Metastatic colorectal cancer (mCRC) is constituted of several biological subgroups characterized by molecular alterations activating specific proliferative pathways. These alterations have, for a long time, lacked target...Metastatic colorectal cancer (mCRC) is constituted of several biological subgroups characterized by molecular alterations activating specific proliferative pathways. These alterations have, for a long time, lacked targeted therapies capable of inactivating these signalling pathways and eventually modifying the course of the disease. This scenario has rapidly been evolving in recent years, thanks to a better understanding of mCRC biology and advances in drug development, that have turned these alternations into "actionable" targets. BRAFV600E is a landmark example of this process. Conceived for roughly a decade as a negative prognostic factor of outcome and as a predictor of resistance to anti-EGFRs, today it is also a predictor of response to the combination of the anti-BRAF encorafenib and of the anti-EGFR cetuximab, and a standard of care in patients with BRAFV600E-mutated mCRC, after failure of previous systemic therapy. In this work, we report three clinical scenarios where encorafenib and cetuximab are used in label as first-line of treatment, at the diagnosis of mCRC, after early relapse occurring at the end of adjuvant chemotherapy.
INTRODUCTION: This study analyses the trend of ordinary acute hospital admissions in Tuscany from 2014 to 2023. METHODS: Hospital discharge records were examined by DRG type, urgency, and period (pre-, during, and post-p...INTRODUCTION: This study analyses the trend of ordinary acute hospital admissions in Tuscany from 2014 to 2023. METHODS: Hospital discharge records were examined by DRG type, urgency, and period (pre-, during, and post-pandemic). RESULTS: In 2023, scheduled surgeries exceeded 2019 volumes, while medical and urgent admissions remained below expected levels. DISCUSSION: The limited recovery of medical and urgent admissions may suggest a structural reduction in demand.
INTRODUCTION: The Informed Health Choices (IHC) group developed key concepts of critical health literacy, gathered them into learning resources, and evaluated them in a large, randomized study involving children aged 10...INTRODUCTION: The Informed Health Choices (IHC) group developed key concepts of critical health literacy, gathered them into learning resources, and evaluated them in a large, randomized study involving children aged 10 to 12. Children who were taught with IHC resources showed a greater ability to assess health claims and understand an informed health choice than children not taught with these resources. Many research groups worldwide are implementing the IHC resources in their school contexts. METHODS: In Italy, after an initial contextualization of the IHC resources in a single primary school in Tuscany, we carried out a second study across three regions. Our objectives were to: 1) investigate the feasibility of introducing IHC resources in primary and secondary schools; 2) evaluate students' and teachers' experiences with these educational resources; 3) identify effects, barriers, and facilitators regarding the implementation of IHC resources in Italian primary and secondary schools. To assess these objectives, we used qualitative and quantitative methods. RESULTS: Qualitative and quantitative analysis indicated that IHC resources integrated well into the curriculum of the participating Italian schools. Students and teachers had a highly positive experience with the IHC resources, despite varying regional socioeconomic contexts. Teachers identified logistical challenges during the pandemic as the main obstacle to the project's implementation. Students and teachers highlighted the multicultural nature of the content, support from healthcare professionals during lessons, and the interactive teaching approach as key facilitators of implementation. CONCLUSIONS: Findings from the contextualization of IHC resources indicate that these materials integrate well into the Italian school curriculum and are suitable and engaging for both students and teachers.
Timely access to care for acute myocardial infarction (AMI) is critical for reducing morbidity and mortality, but women often seek care later than men. This article examines how Leventhal's Self-Regulation of Disease Mod...Timely access to care for acute myocardial infarction (AMI) is critical for reducing morbidity and mortality, but women often seek care later than men. This article examines how Leventhal's Self-Regulation of Disease Model (SRM) can explain these delays and suggests interventions to improve the response to cardiac emergencies in women. Cultural perceptions of the disease as more prevalent in men contribute to the delays. The SRM provides a useful framework for understanding the influence of cultural and personal representations on care seeking. Targeted educational interventions and awareness campaigns highlighting the symptoms of AMI in women may improve timeliness of treatment and reduce mortality.
Functional disorders of the upper digestive tract, including functional dyspepsia and irritable bowel syndrome with predominant gastric symptoms, represent conditions that are highly prevalent in the general population a...Functional disorders of the upper digestive tract, including functional dyspepsia and irritable bowel syndrome with predominant gastric symptoms, represent conditions that are highly prevalent in the general population and are associated with a marked impairment of patients' quality of life. Functional dyspepsia, characterised by symptoms such as epigastric pain, early satiety and bloating, in the absence of detectable structural abnormalities, is commonly divided into two subtypes: postprandial distress syndrome and epigastric pain syndrome, as described in the Rome IV diagnostic criteria. Although the pathogenesis of these disorders is not completely understood, it is believed that there is a complex interaction between altered gastrointestinal motility, visceral hypersensitivity, gut dysbiosis and dysfunction in the central modulation of visceral signals. Current guidelines recommend a multimodal therapeutic approach, including both pharmacological treatments and lifestyle modifications. First-line drugs for the management of functional dyspepsia include prokinetics, such as domperidone and itopride, and proton pump inhibitors, the latter being indicated mainly in patients with symptoms associated with hyperacidity. In refractory cases, numerous studies support the use of tricyclic antidepressants and serotonin modulators, which appear to bring significant symptomatic improvement. Recently, scientific interest has also turned to the role of the intestinal microbiota in the pathogenesis of functional disorders of the upper digestive tract, opening up prospects for innovative therapies, including the use of probiotics and modulation of the intestinal flora. However, current guidelines emphasize the need for further clinical evidence to consider such approaches as standard of care. In conclusion, although significant progress has been made in the understanding and treatment of these disorders, there remains much room for development with regard to targeted and personalized therapeutic strategies.
The world of scientific publishing has undergone, in recent decades, a series of profound transformations supported by continuous technological innovations and strongly motivated by the movement born to promote free acce...The world of scientific publishing has undergone, in recent decades, a series of profound transformations supported by continuous technological innovations and strongly motivated by the movement born to promote free access (Open Access - OA) and without restrictions to scientific information. In this still evolving context, the Diamond Open Access model emerges in which journals and platforms do not require fees from authors or readers. In this article, after a brief overview of how scientific publishing has developed from the traditional publication model to OA and how we arrived at the Diamond OA model, the authors will focus on examining the latter in particular. The aim of this contribution, in fact, is to provide an account as exhaustive as possible of the numerous projects, initiatives and organizations that currently support and promote the Diamond OA model and, at the same time, to reflect on its sustainability and on the concrete problems that hinder its greater diffusion within the varied ecosystem in which scientific information moves today.
The claim that a universal National health service (Nhs) is unsustainable is frequently accepted as fact, yet pharmaceutical care in Italy demonstrates otherwise. Italy ranks among European Union leaders in public drug a...The claim that a universal National health service (Nhs) is unsustainable is frequently accepted as fact, yet pharmaceutical care in Italy demonstrates otherwise. Italy ranks among European Union leaders in public drug access, contradicting the narrative of Nhs unsustainability. Achievements stem from national strategies in drug evaluation, reimbursement criteria, price negotiation and the presence of a competitive context. Private pharmaceutical spending remains substantial, mainly because of lack of price negotiation. Shifting drug costs to citizens and promoting private insurance would increase both private and public expenditures. The US example shows that higher private spending correlates with higher public spending. Reducing Nhs coverage would worsen existing challenges rather than solve them.
Alzheimer-Perusini's disease (AD) represents a growing health crisis. The lack of effective disease-modifying treatments and its increasing prevalence in the elderly population contribute to a major burden for patients a...Alzheimer-Perusini's disease (AD) represents a growing health crisis. The lack of effective disease-modifying treatments and its increasing prevalence in the elderly population contribute to a major burden for patients and their caregivers, challenging health systems globally. The accumulation of beta-amyloid protein (Aβ) within the brain tissue plays an important pathogenic role in the inflammatory and degenerative mechanisms leading to cognitive and functional impairment. In recent years monoclonal antibodies targeting (Aβ) have been developed and one of them (lecanemab) recently received marketing authorization by the European Medicines Agency (Ema). Although they represent an important innovation in the treatment of AD, their clinical net benefit is uncertain, due to modest efficacy and the threat of potentially severe side effects. Cost, mode od delivery and complexity of programs aimed at minimizing risks for people with AD may limit access to these therapies and pose equity issues within health systems.