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The introduction of connected automated vehicles (CAVs) on freeways raises significant challenges, particularly in interactions with human-driven vehicles, impacting traffic flow and safety. This study employs traffic microsimulation and surrogate safety assessment measures software to delve into CAV–human driver interactions, estimating potential conflicts. While previous research acknowledges that human drivers adjust their behavior when sharing the road with CAVs, the underlying reasons and the extent of associated risks are not fully understood yet. The study focuses on how CAV presence can diminish conflicts, employing surrogate safety measures and real-world mixed traffic data, and assesses the safety and performance of freeway interchange configurations in Italy and the US across diverse urban contexts. This research proposes tools for optimizing urban layouts to minimize conflicts in mixed traffic environments. Results reveal that adding auxiliary lanes enhances safety, particularly for CAVs and rear-end collisions. Along interchange ramps, an exclusive CAV stream performs similarly to human-driven ones in terms of longitudinal conflicts, but mixed traffic flows, consisting of both CAVs and human-driven vehicles, may result in more conflicts. Notably, when CAVs follow human-driven vehicles in near-identical conditions, more conflicts arise, emphasizing the complexity of CAV integration and the need for careful safety measures and roadway design considerations. [ABSTRACT FROM AUTHOR]

Pompe disease (PD), also defined as acid maltase deficiency, is a rare autosomal recessive disease that causes glycogen accumulation due to a deficiency of the lysosomal enzyme acid α-glucosidase. An excessive amount of undisposed glycogen causes progressive muscle weakness throughout the body. It particularly affects skeletal muscles and the nervous system, especially in the late-onset phase. Here, we present a clinical case of late-onset PD (LOPD) with normal CK (creatinine kinase) values treated after a misdiagnosis of demyelinating motor polyneuropathy and chronic inflammatory neuropathy. The suspicion of possible fibromyalgia induced the patient to seek a rheumatology consultation, and the investigations performed led to the diagnosis of PD. The patient was investigated for genetic and enzymatic studies. PD was diagnosed using the α-glucosidase assay on DBS. In LOPD, clinical manifestations, such as muscle weakness, exercise intolerance, myalgia, or even high hyperCKemia, often appear as nonspecific and may mimic a wide variety of other muscle disorders, such as limb muscle dystrophies, congenital, metabolic, or inflammatory myopathies. In our case, the patient had CK values in the normal range but with continued complaints typical of PD. An analysis of enzyme activity revealed a pathologic value, and genetic analysis identified the c.-32-13T>G mutation in homozygosis. The association of the pathological enzyme value and mutation in homozygosity with LOPD led to a familial segregation study. Our results contribute to the characterization of PD in Italy and support the importance of rheumatologic attention. This suggests further studies are needed to define the broad clinical and pathological spectrum observed in this disease. [ABSTRACT FROM AUTHOR]

In Italy, a large part of the buildings classified as historical–artistic heritage is in a state of degradation and requires urgent interventions. Among the needs, a reduction in the high energy consumption and an improvement of the indoor comfort are mandatory. The case study of the "Ex Institute of Zoology of Palermo" shows how it is possible to achieve a reduction in energy consumption and preserve the building's historicity through the estimation of energy loads and the subsequent processing. To quantify the energy savings of the structure, it was necessary to follow a few steps, namely an inspection of the building and an evaluation of its consumption. To elaborate a correct energy analysis, the thermal conductance was calculated by considering measurements over a period of 60 days and proceeding with the calculation of the transmittance. The resulting data are imported in the energy model developed with the TERMUS BIM software. In the case study, a potential energy saving equal to 35% of the current energy consumption can be avoided by replacing the lamps with LED ones, installing photovoltaic panels, replacing the heat pumps with a centralized system and the current fixtures with double thermal break fixtures. These interventions are implemented in compliance with the architectural peculiarities. [ABSTRACT FROM AUTHOR]

The experience of third-generation tyrosine kinase inhibitor ponatinib treatment in Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph'+ ALL) patients post-allogeneic transplantation is limited. We retrospectively collected data on 25 Ph'+ ALL patients who were started on ponatinib after allogeneic transplantation between July 2015 and July 2019 from nine transplantation centers in Italy. Ponatinib was given in prophylaxis in five (20%), as pre-emptive treatment in seven (28%), and as salvage therapy in thirteen (52%) patients. It was combined with donor leukocyte infusions in ten patients. Half of the patients (12/25) harbored T315I mutation of BCR/ABL1, while in the remaining mutational analysis was negative or not performed. Among the 20 patients who received ponatinib as pre-emptive/salvage treatment, complete molecular response was achieved in 15 (75%) patients. Estimated overall survival at 2-year post-initiation of treatment in the whole cohort was 65% (respectively 60%, 60%, and 78% for the prophylaxis, pre-emptive, and salvage therapy groups). In patients with T315I-positive mutational status, the estimated 2-year survival was 40%. Fourteen patients (56%) experienced toxicity, requiring temporary or definitive suspension of treatment. In conclusion, treatment of Ph'+ ALL patients with ponatinib after transplantation is effective, although the question of adequate drug dose and treatment duration remains unanswered. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) has been endemic in Italy since 2013. In a multicenter cohort study, we investigated various aspects of KPC-Kp among patients, including 15-day mortality rates and delays in adequate therapy. Most (77%) KPC-Kp strains were sequence types ST512 or ST307. During 2017, KPC-Kp prevalence was 3.26 cases/1,000 hospitalized patients. Cumulative incidence of KPC-Kp acquired >48 hours after hospital admission was 0.68% but varied widely between centers. Among patients with mild infections and noninfected colonized patients, 15-day mortality rates were comparable, but rates were much higher among patients with severe infections. Delays of >4 days in receiving adequate therapy more frequently occurred among patients with mild infections than those with severe infections, and delays were less common for patients with known previous KPC-Kp colonization. Italy urgently needs a concerted surveillance system to control the spread of KPC-Kp. [ABSTRACT FROM AUTHOR]

Background: Several previous randomised controlled trials of dialectical behaviour therapy (DBT) since Linehan's original have shown that it has an advantage over standard care or other psychological treatments, but focus is usually on suicide-related behaviours, and little is known about its effect with offender-patients.Aims: To evaluate DBT with a group of offender-patients in the Italian high intensity therapeutic facilities-the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS), established under the Italian Law 81/2014.Methods: Twenty-one male forensic psychiatric in-patients with borderline personality disorder were enrolled and randomly assigned to 12 months of standard DBT together with all the usual REMS treatments (n = 10) or usual REMS treatments alone (n = 11). All participants completed the same pretreatment and posttreatment assessments, including the Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), and Toronto Alexithymia Scale 20 (TAS-20).Results: Men receiving DBT showed a significantly greater reduction in motor impulsiveness, as measured by the BIS-11, and emotional regulation, as reflected by the DERS total score, than the controls. There were no significant differences between groups in alexithymia scores.Conclusions: Italy has innovative forensic psychiatric facilities with a new recovery-rehabilitation approach, but the ambitious goals behind these cannot be achieved by pharmacology alone. For the first time in clinical forensic settings in Italy, there has been limited access to DBT. This small pilot study suggests this is likely to help ameliorate traits associated with violent and antisocial behaviours, so a full-scale randomised controlled trial should follow. [ABSTRACT FROM AUTHOR]

Aim: Explain the multidisciplinary methodological approach used for the treatment of a post -- surgical peristomal wound Method: Female patient, 17 years old, polytrauma, intubated and underwent tracheostomy. In the post -- operative, presence of a peristomal wound (3 x 3,3 cm), stage III of European Pressure Ulcer Advisory Panel (EPUAP). Treatment: - Debridement: Surgical, autolytic and chemical - Cleansing: Polyhexamethylene Biguanide - Antimicrobial action and exudate management: Azatiractica Indica + Iphyercum Perforatum + Hidrofibra with silver + Silicone foam with silicone border and border support with polyurethane film - Scar care: Elasticizing cream with massage therapy, silicone gel and lymphatic drainage with functional tape (kinesiology taping) - Nutrition: 30 Kcal/Kg; Proteins 1,8 g/Kg; Water 30 ml/Kg - Pain treatment: Lidocaine cream 5%. Results / Discussion: - Wound healing: 6 weeks - Average dressing change: 72 hours - Average pain: VAS = 2 - Scar healing: 6 weeks. Conclusion: Using a multidisciplinary approach to wound healing has proven to be an effective choice. The use of interactive dressings to prepare the bottom of the wound, accelerate neo angiogenesis, granulation, epithelization and reduced healing times. Appropriate nutritional intake allowed the patient not lose weight and supply the wound with the nutrients necessary for healing. The focused use of counseling for motivational support permit to manage the fragile emotional condition of the patient due to an altered perception of his own image which, unavoidably, the wound had generated. Finally, the treatment of the scar with kinesiological tape and silicone gel made it possible to healing the wound with a good aesthetic result. [ABSTRACT FROM AUTHOR]

This study presents a pilot contribution to the new collaborative, multinational study of psychotherapy trainee development that was undertaken by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (see Orlinsky, Strauss, Rønnestad, et al., ). Although the main project is longitudinal in design, this preliminary study investigated cross‐sectional differences between trainees in different years of training and explored the influence of core training experiences—including supervision and personal therapy—on their perceived development as therapists. Using the trainee current‐progress report that was designed for the Society for Psychotherapy Research Interest Section on Therapist Training and Development project, 90 trainees at 4 different 4‐year training programs in Italy provided self‐evaluations of their development and of their therapeutic work experiences. Perceived development included overall change, progress, deterioration, overcoming past limitations, and realization of potential as a therapist. Therapeutic work experiences were assessed using scales of healing and stressful involvement (Orlinsky & Rønnestad, ). Year in training and support in supervision predicted perceived development and healing involvement, whereas experiencing criticism in supervision was associated with stressful involvement. Having had personal therapy, and especially ratings of benefit from personal therapy, was also associated with perceived development and healing involvement. Results are discussed with regard of their implications for psychotherapy training. [ABSTRACT FROM AUTHOR]

The authors discuss the classification and price ceilings of reimbursable drugs in Italy. They find that reimbursable drugs in the country are classified into class A that includes essential drugs and drugs for chronic diseases and class H for hospital care. They comment on the inconsistencies in the country's reimbursable drug classification system, but they agree that this system plays an important role in controling pharmaceutical expenditure.

The author examines access to primary care in the Italian National Health Service (INHS). An overview of Italy's primary health care system is provided as well as the function and services of the INHS. Also discussed are the results of the study on primary care at three northern regions with regard to the public's expectations that arose from political pledges and economic evaluation.

A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in individuals at ultra-high risk for psychosis as compared to help-seeking individuals who screened negative for an ultra-high risk of psychosis. A total sample of 147 adolescents and young adult who were help seeking for emerging mental health problems participated in the study. The sample was divided into two groups: 39 individuals who met criteria for an ultra-high-risk mental state (UHR), and 108 (NS). The whole sample completed the Interpersonal Sensitivity Measure (IPSM) and the Global Functioning: Social and Role Scale (GF:SS; GF:RS). Mediation analysis was used to explore whether attenuated negative symptoms mediated the relationship between interpersonal sensitivity and social functioning. Individuals with UHR state showed higher IPSM scores and lower GF:SS and GF:RS scores than NS participants. A statistically negative significant correlation between two IPSM subscales (Interpersonal Awareness and Timidity) and GF:SS was found in both groups. Our results also suggest that the relationship between the aforementioned aspects of interpersonal sensitivity and social functioning was not mediated by negative prodromal symptoms. This study suggests that some aspects of interpersonal sensitivity were associated with low level of social functioning. Assessing and treating interpersonal sensitivity may be a promising therapeutic target to improve social functioning in young help-seeking individuals. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mechanically assisted cough devices are used in patients with impaired cough to avoid secretion accumulation. We compared 5 mechanically assisted cough devices by bench testing using a breathing simulator and assessed their user-friendliness. METHODS: We measured inspiratory and expiratory airway pressures and peak expiratory flow, the strongest indicator of cough efficacy. We performed 2 bench tests: 1) to ascertain the differences between preset and actual settings in 3 different machines of each mechanically assisted cough device and 2) to assess the effects of varying respiratory impedance and air leaks on performance of the devices. We also evaluated the user-friendliness of the devices by measuring the time required and errors in accomplishing 4 tasks by 10 physicians unfamiliar with mechanically assisted cough devices compared with product specialists from the distributing companies. Physicians also scored the ease of use. RESULTS: Four mechanically assisted cough devices during insufflation and all 5 during exsufflation showed differences between preset and actual airway pressures. All but one device showed uneven actual pressure values between models of the same type. Peak expiratory flow was significantly influenced by the mechanical properties in 2 devices and by air leaks in 4 devices. The median time to accomplish all tasks by the product specialist (10 [interquartile range of 2-29] s) was overall significantly shorter compared with all physicians (from 19 [14-65] to 36 [19 -116] s). The number of procedural errors, but not the perceived ease of use, differed significantly between the devices. CONCLUSIONS: The performance of different mechanically assisted cough devices was erratic and included variance between models from the same manufacturer; it was affected by respiratory system impedance and air leaks. Time and rate of errors for performing procedures were elevated. These findings indicate that the devices are not interchangeable and that the settings should be targeted for each patient with the specific machine being used. Improvements in reliability, performance, and user-friendliness are advisable. [ABSTRACT FROM AUTHOR]

An investigation was carried out on the distribution and biodiversity of steinernematid and heterorhabdtid entomopathogenic nematodes (EPN) in nine regions of Italy in the period 1990–2010. More than 2000 samples were collected from 580 localities and 133 of them yielded EPN specimens. A mapping of EPN distribution in Italy showed 133 indigenous EPN strains belonging to 12 species: 43 isolates of Heterorhabditis bacteriophora, 1 of H. downesi, 1 of H. megidis, 51 of Steinernema feltiae, 12 of S. affine, 4 of S. kraussei, 8 of S. apuliae, 5 of S. ichnusae, 3 of S. carpocapsae, 1 of S. vulcanicum, 3 of Steinernema ‘isolate S.sp.MY7’ of ‘S. intermedium group’ and 1 of S.arenarium. Steinernematids are more widespread than heterorhabditids and S. feltiae and H. bacteriophora are the most commonly encountered species. Sampling sites were grouped into 11 habitats: uncultivated land, orchard, field, sea coast, pinewood, broadleaf wood, grasslands, river and lake borders, caves, salt pan and moist zones; the soil texture of each site was defined and the preferences of habitat and soil texture of each species was assessed. Except for the two dominant species, S. feltiae and H. bacteriophora, EPN occurrence tends to be correlated with a specific vegetation habitat. Steinernema kraussei, H. downesi and H. megidis were collected only in Sicily and three of the species recently described – S. apuliae, S. ichnusae and S. vulcanicum – are known only from Italy and seem to be endemic. [ABSTRACT FROM AUTHOR]

The article discusses the performance-based agreements (PbAs) in Italy. Topics discussed include the interest of payers and manufacturers in PbAs and financial-based agreements (FbAs), the management of PbAs by Italian medicines agency AIFA (Agenzia Italiana del Farmaco), and the implications of the policy to the pharmaceutical sector.

This multicenter, prospective, observational study assessed the global economic impact of HIV care in a large cohort of HIV-infected children and adolescents in Italy. Three pediatric departments of reference participated on a voluntary basis. Centers were asked to enroll all their children during the period April 2010–March 2011. At enrollment, a pediatrician completed a questionnaire for each patient, including the type of service at access (outpatient consultation or day hospital), laboratory tests, instrumental examinations, specialists' consultations, antiretroviral therapy and opportunistic illness prophylaxis. Eligible patients had a confirmed diagnosis of HIV infection caused by direct vertical maternal-fetal transmission, their age ranging from 0 to 24 years. Since patients routinely have quarterly check-ups in all three centers, we adopted a three-month time horizon. Health-care services were priced using outpatient and inpatient tariffs. Drug costs were calculated by multiplying the daily dose by the public price for each active ingredient. A total of 142 patients were enrolled. More than half the patients were female and the mean age was 14 years, with no significant differences by center. There were substantial differences in health-care management among the three centers, particularly as regards the type of access. One center enrolled the majority of its patients in day-hospital and prescribed a large number of clinical tests, while children accessed another center almost exclusively through outpatient consultation. Drug therapy was the main cost component and was very similar in all three centers. The day-hospital was the second highest cost component, much higher than outpatient consultation (including examinations), leading to significant differences between total costs per center. These findings suggest that a recommendation to the Italian National Health Service would be to use more outpatient consultation for patients' access in order to increase their efficiency in treating pediatric HIV infection. [ABSTRACT FROM PUBLISHER]

The article looks at 2012 health reforms in Italy related to liberalization and competition in the pharmaceutical industry, focusing on the impacts of community pharmacy deregulation on patients and the Italian National Health Service (INHS). The reforms roll back some restrictions on number of pharmacy licenses, hours of operation, and accessibility of non-prescription drugs. Other topics include pharmacy laws of other European Union countries, drug supply and demand, and INHS reimbursement.

The article presents the author's views on the Human Papillomavirus (HPV) vaccine prices in Italy. He comments that the coverage of three screening programmes were listed by the Italian Ministry of Health (MoH) recently. He remarks on two linear regressions conducted to examine the correlation between prices, timing of tenders and volumes purchased.

Teratoma is the most common germ cell tumour in childhood; mature (MT) and immature teratomas (IT) are benign tumours, but if they recur, they can be in some cases malignant. The aim of this paper is to evaluate Italian patients with MT and IT enrolled from 1991 to 2001, in a prospective multicentric study. One hundred and eighty-three patients, observed in 15 Italian Centers of Paediatric Oncology and three Paediatric Surgical Units were enrolled. Clinical data, treatment and results were all analysed. Initial evaluation and subsequent follow up included clinical examination, tumour markers and imaging procedures. Surgical resection was recommended for all the tumours. Histology was centrally reviewed and IT was classified as grading 1–3. Chemotherapy (CT) with Vinblastine, D-actinomycin and cyclophosphamide was indicated for extra-testicular IT grade 2 or 3. MT was diagnosed in 127 patients (93 F and 34 M, age 1–192 months, median 24): 58 patients had gonadic tumour (23 testicular, 35 ovaric), 69 extragonadic (45 sacrococcygeal, 11 mediastinic, 7 retroperitoneal, 6 in other sites). A complete resection was performed in 117 patients, a partial resection in eight patients and biopsy in one. IT was diagnosed in 56 patients (34 F, 22 M, age 1–168 months, median 7). The T grading was 1 in 14 cases, 2 in 26, 3 in 16; 28 had gonadic T (17 ovary, 11 testis), 28 extragonadic (sacrococcygeal 19, mediastinic 3, retroperitoneal 2, other sites 4). CT was administered in eight patients; 15/182 patients relapsed (1 in a metastatic site) and in 5/15 the relapse showed malignant histology. Seven MT (5.5%) relapsed (five sacrococcygeal, one retroperitoneal, one mediastinic): surgery at diagnosis had been complete in five and with residual in two; the relapse was malignant in two patients with sacrococcygeal (sc) tumours, who had a complete resection and a partial resection respectively. Eight IT (14.2%) relapsed (four ovary, three sc, one retroperitoneal). The initial surgical resection had been complete in one, with residual in six, and a biopsy had been performed in one. A malignant recurrence occurred in two patients with sc tumours (after partial resection in one and after biopsy + CT in one) and in one patient with ovarian IT after a partial resection. All the patients underwent surgical excision of the recurred mass; CT according to Protocol for Malignant GCT was administered to those who had malignant recurrence; 122/126 patients with MT and 53/56 with IT are alive without disease with a follow up of 8–144 months (median 56). Two patients with malignant relapse (one with sc MT, one with sc IT) died because of the progression of the disease. Another two died due to severe malformations (one MT, one IT) and three were lost to follow up (two MT, one IT). The overall survival (OS) at 10 years is 98% (95% CI 93.9–99.4); the event free survival (EFS) is 90.4% (95 CI 84.8–94.0). At Cox analysis no significant difference in EFS was found regarding age and site of the primary tumour, while females ( P = 0.011), patients with grade 1–3 histology ( P = 0.025) and patients with incomplete resection appeared at higher risk of death or relapse ( P < 0.001), with a seven, three and eightfold increase in risk, respectively. Our data showed that incomplete resection and female gender are important risk factors for relapse or death, more so than IT histology. The number of patients treated with CT is not sufficient to evaluate the efficacy of CT in avoiding malignant relapse. [ABSTRACT FROM AUTHOR]

A reversed-phase HPLC method was utilized for Ocrhratoxin A (OTA) determination in 23 white and red wine samples produced in the year 2000. All were come from some vineyards, treated with different pesticides, located in three Italian regions. Analytical methods included commercial immunoaffinity columns and a HPLC system equipped with a RF detector. The sensitivity of the analytical method was 0.01 ng ml−1. Values of OTA found in wine samples show that OTA is more frequently detected in red than in white wines. In fact, all red wine samples were contaminated. The OTA levels reported in this work are comparable with those reported for mycotoxin in red wine. Moreover, the different contents of Ochratoxin A in the wines can be considered an efficiency index of pesticides used. [Copyright &y& Elsevier]

Presents a study which assessed the management of benign prostatic hyperplasia (BPH) in southern Italy in 1997 and 1998. Tools used in the diagnosis of BPH; Rate of surgical treatment in Sicily and Calabria as opposed to medical therapy; Mean hospital stay in the study.

• Combined Heat, Cooling and Power plants are proposed as retrofit solutions for improving energy efficiency of commercial buildings. • A big Do It Yourself shop located in the northern part of Italy was assumed as a case study. • The analysis is based on real energy consumption data available from ad-hoc energy audits. • A flexible profit-oriented management strategy is applied for operating the CHCP plant. • Results showed that CHCP systems could help to reduce energy consumptions and greenhouse gas emissions in the commercial sector. Commercial buildings play a key-role in the energy consumption of the building sectors. Recent statistics have shown that as the number of commercial buildings is continuously increasing, their effects on energy consumption are expected to grow. These buildings are characterized by high energy demand mainly due to lighting and HVAC requirements. Rooms of energy saving exist by considering that: (i) electricity demands and HVAC requirements occur simultaneously during the day and (ii) both demands are currently satisfied by using separate energy systems. It is apparent that the adoption of polygeneration systems could represent a valid solution to achieve energy savings. To this aim, the paper investigated the profitability of a trigeneration system for commercial buildings, considering a big Do It Yourself shop located in the northern part of Italy, as case study. The analysis was based on (i) energy consumption data collected by energy-audits and (ii) a profit-oriented management strategy for the trigeneration systems proposed in literature. Results showed that trigeneration represents a profitable energy conversion system thanks to revenues achieved by selling surplus electricity and the support of financial mechanism for " High-Efficient " eligibility. In comparison with the currently adopted energy conversion systems, important reductions in energy consumption and CO 2 emissions are observed. [ABSTRACT FROM AUTHOR]

• Analysis of ventilation systems is presented, comparing three DIY stores with different HVAC plants and climates. • A brief review on retrofit solutions in non-residential building sector is performed. • The economic profitability of three new different retrofit hypotheses for each store and climate is evaluated. • A comparison between the less attractive retrofit solution and most widely adopted retrofit solution is provided. • A comparison between international standards for ventilation systems design is provided. This paper investigates energy saving measures for the ventilation system of large shopping centers. This kind of buildings is characterized by high yearly energy consumptions, because of the high level of operating hours and the frequent use of obsolete technologies. In the analyzed case studies, three big Do It Yourself (DIY) shops, located in Italy, are considered. Two different approaches are considered, they are aimed at reducing the annual energy consumption for the indoor air exchange of the sales area. The first considered retrofit solution consists in the installation of heat recovery exchangers, reducing the energy demand for the air thermal treatment without changing the airflow value. In the second scenario, smart air quality sensors are inputs for the modulation of the air exchange rate according to the actual requirement for indoor air quality. In a third scenario, the application of both retrofit solutions is considered. For each scenario, the paper reports the yearly energy savings, the avoided CO 2 emissions and cost saving indicators. Furthermore, as the three shops are equipped with different heating systems and are located in different parts of Italy, a technological and climatic comparison is provided. [ABSTRACT FROM AUTHOR]

Background: Functional Pain (not detectable organic cause) is often associated with psychological problems and, according to literature, it can lead to severe manifestations. The purpose of the study was to investigate the correlation between functional pain and psychological disagreement, in a series of school students. Methods: An observational questionnaire-based study was performed. A questionnaire was given to a group of students of primary school; the following data were collected in the questionnaire: a) sex and age; b) functional pain; c) relation with relatives, teachers and schoolfellows: d) school failure. Statistical methods: P-value of concordance test and P-value of correlation have been performed with MINITAB 15.1 software. Results: Eight hundred nine students, 354 females, 455 males, median age 14 years, participated to the study. Functional Pain was referred from 537/809 students (66%): 265 Females, 272 males: p = 0.155. The difference between the number of pain episodes in females vs. males was statistically significant (p = 0,511), as pain intensity vs. the number of episodes in females (p = 0.001). The most frequent location of pain was abdomen in females, limbs in males. Psychological disagreement was referred from 513/809 students (63%) (260 females; 253 males: p = 0,150). Psychological disagreement was reported with parents (19); siblings (22); other relatives (18); teachers: 42, schoolfellows: 366, relatives as well as school fellows: 46. The correlation between disagreement and functional pain in all the students included in the study was statistically significant (p < 0.001). Conclusions: most students reported psychological disagreement and pain. The most frequent cause of disagreement was schoolfellows' behaviour. The study shows a student's lack of discussing of their problems with parents, teachers, peer. According to literature, confiance would be a useful treatment for avoiding psychological disagreements and functional pain. [ABSTRACT FROM AUTHOR]

Studying a patient with Pompe disease (PD) is like opening Pandora's box. The specialist is faced with numerous clinical features similar to those of several diseases, and very often the symptoms are well hidden and none is associated with this rare disease. In recent years, scientific interest in this disease has been growing more and more, but still no symptom is recognized as key to a correct diagnosis of it, nor is there any specific disease marker to date. New diagnostic/therapeutic proposals on disease allow for the diffusion of knowledge of this pathology for timely diagnosis of the patient. Due to unawareness and difficulty in diagnosis, many adults with PD are diagnosed with great delay. In this article, we report and discuss current knowledge of PD and provide new data from work conducted on a cohort of 2934 Italian subjects recruited in recent years. A genetic analysis of the GAA gene was performed on patients with significant clinical signs and pathological enzyme activity to define the genetic profile of subjects. This identified 39 symptomatic PD subjects with low acid alpha-glucosidase enzyme activity and the presence of two causative mutations in GAA gene regions. Furthermore, 22 subjects with genetic variants of uncertain significance (GVUS) were identified.

This paper gives an overview, in the era of regionalization, of vaccination planning and vaccine price management in the Italian National Health Service. In particular, we analyse the current National Vaccination Plan (NVP) and end with two "case studies" of the latest entries in the Italian vaccination calendar, comparing HPV and PCV vaccines, the most expensive ones in Italy at present. The present NVP put an end to the long period without official documents for vaccination planning, mainly reflecting the controversial relationships between the national and regional tiers. However, this document is not really useful for planning from the health professionals' point of view, lacking epidemiological information. Thorough systematic assessment of the new, expensive vaccines is becoming a real priority in the light of current financial difficulties. In this perspective, the two examples discussed have given different results so far, starting from a heterogeneous situation of potential market competition.

We assessed the actual implementation and achievements of regional HTA in Italy. We conducted a web-based analysis (updated until July 2012). Six key elements were identified: availability of official documents, existence of a specific workgroup, involvement of external organizations, formal funds for HTA, publication of HTA reports, and membership of HTA networks. Then, we searched all HTA reports retrieved by key words to analyze whether their contents included clinical efficacy, economic evaluation, legal issues, ethics and organization. Two researchers analyzed the information separately, as a double check. Sixteen regions have formally established a structured workgroup inside their organizations. Specific funding for HTA activities could be traced in six regions, web-available reports only in four. Around 91% of the total reports concerned drugs. Contents mostly focused on epidemiological and clinical issues, economic evaluation was often restricted to a brief analysis of costs. Only a few reports mentioned organizational implications; ethical, legal and social issues were lacking. This survey showed a very uneven picture of HTA in the Italian regions. As expected, not all the regions were able to perform HTA, probably on account of their wide differences in size, tradition and skills in the health care field., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)