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In the Italian university context, almost all universities offer blended degree courses, digital environments and e-learning systems. In many cases, dedicated centres also provide technical support and, less frequently, teaching and methodological support. The development of digital learning environments often does not correspond to the spread of an effective culture of educational innovation in university courses. The research examined the experiences of instructional design among 44 university teachers of blended degree courses at the University of Modena and Reggio Emilia. The analysis focused on teachers' level of satisfaction and the processes of teaching innovation linked to the blended methodology, investigating also the possible criticalities and strengths related to the process of (re)design and innovation. The activities of training and design for teachers contributed to the dissemination of good teaching practices and professional development. In line with what emerged from the research on blended learning, it seems necessary to build a framework for the adoption and implementation of 'blended learning' strategies at the institutional level, starting from the construction of a concrete agenda setting shared between the actors of the innovation process.

Purpose: This paper aims to propose an explorative metamodel of the key organizational competences management and presents a Web-based tool (Co.S.M.O.© Competences Software Management for Organizations) for all-around assessment of the identified competences. Design/methodology/approach: Building on the Great Eight Competencies Model- GEC, the European Qualifications Framework-EQF and focus group feedback, an online questionnaire was developed to manage the key organizational competences and to adapt the competence metamodel to the Italian context. Findings: The competence metamodel described in this study and its newly designed tool (software with online questionnaire) could be used at the organizational level to improve productivity and efficiency by allowing an easy identification of key organizational competences and facilitating their acquisition and sharing. Research limitations/implications: Currently, the metamodel is mainly theoretical and the software sustained only a partial validation. Practical implications: The developed tool is a dynamic, easy to use and interactive Web-based software useful for managing the competences in both for-profit and not-for-profit organizations. Social implications: European official documents invite companies and institutions to work together and share human capital: the European Qualifications Framework-EQF, at the base of this model, facilitates a common organizational language for human resources management. Originality/value: Managerial competence literature indicates that a comprehensive model capturing a link between the EQF and a managerial competence model has not yet been considered in the literature.

This article is based on the case study of the establishment of the campus of Tongji University (TU) in Florence, Italy, in 2014. This is the first offshore campus of a Chinese university in a Western country, showing an innovative trend, in particular concerning the legitimacy within the host sociopolitical and economic context. This article frames the case in the scenario of academic internationalization and Chinese higher education. The article analyzes the internationalization strategy of TU and the peculiar evolution of Florence as an "education hub," and gives a detailed account of the process leading to the establishment of the campus. Conclusions emphasize the innovative features related to Tongji's choice to follow a delocalized platform approach and to network with local actors. This imposes a more complex view of the impact on the host region.

Aim: To evaluate modifications in foot structure in obese type 2 diabetes mellitus (DM) patients after weight loss. Method: we studied all patients admitted for bariatric surgery between January and March 2019 with body mass index (BMI) between 40 and 48 kg/m2 before and after the weight loss, dividing them according to presence (Group 1) or absence (Group 2) of DM. We compared changes in: skin temperature at first (ST1) and fifth (ST5) metatarsal joint, ultrasound skin and subcutaneous (US) and fascia (F) thickness and dorsal (DC) and ankle circumference (AC). Results / Discussion: We enrolled 46 patients: 19 in Group 1 (M/F 11/8; age 48.2±10.3 yrs) and 27 in Group 2 (M/F 10/17, age 46.8±10.0). Time to reach expected weight loss was longer in Group 2 (461.5±131.3 days vs 334.2±106.4, p=0.0011). Foot and leg volumes significantly decreased in both groups, but more in Group 2: ΔDC 1.9±1.6 vs 0.7±1.4 cm (p=0.02), ΔAC 2.8±1.9 vs 1.2±1.7 cm (p=0.01). Also the reduction of ST was greater in Group 2: ΔST1 3.7±3.1°C vs 1.9±3.1°C (p<0.05) and ΔST5 4.8±3.6°C vs 1.8±3.8°C (p<0.02). US reduction was significantly greater in Group 1: dorsal (0.16±0.14 vs 0.04±0.14 cm, p=0.009) and plantar (0.10±0.18 vs 0.06±0.19 cm, p<0.05) as well as F (ΔF 0.05±0.01 vs 0.02±0.08 cm, p=0.02). Conclusion: Our data confirm structural changes induced by weight loss in severely obese patients, but point out different patterns in DM patients compared to non-diabetic ones: tissue decrease in the former and volume reduction in the latter. [ABSTRACT FROM AUTHOR]

Aim: Diabetes Mellitus (DM) and Obesity (OB) condition motion strategy. Our study aimed to identify differences in gait biomechanical aspects determined by DM and OB. Method: we recruited all patients admitted for bariatric surgery with body mass index (BMI) between 38 and 47 kg/m2, stratified them according to presence (Group 1) or absence (Group 2) of DM and compared them with non-obese diabetic patients (Group 3) and healthy volunteers (Group 4). Subjects performed, before bariatric surgery, 3-D Gait Analysis walking barefoot at self-selected speed. Spatial-temporal and kinematic data were compared. Results / Discussion: We enrolled 100 patients: 25 in each group: Group 1 (BMI 42.6 ± 2.7 kg/m²), Group 2 (BMI 42.2 ± 2.3 kg/m²), Group 3 (BMI 23.4 ± 1.6 kg/m²) and Group 4 (BMI 22.8 ± 2.0 kg/m²). Group 1 compared to 4 showed increased in stance duration (p=0.04), double support time (p=0.02) and step width (0p<0.01) and reduction in step length (p<0.001), stride length (p<0.0001), cadence (p=0.015) and walking velocity (p<0.01). Group 1 compared to 3 showed increased stride time (p=0.04). Step width in Group 1 was increased also compared to 3 (p<0.01). Kinematics data in Group 1 compared to 4 showed a significant reduction in ankle plantarflexion during push-off (p<0.02), knee (p<0.001) and hip peak flexion during swing (p=0.001) and knee dynamic excursion during normal walking (p<0.001). Conclusion: Our data show that diabetic-obese subjects present gait features typical of both conditions. The specific worsening of dynamic joint impairment provides evidence of a synergistic effect on human ambulatory function. [ABSTRACT FROM AUTHOR]

Leptodictyum riparium, a widely distributed aquatic moss, can both tolerate and accumulate very high concentrations of toxic heavy metals, with only slight apparent damage. Here we report the effects on photosynthetic yield, glutathione (GSH), phytochelatin (PCn) synthesis, nitrogen metabolism and cellular localization of molecules rich in SH groups in L. riparium exposed in vitro to heavy metals. We simulated the concentrations of Cu, Zn, Cd, Pb detected in Regi Lagni, Italy, one of the most contaminated freshwater sites in Southern Europe, in the laboratory to test how the moss responds to heavy metal contamination. There was a steady decrease of photosynthetic efficiency correlated with the heavy metal concentrations and ultrastructural organization. All PCn levels increased significantly as the concentration of heavy metals increased, while the GSH levels did not appear to be particularly affected. A significant increase of GDH and NADH-GOGAT activities increased with increasing heavy metal concentration. Immunoblotting analysis revealed an increase of the chl-GS2 while no significant increase was detected in the cyt-GS1. These results give insight into the molecular events underlying the metal-tolerance of the aquatic moss L. riparium exposed to environmental heavy metal concentrations. • The aquatic moss L. riparium was exposed in vitro to a mix of heavy metals. • The stressed conditions used simulate the metal concentrations detected in a strong contaminated freshwater site. • Morphological and biochemical changes were detected in L. riparium exposed to heavy metals at environmental concentrations. • Phytochelatins are synthetized in L. riparium in a dose-response manner. • Nitrogen metabolism is altered by heavy metal exposure. [ABSTRACT FROM AUTHOR]

Background: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new coronavirus detected in China at the end of 2019. Because SARS-CoV-2 is highly infectious due to contamination in the air, there is a high risk of infection in the dental environment which is represents a serious problem for professionals and students (dentistry and dental hygiene). In Italy, since February 23, 2020, the government has suspended all teaching activities of schools and universities., Methods: An anonymous questionnaire was administered to the students of the degree courses in Dental Hygiene of the Emilia Romagna Region, one of the most affected regions in Italy. The survey was intended to highlight the practical and emotional consequences of the emergency of COVID-19 on educational activities and in the training of students., Results: The survey was sent to the 150 students enrolled in the universities of Bologna, Ferrara and Modena and Reggio Emilia; 141 of them completed it (94%). Since the start of the COVID-19 pandemic, several surveys have been proposed to measure the impact of this emergency situation on dental professionals; at present, however, there are still no assessments for dental hygiene degree courses, in particular aimed at assessing the psychological impact on students., Conclusions: Students consider the dental hygienist as a risky profession, while the risk taken by patients is considered as low. Given the concern reported the students, it would be useful to address the issue of proper assessment of risk during the university training of dental hygienists.

The COVID-19 emergency has imposed distanced education and has interrupted most rehabilitation services. Adolescents with disabilities have been isolated, and the burden on their families has been exacerbated. A cross-sectional survey was administered to adolescents with disability and to parents of disabled children to describe their experience during lockdown and their concerns or expectations about rehabilitation. A sample of 53 adolescents and 239 parents completed the survey. Adolescents were ages 13-18 years old (45.3% female). Most parents were between 35 and 55 years old (84.9% female). While 53.6% of the parents reported no positive effects of the lockdown, 92.5% of the adolescents expressed favorable consequences. The increased time spent with family members was judged positively by 27.2% of parents and by 64.2% of adolescents. Concern for their child's disability was expressed by 47.3% of parents, while 73.6% of adolescents expressed concerns regarding the ban on meeting friends. In both groups, anxiety symptoms were correlated with the fear of contracting COVID-19 and with financial problems. Parents would have liked even more remote support from school and healthcare professionals, which was available for most participants. Thus, socioeconomic support, assistive technology and telerehabilitation strategies might help families with disabilities during a lockdown.

Background: Due to droplet production and exposure to saliva and blood, dental practitioners are at high risk of COVID-19 contagion during their routine procedures. The aim of this study was to investigate the behavior of Italian dentists and to analyze their reactions in relation to Sars-CoV-2 pandemic professional restrictive measures., Methods: An online structured survey composed of 40 questions has been sent to dental practitioners all over Italy to investigate their behavior and to analyze their reactions in relation to Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20)., Results: 1109 dentists replied. To assess concerns and psychological responses the sample was divided into two groups based on the number of cases registered in their work area. In the first group were included all the responders working in the Italian regions that had more than 15,000 confirmed cases of COVID-19 as of April 29, 2020. The second group included responders working in the Italian regions that had less than 15,000 confirmed cases. The 45.2% of the respondents showed minimal anxiety, 34.5% showed mild anxiety, 13.9% showed moderate anxiety, while 6.4% showed a score indicative of a severe level of anxiety., Conclusions: The COVID-19-related emergency condition had a highly negative impact on dental practices in Italy. Those who completed the survey reported practice closure or reduction during the lockdown, and a high level of concern about the professional future for all dental practitioners. Concerns related to professional activity were accompanied by severe anxiety levels.

The outbreak and diffusion of the Severe Acute Respiratory Syndrome-Coronavirus-2 (Sars-CoV-2) and COronaVIrus Disease 19 (COVID-19) have caused an emergency status in the health system, including in the dentistry environment. Italy registered the third highest number of COVID-19 cases in the world and the second highest in Europe. An anonymous online survey composed of 40 questions has been sent to dentists practicing in the area of Modena and Reggio Emilia, one of the areas in Italy most affected by COVID-19. The survey was aimed at highlighting the practical and emotional consequences of COVID-19 emergence on daily clinical practice. Specifically, it assessed dentists' behavioral responses, emotions and concerns following the Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20), as well as the dentists' perception of infection likelihood for themselves and patients. Furthermore, the psychological impact of COVID-19 was assessed by means of the Generalized Anxiety Disorder-7 test (GAD-7), that measures the presence and severity of anxiety symptoms. Using local dental associations (ANDI-Associazione Nazionale Dentisti Italiani, CAO-Commissione Albo Odontoiatri) lists, the survey was sent by email to all dentists in the district of Modena and Reggio Emilia (874 practitioners) and was completed by 356 of them (40%). All dental practitioners closed or reduced their activity to urgent procedures, 38.2% prior to and 61.8% after the DM-10M20. All reported a routinely use of the most common protective personal equipment (PPE), but also admitted that the use of PPE had to be modified during COVID-19 pandemic. A high percentage of patients canceled their previous appointments after the DM-10M20. Almost 85% of the dentists reported being worried of contracting the infection during clinical activity. The results of the GAD-7 (General Anxiety Disorder-7) evaluation showed that 9% of respondents reported a severe anxiety. To conclude, the COVID-19 emergency is having a highly negative impact on the activity of dentists practicing in the area of Modena and Reggio Emilia. All respondents reported practice closure or strong activity reduction. The perception of this negative impact was accompanied by feelings of concern (70.2%), anxiety (46.4%) and fear (42.4%). The majority of them (89.6%) reported concerns about their professional future and the hope for economic measures to help dental practitioners., Competing Interests: The authors declare no conflict of interest.

Background: Tracheostomy is a frequently performed surgical procedure and may be required under emergency, semiurgent, or elective conditions. In maxillofacial surgery, it is indicated in congenital, inflammatory, oncologic, or traumatic respiratory obstruction and prolonged intubation. This article presents a simplified tracheostomy procedure based on anatomic markers that gives the best compromise between minimum invasiveness and safety., Patients and Methods: A retrospective study analyzed the clinical aspects, treatment methods, and clinical course of 198 patients who underwent tracheostomies performed by residents in training under the supervision of surgeons between October 2002 and December 2007 at the Maxillofacial Surgery Department of Carlo Poma Hospital, Mantova, and the Maxillofacial Unit, Head and Neck Department, University of Modena and Reggio Emilia, Italy. Tracheostomies were performed in 127 patients (64.14%) with neoplastic diseases (tumors of the tongue base, tonsils, and oral and pharyngeal regions) and in 71 patients with trauma (35.86%). The patients were followed up for 3 to 65 months., Results: Acceptable clinical healing and outcomes were obtained in all patients. Intraoperative complications occurred in 35 patients (17.7%): bleeding in 32 patients (16.2%) and pretracheal or paratracheal tube placement in 3 patients (1.51%). Postoperative complications after tracheostomy closure included tracheostomy dehiscence in 5 patients (2.52%) and subcutaneous emphysema in 26 patients (13.12%). Tracheostomy dehiscence occurred in 3 patients with neoplasia (1.51%) and in 2 patients with trauma (1.01%). No symptomatic tracheal stenosis developed., Conclusions: The standardized surgical technique presented here reduces the associated surgical risk when the correct anatomic markers are used and important structures are recognized and handled correctly.

A meta-analysis of short-term effects of air pollution on health in eight Italian cities from 1990 to 1999 is presented. Death certificates and hospital admission data as well as daily concentrations of pollutants were collected. The same generalized linear model adjusted for age, day of the week, holidays, influenza epidemics, meteorological variables, and seasonality pattern was fitted to the city data. City-specific model selection was not done. In the meta-analysis, for each outcome, the city-specific estimates for each pollutant were combined using fixed and random-effects models. Hierarchical Bayesian models were use to investigate the effects of PM10 in detail. Each pollutant (SO2, NO2, CO, PM10, O3) was significantly associated with mortality for natural causes. The effect of PM10 on mortality was greater during the warm season and for elderly. A north-south gradient in risk was observed for total natural mortality. The excess risks on hospital admission were modified by deprivation score and by the NO2/PM10 ratio. Results add evidence for an association between air pollution and early mortality or morbidity and support the hypothesis of a synergism between meteorological variables and air pollution.

Introduction: the Italian Meta-analysis of short-term effects of air pollution for the period 1996-2002 (MISA-2) is a planned study on 15 Italian cities, among the larger country towns summing up 9 millions and one hundred thousand inhabitants at 2001 census. HEALTH OUTCOMES DATA: mortality for all natural causes (362254 deaths), for respiratory causes (22317) and cardiovascular causes (146830), and hospital admissions for acute conditions, respiratory (278028 admissions), cardiac (455540) and cerebrovascular (60960), have been considered. Mortality data came from Regional or Local Health Unit Registries, while hospital admissions data have been selected from Regional or Hospital Archives (exclusion percentages range for all admissions between 45% and 82%). For each participating city daily series averaged about 4.3 years, with a minimum of three consecutive years. AIR POLLUTANTS DATA: daily pollutants concentration series (SO2, NO2, CO, PM10, O3) came from air quality monitoring networks of Regional Environmental Protection Agencies, of Environmental Offices of Provinces or Municipalities. Monitors' selection has been done by a working group composed by representatives of monitoring network Agencies. The selection criteria are the representativeness of general population exposure for each specific pollutant, avoiding as possible monitors close to high traffic roads; and the number, quality and location of monitors, selecting around 3-4 monitors with continuous data flow in the period (at least 75% of valid hourly data). The final series has been created averaging over monitors and imputing missing values under proportionality assumptions. Median of Pearson correlation coefficients between pairs of monitors of the each city was 0.62, interquartile range 0.42-0.77., Statistical Methods: A generalized linear model on daily counts of health events has been fitted for each city. Linear pollutant effect has been specified and bi-pollutant models have been fitted for PM10+NO2 and PMO+O3. Temperature has been modelled parametrically using a change point at 21 degrees C and lagged effects. Humidity, day of the week, national holidays and influenza epidemics (using data from the National Surveillance Programs from 1999) are the other considered confounders. An age-specific natural cubic spline on season has been specified with 5 degree of freedom (on average) per year for mortality and 7 degree of freedom per year for hospital admission data. The base model is age-stratified (0-64, 65-74, 75+ years). Gender, age, season specific models have been fitted, too. Five sensitivity analyses have been done, varying the degree of freedom for the seasonality spline and specifying non parametric functions on temperature. Constrained distributed lag models have been fitted on mortality data to study potential harvesting effects. City-specific results have been meta-analyzed by random effects hierarchical Bayesian model. Four different models have been fitted in the sensitivity analyses, assuming different priors on heterogeneity variance and outlier-resistant prior on city-specific effects. Bayesian meta-regressions have been fitted on base model, bi-pollutant and season-specific city-specific results. Attributable deaths have been estimated by Monte Carlo methods using effect, pollutant, baseline rate distributions. Fourteen different scenarios have been considered for PM10 and ten for NO2 and CO, using meta-analitic and posterior city-specific effect estimates, Results: Pollutants effects are reported as percent increase on mortality or hospital admissions for an increase of 10 microg/m3 of SO2, NO2 and PM10, and 1 mg/m3 of CO. We found an increase on mortality for all natural causes associated to increase of air pollutants concentration (for NO2 0.6% 95%CrI 0.3,0.9; CO 1.2% 0.6,1.7; PM10 0.31% -0.2,0.7). Similar findings were found for cardiorespiratory mortality and hospital admissions for respiratory and cardiac diseases. We found no difference by gender. There was a weak evidence of greater effect size in extreme age groups (0-24 months and over 85 years where we found a percent increase in mortality for all natural causes for PM10 of 0.39% CrI95% 0.0,0.8). There was a strong evidence for each pollutant of greater effects in the warm season (1st May-30th September) on mortality and hospital admissions (we found a percent increase in mortality for all natural causes for PM10 in the warm season of 1.95% CrI95% 0.6,3.3). The associations between pollutants concentration and health events were present at different time lags, depending on outcome and exposure. For mortality, the excess risk peaked within few days from the exposure increase (two days for PM10, up to four days for NO2 and CO). Mortality displacement was minor and ended within two weeks. Cumulative effects at fifteen days showed higher risks for respiratory diseases (PM10 1.65% CI95% 0.3,3.0). The results of meta-regressions showed associations between PM10 effects on mortality and hospital admissions, and mortality for all causes (SMR) and PM10/NO2 ratio. The effect modification of temperature was very consistent, and also using bi-pollutant models. Such effect modification was greater during the cold season. We found and overall impact on mortality for all natural causes in the period 1996-2002 between 1.4% and 4.1% of all deaths for gaseous pollutants (NO2 and CO). The estimates were more imprecise for PM10, due to the variability among cities of the effect estimates (0.1%; 3.3%). The limits stated in the European Union directives for 2010 would have been saved about 900 deaths (1.4%) for PM10 or 1400 deaths for NO2 (1.7%) among all the MISA cities, applying posterior city-specific effect estimates.

Background: In recent years, much attention has been given to review reports on the early effects of air pollution on health, measured through daily series of deaths and/or hospital admissions. A number of large planned meta-analyses (in which methods for data retrieval and processing are commonly planned a priori for all participating centers) are on going both in the US and in Europe. The National Mortality, Morbidity and Air Pollution Study included data from 90 US cities, whereas APHEA (Air Pollution and Health, a European Approach) considers data from about 30 european cities. The present paper summarizes methods and findings of MISA, a meta-analysis of data from 8 Italian cities. It belongs to an ad hoc supplement of Epidemiologia & Prevenzione (Epidemiol Prev 2001; 25 (2) Suppl: 1-72), the official Journal of the Italian Association of Epidemiology, which contains a full description of the study. MISA was launched on March 2000, within the project "Statistics, Environment and Health" (GRASPA), funded by the Italian Ministry of Education. Additional support was given by the Authorities of the 8 participating cities (from North to South: Turin, Milan, Verona, Ravenna, Bologna, Florence, Rome and Palermo). DAILY HEALTH DATA: Deaths certificate and hospital admission data have been collected respectively from the Local Health Authority and regional files. The same programme for retrieval of data on selected hospital admissions for acute conditions was used in the 8 cities. Main data are summarized in Table 1. DAILY CONCENTRATION OF POLLUTANTS: Most data were obtained from Regional Environmental Protection Agencies, which are responsible for environmental monitoring since 1993. Verona, Palermo and Milan (1990-94) data were obtained from local sources. Monitors with more than 25% of missing data were excluded. Meteorological data were collected by the same monitors and completed with data from monitors situated in the suburbs or (in Milan and Bologna) in the airport. The monitors were selected by a group of experts to ensure comparability. For SO2 and NO2 daily averages of hourly measurements were used, whereas concentrations of ozone and CO were estimated as the maximum 8 hours moving average. Total suspended particulate or PM10 were measured as 24 hours deposition. All analyses used the whole range of observed values (Table 2). Daily data were considered as missing when more than 25% of hourly data were not available. Missing data in one monitor were imputed as average of data from the remaining monitors weighted by the ratio between the specific monitor's year average and the general year average of all the selected city monitors. Missing data in one day were imputed as average of four days (preceding and following day, the same day of the previous and following weeks). In the city of Florence and Palermo PM10 concentrations were available. For the other cities we applied a conversion factor from PTS to PM10 (0.6 for Turin and 0.8 for all the others) estimated through validation studies. Ozone concentrations were used only where background monitors were available (Turin, Verona, Bologna and Florence) and limited to the warm season (May through September)., Methods: A common protocol for the city-specific analyses was defined on the basis of a structured exploratory analysis. The adopted basic model was a Generalized Additive Model for Poisson data. Effect estimates were age-adjusted (0-64, 65-74, 75+) and formal tests of interaction pollutant-age were conducted. In the first two age groups, indicator variables for seasonality were specified, and cubic splines with fixed number of degree of freedom were specified for the last age group and for all age groups for the morbidity data. Model adequacy was checked by residual analysis and inspection of the partial autocorrelation function. In a sensitivity analysis non linear pollutant effects were considered and overdispersed [table: see text] transitional models were fitted; the analysis was conducted for all lags 0-3 and some distributed lags (0-1, 1-2, 0-3); no multipollutant models were fitted. The same model was fitted to the city data. No model selection was done: Table 3 describes the steps in model building. In the meta-analysis, for each outcome, the estimates for each pollutant and for each city were combined using fixed and random effects models. Heterogeneity of effects was tested according to DerSimonian and Laird. Results were checked using a hierarchical bayesian model, which was used to investigate heterogeneity across cities in a meta-regression phase. Non informative priors were used. Posterior distributions of parameters of interest have been obtained with WinBUGS. 10,000 iterations (excluding [table: see text] the first 2000) were retained, while for the meta-regression 100,000 iterations (excluding the first 4000) were stored. To approximate the marginal posteriors only one sample out of five were used. Achieved convergence was assessed using the Gelman and Rubin approach. In the meta-regression the models specified were the following: [formula: see text] i denotes city, j calendar period (1990-1994; 1995-1999). The first model includes only period as effect modifier, while the second model other potential variables. The ui terms (which do not vary with j) represent city specific random effects., Results: For each pollutant, the meta-analysis detected a statistically significant association with mortality for natural causes. But for ozone, positive associations were commonly found for death and hospital admissions for both cardiovascular and respiratory diseases. Indeed, the only estimates whose lower 95% confidence limit bore a negative sign regarded the association between PM10 and mortality from respiratory diseases. Ozone in the warm season was positively and significantly associated with daily mortality and mortality for cardiovascular diseases whereas other estimates did not reach statistical significance and some were negative (only lag 0-1 for external comparability are reported in Table 4). Risks were highest (up to 4%) for respiratory conditions (Table 4). They were more pronounced at lag 1-2 for mortality, and at lag 0-3 for hospital admissions. Age was an effect modifier for mortality, the elderly being more susceptible. In the random effect meta-analysis, at lag 1-2, excess risks for unit increase of the pollutants at age 75+ and at age 0-64 were respectively: 4.9% and -0.4% for SO2, 1.7% and 0.6% for NO2; 2.3% and 0.2% for CO. Corresponding figures for PM10 at lag 0-1 were 1.1% and 0.2%. The effect of PM10 on mortality [table: see text] was greater during the warm season (2.8% vs 0.8%). A complete analysis is reported in the Italian text. Here we provide some details on the effects of PM10, about which the residual heterogeneity across cities was highest (Table 4). In addition, the epidemiological evidence on the hazards from this fraction of particulate matter is more controversial. Table 5 reports the excess risk estimated through the meta-analysis in 1995-99 for a 10 micrograms/m3 increase of PM10 for some outcomes. Proper prior distributions (overdispersed normal and inverse gamma) were adopted in the final bayesian analyses. The sensitivity of results to the choice of the priors were investigated (we defined proper and improper uniform, student's t), obtaining comparable results. Total natural mortality was significantly heterogeneous across cities (Q = 18.96, 5 df, p < 0.001). City-specific estimates are represented graphically in Fig. 1. As expected, the confidence (credibility) intervals are widest [table: see text] for bayesian estimates, intermediate for those obtained under a random effects model, and narrowest for those found under a fixed effects model. Nevertheless, differences in point estimates are negligible. A North-South gradient in risk is obvious. Table 6 shows, for the cities for which mortality data were available, the improvement in precision and the shrinkage of effect estimates toward the overall mean introduced by the bayesian modelling. In the meta-regression, total mortality and a deprivation score were associated with greater effects. The excess risks on hospital admission were modified by the deprivation score and by the NO2/PM10 ratio. Overall, the risk estimates were greater in the calendar period 1995-99 and there was a North-South gradient, with larger effects in cities located in Central and Southern Italy (Florence, Rome, Palermo)., Conclusions: The meta-analysis of the Italian studies on short-term effects of air pollution in 8 cities, MISA, exhibits the following features: With the exception of Naples, all greatest Italian cities were included; overall a population of 7 million was enrolled. The study protocol was accurate with regard to the selection of hospital admissions for acute conditions. Monitored data of concentration of pollutant were carefully evaluated before their inclusion in the meta-analysis. City specific analyses were carried out according to a common protocol controlling for seasonality, influenza epidemics, age and meterological variables; [table: see text] the protocol derived from a structured exploratory analysis. The meta-analysis was done using fixed and random effects models; a hierarchical bayesian model was fitted in a sensitivity analysis. The heterogeneity of effects across cities was investigated using a hierarchical bayesian model for meta-regression. While mortality data are of good quality, hospital admission data are more problematic. Since the filing criteria for the latter changed around 1995, comparability of results before and after such date is limited. Moreover, hospital admissions rely on availability of beds, the offer of which may be restricted during the warm season. Comparability of pollutant concentration estimates among cities may have been influenced by differences in monitor characteristics. (ABSTRACT TRUNCATED)

To investigate a possible relationship between hepatitis C virus infection and cholestasis of pregnancy, we identified all cases of cholestasis of pregnancy (145/16,271) and hepatitis C virus infection (63/16,271) between January 1992 and December 1997. Serologic screening was performed universally. The rate of cholestasis of pregnancy was greater in women whose hepatitis C virus antibodies were positive rather than negative [15.9% (10/63) vs 0.8% (135/16,208), P < 0.001]. Among women with cholestasis of pregnancy, mean (standard deviation) gestational age at onset of symptoms and at delivery was significantly lower among women whose hepatitis C virus antibodies were positive compared with negative women: 28.9 (3.2) vs 34.3 (3.5) weeks, P < 0.001 and 36.3 (0.9) vs 37.0 (1.6) weeks, P = 0.03, respectively. These findings suggest that early occurrence of cholestasis of pregnancy may be an indication for serologic testing for hepatitis C virus.

The anencephaly is a congenital malformation, characterized by the absence of the cerebral structures and of the skull. In this study we have considered 5 cases of anencephaly, occurred in the decade 1985-1994. All the pregnant women have been interviewed and underwent ultrasonographic evaluation. Four out of 5 pregnant women have voluntarily interrupted pregnancy. In only 1 case, having achieved woman the 40th week of pregnancy, the delivery has been spontaneous: the fetus has died after few hours. The results of this study suggest that, being the anencephaly the most commonly indications for the abortion, would be important to help the women bearers of anencephalic fetuses to consent taking the organs, using them for transplantations on children that necessitate them.

Information on the health condition job related of the population are often collected in specific studies, usually limited over time and concerned with a small part of the general population. Looking at official statistics, sources such as national health surveys (in Europe and in North America) are rich on health data, but often offer little information on job-conditions, and job history. On the other hand, one also can find official sources, mainly concerned with labour and job related topics, in which information related to the health status of the people interviewed are routinely collected. These are the Labour Force Surveys, carried out in the most of developed countries. In the Italian Labour Force Survey (RTFL) the Italian Statistical Institute (ISTAT) quarterly collects information on health-related sick absence, part-time job and unemployment. Data from RTFL of two Italian regions (Lombardy: 1985, '86, '89 and Veneto: 1985, '86) show differentials by age and job-position that are consistent with expectation, encouraging an extensive use of this source for surveillance purposes at the national and regional level.

"The aim of this paper is to study [sex,] age and cause differential mortality in the 95 Italian provinces during the last twenty years...." Tabular data on causes of death are presented and compared for regions in Italy and between Italy and the international community. (SUMMARY IN FRE AND ITA), (excerpt)

This paper describes an analysis of the quality of hospital discharge data stored in an Italian regional registry. Although limited in scope, this analysis sheds some light on the level of quality that users can expect in official health data and describes some factors which can influence such quality. Attention focuses on the accuracy with which official administrators code Diseases of Circulatory System (DCS) in a specified health district, using the discharge diagnosis formulated on the case-notes. Investigation of the data, a random sample of 993 medical records, shows a disturbing level of inaccuracy in the assignment of the primary diagnosis to the (DCS) group and sub-groups, especially when compared with other international experiences. Two factors, namely the type of hospital where official administrators routinely collect the data and the age of the in-patients, are found to significantly influence such inaccuracy. Explanations of these findings are suggested and proposals for the improved accuracy of hospital discharge data are presented.

To investigate the possible causes of relatively low blood gamma-globulin levels (less than or equal to 0.5 gm/dl) during the first year of life, 287 patients less than 1 year of age who were suffering from mild diseases were studied retrospectively. They were divided into two groups, those with a gamma-globulin level less than 0.5 gm/dl and those with a gamma-globulin level greater than 0.5 gm/dl. By reconstructing the diets given, it was found that they had been receiving isocaloric diets that differed only in protein supply: patients with lower gamma-globulin levels received 2.9 gm/kg/day of protein and patients with higher gamma-globulin levels received 4.0 gm/kg/day. Fifty-five healthy subjects were studied prospectively during the first year of life on two isocaloric diets that differed only in their protein content: the first one supplied 2.5 gm/kg/day of protein and the second supplied 4.0 gm/kg/day. At approximately 5, 7, and 10 months of age, hemoglobin, total protein, albumin, globulins, immunoglobulins, and other common blood parameters were measured. Patients on the lower protein diet had a gamma-globulin concentration of less than or equal to 0.5 gm/dl and those on the higher protein diet had a gamma-globulin concentration of greater than or equal to 0.8 gm/dl. Immunoglobulin levels, particularly IgG, were lower in patients on the lower protein diet. The subjects with lower protein intake and lower levels of gamma-globulin and immunoglobulins showed significantly higher morbidity.