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O trabalho objetiva empreender uma analise economica sobre os gastos que a judicializacao dos tratamentos contra a toxicodependencia causam nas despesas do Fundo Estadual de Saude do Espirito Santo (FES). Trata-se de pesquisa documental, exploratoria, retrospectiva e descritiva com abordagem quali-quantitativa. Foram utilizados resultados dos estudos sobre os fenomenos da judicializacao direta e indireta da saude, fornecidos pelo Portal da Transparencia do Governo do Estado do Espirito Santo e as informacoes diretamente prestadas pelo FES. Segundo constatou-se em pesquisa realizada pela 1a Vara da Infância e da Juventude da Comarca de Cachoeiro de Itapemirim/ES, os tratamentos contra a drogadicao responderam pela maior parte dos pedidos demandados judicialmente no ano de 2013. Em nivel estadual, observou-se que a compra de leitos para tratamentos de dependentes quimicos e transtornos mentais, realizadas por forca de determinacao judicial, responderam por 49,36% do total de pagamentos dessa rubrica no exercicio de 2015. Concluiu-se que os problemas relacionados ao uso e abuso de drogas constituem grave problema de saude publica, ocasionando profundos impactos sociais e economicos, o que sugere medidas urgentes por parte dos gestores publicos no sentido de se elaborar e implementar politicas de saude mental eficazes e especificamente direcionadas ao tratamento contra a toxicodependencia. Palavras-chave: Direito a saude. Judicializacao da saude. Tratamento contra a drogadicao. Impactos economicos. Espirito Santo. Abstract The work aims to undertake an economic analysis of the expenditures that the judicialization of treatments against drug addiction cause in the expenditure of the State Health Fund of the Espirito Santo (FES). This is documentary research, exploratory, retrospective and descriptive with qualitative and quantitative approach. It uses the results of direct and indirect health justice phenomena, provided by the Transparency Portal of the Government of the State of Espirito Santo and as information directly provided by the FES. According to it was found in a recent survey conducted by the 1st Court of Children and Youth Cachoeiro County of Itapemirim / ES, treatment against drug addiction accounted for most of the defendants in court order in 2013. At the state level, it was observed the purchase of beds for drug addicts treatment and mental disorders, conducted by judicial determination, accounted for 49.36% of all payments under this heading in the 2015 exercise. It appears that the problems related to drug use and abuse are major public health problem, causing deep social and economic impacts, suggesting urgent action by public officials in order to design and implement mental health policies effective and specifically targeted treatment against addiction. Keywords: Right to health. Judicialization of health. Treatment against drug addiction. Economic impacts. Espirito Santo.

Authors have considered the prevalence of hypertension (HT), myocardial infarction (MI) and stroke (S), in elderly subjects with diabetes, impaired fasting glucose (IFG) and normal fasting glucose (NFG), respectively. A high occurrence of diabetes in elderly subjects has been found. MI and S were more frequent in diabetic group than in IFG and NFG ones. HT proved to be elevated in the total pool, especially in older olds, and with a higher prevalence among those with diabetes. A 5-year follow-up has been carried out. The index of survival for MI and S was lower in subjects with diabetes. The subjects affected by both MI and S displayed the worst index of survival in all the three categories considered, therefore, it can be stated that such an association is a determinant factor of mortality.

The term "successful aging" appeared in the first issue of "The Gerontologist" in 1961. During the successive years, this expression has changed its meaning. Nowadays, successful aging means "absence of diseases and disabilities, maintenance of high levels of physical and cognitive abilities, preservation of the social and productive activities". It has become a common opinion that the centenarians may represent the prototypes of the successful aging. This motivated our work to study the clinical, psychical, and functional aspects in a centenarian group, verifying the real autonomy, instrumental capacities, and working abilities. Our study pool consisted of 602 centenarians, who were also subjects of then epidemiological studies of the Italian Multicenter Studies on Centenarians (IMUSCE). All subjects underwent a clinical-anamnestic evaluation, cognitive-functional tests by means of the mini mental state examination (MMSE), the independence index in activities of daily living (ADL), the instrumental activities of daily living (IADL) scale. The centenarians were classified in three groups, according to the criteria elaborated previously by us, based on their psychophysical status and autonomy, as follows. Group A: centenarians in good health status; Group B: centenarians in an intermediate health status. Group C: centenarians in bad health status. Group A represented 20.0% of the total pool, Group B amounted to 33.4%, and the Group C was 46.6%. The centenarians of Group A presented normal ADL values, and 47.9% of them were autosufficient in all functions; 5.7% of them were independent in all IADL items. These data confirm that the centenarians of Group A are free of invalidating chronic diseases, are autonomous, maintain good physical and cognitive capacities, however, have not maintained any social or productive activities. Therefore, they cannot be considered as prototypes of successful aging.

The appearance of diabetes in advanced age may be considered as a part of the involutive processes of aging, and as such, it might have a pathogenesis completely different from that of type 2 diabetes of medium age. As a matter of fact, it has been observed that the pancreas undergoes numerous structural and functional alterations with advancing age, both in exocrine and endocrine parts. The present studies have been performed to reveal the quantity and quality of the pancreatic lesions, which may be attributed to atherosclerosis. We have already studied elderly subjects, therefore, we were now looking for further supports in a population of middle age people, died in complications of malignant hypertension. We investigated the pancreas, kidney and heart of 36 subjects (20 males and 16 females) with mean age of 48.6±8.9 years. Of this group, eight subjects (22.2%) became diabetic after the appearance of malignant hypertension. Arteriolar atherosclerosis damage (hyalinosis, thickening and stenosis) of the pancreatic arterioles were found in 92.8% of the non-diabetic, and in 87.5% of the diabetic subjects. Lesions of the pancreatic islets were observed in 32% of the non-diabetics, and in 50% of the diabetic subjects. The pancreas is an organ, which tends particularly to develop atherosclerotic damage. The vascular lesion of atherosclerotic origin, independently from the mechanism of its appearance, causes first only a decrease of the blood flux and hypoxia in the pancreatic islets with a consecutive functional decline of the β-cells. This is then followed by structural modifications of the islets accompanied by the appearance of hyalinosis, loss of β-cells, and a further decrease of insulin production.

Gender accounts for important differences in the incidence and prevalence of a variety of age-related diseases. Considering people of far advanced age, demographic data document a clear-cut prevalence of females compared to males, suggesting that sex-specific mortality rates follow different trajectories during aging. In the present investigation, we report data from a nationwide study on Italian centenarians (a total of 1162 subjects), and from two studies on centenarians living in two distinct zones of Italy, i.e., the island of Sardinia (a total of 222 subjects) and the Mantova province (Northern Italy) (a total of 43 subjects). The female/male ratio was about 2:1 in Sardinia, 4:1 in the whole of Italy, and about 7:1 in the Mantova province. Thus, a complex interaction of environmental, historical and genetic factors, differently characterizing the various parts of Italy, likely plays an important role in determining the gender-specific probability of achieving longevity. Gender differences in the health status of centenarians are also reported, and an innovative score method to classify long-lived people in different health categories, according to clinical and functional parameters, is proposed. Our data indicate that not only is this selected group of people, as a whole, highly heterogeneous, but also that a marked gender difference exists, since male centenarians are less heterogeneous and more healthy than female centenarians. Immunological factors regarding the age-related increase in pro-inflammatory status, and the frequency of HLA ancestral haplotypes also show gender differences that likely contribute to the different strategies that men and women seem to follow to achieve longevity. Concerning the different impact of genetic factors on the probability of reaching the extreme limits of the human life-span, emerging evidence (regarding mtDNA haplogroups, Thyrosine Hydroxilase, and IL-6 genes) suggests that female longevity is less dependent on genetics than male longevity, and that female centenarians likely exploited a healthier life-style and more favorable environmental conditions, owing to gender-specific cultural and anthropological characteristics of the Italian society in the last 100 years.

Summary This study was aimed at evaluating the cerebral alterations occurring in diabetic subjects. The total study population consisted of 29 males (mean age: 76.2 ± 6.3 years) and 40 females (mean age: 74.2 ± 8.6 years). The patients were divided in 3 groups: (i) Late onset elderly diabetics (15 patients of mean age 76.9 ± 7.6 years, onset of diabetes at 70 years of age); (ii) Early onset elderly diabetics (15 patients of mean age 74.4 ± 8.3 years, onset of diabetes at 46 years of age; (iii) Non-diabetic elderly controls (39 patients of mean age 74.5 ±7.7 years). The patients underwent psychometric testings by using the following methods: mini mental state examination (MMSE), geriatric depression scale (GDS), activity of daily living (ADL), instrumental activity of daily living (IADL); attentional matrix test (AMT), visuo-spatial span test (VSST) and verbal span test (VST). The results indicate that diabetes is apparently not influencing the cognitive performance. As regards the affective disorders, the late onset elderly diabetics display more depressive disorders than the other 2 groups of patients studied.

Eighty-four out of 100 enrolled female patients affected by osteoporosis completed a double-blind, randomized trial, using ipriflavone (IP) in a dose of 3 x 200 mg/day (41 patients) or placebo (P)(43 patients). All patients received 1 g/day oral calcium supplementation. Inclusion criteria were: age over 65 years; at least one vertebral fracture in the past; bone mineral density measured at the distal tenth of the radius lower than the normal average -2 x S.D. The trial period was between June 1990 and November 1993. Patients of the IP group showed a significant increase in bone mineral density (P < 0.05) compared with the starting values during the whole study period. Pain decreased rapidly, intake of analgesics dropped, and often significant decreases in calciuria, hydroxyprolinuria, alkaline phospatase, osteocalcin and parathormone values were observed. Only two new fractures occurred during the trial in the IP group. Patients of the P group at the end of the study displayed decreased bone mineral densities (P < 0.05), increased pain, greater consumption of analgesics, and often significant increases in the bone metabolism parameters listed for the IP group. In the

The effectiveness of a combination of nitrendipine plus lisinopril in preventing renal damage was evaluated for a 12-month period in 20 elderly patients with severe hypertension. Results showed no significant changes in glomerular filtration rate (GFR) but a significant decrease in microalbuminuria; 24-hour diuresis and 24-hour natriuresis were significantly increased after 6 months. These changes persisted until the end of the study. Mean 24-hour ambulatory blood pressure measurements, recorded every 2 months, decreased to normal values starting at month 2; blood pressure control was maintained through the remainder of the study. Left ventricular mass index, interventricular septum thickness, posterior wall thickness, and left ventricular diastolic diameter were also significantly reduced compared with baseline values at 6 months. We conclude that the nitrendipine/lisinopril combination showed beneficial therapeutic effects on blood pressure control, as well as on cardiac and renal function in elderly patients with severe hypertension.

The aging of population has been characteristic for the industrial countries during the last years. It is essentially due to two factors: the increase of life span and the decrease of births. Today the health conditions of the older population are better than in the past, but in octagenarians morbidity and disability globally increased. Therefore, aging of the population involves also more expenses for all the health care services, i.e., both for each older patient's family, and for the community. In departments of geriatric medicine it is right to consider two kinds of patients: older patient and geriatric patient. Multidimensional assessment and global intervention performed by a multidisciplinary team can obtain much better results for the geriatric patients, than the traditional medical strategies. Several reviews show also that departments of geriatric medicine achieve better results, than of the common internal medicine. Geriatric medicine departments have different aspects not only in the treatment of diseases, but also in supporting a global assistance, which aim also at rehabilitating the patient. Because of this central role and indispensability of the geriatric specialists, their work in the network of services should be obligatory, since only a continuous and global care can guarantee significant results for the geriatric patients.

The prolongation of survival in the industrialised nations is indubitably the most important demographic reality of the end of this millennium [1]. The aging of the population is correlated with two factors, i.e. the reduction in the birth and death rates [2]. The progressive increase in the number of elderly subjects has prolonged survival to 100 years of age and over, and this is one of the most important issues in modern gerontology research.

The Italian Longitudinal Study on Aging (ILSA) evaluates the rates of diabetes, cardiovascular and neurological disorders in a random sample of 5632 Italians aged 65-84 years.The ILSA has two components: a first screening phase administered to all participants, that includes a personal interview, physician examination, laboratory and diagnostic tests, and a second phase, consisting of the clinical confirmation of suspected cases by a specialist.Prevalence rates were significantly higher among men for myocardial infarction (10.7% versus 4.8%), cardiac arrhythmia (25.1% versus 20.3%) and peripheral artery disease (8.1% versus 5.2%), and among women for hypertension (67.3% versus 59.4%), heart failure (7.3% versus 5.4%) and dementia (7.2% versus 5.3%). No gender difference was found for stroke, angina, diabetes, Parkinsonism and distal symmetric neuropathy. Unreported diagnoses accounted for 85% of cases of distal symmetric neuropathy, for more than half the cases of cardiac failure, for 40% of cases of angina, and for more than one-third of cases arrhythmia, myocardial infarction, peripheral artery disease, hypertension, Parkinsonism. Data from the phase 1 interview showed substantial overreporting for myocardial infarction, peripheral artery disease, diabetes, and stroke.The authors conclude that self-reported information would lead to inaccurate estimates of prevalence rates suggesting the need for including the clinical ascertainment in any population-based epidemiological study.

The proliferative capacity of the immune system is impaired in elderly subjects and the expression of various genes involved in cell cycle progression is reduced in PHA stimulated lymphocytes during the aging process. Macrophages play a fundamental role in the immune system response. It has recently been demonstrated that the process of macrophage activation is accompanied by a rapid, transient rise of ornithine decarboxylase (ODC) mRNA levels. In fact, the ODC gene seems to be involved in macrophage activation and differentiation. The authors demonstrated that the steady-state levels of ODC mRNA and the correlated superoxide anion production are lower in the monocytes of elderly subjects with respect to those in young subjects used as control. These results confirmed the impaired immune function of the elderly.

The authors analyzed the expression of some genes involved in the control of T lymphocyte proliferation in a group of healthy elderly subjects. They focused their attention on genes involved in the G(0)/G(1) transition (TK, PCNA, H3, IL2-R) and showed decreased expression in the TK, H3 and IL2-R genes. Using flow cytofluorimetry, delayed transition from the G(0)/G(1) to the S stage was observed.

The authors report data obtained from a 3-year study of CSII and humanized insulin (semi-synthetic human insulin) administered to 18 insulin-dependent subjects in the outpatient clinic. The aim of this study was to evaluate the validity of insulin pumps in long-term treatment. Metabolic parameters were significantly improved (p less than 0.001) in the first month and remained so with only slight alterations throughout treatment. The authors underline some metabolic problems (ketosis) caused by malfunctioning of the insulin pumps, by the difficulties with the infusion system or by nodular skin lesions at the infusion site. Only these lesions called for treatment to be discontinued in 4 patients. The highest incidence of nodular skin lesions was seen after one year's uninterrupted treatment and they seem connected to the duration of treatment rather than to the patients' negligence (inadequate hygiene, delayed needle substitution). The authors conclude that CSII treatment is valid over short-term periods, whereas it presents drawbacks over long-term administration.

Gli AA. dopo aver brevemente riferito sulla struttura chimica dell'insulina e sulle principali funzioni di essa, riportano i diversi metodi di dosaggio dell'insulina nel plasma che attualmente sono in uso, ne discutono i pregi ed i difetti pervenendo alla conclusione che tutti questi metodi non forniscono una esatta situazione dello stato fisico-chimico e funzionale dell'insulina circolante.

Gli AA. rilevano che i sieri dell'individuo normale e del diabetico mai trattato con insulina sono provvisti di proprieta insulino-legante di entita analoga. In alcuni sieri, sia del soggetto normale che del diabetico, e presente un'attivita insulino-legante superiore ai valori massimi normali, che diminuisce dopo aggiunta di µU 500 di insulina bovina.

Gli AA. studiano il comportamento elettroforetico di 370 diabetici di cui 175 senza complicanze, 131 con complicanze varie e 74 con associazioni morbose diverse. Dall'insieme dei risultati ottenuti risulta che le complicanze diabetiche vere e proprie determinano, ad eccezione del coma, modificazioni proteiche modeste. Nelle associazioni morbose si osservano le modificazioni proteiche rilevate in tali malattie nei soggetti non diabetici.

Gli Autori studiano le modificazioni glicemiche dopo somministrazione endovena di un grammo di tolbutamide in soggetti normali, in diabetici ed in pazienti con malattie diverse. Iltest alla tolbutamide presenta discrete modificazioni della curva glicemica sia nei soggetti normali con eta al di sopra dei 60 anni che in pazienti affetti da emopatie, tireopatie, acromegalia, cirrosi epatica.

Gli Autori riferiscono su un gruppo di esperienzein vitro relative all'azione diretta della tolbutamide sull'utilizzazione del glucosio da parte del tessuto adiposo di ratto e su quella in presenza di insulina e di siero prelevati da soggetti metabolicamente sani.

Gli AA. prendono in esame i vari aspetti della secrezione somatotropinica: su essa influiscono i substrati energetici, quali glucosio, NEFA e proteine (regolazione di tipo metabolico), e meccanismi di tipo catecolaminico (stress, vasopressina, pirogeni, L-dopa); e presente inoltre una secrezione ritmica di GH, la quale si verifica, con meccanismo ancora non caratterizzato, in rapporto al sonno (SWS). Mentre la stimolazione di tipo metabolico puo essere inibita con la contemporanea somministrazione di glucosio, cio non avviene per la stimolazione di tipo catecolaminico e per quella legata al sonno. Sulla base di queste premesse e del presupposto che la regolazione della secrezione di GH avviene a livello diencefalico, gli AA. avanzano un’ipotesi di interpretazione unitaria del meccanismo di controllo della secrezione somatotropinica. Il segnale metabolico e quello catecolaminico verrebbero cioe percepiti in maniera indipendente, o meglio il secondo agirebbe a valle del primo, cosi da non poter essere influenzato, come questo, dalla iperglicemia. Viene supposta — cioe — la presenza di un chemocettore, sensible all’informazione energetica, che trasmette il segnale con meccanismo adrenergico. La ricezione, a livello della cellula GH-RF-secernente, avverrebbe mediante recettori α. Viene infine postulata una distribuzione topografica della regolazione metabolica nel diencefalo medio-posteriore (nucleo ventromediale) e di quella legata allo stress e al sonno nel diencefalo anteriore (nucleo paraventricolare).

Vengono riferite le modificazioni del comportamento dell'attivita similinsulinica, determinata con la metodica del grasso epididimale di ratto, dopo g l endovena di tolbutamide nel diabetico e nel soggetto metabolicamente sano.

In order to study thyrotropin releasing hormone (TRH)-thyroid hormone interaction, we examined thyrotropin (TSH) behaviour after synthetic TRH administration in 24 euthyroid subjects, 3 patients with primary hypothyroidism and 10 hyper thyroids. 8 normal subjects were studied before and after triiodothyronine (T3) treatment with increasíng TRH dosage. Our results suggest that (1) TRH-thyroid hormone interaction is dose-related: this means that TSH response to TRH depends on both thyroid hormone and TRH concentration; (2) T3-TRH interaction on TSH release is only roughly quantitative since it is suggested that other extrathyroidal factors interfere with this mechanism controlling TSH secretion.

BACKGROUND The inverse relationship of insulin level to high-density lipoprotein (HDL)-cholesterol and its positive association with hypertriglyceridemia has been demonstrated in several studies; however, the relationship of insulin to low-density lipoprotein (LDL)-cholesterol in elderly persons is not clear. This study investigates the relationships of fasting plasma insulin and selected metabolic and biological risk factors in an aged population. METHODS The present study is based on a cross-sectional analysis of the data collected at baseline of the Italian Longitudinal Study on Aging in 1992 on a random sample of 5632 Italians aged 65-84 years. Analyses were performed to compare the distribution of risk factors, such as blood level of lipids, creatinine, albumin, fibrinogen, apolipoprotein A-1 and B, blood pressure, and body mass index (BMI), by quartiles of insulin, in both diabetic and nondiabetic participants. RESULTS Significantly higher levels of triglycerides and BMI and lower levels of HDL-cholesterol were found in the upper quartile of insulin among nondiabetic individuals. In men, we also found significantly higher levels of systolic and diastolic blood pressure. The same trend for these variables, although not significant for HDL-cholesterol and blood pressure, was seen in diabetic men. In diabetic women, total and LDL-cholesterol were significantly lower in the highest insulin quartile (p