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BackgroundBehavioral and psychological symptoms of dementia (BPSD) have a high prevalence, and their presence is associated with a severe impact in terms of social costs. However, dedicated clinical tools or biomarkers to detect these symptoms are lacking. Thus, BPSD management in clinical settings is challenging. The aim of this study was to investigate the perception and the treatment strategies for BPSD in Italian centers working in the dementia field.MethodsA multicenter, national survey was developed by BPSD Study Group of the Italian Neurological Society for Dementia (SINDEM). The survey consisted of a semi-structured questionnaire that was e-mailed to SINDEM members, dementia centers part of the national network of memory clinics (Centers for Cognitive Deterioration and Dementia [CDCD]), and clinicians working in dementia care settings. The questions were focused on (1) perceived global frequency and relevance of BPSD; (2) tools used to assess BPSD; (3) pharmacological treatment for psychosis, apathy, agitation, aggression, depression, anxiety, sleep, and nutrition disturbances; (4) non-pharmacological treatments; (5) drugs side effects.ResultsOne-hundred and thirty-six clinicians participated in this study. Seventy-nine participants worked in a CDCD and 57 in other settings. The perceived frequency of BPSD was 74%. BPSD are detected by means of a clinical assessment for 96.3% or a caregiver interview for 97%. For psychosis treatment the first choice was atypical antipsychotics (83.3%), followed by typical antipsychotic (8.9%) and antidepressants (4.8%). For agitation, atypical antipsychotics were the first-choice treatment in 64% of cases and antidepressants in 16.1%. For aggression, the most used drugs were atypical antipsychotics (82.9%). For anxiety, 55.2% use antidepressants, 17.9% use atypical antipsychotics, and 16.9% use benzodiazepines. Interestingly, most of the centers apply non-pharmacological treatments for BPSD. Some differences emerged comparing the responses from CDCD and other care settings.ConclusionThe survey results revealed many differences in BPSD perception, treatment options, and observed side effect according to the clinical setting. This variability can be explained by the absence of clear guidelines, by differences in patients' characteristics, and by clinical practice based on subjective experience. These results suggest that producing guidelines for the pharmacological treatment of BPSD is a major need.

Background: Osteoarthritis (OA) is the most common form of chronic pain in Europe (34%), representing a great economic and social cost to society. There are studies that suggest an intestine–brain–articulation axis and hint at the existence of low-grade intestinal inflammation in OA, which would be related to an alteration of the microbiota and to the impairment of the epithelial barrier, with leakage of the microbial components. Purpose: The purpose of this study was to review the association between gut microbiome and pain in the OA population through a review of the literature. Methods: A literature search was conducted to identify all available studies on the association between the gut microbiome and pain in the OA population, with no publication date limit until September 2020 and no language limit, in the MEDLINE, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials databases. Results: Only three of 2084 studies detected and analyzed by performing the proposed searches in the detailed databases, were finally selected for this review, of which one was with and two were without intervention. These studies only weakly support a relationship between the gut microbiome and OA, specifically a correlation between certain taxa or microbial products and the inflammatory landscape and severity of OA symptoms, including knee pain. Conclusions: Despite encouraging results, this review highlights the paucity of high-quality studies addressing the potential role of the gut microbiome in OA-related pain, along with the disparity of the techniques used so far, making it impossible to draw firm conclusions on the topic.

L'articolo reinterpreta la categoria narratologica di onniscienza applicata al campo della non-fiction e dopo un preambolo teorico si esaminano due casi particolari della narrativa italiana contemporanea: "Città sommersa" di Marta Barone e "La natura è innocente" di Walter Siti The article reinterprets the narratological category of omniscience applied to the field of non-fiction and after a theoretical preamble we examine two particular cases of contemporary Italian fiction: "Submerged city" by Marta Barone and "Nature is innocent" by Walter Siti

Il libro propone una teoria della categoria di narrativa non-finzionale nota come "non-fiction". Dopo una premessa storico-teorica si esamina la non-fiction in base alle forme e ai generi adoperati in questa categoria di scrittura, dopo di che si procede a un'analisi di temi e costanti concettuali condotta attraverso una lettura per campioni di testi degli ultimi trent'anni. Una breve considerazione su potenzialità e limiti discorsivi, commerciali, comunicativi della non-fiction italiana e straniera chiude il libro.

The article intends to synthetically reconstruct a line of development of the Italian narrative contemporary, from the nineties onwards, based on the concept of authenticity, vast and rich in applications in the most disparate fields (juridical, philosophical, artistic). After a brief review of four emblematic cases for the use of authenticity rhetoric (Siti, Moresco, Mozzi, non-fiction), the article offers a brief overview of the narrative of last twenty years. It therefore ends with a reflection on a possible passage from one demystification of authenticity (with autofiction) to its internal amplification contradictory (with non-fiction). Cet article se propose de retracer une histoire de la fiction italienne contemporaine depuis les années 1990 jusqu’à nos jours, sur la base de la notion d’authenticité, une notion étendue et déclinable dans plusieurs domaines (juridique, philosophique, artistique). Après un recensement initial, qui se focalise autour de quatre exemples pour leur usage des rhétoriques de l’authenticité (Siti, Moresco, Mozzi, la non-fiction), cet article pose un regard panoramique sur la fiction italienne des vingt dernières années. Il se termine avec une réflexion sur le possible passage d’une démystification de l’authenticité (dans l’autofiction) à son amplification contradictoire (avec la non-fiction).

L’intervento s’inserisce nel dibattito sull’autobiografismo di Scotellaro nelle sue due maggiori opere in prosa, arrivateci incomplete e non pronte per la pubblicazione:Contadini del Sud e, soprattutto, L’uva puttanella, che Scotellaro definiva in fase di preparazione un ‘‘romanzo’’. Se Contadini del Sud, nelle parti disponibili oggi, sembra anticipare alcuni esiti dell’attuale non-fiction per via dell’uso disinvolto del materiale documentario, del risalto dato alle testimonianze e alle ricognizioni sul campo, della creazione di veri e propri ‘‘personaggi’’ a tutto tondo che si esprimono direttamente sulla pagina, L’uva puttanella ha caratteristiche che ne sottolineano invece l’inattualita` e insieme la natura di memoir ancora, alla morte di Scotellaro, incerto sulla direzione da prendere. Vengono proposte alcune ricognizioni testuali intorno all’Uva puttanella, al fine di ricostruire la sua natura autobiografica sospesa fra autoapologia politica (il testo fu iniziato durante la prigionia di Scotellaro) ed espressione poetica, ricordo familiare e apertura in forma di micro-racconti di alcuni abitanti del paese. Non si ricompongono le tensioni narrative di una prosa ellittica per scelta, che tende al frammento di realta` da una parte e al lirismo dall’altra: e` cio` che sembra dimostrare la conclusione della Parte prima, di cui si propone una nuova lettura. The intervention is part of the debate on Scotellaro's autobiography in his two major works in prose, which arrived incomplete and not ready for publication: Contadini del Sud and, above all, L'uva puttanella, which Scotellaro defined in preparation as a ''novel''. If Contadini del Sud, in the parts available today, seems to anticipate some outcomes of the current non-fiction due to the casual use of documentary material, the prominence given to the testimonies and reconnaissance in the field, the creation of real '' characters '' in the round that are expressed directly on the page, L'uva puttanella has characteristics that underline instead its out-of-date nature and at the same time the nature of a memoir again, on Scotellaro's death, uncertain about the direction to take. Some textual reconnaissance around the Uva puttanella is proposed, in order to reconstruct its autobiographical nature suspended between political self-apology (the text was started during Scotellaro's imprisonment) and poetic expression, family memory and opening in the form of micro-stories of some inhabitants of the country. The narrative tensions of an elliptical prose by choice are not recomposed, which tends to the fragment of reality on the one hand and to lyricism on the other: this is what seems to demonstrate the conclusion of Part One, of which a new reading is proposed.

Questo articolo tenta di rispondere alla domanda circa la possibilità della sopravvivenza della forma letteraria del romanzo-saggio nella letteratura contemporanea. Dapprima, viene proposta una distinzione teorica fra due forme letterarie che combinano narrazione e riflessione: saggio narrativo (ricco di esempi) e romanzo-saggio (la cui persistenza è invece problematica). In secondo luogo, attraverso la lettura parallela di Estensione del dominio della lotta di Michel Houellebecq e La vita degli animali di J. M. Coetzee, vengono avanzate alcune ipotesi teoriche sulla trasformazione del romanzo-saggio e su un suo possibile declino: è invece la fantascienza, si ipotizza, a rivestire oggi il ruolo di principale forma deputata a formulare ipotesi filosofiche sul presente. Una lettura parallela di La vita in tempo di pace di Francesco Pecoraro e La scuola cattolica di Edoardo Albinati, infine, indica sviluppi, pregi e limiti del romanzo-saggio contemporaneo, soprattutto per quanto riguarda la disgregazione del personaggio e il venir meno di uno slancio utopistico. This article focuses on the literary form of the novel-essay and aims to answer to the question concerning its chances of surviving nowadays. First, a theoretical distinction between two different forms combining narration and reflection is proposed: these forms are the narrative essay (which can provide many examples) and the novel-essay (whose survival is troubled). Secondly, through a compared analysis of Michel Houellebecq’s Whatever and J. M. Coetzee’s The Lives of Animals the article speculates about the transformation occurred in the novel-essay and a hypothetical decline. Science-fiction, conversely, might be the main literary form selected for reflecting on the world today. A parallel close-reading of Francesco Pecoraro’s Life in Peacetime and Edoardo Albinati’s La scuola cattolica concludes the article, by pointing out developments, strengths and weaknesses of the contemporary novel-essay, especially for what concerns the increasing fragmentation of the main characters and the loss of an utopian avocation. PAROLE CHIAVE Romanzo-saggio; animali; razionalismo; filosofia; post-umano; utopia; Francesco Pecoraro; Edoardo Albinati; Michel Houellebecq; J. M. Coetzee., Ticontre. Teoria Testo Traduzione, No 9 (2018)

Summary Background & aims To date, studies assessing the relationship between sarcopenia and delirium, two of the most common geriatric syndromes, are lacking. We sought to explore this association by investigating the co-occurrence of these two conditions and the independent association between them in a population of hospitalized older adults. Methods Cross-sectional multicenter analysis of older adults consecutively admitted to 12 acute geriatric units (AGUs). Sarcopenia was assessed upon admission by evaluating the presence of low skeletal mass index (kg/m 2 ), and either low handgrip strength or low walking speed (European Working Group on Sarcopenia in Older People, EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis. Participants underwent a comprehensive geriatric assessment upon admission; information concerning demographics, cognition (Short Portable Status Mental Questionnaire, SPMSQ) functional (Instrumental Activities of Daily Living, IADL and Basic-Activities of Daily Living, BADL), and health status (Charlson Index and specific diseases) was evaluated. The presence of delirium upon admission was ascertained as an explicit clinical diagnosis recorded by the researcher of each centre on the data form. All association estimates were reported as Prevalence Ratios (PRs) and 95% confidence intervals (CIs), using a Cox hazard proportional regression model with robust variance and constant time. Results Of the 588 analyzed patients (mean age = 80.9 ± 6.8, 53.2% females), 199 (33.8%) had sarcopenia upon admission to the AGU. According to a multivariable Cox regression, delirium upon admission (PR 1.66, 95% CI: 1.12–2.45), IADL total score (PR 0.93, 95% CI: 0.87–0.98), Body Mass Index values (BMI) ranging from 18.5 to 25.0 (PR 1.70, 95% CI: 1.33–2.18), BMI values >18.5 (PR 2.53, 95% CI: 1.81–3.53), previous stroke (PR 1.51, 95% CI: 1.10–2.07) and chronic heart failure (CHF) (PR 1.31, 95% CI: 1.02–1.68) were significantly and independently associated with sarcopenia upon admission to the AGU. Conclusion The study, carried out in a population of hospitalized older patients, shows that a diagnosis of delirium upon admission to the AGU was more frequent in those with sarcopenia than in others. Furthermore, the study found that delirium was independently associated with the risk of being sarcopenic upon admission to the AGU. Future studies are needed to confirm this association.

Osteoporosis and cardiovascular diseases are two of the major public health problems: both are associated with high morbidity and mortality, increased recourse to hospital services, loss of independence, increased risk of institutionalization and high health-related costs. The socio-economic consequences of both these diseases are very important bearing in mind the facts that OP is the second highest world health problem after CVD, and this number will increase with the growth of the elderly population over the next decades.

Aim To characterize elderly medical patients and identify factors associated with prolonged length of stay. Methods The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities. Results Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases – resulting in 2637 days of prolonged hospital stay – and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay. Conclusions Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). Geriatr Gerontol Int 2015; 16: 314–321.

To characterize elderly medical patients and identify factors associated with prolonged length of stay.The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities.Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases - resulting in 2637 days of prolonged hospital stay - and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay.Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49).

The parathyroid hormone (PTH) in physiological conditions is secreted into the circulation in response to low calcium levels and its principal activity is to regulate the concentration of calcium in the blood circulation, modulating movement of calcium into and out of the bone and reabsorption from renal tubules so as to maintain serum calcium concentration within a narrow range [1].

Oggetto d’analisi del saggio è la serie televisiva Westworld, ideata da Jonathan Nolan e Lisa Joy (HBO, 2016– ), e adattamento del film omonimo e diretto da Michael Crichton (Il mondo dei robot, 1973), grande successo degli anni Settanta e testo di culto dell’immaginario distopico sullo sviluppo dell’intelligenza artificiale. Tenendo conto delle diverse teorie critiche sull’adattamento, lo studio mira a mettere in luce le strategie traduttive che l’opera ha attivato rispetto al testo di partenza, nato in un contesto culturale, sociale e tecnologico molto diverso. Temi ricorrenti nella produzione di Crichton, l’uso deviante della scienza, con relativi errori o manomissioni, e le conseguenti catastrofi sono al centro anche di quest’opera. Lo scenario principale è un distopico parco a tema, in cui facoltosi turisti possono sperimentare esperienze proibite nella vita reale, tra le quali lo stupro e l’assassinio. Oggetto delle azioni dei visitatori sono gli abitanti di Westworld, incarnanti al massimo grado “l’Altro”, in quanto “nativi” del parco e soprattutto androidi imprigionati in un’eterna coazione a ripetere, in grado di mostrare emozioni e interagire con gli esseri umani senza mai poterli danneggiare veramente. L’obiettivo dello studio è di mettere in luce le diverse strategie testuali attraverso cui la serie, caratterizzata da una testualità dilatata ed espansa rispetto al formato cinematografico, mette in scena e problematizza diversi temi cruciali, tra i quali la natura delle emozioni, la coscienza e l’intelligenza artificiale in uno scenario futuristico dominato da nuove forme di schiavismo e lotta di classe. Un altro aspetto analizzato è la forte componente metanarrativa dell’opera, che tematizza il racconto stesso e la porosità dei confini tra realtà e finzione.