'F-bcT nucleoside.

Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization

OBJECTIVES The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy. BACKGROUND Since its commercialization in 2007, the number of TAVR procedures has grown exponentially. METHODS The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population. RESULTS Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥ 75 years; p = 0.002). CONCLUSIONS The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.

Investigation of the inhibitory effects of the benzodiazepine derivative, 5-BDBD on P2X4 purinergic receptors by two complementary methods

BACKGROUND/AIMS ATP-gated P2X4 purinergic receptors (P2X4Rs) are cation channels with important roles in diverse cell types. To date, lack of specific inhibitors has hampered investigations on P2X4Rs. Recently, the benzodiazepine derivative, 5-BDBD has been proposed to selectively inhibit P2X4Rs. However, limited evidences are currently available on its inhibitory properties. Thus, we aimed to characterize the inhibitory effects of 5-BDBD on recombinant human P2X4Rs. METHODS We investigated ATP-induced intracellular Ca(2+) signals and whole cell ion currents in HEK 293 cells that were either transiently or stably transfected with hP2X4Rs. RESULTS Our data show that ATP (< 1 μM) stimulates P2X4R-mediated Ca(2+) influx while endogenously expressed P2Y receptors are not activated to any significant extent. Both 5-BDBD and TNP-ATP inhibit ATP-induced Ca(2+) signals and inward ion currents in a concentration-dependent manner. Application of two different concentrations of 5-BDBD causes a rightward shift in ATP dose-response curve. Since the magnitude of maximal stimulation does not change, these data suggest that 5-BDBD may competitively inhibit the P2X4Rs. CONCLUSIONS Our results demonstrate that application of submicromolar ATP concentrations allows reliable assessment of recombinant P2XR functions in HEK 293 cells. Furthermore, 5-BDBD and TNP-ATP have similar inhibitory potencies on the P2X4Rs although their mechanisms of actions are different.

The recombinant adeno-associated virus vector (rAAV2)-mediated apolipoprotein B mRNA-specific hammerhead ribozyme: a self-complementary AAV2 vector improves the gene expression.

BACKGROUND: In humans, overproduction of apolipoprotein B (apoB) is positively associated with premature coronary artery diseases. To reduce the levels of apoB mRNA, we have designed an apoB mRNA-specific hammerhead ribozyme targeted at nucleotide sequences GUA6679 (RB15) mediated by adenovirus, which efficiently cleaves and decreases apoB mRNA by 80% in mouse liver and attenuates the hyperlipidemic condition. In the current study, we used an adeno-associated virus vector, serotype 2 (AAV2) and a self-complementary AAV2 vector (scAAV2) to demonstrate the effect of long-term tissue-specific gene expression of RB15 on the regulation apoB mRNA in vivo. METHODS: We constructed a hammerhead ribozyme RB15 driven by a liver-specific transthyretin (TTR) promoter using an AAV2 vector (rAAV2-TTR-RB15). HepG2 cells and hyperlipidemic mice deficient in both the low density lipoprotein receptor and the apoB mRNA editing enzyme genes (LDLR-/-Apobec1-/-; LDb) were transduced with rAAV2-TTR-RB15 and a control vector rAAV-TTR-RB15-mutant (inactive ribozyme). The effects of ribozyme RB15 on apoB metabolism and atherosclerosis development were determined in LDb mice at 5-month after transduction. A self-complementary AAV2 vector expressing ribozyme RB15 (scAAV2-TTR-RB15) was also engineered and used to transduce HepG2 cells. Studies were designed to compare the gene expression efficiency between rAAV2-TTR-RB15 and scAAV2-TTR-RB15. RESULTS: The effect of ribozyme RB15 RNA on reducing apoB mRNA levels in HepG2 cells was observed only on day-7 after rAAV2-TTR-RB15 transduction. And, at 5-month after rAAV2-TTR-RB15 treatment, the apoB mRNA levels in LDb mice were significantly decreased by 43%, compared to LDb mice treated with control vector rAAV2-TTR-RB15-mutant. Moreover, both the rAAV2-TTR-RB15 viral DNA and ribozyme RB15 RNA were still detectable in mice livers at 5-month after treatment. However, this rAAV2-TTR-RB15 vector mediated a prolonged but low level of ribozyme RB15 gene expression in the mice livers, which did not produce the therapeutic effects on alteration the lipid levels or the inhibition of atherosclerosis development. In contrast, the ribozyme RB15 RNA mediated by scAAV2-TTR-RB15 vector was expressed immediately at day-1 after transduction in HepG2 cells. The apoB mRNA levels were decreased 47% (p = 0.001), compared to the control vector scAAV2-TTR-RB15-mutant. CONCLUSION: This study provided evidence that the rAAV2 single-strand vector mediated a prolonged but not efficient transduction in mouse liver. However, the scAAV2 double-strand vector mediated a rapid and efficient gene expression in liver cells. This strategy using scAAV2 vectors represents a better approach to express small molecules such as ribozyme.