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Purpose: COVID-19 associated pulmonary aspergillosis (CAPA) is common and linked with high fatality rates. To assess the impact on the incidence and outcome of CAPA of an antifungal prophylaxis (AFP) we compared two cohorts of COVID-19 patients admitted to intensive care units (ICU) in Brescia, Italy, from January to August 2021. Methods: The study cohort included all mechanically ventilated patients observed between April 2021 and August 2021 with SARS-CoV-2-pneumonia, who received AFP with oral posaconazole (200 mg every 6 h) and nebulized liposomal amphotericin B (50 mg every 2 weeks) from ICU admission to 7 days after discharge or, if applicable, until tracheostomy removal. The control cohort included COVID-19 patients admitted to the same ICU between January and March 2021 who did not receive any AFP. Subjects with CAPA at ICU admission were excluded. Results: We included 270 patients, of whom 64 (23.7%) received AFP. In patients in the study group, CAPA-related mortality was significantly reduced (29% vs. 48% p = 0.04), as well as the incidence of CAPA (3.1% vs 12.1%, p = 0.03). Patients who developed CAPA were older (mean of 70-y-old vs 63-y-old, p < 0.001). One subject discontinued posaconazole due to an adverse reaction. Among the 46 patients who received it, only one patient reached an effective plasma concentration of posaconazole. Conclusion: AFP was associated with reduced incidence and mortality from CAPA and was well tolerated in patients with severe COVID-19. Posaconazole concentrations below the efficacy threshold in almost all patients may be attributable to drug interactions and prompt further studies to define its clinical significance. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that the prevalence of all-variants Alzheimer's disease (AD) and frontotemporal dementia (FTD) both increase with age, even before the age of 65. However, it is not known whether their different clinical presentations all increase in prevalence with age in the same way. Methods: We studied the prevalence of the different clinical presentations of young-onset AD and FTD by 5-year age groups in a population-based study identifying all dementia patients with a diagnosis of AD and FTD and symptoms onset before age 65 in the Modena province, Italy. By using regression models of cumulative occurrences, we also estimated age-specific prevalence and compared the growth curves of the clinical presentations. Results: The prevalence of all-variants AD increased with age, from 18/1,000,000 in the 40–44 age group to 1411/1,000,000 in the 60–64 age group. The prevalence of all-variants FTD also increased with age, from 18/1,000,000 to 866/1,000,000. An estimation of age-specific prevalence functions of each clinical presentation showed that atypical non-amnestic AD and aphasic FTD grew the most in early ages, followed by the behavioural variant of FTD (bvFTD). Then, around the age of 60, amnestic AD took over and its age-specific prevalence continued to increase disproportionally compared to all the other clinical variants of AD and FTD, which, instead, started to decrease in prevalence. Conclusions: Amnestic AD is the clinical presentation that increases the most with advancing age, followed by bvFTD, suggesting that there is a differential vulnerability to the effect of ageing within the same neurodegenerative disease. [ABSTRACT FROM AUTHOR]

Sedum telephium is a succulent plant used in traditional medicine, particularly in Italy, for its efficacy in treating localized inflammation such as burns, warts, and wounds. Fresh leaves or freshly obtained derivatives are directly applied to the injuries for these purposes. However, challenges such as the lack of microbiologically controlled materials and product standardization prompted the exploration of more controlled biotechnological alternatives, utilizing in vitro plant cell cultures of S. telephium. In the present study, we used HPLC-DAD analysis to reveal a characteristic flavonol profile in juices from in vivo leaves and in vitro materials mainly characterized by several kaempferol and quercetin derivatives. The leaf juice exhibited the highest content in total flavonol and kaempferol derivatives, whereas juice from callus grown in medium with hormones and callus suspensions showed elevated levels of quercetin derivatives. The in vitro anti-inflammatory and wound-healing assays evidenced the great potential of callus and suspension cultures in dampening inflammation and fostering wound closure, suggesting quercetin may have a pivotal role in biological activities. [ABSTRACT FROM AUTHOR]

Introduction In advanced basal cell carcinoma (BCC), the issue of whether Hedgehog inhibitors (HHIs) should be stopped or not after clinical complete response (cCR) achievement remains an unmet clinical need. Materials and Methods We conducted a retrospective, multicenter study across 7 Italian dermato-oncology units including patients with BCC who continued vismodegib after cCR between 2012 and 2019. We assessed the relationship between the duration of vismodegib intake (days to cCR [DTCR], days to stop after cCR [DTS], total treatment days [TTD]), and disease-free survival (DFS). Reasons to stop vismodegib were (R1) toxicity and (R2) disease recurrence. The relationship between DTCR, DTS, TTD, and DFS in the whole population and in R1 subgroup was assessed by Pearson's correlation coefficient (P  < .05) and Bayesian statistics (BF10). Results Sixty-eight BCC patients with a median (m) age of 75.5 years (39-100) were included. Most patients were male (N  = 43, 63%), without Gorlin syndrome (N  = 56, 82%) and with head and neck area as primary site (N  = 51, 75%). After cCR, out of 68 patients, 90% (N = 61/68) discontinued vismodegib: 82% (N  = 50/61) due to toxicity (R1), and 18% (N  = 11/61) due to recurrence (R2). Conversely, 10% (N  = 7/68) continued vismodegib until last follow-up. In the whole population (N  = 68), cCR was achieved with a mDTCR of 180.50 days. DFS showed a significant correlation with DTS (P  < .01, BF10 = 39.2) and TTD (P  < .01, BF10 = 35566), while it was not correlated to DTCR (BF10 < 0.1). The analysis of R1 subgroup (N  = 50) confirmed these results. DFS correlated with DTS in all recurrent patients (N  = 38, r  = 0.44, P  < .01) and in the recurrent patients who stopped vismodegib for toxicity (N  = 26, r  = 0.665, P  < .01). DFS was longer when vismodegib was maintained for >2 months after cCR (mDFS > 2 months, N  = 54 vs. ≤ 2 months, N  = 14: 470 vs. 175 d, P  < .01). Conclusions Our retrospective results suggest that HHIs should be continued after cCR to improve DFS in BCC. [ABSTRACT FROM AUTHOR]

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Higher MIND diet adherence corresponded to lower serum selenium concentrations. • Higher MIND diet adherence corresponded to higher urinary selenium excretion. • MIND diet adherence was inversely associated with serum Selenoprotein P. Selenium is a trace element found in many chemical forms. Selenium and its species have nutritional and toxicologic properties, some of which may play a role in the etiology of neurological disease. We hypothesized that adherence to the Mediterranean-Dietary Approach to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet could influence intake and endogenous concentrations of selenium and selenium species, thus contributing to the beneficial effects of this dietary pattern. We carried out a cross-sectional study of 137 non-smoking blood donors (75 females and 62 males) from the Reggio Emilia province, Northern Italy. We assessed MIND diet adherence using a semiquantitative food frequency questionnaire. We assessed selenium exposure through dietary intake and measurement of urinary and serum concentrations, including speciation of selenium compound in serum. We fitted non-linear spline-based regression models to investigate the association between MIND diet adherence and selenium exposure concentrations. Adherence to the MIND diet was positively associated with dietary selenium intake and urinary selenium excretion, whereas it was inversely associated with serum concentrations of overall selenium and organic selenium, including serum selenoprotein P-bound selenium, the most abundant circulating chemical form of the metalloid. MIND diet adherence also showed an inverted U-shaped relation with inorganic selenium and particularly with its hexavalent form, selenate. Our results suggest that greater adherence to the MIND diet is non-linearly associated with lower circulating concentrations of selenium and of 2 potentially neurotoxic species of this element, selenoprotein P and selenate. This may explain why adherence to the MIND dietary pattern may reduce cognitive decline. In this cross-sectional study of 137 nonsmoking blood donors, Mediterranean-Dietary Approach to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet adherence was assessed using a semiquantitative food frequency questionnaire. Selenium (Se) exposure was assessed through diet, urine, and serum. The MIND diet was associated with low circulating levels of Se and specifically of selenoprotein P and selenate (Made using Biorender). [Display omitted] [ABSTRACT FROM AUTHOR]

Aim: Measuring the phenomenon of gambling and Internet addiction, with analysis of attitudes and psychophysical consequences among nurses working in different care settings. Methods: An observational, cross sectional, multicenter study was conducted from April to September 2020. Participants' socio-demographic information, the "Internet Addiction Test" (IAT) scale, and the "South Oaks Gambling Screen" (SOGS) were collected in order to assess the overuse of and whether an individual has a problematic relationship with gambling, respectively. Results: 502 nurses were enrolled in the study. Significant correlations were found (p <.001) between the IAT score and gender, number of years of work experience, job role, educational qualification; and between the SOGS and gender, number of years of work experience, job role and regions of Italy. Conclusions: The study highlighted an emerging social problem, and the results may be just the tip of the iceberg. Given the lack of knowledge of these phenomena and a high percentage of people who suffer from them but are afraid to admit it and get help, this study could also be useful in expanding knowledge and allow more professionals to get help and learn about possible treatments and cures for the resolution of these addictions. [ABSTRACT FROM AUTHOR]

Iron (Fe) status among healthy male and female blood donors, aged 18–65 years, is estimated. General characteristics and lifestyle factors, dietary habits and major one-carbon metabolism-related polymorphisms were also investigated. An explorative cross-sectional study design was used to examine a sample of blood donors attending the Transfusion Medicine Unit of the Verona University Hospital, Italy. From April 2016 to May 2018, 499 subjects were enrolled (255 men, 244 women, 155 of whom of childbearing age). Major clinical characteristics including lifestyle, dietary habits and Fe status were analysed. The MTHFR 677C > T, cSHMT 1420C > T, DHFR 19bp ins/del and RFC1 80G > A polymorphisms were also assayed. Mean plasma concentrations of Fe and ferritin were 16·6 µmol/l (95 % CI 16·0, 17·2) and 33·8 µg/l (95 % CI 31·5, 36·2), respectively. Adequate plasma Fe concentrations (> 10·74 µmol/l) were detected in 84·3 % and adequate ferritin concentrations (20–200 µg/l) was found in 72·5 % of the whole cohort. Among the folate-related polymorphisms analysed, carriers of the DHFR 19bp del/del mutant allele showed lower ferritin concentration when compared with DHFR 19bp ins/del genotypes. In a sample of Italian healthy blood donors, adequate plasma concentrations of Fe and ferritin were reached in a large proportion of subjects. The relationship of Fe status with lifestyle factors and folate-related polymorphisms requires more investigation to clarify further gene–nutrient interactions between folate and Fe metabolism. [ABSTRACT FROM AUTHOR]

Background: Italy was the first country after China to be severely affected by the COVID-19 pandemic, in early 2020. The country responded swiftly to the outbreak with a nationwide two-step lockdown, the first one light and the second one tight. By analyzing 2020 national mobile phone movements, we assessed how lockdown compliance influenced its efficacy.Methods: We measured individual mobility during the first epidemic wave with mobile phone movements tracked through carrier networks, and related this mobility to daily new SARS-CoV-2 infections, hospital admissions, intensive care admissions and deaths attributed to COVID-19, taking into account reason for travel (work-related or not) and the means of transport.Results: The tight lockdown resulted in an 82% reduction in mobility for the entire country and was effective in swiftly curbing the outbreak as indicated by a shorter time-to-peak of all health outcomes, particularly for provinces with the highest mobility reductions and the most intense COVID-19 spread. Reduction of work-related mobility was accompanied by a nearly linear benefit in outbreak containment; work-unrelated movements had a similar effect only for restrictions exceeding 50%. Reduction in mobility by car and by airplane was nearly linearly associated with a decrease in most COVID-19 health outcomes, while for train travel reductions exceeding 55% had no additional beneficial effects. The absence of viral variants and vaccine availability during the study period eliminated confounding from these two sources.Conclusions: Adherence to the COVID-19 tight lockdown during the first wave in Italy was high and effective in curtailing the outbreak. Any work-related mobility reduction was effective, but only high reductions in work-unrelated mobility restrictions were effective. For train travel, there was a threshold above which no further benefit occurred. These findings could be particular to the spread of SARS-CoV-2, but might also apply to other communicable infections with comparable transmission dynamics. [ABSTRACT FROM AUTHOR]

The article discusses research on the association between concentrations of selenium species in cerebrospinal fluid (CSF) and hippocampal volume in individuals with mild cognitive impairment (MCI). Data shows the sociodemographic characteristics of participants and the CSF levels of organic selenoprotein P species compared with inorganic selenate and selenites species. Results revealed imprecise association of hippocampal volume with selenocysteine and selenium-dependent glutathione peroxidase.

Background: The relation between the magnitude of successive waves of the COVID-19 outbreak within the same communities could be useful in predicting the scope of new outbreaks.Methods: We investigated the extent to which COVID-19 mortality in Italy during the second wave was related to first wave mortality within the same provinces. We compared data on province-specific COVID-19 2020 mortality in two time periods, corresponding to the first wave (February 24-June 30, 2020) and to the second wave (September 1-December 31, 2020), using cubic spline regression.Results: For provinces with the lowest crude mortality rate in the first wave (February-June), i.e. < 22 cases/100,000/month, mortality in the second wave (September-December) was positively associated with mortality during the first wave. In provinces with mortality greater than 22/100,000/month during the first wave, higher mortality in the first wave was associated with a lower second wave mortality. Results were similar when the analysis was censored at October 2020, before the implementation of region-specific measures against the outbreak. Neither vaccination nor variant spread had any role during the study period.Conclusions: These findings indicate that provinces with the most severe initial COVID-19 outbreaks, as assessed through mortality data, faced milder second waves. [ABSTRACT FROM AUTHOR]

Acute events in children with sickle cell disease in Italy during the COVID-19 pandemic: useful lessons learned Acute chest, children, COVID-19, Italy, sickle cell disease, Vaso-occlusive crisis Keywords: acute chest; children; COVID-19; Italy; sickle cell disease; Vaso-occlusive crisis EN acute chest children COVID-19 Italy sickle cell disease Vaso-occlusive crisis 851 854 4 09/02/21 20210901 NES 210901 On March 12th 2021 the Italian Government decided to implement a national lockdown in almost all the regions of the country. [Extracted from the article]

Purpose: To define blood status of folate, vitamin B12, vitamin B6, homocysteine, and major one-carbon metabolism-related polymorphisms in healthy, males and females blood donors, aged 18–65 years were evaluated. General characteristics and lifestyle factors were also investigated. Methods: An explorative cross-sectional study design was used to evaluate a sample of blood donors attending the Unit of Transfusion Medicine of the Verona University Hospital, Italy. From April 2016 to May 2018, 499 subjects were enrolled (255 men, 244 women of whom 155 of childbearing age). Major clinical characteristics including lifestyle and dietary habits, B vitamins and homocysteine were analyzed. The MTHFR 677 C>T, cSHMT 1420 C>T, DHFR 19 bp ins/del, RFC1 80 G>A polymorphisms were also determined. Results: Mean plasma concentrations of folate, vitamin B12, vitamin B6 and homocysteine were 14.2 nmol/L (95% CI 13.7–14.8), 271.9 pmol/L (95% CI 262.6–281.5), 51.0 nmol/L (95% CI 48.7–53.4) and 13.5 µmol/L (95% CI 13.1–14.0), respectively. Plasma folate, was adequate (> 15 nmol/L) in 44.7% of all subjects, 39.0% of males and 42.5% of women < 45 years. Similarly, vitamin B12 was adequate (> 350 pmol/L) in 25.1% of all subjects and in 20.3% of men ≥ 45 years. The rare allele frequencies were 0.21 for MTHFR 677TT, 0.11 for cSHMT 1420TT, 0.18 for DHFR 19 bp del/del, 0.20 for RFC1 80AA, and a gene–nutrient interaction was confirmed for folate concentrations according to MTHFR 677C>T and DHFR 19 bp del/del. Conclusion: An Italian sample of healthy blood donors shows that an adequate concentration of plasma folate and vitamin B12 is reached only in a limited percentage of subjects, thus encouraging consideration for specific public health strategies. [ABSTRACT FROM AUTHOR]

Smart farming technologies, such as information and communication technologies, can provide many advantages for farm management. Nevertheless, their diffusion is still limited, especially in mountainous areas. For this reason and considering the crucial role of mountain farming, public policies have begun to increasingly support innovation practices in these areas. The purpose of this study was to investigate how attitudes and the characteristics of farmers and farms influence the use of technological devices (i.e., smartphones, tablets and computers). The case study was set in the rural area of Valtellina in the Italian Alps, where 63 dairy farmers were interviewed. Cluster analysis was used to classify farmers, considering their levels of technophobia and technophilia as well as their perceived obstacles and motivations to use new technologies. Three different classes of farmers were thus identified: technophobes , insecure technophiles and technophiles. The results show that attitudes towards new technologies are affected by a farmer's age, education level, farm size, actual smartphone usage for professional duties, and optimistic behaviour towards the future of the farm. This study supports policy makers in developing tailored policies in support of mountain farmers and service providers, indicating future directions for the design of their products. [Display omitted] • Smart farming technologies, such as ICTs, can provide many advantages for farm management. • Despite the advantages provided by ICTs, their diffusion is still limited, especially in mountainous areas. • Cluster analysis was used to classify farmers considering attitudinal determinants. • Three different segments of farmers were identified: technophobes, insecure technophiles and technophiles. • The poor success of public policies of smart farming may be due to a top-down undifferentiated intervention. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In an aquifer-acquitard system in the subsoil of the city of Ferrara (Emilia-Romagna region, northern Italy) highly contaminated with chlorinated aliphatic toxic organics such as trichloroethylene (TCE) and tetrachloroethylene (PCE), a strong microbial-dependent dechlorination activity takes place during migration of contaminants through shallow organic-rich layers with peat intercalations. The in situ microbial degradation of chlorinated ethenes, formerly inferred by the utilization of contaminant concentration profiles and Compound-Specific Isotope Analysis (CSIA), was here assessed using Illumina sequencing of V4 hypervariable region of 16S rRNA gene and by clone library analysis of dehalogenase metabolic genes. Taxon-specific investigation of the microbial communities catalyzing the chlorination process revealed the presence of not only dehalogenating genera such as Dehalococcoides and Dehalobacter but also of numerous other groups of non-dehalogenating bacteria and archaea thriving on diverse metabolisms such as hydrolysis and fermentation of complex organic matter, acidogenesis, acetogenesis, and methanogenesis, which can indirectly support the reductive dechlorination process. Besides, the diversity of genes encoding some reductive dehalogenases was also analyzed. Geochemical and 16S rRNA and RDH gene analyses, as a whole, provided insights into the microbial community complexity and the distribution of potential dechlorinators. Based on the data obtained, a possible network of metabolic interactions has been hypothesized to obtain an effective reductive dechlorination process. [ABSTRACT FROM AUTHOR]

Estimation of aquifer recharge is key to effective groundwater management and protection. In mountain hard-rock aquifers, the average annual discharge of a spring generally reflects the vertical aquifer recharge over the spring catchment. However, the determination of average annual spring discharge requires expensive and challenging field monitoring. A power-law correlation was previously reported in the literature that would allow quantification of the average annual spring discharge starting from only a few discharge measurements in the low-flow season, in a dry summer climate. The correlation is based upon the Maillet model and was previously derived by a 10-year monitoring program of discharge from springs and streams in hard-rock aquifers composed of siliciclastic and calcareous turbidites that did not have well defined hydrogeologic boundaries. In this research, the same correlation was applied to two ophiolitic (peridotitic) hard-rock aquifers in the Northern Apennines (Northern Italy) with well-defined hydrogeologic boundaries and base-outflow springs. The correlation provided a reliable estimate of the average annual spring discharge thus confirming its effectiveness regardless of bedrock lithology. In the two aquifers studied, the measurable annual outputs (i.e. sum of average annual spring discharges) could be assumed equal to the annual inputs (i.e. vertical recharge) based on the clear-cut aquifer boundaries and a quick groundwater circulation inferable from spring water parameters. Thus, in such setting, the aforementioned correlation also provided an estimate of the annual aquifer recharge allowing the assessment of coefficients of infiltration (i.e. ratio between aquifer recharge and total precipitation) ranging between 10 and 20%. [ABSTRACT FROM AUTHOR]

Periurban farming systems are characterized by the need to adapt the farming practices coping with a modified natural and social environment. Questions are thus posed on the efficient use of the inputs. The purpose of this study is to estimate the technical efficiency and the productivity of periurban farms. To do so, the study employs a data envelopment analysis that properly captures the heterogeneity of the periurban farming system. The sample considered livestock and crop farms, located in the South Milan Agricultural Park, where 50 farms were selected and interviewed. Results show that crop farms are more efficient than livestock farms, but they have a less productive technology. The participation in short food supply chains and the multifunctional agriculture does not affect the levels of technical efficiency of the farms. Policies are thus needed to improve the education level of farmers and to sustain the efficiency of farms that diversify the farm's economy. [ABSTRACT FROM AUTHOR]

The debate on food security has highlighted the connection between periurban farming systems (PFS) and local food systems (LFS) for academic research. Several researchers have called for in-depth analysis of the participation and impact of farmers in LFS, and the systemic innovation perspective can provide relevant analysis of the sustainability of this agro-food system. The objective of the current study is to investigate the integration of PFS into LFS from the systemic innovation perspective, by analysing systemic failures and merits that hinder or promote the contribution of PFS to LFS for farmers and commercial actors. The case study is the LFS of the urban Pisa region in central Italy. Results show that farmers there are adapting to urban pressure, which improves the sustainability of their farming practices. At the same time, commercial actors have a commercial opportunity to include local farmers in their economic strategy. Nevertheless, individual initiatives must be coordinated to support the sustainability of both LFS and PFS. This study thus developed an innovative method to identify systemic failures and merits for farmers and commercial actors to address sustainability strategies at the territorial level. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The burden of anterior cruciate ligament (ACL) injury in professional soccer players is particularly relevant as it represents a potentially career-threatening injury.Hypothesis: Our hypotheses were that (1) injury incidence rate would be similar to that reported in the literature, (2) we would identify a uniform distribution of the injuries along the season, and (3) injury incidence rate would be similar in high-ranked and lower ranked teams, based on final placement in the league.Study Design: Descriptive epidemiological study.Level Of Evidence: Level 4.Methods: Professional male soccer players participating in the Serie A championship league in 7 consecutive seasons (2011-2012 to 2017-2018) were screened to identify ACL injuries through the online football archive transfermarkt.com . Exposure in matches and training were calculated.Results: There were 84 ACL injuries found (mean player age, 25.3 ± 4.2 years). Overall, 25% of ACL injuries were reruptures (15%) or contralateral injuries (10%). ACL incidence rate was 0.4215 per 1000 hours of play during Serie A matches, 0.0305 per 1000 hours of training (rate ratio [RR], 13.8; 95% CI, 8.4-22.7; P < 0.0001), and 0.0618 per 1000 hours of total play. Injury distribution had a bimodal peak, with the highest number of events in October and March. Alternatively, training injuries peaked in June and July. A significantly higher incidence rate was found for the teams ranked from 1st to 4th place compared with those ranked 5th to 20th (0.1256 vs 0.0559 per 1000 hours of play; RR, 2.2; 95% CI, 1.4-3.6; P = 0.0003). A similar finding was found for injury incidence proportion (3.76% vs 1.64%; P = 0.0003).Conclusion: The overall incidence rate of ACL injuries in Italian Serie A was 0.062 per 1000 hours, with a 14-fold risk in matches compared with training. Relevantly, 25% were second injuries. Most injuries occurred in October and March, and an almost 2-fold incidence rate and incidence proportion were noted in those teams ranked in the first 4 positions of the championship league.Clinical Relevance: Knowing the precise epidemiology of ACL injury in one of the most competitive professional football championship leagues could help delineate fields of research aimed to investigate its risk factors. [ABSTRACT FROM AUTHOR]

Objectives: HbS/β+ patients' presence in Italy increased due to immigration; these patients are clinically heterogeneous, and specific guidelines are lacking. Our aim is to describe a cohort of HbS/β+ patients, with genotype‐phenotype correlation, in order to offer guidance for clinical management of such patients. Methods: Retrospective cohort study of HbS/β+ patients among 15 AIEOP Centres. Results: A total of 41 molecularly confirmed S/β+ patients were enrolled (1‐55 years, median 10.9) and classified on β+ mutation: IVS‐I‐110, IVS‐I‐6, promoter, and "others." Prediagnostic events included VOC 16/41 (39%), ACS 6/41 (14.6%), sepsis 3/41 (3.7%), and avascular necrosis 3/41 (7,3%). Postdiagnostic events were VOC 22/41 (53.6% %), sepsis 4/41 (9.7%), ACS 4/41 (9.7%), avascular necrosis 3/41 (7.3%), aplastic crisis 2/41 (4.8%), stroke 1/41 (2.4%), ACS 1/41 (2.4%), and skin ulcerations 1/41 (2.4%). The IVS‐I‐110 group presented the lowest median age at first SCD‐related event (P =.02 vs promoter group) and the higher median number of severe events/year (0.26 events/patient/year) (P =.01 vs IVS‐I‐6 and promoter groups). Promoter group presented a specific skeletal phenotype. Treatment regimen applied was variable among the centers. Conclusions: HbS/β+ is not always a mild disease. Patients with IVS‐I‐110 mutation could benefit from a standard of care like SS and S/β° patients. Standardization of treatment is needed. [ABSTRACT FROM AUTHOR]

Using an input-output framework, the author derives hypotheses on wage differentials based on the assumption that human capital (in this case, education) will explain workers' wage differentials. The hypothetical wage differentials are tested on data from the Italian economy. (RW)

The debate on climate change arose several concerns on the impacts of floods on agriculture and, consequently, on food security. At the same time, the European Floods Directive asks Members States to implement suitable measures to mitigate flood damage on economic activities, including farms. Still, while several analyses were developed to estimate potential flood damages on crops, a gap exists for livestock productions. The purpose of this study is to develop a conceptual model for the assessment of flood economic damages on dairy farms. Results propose a static and a dynamic model of farms recovery actions to re-establish the farming activity, which takes into account all farm components, as well as their interaction. Facing the destruction caused by floods, a first reaction of farmers could be closing the activity, with repercussion on this well-being as well as on farm workers', and on the economy of rural areas. From this perspective, this study wants to provide a first methodological pathway to support farmers in restoring their activity. [ABSTRACT FROM AUTHOR]

Objective: Increased risk for adverse pregnancy outcomes with advancing maternal age has been described but the strength of association remains debated, particularly in presence of confounding factors such as parity, twin pregnancy and pregnancy from assisted reproductive technologies. The aim of this study was to evaluate pregnancy outcomes in a large cohort of women aged over 40 years. The hypothesis was that advanced maternal age may be an independent risk factor for adverse pregnancy outcome.Study Design: We reviewed the clinical records of 56,211 women who delivered at Sant'Anna University Hospital, Turin, Italy, in the period between 2009 and 2015. Of these, 3798 women aged over 40 years were divided into two age groups (40 - 44 years and ≥45 years). Women of any parity, with singleton or twin pregnancies, or with assisted reproductive technology pregnancies were included. Women aged less than 40 years were considered as controls. Primary outcome measures were maternal and perinatal complications. Comparisons were performed using Chi-square test and Fisher's exact test. Univariate analysis and logistic regression analysis were performed to test the possible independent role of maternal age as a risk factor for adverse pregnancy outcome.Results: Maternal age was an independent risk factor for gestational diabetes (age 40-44 years: odds ratios (OR) 2.10, 95% CI 1.80-2.45; age ≥45 years: OR 2.83, 95% CI 1.79-4.46) and early-onset preeclampsia (age 40-44 years: OR 2.10, 95% CI 1.63-2.70; age ≥45 years: OR 3.16, 95% CI 1.68-5.94). The risk for placenta praevia was higher in the women aged 40-44 years (OR 1.87, 95% CI 1.36-2.57). Neonatal outcomes were similar among groups, except for the rate of birth weight less than 2500 g, which was higher in women aged 40-44 years (OR 1.27, 95% CI 1.12-1.42). However, older women showed an overall higher incidence of preterm birth.Conclusions: Maternal age over 40 years is an independent risk factor for adverse pregnancy outcomes, particularly for the mother. Pregnancies in women over 40 years should be considered at risk and carefully monitored with individualized care protocols. [ABSTRACT FROM AUTHOR]

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium.Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients.Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment).Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia.Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents.Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic studies have raised the possibility that some pesticide compounds induce the neurodegenerative disease amyotrophic lateral sclerosis (ALS), though the available evidence is not entirely consistent.Methods: We conducted a population-based case-control study in two Italian populations to assess the extent to which residence in the vicinity of agricultural crops associated with the application of neurotoxic pesticides is a risk factor for ALS, using crop acreage in proximity to the residence as an index of exposure.Results: Based on 703 cases and 2737 controls, we computed an ALS odds ratio of 0.92 (95% confidence interval 0.78-1.09) for those in proximity to agricultural land. Results were not substantially different when using alternative exposure categories or when analyzing specific crop types, with the exception of a higher risk related to exposure to citrus orchards and olive groves in Southern Italy, though based on few exposed subjects (N = 89 and 8, respectively). There was little evidence of any dose-response relation between crop proximity and ALS risk, and using long-term residence instead of current residence did not substantially change our estimates.Conclusions: Though our index of exposure is indirect and subject to considerable misclassification, our results offer little support for the hypothesis that neurotoxic pesticide exposure increases ALS risk. [ABSTRACT FROM AUTHOR]

The relation between meteorological factors and COVID-19 spread remains uncertain, particularly with regard to the role of temperature, relative humidity and solar ultraviolet (UV) radiation. To assess this relation, we investigated disease spread within Italy during 2020. The pandemic had a large and early impact in Italy, and during 2020 the effects of vaccination and viral variants had not yet complicated the dynamics. We used non-linear, spline-based Poisson regression of modeled temperature, UV and relative humidity, adjusting for mobility patterns and additional confounders, to estimate daily rates of COVID-19 new cases, hospital and intensive care unit admissions, and deaths during the two waves of the pandemic in Italy during 2020. We found little association between relative humidity and COVID-19 endpoints in both waves, whereas UV radiation above 40 kJ/m2 showed a weak inverse association with hospital and ICU admissions in the first wave, and a stronger relation with all COVID-19 endpoints in the second wave. Temperature above 283 K (10 °C/50 °F) showed a strong non-linear negative relation with COVID-19 endpoints, with inconsistent relations below this cutpoint in the two waves. Given the biological plausibility of a relation between temperature and COVID-19, these data add support to the proposition that temperature above 283 K, and possibly high levels of solar UV radiation, reduced COVID-19 spread. • We assessed the role of three key meteorological factors on COVID-19 spread. • We modeled the relation of temperature, humidity and solar radiation using cubic spline models. • We adjusted for confounders of individual mobility, seroprevalence status and air pollution. • This study assists in predicting and controlling virus transmission and to target public health interventions. [ABSTRACT FROM AUTHOR]

Background: Preconception care involves health promotion to reduce risk factors that might affect women and couples of childbearing age. The risk factors of adverse reproductive outcomes include recognized genetic diseases in the family or the individual, previous congenital diseases, miscarriage, prematurity, fetal growth restriction, infertility, chronic maternal diseases, lifestyle, and occupational or environmental factors. Effective preconception care involves a range of preventive, therapeutic and behavioural interventions. Although in Italy there are national preconception care recommendations concerning the general population, they are usually encouraged informally and only for single risk factors. At present there is increasing interest in offering a global intervention in this field. The aim of this study was to investigate attitudes and behaviours of Italian women of childbearing age and healthcare professionals regarding preconception health.Methods: We conducted a qualitative study among women of childbearing age and healthcare professionals between February 2014 and February 2015. Five focus groups were held: 2 with non-pregnant women aged 22 to 44 years and 3 with healthcare professionals. Discussion topics included women's questions about preconception health, worries and barriers regarding preconception care interventions, attitudes and behaviours of women and healthcare professionals towards preconception health, women's information sources. In the analysis of the focus groups priority was given to what was said by the women, supplemented by information from the healthcare professionals' focus groups.Results: Fourteen women of childbearing age (8 nulliparae and 6 multiparae) and 12 healthcare professionals (3 nurses, 4 midwives, 5 doctors) participated in the focus groups. The results indicate the presence of many barriers and a lack of awareness of preconception health relating to women, healthcare professionals and policies. Women's knowledge and attitudes towards primary preconception care information are described. The main reference source of information in this field for Italian women seems to be their obstetric-gynaecologist.Conclusions: The study indicates that several barriers influence preconception care in Italy. Moreover, a lack of awareness of preconception health and care among Italian women of childbearing age and healthcare professionals emerges. The findings might contribute to strategies for the implementation of preconception care guidelines. [ABSTRACT FROM AUTHOR]

Alternative and local food supply chains (ALFSCs) have been indicated as drivers of territorial development through increasing the food security at local scale. The aim of the study is to characterize strategies that periurban farmers adopt to contribute to local food provision through ALFSCs. We surveyed a sample of 55 farmers in the urban region of Pisa, Tuscany (Italy). By combining qualitative and quantitative analysis of on-farm surveys, this study characterized three farmers’ strategies, depending on the percentage of production they allotted to local markets: few/passive, intermediate/opportunistic, entire/active. The main factors influencing each strategy were personal and professional bonds, diversification of the commercial network, and the number and the diversification of products sold in ALFSCs. Even though farmers can allocate 100% of their production to ALFSCs, most farmers combine ALFSCs with conventional food chains, suggesting that hybridization has advantages for the sustainability of these farms. Farmers who adopt an opportunistic strategy appeared more dynamic and adaptable to local opportunities and constraints. This analysis will offer empirical evidence about the participation of farmers in ALFSCs and especially about the hybridization between conventional and alternative food chains, contributing to the characterization of the local supply of produce, with benefits for community food security. [ABSTRACT FROM PUBLISHER]

Background We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy. Methods A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing. Results L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046). LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001). Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010). Conclusions Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilispositive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification. [ABSTRACT FROM AUTHOR]

Essential tremor (ET) is one of the most common movement disorders of adults, characterized by postural and kinetic tremor. It often causes embarrassment and more rarely serious disability, requiring treatment. To assess the current state of knowledge on ET therapy and produce recommendations based on the analysis of evidence the authors reviewed the literature regarding pharmacologic and surgical therapies, providing a quality assessment of the studies and the strength of recommendations for each treatment. A committee of experts selected clinical-based questions to guide the search. A systematic literature review was performed to identify all the studies conducted on patients with ET published until September 2010. Articles were classified according to GRADE evidence profile, a system for grading the quality of evidence and the strength of recommendation based on the quality of the studies. The quality of evidence was often rated as 'low' or 'very low' for the studies analyzed. Propranolol, long-acting propranolol, primidone, and topiramate are recommended as first-line therapy, with restrictions for their side effects. Arotinolol, sotalol, ICI 118.551 and LI 32.468 (experimental drugs), zonisamide, gabapentin, alprazolam, clozapine, and olanzapine are recommended as a second-line treatment. Botulinum toxin type A and thalamic deep-brain stimulation are recommended for refractory ET. The results highlight the need of well-designed direct comparison trials aimed at evaluating relative effectiveness and safety of the drugs currently used in clinical practice. Furthermore, additional controlled clinical trials are required to define other possible treatment strategies for ameliorating the management of ET. [ABSTRACT FROM AUTHOR]

Purpose: To describe the epidemiology of obesity in a large cohort of intensive care unit (ICU) patients and study its impact on outcomes. Methods: All 3902 patients admitted to one of 24 ICUs in the Piedmont region of Italy from April 3 to September 29, 2006, were included in this retrospective analysis of data from a prospective,multicenter study. Results: Mean body mass index (BMI) was 26.0 ± 5.4 kg/m²: 32.8%of patients had a normal BMI, 2.6% were underweight, 45.1% overweight, 16.5% obese, and 2.9% morbidly obese. ICU mortality was significantly (P < .05) lower in overweight (18.8%) and obese (17.5%) patients than in those of normal BMI (22%). In multivariate logistic regression analysis, being overweight (OR = 0.73; 95%CI: 0.58-0.91, P = .007) or obese (OR = 0.62; 95%CI: 50.45-0.85, P = .003) was associated with a reduced risk of ICU death. Being morbidly obese was independently associated with an increased risk of death in elective surgery patients whereas being underweight was independently associated with an increased risk of death in patients admitted for short-term monitoring and after elective surgery. Conclusions: In this cohort, overweight and obese patients had a reduced risk of ICU death. Being underweight or morbidly obese was associated with an increased risk of death in some subgroups of patients. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the potential role of CC chemokine receptor 5 (CCR5)Δ32 polymorphism in the susceptibility to and clinical expression of Behçet’s disease (BD) in a cohort of Italian patients.Methods. One hundred and ninety-six consecutive Italian patients satisfying the ISG criteria for BD were followed up for 8 years, and 180 healthy age- and sex-matched blood donors were molecularly genotyped for the CCR5Δ32 polymorphism. A standard microlymphocytotoxicity technique was used to serotype HLA-B51. The patients were subgrouped on the basis of the presence or absence of clinical manifestations.Results. The distribution of the CCR5Δ32 genotype differed between BD patients and controls (P = 0.02). The CCR5Δ32 allele was more common in BD patients than in controls [P = 0.02, odds ratio (OR) 2.28 (95% CI 1.1, 4.8)]. Carriers of the CCR5Δ32 allele (Δ32/Δ32 + CCR5/Δ32) were significantly more common in BD patients than in controls [P = 0.02, OR 2.37 (95% CI 1.1, 5.1)]. Population-attributable risk was 7.1%. In categorizing patients according to gender, the association between CCR5Δ32 polymorphism and BD was similar in females and males (ORs 2.76 and 2.0, respectively). No significant differences were found when the frequencies of clinical manifestations were compared between CC5RΔ32 allele carriers and non-carriers.Conclusion. CCR5Δ32 polymorphism is associated with an increased susceptibility to develop BD. Chemokines may have a role in the pathophysiology of BD. [ABSTRACT FROM PUBLISHER]

Because of bacterial resistance, current antibiotic consumption is reinforced by past use, and future utility is lower. The purpose of this article is to provide evidence on habit and addictive behavior toward antibiotics by exploring variations in the average consumption of antibiotics across 20 Italian regions. Using a balanced panel data set (2000-2009), we estimate myopic and rational addiction models, in which antibiotic consumption depends upon demographic and socioeconomic characteristics of the population, the supply of health care in the community, antibiotic price, and the 'capital stock' of endogenous bacterial resistance measured by past and future consumption. Our empirical evidence shows that past antibiotic consumption stimulates current consumption and is also consistent with the rational addiction hypothesis. The low price elasticity of antibiotic demand suggests that policy measures targeted at antibiotic co-payments may not be effective in controlling antibiotic consumption. There is scope for other policy interventions, such as incentives and information campaigns targeted at doctors. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Lung cancer is a disease with high consumption of health care resources. The aim of this study was to describe hospital costs due to lung cancer care from diagnosis until death or end of the study follow-up, in a cohort of incident cases, by using administrative data. Methods Particular attention was given to the determinants of total costs and the impact of the initial treatment approach on the process of costs accumulation. Incident cases were identified by the local Cancer Registry (January 2000-December 2003) among the residents of Turin (Italy). Per patient hospital care has been determined from administrative databases (outpatient radiotherapy records and hospital discharge records). Costs determinants were identified via a multivariable generalized linear model (GLM), with a Gamma cost distribution and a logarithmic link function. To assess the time effect over the cost accumulation process for non-small-cell lung cancer cases, the same GLM Gamma model was repeated at different follow-up periods. Analyses were stratified by cancer histotype. Results Results evidenced the relevant role of initial patterns of care on the cost accumulation process, with increased midterm costs associated with curative patterns of care. Conclusion The use of administrative data enabled hospital lung cancer care to be described, and related costs to be estimated. [ABSTRACT FROM AUTHOR]

Objective To conduct a long-term, prospective, randomized controlled trial evaluating rituximab (RTX) therapy for severe mixed cryoglobulinemia or cryoglobulinemic vasculitis (CV). Methods Fifty-nine patients with CV and related skin ulcers, active glomerulonephritis, or refractory peripheral neuropathy were enrolled. In CV patients who also had hepatitis C virus (HCV) infection, treatment of the HCV infection with antiviral agents had previously failed or was not indicated. Patients were randomized to the non-RTX group (to receive conventional treatment, consisting of 1 of the following 3: glucocorticoids; azathioprine or cyclophosphamide; or plasmapheresis) or the RTX group (to receive 2 infusions of 1 gm each, with a lowering of the glucocorticoid dosage when possible, and with a second course of RTX at relapse). Patients in the non-RTX group who did not respond to treatment could be switched to the RTX group. Study duration was 24 months. Results Survival of treatment at 12 months (i.e., the proportion of patients who continued taking their initial therapy), the primary end point, was statistically higher in the RTX group (64.3% versus 3.5% [ P < 0.0001]), as well as at 3 months (92.9% versus 13.8% [ P < 0.0001]), 6 months (71.4% versus 3.5% [ P < 0.0001]), and 24 months (60.7% versus 3.5% [ P < 0.0001]). The Birmingham Vasculitis Activity Score decreased only after treatment with RTX (from a mean ± SD of 11.9 ± 5.4 at baseline to 7.1 ± 5.7 at month 2; P < 0.001) up to month 24 (4.4 ± 4.6; P < 0.0001). RTX appeared to be superior therapy for all 3 target organ manifestations, and it was as effective as conventional therapy. The median duration of response to RTX was 18 months. Overall, RTX treatment was well tolerated. Conclusion RTX monotherapy represents a very good option for severe CV and can be maintained over the long term in most patients. [ABSTRACT FROM AUTHOR]

A cross-sectional survey was conducted among a random sample of 449 nurses in Italy, using a self-administered questionnaire to assess knowledge, attitudes, and behaviors regarding evidence-based practice (EBP). A significantly higher level of knowledge was observed among nurses who (a) did not work in medical and surgical wards; (b) believed that the evaluation of the efficacy of the health interventions is needed in their activity; (c) believed that the clinical experience must be combined with the evidence; (d) attended a course about EBP in the last year; and (e) received information from courses and scientific journals. The perceived importance of the application of guidelines and protocols was significantly higher among nurses who (a) worked in medical wards; (b) agreed that the guidelines are useful in identifying and selecting interventions; (c) believed that the evaluation of the efficacy of the health interventions is needed in their activity; (d) believed that the clinical experience must be combined with the evidence; (e) attended a course about EBP in the last year; and (f) received information from courses and scientific journals. Nurses were more likely to have modified their practice in the last year if they attended a course about EBP in the last year and if they often/always read scientific journals and guidelines. While these data were cross-sectional and the response rate was only 49%, the results suggest that continuing education programs are needed for improving nurses’ knowledge and practice of EBP among nurses in Italy. [ABSTRACT FROM AUTHOR]

This study investigates the effects of the corporatization process – i.e., the transformation of a municipal firm into a limited liability company – on the production costs of local public services whose ownership is maintained by the local government. Theoretical analysis predicts that, even without privatization, corporatization is a potentially effective way to improve efficiency (Shleifer and Vishny, 1994; Stiglitz, 2000). We explore this issue by using information on a typical local utility, such as the bus service provided by public transit systems in Italy, which experienced a reform of the governance towards the corporatization structure during the ’90s. The results on a sample of 33 local bus companies over the period 1993-2002 show that, even if public ownership persists, the transformation of a municipal enterprise into an autonomous company – corresponding to the first stage of the corporatization of local utilities in Italy – or into a limited liability company exerts a reducing impact on production costs. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To analyze the role of sociodemographic factors as determinants of the initial pattern of care and survival in incident NSCLC cases. Methods: We linked 2298 incident NSCLC cases, identified by the Piedmont Cancer Registry of Turin (PCRT) with administrative health records to identify the initial pattern of care. Because stage of disease strongly influences pattern of care and prognosis of NSCLC, all the analyses were stratified according to stage (early and advanced). The association between the set of patient''s characteristics and the probability of accessing a specific pattern of care was analysed with a multivariable multinomial logistic regression model. Survival was analysed with the Cox proportional hazard model. Results: In the early stage group, presence of comorbidities, older age and low educational level were all associated with a lower probability of receiving surgery. These same factors, as well as being unmarried, were associated with higher probability of receiving other non-curative care only. The effects of comorbidities and low educational level as barriers to receiving more effective patterns of care were not relevant in the advanced stage group. When controlling for initial patterns of care, in the early stage group, an age older than 75 years and being unmarried were negative prognostic factors, while survival was completely independent from educational level. Among patients with an advanced stage of disease, only comorbidities had a negative impact on survival. Conclusion: Appropriate lung cancer care is affected by sociodemographic factors. Greater attention to social and health programs is recommended to improve the timeliness of diagnosis, the staging of potentially resectable patients, and to implement more comprehensive multidisciplinary evaluations of those who may benefit from curative treatments. [Copyright &y& Elsevier]

The article offers information on a study which compared the effectiveness of early tracheotomy from late tracheotomy in reducing the incidence of pneumonia and increasing the number of ventilator-free and intensive care unit (ICU)-free days. The randomized controlled trial, conducted from June 2004 to June 2008 in Italy, involved 600 adult patients with or without lung infection. Main outcome measures included incidence of ventilator-associated pneumonia, number of ventilator-free days and number of ICU-free days. A detailed discussion on the research findings is given.

Objective. To investigate potential associations between the −463 G/A myeloperoxidase (MPO) promoter polymorphism and susceptibility to, and clinical expression of, Behçet's disease (BD). [ABSTRACT FROM PUBLISHER]

Abstract: One multiplex system for the co-amplification of 12 X-chromosomal short tandem repeats (STRs) DXS7132, DXS8378, DXS6809, DXS7133, DXS6789, DXS7424, GATA172D05, HPRTB, DXS7423, GATA31E08, DXS101, DXS6807 and amelogenin was analysed in a sample of 200 (100 males and 100 females) unrelated healthy individuals living in Northern Italy. The χ 2-test for genotype distribution of the X-chromosomal STRs showed no significant deviation from the Hardy–Weinberg equilibrium (HWE). Allele frequencies between female and male samples were not significantly different in all examined markers. In the kinship cases involving 40 family trios with daughter and 10 father/daughter duos, no mutation was detected. The combined power of discrimination (PDc) of the 12 X-STRs for both females and males was PDc>0.999999. [Copyright &y& Elsevier]

We carried out a multicentre study on 2830 patients with chronic liver disease from 79 liver units (25 in northern, 24 in central and 30 in southern Italy) to evaluate naturally acquired immunity against hepatitis A virus (HAV) in relation to age, sex, geographical area of origin and entity of liver disease, and to define the strategy for specific vaccination. Antibody to HAV (anti-HAV) was detected in 1514 (53.5%) of the 2830 patients tested; the prevalence was 50.4% in males and 59.1% in females. Both in central and southern Italy the prevalence of anti-HAV positive subjects increased with increasing age from 43.3 and 44.7%, respectively, in the 0–30-year-old subjects to 80.1 and 68.3%, respectively, in those aged over 60 years. The overall prevalence was much lower in northern Italy, as were the variations from one age group to another, from 28.4% in the 0–30-year-old subjects to 38% in those aged over 60 years. 40.6% of patients with cirrhosis lacked naturally acquired protection against HAV; this percentage was higher in northern (60.5%) than in central (34.9%, P < 0.0001) and southern Italy (27.6%, P < 0.0001). The high prevalence of patients in Italy with chronic hepatitis or cirrhosis who lack naturally acquired immunity to HAV warrants the implementation of vaccination programmes against hepatitis A in such patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the accuracy of death certificates (DCs) for amyotrophic lateral sclerosis (ALS) in different parts of Italy. Studies based on DC diagnosis for ALS have shown a reduced mortality comparing northern with southern Italy. These data are in contrast with results from other surveys on the incidence of ALS performed in Italy and other countries. Methods: Archives of neurological clinics from northern (Milano, Monza, Pavia, and Bologna) and southern Italy including islands (Napoli, Sassari, Palermo, and Messina) were searched for patients discharged with a diagnosis of ALS in the period 1970–1995. Subjects affected by definite/probable ALS according to the Scottish Motor Neuron Disease Research Group diagnostic criteria were included. DCs were obtained from the vital statistic bureau. True positive rates (TPRs) and 95% confidence intervals (CIs) for proportions were calculated for northern and southern Italy separately. Multiple logistic regression analysis was performed according to gender, age at onset, age and year of death, and interval between onset and death. Results: We found 651 patients affected by definite/probable ALS; 573 of them had died by December 31, 1996. DCs were available for 566 subjects (411 from northern Italy and 155 from southern Italy). TPR was 66.7% (95% CI 61.9–71.2) for northern Italy and 51.6% (95% CI 43.5–59.7) for southern Italy (χ2 = 10.9, p = 0.001). Logistic regression analysis showed an association between a lower accuracy of DCs and the interval between onset of symptoms and death. TPR calculations considering different death periods (1970–1982 and 1983–1996) showed comparable rates of accuracy over time. Conclusions: Mortality statistics based on official death records do not accurately reflect interregional mortality for ALS in Italy.Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

When defining how to implement tendering procedures for the regional bus transportation industry, one of the main problems local authorities have to face is setting the area size to be assigned as franchised monopoly. This paper's aim is to analyse the topic by combining some empirical results and evidence from recent developments in the Italian regional bus industry. The empirical results show that the bus transportation sector is characterized by the presence of economies of density and scale. These results imply that the best strategy for introducing competition in the bus industry is a competitive tendering approach for an area of given dimension and not necessarily a route-by-route tendering. However, it seems that the criterion applied by local authorities in Italy is much more related to political issues—such as jurisdictional boundaries of a municipal or provincial area—than a desire to promote the exploitation of economies of scale and density. [ABSTRACT FROM AUTHOR]

Summary In this study, we have investigated the genetic variability of three Italian cattle breeds, autochthonous of the Tuscany region (Chianina, Maremmana and Mucca Pisana), using the parameters based on probabilities of gene origin: f e , f a and N g . Compared with Chianina (N g =53.9) and Maremmana (N g =79.6), Mucca Pisana was found to be the genetically smaller (N g =10.1) and less diverse population. The genetic variability in Chianina population was lower than in Maremmana probably because of bottlenecks in its pedigree and genetic drift. However, the values found in these breeds were higher than those found in dairy cattle breeds, but lower than those found in beef cattle breeds. [ABSTRACT FROM AUTHOR]

Analyzes the cost structure of the waste collection sector in Italy. Assessment on economies of scale; Definition of the optimal size of the service area; Characterization of the economies of customer density.

The Regional Meteorological Service for the Emilia-Romagna Region manages a network of automatic weather stations equipped with electronic sensors suitable for measuring meteorological parameters. The automatic stations consist of electronic instruments, which are subject to failures at more or less frequent intervals. A summary of their performance is necessary. In this paper, we compare the results of the summary, such as the contiguous absence or simultaneous inactivity of different stations, with theoretical simulations in order to evaluate the nature and recurrence of the failures. A single- and multi-server queue simulation model was also used to evaluate the performance of the data transmission system, so as to optimize the communications system. [ABSTRACT FROM AUTHOR]

Fifty depressed in-patients at two psychiatric units, one in Italy the other in England, were treated with clomipramine, either orally, or intravenously and orally. A comparison of clinical response with plasma levels of clomipramine and its metabolite, desmethylclomipramine, showed clear relationships especially in the case of desmethylclomipramine. In the intravenously-treated group this was linear, in the orally-treated group it was curvilinear. Plasma levels of desmethylclomipramine and administered clomipramine correlate highly. These findings, together with the fact that significant clinical improvement was observed in only 55 per cent of the patients, suggest that titration of the administered dose to obtain more effective plasma levels of the metabolite might improve the clinical response to the drug in some patients. [ABSTRACT FROM AUTHOR]