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Objective. To evaluate the validity, in terms of the patients’ acceptance, preference, feasibility and reliability of an innovative, interactive computerized system for collection of patient-reported outcome (PRO) data on axial SpA against the paper-and-pencil version.Methods. Fifty-five patients with axial SpA completed both the touch screen and the paper-and-pencil set of questionnaires. A computerized touch-screen system, SPEAMonitor, was developed to capture PRO data. Variables recorded included demographic data, patient’s assessment of general health status, BASDAI, BASFI, BASMI and acute-phase reactant levels. In order to assess the patient’s acceptance of, preference for and feasibility of computer-based questionnaires, the participants filled in an additional questionnaire. The time taken to complete both formats was measured. In a further test–retest study, 25 patients were re-evaluated.Results. The agreement between the paper-administered and computer touch-screen format of the BASFI, BASDAI questionnaires and the Ankylosing Spondylitis Disease Activity Scores was excellent. Intraclass correlation coefficients (ICCs) between data ranged from 0.90 to 0.96. Additionally the test–retest study showed a very good agreement between the scores for the two administrations (ICC ≥ 0.90). Age, computer experience and education level had no significant impact on the results. The computerized questionnaires were reported to be easier to use. The mean time spent completing the questionnaires on a touch screen was 5.1 min and on paper 7.9 min.Conclusion. Our newly developed computer-assisted touch-screen questionnaires for PRO in axial SpA were well accepted by patients, with good data quality, reliability and score agreement. [ABSTRACT FROM PUBLISHER]

The Electronic Personal Health Record (EPHR) provides an innovative service for citizens and professionals to manage health data, promoting patient-centred care. It enhances communication between patients and physicians and improves accessibility to documents for remote medical information management. The study aims to assess the prevalence of awareness and acceptance of the EPHR in northern Italy and define determinants and barriers to its implementation. In 2022, a region-wide cross-sectional study was carried out through a paper-based and online survey shared among adult citizens. Univariable and multivariable regression models analysed the association between the outcome variables (knowledge and attitudes toward the EPHR) and selected independent variables. Overall, 1634 people were surveyed, and two-thirds were aware of the EPHR. Among those unaware of the EPHR, a high prevalence of specific socio-demographic groups, such as foreign-born individuals and those with lower educational levels, was highlighted. Multivariable regression models showed a positive association between being aware of the EPHR and educational level, health literacy, and perceived poor health status, whereas age was negatively associated. A higher knowledge of the EPHR was associated with a higher attitude towards the EPHR. The current analysis confirms a lack of awareness regarding the existence of the EPHR, especially among certain disadvantaged demographic groups. This should serve as a driving force for a powerful campaign tailored to specific categories of citizens for enhancing knowledge and usage of the EPHR. Involving professionals in promoting this tool is crucial for helping patients and managing health data. [ABSTRACT FROM AUTHOR]

Simple Summary: Completion lobectomy (CL) entails the resection of the remaining pulmonary lobe subsequent to wedge resection or segmentectomy. Indications for CL include reoperations for multiple or relapsed lung cancers and metastatic lung tumors, and the prognostic advantage of these procedures has been widely reported. However, ipsilateral surgical treatments, particularly within the same lobe, present challenges due to the development of intrapleural adhesions, rendering reoperation more difficult and time-consuming. VATS has emerged as the gold standard in the surgical treatment of early-stage NSCLC, offering superior postoperative outcomes when compared to thoracotomy. Its efficacy has been well established, even during complex procedures. However, its application in ipsilateral reoperations remains anecdotal, and to the best of our knowledge, no studies have analyzed the safety and efficacy of uniportal-VATS in this setting. This paper aims to evaluate the role of iniportal-VATS in CL long after wedge resection or anatomical segmentectomy in the same lobe. Background: Completion lobectomy (CL) following a prior resection in the same lobe may be complicated by severe pleural or hilar adhesions. The role of uniportal video-assisted thoracoscopic surgery (U-VATS) has never been evaluated in this setting. Methods: Data were collected from two Italian centers. Between 2015 and 2022, 122 patients (60 men and 62 women, median age 67.7 ± 8.913) underwent U-VATS CL at least 4 weeks after previous lung surgery. Results: Twenty-eight (22.9%) patients were affected by chronic obstructive pulmonary disease (COPD) and twenty-five (20.4%) were active smokers. Among the cohort, the initial surgery was performed using U-VATS in 103 (84.4%) patients, triportal-VATS in 8 (6.6%), and thoracotomy in 11 (9.0%). Anatomical segmentectomy was the initial surgery in 46 (37.7%) patients, while hilar lymphadenectomy was performed in 16 (13.1%) cases. CL was performed on 110 (90.2%) patients, segmentectomy on 10 (8.2%), and completion pneumonectomy on 2 (1.6%). Upon reoperation, moderate pleural adhesions were observed in 38 (31.1%) patients, with 2 (1.6%) exhibiting strong adhesions. Moderate hilar adhesions were found in 18 (14.8%) patients and strong adhesions in 11 (9.0%). The median operative time was 203.93 ± 74.4 min. In four (3.3%) patients, PA taping was performed. One patient experienced intraoperative bleeding that did not require conversion to thoracotomy. Conversion to thoracotomy was necessary in three (2.5%) patients. The median postoperative drainage stay and postoperative hospital stay were 5.67 ± 4.44 and 5.52 ± 2.66 days, respectively. Postoperative complications occurred in 34 (27.9%) patients. Thirty-day mortality was null. Histology was the only factor found to negatively influence intraoperative outcomes (p = 0.000). Factors identified as negatively impacting postoperative outcomes at univariate analyses were male sex (p = 0.003), age > 60 years (p = 0.003), COPD (p = 0.014), previous thoracotomy (p = 0.000), previous S2 segmentectomy (p = 0.001), previous S8 segmentectomy (p = 0.008), and interval between operations > 5 weeks (p= 0.005). In multivariate analysis, only COPD confirmed its role as an independent risk factor for postoperative complications (HR: 5.12, 95% CI (1.07–24.50), p = 0.04). Conclusions: U-VATS CL seems feasible and safe after wedge resection and anatomical segmentectomy. [ABSTRACT FROM AUTHOR]

Simple Summary: Since the introduction of effective systemic therapies (ESTs) (in the form of both targeted and immuno-based therapies) in the treatment of malignant melanoma, the prognosis of metastatic patients has dramatically changed. The role of metastasectomy in oligometastatic patients has rarely been addressed in this new pharmacological era. Even though lungs represent the most frequent site of melanoma metastases, only limited data are available on the role of surgery in isolated pulmonary metastases from malignant melanoma (PmMM). In this study, we describe the outcomes of patients who underwent metastasectomy of PmMM in the era of ESTs, and identified prognostic factors affecting survival in our multicentric experience. To the best of our knowledge, this is the first paper analyzing in detail the impact of metastasectomy of PmMM in the era of ESTs. In the last decade, the emergence of effective systemic therapies (ESTs) in the form of both targeted and immuno-based therapies has revolutionized the treatment of patients with advanced stage III and stage IV melanoma. Even though lungs represent the most frequent site of melanoma metastases, only limited data are available on the role of surgery in isolated pulmonary metastases from malignant melanoma (PmMM) in the era of ESTs. The aim of this study is to describe the outcomes of patients who underwent metastasectomy of PmMM in the era of ESTs, in order to identify prognostic factors affecting survival and to provide a framework for more informed patient selection of treatmeant with lung surgery in the future. Clinical data of 183 patients who underwent metastasectomy of PmMM between June 2008 and June 2021 were collected among four Italian Thoracic Centers. The main clinical, surgical and oncological variables reviewed were: sex, comorbidities, previous oncological history, melanoma histotypes and primary site, date of primary cancer surgical treatment, melanoma growth phase, Breslow thickness, mutation pattern disease, stage at diagnosis, metastatic sites, DFI (Disease Free Interval), characteristics of lung metastases (number, side, dimension, type of resection), adjuvant therapy after lung metastasectomy, site of recurrence, disease-free survival (DFS) and cancer-specific survival (CSS; defined as the time interval between the first melanoma resection or lung metastasectomy and death from cancer). All patients underwent surgical resection of the primary melanoma before lung metastasectomy. Twenty-six (14.2%) patients already had a synchronous lung metastasis at the time of primary melanoma diagnosis. A wedge resection was performed in 95.6% of cases to radically remove the pulmonary localizations, while an anatomical resection was necessary in the remaining cases. The incidence of major post-operative complications was null, while only 21 patients (11.5%) developed minor complications (mainly air leakage followed by atrial fibrillation). The mean in-hospital stay was 4.46 ± 2.8 days. Thirty- and sixty-day mortality were null. After lung surgery, 89.6% of the population underwent adjuvant treatments (47.0% immunotherapy, 42.6% targeted therapy). During a mean FUP of 107.2 ± 82.3 months, 69 (37.7%) patients died from melanoma disease, 11 (6.0%) from other causes. Seventy-three patients (39.9%) developed a recurrence of disease. Twenty-four (13.1%) patients developed extrapulmonary metastases after pulmonary metastasectomy. The CSS from melanoma resection was: 85% at 5 years, 71% at 10 years, 54% at 15 years, 42% at 20 years and 2% at 25 years. The 5- and 10-year CSS from lung metastasectomy were 71% and 26%, respectively. Prognostic factors negatively affecting CSS from lung metastasectomy at multivariable analysis were: melanoma vertical growth (p = 0.018), previous metastatic sites other than lung (p < 0.001) and DFI < 24 months (p = 0.007). Our results support the evidence that surgical indication confirms its important role in stage IV melanoma with resectable pulmonary metastases, and selected patients can still benefit from pulmonary metastasectomy in terms of overall cancer specific survival. Furthermore, the novel systemic therapies may contribute to prolonged survival after systemic recurrence following pulmonary metastasectomy. Patients with long DFI, radial growth melanoma phase and no site of metastatization other than lung seem to be the best candidate cases for lung metastasectomy; however, to drive stronger conclusions, further studies evaluating the role of metastasectomy in patients with iPmMM are needed. [ABSTRACT FROM AUTHOR]

Background: Involvement in research activities is complex in pediatric nursing and allied health professionals (AHPs). It is important to understand which individual factors are associated with it to inform policy makers in promoting research. Methods: A cross-sectional observational study was conducted to describe the level of participation in research activities over the last ten years of nurses and AHPs working in a tertiary pediatric hospital. A large sample of nurses and AHPs working in an Italian academic tertiary pediatric hospital completed an online self-report questionnaire between June and December 2018. Three multivariate logistic regression analyses were performed to predict participation in research projects, speaking at conferences, and writing scientific articles. Results: Overall, data from 921 health professionals were analyzed (response rate = 66%), of which about 21% (n = 196) reported participating in a research project, while 33% (n = 297) had attended a scientific conference as a speaker, and 11% (n = 94) had written at least one scientific paper. Having a Master or a Regional Advanced Course, working as an AHP or a ward manager, as well as regularly reading scientific journals and participation in an internal hospital research group or attendance in a specific course about research in the hospital, significantly predicted participation in research projects, speaking at conferences and writing scientific papers. It is important to foster research interest and competencies among health professionals to improve participation in research projects, speaking at conferences, and writing scientific papers. Conclusions: Overall, we found a good level of attendance at conferences as speakers (33%), a moderate level of participation in research (21%), and low levels for writing scientific papers (11%). Our study highlighted the need to support participation in research activities among nurses and AHPs. Policymakers should identify strategies to promote research among nurses and AHPs, such as protected rewarded time for research, specific education, strengthened collaboration with academics, and financial support. Moreover, hospital managers should promote the development of research culture among health professionals, to improve their research competencies and evidence-based practice. [ABSTRACT FROM AUTHOR]

Aims: To analyze whether patient verbal aggression would be related to emotional exhaustion and whether this relationship would be mediated by work–family conflict and moderated by dehumanization and resilience. Background: Although patient verbal aggression has been identified as one of the most experienced forms of aggression, its effects on Italian health care providers during the pandemic are still poorly known. Methods: A total of 197 Italian health care professionals completed paper‐and‐pencil questionnaires. Descriptive statistics and moderated mediation analyses were performed. Results: Patient verbal aggression was positively related to health care professionals' emotional exhaustion, both directly and indirectly, as mediated by work–family conflict. Health care providers were more likely to become emotionally exhausted when they had low resilience and, simultaneously, tended to ascribe patients non‐uniquely human traits. Conclusions: Patient verbal aggression may spill over onto health care professionals' family lives. Dehumanization represents an ineffective coping strategy that exacerbates the effects of aggression on work–family conflict, whereas resilience represents a protective resource against emotional exhaustion. Implications for nursing management: Hospital organisations could benefit from providing their staff with stress management interventions, aggression management, psychological support and psychological resilience training programmes. These programmes should incorporate coping skills on establishing work–home boundaries and balancing empathy with cognitive problem‐solving abilities. [ABSTRACT FROM AUTHOR]

An infinite number of fitness apps are available on various app stores. However, hardly any of them are fitted to the needs and requirements of care‐dependent people. This paper investigates the effectiveness of a customised fitness‐app prototype for increasing physical activity in home care service users. Home care service users from Austria and Italy were randomly assigned to two groups. In total, 216 participants were involved in the field trial, 104 received a tablet with the fitness app and an activity tracker (treatment group), 112 did not (control group). Regularity of physical activity, frequency of fitness exercises and walking behaviour were self‐reported by participants at baseline, after 4 months and after 8 months. In addition, the frequency of using the prototype was assessed based on the fitness app's logged usage data. We estimated multilevel mixed‐effects ordered logistic models to examine the effects of the intervention. After 4 months, the intervention increased the home care users' probability of agreeing strongly with being physically active on a regular basis by 28 percentage points (p < 0.001; 95% CI: 0.20, 0.36) and their probability of reporting to exercise more than once a week by 45 percentage points (p < 0.001; 95% CI: 0.32, 0.57). Walking behaviour was not affected on group‐level but improved for frequent users of the activity tracker. Frequent and regular users of the fitness app benefited most and effects persisted until the end of the 8 months controlled trial. Tailoring a fitness‐app prototype to the needs of care‐dependent people has the potential to support people with functional limitations to engage in a more active lifestyle. Future research is encouraged to seek further insights into how new technologies can support physical activities in people with long‐term care needs. [ABSTRACT FROM AUTHOR]

Background: Selective crossectomy and mechanochemical ablation (MOCA) of great saphenous vein (GSV) have been used, for years, individually in the treatment of chronic venous insufficiency. In this paper, we focus on the advantages of a combination of the two techniques, in order to prevent complications and recurrence. Methods: A preoperative clinical and instrumental screening phase was conducted for the purpose of dividing patients into three groups: "Saph+Cross" group (51/139 patients) underwent saphenectomy and crossectomy; "MOCA" group (44/139 patients) underwent MOCA of GSV with Flebogrif® device; "MOCA + Cross" group (44/139 patients) subjected to both MOCA and crossectomy procedures. Recurrence rate, defined as total recanalization of GSV and/or onset of neosaphena and/or new varicose veins, was used as a primary outcome. Secondary outcomes were procedural time and intra- and post-procedural complications. Results: We conducted a 1-, 6-, and 12-month follow-up with Duplex scan. The recurrence rates were 3.9%, 21.8%, and 4.5% for "Saph+Cross," "MOCA," and "MOCA+Cross," respectively, with a significant difference for the comparison between "MOCA" and "Saph+Cross" (MOCA vs Saph+Cross: OR 5.35, CI95% [0.98; 54.6], p -value.040). The sub-analysis of primary outcome highlighted a lower recanalization rate of GSV when combining the crossectomy with MOCA procedure (2.2% MOCA+Cross vs 15.9% MOCA; 0.12 OR, [0.002; 1.02] CI95%, p -value.029). Among the secondary outcomes, "MOCA" showed a shorter procedural time than the other groups (Saph+Cross: 51.3 ± 11.4; MOCA: 45.1 ± 7.5; MOCA+Cross: 50.4 ± 10; p -value.027). No significant differences were noted in terms of intra- and post-procedural complications. Conclusions: The results showed that patients treated with saphenectomy and crossectomy have a lower recurrence rate compared to MOCA alone and MOCA + crossectomy procedures. The association of crossectomy with MOCA significantly reduces the recanalization rate of GSV, and it is also characterized by a higher free survival from recurrence (SSF) than with MOCA alone. [ABSTRACT FROM AUTHOR]

Early warning tools are crucial for the timely application of intervention strategies and the mitigation of the adverse health, social and economic effects associated with outbreaks of epidemic potential such as COVID-19. This paper introduces, the Epidemic Volatility Index (EVI), a new, conceptually simple, early warning tool for oncoming epidemic waves. EVI is based on the volatility of newly reported cases per unit of time, ideally per day, and issues an early warning when the volatility change rate exceeds a threshold. Data on the daily confirmed cases of COVID-19 are used to demonstrate the use of EVI. Results from the COVID-19 epidemic in Italy and New York State are presented here, based on the number of confirmed cases of COVID-19, from January 22, 2020, until April 13, 2021. Live daily updated predictions for all world countries and each of the United States of America are publicly available online. For Italy, the overall sensitivity for EVI was 0.82 (95% Confidence Intervals: 0.75; 0.89) and the specificity was 0.91 (0.88; 0.94). For New York, the corresponding values were 0.55 (0.47; 0.64) and 0.88 (0.84; 0.91). Consecutive issuance of early warnings is a strong indicator of main epidemic waves in any country or state. EVI's application to data from the current COVID-19 pandemic revealed a consistent and stable performance in terms of detecting new waves. The application of EVI to other epidemics and syndromic surveillance tasks in combination with existing early warning systems will enhance our ability to act swiftly and thereby enhance containment of outbreaks. [ABSTRACT FROM AUTHOR]

Italian coasts are docking berths for the majority of boats carrying asylum seekers coming from Middle East and Sub-Saharan countries. These people escaped from their home countries in an effort to survive war, hunger and torture. These experiences might have affected their mental health, which became more endangered during their journey. The main aim of our work was to assess the prevalence of post-traumatic stress disorder (PTSD) in asylum seekers in a first aid facility, where immigrants were aided after their arrival. Thus, we designed a cross-sectional survey with paper-and-pen questionnaires. The setting was the C.A.R.A. (Centro Accoglienza Richiedenti Asilo) in Mineo (Sicily). Participants were asked for general information. They also completed the PTSD Checklist of the DSM-IV (PCL-C) and the Harvard Trauma Questionnaire (HTQ). We collected 140 questionnaires and the PCL-C was completed by 98 residents; 44% of responders were considered affected by PTSD. Although we used a conservative cut-off, PTSD prevalence was found to be much higher than that in the general population. [ABSTRACT FROM AUTHOR]

BACKGROUND: In spring 2013, groundwater of a vast area of the Veneto Region (northeastern Italy) was found to be contaminated by perfluoroalkyl substances (PFAS) from a PFAS manufacturing plant active since the late 1960s. Residents were exposed to high concentrations of PFAS, particularly perfluorooctanoic acid (PFOA), through drinking water until autumn 2013. A publicly funded health surveillance program is under way to aid in the prevention, early diagnosis, and treatment of chronic disorders possibly associated with PFAS exposure. OBJECTIVES: The objectives of this paper are: a) to describe the organization of the health surveillance program, b) to report serum PFAS concentrations in adolescents and young adults, and c) to identify predictors of serum PFAS concentrations in the studied population. METHODS: The health surveillance program offered to residents of municipalities supplied by contaminated waterworks includes a structured interview, routine blood and urine tests, and measurement of 12 PFAS in serum by high-performance liquid chromatography–tandem mass spectrometry. We studied 18,345 participants born between 1978 and 2002, 14–39 years of age at recruitment. Multivariable linear regression was used to identify sociodemographic, lifestyle, dietary, and reproductive predictors of serum PFAS concentrations. RESULTS: The PFAS with the highest serum concentrations were PFOA [median 44.4 ng/mL, interquartile range (IQR) 19.3–84.9], perfluorohexanesulfonic acid (PFHxS) (median 3.9 ng/mL, IQR 1.9–7.4), and perfluorooctanesulfonic acid (PFOS) (median 3.9 ng/mL, IQR 2.6–5.8). The major predictors of serum levels were gender, municipality, duration of residence in the affected area, and number of deliveries. Overall, the regression models explained 37%, 23%, and 43% of the variance of PFOA, PFOS, and PFHxS, respectively. CONCLUSIONS: Serum PFOA concentrations were high relative to concentrations in populations with background residential exposures only. Interindividual variation of serum PFAS levels was partially explained by the considered predictors. [ABSTRACT FROM AUTHOR]

An increased risk of death by suicide in cancer patients has been documented since decades. We evaluated the risk of death by suicide in an Italian population-based cancer case series and added the results to a systematic review and meta-analysis of the literature. The Italian series, including 127,042 primary cancer patients diagnosed between 1996 and 2014, was obtained from the Romagna Cancer Registry (northern Italy). Standardised mortality ratios (SMRs) were calculated. Regarding the systematic review and meta-analysis, the PubMed database was searched for English language studies published up to 2017. Fifty-seven potentially eligible papers were reviewed in full, and 19 of them were selected for analysis. The SMR was the first outcome, replaced by rate ratio if the SMR was not available. In the Italian case series, an increased suicide risk was found for both sexes combined (SMR = 1.5; 95% confidence interval [CI]: 1.3–1.8), for males (SMR = 1.6; 95% CI: 1.4–1.9) but not females (SMR = 1.1; 95% CI: 0.7–1.7), for patients aged ≥55 years, with poor prognosis and advanced-stage disease and during the first year after diagnosis. The absolute excess risk of suicide was 0.9 per 10,000 patient-years. Multivariate analysis confirmed the role of univariate factors except for poor prognosis. Meta-analysis showed a strong heterogeneity between studies. The risk was significantly elevated for both sexes combined (pooled SMR = 1.7; 95% CI: 1.5–1.9), men (pooled SMR = 1.8; 95% CI: 1.6–2.0) and women (pooled SMR = 1.4; 95% CI: 1.3–1.6). There was no evidence for small-study effects. The Italian study confirmed the previous common finding that cancer patients are at increased risk for suicide. A clinical multidisciplinary approach to support them is needed. • A study on the risk of death by suicide among northern Italian cancer patients was included in a meta-analysis of the literature. • The meta-analysis confirmed a robust increase in the risk of death by suicide for cancer patients. • A multidisciplinary approach to detect symptoms of anxiety and depression is needed. [ABSTRACT FROM AUTHOR]

The work-related well-being of social workers has become a central concern in international psychosocial literature. The majority of studies have focused on the negative outcomes of social work (for example, work-related stress, burnout, job dissatisfaction) and only a few studies have considered the positive work-related health outcomes. In an attempt to address this gap, the aim of the present study was to investigate the role of both psychological well-being (PWB)--from a eudaimonic paradigm (that is, person's optimal functioning)-- and job resources in promoting social workers' work engagement (WE). Following the job demands-resources model and the conservation of resources theory, authors hypothesized that job resources mediate the relationship between PWB and WE. The study sample was composed of 140 social workers provided with a paper-and-pencil questionnaire. Structural equation models and mediational analyses were applied and confirmed that job resources fully mediate the association between PWB and WE. PWB acts as a personal resource that endorses perception, identification, and even promotion of job resources. Job resources, in turn, were associated with WE. The article concludes with proposals of systemic interventions aiming at improving social workers' work-related health. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The increasing number of diagnostic tests requests all over the world is a problem that can partially be explained by inappropriate testing. Impact on the total costs of health systems becomes relevant when tests are performed in a large amount. In this paper, retesting of total cholesterol, ferritin, vitamin B12, vitamin D, and folate is assessed. Methods The Quality Unit of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano (Fondazione) decided to perform a first assessment of the appropriate use of the laboratory tests cholesterol, ferritin, vitamin B12, vitamin D, and folate focusing on the retesting interval for the same patient in the time period January 1, 2012, to December 31, 2014, in every care setting. The minimum retesting intervals were chosen following the ACB recommendations. The Fondazione is a research and teaching hospital with 3 emergency units (adult, pediatric, and obstetric), kidney, liver, lung, cornea, and bone marrow transplant centers and a medical school. Record linkage of laboratory records selected for the time interval January 1, 2012, to December 31, 2014, was applied using tax code. For each marker, the distribution of retesting intervals was evaluated for every year and the total period. With the same record linkage variable, requests on inpatients were identified from hospital discharge records. A cost analysis of inappropriate retesting was performed for every test. Results We examined 466 035 requests for 113 019 patients. Proportions of tests judged potentially inappropriate varied between 8.1% for 1,25-dihydroxy vitamin D and 37.1% for total cholesterol. The rates of inappropriate tests from year to year never showed significant decrease, and the maximum increase corresponded to an odds ratio of 1.85 (95% CI, 1.36-2.51) for 1,25-dihydroxy vitamin D from 2012 to 2013. Calculated loss of money was approximately €500 000 in the 3 years. Conclusions Inappropriate requests represent a waste of time and money resources. Our analysis highlighted economically unacceptable rates of inappropriate retesting, with no evidence of decreasing trend. Actions to raise awareness in clinicians or automated electronic solutions are necessary to limit unnecessary test repetitions. [ABSTRACT FROM AUTHOR]

This paper updates a previous cross-sectional study on the effectiveness of electronic cigarettes (e-cigarettes) as an aid to quit smoking. In the 2014–2021 PASSI survey, the ongoing Italian behavioural risk factor surveillance system, on a total of 239,812 subjects representative of the Italian adult population respondents who smoked and made at least one quit attempt in the previous 12 months (i.e., 19,234 subjects) were categorized into four groups according to the method used in their most recent quit attempt: no aid, e-cigarettes, standard pharmacological support (medications) and/or smoking cessation services (SCSs), other unspecified methods. The primary outcome was self-reported abstinence for a period ≥6 months. Thirteen percent of participants used e-cigarettes to quit, 83% no aid, 2% medications/SCSs, 3% other unspecified methods. Smoking abstinence was reported among 10% of those using no aid; 11% among e-cigarette users; 16% among those using medications/SCSs; and 13% among those using other unspecified methods. No significant difference in abstinence was observed for those reporting no aid compared with e-cigarette users (adjusted Prevalence Ratio [aPR] = 0.93; 95% confidence interval [CI] = 0.79–1.10). Those using medications/SCSs were significantly more likely to report abstinence than e-cigarette users (aPR = 1.35; 95% CI = 1.01–1.81). E -cigarettes as consumer products are not associated with higher quitting rates than those recorded using no aid, therefore there is no health benefit for allowing them to be marketed to smokers. [ABSTRACT FROM AUTHOR]

Purpose -- The main aim of this paper is to examine labour productivity trends in Italy over the period 1981-2004. Design/methodology/approach -- To this end, relying on recent developments in the analysis of non-stationary dependent panels, the paper develops a new method for estimating total factor productivity (TFP) trends. Findings -- The conclusions confirm the view that the recent decline in Italian labour productivity growth is mostly due to a widespread fall in TFP growth. Research limitations/implications -- The main assumption underlying the proposed TFP estimation method is that technology growth is driven by a single trend common to all units included in the panel (industries, regions or countries). Originality/value -- The paper provides two distinct contributions: empirically, it provides robust evidence that TFP slow-down is the main cause of recent negative trends in labour productivity in Italy. Methodologically, the paper proposes an approach to estimating TFP that enjoys several advantages: only basic data for input and output flows are needed, the non-stationary nature of the data is explicitly taken into account, and confidence intervals for TFP growth can be computed. This method can thus be easily applied to many routinely available datasets, to either corroborate existing growth accounting estimates or to obtain previously unavailable estimates. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe the design and the preliminary validation of a platform developed to collect and automatically analyze biomedical signals for risk assessment of vascular events and falls in hypertensive patients. This m-health platform, based on cloud computing, was designed to be flexible, extensible, and transparent, and to provide proactive remote monitoring via data-mining functionalities. A retrospective study was conducted to train and test the platform. The developed system was able to predict a future vascular event within the next 12 months with an accuracy rate of 84 % and to identify fallers with an accuracy rate of 72 %. In an ongoing prospective trial, almost all the recruited patients accepted favorably the system with a limited rate of inadherences causing data losses (<20 %). The developed platform supported clinical decision by processing tele-monitored data and providing quick and accurate risk assessment of vascular events and falls. [ABSTRACT FROM AUTHOR]

Background: Many ethnobotanical studies have investigated selection criteria for medicinal and non-medicinal plants. In this paper we test several statistical methods using different ethnobotanical datasets in order to 1) define to which extent the nature of the datasets can affect the interpretation of results; 2) determine if the selection for different plant uses is based on phylogeny, or other selection criteria. Methods: We considered three different ethnobotanical datasets: two datasets of medicinal plants and a dataset of non-medicinal plants (handicraft production, domestic and agro-pastoral practices) and two floras of the Amalfi Coast. We performed residual analysis from linear regression, the binomial test and the Bayesian approach for calculating under-used and over-used plant families within ethnobotanical datasets. Percentages of agreement were calculated to compare the results of the analyses. We also analyzed the relationship between plant selection and phylogeny, chorology, life form and habitat using the chi-square test. Pearson's residuals for each of the significant chi-square analyses were examined for investigating alternative hypotheses of plant selection criteria. Results: The three statistical analysis methods differed within the same dataset, and between different datasets and floras, but with some similarities. In the two medicinal datasets, only Lamiaceae was identified in both floras as an over-used family by all three statistical methods. All statistical methods in one flora agreed that Malvaceae was over-used and Poaceae under-used, but this was not found to be consistent with results of the second flora in which one statistical result was non-significant. All other families had some discrepancy in significance across methods, or floras. Significant over- or under-use was observed in only a minority of cases. The chi-square analyses were significant for phylogeny, life form and habitat. Pearson's residuals indicated a non-random selection of woody species for non-medicinal uses and an under-use of plants of temperate forests for medicinal uses. Conclusions: Our study showed that selection criteria for plant uses (including medicinal) are not always based on phylogeny. The comparison of different statistical methods (regression, binomial and Bayesian) under different conditions led to the conclusion that the most conservative results are obtained using regression analysis. [ABSTRACT FROM AUTHOR]

Mind-body practices (MBP) are known to induce electrophysiological and morphological changes, whereas reports related to changes of neurotrophins are surprisingly scarce. Consequently, in the current paper, we focused on the Quadrato motor training (QMT), a newly developed whole-body movement-based MBP, which has been reported to enhance creativity. Here we report the effects of 4 weeks of daily QMT on creativity and proNGF level in two interrelated studies. In Study A, we examined the effects of QMT compared with a walking training (WT) in healthy adults, utilizing the alternate uses task. In contrast with the WT, QMT resulted in increased creativity. In addition, the change in creativity negatively correlated with the change in proNGF levels. In Study B, we examined QMT effects on creativity and additional metacognitive functions in children, using a nonintervention group as control. Similar to Study A, following QMT, we found a negative correlation of proNGF with creativity, as well as working memory updating and planning ability. Together, the current results point to the relationship between increased creativity and decreased proNGF following MBP. Thus, the current research emphasizes the importance of widening the scope of examination of “MBP in motion” in relation to metacognition and well-being. [ABSTRACT FROM AUTHOR]

Aims: The role of the serotonin transporter gene (SLC6A4) in alcohol dependence (AD) is still unclear. In this paper, we have evaluated the association of the SLC6A4 gene polymorphisms 5-HTTLPR and rs25531 in AD and assessed the polymorphic patterns both in alcoholics and in healthy people of an Italian population. Methods: Genotyping of the 5-HTTLPR (L/S) and rs25531 (A/G) polymorphisms of the SLC6A4 gene was performed on 403 alcoholics outpatients and 427 blood donors. Results: Comparing AD and control populations and taking into account statistical correction for multiple testing,we found no statistically significant differences for 5-HTTLPR (L/S) and rs25531 polymorphisms in terms of either genotypes or alleles frequencies. By univariate ANOVA, a statistically significant difference was found in the onset of AD: the mean age of onset resulted to be of 25.4 years in males in respect to 28.1 in females. In particular in males, the early AD onset was different, in a statistically significant manner, depending on the presence of at least one S or Lg allele (24.6 years) in respect to La homozygotes (27.5 years) (P = 0.03). Conclusions: These findings suggest that genetic factors contribute, together with gender and age, to the onset differences in alcohol-dependent phenotypes. [ABSTRACT FROM AUTHOR]

This paper focuses on whether the on-going dramatic decrease in alcohol consumption in Italy, especially of wine, during 1961-2008, was associated with which parallel sociodemographic and economic changes and with alcohol control policies. The study, using both time series (TS) and artificial neural network (ANN)-based analyses documents that its selected sociodemographic and economic factors, and particularly urbanization, had a definite connection with wine consumption decrease, spirits decrease, and the increase in beer consumption over time. On the other hand, control policies showed no effect on the decline in alcohol consumption, since no alcohol control policy existed in Italy between 1960 and 1987. A few policies introduced since 1988 (BAC and sale restrictions during mass events) may have contributed to reducing or to maintaining the on-going reduction. Study limitations are noted and future needed research is suggested. [ABSTRACT FROM AUTHOR]

Objective The aim of this retrospective study was to evaluate the esthetic outcome of single tooth Morse taper connection implants used to replace congenitally missing lateral incisors after orthodontic treatment by means of the pink esthetic score ( PES) and white esthetic score ( WES) index. Materials and Methods Twenty consecutive patients who were treated with a single tooth Morse taper connection implants ( Leone Implant System®, Florence, Italy) were enrolled in this study. An independent calibrated examiner applied the PES/ WES index to 20 implant-supported restorations 3 months and 3 years after implant placement. Results No implants were lost. All 20 implants fulfilled the established success criteria for dental implants with regard to osseointegration and prosthetic complications, with an overall implant-crown success of 100.0%. At the 3 year examination, the mean distance between the implant shoulder and the first visible bone-implant contact was of 0.49 ± 0.18 mm (95% confidence interval 0.41-0.57); the mean PES was 8.15 ± 1.69, and the mean WES was 8.70 ± 0.92. Conclusions The placement of single-tooth Morse taper connection implants for rehabilitation of congenitally missing lateral incisors after orthodontic treatment represents a successful procedure in the medium term. Further studies are necessary in order to assess the long-term esthetic score. Clinical Significance This paper evaluates the esthetic outcome of Morse taper connection implants placed to restore congenitally missing lateral incisors after orthodontic treatment. [ABSTRACT FROM AUTHOR]

BATTISTELLI A., PORTOGHESE I., GALLETTA M. & POHL S. (2013) Beyond the tradition: test of an integrative conceptual model on nurse turnover. International Nursing Review 60, 103-111 Aim: This paper aimed to extend research on nurse turnover by developing and testing a theoretical model of turnover intention that includes two emergent key off-the-job constructs, work-family conflict (WFC) and community embeddedness (CE). Background: Nurse turnover is considered one of the most significant issues in health care. There is a considerable body of knowledge that has focused on the study of the on-the-job factors of nurse turnover, showing the important role of job attitudes. Recently, WFC and job embeddedness (JE) have been identified as variables that could help explain levels of nurse turnover. Methods: Using structural equation modelling from a cross-sectional survey, the relationships between the variables were explored in a sample of 440 nurses from an Italian public hospital. The questionnaire measures demographic data and psychosocial factors such as job satisfaction, organizational commitment, WFC, CE and turnover intentions. Results: The findings supported the importance of non-work dimensions in turnover models. Conclusions: The results suggest that when studying turnover phenomena in health organizations, the extra-work domains (WFC and JE) can contribute to a decrease in the intention to leave, in addition to the more typically emphasized attitude dimension. [ABSTRACT FROM AUTHOR]

Abstract: Background: Elderly people are particularly vulnerable to the effects of social reduction, so there is an urgent need to identify the risks associated with social isolation. The aim of this paper was to analyze associations between psychological, socio-demographic, functional aspects on the risk of social isolation, mortality and re-hospitalization in older persons. Methods: This is a longitudinal study on 580 hospitalized elderly sample aged ≥70yrs recruited from 2005 to 2007 in the Geriatrics Operative Unit of INRCA in Fermo, Italy. The comprehensive geriatric assessment (CGA) was used. Outcome measures included 36-month mortality and re-hospitalization. Results: In all patients, approximately 20% (n =112) of the subjects were socially isolated. Women perceived their social support significantly worse than men (77.7 vs. 22.3%; p <0.001). A multiple logistic regression analysis (goodness of fit χ 2 =102.86, p <0.001) with risk of social isolation as the dependent variable, showed that women were at a greater risk than men for social isolation (OR=1.99, 95% CI=1.13–3.50). Furthermore, patients with a higher number of family components (OR=0.72, 95% CI=0.59–0.88) and good parameters of quality of life (PCS-12: OR=0.94, 95% CI=0.91–0.98; MCS-12: OR=0.94, 95% CI=0.92–0.97) were less likely to be socially isolated. Cox regression models adjusted for gender, quality of life and number of family components, showed that the social isolation did not predict mortality (HR=1.44, 95% CI=0.84–2.46, p =0.19), but was associated with higher re-hospitalization rates (HR=1.28, 95% CI=1.02–1.59, p =0.03). Conclusions: Our findings highlight several aspects related to the risk of social isolation and re-hospitalization in a specific group of older persons. [Copyright &y& Elsevier]

The carotid intima-media thickness (IMT) is a validated marker of cerebrovascular disease risk. This paper presents a new parameter, the IMT variability (IMTV), and compares it between symptomatic and asymptomatic patients taken from a cohort of Italian population. One hundred forty-two patients were analyzed (age 59 ± 112 years, 59% males), 42 of these patients suffered from TIA or minor stroke. The lumen-intima (LI) and media-adventitia (MA) interfaces of the far wall were manually traced by a Reader. We also used a computer-based automated system (called AutoEdge) to obtain the LI/MA interfaces. The LI/MA interfaces were used to measure the IMT and the IMTV along the distal wall of the common carotid artery. Wilcoxon and Pearson correlation analyses were performed. The agreement between the Reader's IMT and the AutoEdge IMT values was 98.7% for the symptomatic (0.83 ± 0.44 mm for Reader, 0.82 ± 0.35 mm for AutoEdge) and 94.9% for the asymptomatic patients (0.78 ± 0.45 mm for Reader, 0.74 ± 0.30 mm for AutoEdge). Correlation was 65% for symptomatic and 68% for asymptomatic patients, respectively. The IMT measured using AutoEdge was 1.2% lower compared to manual measurements in symptomatic population, while 5.12% lower in asymptomatic. The IMTV was 11% higher in symptomatic patients compared to asymptomatic when using manual delineations, 8% higher when using AutoEdge. There was no statistical difference between the manual and automated IMTV measurements (Wilcoxon signed rank, P > 0.7). We conclude that the IMT and IMTV values were very similar between Reader and AutoEdge software when studying symptomatic and asymptomatic patients in Italian population. [ABSTRACT FROM AUTHOR]

Employee organizational identification has been proposed and found to be positively related to employee health and well-being. The empirical evidence, however, is not unequivocal, and some authors have suggested possible downsides of identification with the organization as a whole or with a group within it. The potential negative effect of over-identification was tested empirically for the first time in the present paper. Two studies were conducted; Study 1 was cross-sectional and used a sample of Italian law court clerks (N=195) and Study 2 was longitudinal and employed a sample of Italian teachers (N=140 at T2). We proposed a curvilinear mediation model with identification curvilinearly predicting workaholism, and workaholism, in turn, negatively affecting employee well-being. This curvilinear link between organizational identification and workaholism means that workaholism at first decreases with growing identification, but when identification becomes too strong, workaholism increases. The results confirmed our hypotheses, and we discuss theoretical and practical implications. [ABSTRACT FROM AUTHOR]

papastavrou e., efstathiou g., tsangari h., suhonen r., leino-kilpi h., patiraki e., karlou c., balogh z., palese a., tomietto m., jarosova d. & merkouris a. (2011) A cross-cultural study of the concept of caring through behaviours: patients' and nurses' perspectives in six different EU countries. Journal of Advanced Nursing 68(5), 1026-1037. Abstract Aim. This paper is a report of an international study of patients' and nurses' perceptions of nurse caring behaviours. Background. Current economic constraints on healthcare systems, demand to increase the quality of care and the incorporation of the consumers' perspective into care, have created a need to develop a clear understanding of nursing behaviours which convey caring. Patients in different areas of the world report different expectations of nurses' caring actions when compared to nurses' views. Method. A descriptive comparative survey design was used to analyse a sample of surgical patients ( n = 1659) and their nurses ( n = 1195) in 88 wards of 34 hospitals in Cyprus, the Czech Republic, Finland, Greece, Hungary and Italy. Data were collected in autumn 2009 using the Caring Behaviours Inventory-24. Nurses' and patients' responses were compared using both inferential and descriptive statistics. Results. Independent samples t-tests showed important differences between nurses' and patients' views. Although both groups perceived knowledge and skill as being the most important sub-scale, the nurses' responses were higher compared to patients ( P < 0·05) with important differences in the 'assurance of human presence' ( P < 0·001) and the 'respectful deference to others' ( P < 0·001) sub-scales. Cross-country comparisons showed important differences between the nurses' ( F = 24·199, P < 0·001) and patients' views on caring ( F = 26·945, P < 0·001). Conclusions. Important differences were observed between patient-nurse perceptions in the participating countries. The results form a foundation for future research into the development of a common international perspective about caring behaviours between patients and their nurses. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyses variables associated with community-dwelling older people''s engagement in physical activity (PA). Data were examined using the results from the European ZINCAGE study on 306 community-dwelling Italians aged 65years and over. The lifestyle questionnaire was used to evaluate the data. Levels of regular/non-regular PA were based on ≥1h of weekly exercise. Logistic regression analysis was used to analyze the predictors of PA. Participants reported the time they had spent per week engaging in PA over the last year. Overall, 56.2% of them engaged in regular physical exercise. PA levels decreased in subjects with probable cognitive decline, depression and high perceived stress levels (p <0.001). Lower age, a lower body mass index (BMI), better health status, absence of depression, being married, were all associated with regular PA. The importance of monitoring PA in the elderly emerged, in particular in those having some certain social-demographic characteristics. [Copyright &y& Elsevier]

Background: Recent immigrants face various difficulties in adjusting to western countries and show a high prevalence of mental disorders. Access to a culturally appropriate community mental health centre (CMHC) is crucial for immigrants (Bhui et al., 2007). The Bologna West Transcultural Psychiatric Team (BoTPT, Tarricone et al., 2009) is one of the first projects in Italy that prioritizes cultural competence care. This paper aims to evaluate the effectiveness of this service and to describe what characteristics of patient and psychiatric intervention are related to ‘drop-out’.Method: All migrants who consecutively attended the BoTPT between 1 July 1999 and 30 June 2008 were included and evaluated at first contact and again six months later.Results: After six months we followed up 162 patients; 32 (17.9%) of these had interrupted treatment. Non-Asian origin, a recent history of migration and not receiving social intervention were the strongest predictors of drop-out cases.Conclusion: Psychiatric consultation services to migrants could be made more effective by enhancing: (a) cultural competence, through cultural mediator involvement; and (b) social support from the first psychiatric contact. These two characteristics of psychiatric consultation could be developed from resources ordinarily present in the context of a CMHC and could then become a cost-effective strategy for addressing mental health needs among first-generation immigrants. [ABSTRACT FROM PUBLISHER]

Abstract: This paper includes the results of the application of novel methodologies for the statistical analysis of tensile fracture attributes (spacing, density, and aperture). The statistical methods have been applied to a fractured Lower Cretaceous carbonate succession cropping out in the Sorrento Peninsula (Naples area, Italy), representing a geological analogue of buried reservoirs of southern Apennines major oil fields. As fracture networks (observable from outcrop to the crystal scale) can significantly affect the hydraulic behavior of a fractured reservoir, the definition of appropriate models of fracture spacing and aperture probability distribution at various scales represents an important goal of structural analysis. In order to achieve such an objective, sampling has been carried out at different scales, by means of traditional scan lines at outcrop, as well as micro-scan lines carried out both by a digital micro-camera (50×) and by the optical microscope (200×). Fracture spacing and density analysis are mainly aimed at establishing the characteristics of joint spatial distribution over a range of scales. Aperture analysis is aimed at verifying that the aperture cumulative frequency is described by a power law and, in the latter instance, to provide an effective method for a more precise determination of the exponent of the power law. Finally, new expressions are provided, in closed form, in order to calculate the confidence interval of the power-law exponent. The proposed criteria provide handy and effective methods for a significantly improved statistical analysis of fracture attributes. [Copyright &y& Elsevier]

The click detection paradigm was once conceived as a method to study online syntactic processing, but well-controlled empirical investigations casted many doubts on the early findings based on it. In this paper, we show that click methods can still prove valid and useful. We asked adult participants to listen to an artificial speech stream composed of statistically defined trisyllabic nonce words, while having to detect clicks superposed on the stream. The clicks were presented either within or between consecutive words. After 2 minutes of exposure to the stream, participants were slower to detect clicks located within words than clicks located between words. This result suggests that methods like click detection are sensitive to online statistical computations, opening new possibilities to obtain a richer picture of the segmentation process than what was hitherto possible. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a neurodegenerative disorder whose clinical onset is mainly characterized by memory loss. During AD progression, behavioral and psychological symptoms of dementia (BPSD) frequently occur. In this paper we evaluated the association between AD and the short/long (S/L) functional polymorphism of the promoter region of the 5-hydroxytryptamine (5-HT) transporter gene (SLC6A4). The S-allele shows a 2-fold reduced transcriptional rate, causing an imbalance in 5-HT intracellular availability that might in turn trigger behavioral and cognitive alterations. We also genotyped the SLC6A4 promoter functional variant rs25531 (A → G). By comparing the genotypic and allelic frequencies in an Italian population of 235 AD and 207 controls, we found an association between 5-HTTLPR and AD (odds ratio for the L-allele versus the S-allele: 0.74, associated P value = .03), while no difference was found for the rs25531. A meta-analysis of studies in Italy assessing 5-HTTLPR and AD risk gave an estimation of odds ratio for the L-allele versus the S-allele of 0.85 (associated P value = .08). Overall, our findings are not supportive of a large genetic effect of the explored polymorphisms on AD risk. [ABSTRACT FROM AUTHOR]

Simple Summary: Immunotherapy revolutionized the treatment of cutaneous melanoma and greatly improved treatment outcomes in this group of patients. Mucosal melanoma is a rare disease, biologically distinct from the cutaneous subtype. There is little real-world data on immunotherapy efficacy in mucosal melanoma. Therefore, we aimed to analyze and describe experiences in mucosal melanoma treatment in five high volume oncology centers in Europe. Furthermore, we evaluated if concomitant radiotherapy may improve the outcomes of these patients. We conclude that immunotherapy with anti-PD1 antibodies is a safe and effective treatment of mucosal melanoma. Concomitant radiotherapy may be beneficial in a selected subgroup of patients with advanced mucosal melanoma. Mucosal melanoma is a rare disease epidemiologically and molecularly distinct from cutaneous melanoma developing from melanocytes located in mucosal membranes. Little is known about its therapy. In this paper, we aimed to evaluate the results of immunotherapy and radiotherapy in a group of patients with advanced mucosal melanoma, based on the experience of five high-volume centers in Poland and Italy. There were 82 patients (53 female, 29 male) included in this retrospective study. The median age in this group was 67.5 (IQR: 57.25–75.75). All patients received anti-PD1 or anti-CTLA4 antibodies in the first or second line of treatment. Twenty-three patients received radiotherapy during anti-PD1 treatment. In the first-line treatment, the median progression-free survival (PFS) reached six months in the anti-PD1 group, which was statistically better than 3.1 months in the other modalities group (p = 0.004). The median overall survival (OS) was 16.3 months (CI: 12.1–22.3) in the whole cohort. Patients who received radiotherapy (RT) during the anti-PD1 treatment had a median PFS of 8.9 months (CI: 7.4–NA), whereas patients treated with single-modality anti-PD1 therapy had a median PFS of 4.2 months (CI: 3.0–7.8); this difference was statistically significant (p = 0.047). Anti-PD1 antibodies are an effective treatment option in advanced mucosal melanoma (MM). The addition of RT may have been beneficial in the selected subgroup of mucosal melanoma patients. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the risk of adverse maternal, fetal, and neonatal outcomes associated with administration of an MF59 adjuvanted A/H1N1 vaccine during pregnancy? SUMMARY ANSWER No increased risk of either fetal or birth outcomes was seen following vaccination, whereas a limited increase in the prevalence of gestational diabetes and eclampsia was observed. WHAT IS KNOWN AND WHAT THIS PAPER ADDS The effect of MF59 adjuvanted A/H1N1 vaccine on “hard” pregnancy outcomes, such as gestational diabetes, eclampsia, and congenital malformations, has rarely been explored. The findings of this study add to the available body of evidence on the safety of the MF59 adjuvanted pandemic vaccine in pregnancy. [ABSTRACT FROM AUTHOR]