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Background: Annexin A1 (ANXA1) and the NOD‐like receptor family pyrin domain‐containing protein 3 (NLRP3) inflammasome play important roles in bone remodeling. However, expression profiles of these factors in bone cells under diabetes mellitus (DM) and estrogen‐deficient conditions are poorly understood. This study investigated the immunoexpression of ANXA1 and its formyl peptide receptor 2 (FPR2), as well as NLRP3 inflammasome mediators, during remodeling of the alveolar process in diabetic and estrogen‐deficient rats. Methods: Twenty adult female Wistar rats were divided into four groups (n = 5): Sham‐operated (SHAM) and ovariectomized (OVX) rats received a vehicle solution, and SHAM and OVX rats were intraperitoneally administered 60 mg/kg/body weight (BW) of streptozotocin (STZ) to induce DM (SHAM‐Di and OVX‐Di groups). After 7 weeks, the rats were euthanized and their maxillae were fixed in phosphate‐buffered 4% formaldehyde and embedded in paraffin. Sections were stained with hematoxylin/eosin (H&E) and picrosirius red or subjected to immunohistochemical detection of ANXA1, FPR2, NLRP3, interleukin‐1β (IL‐1β), and cyclooxygenase‐2 (COX2). Results: Estrogen deficiency and DM were associated with deleterious effects in bone tissue, as evidenced by a lower number of osteocytes and higher number of empty lacunae in the SHAM‐Di and OVX‐Di groups compared to the nondiabetic groups. Both diabetic groups showed a smaller vascular area and weaker collagen fiber birefringence intensity in alveolar bone tissue. A significantly higher number of ANXA1/FPR2‐positive osteoblasts, osteocytes, and osteoclasts was accompanied by a significantly higher number of these cells immunolabeled for COX2, NLRP3, and IL‐1β in the diabetic and OVX groups, especially in both estrogen‐deficient and diabetic rats. Conclusion: These results indicate a possible role for the ANXA1/FPR2 pathway as a fine‐tuning/anti‐inflammatory regulator to counterbalance exacerbated COX2/NLRP3/IL‐1β activation in bone cells during bone remodeling under estrogen deficiency and DM. [ABSTRACT FROM AUTHOR]

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To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context. What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach. Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital. Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization. Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals. • Child and Family Centered Care is an important outcome to take in consideration. • Child H-CAHPS is a validated tool to measure user satisfaction with healthcare received. • Hospital environment and healthcare staff have an impact on family satisfaction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: As of today, healthcare systems worldwide face severe challenges that undermine their sustainability. The value-based healthcare (VBHC) approach has been proposed as a strategic and methodological framework to ensure the delivery of the best patient outcomes with economic efficiency. Through the illustrative example of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for heart failure (HF) patient management in the context of the Italian National Healthcare system, this article explores the role that in vitro diagnostics (IVDs) can play in enabling value-based care models. SUBJECTS AND METHODS: 14 healthcare professionals representing the relevant professional figures involved in HF patient management met to revise the current HF patient journey and design a new care pathway that, leveraging on BNP/NT-proBNP, reflects the VBHC principles. RESULTS: The literature recognizes the dosage of BNP/NT-proBNP as the gold standard for diagnosing HF. However, as of today, these IVDs are not employed at their full potential regarding HF patient management. A new patient journey is proposed so that patients are diagnosed early and properly monitored in the aftermath of hospitalization, improving outcomes at contained costs. CONCLUSIONS: As testified by the example of HF patient management in Italy, laboratory medicine can represent a lever for adopting value-based care models. Still, large-scale adoption of VBHC will call for structural reforms that revise how healthcare delivery is organized, measured, and reimbursed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: COVID-19 is an extremely contagious illness caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), that will keep broadly circulating and evolving. Collected evidence revealed the clinical profile of COVID-19 patients as a potential predictor of their outcome. The aim of this study was to investigate the causal relationship between poor outcomes and laboratory parameters in hospitalized COVID-19 patients, in this sense observing how SARS-CoV-2 infection affects other organs. PATIENTS AND METHODS: We retrospectively evaluated a cohort of 133 patients, positive for SARS-CoV-2, aged between 30 to 94 years, between January 12th and April 25th, 2021. Discharge from the hospital, transferral to the ordinary ward or nursing home, intensive care unit (ICU) admission, and in-hospital mortality were recorded, along with demographic, laboratory and clinical parameters. The whole sample was summarized by median (interquartile range) for quantitative data, and absolute and relative percentage frequencies for qualitative variables. Univariable logistic regression models were performed to assess the association between all the parameters of interest and COVID-19 adverse outcomes, single (in-hospital mortality) and composite (in-hospital mortality and ICU admission). Hence, a multivariable model was fitted to identify potential independent predictors of the composite outcome. The accuracy of the model was assessed through appropriate fitting indices, such as the C-statistic and Hosmer-Lemeshow test. Moreover, to detect multicollinearity, the variance inflation factor (VIF) was used. RESULTS: Our study sample had a median age of 72 years old (59.0-83.0). The most common comorbidities were hypertension (63.7%), cardiovascular disease (41.9%), diabetes (33.6%), and cerebrovascular disease (21.5%); while as the most common symptoms, we observed dry cough (32.5%), dyspnoea (50.8%), and fatigue (29.8%). Totally, 18 patients died during hospitalization (13.5%), 10 required ICU admission (7.5%), 78 (58.6%) were discharged from the hospital, and 27 (20.3%) were transferred to either ordinary wards or nursing homes. We disclosed an association of older age with both composite [OR 1.06, 95% CI 1.02-1.09; p=0.003] and single outcome [OR 1.10, 95% CI 1.04-1.16; p=0.001]. A higher oxygen saturation (SpO2) was associated with a better outcome [OR 0.75, 95% CI 0.60-0.93; p=0.009 and OR 0.76, 95% CI 0.61-0.95, p=0.009]. Among laboratory parameters, higher levels of neutrophils increased the risk of a poor outcome [OR 1.05, 95% CI 1.00-1.10; p=0.043]; while higher levels of lymphocytes seem associated with a better outcome [OR 0.94, 95% CI 0.88-0.99; p=0.043]. Higher levels of creatinine were associated with a higher risk of both adverse outcomes [OR 6.20, 95% CI 2.16-17.81; p<0.001 and OR 19.90, 95% CI 5.07-78.06; p<0.001, respectively]. Higher levels of sodium (Na) were associated with a higher risk of adverse events [OR 1.15, 95% CI 1.03-1.28; p=0.014 and OR 1.14, 95% CI 1.01-1.27]. Similar findings were also observed for C-reactive protein (CRP) levels [OR 1.01, 95% CI 1.00-1.02; p=0.010 and OR 1.01, 95% CI 1.00-1.02; p=0.024]. Conversely, being positive to IgM and IgG decreases the risk of adverse outcomes [IgM: OR 0.33, 95% CI 0.14-0.77; p=0.011 and OR 0.23, 95% CI 0.08-0.66; p=0.006. IgG: OR 0.30 95% CI 0.13-0.72; p=0.007 and OR 0.22 95% CI 0.07-0.66; p=0.007]. Hence, a multivariable model was fitted to identify potential independent laboratory predictors of the composite outcome, with laboratory parameters that showed an association with composite outcome. The model can be considered accurate according to Hosmer-Lemeshow test and C-statistic [p>0.83, C-stat=0.90]. CONCLUSIONS: Our findings confirm that COVID-19 is a multiorgan disease. In fact, the analysis of laboratory parameters has revealed a strong relationship between poorer outcomes and multiple organ dysfunction, particularly established by higher levels of neutrophils, creatinine, sodium, and CRP. Alongside, cerebrovascular diseases, chronic kidney disease and older age supported this finding. Of note, higher levels of SpO2, and lymphocytes, as well as positivity to IgM and IgG were associated with a lower risk of a poor outcome. [ABSTRACT FROM AUTHOR]

Background: Periodontitis is an immunoinflammatory disease that involves the release of cytokines and enzymes, including interleukin-1 (IL-1) and matrix metalloproteinases (MMPs). Diacerein is an anti-IL-1 drug used for the treatment of osteoarthritis. The aim of the study was to evaluate whether diacerein suppresses the inflammatory reaction and reduces the collagen degradation in the gingival connective tissue in periodontitis.Methods: Fifty-four male rats were distributed into three groups (n = 18 animals/group): 1) periodontitis + diacerein group (PDG), 2) periodontitis + saline group (PSG) and control Group (CG; without treatment). Periodontitis was induced for 7 days in the upper right first molars; after 7 days, the animals of PDG received 100 mg/kg of diacerein while in PSG, the animals received saline solution for 7, 15, and 30 days. The animals were killed and fragments of maxilla containing the right molars were processed for paraffin embedding. In hematoxlin & eosin-stained sections, the volume density of inflammatory cells (VvIC) and fibroblasts (VvFb) in the gingival mucosa, the distances between the junctional epithelium (JE) to the cemento-enamel junction (CEJ) and the CEJ to the alveolar process crest (AP) were obtained. The number of IL-1β- and MMP-8-immunolabeled cells, and collagen content in the gingival mucosa were computed. Data were subjected to two-way analysis of variance and Tukey post-test (P ≤ 0.05).Results: The PDG and PSG rats showed a significant increase in the distances of JE-CEJ and CEJ-AP. In all periods, the VvIC, the number of IL-1β- and MMP-8-immunolabeled cells was significantly lower in PDG than in PSG while the collagen content was significantly greater in PDG than PSG. At 30 days, significant differences in the IL-1β immunoexpression, collagen content, and in the MMP-8 immunostaining were not seen between PDG and CG groups.Conclusions: Our results show an inhibitory effect of diacerein on IL-1β in the inflamed gingival mucosa of rat molars, decreasing the inflammatory infiltrate and immunoexpression of MMP-8, and restoring the collagen content. [ABSTRACT FROM AUTHOR]

• The rapid maxillary expansion is followed by pain during and after the opening of the midpalatal suture. • The cause of the pain resulting from orthodontic treatment is not entirely clear. • The sites of processing for the nociceptive information originating in the midpalatal suture after rapid maxillary expansion have not been investigated to date in the trigeminal subnucleus complex and parabrachial area. The aim of this in vivo study was to quantitatively evaluate pain after rapid maxillary expansion (RME) in young rats by analyzing the activation of nociception-related structures, that is, the caudalis, interpolaris, and oralis subnuclei, according to the Fos expression. A total of 65 Wistar rats were assigned to three groups: control group (n = 15) with no treatment, positive control group (n = 25), and experimental group (n = 25) with RME. The experimental animals were euthanized at 6, 12, 24, 48, and 72 hours after RME, and the brain was later carefully collected. Coronal sections through the spinal trigeminal caudalis, spinal trigeminal interpolaris, and spinal trigeminal oralis were cut (thickness of 40 µm) on a cryostat and processed for Fos immunohistochemistry. Images from the sections were captured under light microscopy, and ImageJ software was used to count Fos -like immunoreactive neurons. The Analysis of variance (ANOVA) and Tukey test were used for statistical analysis, and the significance level was set at 5%. RME induced incisor distalization and opening of the midpalatal suture, as well as neuronal activation of the spinal trigeminal nucleus. The experimental group demonstrated significantly more Fos -positive neurons in subnuclei caudalis and subnuclei interpolaris 6 hours after the maxillary expansion. The Fos immunoreactivity significantly decreased at 12 hours and increased again at 24 and 48 hours (P < 0.001). The RME increases the neural activation of brain regions involved in the nociception region, as determined by the Fos expression. The most intense Fos -like immunoreactive expression was detected in the brain 6 hours after the start of the palatal expansion. [ABSTRACT FROM AUTHOR]

To reveal the effectiveness of didactic architectures and pedagogical strategies to be implemented in nursing curricula to develop and improve Emotional Competencies (EC) in undergraduate nursing students. Systematic review of effectiveness conducted according to Joanna Briggs Institute (JBI) guidelines. We followed the PRISMA statement to guarantee the transparency of the review and the GRADE to report the strength of evidence. Seven databases were searched: MEDLINE, The Cochrane Library, SCOPUS, CINAHL, EMBASE, PsycINFO and ERIC. Grey literature was also searched through the OpenGrey database. Studies focusing on educational programmes and/or activities to develop EC in nursing curricula, published in English or Italian were included. Quality assessment of the studies was evaluated using JBI critical evaluation tools and the Mixed Methods Appraisal Tool (MAAT). Following JBI guidelines, a narrative synthesis was performed. A total of 19 studies from 8 countries were included. The population varied from first to fourth-year students in relation to the duration of the undergraduate nursing program across the various countries. Most of the students were females. The age of the participants ranged between18 and 56 years. The most common pedagogical strategies were simulation, role playing, and face-to-face lessons. In some cases, studies combined two or three pedagogical strategies in the same intervention. The most effective strategy was simulation, which improved EC, compassion, self-awareness, self-efficacy, empathy, critical thinking, clinical practice skills, and teamwork skills. Furthermore, the combination of lessons, simulation, and literature exploration effectively developed communication skills, and improved students' satisfaction. Investing in simulation, role-playing activities, and lessons regarding the importance of EI, empathy and compassion, and the role of an emotionally competent nurse leads to improved nursing care and wellbeing. • It is important to improve and develop EI in nursing students. • The review identified different strategies to improve EI in nursing students. • Simulation proved to be an effective strategy to improve EI in nursing students. • Combining lessons, simulation, and literature exploration is also effective. [ABSTRACT FROM AUTHOR]

Due to large outbreaks observed worldwide, Candida auris has emerged as a major threat to healthcare facilities. To prevent these phenomena, a systematic screening should be performed in patients transferred from regions where the pathogen is highly endemic. In this study, we recorded and analyzed French mycologists' current knowledge and practice regarding C. auris screening and diagnosis. Thirty-six centers answered an online questionnaire. Only 11 (30.6 %) participants were aware of any systematic screening for C. auris for patients admitted to their hospital. In the case of post-admission screening, axillae/groins (n = 21), nares (n = 7), rectum (n = 9), and mouth (n = 6) alone or various combinations were the body sites the most frequently sampled. Only six centers (8.3 %) reported using a commercially available plate allowing the differentiation of C. auris colonies from that of other Candida species, while five laboratories (13.8 %) had implemented a C. auris -specific qPCR. Considering the potential impact on infected patients and the risk of disorganization in the care of patients, it is crucial to remember to biologists and clinicians the utmost importance of systematic screening on admission. [ABSTRACT FROM AUTHOR]

Today, hydrological and hydraulic modelling are essential tools for flood risk management, although these models are still affected by elements of uncertainty that needs to be reduced by optimizing their results. The present research aims to implement an operational mechanism on the Basento river basin in Southern Italy based on the cascading use of a physically based concentrated-parameter hydrological model for the estimation of flood hydrographs, and a two-dimensional hydraulic model for flood mapping. The calibration of the hydrological model uses physical information to reduce the initial range of the set parameter values, and an automated optimisation procedure based on a genetic algorithm to find optimal values of the model parameters by comparing simulated and observed data for the 2013 flood event. To calibrate the hydraulic model, a series of flood maps extracted from multi-temporal SAR images was used. In addition, validation of the hydrological and hydraulic models was carried out on March 2011 flood event. The results show the reliability of the models during both calibration and validation, with the hydrological model achieving a Nash-Sutcliffe Efficiency coefficient between 0.86 and 0.91, and the hydraulic model leading to results with an accuracy close to 70 %. Considering the significance of the results, the developed modelling chain was used to simulate future event scenarios for risk management assessment and could operate as an early warning system. [ABSTRACT FROM AUTHOR]

Objectives: To identify dental students' perceptions of stress over returning to in‐person clinical training after remote learning required from the coronavirus disease 2019 (COVID‐19) pandemic. Methods: This was a qualitative observational study. The sample was composed of undergraduate students (n = 47) in the final year of São Paulo State University, School of Dentistry, Araraquara program. The data were collected using a questionnaire created in Google Forms. The data was analyzed using the discourse of the collective subject technique. Results: More than half of the students (63.8%) reported experiencing stress in the transition from remote learning to clinical training. According to the students, the main causes of this stress were fear of COVID‐19 infection or contamination (31.5%) and insecurity in their clinical treatment skills after having gone so long without training (25.5%). Half of the students surveyed (51.1%) exhibited at least one stress‐related symptom. For most of the students (70.2%), remote learning was insufficient to prepare them for returning to in‐person clinical activities. Performing laboratory pre‐clinical activities prior to clinical training was the suggestion most frequently cited by the students (25.5%), as a way to avoid some of the stress associated with their return to in‐person learning. The main coping strategies adopted by the students upon their return to in‐person learning were making the most of their clinical training, planning cases, and studying relevant topics before treating patients (48.9%). Conclusion: The dental students perceived high levels of stress during the transition from remote learning to clinical training. [ABSTRACT FROM AUTHOR]

This article aims to analyze the evidence available in the literature on the process of identifying adults and elderly people who can benefit from palliative care (PC) in primary health care (PHC). This is an integrative literature review carried out in PubMed, CINAHL, LILACS, Web of Science, and Embase. Eight studies were selected, in which different instruments and methods were distinguished with the purpose of identifying people who can benefit from PC in the context of PHC. The incorporation of these instruments into clinical practice is urgent in order to increase the reach and effectiveness of the services offered by health professionals, considering the current demographic and epidemiological profile that points to the increase of people with a potential need for PC. Different instruments have been successfully used to identify PC in the context of PHC. However, some have weaknesses, such as the fact that they only allow the identification of people with oncological diseases, leaving out other health conditions, which reinforces the need for further studies on this topic. [ABSTRACT FROM AUTHOR]