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Purpose The aims of this observational study were: to assess the relationship between psychological variables, pain, Duration Untreated Endometriosis (DUE) in a sample of women with Endometriosis; and to assess the effect of dienogest 2 mg/daily (DNG) and dienogest/ethinylestradiol 0.03 mg/daily (EE/DNG) on Symptoms, QoL, HRQoL, pain and sexual satisfaction, over time. Methods 64 women constituted the study group; (56%) took DNG and (44%) took EE/DNG. VAS, SF-36, EHP-30 and ISS were used to assess endometriosis-associated pelvic pain, QoL, HRQoL and sexual satisfaction, respectively. The study included one follow-up at 18 months. Results At T0, a longer period of DUE was related both to worst HRQoL and Physical QoL. At T1, a correlation was found between longer DUE and worst HRQoL. At T0, a negative correlation was found between VAS and PCS and between VAS and EHP-30. At T1, the same above correlation was found between VAS and PCS/MCS and VAS and EHP-30 scale. There was a correlation between ISS and VAS. ANOVA showed a reduction in dysmenorrhea, in general pain level and an improvement in emotional wellbeing, relationship with medical profession, and PCS over time, regardless to type of treatment. Moreover, a significant time × treatment group interaction for dysmenorrhea was found. Conclusion DUE and pain are important variables related to psychological aspects of women with endometriosis. Treatment with both DNG and EE/DNG may have positive effects on the QoL, HRQoL and symptoms. Moreover, DNG seems to have a greater effect than EE/DNG on dyspareunia reduction over time.

Il capitolo descrive, nell'ambito del Progetto CISAS (Centro di studi avanzati su ambiente, ecosistema e salute umana), il disturbo olfattivo e la sua valutazione, strettamente associata alla percezione umana soggettiva.

Asthma may have an impact on lung function decline but conflicting results are reported in forced expiratory volume in one second (FEV1) decline. We aimed to describe the changes in FEV1 in lifelong non-smoking adult asthmatic outpatients during a 10-year follow-up comparing years 1–5 (1st period) with years 6–10 (2nd period) to assess factors affecting these changes. A total of 100 outpatients performed spirometry every 3 months during a 10-year survey. FEV1/Ht3 slope values of the 2nd period reduced significantly respect to the 1st period (p < 0.0001). FEV1 slopes of years 1–5 and 6–10 were inversely associated with FEV1 at enrolment (p = 0.02, p = 0.01, respectively). Reversibility and variability FEV1 showed a significant effect on the 1st period slopes (p = 0.01 and p < 0.04, respectively). Frequent exacerbators in the 1st year had steeper FEV1/Ht3 slopes in the 1st period (p = 0.01). The number of subjects using higher doses of ICS was significantly lower at the 10th years respect to the 5th and the 1st year (p < 0.001, p = 0.003, respectively). This study shows that FEV1 decline in treated adult asthmatics non-smokers, over 10-year follow-up, is not constant. In particular, it slows down over time, and is influenced by FEV1 at enrolment, reversibility, variability FEV1 and exacerbation score in the 1st year.

Resume Objectifs A travers le recours a la mediation photographique, nous souhaitons montrer les benefices du recours a un dispositif groupal a mediation dans le contexte migratoire. L’accent sera mis sur la circulation des affects en groupe et sur l’articulation sujet-groupe dans ce type specifique de prise en charge. Methode Le groupe Photolangage® ici presente s’inscrit dans le cadre d’une prise en charge et d’un soutien psychologique adresse a des mineurs isoles etrangers (MIE). Il s’agit de cinq adolescents ressortissants d’Afrique Noire et du Bangladesh, d’âge compris entre 15 et 17 ans. Pour notre analyse, nous aurons recours a la methode clinique apte a favoriser les processus de lien, de representation et de symbolisation dans la situation groupale. Resultat Les elements cliniques observes, nous montrent comment les objets culturels representes dans et par les photos, ainsi que le recours a la langue maternelle de la part des participants ont tenu un statut d’objet de mediation, en ouvrant un veritable espace potentiel garant de transformation et de changement. L’objet culturel se presente ici comme un « passeur » des affects et des representations non encore accessibles aux sujets. Discussion Les mouvements migratoires actuels ont des repercussions, sociales, politiques et psychologiques a la fois individuelles et collectives tres complexes. Les problematiques concernant les migrants mineurs non-accompagnes et leur prise en charge, nous sollicitent a penser nos cadres de soin dans une dimension transculturelle et modifient nos facons de penser et de pratiquer la clinique. Les effets du colonialisme sur la psyche du sujet migrant sont davantage actuels et structurants de leur identite subjective et collective. Ces elements nous aident d’ailleurs a une meilleure comprehension des imaginaires emergents en groupe. Conclusions Les problematiques concernant la migration dans un contexte de violences sociales et collectives, doivent etre pensees a nos yeux en articulation avec la complexite des differents espaces psychiques mobilises. De plus, ces problematiques sont remises a la fois en question, en jeu, en travail, en interrogations et parfois en echec dans un contexte transculturel. L’introduction de la mediation des images en groupe favorise, ainsi, l’articulation des differents espaces psychique et soutient la mise en mouvement des processus de lien et de representations des affects.

Introduction: Primary care is the frontline for diagnosis and treatment of chronic obstructive pulmonary disease. Airway obstruction (AO) may not be diagnosed, although airflow obstruction is present on spirometry. Thus, a proportion of subject is underdiagnosed. Aims To identify clinical predictors that can induce General Practitioners (GPs) to assess patient’s respiratory function through spirometry. Methods: 259 adults (148 M, aged 40-88) attending the GPs’ office for a generic consultation, January-June 2014, performed spirometry, IMCA questionnaire. Comorbidities were assessed. We evaluated reported respiratory diagnoses: asthma (A), chronic obstructive pulmonary disease (COPD), asthma plus chronic obstructive pulmonary disease (ACOS). Non respiratory diagnosis (NRD) were subjects not reporting any respiratory diagnosis. For screening purpose a cut-off of FEV1/FVC Results: We found: A-8%; COPD-12%; ACOS-4%; NRD-76%. 16% showed AO: 26% in A; 30% in COPD; 43% in ACOS; 10% in NRD. Among NRD 56% reported at least one respiratory symptom. 82% among obstructed NRD. AO severity was: 33% Level 1, 51% Level 2, 16% Level 3. None in Level 4. 69% showed comorbidities. 40% showed cardiovascular diseases. In a logistic multiple regression model, wheezing, male gender, and age >65, were predictors of AO in the NRD, when adjusted for smoking habit (OR=2.76; 3.12; 2.97 respectively). Conclusions In a sample of adults in a primary care setting, wheezing, male gender, and age>65 are predictors of AO. This should suggest to GPs to prescribe spirometry.

Introduction: Comorbidities are known to impair Quality of Life (QoL)in patients with chronic obstruction pulmonary disease. A poor QoL is associated with higher dyspnoea perception. How comorbidities influence QoL in these patients is limited and needs clarification. Aim: To study the role of dyspnoea perception in the relationship between comorbidities number and QoL in obstructed and not obstructed adults in a primary care setting. Methods: Seventeen general practitioners participated to the study: 566 adults, attending the Practitioner9s study for any reason, performed spirometry and fulfilled a respiratory questionnaire between January and June 2014. 259 adults (148 M, aged 40-88) accepted to perform all the procedures: spirometry, IMCA and QoL(SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and mMRC Dyspnoea Scale. For screening purpose a cut-off of FEV 1 /FVC Results: The 25% of sample showed AO. No significant difference in mMRC score, neither comorbidities number nor PCS was found between AO and not AO. Comorbidities number and PCS were inversely related in both AO (p Conclusions: We conclude that the effect of comorbidity number on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in obstructed adults also in a primary care setting may be a useful indicator for evaluating the patient global health.

Aim of the study was to assess the treatment of airway obstructive diseases in a sample of adult patients in a primary care setting in the city of Palermo, southern Italy. Seventeen general practitioners (GPs) participated in the study (January-June 2014). 583 adults (323 males) fulfilled a respiratory questionnaire and performed a spirometry. We evaluated doctor diagnosis of: asthma (A), chronic obstructive pulmonary disease (COPD), asthma plus chronic obstructive pulmonary disease (ACOS), inhaler respiratory treatment. For screening purpose a cut-off of FEV1/FVC < 0.70 was considered as marker of airway obstruction (AO). We found:A-8%; COPD-12%; ACOS-4%; subjects not reporting respiratory disease (NRD)-76%. Inhaler treatment was present in: 56%-A; 40%-COPD; 62%-ACOS; 7%-NRD. Airway obstruction was found in 95 (16.3%) subjects: 26%-A; 30%-COPD; 43%-ACOS; 10%-NRD. Only 52% of AO subjects reported inhaler treatment: 83%-A; 69%-COPD; 67%-ACOS; 29%- NRD. Inhaler treatment prevalence was: 8%-long-acting β2-agonist (LABA) and/or long-acting muscarinic antagonist (LAMA); 33%-LAMA and/or LABA and inhaled corticosteroid (ICS); 26%-LAMA and LABA and ICS; 2%-ICS; 31%-Other. In a logistic regression model, wheezing (OR=4.50), cough (OR= 2.12), and dyspnea (OR= 2.22), were predictors of treatment in overall sample, when adjusted for age, sex and smoking habit. In AO dyspnoea was the best predictor of inhaler respiratory treatment (OR= 3.61). This study points out that in a sample of adults in a primary care setting the inhaler respiratory treatment is underused with respect to diagnosis and airway obstruction. Respiratory symptoms, in particular dyspnea, appear to be predictors of GPs' inhaler prescription.