Search

Objective: The aim of the present study was to assess emergency neurology management in Italy by comparing patients admitted to the hub and spoke hospitals. Methods: Data obtained from the annual Italian national survey (NEUDay) investigating the activity and facilities of neurology in the emergency room conducted in November 2021 were considered. Information for each patient who received a neurologic consultation after accessing the emergency room was acquired. Data on facilities were also gathered, including hospital classification (hub vs spoke), number of consultations, presence of neurology and stroke unit, number of beds, availability of neurologist, radiologist, neuroradiologist, and instrumental diagnostic accessibility. Results: Overall, 1,111 patients were admitted to the emergency room and had neurological consultation across 153 facilities (out of the 260 Italian ones). Hub hospitals had significantly more beds, availability of neurological staff, and instrumental diagnostic accessibility. Patients admitted to hub hospital had a greater need for assistance (higher number of yellow/red codes at neurologist triage). A higher propensity to be admitted to hub centers for cerebrovascular problems and to receive a diagnosis of stroke was observed. Conclusions: The identification of hub and spoke hospitals is strongly characterized by the presence of beds and instrumentation mainly dedicated to acute cerebrovascular pathologies. Moreover, the similarity in the number and type of accesses between hub and spoke hospitals suggests the need to look for adequate identification of all the neurological pathologies requiring urgent treatment. [ABSTRACT FROM AUTHOR]

Background: Social cognition refers to all mental operations to decipher information needed in social interactions. Here we aimed to outline the socio-cognitive profile of Chronic Migraine with Medication Overuse (CM + MO), given they are recognized to be at risk of socio-cognitive difficulties. Given the multidimensionality of this construct, we considered: (1) socio-cognitive abilities, (2) socio-cognitive beliefs, (3) alexithymia and autism traits, and (4) social relationships. Methods: Seventy-one patients suffering from CM + MO, 61 from episodic migraine (EM), and 80 healthy controls (HC) were assessed with a comprehensive battery: (1) the Faux Pas test (FP), the Strange Stories task (SS), the Reading Mind in the Eyes test (RMET), (2) the Tromsø Social Intelligence Scale, (3) the Toronto Alexithymia Scale, the Autism Spectrum Quotient, (4) the Lubben Social Network Scale, the Friendship Scale. Results: CM + MO: (1) performed similar to EM but worse than HC in the FP and SS, while they were worse than EM and HC in the RMET; (2) were similar to EM and HC in social intelligence; (3) had more alexithymic/autistic traits than EM and HC; (4) reported higher levels of contact with their family members but felt little support from the people around them than HC. Conclusions: CM + MO results characterized by a profile of compromised socio-cognitive abilities that affects different dimensions. These findings may have a relevant role in multiple fields related to chronic headache: from the assessment to the management. [ABSTRACT FROM AUTHOR]

Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient. [ABSTRACT FROM AUTHOR]

Simple Summary: Colic surgery, despite the improvements in recent years, is not without risks and still has a high risk of death compared with other procedures. Although about 90% of cases of colic in horses resolve spontaneously or with medical treatment, the remaining 10% can be fatal if not treated surgically. Furthermore, postoperative complications can have important welfare and economic consequences. Studies of predictive prognosis indices, incidence of postoperative complications, and survival rates in different geographical areas may not be comparable. Consequently, there is a need to perform a study that investigates the Italian population of animals subjected to colic surgery. A total of 451 horses were included. The short-term survival rate was 68.5% for all the horses that underwent colic surgery and 80% of the horses surviving anaesthesia. Several risk factors were evaluated and age, body condition score (BCS), packed cell volume (PCV) and total plasma protein (TPP) before and after surgery, amount of reflux, type of disease, type of lesion, duration of surgery and surgeon's experience, and amount of intra- and postoperative fluids administered affected the outcome. The multivariate analysis revealed that PCV at arrival, TPP after surgery, and BCS had the highest predictive power. This is the first multicentre study in Italy and the results of this study could help surgeons choose the best treatment and clearly communicate risks to referring veterinarians and owners. Further prospective studies should be conducted to confirm the effect of predictive indices considered in this study on short-term survival. The occurrence of colic could be influenced by the characteristics of a population, geographical area, and feeding management. The aim of this study was to report the short-term postoperative complications and survival rates and to identify factors that might affect the outcome of horses that underwent colic surgery in three Italian surgical referral centres. Data of horses subjected to colic surgery in three referral centres (2018–2021) were analysed. Comparisons of the outcomes were performed using a Mann–Whitney or a Chi square test. Areas under the receiver operating characteristic (ROC) curve and multivariable logistic regression analysis were used for parameters that were significant in the previous univariate analysis. The goodness-of-fit of the model was assessed using the Akike information criterion (AIC). Significance was defined as p < 0.05, and odds ratios and 95% confidence intervals were calculated as percentages. A total of 451 horses were included. The survival rate was 68.5% of all of the horses that underwent colic surgery and 80% of the horses surviving anaesthesia. Age, BCS, PCV and TPP before and after surgery, amount of reflux, type of disease, type of lesion, duration of surgery, surgeon's experience, and amount of intra- and postoperative fluids administered influenced the probability of short-term survival. The multivariate analysis revealed that PCV at arrival, TPP after surgery, and BCS had the highest predictive power. This is the first multicentre study in Italy. The results of this study may help surgeons to inform owners regarding the prognosis of colic surgery. [ABSTRACT FROM AUTHOR]

To evaluate the subjective experience of the COVID-19 outbreak in healthy older adults and develop a model of the older population's psychological adaptation to the COVID-19 pandemic. A qualitative grounded theory approach was taken to the study design and analysis, using semi-structured interviews to collect data from 19 community-active Italian older people by telephone during the first wave of COVID-19 (May 2020). The theory emerging from the study conceptualized the COVID-19 subjective experience in older people as an adjustment process to the disruption of habits, social contacts, and routines that prompted a meaning-making process to face this adverse experience. Three emergent categories included 'loss, uncertainty, and distress' as the psychological impact of the pandemic emergency, 'making sense of COVID-19' as a subjective sense-making process of the pandemic, and 'living with the pandemic' as agency and self-management within the pandemic experience. The resulting narratives encompassed themes, i.e. risk perception, representation of the self, connection with past-time memories, and compliance with safety measures. The results have implications for designing effective messages to promote hope, social responsibility, and commitment in aging during the COVID-19 pandemic and for health workers who wish to support the psychological health of older adults. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is a global traumatic experience for citizens, especially during sensitive time windows of heightened plasticity such as pregnancy and neonatal life. Pandemic-related stress experienced by mothers during pregnancy may act as an early risk factor for infants' regulatory capacity development by altering maternal psychosocial well-being (e.g., increased anxiety, reduced social support) and caregiving environment (e.g., greater parenting stress, impaired mother–infant bonding). The aim of the present longitudinal study was to assess the consequences of pandemic-related prenatal stress on infants' regulatory capacity. A sample of 163 mother–infant dyads was enrolled at eight maternity units in northern Italy. They provided complete data about prenatal stress, perceived social support, postnatal anxiety symptoms, parenting stress, mother–infant bonding, and infants' regulatory capacity at 3 months of age. Women who experienced emotional stress and received partial social support during pregnancy reported higher anxious symptoms. Moreover, maternal postnatal anxiety was indirectly linked to the infants' regulatory capacity at 3 months, mediated by parenting stress and mother–infant bonding. Dedicated preventive interventions should be delivered to mothers and should be focused on protecting the mother–infant dyad from the detrimental effects of pandemic-related stress during the COVID-19 healthcare emergency. [ABSTRACT FROM AUTHOR]

The Turkey oak (Quercus cerris L.) is widely distributed in Italy, where it is the ecologically dominant oak on sandy and acidic soil. In this work, we analysed 23 natural populations by means of eight SSR (microsatellite) markers, to obtain the first synthetic map of genetic variability for this species and to study its dispersion during the Holocene, due to the possibility that at least one refugium during the Last Glacial Maximum was in Italy. The analyses showed a good amount of genetic variability together with fair differentiation between populations, as indicated by FST = 0.059. A Bayesian analysis of the amount of admixture among populations revealed the presence of four putative gene pools of origin and a rough subdivision of the populations according to their geographic location, as confirmed by the spatial analysis. No evidence for the existence of putative refugial populations was found; however, this study paves the way for the planning of conservation strategies also with regard to the relationship between Turkey oak and other oak species in Italy. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic resulted in a particularly adverse and stressful environment for expecting mothers, possibly enhancing feelings of anxiety and parenting stress. The present work assesses mothers' anxiety levels at delivery and parenting stress after 3 months as moderated by home-visiting sessions. Methods: Women (n = 177) in their second or third trimester of pregnancy during the COVID-19 lockdown were enrolled in northern Italy and split into those who did and did not receive home visits. After 3 months, the association between anxiety at delivery and parenting stress was assessed with bivariate correlations in the whole sample and comparing the two groups. Results: Higher anxiety at birth correlated with greater perceived stress after 3 months. Mothers who received at least one home-visiting session reported lower parenting stress at 3 months than counterparts who did not receive home visits. Conclusions for Practice: The perinatal period is a sensitive time window for mother-infant health, especially during a critical time like the COVID-19 pandemic. We suggest that home-visiting programs could be beneficial during global healthcare emergencies to promote maternal well-being after delivery. [ABSTRACT FROM AUTHOR]

Background: Hematoma expansion (HE) is common and associated with poor outcome in intracerebral hemorrhage (ICH) with unclear symptom onset (USO). Aims: We tested the association between non-contrast computed tomography (NCCT) markers and HE in this population. Methods: Retrospective analysis of patients with primary spontaneous ICH admitted at five centers in the United States and Italy. Baseline NCCT was analyzed for presence of the following markers: intrahematoma hypodensities, heterogeneous density, blend sign, and irregular shape. Variables associated with HE (hematoma growth > 6 mL and/or > 33% from baseline to follow-up imaging) were explored with multivariable logistic regression. Results: Of 2074 patients screened, we included 646 subjects (median age = 75, 53.9% males), of whom 178 (27.6%) had HE. Hypodensities (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.79–3.98), heterogeneous density (OR = 2.16, 95% CI = 1.46–3.21), blend sign (OR = 2.28, 95% CI = 1.38–3.75) and irregular shape (OR = 1.82, 95% CI = 1.21–2.75) were independently associated with a higher risk of HE, after adjustment for confounders (ICH volume, anticoagulation, and time from last seen well (LSW) to NCCT). Hypodensities had the highest sensitivity for HE (0.69), whereas blend sign was the most specific marker (0.90). All NCCT markers were more frequent in early presenters (time from LSW to NCCT ⩽ 6 h, n = 189, 29.3%), and more sensitive in this population as well (hypodensities had 0.77 sensitivity). Conclusion: NCCT markers are associated with HE in ICH with USO. These findings require prospective replication and suggest that NCCT features may help the stratification of HE in future studies on USO patients. [ABSTRACT FROM AUTHOR]

An economically important pest of Ficus carica L. is causing severe infestations in many fig nurseries and orchards in Italy. Belonging to the genus Aclees spp. (Coleoptera Curculionidae), this Asiatic species was accidentally introduced in Europe about 15 years ago, in a Tuscan nursery. Originally identified as Aclees cribratus Gyllenhal, it has been then reported as Aclees sp.cf. foveatus Voss and, more recently, identified as Aclees taiwanensis Kono. A serious damage to fig plants is caused mainly by the larvae, which drill tunnels into the wood and by adults that feed on buds, leaves and young fruits. The present survey applies molecular genetics techniques to reconstruct the genetic profile of the species. To this purpose, the partial sequence of the 18S rRNA gene and the hypervariable region ITS2 of the ribosomal cistron were used as molecular markers for specimens of A. taiwanensis collected in Italy and Aclees hirayamai Kono from Philippines. The analysis of the partial sequences of the 18S rRNA allowed the distinction of two haplotypes for each insect, except for a sample from Philippines, for which one haplotype does exist. The use of the ITS2 hypervariable region highlighted the existence of only one haplotype in the Italian accessions. Only in the sample collected in Lucca (2LU) two haplotypes were highlighted in ITS2. These results are discussed with the occurrence of A. taiwanensis in Italy. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is a collective trauma that is threatening citizens' mental health resulting in increased emotional stress, reduced social support, and heightened risk for affective symptoms. The present study aimed to investigate the effects of antenatal pandemic-related emotional stress and perceived social support on the symptoms of depression and anxiety of mothers who were pregnant during the initial COVID-19 outbreak in northern Italy. A sample of 281 mothers was enrolled at eight maternity units in the first hotspot region of the COVID-19 outbreak in northern Italy. Participants filled out online questionnaires assessing the direct or indirect exposure to the SARS-CoV-2 virus, pandemic-related stress, perceived social support, as well as symptoms of depression and anxiety. Depressive and anxious symptomatology was above clinical concern, respectively, in 26 and 32% of the respondents. Mothers who reported no exposure to SARS-CoV-2 during pregnancy and those who reported at least one direct or indirect exposure did not differ in terms of affective symptoms. Continuous scores and risk for severe depression and anxiety were positively associated with prenatal pandemic-related emotional stress and negatively linked with perceived social support during pregnancy. Women who become mothers during the COVID-19 emergency may be at high risk for affective problems. Dedicated preventive programs are needed to provide adequate preventive support and care for maternal mental health during and after the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Delirium is a severe condition that can arise in many contexts during hospitalization. The aim of this research was to measure the incidence of postoperative delirium in patients aged 75 years or older, with the exclusion of those with preexisting neurocognitive disorders (NCD), who underwent fast-track, moderate surgery. Methods: We conducted a prospective cohort study with patients ≥ 75 years of age who were eligible for fast-track, moderate surgery, without severe dementia, with a planned hospitalization of 24 h and with a physical status varying from very fit to vulnerable. The 4-item confusion assessment method (CAM4) was used to measure delirium. Results: Of the 209 eligible patients, 195 subjects were enrolled in the study. The percentage of the population with a CAM4 score above 0 before surgery was 2.56%; after surgery, the percentage was 10.25%; and on the following day, the percentage was 4.61%. There was a statistically significant difference in the CAM4 scores between immediately after surgery and at 24 h after surgery (p = 0.0172). Conclusion: The data from this study support an enhanced recovery approach for elderly patients, in which after a minor surgical procedure with anaesthesia, a recovery period of one night in the hospital can contribute to normalizing the CAM4 score and reducing the incidence of delirium. [ABSTRACT FROM AUTHOR]

Background and purpose: Comorbidity of acute ischaemic stroke with Covid‐19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1‐month outcome in ischaemic stroke patients with Covid‐19 infection who received IVT alone or before thrombectomy (bridging therapy). Methods: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid‐19 who received IVT. Results: Seventy‐five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1‐month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died. Conclusions: Intravenous thrombolysis for patients with stroke and Covid‐19 was not a rare event in the most affected areas by pandemic, and rates of 1‐month unfavorable outcomes were high compared to previous data from the pre–Covid‐19 literature. However, risk of sICH was not increased. [ABSTRACT FROM AUTHOR]

Long-term consequences of cervical artery dissection (CeAD), a major cause of ischemic stroke in young people, have been poorly investigated. The Italian Project on Stroke at Young Age - Cervical Artery Dissection (IPSYS CeAD) project is a multicenter, hospital-based, consecutively recruiting, observational, cohort study aimed to address clinically important questions about long-term outcome of CeAD patients, which are not covered by other large-scale registries. Patients with radiologically diagnosed CeAD were consecutively included in the registry. Baseline demographic and clinical variables, as well as information on risk factors, were systematically collected for each eligible patient. Follow-up evaluations were conducted between 3 and 6 months after the initial event (t1) and then annually (t2 at 1 year, t3 at 2 years , and so on), in order to assess outcome events (long-term recurrent CeAD, any fatal/nonfatal ischemic stroke, transient ischemic attack (TIA), or other arterial thrombotic event, and death from any cause). Between 2000 and 2019, data from 1530 patients (age at diagnosis, 47.2 ± 11.5 years; women, 660 [43.1%]) have been collected at 39 Italian neurological centers. Dissection involved a single vessel in 1308 (85.5%) cases and caused brain ischemia in 1303 (85.1%) (190 TIA/1113 ischemic stroke). Longitudinal data are available for 1414 (92.4%) patients (median follow-up time in patients who did not experience recurrent events, 36.0 months [25th to 75th percentile, 63.0]). The collaborative IPSYS CeAD effort will provide novel information on the long-term outcome of CeAD patients. This could allow for tailored treatment approaches based on patients' individual characteristics. [ABSTRACT FROM AUTHOR]

Italian teams have been involved many times in Space Weather observational campaigns from space and from the ground, contributing in the advancing of our knowledge on the properties and evolution of the related phenomena. Numerous Space Weather forecasting and now-casting modeling efforts have resulted in a remarkable add-on to the overall progress in the field, at both national and international level. The Italian Space Agency has participated several times in space missions with science objectives related to Space Weather; indeed, an important field for the Italian scientific and industrial communities interested in Heliophysics and Space Weather, is the development of new instrumentation for future space missions. In this paper, we present a brief state-of-the-art in Space Weather science in Italy and we discuss some ideas on a long-term plan for the support of future scientific research in the related disciplines. In the context of the current roadmap, the Italian Space Agency aims to assess the possibility to develop a national scientific Space Weather data centre to encourage synergies between different science teams with interest in the field and to motivate innovation and new mission concept development. Alongside with the proposed recommendations, we also discuss how the Italian expertise could complement international efforts in a wider international Space Weather context. [ABSTRACT FROM AUTHOR]

Objective: To determine whether out-of-hospital healthcare and adverse outcomes are better in stroke patients admitted to a neurology ward compared with those admitted to general wards.Methods: Beneficiaries of the National Health Service from the Italian Lombardy Region who were discharged alive after hospital admission during the year 2009 for ischemic stroke (9776 patients) or intracerebral or subarachnoid hemorrhage (1102 patients) entered into the cohort and were followed until 2012. Exposure of interest was the ward type where inpatients were admitted (neuro vs. general wards). Outcomes were out-of-hospital healthcare (i.e., drug prescriptions, diagnostic procedures, and laboratory clinical evaluations) and adverse clinical outcomes (i.e., all-cause death and hospital readmission). Exposure-outcome associations were investigated. High-dimensional propensity score methodology was used for taking into account confounders. Mediation analysis was used to verify whether the association between ward type and clinical outcomes is mediated by out-of-hospital adherence to healthcare.Results: Better adherence to out-of-hospital healthcare received from patients discharged from neuro, rather than general, wards was observed being the proportions of adherent patients 42.4% and 39.5%, respectively. Compared with general wards, discharge from neuro was associated with reduced 3-year emergency admissions (from 50.1 to 47.5% among ischemic stroke patients) and reduced 3-year mortality (from 37.5 to 27.0% among hemorrhagic stroke patients). From 10 to 15% of outcome risk, reductions were mediated by better adherence to out-of-hospital healthcare.Conclusions: For patients with acute ischemic and hemorrhagic stroke, admission to neuro vs. general wards is associated with better out-of-hospital healthcare and long-term adverse outcomes. [ABSTRACT FROM AUTHOR]

Objectives:Previous research has shown that individual differences in Theory of Mind (ToM) are crucial for people's social relationships. However, very few studies have investigated this issue in ageing. The present study was designed to fill this gap and examine the associations between ToM and social relationships in elderly adults. In doing so, this study considered people's relationships with their relatives and friends, and examined the possible moderating role of social motivation. Method:The study involved 53 healthy older adults (age:M= 67.91; SD = 6.93; range: 60--85 years). All participants were tested collectively during a 2-hr session and completed a demographic questionnaire as well as a battery of tests assessing verbal ability (vocabulary and word fluency), ToM and social relationships. They also answered a social motivation question. Results:Results showed that individual differences in older people's ToM were overall significantly associated with those in relationships with friends, but not relatives. In addition, the Hayes moderating procedure showed that individual differences in ToM were related to those in friendships only for those people who had a high or medium level of social motivation. Conclusion:These findings underline the importance of motivation in guiding the use of ToM in everyday social interactions. [ABSTRACT FROM AUTHOR]

To assess the clinical utility of targeted Next-Generation Sequencing (NGS) for the diagnosis of Inherited Retinal Dystrophies (IRDs), a total of 109 subjects were enrolled in the study, including 88 IRD affected probands and 21 healthy relatives. Clinical diagnoses included Retinitis Pigmentosa (RP), Leber Congenital Amaurosis (LCA), Stargardt Disease (STGD), Best Macular Dystrophy (BMD), Usher Syndrome (USH), and other IRDs with undefined clinical diagnosis. Participants underwent a complete ophthalmologic examination followed by genetic counseling. A custom AmpliSeq™ panel of 72 IRD-related genes was designed for the analysis and tested using Ion semiconductor Next-Generation Sequencing (NGS). Potential disease-causing mutations were identified in 59.1% of probands, comprising mutations in 16 genes. The highest diagnostic yields were achieved for BMD, LCA, USH, and STGD patients, whereas RP confirmed its high genetic heterogeneity. Causative mutations were identified in 17.6% of probands with undefined diagnosis. Revision of the initial diagnosis was performed for 9.6% of genetically diagnosed patients. This study demonstrates that NGS represents a comprehensive cost-effective approach for IRDs molecular diagnosis. The identification of the genetic alterations underlying the phenotype enabled the clinicians to achieve a more accurate diagnosis. The results emphasize the importance of molecular diagnosis coupled with clinic information to unravel the extensive phenotypic heterogeneity of these diseases. [ABSTRACT FROM AUTHOR]

Objective: Although a concern exists that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) might increase the risk of intracerebral haemorrhage (ICH), the contribution of these agents to the relationship between serum cholesterol and disease occurrence has been poorly investigated.Methods: We compared consecutive patients having ICH with age and sex-matched stroke-free control subjects in a case-control analysis, as part of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy), and tested the presence of interaction effects between total serum cholesterol levels and statins on the risk of ICH.Results: A total of 3492 cases (mean age, 73.0±12.7 years; males, 56.6%) and 3492 control subjects were enrolled. Increasing total serum cholesterol levels were confirmed to be inversely associated with ICH. We observed a statistical interaction between total serum cholesterol levels and statin use for the risk of haemorrhage (Interaction OR (IOR), 1.09; 95% CI 1.05 to 1.12). Increasing levels of total serum cholesterol were associated with a decreased risk of ICH within statin strata (average OR, 0.87; 95% CI 0.86 to 0.88 for every increase of 0.26 mmol/l of total serum cholesterol concentrations), while statin use was associated with an increased risk (OR, 1.54; 95% CI 1.31 to 1.81 of the average level of total serum cholesterol). The protective effect of serum cholesterol against ICH was reduced by statins in strictly lobar brain regions more than in non-lobar ones.Conclusions: Statin therapy and total serum cholesterol levels exhibit interaction effects towards the risk of ICH. The magnitude of such effects appears higher in lobar brain regions. [ABSTRACT FROM AUTHOR]

Objective. Pain prevalence data for patients at various stages after stroke. Design. Repeated cross-sectional, observational epidemiological study. Setting. Hospital-based multicenter study. Subjects. Four hundred forty-three prospectively enrolled stroke survivors. Methods. All patients under went bedside clinical examination. The different types of post-stroke pain (central post-stroke pain, musculoskeletal pains, shoulder pain, spasticity-related pain, and headache) were diagnosed with widely accepted criteria during the acute, subacute, and chronic stroke stages. Differences among the three stages were analyzed with v2 -tests. Results. The mean overall prevalence of pain was 29.56% (14.06% in the acute, 42.73% in the subacute, and 31.90% in the chronic post-stroke stage). Time course differed significantly according to the various pain types (P< 0.001). The prevalence of musculoskeletal and shoulder pain was higher in the subacute and chronic than in the acute stages after stroke; the prevalence of spasticity-related pain peaked in the chronic stage. Conversely, headache manifested in the acute post-stroke stage. The prevalence of central post-stroke pain was higher in the subacute and chronic than in the acute post-stroke stage. Fewer than 25% of the patients with central post-stroke pain received drug treatment. Conclusions. Pain after stroke is more frequent in the subacute and chronic phase than in the acute phase, but it is still largely undertreated. [ABSTRACT FROM AUTHOR]

Objectives:Previous research on age-related changes in Theory of Mind (ToM) showed a decline in older adults, particularly pronounced over 75 years of age. Evidence that ToM may be enhanced in healthy aging people has been demonstrated, but no study has focused on the role of age on the effects of ToM training for elderly people. The present study was designed to examine the efficacy of a ToM training on practiced (ToM Strange Stories) and transfer tasks (ToM Animations) in both young and older adults. Method:The study involved 127 older adults belonging to two age groups: young–old (Mage= 64.41; SD = 2.49; range: 60–69 years) and old–old (Mage= 75.66; SD = 4.38; range: 70–85 years), randomly assigned to either a ToM group or a control group condition. All participants took part in two 2-hour testing sessions and four 2-hour training sessions. Results:Results showed that both young–old and old–old adults in the ToM group condition improved their ability to reason on complex-mental states significantly more than participants in the control group condition. This positive effect of the training was evident on practiced and transfer ToM tasks. Crucially, age did not moderate the effect of the ToM training. Conclusion:These findings demonstrate that young–old and old–old adults equally benefit from the ToM training. Implications for the positive effect of the ToM training in old–old adults are discussed. [ABSTRACT FROM PUBLISHER]

We examined the incidence and predictors of acute kidney injury (AKI) in elderly patients (≥75 years) enrolled in the prospective Italian Elderly acute coronary syndrome (ACS) study and explored the impact of AKI on clinical outcome. Acute kidney injury, defined according to the Acute Kidney Injury Network criteria, occurred in 128 (21%) of 615 patients. Patients submitted to coronary angiographic procedures did not present higher rate of AKI. The only baseline variables independently associated with AKI development were creatinine clearance (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.97-0.99) and left ventricular ejection fraction (OR: 0.98; 95% CI: 0.96-0.99). Adverse clinical events were significantly higher in patients who developed AKI. After multivariable adjustment, AKI (hazard ratio: 2.73; 95% CI: 1.87-4.0) was an independent predictor of all-cause mortality within 1 year. [ABSTRACT FROM AUTHOR]

We determined the applicability of deriving the stature from knee height in an older Italian population, and, in the same population, we assessed longitudinally the change in stature over a 6-year interval. The standing stature and knee height in a supine position were measured in the entire home-dwelling older (65 + years) population of a small Italian town (N = 606). Stature measured in 1989 and in 1995 was used to assess longitudinal changes in 258 subjects of the same population. Stature derived from knee height was greater than measured stature in this population and in the two sexes. This difference disappeared when subjects with evident kyphosis were excluded. From 1989 to 1995, stature decreased by 1.7+/-3.0 cm, with women showing a larger decrement than men. Stature estimated from knee height is more accurate than measured stature in subjects with kyphosis. In accordance with previous studies, stature decreases with aging, and such height loss is greater in women than in men. [ABSTRACT FROM AUTHOR]

Background: Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear. Aims of the present study are to describe the quality indicators of nutritional care in older residents in a sample of NHs in Tuscany, Italy, and to evaluate the predictors of protein-energy malnutrition risk. Methods: A cross-sectional survey was conducted in 67 NHs. Information was collected to evaluate quality indicators of nutritional care and the individual risk factors for malnutrition, which was assessed using the Malnutrition Universal Screening Tool. A multilevel model was used to analyse the association between risk and predictors. Results: Out of 2395 participants, 23.7 % were at high, 11 % at medium, and 65.3 % at low risk for malnutrition. Forty-two percent of the NHs had only a personal scale to weigh residents; 88 % did not routinely use a screening test/tool for malnutrition; 60 % used some standardized approach for weight measurement; 43 % did not assess the severity of dysphagia; 12 % were not staffed with dietitians. Patients living in NHs where a chair or platform scale was available had a significantly lower risk of malnutrition (OR = 0.73; 95 % CI = 0.56-0.94). None of the other structural or process quality indicators showed a statistically significant association with malnutrition risk. Conclusions: Of all the process and structural indicators considered, only the absence of an adequate scale to weigh residents predicted the risk of malnutrition, after adjusting for case mix. These findings prompt the conduction of further investigations on the effectiveness of structural and process indicators that are used to describe quality of nutritional care in NHs. [ABSTRACT FROM AUTHOR]

Background and purpose There is an increasing interest in new risk factors for ischaemic stroke. Acute and chronic infections could contribute to different aetiological mechanisms of atherosclerosis that lead to cerebrovascular disease. The aim of this study was to investigate the hypothesis that previous infections and Chlamydia pneumoniae in particular increase the risk of ischaemic stroke in the population. Methods This was a prospective case−control study involving 11 Italian stroke units. Controls were age- and sex-matched with cases, represented by patients admitted to hospital for acute ischaemic stroke. For each participant classical vascular risk factors and previous inflammatory and infectious events up to 1 month before were registered. Blood samples were collected to analyse inflammatory markers and titres of antibodies against C. pneumoniae. Results A total of 1002 participants were included (mean age 69 years) with 749 ischaemic stroke patients. Infections occurred within 1 month previously in 12% of the entire sample with a higher prevalence in the case group (14.4% vs. 3.9%). At multivariate analysis of the seropositivity of IgA antibodies against C. pneumoniae increased the risk of stroke significantly (relative risk 2.121; 95% confidence interval 1.255-3.584) and an early previous infection (up to 7 days before the event) contributed to a rise in probability of acute cerebral ischaemia (relative risk 3.692; 95% confidence interval 1.134-6.875). Conclusions Early previous infections and persistent chronic infection of C. pneumoniae could contribute to increase the risk of ischaemic stroke significantly, in the elderly especially. [ABSTRACT FROM AUTHOR]

Objectives To determine whether type 2 diabetes mellitus and hyperglycemia on admission should be considered independent predictors of mortality in elderly adults with acute coronary syndrome (ACS). Design Prospective cohort study. Setting Twenty-three hospitals in Italy. Participants Individuals aged 75 and older with non- ST-elevation ACS ( NSTEACS) (mean age 82, 47% female) (N = 645). Measurements Diabetic status and blood glucose levels were assessed on admission. Hyperglycemia was defined as glucose greater than 140 mg/dL. Multivariable Cox proportional hazard regression was used to assess the potential confounding effect of major covariates on the association between diabetic status, admission glucose, and 1-year mortality. Results A history of diabetes mellitus was found in 231 participants (35.8%), whereas 257 (39.8%) had hyperglycemia. Hyperglycemia was found in 171 participants with diabetes mellitus (70%) and 86 (21%) without diabetes mellitus. Participants with diabetes mellitus were significantly ( P < .05) more likely to have had prior myocardial infarction and stroke and had lower ejection fraction and blood hemoglobin. Hyperglycemia was associated with lower ( P < .05) ejection fraction and estimated glomerular filtration rate ( eGFR). Diabetic status and hyperglycemia were associated with greater 1-year mortality according to univariate analysis (54 participants with diabetes mellitus died (23.4%), versus 66 (15.9%) without diabetes mellitus (hazard ratio (HR) = 1.5 95% confidence interval (CI) = 1.0-2.1), and 60 participants with hyperglycemia died (23.3%), versus 60 (15.5%) without hyperglycemia (HR=1.6; 95% CI = 1.1-2.2), but this association was not statistically significant after adjustment for ejection fraction, age, blood hemoglobin, and eGFR. Conclusion In elderly adults with NSTEACS, diabetes mellitus and hyperglycemia on admission are associated with higher mortality, mostly because of preexisting cardiovascular and renal damage. [ABSTRACT FROM AUTHOR]

Patent foramen ovale (PFO) is a common congenital anatomical defect in the general population with a mean prevalence of 20 %. Transcranial Doppler sonography and echocardiography, both with infusion of agitated saline as an echo contrast, have been introduced for the diagnosis of PFO. Transesophageal echocardiography is considered the gold standard. Several studies have suggested an association between cryptogenetic stroke and PFO, but the role of this condition as a risk factor for stroke is still debated. The aims of this prospective multicentre study are the evaluation of PFO prevalence in the whole ischemic stroke population and the identification of a stroke recurrence profile risk in patients with PFO. All consecutive patients admitted for acute ischemic stroke and with a confirmed diagnosis at discharge are eligible cases for the study. Demographic and vascular risk factors are registered. Clinical severity is summarized by the National Institute of Health stroke scale. Echocardiographic and transcranial studies are performed in each patient to detect the presence of PFO. Prevalence of PFO will be calculated with 95 % CIs. Univariate analysis will be performed to detect the correlation of PFO with different registered factors and multivariable analysis with PFO as independent variable. The present study should contribute to better identify the role of PFO in ischemic stroke risk and recurrence-related events. Qualifying findings of the study are represented by the high number of enrolled patients, the prospective methodology of the study and the presence of secondary instrumental endpoints. [ABSTRACT FROM AUTHOR]

Given the multi-componential nature of executive functions, we compared 48 outpatients affected by Type 2 diabetes and 49 control subjects on the executive domains of inhibition, updating, shifting, and word fluency. Variables commonly associated with diabetes were considered in explaining the relationship between diabetes and executive functioning. Each participant underwent a clinical and cognitive (addressing the four executive domains) evaluation. Raw test scores were standardized per domain and compared between groups. Possible risk factors related to diabetes were examined. The diabetes group scored lower than the control subjects only in the inhibition measure, whereas no differences resulted in the other executive domains. [ABSTRACT FROM AUTHOR]

Abstract: This study examined cultural differences in stereotypes and attributions regarding aging and memory. Two subcultures belonging to the same country, Italy, were compared on general beliefs about memory. Sardinians live longer than other areas of Italy, which is a publically shared fact that informs stereotypes about that subculture. An innovative instrument evaluating simultaneously aging stereotypes and attributions about memory and memory change in adulthood was administered to 52 Sardinian participants and 52 Milanese individuals divided into three age groups: young (20–30), young–old (60–70), and old–old (71–85) adults. Both Milanese and Sardinians reported that memory decline across the life span is more typical than a pattern of stability or improvement. However, Sardinians viewed stability and improvement in memory as more typical than did the Milanese. Interestingly, cultural differences emerged in attributions about memory improvement. Although all Sardinian age groups rated nutrition and heredity as relevant causes in determining the memory decline, Sardinians’ rated typicality of life-span memory improvement correlated strongly with causal attributions to a wide number of factors, including nutrition and heredity. [Copyright &y& Elsevier]

Background: The prevalence of asthma, a common disorder in childhood, is often estimated by cross-sectional studies based on questionnaires, with the drawback that estimates are limited to certain age groups and areas. The use of electronic health data is increasingly allowing researchers to overcome these limitations. This study is aimed at assessing asthma occurrence of a school-aged population in Northeast Italy using two different data sources. Methods: In 2004, a population-based survey using a standardized questionnaire was conducted to estimate asthma occurrence among a resident population of children aged 6–7 years and adolescents aged 13 years. A selection of dispensed asthma medications was extracted from electronic databases for a 4-year period prior to questionnaire completion (2000–03). Asthma prevalence was estimated by commonly used questionnaire classifications and compared with use of inhaled bronchodilators (alone or in combination) in various time periods. Correlations between the two approaches were calculated. Results: A total of 10 252 subjects were eligible for analysis (85% of the resident population). A total of 4747 subjects (38% of the resident population) were registered in the drug database during 2000–03. Asthma prevalence was higher in males and in children. Congruence between the two enquiry methods varied according to criteria applied and improved with the protraction of the observation period. Conclusion: A longer period for the capture of medication data yielded higher congruence. A degree of mismatch was observed between the two methods most likely related to factors of drug use and questionnaire reliability. Nonetheless, the benefits of using easily accessible population data prevail, and further studies are warranted. [ABSTRACT FROM AUTHOR]

Theory of mind (ToM) refers to humans' ability to recognize the existence of mental states, such as beliefs, emotions, and desires. The literature on ToM in aging and on the relationship between ToM and other cognitive functions, like executive functions, is not homogenous. The aim of the present study was to explore the course of ToM and to investigate the role of working memory, inhibition, and language on the possible age differences in ToM. To address these issues, we examined ToM using the Strange Stories task and executive function task in three age groups. Results showed that young adults outperform both old groups on the ToM stories. This difference remains significant also when controlling for working memory and inhibitory control. Our findings suggest a specific impairment in inferring mental states starting from 60 years of age that seems to be independent of changes in executive functions. [ABSTRACT FROM AUTHOR]

Abstract: This study examined age and cultural differences on both personal and general beliefs about memory by comparing three age groups within two subcultures belonging to the same country: Milanese and Sardinian. Two innovative instruments on general and personal beliefs with graphic-rating-scale format (General Beliefs about Memory Instrument and Personal Beliefs about Memory Instrument) and a memory task (recall of 40 words) were administrated to participants. Sardinians held more positive attitudes about the effects of aging on memory reporting a later onset of declining memory ability and control over memory across the life span. They were also more optimistic in rating their global memory efficacy, control, and retrospective change. The two subcultural groups differed in terms of memory performance, with Sardinian individuals outperforming the Milanese. Findings are discussed in relation to the view of aging in different subcultural contexts. [Copyright &y& Elsevier]

In nonpathological elders, cognitive decline is more evident by middle age and depends on different factors, such as speed of processing, nature of the task (i.e., storing versus processing), and type of stimuli (i.e., verbal versus visual and spatial) to be recalled. The present study aimed to investigate the impact of age and environmental factors (i.e., retirement home versus one's own home) on visuo-spatial working memory functions of healthy elderly (73 to 81 years old) and very old participants (83 to 90 years old). Results showed that visuo-spatial working memory processes in the institutionalized sample were comparable with those in free-living participants. A differential age effect was more evident for mnestic tasks involving the manipulation of stimuli. [ABSTRACT FROM AUTHOR]

Background and aims: Many studies have focused on memory training in aging, showing that older adults can improve their performance. Unfortunately, the benefits of training can rarely be generalized to other tasks for which adults were not specifically trained. We investigated the benefits of instruction- based training in promoting transfer effects in older adults. Methods: In Experiment 1, we evaluated transfer effects in a training group who practiced using standard mnemonics to learn paired associates and word lists, and this group was given instructions about how the mnemonics could be used for two of the four transfer tasks (text learning, name-face learning, grocery list learning, place learning). In Experiment 2, we compared transfer effects for two different training groups: one practiced the strategies with the two trained tasks and did not receive instructions, and the other had the same practice but also received instructions on all the transfer tasks. Results: Transfer in text learning occurred in both experiments. This transfer is particularly interesting, as text learning was the most dissimilar task in terms of both the nature of the materials and the underlying processes that support performance. The transfer was reliably greater when training involved instructions about applicability than when it did not. Conclusions: Instructions to use practiced strategies on new materials may be a useful technique in promoting transfer in older adults. It seems that the lack of transfer does not necessarily arise from older adults' inabilities, but because they do not realize that trained strategies can (or should) be applied to new materials. [ABSTRACT FROM AUTHOR]

The article discusses a study which explored the effects of radio transmitters on bird survival and reproduction specifically on ring-necked pheasants in Central Italy. The experiment used the Kaplan-Meier method where an estimate of the mortality of female ring-necked pheasants in relation to radio load was made. Results showed that low-load birds survived better after 2 -3 months from release, implying that there are no short-term effects for the birds in adjusting to loads. It was proven that low loads did not affect the reproductive capability of the birds in spite of age or body mass. It concluded that using radio packages that are lighter than 1.5% of body mass is safe for pheasants while adverse effects can result if the ratio is increased beyond two percent.

Abstract: Sediment from harbors of the Emilia-Romagna (Northern Adriatic Sea) were dredged and dumped in four disposal areas characterized by muddy bottoms. The long-term effects of the dumping on macrozoobenthic communities were investigated before and after 6month, 8month, 2years and 4years. The disposal of dredged material did not influence the granulometry and %TOC in the sediment, and no alterations in the structure of the macrobenthic communities were observed in the four areas. The lack of impact could be ascribed to the environmental characteristics and precautionary measures taken to minimize the effects of the dumping. It appears that: (1) the communities of the dumping areas are well adapted to unstable environments; (2) the sediments were disposed gradually and homogeneously over relatively large areas; Other factors that help to reduce the impact of sediment disposal are the low concentrations of contaminants in dredged materials and the similarity of sediment in the dredged and disposal areas. Off-shore discharge appears a sustainable strategy for the management of uncontaminated dredged sediments from the Northern Adriatic Sea harbors. [Copyright &y& Elsevier]

Summary Background Environmental factors are likely to be involved in explaining the wide geographical variation in asthma and atopic diseases that has been documented in many recent epidemiological studies. Aim To evaluate to what extent climate and outdoor NO2 pollution can explain the geographical variation in the prevalence of asthma and allergic rhinitis, and to estimate the relative risk for exposure to different levels of these two factors. Methods The impact of climate and long-term exposure to nitrogen dioxide (NO2 ) pollution on asthma and allergic rhinitis was assessed in a cross-sectional study, carried out during 1998 to 2000 on young adults aged 20 to 44 years ( n = 18 873), living in 13 areas from two different Italian climatic regions (subcontinental and Mediterranean). Results Mediterranean areas had a significantly higher prevalence of asthma-like symptoms (P < 0.001), higher annual mean temperature (16.2 °C vs. 12.9 °C), lower temperature range (16.0 C° vs. 22.1 C°) and lower NO 2 levels (31.46 µg/m 3 vs. 57.99 µg/m 3 ) than subcontinental ones. Mediterranean climate was associated with an increased risk of wheeze (OR = 1.23; 95% CI 1.13 to 1.35), tightness in the chest (OR = 1.21; 95% CI 1.11 to 1.33), shortness of breath (OR = 1.21; 95% CI 1.08 to 1.36) and asthma attacks (OR = 1.19; 95% CI 1.07 to 1.31). After adjusting for climate, an increase of 18.3 µg/m 3 in NO 2 levels moderately increased the risk of asthma attacks (OR = 1.13; 95% CI 0.98 to 1.32), tightness in the chest (OR = 1.11; 95% CI 0.98 to 1.26) and wheeze (OR = 1.11; 95% CI 0.96 to 1.28). When the levels of outdoor NO 2 exposure rose, the prevalence of allergic rhinitis increased significantly in the Mediterranean region (OR = 1.38; 95% CI 1.12 to 1.69), but not in the subcontinental one (OR = 1.03; 95% CI 0.83 to 1.28). Conclusion Our results show that... [ABSTRACT FROM AUTHOR]

Features a study on the effects of hepatitis C virus (HCV) genotypes on patients with cirrhosis in southern Italy. Details on HCV genotypes; Methods of the study; Results; Discussion.

Background: Hepatitis C virus (HCV) is a common cause of chronic liver diseases but the degree to which these diseases contribute to liver-related mortality is not well established. The aim of this study was to estimate the absolute and relative effects of HCV infection on liver-related mortality.Methods: A population random sample of 2472 subjects aged > or = 30 years was enrolled and followed up from 1985 to 1996. At enrollment, a structured interview and a clinical evaluation were performed. Serum samples were tested using HCV ELISA and RIBA HCV. Outcomes were overall and liver-related mortality and tracing procedures included review of office and hospital records, death certificates, and interviews with general practitioners, attending hospital and next of kin. Statistical analysis was performed using Poisson and binomial prospective data regression.Results: Crude overall and liver-related mortality rates were 7.66 (95% CI : 6.68-8.79) and 0.9 (95% CI : 0.3-2.2) per 10(3) person-years, respectively. For HCV infection effect, incidence rate ratio and difference (per 10(3) person-year), risk ratio and difference were 27.5 (95% CI : 6.5-115.6), 4 (95% CI : 3-7), 33.1 (95% CI : 7.8- 139.3) and 0.06 (95% CI : 0.04-0.08), respectively; all measures were adjusted for age at death, sex and daily alcohol intake.Conclusions: The results show a strong relative but weak absolute effect of HCV infection on liver-related mortality in the 10-year period considered. Poisson and binomial models are virtually equivalent, but the choice of the summarizing measure of effect may have a different impact on health policy. [ABSTRACT FROM AUTHOR]

Background: We investigated the epidemiologic, clinical, and radiologic aspects of a mixed medicosurgical series of chronic pancreatitis patients observed at the University of Verona Centre for the Study of Pancreatic Diseases over the period 1971-1995. Methods: Even though the pathogenesis of chronic pancreatitis has yet to be clarified and the classification is still debatable, the patients were subdivided in accordance with the Marseilles-Rome classification into those with alcoholic, obstructive, familial, and idiopathic forms of the disease. A total of 715 patients were analysed with a median follow-up period of 10 years (range, 1-25 years). Results and Conclusions: At the end of follow-up the dropout rate amounted to 7.1% (51 patients), and 176 patients (24.6%) had died. Data are reported about the type of chronic pancreatitis, sex, and age distribution at the onset of the disease, drinking and smoking habits before onset and during follow-up, and incidence of calcifications, pain, diabetes, steatorrhoea, and pseudocysts. Surgical aspects, survival curves, and causes of death are also analysed, and the most frequent concomitant diseases in chronic pancreatitis sufferers are discussed. [ABSTRACT FROM AUTHOR]

The article focuses on a Chronic tension-type headache (CTTH) induce a pain sensation in the trapezium area. The article discusses the CTTH treatment with Quantum Molecular Resonance (QMR) therapy which helps to promote cell regeneration process through direct cell stimulation which is able to decrease local inflammatory reaction and consequently pain level. The article also discusses the prophylactic treatment for CTTH including antidepressants, muscle relaxants, drugs is used by patients.

In 2005 the American Stroke Association’s task force on the development of stroke systems established that providers and policymakers at the local, state and national levels can make significant contributions to reducing the devastating effects of stroke by working to promote coordinated systems that improve patient care. In the last few years in North America and Canada several quality stroke registers have been implemented with the aim of improving the processes of care by the diffusion and implementation of national guidelines and by the identification and correction of critical points of stroke care provided in the hospitals participating in the register. The Italian guidelines for stroke, SPREAD, have been developed with the aim of generating a tool applicable to the Italian clinical setting, able to promote the planning and linking of the assistant interventions between the different phases of the stroke care process, from the hyper-acute to the rehabilitation phase, and from primary to secondary prevention in order to harmonise and streamline the actions of the various health-care providers involved in the different phases of the diagnostic and therapeutic path of patients with stroke. The primary end-point of the Stroke Active Guideline Evaluation (STAGE) project, founded by the Italian Ministry of Health in 2003, is the diffusion, implementation and validation of the Italian Guideline for Stroke, SPREAD, in 15 acute care and 3 rehabilitative institutions across Italy. Secondary end-points are the evaluation of impact of the implementation of a workflow management in the processes of care and the identification of a national, streamlined diagnostic and therapeutic path for ischaemic stroke patients. An existing electronic patient record (EPR) has been shared with the referents of the Centres participating in the study and adapted to SPREAD’s indicators. This EPR has been augmented with the decision support system. The STAGE project represents the first Italian effort in this direction. A lot of work has to be done before this goal will be achieved, but as Albert Einstein said “Imagination is more important than intelligence”. [ABSTRACT FROM AUTHOR]

Primary headaches can be considered simultaneously as symptom and disease itself, while secondary headaches are expressions of a pathological process that can be systemic or locoregional. Because of its subjective features, headache is often difficult to assess and quantify by severity, frequency and invalidity rate, and for these reasons it has often been implicated in legal controversies. Headache has seldom been considered in the criminal law, except when it represents a typical symptom of a disease whose existence can be objectively assessed (i. e. raised intracranial pressure). Therefore, in civil legislation it is not yet coded to start claiming for invalidity compensation. In particular, one of the most debated medical-legal questions is represented by headaches occurring after head injury. Headache is often the principal symptom at the beginning of several toxic chronic syndromes, with many implications, especially in working claims, and, more recently, it may be referred to as one of the most frequent symptoms by victims of mobbing (i. e. psychological harassment in the workplace). The National Institute for Industrial Accident Insurance (INAIL) scales (instituted by the law 38/2000) mention the “Subjective cranial trauma syndrome” and give an invalidity rate evaluation. With reference to other headache forms, no legislation really exists at the present time, and headache is only considered as a symptom of a certain coded disease. Requests for invalidity social pension and the question of off-label prescriptions (drug prescription for a disease, without formal indication for it) are other controversial matters. [ABSTRACT FROM AUTHOR]

Lombardy was one of the hardest hit regions in Italy during the COVID19 pandemic. We hereby report our experience with SARS-CoV2 infection in lung transplant recipients. We retrospectively collected clinical data on all the consecutive cases of COVID19 in our centre, based in Milan, from March 2020 to August 2021. Diagnosis was always confirmed by a positive nucleic acid amplification test (RT-PCR) for SARS-CoV-2 on nasopharyngeal swab and/or tracheal aspirate. 21 patients were diagnosed with COVID19. Figure 1 summarizes the clinical course of these individuals. We reduced immunosuppressive regimen in all these patients, typically holding the antiproliferative agent and augmenting steroids; when hospitalized, everybody received initial empiric antibiotic treatment with piperacillin/tazobactam and high-dose LMWH. Hydroxychloroquine was used only in the "first wave" (4 patients). One patient was compassionately administered anakinra and remdesivir as a "rescue therapy". Lymphocitopenia was a common presenting sign (14 patients, 66%). Aspergillus co-infection occurred in 5 patients (24%). Mortality rate was 29%; 4 out of these 6 patients were affected by CLAD and 3 had chronic kidney disease. Of note, in March 2021, we tested all our patients for anti-SARS-CoV-2 nucleocapsid antibodies before starting vaccinations: we found three additional seropositive patients, who were not included in the present analysis, but had been presumably affected by an asymptomatic/mild form of the disease. Apart from immunosuppression, the majority of our patients presented at least one risk factor for mortality in COVID-19 (diabetes, chronic kidney disease, arterial hypertension) and, for this reason, we felt that they should be hospitalized to enable close monitoring and prompt management of possible complications and deterioration. Clinical course seemed favorable in only two thirds of our patients but, for the time being, none of these individuals showed sign of new-onset CLAD after COVID19. [ABSTRACT FROM AUTHOR]

Abstract  Time-dependent models for seismic hazard and earthquake probabilities are at the leading edge of research nowadays. In the framework of a 2-year national Italian project (2005–2007), we have applied the Brownian passage time (BPT) renewal model to the recently released Database of Individual Seismogenic Sources (DISS) to compute earthquake probability in the period 2007–2036. Observed interevent times on faults in Italy are absolutely insufficient to characterize the recurrence time. We, therefore, derived mean recurrence intervals indirectly. To estimate the uncertainty of the results, we resorted to the theory of error propagation with respect to the main parameters: magnitude and slip rate. The main issue concerned the high variability of slip rate, which could hardly be reduced by exploiting geodetic constraints. We did some validation tests, and interesting considerations were derived from seismic moment budgeting on the historical earthquake catalog. In a time-dependent perspective, i.e., when the date of the last event is known, only 10–15% of the 115 sources exhibit a probability of a characteristic earthquake in the next 30 years higher than the equivalent Poissonian probabilities. If we accept the Japanese conventional choice of probability threshold greater than 3% in 30 years to define “highly probable sources,” mainly intermediate earthquake faults with characteristic M α ranging between 0.22 and 0.36 to 31 sources out of 115 in the case of an α value fixed at 0.7). On the other hand, in stationary time-independent approaches, more than two thirds of all sources are considered probabilistically prone to an impending earthquake. The performed tests show the influence of the variability of the aperiodicity factor in the BPT renewal model on the absolute probability values. However, the influence on the relative ranking of sources is small. Future developments should give priority to a more accurate determination of the date of the last seismic event for a few seismogenic sources of the DISS catalog and to a careful check on the applicability of a purely characteristic model. [ABSTRACT FROM AUTHOR]

We sought to compare construct and predictive validity of four sets of heart failure (HF) diagnostic criteria in an epidemiologic setting.The prevalence estimates of HF vary broadly depending on the diagnostic criteria.Data were collected in a survey of community dwellers who were ≥65 years of age living in Dicomano, Italy. At baseline, HF was diagnosed with the criteria of the Framingham, Boston, and Gothenburg studies and of the European Society of Cardiology (ESC). Left ventricular mass index and ejection fraction, left atrium systolic dimension, lower extremity mobility disability, summary physical performance score, and 6-min walk test were compared between HF and non-HF participants to test for construct validity of each set of criteria. Predictive validity was evaluated with follow-up assessment of cardiovascular mortality, incident disability, and HF-related hospitalizations. Comparisons were adjusted for demographics, comorbidity, and psychoaffective status.Of 553 participants, 11.9%, 10.7%, 20.8%, and 9.0% had HF, according to Framingham, Boston, Gothenburg, and ESC criteria, respectively. In terms of construct validity, Framingham and Boston criteria discriminated HF from non-HF participants better than Gothenburg and ESC criteria across the measures of cardiac function and global performance. The Boston criteria showed a superior predictive validity because they indicated a significantly greater adjusted risk of cardiovascular death (hazard ratio3.9, 95% confidence interval 1.2 to 13.2), incident disability, and hospitalizations in participants with HF.The Boston criteria are preferable to Framingham, Gothenburg, and ESC criteria for the diagnosis of HF in older community dwellers because they have good construct validity and more accurately predict cardiovascular death, incident disability, and hospitalizations. [Copyright &y& Elsevier]

COVID-19 pandemic had a great impact on outcome in SARS-CoV-2 positive patients with ischemic stroke during the first wave in Italy. Few data are available on outcome stratified by sex. The Italian Society of Hospital Neuroscience conducted a multi-center, retrospective, observational study on neurological complications in COVID-19 patients with ischemic stroke. All the patients admitted from March 1st to April 30th, 2020 in 20 Neurology Units in Northern Italy were recruited. Demographical and clinical features, treatment and outcome data were compared focusing on sex differences. 812 patients with ischemic stroke were enrolled, of whom 129 with COVID-19; males were 53.8%. In-hospital mortality in COVID-19 patients was 35.3% in males and 27.9% in females while 8.5% in male and 5.8% in female patients without COVID-19. SARS-CoV-2 positive patients had a higher frequency of stroke of undetermined etiology, than negative ones (32.8% vs 22.5%; p = 0.02), especially in females compared to males (36.1% vs 27.9%), albeit without statistical significance. Male patients with SARS-CoV-2 were more likely to require cPAP (30.9% vs 14.8%; p = 0.03), endotracheal tube (14.9% vs 3.3%; p = 0.02) and reperfusion strategies (29.4% vs 11.5%; p = 0.01) than females, as well as to have a higher CRP and D-dimer. These elements together with older age, a total anterior circulation stroke and lymphopenia were predictors of a worse outcome. Our study detected some differences due to sex in ischemic stroke with and without COVID-19, supporting the possibility to perform sex analyses for SARS-CoV-2 positive patients for a better clinical management. • Northern Italy, first in Europe, experienced an extensive outbreak of Severe Acute Respiratory Syndrome Coronavirus 2. • Relevant impact of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on cerebrovascular events. • Intra-hospital mortality for ischaemic stroke significantly increased in SARS-CoV-2 positive patients. • Our study detected some differences due to sex in ischemic stroke with and without COVID-19. [ABSTRACT FROM AUTHOR]

The most relevant problems related to the management of neurological disorders are (i) the frequent hospitalization in nonspecialist departments, with the need for neurological consultation, and (ii) the frequent requests of GPs for highly specialized investigations that are very expensive and of little value in arriving at a correct diagnosis. In 1996, the Consorzio di Bioingegneria e Informatica Medica in Italy realized the CISNet project (in collaboration with the Consorzio Istituti Scientifici Neuroscienze e Tecnologie Biomediche and funded by the Centro Studi of the National Public Health Council) for the implementation of a national neurological excellence centers network (CISNet). In the CISNet project, neurologists will be able to give on-line interactive consultation and off-line consulting services identifying correct diagnostic/therapeutic procedures, evaluating the need for both examination in specialist centers and admission to specialized centers, and identifying the most appropriate ones. [ABSTRACT FROM AUTHOR]

In 2013–2014, 201 pigs belonging to 67 batches were tested for Salmonella in their mesenteric lymph nodes (MLN) in one abattoir of Northern Italy. For each batch, faecal material was collected at lairage by swabbing the pen floor for approximately 1600 cm 2 . The aim of this study was to investigate the prevalence of Salmonella in MLN of pigs at slaughter, to assess Salmonella contamination at lairage and to evaluate the effect of lairage duration on its prevalence. Serotyping, Xba I PFGE typing and antimicrobial testing of the isolates were performed. Pig and human Salmonella isolates of the same region of Italy were compared to evaluate possible correlations. Salmonella enterica was isolated from 19.9% of the MLN and 49.3% of the environmental faecal samples. Nine different serovars were identified among 75 S. enterica isolates. In MLN Salmonella Derby was the most common (52.5%), followed by S. enterica 4,[5],12:i:- (17.5%) and Salmonella Rissen (10.0%). In faecal samples S. Derby was prevalent (51.4%), followed by S. enterica 4,[5], 12:i:- (20.0%) and Salmonella Brandenburg (14.3%). Lairage holding varied between 1 and ≥ 12 h (median value: 2.5 h). In pigs held for 1–3 h, 14.1% were positive for Salmonella in MLN but the prevalence reached 31.8% when they were held for ≥ 12 h. The contamination of MLN was statistically different ( p = 0.0045) between the two groups, thus confirming the role of long-lasting lairage in Salmonella contamination of pigs. Xba I PFGE typing detected 36 PFGE types. Twenty-three PFGE types were identified among the 40 MLN isolates and 22 PFGE types among the 35 faecal isolates. A total of 11 PFGE types were shared between the MLN of pigs and the lairage environment. Among S. Derby, 6 shared PFGE types between MLN and faeces were found and among S. enterica 4,[5],12:i:- one PFGE type was common between MLN and the faecal samples. Shared profiles between human and swine isolates of S. Derby, S. enterica 4,[5],12:i:-, S. Rissen, Salmonella Manhattan, S. Brandenburg, Salmonella Livingstone, Salmonella London and Salmonella Muenchen were identified. Among S. Derby and S. enterica 4,[5],12:i:- isolates found in pigs, 6/15 profiles (40.0%) and 8/10 (80.0%) were shared with human isolates. High resistance rates to streptomycin (97.3%), sulphonamide compounds (84.0%) and tetracycline (56.0%) were observed. No resistance was detected to ertapenem and meropenem. High proportions of isolates showed intermediate sensitivity to ciprofloxacin (85.3%) and cefotaxime (66.7%). High sensitivity rates were found to chloramphenicol (96.0%) and trimethoprim/sulfamethoxazole (81.3%). [ABSTRACT FROM AUTHOR]