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Focuses on the levels of environmental organophosphorous pesticide exposure of children in Italy. Effect of various exposure levels on the children's health; Determination of pesticide residues or metabolites in biologic fluids of the general population of children; Factors causing children to have more exposure to the compounds.

Abstract Between September 1993 and December 1995, 528 foreign individuals at risk of HIV infection attended the drug treatment centre located in the Santo Spirito Hospital in Rome, undergoing medical examination, HIV testing and counselling. The geographic distribution showed that the majority of the participants were from South America (40.0%), most of whom were transsexual sex workers (from Brazil or Columbia), and from North Africa (37.5%); all the individuals coming from Western and Eastern Europe and the USA were heroin users. The overall HIV prevalence was high (21.6%), though it varied by nationality, ranging from 5.1% among North Africans to 68.3% among Brazilian transsexuals. During the study period, 170 of the individuals returned for at least one follow-up visit. Three seroconversions occurred among the 118 initially HIV-negative immigrants who were retested, all three among the 26 HIV-negative Columbian transsexuals; the seroconversion rate within this group was 10.1 per 100 persons/years. During follow-up, there was no reduction observed in drug-related practices associated with HIV infection, yet a general increase in regular condom use was reported. The increasing number of foreign persons contacting our programme emphasizes the need for easy access to care and treatment for marginalized populations possibly engaging in behaviour at risk for HIV infection. Counselling strategies seem to be relatively effective in promoting safer sex among these population groups. [ABSTRACT FROM AUTHOR]

Abstract The aim of the paper is to examine the influence of socio-economic conditions, mental health and functional status on survival of a sample of people with AIDS. It is a longitudinal prospective study carried out in five infectious disease wards in Rome and Naples, Italy. Patients enrolled (total 168) are all diagnosed as having AIDS in 1992. The Functional Multidimensional Evaluation Questionnaire for people infected with HIV was administered to all subjects. It collects information on social and economic conditions, physical and mental health, self-sufficiency in Activities of Daily Living (ADLs) and on the demand for and/or utilization of a package of nonhospital care services. In the overall assessment, 11.3% of patients had inadequate socio-economic resources to cover their needs. More than half of those interviewed were partially or totally dependent on help to perform ADLs. There was a high prevalence of psychiatric symptoms (60.6%). Lower CD4 count and lower ability to perform ADLs were related to shorter survival with a mortality risk ratio by Cox regression of 1.5 (95 CI: 1.2-1.9) and 1.6 (95 CI: 1.1-2.3), respectively. A lower ADL performance level was also associated with a higher prevalence of psychiatric symptoms and reduced socio-economic circumstances. The ADL performance level could be a useful predictor of survival in people with AIDS. There was, moreover, a marked association between functional status, socio-economic resources and mental health. The results support the hypothesis that these three factors have an impact on the survival of AIDS patients. [ABSTRACT FROM AUTHOR]

The significant impact of acute respiratory tract infections on healthcare systems is well-documented, given their contribution to emergency department admissions, hospitalizations, and increased use of antibiotics and other medications. However, further research is needed to understand the burden of acute respiratory tract infections in pediatric community care to develop effective public health interventions and improve child health outcomes. Real-world data were retrieved from Pedianet, an Italian network of over 200 family pediatricians. Acute respiratory tract infection visits were identified and analysed using an infection-duration algorithm to extract individual cases. The number of follow-up visits per 100 cases was calculated to assess the burden on the Italian National Health Service. Comparisons were made overall and stratified by type of acute respiratory tract infections and epidemiological season. A total of 1,402,953 acute respiratory infections-related visits were recorded, with an overall rate of 12 visits per 100 cases. Upper respiratory tract infections had an average of 9 visits per 100 cases. Lower respiratory tract infections exhibited a higher burden, with 29 visits per 100 cases. Pneumonia showed a declining trend in the pre-pandemic era (62 to 48 visits) but rebounded in the post-COVID-19 years (32 to 42 visits). This study underscores the importance of monitoring and managing acute respiratory infections, especially lower respiratory tract infections, in pediatric care., (© 2024. The Author(s).)

This study aims to estimate long-term survival, cancer prevalence, and several cure indicators for Italian women with gynecological cancers. Thirty-one cancer registries, representing 47% of the Italian female population, were included. Mixture cure models were used to estimate net survival, cure fraction, time to cure (when 5-year conditional net survival becomes > 95%), cure prevalence (women who will not die of cancer), and already cured (living longer than time to cure). In 2018, 0.4% (121 704) of Italian women were alive after diagnosis of corpus uteri cancer, 0.2% (52 551) after cervical cancer, and 0.2% (52 153) after ovarian cancer. More than 90% of patients with uterine cancers and 83% with ovarian cancer will not die from their neoplasm (cure prevalence). Women with gynecological cancers have a residual excess risk of death <5% at 5 years after diagnosis. The cure fraction was 69% for corpus uteri, 32% for ovarian, and 58% for cervical cancer patients. Time to cure was ≤10 years for women with gynecological cancers aged <55 years; 74% of patients with cervical cancer, 63% with corpus uteri cancer, and 55% with ovarian cancer were already cured. These results can contribute to improving follow-up programs for women with gynecological cancers and supporting efforts against discrimination of already cured ones. This article is part of a Special Collection on Gynecological Cancers., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Natural populations are subject to selection caused by a range of biotic and abiotic factors in their native habitats. Identifying these agents of selection and quantifying their effects is key to understanding how populations adapt to local conditions. We performed a factorial reciprocal-transplant experiment using locally adapted ecotypes of Arabidopsis thaliana at their native sites to distinguish the contributions of adaptation to soil type and climate. Overall adaptive differentiation was strong at both sites. However, we found only very small differences in the strength of selection on local and non-local soil, and adaptation to soil type at most constituted only a few per cent of overall adaptive differentiation. These results indicate that local climatic conditions rather than soil type are the primary driver of adaptive differentiation between these ecotypes.

Objective: To report variants in 26 candidate genes and describe the clinical features of Italian patients with keratoconus (KC)., Subjects/methods: Sixty-four patients with a confirmed diagnosis of KC were enrolled in this genetic association study. Patients were classified into two study groups according to whether they had a confirmed diagnosis of progressive or stable KC. A purpose-developed Next Generation Sequencing (NGS) panel was used to identify and analyse the coding exons and flanking exon/intron boundaries of 26 genes known to be associated with KC and corneal dystrophies. Interpretation of the pathogenic significance of variants was performed using in silico predictive algorithms., Result: The targeted NGS research identified a total of 167 allelic variants of 22 genes in the study population; twenty-four patients had stable keratoconus (n. 54 variants) and forty patients had progressive disease (n. 113 variants). We identified genetic variants of certain pathogenic significance in five patients with progressive KC; in addition, eight novel genetic variants were found in eight patients with progressive KC. Mutations of FLG, LOXHD1, ZNF469, and DOCK9 genes were twice more frequently identified in patients with progressive than stable disease. Filaggrin gene variants were found in 49 patients (76% of total), of whom 32 patients (80% of progressive KC group) had progressive disease., Conclusions: Targeted NGS research provided new insights into the causative effect of candidate genes in the clinical phenotype of keratoconus. Filaggrin mutations were found to represent a genetic risk factor for development of progressive disease in Italy., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background: We created a multicenter survey for Italian orthopedic surgeons on how they approach leg length discrepancy (LLD) when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow the literature recommendations during clinical practice., Methods: The survey was composed of 25 questions divided into four sections: 1-surgeon's profile, 2-preoperative and 3-intraoperative evaluation, and 4-postoperative management. In this paper, we report results to answer Sects. 1 and 2. Absolute and relative frequencies of answers to Sects. 2 and 3 are reported. We divided the participants in subgroups based on the "surgeon's profile" and evaluated difference in the answers given., Results: Absolute and relative frequencies demonstrate low agreement among participants in all phases of LLD management. We demonstrated a statistically significant difference based on the surgeon's profile regarding these questions: radiographic measure of LLD depending on working experience, p = 0.008; digital planning based on surgeons' age, p < 0.001, and workplace, p = 0.026; intraoperative anatomical landmarks based on numbers of procedures per year, p = 0.020; and use of intraoperative X-rays based on working experience, p = 0.002., Conclusions: LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition and surgeons' preference., (© 2024. The Author(s).)

The Fossetto landfill has operated in the municipality of Monsummano Terme (Tuscany, Italy) since 1988, being considered a state-of-the-art landfill for 35 years. Initially, Fossetto acted as a conventional sanitary landfill for mixed municipal solid waste. With changes in regulations and technology, the Fossetto landfill was gradually equipped with a biogas recovery and valorisation system, a mechanical-biological treatment (MBT) plant in 2003 and a reverse osmosis leachate treatment plant, so the concentrated leachate has been recirculated back into the landfill body since 2006. Long-term biogas monitoring, enables the calculation of the efficiency of biogas recovery using a rather simplified methodology, which was assessed as being approximately 40% over the prior ten-years period. This value was lower than expected, confirming the results of previous studies and indicating the need of attributes. Applying the USEPA LandGEM model showed that the adoption of MBT substantially reduced biogas generation yields and rates by up to approximately 90% which was facilitated by the adoption of landfill leachate recirculation transforming the conventional landfill into a bioreactor. Detailed fugitive emission monitoring has allowed the evaluation of the impact of the cover type (final or temporary) and the emissions hotspots. From these results, possible remedial actions have been suggested including the more frequent monitoring of the fugitive emissions using simple and cost-effective methods (e.g., UAVs). Approximately 50% of fugitive emissions can be attributed to emissions hotspots, which reduce biogas recovery and the efficiency of temporary covers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The current pandemic, in addition to putting a strain on healthcare systems and global economies, has exacerbated psychiatric problems and undermined the mental health of many individuals. In an Italian cohort, this phenomenon has been assessed through a retrospective study aimed at evaluating the consumption and costs of antipsychotic drugs between 2020 and 2022., Methods: All dispensations made in local pharmacies accessible to the public have been extracted from a database called 'Sistema Tessera Sanitaria', which covers a population of approximately one million people residents in the ASL Napoli 3 Sud. Consumption data expressed in defined daily dose (DDD) and expenditure data expressed in Euro have been extrapolated., Results: The results in the years 2020-2021 were relatively consistent, with consumption and expenditure decreasing slightly from 2020 to 2021. In 2022, the results showed a decrease in consumption and expenditure (2,706,951.07 DDD and €1,700,897.47) representing the reduced accessibility of patients to the healthcare facilities due to the pandemic. However, it should be noted that the antipsychotic drug aripiprazole showed an upward trend, registering an increase in consumption., Conclusion: Despite expectations of increased consumption of antipsychotic medications, real-world evidence indicated a different phenomenon, with the pandemic seemingly not affecting the consumption of these drugs. The difficulty in accessing care and medical appointments has probably influenced this data, masking the therapeutic needs of citizens. It will be necessary to assess in the coming years, as normal clinical activity resumes, whether there will be a growing consumption of these medications, which represent one of the main expenditure categories for the National Healthcare System., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

The management of patients with diverticular disease remains challenging. The aim of this national survey was to assess how gastroenterologists and general practitioners use rifaximin to manage diverticulosis and diverticular disease. Members of the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Federation of General Practitioners (FIMMG) were invited to complete a 39-item online survey concerning the use of rifaximin in five clinical settings: (1) diverticulosis; (2) reducing symptoms in symptomatic uncomplicated diverticular disease; (3) reducing the occurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease (primary prevention); (4) reducing the recurrence of diverticulitis in patients with previous attacks of diverticulitis (secondary prevention); (5) treatment of uncomplicated acute diverticulitis. A total of 1094 physicians completed the survey. Overall, 25.1%, 83.5%, 68%, 74.2%, and 63% of physicians prescribed rifaximin for the clinical settings 1, 2, 3, 4, and 5, respectively. In each clinical setting, the dosage of rifaximin most frequently used was 800 mg/day, the most common duration of therapy was 7 days, and the cyclic administration of treatment (expressed in months) most frequently used was > 24 months. These results highlight that a reappraisal of the use of rifaximin in patients with diverticulosis and diverticular disease is required to reduce the gap between the evidence available and the daily clinical practice, optimizing also the use of healthcare resources., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

To evaluate the prognostic stratification ability of 4C Mortality Score and COVID-19 Mortality Risk Score in different age groups. Retrospective study, including all patients, presented to the Emergency Department of the University Hospital Careggi, between February, 2020 and May, 2021, and admitted for SARS-CoV2. Patients were divided into four subgroups based on the quartiles of age distribution: patients < 57 years (G1, n = 546), 57-71 years (G2, n = 508), 72-81 years (G3, n = 552), and > 82 years (G4, n = 578). We calculated the 4C Mortality Score and COVID-19 Mortality Risk Score. The end-point was in-hospital mortality. In the whole population (age 68 ± 16 years), the mortality rate was 19% (n = 424), and increased with increasing age (G1: 4%, G2: 11%, G3: 22%, and G4: 39%, p < 0.001). Both scores were higher among non-survivors than survivors in all subgroups (4C-MS, G1: 6 [3-7] vs 3 [2-5]; G2: 10 [7-11] vs 7 [5-8]; G3: 11 [10-14] vs 10 [8-11]; G4: 13 [12-15] vs 11 [10-13], all p < 0.001; COVID-19 MRS, G1: 8 [7-9] vs 9 [9-11], G2: 10 [8-11] vs 11 [10-12]; G3: 11 [10-12] vs 12 [11-13]; G4: 11 [10-13] vs 13 [12-14], all p < 0.01). The ability of both scores to identify patients at higher risk of in-hospital mortality, was similar in different age groups (4C-MS: G1 0.77, G2 0.76, G3 0.68, G4 0.72; COVID-19 MRS: G1 0.67, G2 0.69, G3 0.69, G4 0.72, all p for comparisons between subgroups = NS). Both scores confirmed their good performance in predicting in-hospital mortality in all age groups, despite their different mortality rate., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Aim: To compare the effectiveness of different basal insulins (BI) prescribed as an add-on to or switch from glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy., Materials and Methods: Retrospective, real-world data from electronic medical records of 32 Italian diabetes clinics were used, after propensity score adjustment, to compare effectiveness after 6 months of treatment with second- versus first-generation BI (2BI vs. 1BI) or glargine 300 U/ml versus degludec 100 U/ml (Gla-300 vs. Deg-100), when added to (ADD-ON) or in substitution of (SWITCH) GLP-1 RA. Only comparisons, including a minimum of 100 patients per group, were performed to ensure adequate robustness of the analyses., Results: In the ADD-ON cohort (N = 700), greater benefits of 2BI versus 1BI were found in glycated haemoglobin {HbA1c; estimated mean difference: -0.32% [95% confidence interval (CI) -0.62; -0.02]; p = .04} and fasting blood glucose [FBG; -20.73 mg/dl (95% CI -35.62; -5.84); p = .007]. In the SWITCH cohort (N = 2097), greater benefits of 2BI versus 1BI were found in HbA1c [-0.22% (95% CI -0.42; -0.02); p = .03], FBG [-10.15 mg/dl (95% CI -19.04; -1.26); p = .03], and body weight [-0.67 kg (95% CI -1.30; -0.04); p = .04]. In the SWITCH cohort starting 2BI (N = 688), marked differences in favour of Gla-300 versus Deg-100 were documented in HbA1c [-0.89% (95% CI -1.26; -0.52); p < .001] and FBG [-17.89 mg/dl (95% CI -32.45; -3.33); p = .02]. Using propensity score matching as a sensitivity analysis, the benefit on HbA1c was confirmed [-0.55% (95% CI -1.02; -0.08); p = .02]. BI titration was suboptimal in all examined cohorts., Conclusions: 2BI are a valuable option to intensify GLP-1 RA therapy. Switching to Gla-300 versus Deg-100 was associated with greater HbA1c improvement., (© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

According to the Tripartite Influence Model, social media is one of the primary sources influencing women's body dissatisfaction. However, the role of social media influencers as a potential driver for impacting users' body image evaluation when disseminating content on social networks has been little investigated. The present research aims to explore the relationship between following three Instagram influencers (i.e., nutrition, fitness, and entertainment) and eating disorder (ED) symptoms and body dissatisfaction among a group of female users. A sample of 5060 women (mean age = 35.33 ± 9.33) were recruited with the collaboration of three Italian influencers, and self-reported questionnaires were administered. Women who followed the nutritional influencer account reported significantly higher scores on ED symptoms and body dissatisfaction than women who followed the fitness and entertainment influencer accounts (η 2 = 0.05 and η 2 = 0.02, respectively). Overall, following nutrition and fitness accounts (compared to entertainment accounts) and spending more time daily on social networks positively predicts ED symptoms (β = 0.28, p < 0.001, β = 0.10, p < 0.001, β = 0.11, p < 0.001, respectively) and body dissatisfaction (β = 0.07, p < 0.001, β = 0.04, p < 0.001, β = 0.07, p < 0.001, respectively). Moreover, following nutritional influencers compared to fitness influencers positively predicts ED symptoms (β = 0.17, p < 0.001) but not body dissatisfaction. The current results suggest that being exposed to dieting and weight loss topics on social media might be particularly harmful for individuals with specific vulnerabilities. Practical implications will be discussed.

Dynamic changes in protein glycosylation impact human health and disease progression. However, current resources that capture disease and phenotype information focus primarily on the macromolecules within the central dogma of molecular biology (DNA, RNA, proteins). To gain a better understanding of organisms, there is a need to capture the functional impact of glycans and glycosylation on biological processes. A workshop titled "Functional impact of glycans and their curation" was held in conjunction with the 16th Annual International Biocuration Conference to discuss ongoing worldwide activities related to glycan function curation. This workshop brought together subject matter experts, tool developers, and biocurators from over 20 projects and bioinformatics resources. Participants discussed four key topics for each of their resources: (i) how they curate glycan function-related data from publications and other sources, (ii) what type of data they would like to acquire, (iii) what data they currently have, and (iv) what standards they use. Their answers contributed input that provided a comprehensive overview of state-of-the-art glycan function curation and annotations. This report summarizes the outcome of discussions, including potential solutions and areas where curators, data wranglers, and text mining experts can collaborate to address current gaps in glycan and glycosylation annotations, leveraging each other's work to improve their respective resources and encourage impactful data sharing among resources. Database URL: https://wiki.glygen.org/Glycan&#95;Function&#95;Workshop&#95;2023., (© The Author(s) 2024. Published by Oxford University Press.)

The transition to adult health care (HCT, Health Care Transition), is the purposeful, planned movement of patients from paediatric to adult services. For the adolescent living with obesity (ALwO), the HCT represents a crucial window for effective intervention that can help improve body weight, adiposopathy, and metabolic complications. Nevertheless, no transition guidelines, models, and tools have been developed for these patients. The present statement of the Italian Society of Obesity examines the critical transition of ALwO from paediatric to adult healthcare. It synthesises current knowledge and identifies gaps in HCT of ALwO. Drawing on successful practices and evidence-based interventions worldwide, the paper explores challenges, including disparities and barriers, while advocating for patient and family involvement. Additionally, it discusses barriers and perspectives within the Italian health care scenario. The need for specialised training for healthcare providers and the impact of transition on healthcare policies are also addressed. The conclusions underscore the significance of well-managed transitions. The SIO recognises that without proper support during this transition, ALwOs risk facing a gap in healthcare delivery, exacerbating their condition, and increasing the likelihood of complications. Addressing this gap requires concerted efforts to develop effective transition models, enhance healthcare provider awareness, and ensure equitable access to care for all individuals affected by obesity. The document concludes by outlining avenues for future research and improvement., (© 2024. The Author(s).)

The loggerhead sea turtle Caretta caretta has been chosen as bioindicator to monitor the amount of litter ingested by marine animals within the European Marine Strategy Framework Directive and the Barcelona Regional Sea Convention. European Member States and Contracting Parties are committed to achieve the Good Environmental Status (GES), which is reached when the quantity of ingested litter does not adversely affect the health of the species concerned. Although the monitoring strategy has been outlined for more than a decade, to date no threshold values have been adopted to verify GES achievement. After five years of extensive monitoring along the Italian coasts, this study evaluates the suitability of five different GES scenarios and proposes a new threshold value (i.e., "there should be less than 33% of sea turtles having more than 0.05 g of ingested plastic in the GI") for its implementation in the European seas and the Mediterranean basin., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Higher education institutes (HEIs) are important drivers for the development and implementation of best practices for environmental sustainability. However, reliable indicators are needed to objectively evaluate the environmental performance of HEIs and their policies. The present paper aims at identifying suitable indicators for unbiased comparisons among different HEIs and for the identification of temporal trends in terms of environmental sustainability performance. At this aim, sustainability reports made publicly available by 24 Italian HEIs over a 10-year period were considered. Normalization of sustainability variables such as the annual electrical and thermal energy consumptions, related greenhouse gas emissions, and water consumption, against context-specific factors such as the number of users of each university, latitude, illuminance, heating degree days (HDDs) and cooling degree days allowed identifying the actual possible disturbance of the same variables. HDDs were found to positively affect the thermal energy consumption and the related CO 2 emissions. Based on this, a novel indicator was formulated where the actual value of thermal energy consumption and the related CO 2 emissions are divided not only by the number of users but also by the HDDs of the HEIs' locations. Indeed, this is a remarkable finding that, prior to confirmation with data from world HEIs, could be implemented in world university green ranking systems for improved and less biased sustainability assessments., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Luca Adami reports financial support was provided by University of Trento Department of Civil Environmental and Mechanical Engineering. Luca Adami reports a relationship with University of Trento Department of Civil Environmental and Mechanical Engineering that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To assess the perceptions and attitudes of radiologists toward the adoption of artificial intelligence (AI) in clinical practice., Methods: A survey was conducted among members of the SIRM Lombardy. Radiologists' attitudes were assessed comprehensively, covering satisfaction with AI-based tools, propensity for innovation, and optimism for the future. The questionnaire consisted of two sections: the first gathered demographic and professional information using categorical responses, while the second evaluated radiologists' attitudes toward AI through Likert-type responses ranging from 1 to 5 (with 1 representing extremely negative attitudes, 3 indicating a neutral stance, and 5 reflecting extremely positive attitudes). Questionnaire refinement involved an iterative process with expert panels and a pilot phase to enhance consistency and eliminate redundancy. Exploratory data analysis employed descriptive statistics and visual assessment of Likert plots, supported by non-parametric tests for subgroup comparisons for a thorough analysis of specific emerging patterns., Results: The survey yielded 232 valid responses. The findings reveal a generally optimistic outlook on AI adoption, especially among young radiologist (<30) and seasoned professionals (>60, p<0.01). However, while 36.2 % (84 out 232) of subjects reported daily use of AI-based tools, only a third considered their contribution decisive (30 %, 25 out of 84). AI literacy varied, with a notable proportion feeling inadequately informed (36 %, 84 out of 232), particularly among younger radiologists (46 %, p < 0.01). Positive attitudes towards the potential of AI to improve detection, characterization of anomalies and reduce workload (positive answers > 80 %) and were consistent across subgroups. Radiologists' opinions were more skeptical about the role of AI in enhancing decision-making processes, including the choice of further investigation, and in personalized medicine in general. Overall, respondents recognized AI's significant impact on the radiology profession, viewing it as an opportunity (61 %, 141 out of 232) rather than a threat (18 %, 42 out of 232), with a majority expressing belief in AI's relevance to future radiologists' career choices (60 %, 139 out of 232). However, there were some concerns, particularly among breast radiologists (20 of 232 responders), regarding the potential impact of AI on the profession. Eighty-four percent of the respondents consider the final assessment by the radiologist still to be essential., Conclusion: Our results indicate an overall positive attitude towards the adoption of AI in radiology, though this is moderated by concerns regarding training and practical efficacy. Addressing AI literacy gaps, especially among younger radiologists, is essential. Furthermore, proactively adapting to technological advancements is crucial to fully leverage AI's potential benefits. Despite the generally positive outlook among radiologists, there remains significant work to be done to enhance the integration and widespread use of AI tools in clinical practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Peripheral artery disease (PAD) in hemodialysis (HD) patients has a significant social impact due to its prevalence, poor response to standard therapy and dismal prognosis. Rheopheresis is indicated by guidelines for PAD treatment., Materials and Methods: Twenty-five HD patients affected by PAD stage IV Lerichè-Fontaine and ischemic ulcer 1C or 2C according to the University of Texas Wound Classification System (UTWCS), without amelioration after traditional medical therapy and/or revascularization, were selected and underwent 12 Rheopheresis sessions in 10 weeks. Improvements in pain symptoms using Numerical Rating Scale (NRS), healing ulcers and laboratory hemorheological parameters have been evaluated., Results: A clinically and statistically significant mean value reduction and of relative percentage differences between estimated marginal means (Δ), calculated at each visits, of NRS was observed, with a maximum value (-48.5%) between the first and last visit. At the end of the treatment period 14.3% of ulcers were completely healed, 46.4% downgraded, 53.6% were stable. Overall, no ulcers upgraded. A statistically significant reduction of the Δ, between the first and last visit, for fibrinogen (-16%) was also observed., Conclusion: Rheopheresis reduced overall painful symptoms; data suggest that it could heal or improve ulcers and hemorheological laboratory parameters in HD patients with PAD and ischemic ulcers resistant to standard therapies., (© 2024 The Author(s). Journal of Clinical Apheresis published by Wiley Periodicals LLC.)

Violence against women is a significant public health concern, with femicide as its most extreme manifestation. This crime is often perpetrated by current or former intimate partners, thus taking the name of intimate partner femicide (IPF). Although international comparisons are essential for prevention policies, cross-country comparative studies are scarce in this context. The aim of this study was to evaluate and compare clinical, epidemiological and medico-legal characteristics of IPF autopsy cases investigated at the Institutes of Legal Medicine of two Western European cities, in order to identify a potential medico-legal pattern of IPF. Autopsy and police reports of IPF cases occurred in the judicial district of Freiburg (Germany) and Padova (Italy) from 2000 to 2022 were analyzed. Data relating to victims, perpetrators, relationship context, and circumstantial and pathological-forensic characteristics of the homicide were collected. Statistical analyses were performed to explore potential relationships between the data collected. Additionally, a review of the literature dealing with autopsy-based studies on IPF was performed. Overall, 82 cases of IPF were analyzed, 39 from Freiburg and 43 from Padova. A total of 6 papers fulfilled the review inclusion criteria. Our study identified a medico-legal pattern of IPF and demonstrated that it did not vary substantially between the two European Countries considered, suggesting that certain IPF characteristics are shared at the European level. However, a significant finding emerged regarding the higher prevalence of firearm-related IPFs in Italy compared to Germany. Forensic pathology research might contribute to developing targeted prevention policies to protect women from this lethal form of violence., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To develop and assess the GAIA! app, designed to assist pregnant women and healthcare professionals in managing infectious diseases during pregnancy, and to bridge the information gap between health professionals and expectant mothers., Study Design: This collaborative initiative in Italy involved partnerships with the University of Florence, Careggi University Hospital, and other institutions. The app, built on the Ionic framework, is available on both Apple and Google App Stores. It offers two distinct modes: "healthcare providers" and "patients." Content for the app was derived from extensive literature reviews and clinical guidelines., Results: Since its August 2022 launch, the GAIA! app has garnered over 2,500 downloads, indicating its effectiveness and acceptance within the community. The app differentiates itself from others, such as the Sanford Guide, by focusing specifically on the needs of pregnant women. It ensures cross-platform compatibility, a user-friendly interface, and offline functionality., Conclusions: The GAIA! app has successfully addressed a niche in infectious disease management for pregnant women, gaining significant traction within the community. While it has seen substantial success, challenges like continuous updates and potential language expansion remain. Future endeavors will address these challenges and further evaluate the app's impact on maternal and child health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background and Aims: Add-on of basal insulin (BI) to intensify the ongoing therapy with glucagon-like peptide 1 receptor agonist (GLP-1 RA) is recommended, but it is unclear if free or fixed combination of BI and GLP-1 RA produce similar outcomes. A retrospective comparative effectiveness analysis of the add-on of glargine 300 U/mL (Gla-300) to ongoing GLP-1 RA vs. switch to fixed ratio combination of degludec and liraglutide (iDegLira) was performed., Methods and Results: Real-world data collected in electronic medical records by 32 Italian diabetes clinics. Propensity score (PS) adjustment was applied to assess changes in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), body weight, and BI dose after 6 months from Gla-300 or iDegLira initiation. Compared to iDegLira group (N = 260), Gla-300+GLP-1 RA group (N = 255) had older age and higher levels of HbA1c (9.1 vs. 8.9%). After 6 months, statistically significant greater FBG improvement [estimated mean difference and 95% confidence intervals: -24.05 mg/dl (-37.04; -11.06; p = 0.0003) and BI dose increase [+0.03 U/kg (95%CI 0.00; 0.06); p = 0.009] were found in the free vs. fixed combination group, although low doses of BI (0.2 U/kg) were reached in both groups. Trends of larger HbA1c and body weight reductions with the free combination were also found, without reaching the statistical significance., Conclusion: Although inertia in insulin initiation and titration was documented in both groups, higher benefit on FBG control was obtained with free vs. fixed combination, likely due to a better titration of BI and GLP-1 RA., Competing Interests: Declaration of competing interest Riccardo Candido has received consultancy fees from Boehringer Ingelheim, Eli-Lilly, Novo Nordisk, Astra-Zeneca, Sanofi-Aventis, Roche Diabetes Care; speaking fees from Astra Zeneca, Boehringer Ingelheim, Eli-Lilly, Novo Nordisk, Sanofi-Aventis, Mundipharma Pharmaceutical, Abbott, MSD, Neopharmed Gentili, Menarini, Essex Italia, Ascensia Diabetes. Antonio Nicolucci and Maria Chiara Rossi have received funding for research from Sanofi, NovoNordisk, Alfasigma, Artsana, AstraZeneca, Johnson&Johnson, Medtronic, Shionogi, SOBI, Meteda and Theras. Monica Larosa is an employee of Sanofi and may hold shares and/or stock options in the company. Raffaele Napoli has served on advisory board panels, received consultancy and speaker's fees or financial support for research from AstraZeneca, Boerhinger Ingelheim, Eli Lilly, Novo Nordisk, MSD, Sanofi., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that accounts for 20% of perinatal strokes. CVT incidence ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT., Materials and Methods: Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI). Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol., Results: Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15). Symptom onset occurred in the first week of life (median 8 days, IQR 4-14) with a male prevalence of 59%. The most common risk factors for CVT were complicated delivery (38%), prematurity (40%), congenital heart diseases (48%), and infections (40%). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT (77%) compared to patients with CVT without DMVT (p = 0.013). Antithrombotic treatment was initiated in 36% of patients. Neurological impairment was observed in 48% of cases at discharge, while 18 out of 31 infants (58%) presented one or more neurological deficits at long term follow up.     Conclusion: DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Olive leaves are a rich source of polyphenols with healthful properties and represent one of the most abundant waste products of olive oil production. The aims of this study were to explore the phenolic composition of olive leaves from the three main Tuscan cultivars (Leccino, Moraiolo and Frantoio) collected in Siena and Grosseto provinces and to investigate the possible use of these compounds as varietal and geographic origin markers. Discriminant factorial analysis (DFA) was used for distinguishing between different cultivars and locations. Apigenin and caffeoyl-secologanoside showed significant differences between cultivars. DFA showed that ligstroside, apigenin and luteolin have the most influence in determining the differences between sites, whereas total polyphenols, olacein and hydroxytyrosol acetate allowed for separation between leaves from the same province. The results of the present study indicate that concentrations of phenolic compounds, measured through high-resolution mass spectrometry, can be used as a marker for both the cultivar and of geographical origin of olive leaves, and possibly of olive-related products, as well as across small geographic scales (less than 50 km distance between sites).

Background: The demographic changes affecting Switzerland and other European countries, including population ageing, will continue to challenge policymakers in building accessible, affordable, comprehensive and high-quality long-term care (LTC) systems. The purpose of this paper is to investigate how Switzerland's LTC system compares to other European countries, in order to inform how to respond to the increasing need for LTC. We carried out a descriptive study using secondary data from key national and international organizations., Methods: By comparing the financing, workforce, service delivery and need for LTC in Switzerland, Germany, Italy, Norway and the United Kingdom, we described similarities and differences in these five European countries between 2005-2019. Thirty-three indicators within five domains were analysed: (1) Population statistics and health expenditure, (2) Need for LTC, (3) LTC financing, (4) LTC service delivery, and (5) LTC workforce., Results: Switzerland has the highest life expectancy in comparison to the other four high-income countries. However, similarly to other countries, the years lived with disability are increasing in Switzerland. Switzerland's public expenditure on LTC as a share of GDP is lower than that of Norway and Germany, yet out-of-pocket expenditure on LTC is highest in Switzerland. Switzerland has the highest proportion of persons receiving formal LTC both in institutions and at home. Switzerland has had the most pronounced increase in the proportion of over 65-year-olds receiving LTC at home. Even though more than fourfold more persons receive care at home, Switzerland still has more workforce in LTC institutions than in home-care. In comparison to Germany and the UK, Switzerland has a lower number of informal carers as a proportion of 50-year-olds and over, as well as fewer nationally available services for informal carers compared to Germany, Italy, Norway and the UK., Conclusions: Our comparative study corroborates the importance of improving the affordability of LTC, continuing to support the movement towards home care services, improving the support given to both the professional workforce and informal carers, and improving the amount and quality of LTC data. It also provides a valuable contrast to other European countries to support evidence-informed policymaking., (© 2024. The Author(s).)

Background: Multimorbidity is a significant public health concern, characterized by the coexistence and interaction of multiple preexisting medical conditions. This complex condition has been associated with an increased risk of COVID-19. Individuals with multimorbidity who contract COVID-19 often face a significant reduction in life expectancy. The postpandemic period has also highlighted an increase in frailty, emphasizing the importance of integrating existing multimorbidity details into epidemiological risk assessments. Managing clinical data that include medical histories presents significant challenges, particularly due to the sparsity of data arising from the rarity of multimorbidity conditions. Also, the complex enumeration of combinatorial multimorbidity features introduces challenges associated with combinatorial explosions., Objective: This study aims to assess the severity of COVID-19 in individuals with multiple medical conditions, considering their demographic characteristics such as age and sex. We propose an evolutionary machine learning model designed to handle sparsity, analyzing preexisting multimorbidity profiles of patients hospitalized with COVID-19 based on their medical history. Our objective is to identify the optimal set of multimorbidity feature combinations strongly associated with COVID-19 severity. We also apply the Apriori algorithm to these evolutionarily derived predictive feature combinations to identify those with high support., Methods: We used data from 3 administrative sources in Piedmont, Italy, involving 12,793 individuals aged 45-74 years who tested positive for COVID-19 between February and May 2020. From their 5-year pre-COVID-19 medical histories, we extracted multimorbidity features, including drug prescriptions, disease diagnoses, sex, and age. Focusing on COVID-19 hospitalization, we segmented the data into 4 cohorts based on age and sex. Addressing data imbalance through random resampling, we compared various machine learning algorithms to identify the optimal classification model for our evolutionary approach. Using 5-fold cross-validation, we evaluated each model's performance. Our evolutionary algorithm, utilizing a deep learning classifier, generated prediction-based fitness scores to pinpoint multimorbidity combinations associated with COVID-19 hospitalization risk. Eventually, the Apriori algorithm was applied to identify frequent combinations with high support., Results: We identified multimorbidity predictors associated with COVID-19 hospitalization, indicating more severe COVID-19 outcomes. Frequently occurring morbidity features in the final evolved combinations were age>53, R03BA (glucocorticoid inhalants), and N03AX (other antiepileptics) in cohort 1; A10BA (biguanide or metformin) and N02BE (anilides) in cohort 2; N02AX (other opioids) and M04AA (preparations inhibiting uric acid production) in cohort 3; and G04CA (Alpha-adrenoreceptor antagonists) in cohort 4., Conclusions: When combined with other multimorbidity features, even less prevalent medical conditions show associations with the outcome. This study provides insights beyond COVID-19, demonstrating how repurposed administrative data can be adapted and contribute to enhanced risk assessment for vulnerable populations., (©Dayana Benny, Mario Giacobini, Alberto Catalano, Giuseppe Costa, Roberto Gnavi, Fulvio Ricceri. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 18.07.2024.)

People alive many years after breast (BC) or colorectal cancer (CRC) diagnoses are increasing. This paper aimed to estimate the indicators of cancer cure and complete prevalence for Italian patients with BC and CRC by stage and age. A total of 31 Italian Cancer Registries (47% of the population) data until 2017 were included. Mixture cure models allowed estimation of net survival (NS); cure fraction (CF); time to cure (TTC, 5-year conditional NS >95%); cure prevalence (who will not die of cancer); and already cured (prevalent patients living longer than TTC). 2.6% of all Italian women (806,410) were alive in 2018 after BC and 88% will not die of BC. For those diagnosed in 2010, CF was 73%, 99% when diagnosed at stage I, 81% at stage II, and 36% at stages III-IV. For all stages combined, TTC was >10 years under 45 and over 65 years and for women with advanced stages, but ≤1 year for all BC patients at stage I. The proportion of already cured prevalent BC women was 75% (94% at stage I). Prevalent CRC cases were 422,407 (0.7% of the Italian population), 90% will not die of CRC. For CRC patients, CF was 56%, 92% at stage I, 71% at stage II, and 35% at stages III-IV. TTC was ≤10 years for all age groups and stages. Already cured were 59% of all prevalent CRC patients (93% at stage I). Cancer cure indicators by stage may contribute to appropriate follow-up in the years after diagnosis, thus avoiding patients' discrimination., (© 2024 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Motorized spiral enteroscopy (MSE) is the latest advance in device-assisted enteroscopy. Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial. Following the real-life application of MSE, an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market, despite encouraging results in terms of diagnostic and therapeutic yield. We conducted an Italian multicenter real-life prospective study, which was prematurely terminated after the withdrawal of MSE from the market. The primary goals were the evaluation of MSE performance (both diagnostic and therapeutic) and its safety in routine endoscopic practice, particularly in the early phase of introduction in the endoscopic unit. A subanalysis, which involved patients who underwent MSE after unsuccessful balloon enteroscopy, demonstrated, for the first time, the promising performance of MSE as a rescue procedure. Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy, it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it., Competing Interests: Conflict-of-interest statement: All authors declare no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: People with substance use disorder (SUD) face challenges like stigma and discrimination, impacting their healthcare experiences., Aim: This study aims to: (i) assess physicians' clinical practices and stigma toward SUD patients among healthcare personnel and (ii) explore the relationship among stigma, psychological well-being, and burnout., Methods: A survey covering sociodemographic data, physicians' clinical practices, stigmatizing attitudes, psychological well-being, and burnout was completed by 1,796 employees of the Veneto's Local Health Units (Italy)., Results: Healthcare professionals reported increased stigma towards SUDs (p-values<0.05). Stigma consistently correlated with variables such as sex, profession, department, and levels of burnout (p-values<0.05). Notably, high burnout levels were associated with increased stigma. Staff in addiction departments displayed lower stigma levels compared to other departments. No significant differences were found in physicians' clinical practices., Conclusions: Targeted training for healthcare professionals is crucial to reduce stigma, enhance attitudes toward SUDs, and broaden overall knowledge of the condition.

Italian guidelines recommend HIV pre-exposure prophylaxis (PrEP) only upon satisfying strict eligibility criteria. The objective of this study is to evaluate if PrEP candidates attending a community-based service comply with these criteria and whether these prescribing conditions affect retention in care and sexually transmitted infections (STIs) acquisition. A retrospective analysis was performed on PrEP candidates evaluated from January 2019 to June 2022. Data were collected from self-administered questionnaires and clinical files. The population was divided in subjects with 0/1 (0/1 C) and ≥ 2 (≥ 2 C) criteria. Descriptive statistics and non-parametric tests were employed to describe study population. Incidence of PrEP discontinuation and of STIs was estimated per 100 persons-year of follow up (PYFU), and incidence rate ratio (IRR) was calculated. Univariate and multivariable Cox regression analyses were used to evaluate the association strength between PrEP drop out and other variables. The analyses enrolled 659 individuals: 422 individuals were included in 0/1 C, 237 in ≥ 2 C group, respectively. Inconsistent condom use was the most reported prescribing criteria (399 individuals, 60.6%), followed by a previous STI (186 individuals, 28.2%). 0/1 C exhibited lower STIs incidence. PrEP discontinuation was 29% in 0/1 C and 38% in ≥ 2 C (p = 0.031). Cox model revealed that inconsistent condom use was the only prescribing criteria associated to PrEP persistence. The majority of PrEP candidate did not comply with prescribing conditions. Eligibility criteria failed to identify individuals with better retention in care. Our results suggest that Italian guidelines should be updated removing barriers to prescription., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Feather analysis is an ethical and effective method for assessing the exposure of wild birds to environmental contamination due to trace elements and organic pollutants. We used feather to monitor the exposure to three toxic and non-essential metals (Hg, Cd, and Pb) and rare earth elements (REEs) of Kentish plover (Charadrius alexandrinus) breeding in different coastal areas (Veneto, Emilia-Romagna, Marche, Abruzzo, and Apulia) along the Italian coast of the Adriatic Sea. Feathers (n = 113) were collected from April to June. Feather concentrations evidenced a significant exposure to Hg (13.05 ± 1.71 mg kg -1 dw) and REEs (447.3 ± 52.8 ng g -1 dw) in the Kentish plover breeding in Veneto (n = 21) compared to the other coastal areas, with several individuals showing Hg concentrations above the adverse effect (5 mg kg -1 dw) and high-risk (9.14 mg kg -1 dw) thresholds reported for birds. Higher REE concentrations compared to Marche (n = 29), Abruzzo (n = 11) and Apulia (n = 13) were also reported for birds breeding in Emilia-Romagna (474.9 ± 41.9 ng g -1 dw; n = 29). The exposure to Cd and Pb was low in all the coastal areas, and only a few samples (n = 6 and n = 4 for Cd and Pb, respectively) exceeded the adverse effect thresholds (0.1 and 4 mg kg -1 for Cd and Pb, respectively). A significant sex-related difference was observed for REE-concentrations, with females showing higher concentration than males. These data highlight the need to monitor the exposure of the Kentish plover to Hg and REEs, especially in the northern basin of the Adriatic Sea, since these elements might negatively affect species' reproductive success and threaten its conservation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The current study investigated linguistic predictors of word reading and spelling skills in a cross-linguistic comparison (French vs. Italian) in heritage bilinguals (HBs) and their monolingual peers. The sample included 265 children (French: n = 113; 67 monolinguals and 46 HBs; Italian: n = 152; 82 monolinguals and 70 HBs) attending Grades 3, 4, and 5 while performing oral language, reading, and spelling tasks. The battery included verbal knowledge, morphosyntactic comprehension, nonword repetition, word reading (speed and accuracy), and spelling tasks. Results showed that for reading speed, there were no main effects of single predictors, but a significant interaction of morphosyntactic comprehension by language of schooling emerged. For reading accuracy, there was a main effect of verbal knowledge and syntactic comprehension, with a significant interaction of verbal knowledge and language of schooling. Finally, spelling accuracy was predicted only by linguistic status. The results suggest different pathways for word reading and spelling, with oral language skills' main role in reading accuracy and linguistic status's main role in spelling skills, possibly hindered by linguistic exposure and lexical access. Discussions are focused on potential implications for multilingual settings and cross-linguistic research., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims: The primary objectives were to investigate the incidence rate (IR) of type 1 diabetes (T1D) in Sardinian children aged 0-14 years in 2019-2022 and to examine the temporal trend from 1989-1999., Methods: Data from new-onset T1D patients aged 0-14 years who were residents of Sardinia were collected from all pediatric diabetology clinics. The overall, sex- and age specific (groups 0-4, 5-9, and 10-14 years), and calendar year IRs were calculated. The standardized IR (SIR) was also calculated using the direct method. Poisson regression was used to estimate the temporal trend in the SIRs from 1989-1999 to 2019-2022., Results: In 2019-2022, 512 patients aged 0-14 years were diagnosed with T1D in Sardinia. The overall IR was 73.9 per 100,000 person-years (95 % CI 67.6-80.0). Since 1989, the SIR has increased by 2.3 % per year (CI 1.7-2.8, p < 0.0001). The frequency of ketoacidosis at onset was 26.4 %, with no significant differences among the four years., Conclusions: The incidence of T1D in Sardinia, unlike in other countries such as Finland, has almost doubled in the last 20 years, and currently, it appears to be the highest in the world., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare that they have no potential conflicts of interest related to this article. In the last 36 months, the authors reported the following conflicts of interest not specific to this work. C.R. received a speaker honorarium from Eli-Lilly and Sanofi and received support for attending meetings and travel from Medtronic, Theras, MOVI, and Roche. M.RC. received support for attending meetings and travel from Medtronic, Theras, and Roche. G.P. received support for attending meetings and travel from Medtronic, Theras, MOVI, and Roche. A.O. received support for attending meetings and travel from Medtronic, MOVI, and Theras. M.M.O., G.L.C., and A.C. received support for attending meetings and travel from Medtronic and MOVI. R.M. and M.P.S. received support for attending meetings and travel from Medtronic. M.R.A., G.M., A.P., G.P., V.C., P.B., L.C., and O.A. have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Biosimilar drugs offer an opportunity for all global healthcare systems because they provide significant cost savings while ensuring equal efficacy and safety in the treatment of chronic diseases. These savings can be allocated to support ongoing innovation. An analysis of the usage of major biosimilar drugs across various therapeutic areas has been conducted within an Italian healthcare company serving a population of over one million. Data on consumption, expenditure, and the number of treated patients has been extracted from the company's databases. Finally, a comparison with the year 2021 has been performed to determine if biosimilar drug usage increased in 2022. In 2022, the data reveals that a substantial portion of the analysed active ingredients are being used as biosimilar drugs, except in a few residual cases. However, among the most consumed drugs, resistance still exists in the case of Adalimumab and Etanercept, for which expenditure on originator drugs exceeds 2 million euros. The 2022-2021 comparison highlights the increasing use of biosimilar drugs. This data is encouraging and suggests that in the coming months, we may achieve total utilization, which would be to the benefit of the National Healthcare System (NHS) and the citizens who can rely on an efficient and sustainable healthcare policy that is continually improving., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Post-fecal immunochemical test (FIT) colonoscopy represents a setting with an enriched prevalence of advanced adenomas. Due to an expected higher risk of colorectal cancer (CRC), postpolypectomy surveillance is recommended, generating a substantially increased load on endoscopy services. The aim of our study was to investigate postpolypectomy CRC risk in a screening population of FIT+ subjects after resection of low-risk adenomas (LRAs) or high-risk adenomas (HRAs)., Methods: We retrieved data from a cohort of patients undergoing postpolypectomy surveillance within a FIT-based CRC screening program in Italy between 2002 and 2017 and followed-up to December 2021. Main outcomes were postpolypectomy CRC incidence and mortality risks according to type of adenoma (LRA/HRA) removed at colonoscopy as well as morphology, size, dysplasia, and location of the index lesion. We adopted as comparators FIT+/colonoscopy-negative and FIT- patients. The absolute risk was calculated as the number of incident CRCs per 100,000 person-years of follow-up. We used Cox multivariable regression models to identify associations between CRC risks and patient- and polyp-related variables., Results: Overall, we included 87,248 post-FIT+ colonoscopies (133 endoscopists). Of these, 42,899 (49.2%) were negative, 21,650 (24.8%) had an LRA, and 22,709 (26.0%) an HRA. After a median follow-up of 7.25 years, a total of 635 CRCs were observed. For patients with LRAs, CRC incidence (hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.92-1.53) was not increased compared with the FIT+/colonoscopy-negative group, while for HRAs a significant increase in CRC incidence (HR, 1.53; 95% CI, 1.14-2.04) was found. The presence of 1 or more risk factors among proximal location, nonpedunculated morphology, and high-grade dysplasia explained most of this excess CRC risk in the HRA group (HR, 1.85; 95% CI, 1.36-2.52). Patients with only distal pedunculated polyps without high-grade dysplasia, representing 39.2% of HRA, did not have increased risk compared with the FIT- group (HR, 0.87; 95% CI, 0.59-1.28)., Conclusions: CRC incidence is significantly higher in patients with HRAs diagnosed at colonoscopy. However, such excess risk does not appear to apply to patients with only distal pedunculated polyps without high-grade dysplasia, an observation that could potentially reduce the burden of surveillance in FIT programs., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: The number and projections of cancer survivors are necessary to meet the healthcare needs of patients, while data on cure prevalence, that is, the percentage of patients who will not die of cancer by time since diagnosis, are lacking., Materials and Methods: Data from Italian cancer registries (duration of registration ranged from 9 to 40 years, with a median of 22 years) covering 47% of the population were used to calculate the limited-duration prevalence, the complete prevalence in 2018, projections to 2030, and cure prevalence, by cancer type, sex, age, and time since diagnosis., Results: A total of 3 347 809 people were alive in Italy in 2018 after a cancer diagnosis, corresponding to 5.6% of the resident population. They will increase by 1.5% per year to 4 012 376 in 2030, corresponding to 6.9% of the resident population, 7.6% of women and ∼22% after age 75 years. In 2030, more than one-half of all prevalent cases (2 million) will have been diagnosed by ≥10 years. Those with breast (1.05 million), prostate (0.56 million), or colorectal cancers (0.47 million) will be 52% of all prevalent patients. Cure prevalence was 86% for all patients alive in 2018 (87% for patients with breast cancer and 99% for patients with thyroid or testicular cancer), increasing with time since diagnosis to 93% for patients alive after 5 years and 96% after 10 years. Among patients who survived at least 5 years, the excess risk of death (1 - cure prevalence) was <5% for patients with most cancer types except for those with cancers of the breast (8.3%), lung (11.1%), kidney (13.2%), and bladder (15.5%)., Conclusions: Study findings encourage the implementation of evidence-based policies aimed at improving long-term clinical follow-up and rehabilitation of people living after cancer diagnosis throughout the course of the disease. Updated estimates of complete prevalence are important to enhance data-driven cancer control planning., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

End-stage kidney disease (ESKD) poses a high burden on patients and health systems. While numerous studies indicate an association between air pollution and chronic kidney disease, studies on ESKD are rare. We investigated the association of long-term exposure to nitrogen dioxide (NO₂), fine particulate matter (PM 2.5 ), black carbon (BC) and ozone (O 3 ) with ESKD incidence in two large population-based European cohorts. We followed individuals in the Austrian Vorarlberg Health Monitoring and Promotion Program (VHM&PP) and the Italian Rome Longitudinal Study (RoLS) using dialysis and kidney transplant registries. Long-term exposure to pollutants was estimated at the home address using Europe-wide land use regression models at 100x100m scale. Hazard ratios (HR) were determined from Cox-proportional hazard models adjusted for individual and neighbourhood level confounders. We observed 501 events among 136,823 individuals in VHM&PP (mean age 42.1 years; crude incidence rate (IR) 0.14 per 1000 person-years) and 3231 events among 1,939,461 individuals in RoLS (mean age 52.4 years; IR 0.22 per 1000 person-years). In VHM&PP, there was no evidence of an association between PM 2.5 or O 3 and ESKD. There were elevated HRs but with large confidence intervals for BC (HR 1.17 [95 % confidence interval (CI): 0.98, 1.39] for 0.5*10 -5 /m), and for NO₂ (HR 1.14 [95%CI: 0.96, 1.35] for 10 μg/m 3 ). In RoLS, ESKD was associated with PM 2.5 (HR 1.37 [95 % CI: 1.06, 1.76] for an increase of 5 μg/m 3 ), while there was no evidence of association with BC, NO 2 , or O 3 exposure. Our study suggests an association of air pollution with ESKD incidence, which differed between the two cohorts and may possibly be influenced by respective air pollution mixtures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Heavy metals and metalloids in the environment are recognised as a threat to the health of organism. Terrestrial birds are ideal subjects for the examination of these pollutants because of their high mobility and high intra- and interspecific variation in trophic levels. We examined the contents of 6 trace metals (Cd, Pb, Cr, Sb and V) and metalloids (As) in the liver, kidney, muscle, and feathers of woodcocks (Scolopax rusticola) from Southern Italy by a validated ICP-MS method. Significant differences in trace elements were found in all the tissues examined (p < 0.05). The highest Sb and Cr levels were found in feathers samples with mean values of 0.019 mg/Kg and 0.085 mg/Kg, respectively. High Pb levels were found in muscle, with 23 % of the samples exceeding the limits set by the European Union. Cd was predominantly found in the kidney samples (0.76 mg/Kg). Vanadium was the less abundant trace metal, showing the highest concentrations in the liver (0.028 ± 0.011 mg/Kg). Higher As levels were found in muscle (0.02 ± 0.015 mg/Kg). No significant differences between sex and age classes (juveniles vs. adults) were found, nor were there correlations between morphometric parameters and trace metal/metalloid contents. Principal Component Analysis determined differences in metal accumulation between tissues. Feathers were confirmed as useful indicators of metal contamination. The results of this work confirmed that the accumulation of toxic elements in the tissues of woodcocks is primarily influenced by ecological traits such as feeding habits and migration status. Statistical analysis of the tissues would seem to exclude important accumulation phenomena of Pb. The high levels found in the muscle could be due to lead ammunition. This work provides the first data on the accumulation of As, Cr, Sb, and V in woodcocks tissue, providing a more comprehensive insight into the potential impact of these pollutants on birds., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Aim: To verify the prevalence of positive Fibrosis-4 (FIB-4) score, a screening test for metabolic-associated liver disease, in a large population-based sample in the Tuscany Italian Region, and to identify sub-populations at higher risk which could be targeted by specific screening programs., Methods and Results: Population-based survey performed in the Italian region of Tuscany, with Tuscany health informative system's administrative data. We included 594,923 subjects, of which 32% had available data for the FIB-4 calculation. The overall proportion of subjects with an FIB-4 value > 1.3, was 41.6% of those with available exams, and 12,8% of the whole population, whereas 5.4% and 1.7% had FIB-4 >2.67. In those younger than 80 years, FIB >1.3 had a 33.1% and 9.4%. People with diabetes mellitus had higher figures (52.8.% and 28.9% for FIB>1.3). Among subjects aged 70 years or over, 74.9% of those with available data and 38.4% of the general population had a FIB-4>1.3, whereas 32% and 16% had a FIB-4 > 2., Conclusions: The relevant proportion of FIB-4 positivity in the general population poses a significant burden for further screening with liver elastography. Targeting people with diabetes, excluding people older than 80 years and/or adopting a FIB-4 threshold of 2 in those aged more than 70 years could increase the cost-effectiveness of the screening procedures., Competing Interests: Declaration of competing interest EM has received speaker and consultant fees from Astra Zeneca, Novo Nordisk, Eli Lilly, Merck, and Sanofi. GAS, FP and PF have no competing interests., (Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Chronic pelvic pain is a hidden issue which needs to involve many different usually uncoordinated specialists. For this reason there is a risk that treatments, in the absence of well-defined pathways, common goals, and terminology, may be poorly effective. The aim of the present paper is to summarize the evidence on anorectal pelvic pain, offering useful evidence-based practice parameters for colorectal surgeons' daily activity. Analysis of chronic anorectal and pelvic pain syndromes, the diagnostic and clinical optimal needs for evaluation, and the innumerable low evidence treatments and therapeutic options currently available suggests that a multimodal individualized management of pain may be the most promising approach. The limited availability of dedicated centers still negatively affects the applicability of these principles., (© 2024. Springer Nature Switzerland AG.)

Background: Biosimilar drugs offer an opportunity for all global healthcare systems because they provide significant cost savings while ensuring equal efficacy and safety in the treatment of chronic diseases. These savings can be allocated to support ongoing innovation., Methods: An analysis of the usage of major biosimilar drugs across various therapeutic areas has been conducted within an Italian healthcare company serving a population of over one million. Data on consumption, expenditure, and the number of treated patients has been extracted from the company's databases. Finally, a comparison with the year 2021 has been performed to determine if biosimilar drug usage increased in 2022., Results: In 2022, the data reveals that a substantial portion of the analysed active ingredients are being used as biosimilar drugs, except in a few residual cases. However, among the most consumed drugs, resistance still exists in the case of Adalimumab and Etanercept, for which expenditure on originator drugs exceeds 2 million euros., Conclusion: The 2022-2021 comparison highlights the increasing use of biosimilar drugs. This data is encouraging and suggests that in the coming months, we may achieve total utilization, which would be to the benefit of the National Health System (NHS) and the citizens who can rely on an efficient and sustainable healthcare policy that is continually improving., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Coastal areas have historically thrived as centers of human activities due to their resources, economic opportunities, and natural allure. The rapid growth of coastal populations has however brought forth a multitude of challenges to tackle, with pollution emerging as a significant and far-reaching issue. Our study focuses on the Mar Piccolo of Taranto (Ionian Sea, Southern Italy), a lagoon-like coastal basin (separated in two sub-basins) that, since decades, has been heavily affected by human activities and aquaculture, leading to environmental deterioration. Although past studies have looked at environmental conditions in the Mar Piccolo from a chemical perspective, the biological component (e.g., biological indicators) has been mostly neglected. In this study, we firstly aim to examine the distribution and diversity of foraminifera, ostracods, and dinoflagellate cysts in December 2016 and compare our findings with data collected in December 2011. Foraminiferal and ostracod communities exhibit similar patterns in the two sampling campaigns, while the communities of encysted dinoflagellates show differences concerning both densities and diversity. Then, we evaluate the Ecological Quality Status (EcoQS) using ecological indices. While the indices in the inner basin appear to reflect an actual ecological degradation, they yield conflicting results in the outer basin. In the outer basin, indeed, the indices overestimate the EcoQS. This study highlights the potential of these indices for characterizing the EcoQS but emphasizes the need for improvements in their reliability. This research also contributes to a more holistic understanding of environmental condition in the Mar Piccolo and underscores the importance of integrating biological quality elements into ecosystem management and remediation strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In this article we aimed to perform a subgroup analysis using data from the COVID-AGICT study, to investigate the perioperative outcomes of patients undergoing surgery for pancreatic cancers (PC) during the COVID-19 pandemic., Methods: The primary endpoint of the study was to find out any difference in the tumoral stage of surgically treated PC patients between 2019 and 2020. Surgical and oncological outcomes of the entire cohort of patients were also appraised dividing the entire peri-pandemic period into six three-month timeframes to balance out the comparison between 2019 and 2020., Results: Overall, a total of 1815 patients were surgically treated during 2019 and 2020 in 14 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (p = 0.846). During the pandemic, neoadjuvant chemotherapy (NCT) has dropped significantly (6.2% vs 21.4%, p < 0.001) and, for patients who didn't undergo NCT, the latency between diagnosis and surgery was shortened (49.58 ± 37 days vs 77.40 ± 83 days, p < 0.001). During 2020 there was a significant increase in minimally invasive procedures (p < 0.001). The rate of postoperative complication was the same in the two years but during 2020 there was an increase of the medical ones (19% vs 16.1%, p = 0.001)., Conclusions: The post-pandemic dramatic modifications in healthcare provision, in Italy, did not significantly impair the clinical history of PC patients receiving surgical resection. The present study is one of the largest reports available on the argument and may provide the basis for long-term analyses., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Data from recently trials have provided practice-changing recommendations in management of the axilla in early breast cancer (eBC). However, further controversies have been raised, resulting in heterogeneous diffusion of these recommendations. Our purpose was to obtain a better homogeneity., Material and Methods: In 2021, the Tuscan Breast Network (TBN) established a consensus with the aim to update recommendations in this area. We performed a literature review on axillary management in eBC patients which led to an expert Delphi consensus aiming to explore the gray areas, build consensus and propose evidence-based suggestions for an appropriate management. Thereafter, we investigate their implementation in clinical practice., Results: (1) DCIS patients should have SLN biopsy only in case of mastectomy or in conservative surgery if tumor is in a location that would preclude future nodal sampling or in case of a mass; (2) ALND may be omitted for 1-2 positive SLN patients undergoing BCS in T1-2 tumors with 1-2 SLN positive, eligible for whole-breast irradiation and adjuvant systemic therapies; (3) consider the option of RNI in patients with 1-3 positive lymph nodes and one or more high-risk characteristics; (4) the population identified in 2) should NOT undergo lymph node irradiation as an alternative to axillary surgery and (5) patients with clinically (pre-operatively) positive axilla, or undergoing primary systemic therapy, or outside the criteria reported in 2) must receive additional ALND and/or RT as per local policy., Conclusion: This consensus provided a practical tool to stimulate local and national breast surgical and radiotherapy protocols., (© 2024. Italian Society of Medical Radiology.)

Introduction: Paget's disease of bone is a focal skeletal disorder causing bone deformities and impairing bone quality. Despite the prevalence of asymptomatic cases is increasing, the progression of the disease can lead to invalidating complications that compromise the quality of life. Doubts on clinical and therapeutic management aspects exist, although beneficial effects of antiresorptive drugs, particularly bisphosphonates are known. However, limited information is available from randomized controlled trials on the prevention of disease complications so that somewhat contrasting positions about treatment indications between expert panels from the main scientific societies of metabolic bone diseases exist. This task force, composed by expert representatives appointed by the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases and members of the Italian Association of Paget's disease of bone, felt the necessity for more specific and up to date indications for an early diagnosis and clinical management., Methods: Through selected key questions, we propose evidence-based recommendations for the diagnosis and treatment of the disease. In the lack of good evidence to support clear recommendations, available information from the literature together with expert opinion of the panel was used to provide suggestions for the clinical practice., Results and Conclusion: Description of the evidence quality and support of the strength of the statements was provided on each of the selected key questions. The diagnosis of PDB should be mainly based on symptoms and the typical biochemical and radiological features. While treatment is mandatory to all the symptomatic cases at diagnosis, less evidence is available on treatment indications in asymptomatic as well as in previously treated patients in the presence of biochemical recurrence. However, given the safety and long-term efficacy of potent intravenous bisphosphonates such as zoledronate, a suggestion to treat most if not all cases at the time of diagnosis was released., (© 2024. The Author(s).)

Background: The European-funded Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) project aims to improve knowledge on the effects of medical exposure to ionizing radiation (IR) received during childhood. One of its objectives is to build a consolidated European cohort of pediatric patients who have undergone cardiac catheterization (Cath) procedures, with the goal of enhancing the assessment of long-term radiation-associated cancer risk. The purpose of our study is to provide a detailed description of the Italian cohort contributing to the HARMONIC project, including an analysis of cumulative IR exposure, reduction trend over the years and an overview of the prospective collection of biological samples for research in this vulnerable population., Methods: In a single-center retrospective cohort study, a total of 584 patients (323 males) with a median age of 6 (2-13) years, referred at the Pediatric Cardiology in Niguarda Hospital from January 2015 to October 2023, were included. Biological specimens from a subset of 60 patients were prospectively collected for biobanking at baseline, immediately post-procedure and after 12 months., Results: Two hundred fifty-nine (44%) patients were under 1 year old at their first procedure. The median KAP/weight was 0.09 Gy·cm 2 /kg (IQR: 0.03-0.20), and the median fluoroscopy time was 8.10 min (IQR: 4.00-16.25). KAP/weight ratio showed a positive correlation with the fluoroscopy time (Spearman's rho = 0.679, p < 0.001). Significant dose reduction was observed either after implementation of an upgraded technology system and a radiation training among staff. The Italian cohort includes 1858 different types of specimens for Harmonic biobank, including blood, plasma, serum, clot, cell pellet/lymphocytes, saliva., Conclusions: In the Italian Harmonic cohort, radiation dose in cardiac catheterization varies by age and procedure type. An institution's radiological protection strategy has contributed to a reduction in radiation dose over time. Biological samples provide a valuable resource for future research, offering an opportunity to identify potential early biomarkers for health surveillance and personalized risk assessment., (© 2024. The Author(s).)