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The choice of influencer marketing as an endorser for promoting products and services is becoming a more and more effective communication strategy of open innovation. Their use of social media platforms, such as Instagram, allows them to be reached by millions of followers all over the world. As a response to the economic crisis that affected Italy after the first wave of the COVID-19 pandemic, Chiara Ferragni, one of the most endorsed influencers worldwide, started a communication campaign with the aim to promote Italian food and tourist destinations (cities of art, seaside, ski and countryside locations, thermal baths, museums, galleries, hotels, etc.). This study analyses Chiara Ferragni's activity and the dynamic of communication she used via her Instagram (IG) profile to enhance Italian tourist destinations and "local food & wine". Specifically, it measured the contribution of local food used as an evocative factor in the appreciation of a tourist destination and its power in different contexts. Hundreds of posts on the influencer's IG profile were observed using the netnographic analysis. Subsequently, the AGIL model (Adaption, Goal Attainment, Integration, and Latent pattern maintenance) was applied to measure the main dimensions of this communication campaign and its effectiveness to relaunch touristic catering sectors. The study offers a new model of open innovation for advertising and promoting food and catering businesses. [ABSTRACT FROM AUTHOR]

Sixty women with a diagnosis of endometriosis (30 with low pain severity - LP; 30 with high pain severity - HP) were evaluated at study entry (T0) and after three months (T1). At T0 they were compared for different psychological dimensions to sixty-two age-paired healthy women (CG). HP group had significantly higher scores on depressive symptomatology, sexual distress, and catastrophizing than CG, and higher scores on worry traits than LP. Metacognitive beliefs predicted sexual distress at T1, over and above pain severity. Pain affects different domains of mental health in this population. Coping strategies, metacognitive beliefs, and worry traits may modulate pain experience and psychological distress. [ABSTRACT FROM AUTHOR]

Biofortification is a strategy to reduce micronutrient deficiency in humans by fortifying food through natural processes, agronomic practices and genetic modification. In this study, we seek to shed light on what consumers understand by the term 'biofortified products' and thus to understand their level of knowledge about these products, as well as the reasons that dictate their purchasing choices and the relationship between consumption choices and lifestyles. The analysis focuses on vegetables and, in particular, on tomatoes with a high lycopene content. Research shows that consumers of biofortified food products are generally confused and uninformed, even though they show a high willingness to pay. This confusion seems to result, moreover, from the lack of a clear definition of a biofortified product, as well as from the lack of clear information on the specifics of biofortified products and the benefits they can bring. The future of biofortified products can, therefore, be improved by the creation of clear standards and reference definitions and better information and transparency that would benefit the consumer. [ABSTRACT FROM AUTHOR]

The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed. [ABSTRACT FROM AUTHOR]

Introduction: The knowledge of high sensitivity cardiac troponin I (hsTnI) distribution in a reference population is mandatory for its introduction in clinical practice. The aim of this study was to define the Upper Reference Limit (URL) of hsTnI measured by Single Molecule Counting technology (SMC) in an accurately selected reference population. Materials and methods: In the study 1140 blood donors were included and selected on the basis of medical history and biomarkers. High sensitivity cardiac troponin I was measured by SMC technology (Clarity, Singulex, Alamed, USA). The 99th percentile was calculated by the non-parametric method according to the Clinical and Laboratory Standard Institute - CLSI C28-A3. Results: The median age was 41 years (IQR: 28 - 50) and 69% were males. The overall 99th percentile was 5 ng/L (90% CI: 4.2 - 5.6). When considering sex-related differences, we found slight differences between the 99th percentile in males and females. Moreover, the 99th percentile trended with age, especially in females. Conclusions: We defined the 99th percentile of hs-cTnI measured by SMC technology in a highly selected healthy population, with only minor differences between males and females. Our findings provide the basic criteria for the reliable interpretation of hsTnI concentrations measured by the SMC technology in clinical settings. [ABSTRACT FROM AUTHOR]

Aim: The study aimed is to evaluate the effectiveness of a dedicated multidisciplinary diabetic foot team (MDFT) in the management of hospital patients affected by an acute diabetic foot ulcer (DFU). Method: The study group was composed of patients who referred to a tertiary diabetic foot service due to a new diabetic foot problem requiring hospitalization. All patients have been managed by a MDFT through a pre-set limb salvage protocol and diabetes, diabetic complications and concomitant co-morbidities were closely managed. The outcomes measures were hospital mortality, major amputation in-hospital complications (IHC). Results / Discussion: Three-hundred twenty-two patients were included. The mean age was 68.6±12 years, 75.8% were male, 93.1% had T2 diabetes with a mean diabetes duration of 20.3±9.8 years, and a mean HbA1c of 8.1±0.2% (65±1 mmol/mol); 64.5% had ischaemic DFUs, and 84.1% infected DFUs. Overall, in-hospital mortality was 1.5 %, major amputation 4.3%, and IHC 7.4% (among them,45.5% of cases were anaemia requiring blood transfusion, 20.8% pneumonia, 8.3% acute heart failure, and 4.1% acute myocardial ischaemia, uncontrolled hypertension, acute kidney failure, bowel ischaemia). IHC were recovered in 83.3% of cases. Ischaemic heart disease [OR 3.6 95% CI (1.6-14.2)p=0.04] was an independent predictor of IHC, while IHC [OR 3.1 95% CI (1.2- 7.6)p=0.03] was an independent predictors of in-hospital mortality. Conclusion: The management of patients with DFUs through a dedicated MDFT achieved a low risk of IHC and in-hospital mortality. Ischaemic heart disease increases the risk of IHC, while IHC increases the risk of in-hospital mortality. [ABSTRACT FROM AUTHOR]

Aim: Up to 30% of patients with diabetic foot ulcers (DFUs) and no-option critical limb ischaemia (NO-CLI) had major amputation. The current study aimed to evaluate the effectiveness of peripheral blood mononuclear cell (PB-MNCs) therapy as adjuvant treatment for patients with DFUs and NO-CLI who had unsuccessful lower limb revascularization. Method: This study is a prospective non-controlled observational study including patients with neuro-ischaemic DFUs and NO-CLI who had unsuccessful revascularization below-the-ankle (BTA) and persistence of foot ischaemia defined by TcPO2 values less than 30 mmHg. After unsuccessful revascularization, all patients received PB-MNCs therapy which was administered in the affected foot along the wound related artery according to the angiosome theory. The treatment was repeated for three times 21-42 days apart. The primary outcomes measures were healing, major amputation, survival after 1-year of follow-up. The secondary outcomes measures were the evaluation of tissue perfusion by TcPO2 and foot pain defined by the visual analogic scale (VAS). Results / Discussion: Twenty-eight patients were included. The mean age was 75±7yrs, 24(86.7%) were male, all of them were affected by type 2 diabetes with a mean duration of 22±7yrs. Twenty-two (78.6%) patients healed, 2 (7.14%) deceased with wound healing, 2 (7.14%) reported non-healing ulcer, 2 (7.14%) had major amputation. TcPo2 valued increased after PB-MNCs therapy (14±9 vs 42±10 mmHg,p<.0001) and pain was significantly reduced (6/10±2/10 vs 2/10±1/10,p<0.002) Conclusion: The current study highlights the potential benefit of PB-MNC in patients with NO-CLI neuro-ischaemic DFUs and unsuccessful BTA revascularization by promoting wound healing and reducing major amputation. [ABSTRACT FROM AUTHOR]

Aim: In the respect of the benefits of TLC-NOSF in forefoot and midfoot neuro-ischaemic DFUs1, this current study aimed to evaluate the effectiveness of TLC-NOSF in the management of neuro-ischaemic heel DFUs. Method: This study is a retrospective single arm non-comparative study including consecutive patients with a non-infected neuro-ischaemic heel DFU (Grade IC or IIC of Texas University Classification, TUC). All patients were managed according to IWGDF Guidance2. After the revascularization of affected limb and the surgical removal of non-viable tissues, the local treatment with TLCNOSF was regularly performed. After 24 weeks of follow-up, the following outcomes were evaluated: wound healing, healing time (days), wound area regression (>50%), re-ulceration, and safety. Results / Discussion: Thirty patients were included. The mean age was 67±11 years, 17 (56.7%) were male, 30 (100%) were affected by type 2 diabetes with a mean duration of 18±7 years. Twenty patients (66.7%) had deep ulcers (TUC grade 2), the mean TcPO2 value after revascularization procedure was 42 ±7 mmHg. Twenty-two patients (73.3%) healed in a mean time of 84±32 days. Twenty-eight patients (93.3%) had wound regression, 2 (6.7%) had ulcer relapse after healing, 2 (6.7%) had mild infection, and 1 (3.3%) reported major amputation due to severe infection. No serious adverse events related to TLC-NOSF or local reactions were reported during the course of the study. Conclusion: The current study highlighted the potential benefit of TLC-NOSF also in the management of neuro-ischemic heel DFUs as a part of the integrated standard of care. [ABSTRACT FROM AUTHOR]

Background There are some inconsistencies on prevalence estimates of familial hypercholesterolemia (FH) in general population across Europe due to variable application of its diagnostic criteria. We aimed to investigate the FH epidemiology in Italy applying the Dutch Lipid Clinical Network (DLCN) score, and two alternative diagnostic algorithms to a primary care database. Methods We performed a retrospective population-based study using the Health Search IMS Health Longitudinal Patient Database (HSD) and including active (alive and currently registered with their general practitioners (GPs)) patients on December 31, 2014. Cases of FH were identified by applying DLCN score. Two further algorithms, based on either ICD9CM coding for FH or some clinical items adopted by the DLCN, were tested towards DLCN itself as gold standard. Results We estimated a prevalence of 0.01% for “definite” and 0.18% for “definite” plus “probable” cases as per the DLCN. Algorithms 1 and 2 reported a FH prevalence of 0.9 and 0.13%, respectively. Both algorithms resulted in consistent specificity (1: 99.10%; 2: 99.9%) towards DLCN, but Algorithm 2 considerably better identified true positive (sensitivity = 85.90%) than Algorithm 1 (sensitivity = 10.10%). Conclusion The application of DLCN or valid diagnostic alternatives in the Italian primary care setting provides estimates of FH prevalence consistent with those reported in other screening studies in Caucasian population. These diagnostic criteria should be therefore fostered among GPs. In the perspective of FH new therapeutic options, the epidemiological picture of FH is even more relevant to foresee the costs and to plan affordable reimbursement programs in Italy. [ABSTRACT FROM AUTHOR]

The concept of agricultural multi-functionality is affirmed in European countries in the 1990s of the XX century to contrast the agricultural crisis, sustain the farmers income and protect the biodiversity of rural landscapes. In 1996, the Declaration of Cork, after revealing incoherence in CAP and underlining that public support for rural development is acceptable if harmonized with a proper management of natural resources and with the conservation and maintenance of biodiversity of the landscape, promoted a ten-step program to battle rural mass migration and to promote employment and equal opportunities. This paper wants to emphasize the state of the art relation that there is among agriculture, territory and multi-functionality in consideration of the new European program 2014-2020. Taking for example, the South-East of Sicily in general and the Plateau of Modica in particular. Where we can find a considerable livestock patrimony which, on its own, is of great aesthetic and identity value. If preserved, it may continue to be a great resource for the whole territory. These objectives can be reached, not only, by a marked rural policy with strong local roots in the territory and the diversification of livestock farms that can satisfy the social demand for leisure time, tourism and culture. Multi-functionality in the rural environment is completely recognized by the new European program 2014-2020, which again aims to assure a sustainable, competitive and multi-functional agriculture. Consequently, the experimentation of additional activities, compared to the primary function of producing food, fits into the areas under inspection as strategies to avoid the decline of agricultural land values and at the same time as an opportunity to benefit from European programs. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is an auto-immune disease whose etiology remains controversial. Both genetic and environmental factors are thought to be involved in the risk of developing the disease. The purpose of our study was to assess the association of Vitamin D receptor (VDR) polymorphisms with MS and to investigate the interaction of these polymorphisms with vitamin D levels. A total of 179 Sicilian subjects, including 104 MS patients and 75 healthy controls, were studied. The most common VDR polymorphisms (Fok-I, Bsm-I, Taq-I and Apa-I) were genotyped by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) analyses in both groups and serum 25-hydroxyvitamin D [25(OH)D] levels were determined in MS patients by high-performance liquid chromatography (HPLC). The distribution of genotype and allele frequencies of the four VDR polymorphisms did not differ significantly between MS patients and healthy controls, and were unrelated to the forms and the course of MS. Low serum levels of 25(OH)D were observed in MS patients but no association was observed between VDR and 25(OH)D levels except for Fok-I. Moreover, MS patients with FF and Ff genotype had a significantly lower serum levels of 25(OH)D compared with ff carriers (P < 0.05 FF vs Ff and Ff vs ff). Our findings showed no association between VDR polymorphisms and risk of MS. Interestingly, F allele could confer a genetic predisposition to lower 25(OH)D levels. [ABSTRACT FROM AUTHOR]

Background: An ethnobotanical field study on the traditional uses of wild plants for food as well as medicinal and veterinary plants was conducted in four Waldensian valleys (Chisone, Germanasca, Angrogna, and Pel l ice) in the Western Alps, Piedmont, NW Italy. Waldensians represent a religious Protestant Christian minority that originated in France and spread around 1,170 AD to the Italian side of Western Alps, where, although persecuted for centuries, approximately 20,000 believers still survive today, increasingly mixing with their Catholic neighbours. Methods: Interviews with a total of 47 elderly informants, belonging to both Waldensian and Catholic religious groups, were undertaken in ten Western Alpine villages, using standard ethnobotanical methods. Results: The uses of 85 wild and semi-domesticated food folk taxa, 96 medicinal folk taxa, and 45 veterinary folk taxa were recorded. Comparison of the collected data within the two religious communities shows that Waldensians had, or have retained, a more extensive ethnobotanical knowledge, and that approximately only half of the wild food and medicinal plants are known and used by both communities. Moreover, this convergence is greater for the wild food plant domain. Comparison of the collected data with ethnobotanical surveys conducted at the end of the 19th Century and the 1980s in one of studied valleys (Germanasca) shows that the majority of the plants recorded in the present study are used in the same or similar ways as they were decades ago. Idiosyncratic plant uses among Waldensians included both archaic uses, such as the fern Botrychium lunaria for skin problems, as well as uses that may be the result of local adaptions of Central and Northern European customs, including Veronica allionii and V. officinalis as recreational teas and Cetraria islandica in infusions to treat coughs. Conclusions: The great resilience of plant knowledge among Waldensians may be the result of the long isolation and history of marginalisation that this group has faced during the last few centuries, although their ethnobotany present trans-national elements. Cross-cultural and ethno-historical approaches in ethnobotany may offer crucial data for understanding the trajectory of change of plant knowledge across time and space. [ABSTRACT FROM AUTHOR]

Background: a multidimensional approach—the BODE index—has been proposed for prognostic purposes in chronic obstructive pulmonary disease (COPD) and theoretically seems to be well suited for elderly people, but there is a lack of data in this population, especially with respect to long-term survival. The objective of this study is to evaluate whether the BODE index can predict both long (5 years) and very-long (10 and 15 years)-term mortality in an unselected population of elderly people with COPD better than a set of variables commonly taken into account in a geriatric multidimensional assessment (MDA).Methods: this was a multicentre, prospective, population study. We used data from the SaRA study, which included 563 elderly people with COPD whose vital status was ascertained for up to 15 years after enrolment. The discriminative capacity of the BODE index in predicting mortality was derived from Cox proportional hazard models including the components of the BODE index and compared with that of an alternative model based on MDA variables: age, gender, physical disability, cognitive function and mood status.Results: at 5 years, the HRs for mortality were 1.04 (95% CI: 0.60–1.79), 1.88 (1.10–3.22) and 3.55 (2.15–5.86) for quartiles 2–4, respectively, compared with quartile 1 of the BODE index. The corresponding figures for 10-year mortality were 1.50 (1.01–2.24), 2.11 (1.39–3.20) and 3.903 (2.62–5.82), and for 15-year mortality were 1.68 (1.19–2.36), 2.08 (1.44–3.01) and 3.78 (2.64–5.41). Similar results were obtained using variables included in the usual MDA.Conclusions: Both the ‘classic’ MDA and the BODE index are comparably associated with mortality, even at very long term, in elderly people with COPD. [ABSTRACT FROM AUTHOR]

Background and Objective: We aimed to explore to what extent an unselected population of chronic obstructive pulmonary disease (COPD) outpatients would be eligible for inclusion in randomized clinical trials (RCTs). Methods: Retrospective analysis of the clinical records of outpatient subjects with an ascertained diagnosis of COPD. COPD outpatients were assessed against the following inclusion criteria: 40 < age < 80 years, current or former smokers, forced expiratory volume in the first second (FEV1) <70% predicted, no long-term oxygen therapy, no other concomitant lung diseases and absence of major extrapulmonary comorbidities. The study consisted of 2 phases; in phase 1, the criteria for inclusion in RCTs on COPD were selected, and in phase 2, the above criteria were applied to an unselected outpatient COPD population. Results: A total of 578 subjects (83% of the whole group) failed at least one of the inclusion criteria. Lung diseases other than COPD (occurring in 30% of our population, mostly bronchiectasis), long-term oxygen therapy (31%), FEV1 (19%), age (14%) and extrapulmonary comorbidities such as cognitive impairment (14%), arrhythmias (17%) and congestive heart disease (13%) would have been the most frequent causes for exclusion from RCTs. Conclusions: In real-life settings, more than 80% of COPD subjects are currently treated by protocols based on results of RCTs for which they would not have been eligible. We encourage a more extensive use of pragmatic trials in COPD to better modulate the application of results of RCTs to patients encountered in daily practice. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The study moves from the observation that, in the last fifty years (1961-2010) the territory of our country, like those of other countries with advanced economies, has undergone extensive economic processes of change in the use of land, mostly due to a strong reduction of Agricultural Area Use (AAU), whose consistency -- on the basis of official statistics (National Statistics Institute) and, in particular, the results of the General Census of Agriculture -- is estimated at around 7,8 million hectares, from 20,7 million hectares in 1961 to 12,9 million in 2010. It should be noted in fact that the intensity of the processes of reduction of the UAA was much greater in the first three decades, compared to subsequent of entire period, in which there has been a growing flowering of studies and research on the subject, aimed to analyze causes, modes and effects of the change in the economic use of the land with reference to agriculture, to rural world and the entire socio-economic system. [ABSTRACT FROM AUTHOR]

We analyzed MBL2 gene variants in two cohorts of centenarians, octo-nonagenarians and nonagenarians, and in the general population, one from Sardinia Island (Italy), recruited in the frame of the AKea study, and another from Campania (southern Italy), to search for haplotypes related to longevity. We also assessed in vitro the effect of mannose-binding lectin (MBL) on various human cells at different stage of senescence. The frequency of high and null activity haplotypes was significantly lower, and the frequency of intermediate activity haplotype significantly higher in centenarians and in subjects between 80 and 99 years from both the cohorts as compared each to the general population from the same geographic area. Furthermore, serum MBL concentration (also after normalization to serum albumin) was significantly lower in centenarians and in octo- and nonagenarians as compared to the general population, suggesting that intermediate MBL haplotype/activity may be protective. We also demonstrated that in vitro MBL protein bound to senescent IMR90 fibroblasts thereby causing cell lysis, but not to other types of cycle-arrested cells not in senescence. This implicates a novel role of MBL in the clearance of senescent cells. [ABSTRACT FROM AUTHOR]

The article presents a vivid description of the musical instruments depicted in the grandeur constructions of King Ruggero II, also called Roger II of Sicily. The restoration of Sicily based Cefalù cathedral, representing medieval music during the Norman period, in the 1980's made it possible to study such monuments, the ceilings of which had a great touch of Islamic art. Numerous instruments are portrayed through the art including ūd, tunbūr and rabāb.

Abstract: The European Energy Efficiency Building Directive 2002/91/CE, as well as other acts and funding programs, strongly promotes the adoption of passive strategies for buildings, in order to achieve indoor thermal comfort conditions above all in summer, so reducing or avoiding the use of air conditioning systems. In this paper, the energy performances achievable using an earth-to-air heat exchanger for an air-conditioned building have been evaluated for both winter and summer. By means of dynamic building energy performance simulation codes, the energy requirements of the systems have been analysed for different Italian climates, as a function of the main boundary conditions (such as the typology of soil, tube material, tube length and depth, velocity of the air crossing the tube, ventilation airflow rates, control modes). The earth-to-air heat exchanger has shown the highest efficiency for cold climates both in winter and summer. The possible coupling of this technology with other passive strategies has been also examined. Then, a technical-economic analysis has been carried out: this technology is economically acceptable (simple payback of 5–9 years) only in the cases of easy and cheap moving earth works; moreover, metallic tubes are not suitable. Finally, considering in summer a not fully air-conditioned building, only provided with diurnal ventilation coupled to an earth-to-air heat exchanger plus night-time ventilation, the possible indoor thermal comfort conditions have been evaluated. [Copyright &y& Elsevier]

Objectives: To evaluate whether measures easier to obtain than the FVC can substitute it as a prognostic marker in elderly people. Design: Prospective, observational study. Setting: Community. Participants: Outpatients (n = 1485) aged 73.4 years (SD: 6.2 range 65–98) enrolled in the Salute Respiratoria nell'Anziano (SaRA) study. Measurements: We calculated the risk for mortality associated with a reduction below 80% of the predicted FVC, of the forced expiratory volume at 6 seconds (FEV6), and of a surrogate measure for forced vital capacity (SFVC), defined as the largest volume exhaled in 2 forced maneuvers regardless of its duration and of the presence of plateau. Results: Among the 907 participants who attained the FVC, the mortality rate ratio (MRR) associated with having a low FVC, FEV6, and SFVC were 1.37 (95% CI: 0.91–2.00), 1.66 (95% CI: 1.15–2.36), and 1.28 (95% CI: 0.88–1.84), respectively. In those who could not obtain the FVC, mortality was more strongly associated with both low FEV6 (MRR: 3.02, 95% CI: 1.72–5.24) and low SFVC (MRR: 2.18; 95% CI: 1.53–3.10). The association between SFVC and mortality was present in the whole population, even after adjustment for age, gender, disability, mood, and cognitive status (MRR: 1.64; 95% CI: 1.29–2.09). Conclusions: The SFVC provides similar prognostic information compared with the FVC, and is associated with increased mortality in the subgroup of patients not able to attain the FVC. This measure can make the respiratory assessment for prognostic purposes easier, especially in elderly patients who have a high prevalence of respiratory diseases, but frequently fail to perform an FVC maneuver complying with recommended standards. [Copyright &y& Elsevier]

Abstract: Sicily, the largest Mediterranean island (with an extension of about ), exhibits a very wide variety of lithologies, ranging from sedimentary to metamorphic and volcanic rocks. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) have been applied to air kerma values measured by thermoluminescent dosimetry in several sites and to data of radionuclide concentrations, geochemical and mineralogical features of rocks and soils sampled in 29 sites of Sicily to point out similarities among different lithologies. The study was devoted to find multiple correlations and allow a better classification of Sicilian lithotypes. Samples of rocks and soils have been analyzed by X-ray fluorescence (XRF), X-ray diffractometry (XRD), and gamma-ray spectrometry. Major element concentrations, mineralogical data, along with specific activities of 40K, 238U, and 232Th natural radionuclides, have been determined in several samples. Geochemical, mineralogical and petrographic features are in good agreement with radiometric data. A survey was also performed to measure air kerma in outdoor environment using thermoluminescent dosimeters. The measured values were compared with the predicted levels computed from the radioisotope concentrations present in rock and soil samples. Moreover, collected data can be used to evaluate the health impact of the natural radioactivity on the population. [Copyright &y& Elsevier]

Background: Spirometry is more and more frequently used for the diagnosis of respiratory diseases in the elderly people. Unfortunately, reliable predictive values for the spirometric variables in the elderly are lacking. Objectives: Data obtained from 429 subjects participating in the multicenter Italian study SARA on respiratory health in the elderly were analyzed in order to derive reference values for spirometry in the age range of 65-85 years. The second aim of this study was to assess the influence of variables describing many dimensions of the health status on the prediction of spirometric variables in that age range. Methods: Subjects were recruited as consecutive outpatients referred during the study period to 24 geriatric or respiratory institutions distributed throughout Italy. Spirometries were performed using the same equipment by specifically trained and certified personnel supervised by a real-time quality control program. In addition to the standard anthropometric variables, covariates describing the affective, mental, and general health conditions were investigated through standardized questionnaires, to improve the modeling of spirometric outcomes. Results: Reliable predictive values for forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were produced (coefficient of determination, for FVC: R² = 0.64; for FEV1: R² = 0.54). The effect of general health conditions on spirometric outcomes accounted for the most part of the between-gender difference in the ageing-dependent decrease in lung function. Conclusions: We suggest that a multidimensional approach to health problems should be used for a better interpretation of spirometric results in the elderly. [ABSTRACT FROM AUTHOR]

Study objectives: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis and underdiagnosis of asthma in such patients. Design: A multicenter study involving 24 Italian pulmonary or geriatric institutions. Patients: One hundred twenty-eight asthmatic patients (98 women, 76.6%) aged 73 ± 6.4 years (mean ± SD) were selected from the cohort of the Salute Respiratoria nell'Anziano (respiratory health in the elderly) study. Methods: All patients underwent a clinical evaluation that included clinical history and spirometry with a bronchodilator test. A diagnosis of asthma was based on criteria proposed by international guidelines adapted to the elderly population. A multidimensional geriatric assessment was performed to estimate physical and cognitive impairments and mood state. Finally, the diagnosis of respiratory disease previously made by a doctor, if any, was recorded. Results: Of asthmatic patients, COPD had been improperly diagnosed in 19.5%, whereas 27.3% of asthmatic patients did not report any previous diagnosis of asthma. The main correlates of misdiagnosis were older age and disability. Conversely, underdiagnosis was associated with better functional conditions, expressed by spirometry, even when wheezing or a significant response to the bronchodilator test occurred. Conclusions: Asthma in the elderly is frequently confused with COPD. Misdiagnosis can be related to older age and to greater degree of disability. Asthma in patients with mild functional impairment may be underdiagnosed in spite of overt respiratory symptoms suggestive of asthma. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the clinical practice of Italian specialist physicians including pneumologists, geriatricians and internists in exploring chronic obstructive pulmonary disease (COPD) on the basis of experience. It discusses how physicial specialty has become a source of heterogeneity in the care of COPD patients. The improvement of specialty practice in managing COPD is suggested.

[Display omitted] • DAYKE-Italy is a project that investigated daylighting in 5 Italian universities. • A survey was distributed to students (N = 542) on perception of daylight in classrooms. • DIVA+ALFA simulations were run to calculate daylight, circadian and energy metrics. • Most metrics have significant statistical correlation with subjective responses. • Highest correlation was found for DFm, ALE, and circadian EML. Results from the DAYKE-Italy project are presented. An investigation on daylighting in eight classrooms in five Italian universities was carried out through a combined approach: an ad-hoc survey administered to students to investigate how they perceive daylight in classroom, and numerical simulations (DIVA + ALFA) to calculate a set of objective metrics (daylight, circadian, and energy-related). A sample of 542 questionnaires was collected through two sessions and the subjective judgments were correlated to objective metrics. Results from descriptive and statistical analyses showed: (i) the correlation was significant for all daylight metrics: among them, average daylight factor and annual light exposure performed higher correlations compared to daylight autonomy, spatial daylight autonomy and useful daylight illuminance; (ii) rooms with a scarce or an optimal daylight provision (according to standards) were rated with comparable subjective score; (iii) the equivalent melanopic lux showed a higher correlation than daylight metrics based on the horizontal workplane; (iv) energy saving up to 50% can be achieved in the presence of high daylight provision and through daylight responsive controls; however, a relamping of fluorescent systems with LED system is recommended to optimize the consumption; furthermore, estimated saving correlated significantly with objective metrics. [ABSTRACT FROM AUTHOR]

Objective: To assess the magnitude of COVID-19 spread and the associated risk factors among health care workers (HCWs), we conducted an in-hospital survey in a central Italian COVID Hospital., Methods: Participants underwent nasopharyngeal swab and/or serum collection for SARS-CoV-2 IgG examination. We divided participants according to working status, into rotating-night shift workers (r-NSW) and day-workers., Results: We found 30 cases of COVID-19 infection in a total of 1180 HCWs (2.5%). Most COVID-19-positive hospital employees were r-NSWs with significantly higher BMI than that of individuals who tested negative. After adjustment for covariates, night work and BMI > 30 were associated with a markedly greater risk of COVID-19 diagnosis (OR 3.049 [95%CI 1.260-7.380] and OR 7.15 [95%CI 2.91-17.51], respectively)., Conclusions: Our results describe a low prevalence of COVID-19 infection among HCWs at a central Italian COVID Hospital. COVID-19 infection risk appears to be associated with obesity and night shift work, thus supporting the need for careful health surveillance among frontline HCWs exposed to COVID-19.

There are few long-term nutritional studies in subjects undergoing bariatric surgery that have assessed weight regain and nutritional deficiencies. In this study, we report data 8 years after surgery on weight loss, use of dietary supplements and deficit of micronutrients in a cohort of patients from five centres in central and northern Italy. The study group consisted of 52 subjects (age: 38.1 ± 10.6 y, 42 females): 16 patients had Roux-en-Y gastric bypass (RYGB), 25 patients had sleeve gastrectomy (SG) and 11 subjects had adjustable gastric banding (AGB). All three bariatric procedures led to sustained weight loss: the average percentage excess weight loss, defined as weight loss divided by excess weight based on ideal body weight, was 60.6% ± 32.3. Despite good adherence to prescribed supplements, 80.7% of subjects (72.7%, AGB; 76.7%, SG; 93.8 %, RYGB) reported at least one nutritional deficiency: iron (F 64.3% vs. M 30%), vitamin B12 (F 16.6% vs. M 10%), calcium (F 33.3% vs. M 0%) and vitamin D (F 38.1% vs. M 60%). Long-term nutritional deficiencies were greater than the general population among men for iron and among women for vitamin B12.

Background and Aims: To describe cross-sectional associations of BMI-adjusted handgrip strength with the presence of diabetes and hypertension in a community setting., Methods and Results: Between 2016 and 2018, 601 consecutive elderly active women (70.7 ± 6.9 years) were enrolled. Nutritional status was evaluated by the Mini Nutritional Assessment (MNA) score. Muscle strength and level of fitness were assessed by standardized physical functional tests and handgrip strength (HGS). The majority of participants were overweight or obese (80% with BMI > 25). Prevalence of diabetes and hypertension was 13 and 60%, respectively. Participants in the lowest quartile of BMI-adjusted HGS (RHGS) had significantly higher prevalence of diabetes and hypertension compared with those in the top quartile (20.7 vs 5.3% and 49.3 vs 39.3%, respectively, p < 0.01 for both), without significant differences in nutritional status. Association with the presence of diabetes was significantly weaker in women with higher vs lower RHGS values (OR 0.77; 0.59-0.86 CI95%; p = 0.002), independent of age, abdominal adiposity, and presence of hypertension. RHGS was positively correlated with most of the physical functional tests performed., Conclusion: RHGS is an easy-to-obtain measure of muscular strength, independently associated with the presence of diabetes in overweight active elderly women. Prospective studies are required to assess its predictive value to identify adults at risk of developing diabetes.

Aims: The aim of the study was to describe ECG modifications and arrhythmic events in COVID-19 patients undergoing hydroxychloroquine (HCQ) therapy in different clinical settings., Methods and Results: COVID-19 patients at seven institutions receiving HCQ therapy from whom a baseline and at least one ECG at 48+ h were available were enrolled in the study. QT/QTc prolongation, QT-associated and QT-independent arrhythmic events, arrhythmic mortality, and overall mortality during HCQ therapy were assessed. A total of 649 COVID-19 patients (61.9 ± 18.7 years, 46.1% males) were enrolled. HCQ therapy was administrated as a home therapy regimen in 126 (19.4%) patients, and as an in-hospital-treatment to 495 (76.3%) hospitalized and 28 (4.3%) intensive care unit (ICU) patients. At 36-72 and at 96+ h after the first HCQ dose, 358 and 404 ECGs were obtained, respectively. A significant QT/QTc interval prolongation was observed (P < 0.001), but the magnitude of the increase was modest [+13 (9-16) ms]. Baseline QT/QTc length and presence of fever (P = 0.001) at admission represented the most important determinants of QT/QTc prolongation. No arrhythmic-related deaths were reported. The overall major ventricular arrhythmia rate was low (1.1%), with all events found not to be related to QT or HCQ therapy at a centralized event evaluation. No differences in QT/QTc prolongation and QT-related arrhythmias were observed across different clinical settings, with non-QT-related arrhythmias being more common in the intensive care setting., Conclusion: HCQ administration is safe for a short-term treatment for patients with COVID-19 infection regardless of the clinical setting of delivery, causing only modest QTc prolongation and no directly attributable arrhythmic deaths., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Background and Aims: Growing evidence suggests that the metabolic syndrome (MetS) has both a genetic and environmental basis. To evaluate the possibility of a further genetic analysis, we estimated prevalence rates and heritabilities for the MetS and its individual traits in the adult population of Linosa, a small and isolated Italian Island in the southern-central part of the Mediterranean Sea., Methods and Results: The Linosa Study (LiS) group consisted of 293 Caucasian native subjects from 51 families (123 parents; 170 offsprings). The MetS was defined according to NCEP/ATP III criteria and the following prevalence rates were calculated: hyperglycaemia 20.3%; central obesity 34.9%; hypertension 43.4%; hypertriglyceridaemia 29.9%; "low HDL" 56.6%; MetS 29.9%. Waist circumference was significantly related to all the quantitative parameters included in the NCEP/ATP III MetS definition. The MetS showed a heritability of 27% (p=0.0012) and among its individual components, treated as continuous and discrete traits, heritability ranged from 10% for blood glucose to 54% for HDL-cholesterol. Among MetS subtypes, the clustering of central obesity, hypertriglyceridaemia and "Iow HDL" had the highest heritability (31%; p<0.001)., Conclusion: These data showed high prevalence rates for the MetS and its related traits in an isolated and small Caucasian population. The appreciable heritability estimates for the MetS and some of its components/clusters in the LiS population might support the observation of genetic factors underlying the pathogenesis of the MetS and encourage further analysis to identify new susceptibility genes.

Longitudinal research has shown that social failure to adjust can be prevented by early removal of ambiental factors encouraging pathological development of the Ego, and the detection and treatment of psychological tendencies towards the acquisition of deviant stimuli.