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Cu re



m a g a z i n e

N°07 September

World Heart Day

02 Editorial 03 Secretary of State for Health and Safety Francesco Mussoni 04 Alimentary Pyramid, a Presentation 05 A dog is a man’s best

friend. It touches your heart 06 Nordic Walking 07 Health in Philately 08 Tell us about it.. 10 “Systolic and Diastolic” Blood pressure 11 World Heart Day

12 Life according to... Vito 13 The role of rehabilitation in cardiovascular disease 14 Curiosities from the World of Science 15 Health and the Commonplace of Medicine

Autorizzazione N. 1962/75/2011

29th September


ed it or ial Welcome Back! Editorial by Dr. Giovanni Michele Zangoli


he publication date of this issue of our magazine could not fall more appropriately given the occasion of World Heart Day (September 29). That’s why our Association rightly wants to be at

the forefront of the event with a series of initiatives, including the special issue of a postal mark and a themed stamp issued by the State Philatelic and Numismatic Company that has also attracted enthusiastic attention across the ocean. The message contained in a square of so few centimetres is clear: heart health starts with prevention through a series of healthy lifestyles.


an Marino already has an optimal coverage of defibrillators throughout its territory, a wealth

that, as stated by the Secretary of State for Health (see interview inside), is worth enhancing and strengthening in terms of communication and information so that the service is optimally beneficial.


oping that all citizens take action by participating in this Cuore-Vita, Heart-Life anniversary celebration capturing its true meaning: the event is tied to a day, the message applies all year



Four Questions to Francesco Mussoni

By Dr. Giovanni Michele Zangoli

Secretary of State for Health and Safety 1) The economic tightening entails cuts and sacrifices: will it also affect public health? I asked for a 2 million savings in 2013 compared to a budget of 69 for health spending. With the social security expenditure the budget of the Institute rises up to over 100 million euro. Only health and social health spending was at 69 million in 2012. The objective therefore is a reduction of 2 million because I realized that there are potential economies to pursue and it seems logical to fit the country’s economic performance into a general reading of the general budget. We’re playing the game together but without adopting a policy that would penalize anyone. This is to identify all possible economies while keeping the guarantees and benefits intact for health and safety because health, as much as primary education, is one of the primary assets of the State and as such must be safeguarded. 2) Sammarinese citizens are top in the world rankings of longevity (80 years for men and 83 women). Is it lifestyles that make a difference or what? I’m carefully considering these record data to understand this reality in depth. There is a project with the World Health Organization that we are enquiring into together. We must consider that the quality of life, longevity, stem from several factors: the economic situation of a country like San Marino where life is good and a type of welfare that affects it in a positive sense. To these we can add the lowest child mortality rate record in the world. Because of this I would like to adopt the slogan: San Marino the Capital of health and well-being. 3) Yet paradoxically there is little talk about quality of life in election proclamations. I think it is also a cultural issue: like when you acquire a certain lifestyle as you do in your daily behaviour. This concept of living in good health then becomes obvious when we compare it to other contexts. Moreover, people are not numbers and as such should be protected regardless of sex and age, a basic concept in a universal health care system like ours. Evidently the quality of life is a value acquired by the population and as such heavily involves our culture regardless of political proclamations. 4) San Marino enjoys widespread coverage in terms of defibrillators. Considering that heart disease is the leading cause of death in the world, it is also an eloquent message for the next World Heart Day? (September 29). Yes, it is a strong message that we would like to develop with specialists and your own CuoreVita Association. Despite the scarce resources, continuity should be given to these projects so that the service is optimally beneficial. In this sense, I think that communication and information should be strengthened. On the Heart Project, there have been well-organized campaigns, but this can be enhanced even more through an institutional collaboration between cardiology associations, the Heart Project and the Secretariat for health. We are already working on initiatives and projects that will create more homogeneity in the knowledge of this reality.


Presentation of the Alimentary Pyramid By Dr. Marina Corsi Nutritionist Part One There are many dietary models in the world but the only one that has received recognition as a World Heritage is represented by the Mediterranean diet, which amongst others is also supported by the WHO (World Health Organization) in the fight against obesity and for the prevention of cardiovascular diseases and chronic degenerative diseases. The term “Mediterranean Diet” follows the traditional dietary patterns typical of some Mediterranean regions such as Crete, parts of Greece, Southern Italy, North Africa, the Middle East, Spain. This dietary model is characterized by the habitual consumption of servings of vegetables, fruits and legumes, dried fruit, the use of cereals in the form of bread and pasta, preferably wholemeal; with preferably moderate consumption of salt water fish, white meat, wine and occasional consumption of red meat and the use of, as the only “fat” dressing, extra virgin olive oil. The Mediterranean diet also supports the use of fresh and seasonal produce, the proper use of herbs and spices and the safeguarding of smells and tastes that characterize a cultural heritage and a land and that are not artificially reproduced. The Mediterranean diet further provides: accord with the guidelines for healthy eating; a variety of colours, smells and tastes, availability of healthy foods that are also suitable for snacks, appetising and tasty recipes; the consumption of local produce according to the seasons; the diet proposes a well defined alimentary scheme that competes well with convoluted models.

It also proved the possibility of acheiving favourable effects in the prevention of: obesity, diabetes, hyperlipidemia, hypertension, atherosclerosis, certain cancers. The foods included in the Mediterranean diet are: cereals, fruits and vegetables, legumes, dairy products, fish, eggs and meat alternatives, extra virgin olive oil, wine in moderate amounts Nutrients of the Mediterranean diet are represented by: 55% -60% carbohydrates, 12% proteins, fats <30%, fibre, reduced sodium content, high amounts of antioxidants.


A dog is a man’s best friend. It touches your heart By Dr. Giovanni Iwanejko

Today it is demonstrated and confirmed at the scientific level that a dog, that has had a privileged relationship with man for more than 33,000 years, has positive effects on the overall health of our species, with visible benefits both physically and mentally. It is a companion at play, work, in adventure and gives us its love without asking anything in return, yes ... it shares its life with us providing us love, fun and health! A few months ago the American Heart Association announced that owning a dog (or a pet) “can most likely be associated with a decrease in cardiovascular risk, and can help to lower cholesterol levels and blood pressure, to fight obesity, to do more physical activity, reduce stress, anxiety, depression.” According to Dr. Glenn Lewine, a professor at Baylor College of Medicine in Houston (USA), owning a dog reduces cardiovascular risk factors since it must be taken for a walk and this is definitely a motivation for exercise that is essential for cardiovascular health. Also it can affect reactions to stressful stimuli in a positive way, perhaps because you are happier when you have a pet at home. But the studies are not definitive: they don’t necessarily show that owning a dog directly causes a reduction in cardiovascular risk; it could also be that healthy people are simply those that most often adopt pets. (Lewine Glenn). The fact is that even if we have to wait for further confirmation from the scientific world on the positive aspects of adopting

a four legged friend, for those already suffering from cardiovascular disease, the company of a dog improves mood and forces us to take regular daily walks thereby forever remaining a great friend of our hearts!


Nordic Walking By Dr. Danilo Ridolfi Personal Trainer RSM Nordic Walking originated in Finland in the 30s when cross-country skiers trained in the summer walking with poles. Over the years, the number of practitioners has increased extending even to those who aren’t athletes due to the simplicity, versatility and health benefits resulting from walking with poles. In 2006 this new discipline was “codified“ by the International Federation of Nordic Walking and today it is one of the disciplines in great expansion.

“Nordic Walking” permits you to use 90 % of the muscles of the body, as in swimming, and to burn 40% more calories than just walking, as in running, but without the “traumatic impact“ on the ground. The benefits on calorie consumption added to those relating to the increase in overall tone, by using “harmonic” and combined muscle chains crusades, and, in cases of mild to moderate cases it has the ability to eliminate the classic “back pain”. In the sports fielditis used to improve strength, coordination, and postural control. Thanks to the pleasure of “practicing” in contact with nature and to its ease of use, just walk out with the sticks wherever you want to train: Nordic Walking has considerable “success” even with those who are more “reluctant” to move. In recent years after a great increase of walker practitioners, the medical sector became further interested in this discipline finding great results in the fields of general prevention, recovery coordination skills, post- trauma and / or post -entrapment, and in the fields of oncology rehabilitation and heart failure.

Today Nordic Walking is a physical activity most recommended by family doctors. It is an activity that is suitable for everyone and of all ages.


Health in Sammarinese Philately By Dr. Daniele Cesaretti

On the occasion of World Health Day, on March 6, 1986, San Marino issued a set of two stamps to celebrate two separate events. The value of Lire 450 is, in fact, dedicated to the “World Health Day” in accordance with the suggestion that the World Health Organization had advanced to the member states. The other value, of Lire 650, celebrates the 30th anniversary of the establishment of the Institute for Social Security, and was officially launched on December 22, 1955, the pride of San Marino reality since its inception. The ISS is a state agency with autonomous administrative management and is the organ through which the state ensures the provision of health, social care, welfare and social security, in the framework of the policies enacted by the General Council on the basis of the choices and priorities adopted by the State Congress. The stamps depict two views of the State Hospital in the Republic of San Marino inaugurated on July 25, 1981 in the presence of the Captains Regent Gastone Pasolini and Maria Lea Pedini. The previous hospital, the Hospital of Mercy, was located in the historical centre of San Marino and was inaugurated in 1941, it is currently the seat of the High Schools. The efficiency of the San Marino health service ensures that the average life expectancy of its citizens are among the highest in the world. The two values (Sassone ​​ catalog 1178/1179) were printed in gravure sheets of 50 for a print run of 450,000 copies.


Tell us about it... Edited by Medical Doctor Dr. Marco M. Benedettini and by Nutritionist Dr. Marina Corsi

Usually, compared to a peer of equal body structure, those constrained to a wheelchair have a 30% lower metabolism with a marked tendency to develop overweight and obesity. The nutritional advice in general refers to a Mediterranean diet pattern with careful fibre consumption to promote amongst others, the intestinal transit, a reduced intake of fats and a proper protein intake. It is often necessary to integrate the diet and that should be done under medical supervision as it mostly concerns mineral salts including calcium and vitamins such as those comprising group B. I take this opportunity to remind you that thanks to Cuore-Vita’s donation of a scale to sports medicine, it is the case to undergo periodic weight control as necessary from time to time. Finally, I can only wish you much good courage to face with grit all aspects of your somewhat “special” condition and that you to live remembering to request the all important help of those who are responsible to provide for your health!

I am a paraplegic boy and I regularly do physical activity even participating in competitive handbikes. I would like some guidance on proper nutrition in my situation and why I have difficulty with my weight control. (Antonio) The nutritionist’s advice In the case of a person forced to use a wheelchair it is extremely important not only for the emotional aspects and for the dignity of the person but for the maintenance of a good state of health, to have a lifestyle that allows access to many options and not least the option of sport. The diet of those who are in this condition and who play amateur or pre-competitive practices must be properly balanced according to the physical and nutritional needs of every individual and this is possible only in the context of sports medical practice, in which meeting with specialized staff will provide all the information and controls required and applicable to the case. In general, people who more than others have to keep a sedentary posture, such as those who are forced to sit, incur a significant loss of muscle mass and the tendency to gain weight. Therefore, if the sport allows you to increase your metabolism, you need to pay attention to body composition and caloric intake to set a proper diet without the risk of losing control of your weight.

Dr. Marina Corsi Pharmacist, Nutritionist.



The sports physicianâ&#x20AC;&#x2122;s advice

of the effort that an athlete makes in handbikes. The sports physician must also collect all documentation relating to the trauma or pathology that led the athlete to the disability, including specialist visits and various hospital stays. A declaration will also be required from the specialist who regularly cares for the athlete (often a neurologist) that declares the type of disability and the absence of other diseases in connection with the training of the sport. The final assessment is in any case and always up to the sport doctor. Dr. Marco M. Benedettini Manager of Medical Sport Services I.S.S.(Social Security Institute)

From the point of view that performance is intuitive, every extra kilogram of body weight goes against the weight / power ratio. From this perspective it is necessary for athletes in a wheelchair to carefully check their weight and initially, to do as vigorous an aerobic activity, in a manner conducive to slimming and a good cardiovascular response to the effort. We must remember how every competitive athlete is classified before competitions according to their disability, for this there are doctors called classifiers. In the question you donâ&#x20AC;&#x2122;t specify the nature of your injury, but we can say that generally who has been injured in the spinal column that involves a paralysis of all the muscles of the lower lesion, has a more recumbent in position in handbikes rather than, for example, an amputee, who assumes a sitting position; the latter case will be less aerodynamic but advantage can be taken of the thrust of the dorsal muscles. Another very important aspect is the medical sports check-up insofar as the cardiovascular evaluation in relation to physical exertion must be made by means of a specific hand driven ergometer; this tool will allow for a realistic and very close to reality evaluation


“Systolic and Diastolic” Blood pressure By Dr. Francesca Nicolini Sammarinese Society of Cardiology The heart is a pump that, with its contractions, sends blood to all organs and tissues of the body. Blood pressure is the pressure that the heart exerts to circulate the blood in the body. The pressure is measured in millimetres of mercury (mmHg) . The value of the pressure is given by two numbers: the first is the systolic pressure, the second diastolic. Systolic blood pressure: is measured at the time when the heart contracts and pumps blood into the arteries. Diastolic blood pressure is measured between two contractions, while the heart relaxes and fills with blood. Pressure that does not exceed 120 mmHg for systolic and 80 mmHg diastolic is considered “desirable”. The value of the pressure normally varies in course of the day: it increases with effort, emotions, cold or pain and decreases with rest and sleep.

According to data from the National Research Institute for Food and Nutrition (INRAN), every day the Italian adult consumes a dietary on average of about 10 g of salt (corresponding to about 4 g of sodium), a value of almost ten times higher than is physiologically necessary. Some simple rules to keep the blood pressure at a favourable level 1) Have a healthy diet, in particular: a. limit the consumption of salt. Reducing daily consumption to about 5 grams of salt per day can lower the pressure by approximately 5 mmHg. The amount of salt already naturally contained in food is sufficient for the needs of our body; b. eat plenty of fruits and vegetables. Fruits and vegetables are rich in potassium, a substance that helps to maintain low pressure; c. eat less; d. moderate coffee consumption.

The majority of cases of hypertension are also due to incorrect lifestyle habits. It is advisable from a young age to keep blood pressure at desirable levels by following some simple rules of behaviour. One of these habits is the incorrect abuse of salt that we normally implement in our diet. To try and prevent related diseases to excessive sodium consumption, the World Health Organization has developed intensive study that has led, among other things, to recommend a daily intake per capita of less than 5 grams of salt.

2) Do regular physical activity. a. Regularly practicing a physical activity of moderate intensity (it only takes 30 minutes of walking briskly per day) helps to maintain blood pressure at favourable level. 3) Do not smoke. 4) Keep your weight under control. a. With weight gain, the heart must pump with more energy to send the blood in all tissues and therefore the pressure increases. 5) Relax. a. When you are angry, excited, scared, under stress or while smoking, the pressure increases.

ainst g a t l a Less s od obesity o childh

It’s never too late to improve your Lifestyle


World Heart Day 2013 The contents of the posters were written by cardiologists from the Scientific Committee of Cuore-Vita: Dr. Francesca Nicolini and Dr. Emidio Trojans


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Life according to Vito Cartoons by: Gigi Belisardi

“Foods that are too salty may promote childhood obesity”

“You strike too! Avoid sugary soft drinks, flavoured waters and fruit juices”


The role of rehabilitation in cardiovascular disease By Dr. Eleonora Marchi Specialist in Rehabilitative Physical Medicine

Part Two The complicated and high-risk patients should therefore be directed to the inpatient rehabilitation facilities with the highest diagnostic level and organizational level. Patients at medium or low risk can be effectively managed at rehabilitation structures of lower organizational complexity, but nevertheless always specialist. Rehabilitation programs are based on the following points: • estimate of the global cardiovascular risk, carried out by a specialist cardiologist by clinical evaluation and also complex imaging studies; • Identification of specific objectives for each factor that influences the risk; • evaluation of other diseases present at the same time in the same subject; • formulation of an individual treatment plan that includes: a) therapeutic interventions aimed at reducing the risks; b) education to lifestyle (stopping smoking, proper diet, weight control, states of anxiety and depression); c) the prescription of physical activity appropriate to the clinical situation and state of severity; d) long-term maintenance of intervention for each patient in order to consolidate the results obtained, re-evaluating over time the opportunity to change the treatment. If we consider, on the one hand, the

increasing weight of social and welfare of cardiovascular disease and, secondly, the increasingly convincing evidence of the benefits of rehabilitation, along with the containment of costs (especially compared to the new techniques of interventional cardiology) the cardiac rehabilitation program should be recognized as an essential component of care for cardiac patients and integrate this intervention within the resources available for health spending. Notwithstanding this, the involvement of family members that are a constant presence in the every day life of the person suffering from heart disease must not be forgotten. In addition, the real key to successful treatment is the person who is labelled as a cardiopath. We must not forget that beyond the medical definition of their physical problem, there is a human being, a whole of physicality, of experiences, emotions, affections, desires and expectations of a return to their daily lives and the recovery of their lives.


Curiosities from the Scientific World By Dr. Niksa Simetovic

Soon a single drug for Alzheimer’s and Parkinson’s A common treatment is possible against many neurodegenerative diseases including Alzheimer’s and consists of preventing the death of neurons by disabling a protein involved in these diseases. The prospect is then to develop a single drug that works for all. The big step forward that opens up a whole new field of investigation and unexpected treatment of these diseases is due to research by Giovanna Mallucci of the Unit of Toxicology, University of Leicester, conducted on mice with Creutzfeldt -Jakob disease (prion similar to mad cow disease).

not obscured by strong risk factors such as obesity. Insulin resistance may be limited by food that is simmered A study in Diabetes Care found that overweight women who ate foods cooked at low temperatures showed a better sensitivity index (best functioning of insulin) and insulin levels after fasting 4 weeks, compared with those who ate foods cooked at high temperatures. The researchers said that the high temperature firing produces end products related to glucose metabolism. Inhibitor of a protein could help in wound healing Canadians researchers found that blocking the enzyme “Granzyme B” has helped to improve the healing of chronic wounds in mice. The discovery may help diabetic patients and the elderly, in particular, because they often have sores that do not heal or that re-open easily. The study was published in the medical journal Cell Death and Differentiation.

Increased intake of whole fruit lowers risk of type2 diabetes A study in the British Medical Journal shows that taking an additional three portions of fruit a week shows a reduction from 2% to 26% of the risk of type 2 diabetes. Although a causal relationship was not demonstrated, the researchers support the guidelines that recommend whole fruit to prevent diabetes. Having a family history of diabetes raises the risk of pre-diabetes According to a study in the journal Diabetologia, people with a family history of diabetes have a risk of 26% of experiencing pre-diabetes. The researchers found that the link between family history and pre-diabetes was among those who were not obese and therefore easily measurable only when


Health and the Commonplace of Medicine By Dr. Daniele Cesaretti


that are the substrate of confusion that sometimes exists in science and are the gasoline that fuels many absurd conspiracy theories, heard and read daily in other social fields. Returning to mortality, what is the place where you die more frequently? It’s in bed! On second thought it results, that the bed is deadly. Avoiding the bed you die maybe less? The answer lies in the above considerations. (Modified from Le Scienze/ Scientific American, no.517, September 2011, Paulo Attivissimo)

During strikes by doctors mortality is drastically reduced

It’s true! But only in part. On some occasions in the world (U.S., Israel) during the longer doctors’ strikes mortality was reduced! So what? What does this mean? That going to the doctor is bad for your health? It may seem so. But it is not as common in this place, for here lurk various errors of method and evaluation of the data (as is often the case in any other social or scientific fields). In other words, it is necessary to interpret the data correctly. For it may be merged with those omitted in order to reinforce a preconceived tense. But this requires mental acuity, research depth, objectivity and impartiality. The first correction to make: on other strike occasions mortality remained unchanged. This shows that it is always good to ask if there are cases against the thesis that were omitted on purpose to create sensationalism. Second point to highlight: One must consider the emotional bias and the widespread distrust of medicine (which is not an exact science!), two good reasons to redouble the effort of verification. Third consideration is the elimination of the context. During the strikes operations such as hip replacement and coronary bypass - interventions that involve a significant risk of death anyway, are sent to elective surgery. This produces a momentary drop of hospital mortality that will be “offset” a few days later! Procedural errors in analysis, prejudice the lack of objectivity in wilful omissions

You have to wait three hours after eating before diving into the water.

In this case too, everything is relative. See above! There is no fixed time to avoid blocking digestion caused by the diversion of blood from the digestive tract to the rest of the body to maintain body temperature at a comfortable level. The waiting time depends on how much is eaten (less food? Less time!), what you ate, air temperature, time spent in the water, previous immersions, individual sensitivities and reactions, physical exertion ... and much more !


Grafica: AVALON | Stampa: Seven Seas

Cuore Vita continues to invite your much appreciated support to enable us to deliver excellence in health education programs and facilities like defibrillators and other life saving equipment for the people of the Republic of San Marino, if it is possible for you to do so. Every donation you make is put to immediate good use by our Association. Grazie di Cuore! (


Director: Giovanni Iwanejko / Chief Editor: Gianni Michele Zangoli Editorial Committee: Niksa Simetovic â&#x20AC;˘ Emidio Troiani â&#x20AC;˘ Daniele Cesaretti Translated by dr. Sacha G. Mullins a Moving Universe translator -

Associazione Cuore Vita - Via Napoleone Bonaparte, 25 47890 Repubblica di San Marino Tel e fax: 0549 991011 -

Cuore-Vita Magazine N.7 - September 2013  
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