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The Coping Power Program is an evidence-based intervention for children identified to be at risk for developing externalizing behavioral problems. The Coping Power Program has been adapted to universally prevent behavioral problems in school-aged children. This study sought to test the efficacy of this adaptation, the Coping Power Universal program, on preschoolers' behavioral difficulties and pre-academic skills. Teachers delivered the intervention in their classes. The study included a sample of Italian children (N = 250, 125 boys) with a mean age of 4.50 years (SD = 0.50) at the beginning of the study. Classrooms of these children were randomly assigned to receive either the intervention or the Italian preschool standard curriculum. Measures included a questionnaire and objective and standardized measures for numerical intelligence and metaphonological skills delivered by a psychologist to the preschoolers. Classes in which teachers applied the Coping Power Universal program showed lower problematic behaviors and higher pre-academic skills than those in which teachers followed the standard curriculum only. Although further studies are still needed, the current findings showed that the Coping Power Universal program can be adapted for preschoolers with good results. Implications for practice, methodological limitations, and directions for future research are reviewed.

Long-span structures such as school gyms and sports centres are often used by the Italian Department of Civil Protection as post-catastrophe shelters or headquarters. The Emilia 2012 earthquake drew the attention of the department to this type of structure due to the damage that many of these buildings suffered. In this work, a dataset of 101 timber structures was analysed based on a simplified methodology that detects the major vulnerabilities in long-span timber roofs in order to help plan further investigations and retrofit interventions. Using fast and straightforward approaches, the elements most vulnerable to seismic action were analysed quantitatively and qualitatively. Quantitative evaluation of the vulnerabilities was achieved by applying the Italian Building Code. The aspects not considered in the quantitative evaluation were assessed through qualitative parameters inspired by damage identification forms (e.g. the AeDES form). The analysed structures are located near the epicentres of the last strong earthquakes that struck Italian territory: Abruzzo in 2009, Emilia in 2012 and central Italy in 2016. Damage and retrofits, identified by interviewing owners, designers and builders, showed a good correlation between the real behaviour shown by the surveyed structures and the vulnerabilities detected using the simplified methodology. [ABSTRACT FROM AUTHOR]

Introduction: Repolarization dispersion in the right ventricular outflow tract (RVOT) contributes to the type‐1 electrocardiographic (ECG) phenotype of Brugada syndrome (BrS), while data on the significance and feasibility of mapping repolarization dispersion in BrS patients are scarce. Moreover, the role of endocardial repolarization dispersion in BrS is poorly investigated. We aimed to assess endocardial repolarization patterns through an automated calculation of activation recovery interval (ARI) estimated on unipolar electrograms (UEGs) in spontaneous type‐1 BrS patients and controls; we also investigated the relation between ARI and right ventricle activation time (RVAT), and T‐wave peak‐to‐end interval (Tpe) in BrS patients. Methods: Patients underwent endocardial high‐density electroanatomical mapping (HDEAM); BrS showing an overt type‐1 ECG were defined as OType1, while those without (latent type‐1 ECG and LType1) received ajmaline infusion. BrS patients only underwent programmed ventricular stimulation (PVS). Data were elaborated to obtain ARI corrected with the Bazett formula (ARIc), while RVAT was derived from activation maps. Results: 39 BrS subjects (24 OType1 and 15 LTtype1) and 4 controls were enrolled. OType1 and post‐ajmaline LType1 showed longer mean ARIc than controls (306 ± 27.3 ms and 333.3 ± 16.3 ms vs. 281.7 ± 10.3 ms, p = .05 and p < .001, respectively). Ajmaline induced a significant prolongation of ARIc compared to pre‐ajmaline LTtype1 (333.3 ± 16.3 vs. 303.4 ± 20.7 ms, p < .001) and OType1 (306 ± 27.3 ms, p < .001). In patients with type‐1 ECG (OTtype1 and post‐ajmaline LType1) ARIc correlated with RVAT (r = .34, p = .04) and Tpec (r = .60, p < .001), especially in OType1 subjects (r = .55, p = .008 and r = .65 p < .001, respectively). Conclusion: ARIc mapping demonstrates increased endocardial repolarization dispersion in RVOT in BrS. Endocardial ARIc positively correlates with RVAT and Tpec, especially in OType1. [ABSTRACT FROM AUTHOR]

Purpose: To examine the construct validity of the session rating perceived exertion (s-RPE) assessed with the Borg CR100 scale to measure training loads in elite soccer and to examine if the CR100 is interchangeable and can provide more-accurate ratings than the CR10 scale. Methods: Two studies were conducted. The validity of the CR100 was determined in 19 elite soccer players (age 28 ± 6 y, height 180 ± 7 cm, body mass 77 + 6 kg) during training sessions through correlations with the Edwards heart-rate method (study 1). The interchangeability with CR10 was assessed in 78 soccer players (age 19.3 ±4.1 y, height 178 ± 5.9 cm, body mass 71.4 + 6.1 kg) through the Bland-Altman method and correlations between change scores in different sessions. To examine whether the CR100 is more finely graded than the CR10, the proportions of responses corresponding to the verbal expressions were calculated (study 2). Results: Individual correlations between the Edwards method and s-RPE were large to very large (.52-85). The mean difference between the 2 scales was-0.3 ± 0.33 AU (90% CI -0.41 to -0.29) with 95% limits of agreements (0.31 to -0.96 AU), Correlations between scales and between-changes scores were nearly perfect (.95 and .91-.98). Ratings corresponding to the verbal anchors were 49% in CR10 and 26% in CR100. Conclusions: The CR100 is valid for assessing the training load in elite soccer players. It can be used interchangeably with the CR10 and may provide more-precise measures of exercise intensity. [ABSTRACT FROM AUTHOR]

Churches struck by the earthquake sequence of 2016–2017 in Central Italy confirmed their seismic vulnerability, significantly higher than the one of other unreinforced masonry structures. This resulted in a much wider area affected by significant damages to churches, which were characterised by a rich variability of materials, typologies, dimensions and styles. In the area where significant damages were observed for ordinary buildings, most of the churches exhibited total or partial collapses. The time sequence of the main shocks helped in preventing casualties in churches although the collapse of a bell-gable in Accumoli caused victims in a neighbour house during the first event of August 24th, 2016. Damage surveys to churches were carried out on more than 4000 buildings, in a land area of about 30 000 km2 from September 2016 to May 2017. The data collected during the post-earthquake surveys represent a valuable source of information for better understanding the vulnerability of these structures as well as the effectiveness of past retrofitting interventions. Some examples are reported to show both damage progression due to the cumulated effect of repeated shaking and state-of-the-art strategies for short-term countermeasures. [ABSTRACT FROM AUTHOR]

We aim to provide an explanation for the combination of the relatively low female participation rates and lowest-low fertility levels in Italy. Starting from the assumption that childbearing decisions also depend on uncertainty about future employment, income, and wealth, we empirically assess how fertility intentions are affected by job instability, which may severely compromise the employment stability of workers, and economic disadvantages in terms of household income and wealth, which may imply insufficient means to deal with potential adverse future events, thereby generating in the household feelings of anxiety and economic insecurity. We show that the instability of women's work status (i.e., the holding of occasional and precarious jobs) significantly discourages the decision to attempt having a first child. Low levels of household wealth significantly and positively influence the decision to postpone attempting a first child. The chances of further childbirth are significantly and negatively influenced by household income insecurity. [ABSTRACT FROM AUTHOR]

In this work an integrated procedure for the evaluation of the seismic vulnerability of bridges included in the transportation network and a rational resource allocation for retrofitting with the aim of minimizing the consequences of an earthquake is shown at a network level. Both normal service and post-earthquake emergency conditions are considered as possible scenarios. The final result consists in global delay in the network versus seismic action occurring time. An iterative procedure finally defines the priority for optimal budget allocation for retrofitting. The procedure has been tested on a wide bridge network located in the North-eastern part of Italy. [ABSTRACT FROM AUTHOR]

Traffic patterns increasing and the degradation of existing railway steel bridges has lead to the need of an assessment of their remaining fatigue life, and deciding whether to retrofit or supply structure replacement. This paper deals with the structural assessment of an actual case study, the Adige Bridge, which connects the Rovigo and Padua provinces in northern Italy. The bridge has been in service since 1886 and the overall length is about 161m through three spans. As a reference the innovative procedures to estimate the remaining fatigue life of bridges outlined in the JRC-ECCS document Assessment of Existing Steel Structures: Recommendations for Estimation of Remaining Fatigue Life, has been applied for the case study, together with other codes and technical instructions. Stress data, obtained by a 3D finite element model, were used to estimate the remaining fatigue life. Assessment results, obtained by considering different traffic estimations, point out that most of the identified critical details have an infinite remaining safe life, but at the same time some members appear critical. Appropriate retrofitting criteria are proposed to support the designer in common damage situations. [ABSTRACT FROM PUBLISHER]

This article focuses on the effects of the earthquake which struck the Abruzzo region (Central Italy) on April 6, 2009, causing considerable damage to many ancient buildings, particularly churches. During the emergency after the earthquake, many churches and other historical monuments (towers, city walls, large town houses, etc.) were surveyed, according to first-level damage survey forms for Cultural Heritage buildings, by multidisciplinary working groups composed of experts from several Italian institutions (Universities, Ministry for Cultural Heritage, Fire Brigade, etc.). This article presents a statistical study on the information collected by the University of Padova during the surveys, which was later inserted and organized in a database, and illustrates data on damage assessment of the buildings in question. It also presents an intuitive overview of the seismic effects on several churches, allowing not only better understanding of the response of these structures to this particular earthquake, but also correlating data on it with its effects on the churches. [ABSTRACT FROM AUTHOR]

Abstract: This paper argues that the evaluation of a society''s economic well-being should account for the employment risk associated with being a temporary worker and for the relative income loss of young generations with respect to older ones. We show that the inclusion of new measures of both these aspects in the IEWB almost halves economic well-being growth rates in Italy over the 1995–2007 period, with a larger reduction in Lombardy (the leading Italian region), where the incidence of the private sector is higher. In both areas well-being advanced at a significantly lower rate than GDP. [Copyright &y& Elsevier]

This paper carries out an investigation into the socio-economic determinants of childbearing decisions made by couples in Italy. The analysis accounts for the characteristics of both possible parents. Our results do not support established theoretical predictions according to which the increase in the opportunity cost of motherhood connected to higher female labour participation is responsible for the fall in fertility. On the contrary, the instability of women's work status (i.e. having occasional, precarious, and low-paid positions) is revealed as a significant dissuasive factor in the decision to have children. Couples in which there is an unemployed woman are less likely to plan childbearing as well. Other relevant explanatory variables are women's age, men's work status and education, women's citizenship, marital status and perceived economic well-being. [ABSTRACT FROM AUTHOR]

Aims Despite the American Society of Echocardiography (ASE)/European Association of Echocardiography (EAE) recommended the use of left ventricular (LV) mass to diagnose left ventricular hypertrophy (LVH), several laboratories continue to use only the septal thickness by M-mode because it appears easier to measure. Aim of the study was to investigate the discrepancy between the categorization of LVH severity based on measurement of septal thickness and indexed LV mass and the relative prognostic utility of these two methods. Methods and results Observational cohort study. Unselected adults (>18 years) referred to the echocardiography laboratory for any indication had septal thickness and LV mass measured by the ASE/EAE formula using LV linear dimensions indexed to body surface area. LVH was categorized as absent, mild, moderate, and severe according to the ASE/EAE guideline sex-specific categorization cut-offs for septal thickness and LV mass. Follow-up for death was obtained from the national death index. A total of 2545 subjects (mean age 61.9 ± 15.8, 53% women, mean diastolic septal thickness 10.3 ± 2.2 mm, and mean indexed LV mass 107.5 ± 37.3 g/m2) were enrolled. Agreement between the two methods in classifying LVH degree across the four categories was 52.6% (Kappa = 0.29, 95% confidence interval (CI): 0.26–0.32, P < 0.001). Of the 2513 subjects without severely thickened septum, 472 (18.9%) had severely abnormal indexed LV mass. Vice versa, of the 2045 individuals without severely abnormal indexed LV mass, only 4 (0.1%) were classified as severe LVH by septal thickness. After a mean follow-up of 2.5 ± 1.2 years 121 (4.7%) deaths occurred. Using indexed LV mass partition values there was a graded association between LVH degree and survival. Compared with patients with normal indexed LV mass, the adjusted hazard ratio (HR) for death from all causes was 2.17 for mild (95% CI: 1.23–3.81, P = 0.007), 3.04 for moderate (95% CI: 1.76–5.24, P < 0.001), and 3.81 for severe (95% CI: 2.43–5.97, P < 0.001) LVH by indexed LV mass. The area under the receiver-operator characteristic (ROC) curve for the four degrees of LVH by indexed LV mass was superior [area under the curve (AUC) = 0.66] to that of the septal thickness partition values (AUC = 0.58, P = 0.0004). Conclusion In a large cohort study of unselected adult outpatients referred to the echocardiography laboratory, the measurements of indexed LV mass applying the ASE/EAE recommended cut-offs yielded remarkable discrepancy in the diagnosis of LVH severity and offered prognostic information beyond that provided by septal thickness only criteria. [ABSTRACT FROM AUTHOR]

Preservation of historic buildings is a demanding task, especially in seismic zones, where vulnerable constructions can suffer severe damages and losses. The last earthquake that struck the Abruzzo region in Italy in 2009 caused a particularly extensive damage. Lessons learned by previous experiences and the knowledge acquired through researches allowed facing the first emergency period involving universities, civil protection, and the Cultural Heritage Ministry. The result of this collaboration was the survey and the realization of emergency interventions for thousands of buildings in few months after the earthquake, waiting for the definition and design of definitive solutions. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of patients with 'borderline' levels of cardiovascular risk factors has been rarely investigated, being often reported in studies evaluating abnormal values of these parameters. The BORDERLINE study represents a pilot experience to primarily identify the prevalence of 'high-normal' conditions, such as pre-hypertension, lipid and glucose levels in the upper range of normality in the setting of general practice in Italy. Aim: The aim of this study was to evaluate the prevalence of patients with 'borderline' values of cardiovascular risk factors in Italy. Methods: Involved physicians were asked to evaluate the first 20 outpatients, consecutively seen in June 2009. Data were collected in a study-designed case-report form, in which physicians identified thresholds rather than reported absolute values of several clinical parameters. High-normal values were defined as follows: blood pressure (BP) 130-140/85-90 mmHg; total cholesterol 180-200 mg/dL; low-density lipoprotein cholesterol (LDL-C) 130-150 mg/dL; high-density lipoprotein cholesterol (HDL-C) 30-40 mg/dL in males and 40-50 mg/dL in females; triglycerides 130-150 mg/dL and fasting glucose 100-110 mg/dL. Results: Fifty-three Italian physicians provided valuable clinical data on 826 individual outpatients, among which 692 (83.7%, 377 women, mean age 60.9 ± 13.2 years, body mass index 26.6 ± 5.0 kg/m2) were included in the present analysis. Prevalence of borderline values of systolic BP and total cholesterol levels were at least comparable with those in the normal limits of the corresponding parameters, whereas prevalence of borderline diastolic BP, LDL-C, HDL-C, triglycerides and fasting glucose levels was significantly lower than that of normal values, but higher than that of abnormal values of the corresponding parameters. Conclusions: Using this sample of healthy subjects in the setting of general practice in Italy, our results demonstrated a relatively high prevalence of borderline values of cardiovascular risk factors, which was at least comparable with that of normal, but significantly higher than that of abnormal thresholds. These preliminary findings may prompt more extensive investigations in the area of 'borderline' cardiovascular risk. This information may, in fact, potentially enable the design of more effective prevention strategies in the future to limit the burden of cardiovascular disease in the general population in Italy. [ABSTRACT FROM AUTHOR]

Structural problems due to corrosion, ageing, durability, aggressive environments, materials defects, lack of ductility and unforeseen behaviour under seismic loads may significantly compromise the resistance and safety of bridges. Scheduled maintenance of bridges becomes important to ensure complete serviceability of the road network. Among existing bridge management systems (BMSs), this work is a contribution to the evaluation criteria of bridge condition by means of visual inspection, prediction of future structural condition and planning of maintenance intervention. After a brief review of some existing BMSs, a simple new procedure for evaluation of bridge condition by means of visual inspection, aimed at general planning of maintenance in a BMS framework, is presented in this paper. This procedure is applied to stock, including about 200 bridges and viaducts, of the Veneto region road network in the north-eastern part of Italy, and is then discussed. [ABSTRACT FROM AUTHOR]

Early reperfusion is the key to therapeutic success in acute myocardial infarction (AMI). The duration of the process is influenced by various factors which in most of the cases are not easily modifiable. The aim of this study is to analyse AMI treatment process duration to identify determining factors. The objective is to better exploit time intervals imposed by spatial distance from the hospital. One-year data regarding acute coronary syndromes with elevated ST segment for patients presenting to Policlinico teaching hospital (Modena, Italy) have been studied. Patients were divided into two groups for hospital access: A - ambulance access to Policlinico emergency room (ER); B - self-referral to ER. A total of 141 patients have undergone percutaneous transluminal coronary angioplasty for AMI at Policlinico, 106 males, 35 females (58.1% males in group A, 82.7% in B, P 0.002), with an average age of 66.09 ± 14.30 years in group A and 60.90 ± 13.47 in B ( P 0.047). Mean pre-hospital time for group A was 122.54 ± 130.69 minutes and B 171.49 ± 353.60 ( P 0.25), mean hospital time in group A was 196.03 ± 67.66 and B 255.14 ± 113.16 ( P < 0.001), mean total time in group A was 318.56 ± 146.91 and B 426.63 ± 382.01 ( P 0.02). Data show that group B suffered on average a 108-minute delay from symptoms insurgence to definitive treatment. The duration of hospital time plays more important role in this finding than distance from the medical facility. In fact, on the ambulance a medical crew starts the diagnostic and therapeutic process relieving ER from initial evaluation. [ABSTRACT FROM AUTHOR]

Between 1870 and 1938, a small but visible minority of Jewish women were very active in secular philanthropy in Italy. Excluded from the institutional Jewish community, which refused to recognize their changing roles, a few well-educated Jewish women became leaders, promoters and major donors in non-Jewish philanthropic projects specifically devoted to education and women's welfare. The present paper explores this phenomenon from 1870, when the walls of the ghetto of Rome were finally brought down, to 1938, when Fascist antisemitic legislation forced the expulsion of Jewish activists and philanthropists from the institutions they had contributed to and, indeed, had often created. [ABSTRACT FROM AUTHOR]

Background: Median laparotomy is the most common approach to the abdominopelvic cavity in patients with gynaecological tumours. Aims: The primary endpoint of the study was to evaluate the onset of incisional hernia. The secondary endpoint was to evaluate the onset of infection, wound dehiscence, wound infection, and scar pain during the post-operative period. Methods: A total of 191 patients were eligible for the study. They were divided into three groups. Group A underwent en bloc closure of the peritoneum and fascia with Premilene® suture, Group B en bloc closure of the peritoneum and fascia with Polydioxanone suture, and Group C separate closure of the peritoneum and fascia with single stitches of Ethibond suture. Statistical analysis was performed using the Statistical Software Package for Social Sciences 12.0. Results: Group A and Group B comprised 63 patients, and Group C included 65 patients. The three groups proved homogeneous on statistical analysis ( P > 0.05). The statistical analysis did not reveal significant differences between the different suture types and techniques with respect to the incidence of incisional hernia ( P > 0.05). Conclusion: In our study, the incidence of incisional hernia was 8%. Randomised patients were homogeneous for sample size and risk factors. No significant differences were found between suture types or techniques. Currently, there is no suture material or technique that can be considered superior to others. When possible, we believe that the best way to prevent incisional hernia is to preserve the integrity of the abdominal wall using minimally invasive techniques. [ABSTRACT FROM AUTHOR]

The Paderno Bridge along the Adda river in the northern part of Italy is a relevant arch-bridge connecting Milan and Bergamo province in the northern part of Italy: the bridge is part of the Monza-Bergamo line and is in service from 1889. A stepwise and practical approach for evaluating the structural integrity of historical and deteriorated steel bridges, incorporating analytical, mechanical, and structural characterizations, is presented. Critical regions of hot spot members were identified using structural finite-element analysis, and fatigue reliability assessment analysis has been performed along with traffic estimation, taking into account various scenarios of traffic increase, in order to assess the possible remaining fatigue life. This analysis has evidenced that the structure might be kept in service at least for other 10 years. Appropriate retrofitting interventions are also indicated. [ABSTRACT FROM AUTHOR]

The definition of structural safety of a historical masonry structure is still a concept that is somewhat difficult to interpret. Whereas for new masonry structures, it is possible to have useful indications about their structural behavior, as the analysis turns to “historical” constructions such a task became increasingly more difficult. Furthermore, the needs of preservation of the historical, cultural, and architectural essence of the building in many cases contrast with the needs of providing the “adequate” capacity to its structure, especially in order to withstand the design seismic loads. The study presented in the article is related to the definition of a knowledge and safety assessment path, concerning masonry religious buildings with a monumental character. A complex building, the Santa Maria Assunta (Our Lady of the Assumption) Cathedral in Reggio Emilia (Italy), is studied in order to evaluate its structural behavior thus defining its seismic vulnerability, by using different investigation and analysis methodologies. [ABSTRACT FROM AUTHOR]

The article focuses on the significance of hormone replacement therapy (HRT) to Italians health after the publication of the randomized Women's Health Initiative (WHI) trial in July 2002. Female doctors are the greatest consumers of HRT in Italy and 8% of them interrupted their therapy after the publication. According to the authors, a complete medical history of the patient should be taken and a thorough physical examination performed before prescribing HRT.

Studies the impact of tar aggregated deriving from the Haven oil spill that occurred on the soft-bottom macrobenthos off Arenzano in Ligurian Sea of Italy. Collection of core samples to evaluate the composition of macrobenthos; Domination of macrobenthos by polychaetes other isopods; lack of differences in the abundance of benthic assemblage and of the main benthic taxonomic groups.

Evaluates the effects of home environment pollution on respiratory symptoms in Pisa, Italy. Characterization of respiratory symptoms; Association of forced-air circulation for heating with shortness of breath attacks; Identification of the need to characterize the dose-response relationship in indoor air pollution.

Abstract: The evaluation of existing structures, in particular bridges, is becoming increasingly important. In particular for railway bridges, service loads and stress cycles accumulated under traffic loads, and the consequent ageing of existing structures, lead to the need for an assessment of their remaining fatigue life, in order to decide on retrofit or structure replacement. In this context, a 12.4 m span railway bridge near Sacile, Italy, with a common structural scheme for railway bridges, about ninety years old, was taken out of service, transported to a structural laboratory and subjected to both material characterization, monotonic and high-cycle fatigue shear tests. Materials exhibited a yield strength and a tensile strength of about 322 and 421 MPa, respectively, and the hot-spot critical details resulted in the riveted connections of the shear diaphragms that carried the rails. Other material properties that affected the fatigue endurance in a favorable way, and are not taken explicitly into account in structural Codes, were determined. As a result, the equating of riveted shear splices with splices jointed with non-preloaded bolts has been shown, and Eurocode 3-1-9 [EN 1993-1-9. Eurocode 3: Design of steel structures — part 1-9: Fatigue, Brussels: CEN; 2005] design rules have resulted on the safe side, even though no specific category of riveted details has been found to be available. [Copyright &y& Elsevier]

Systematic interventions are being planned and progressively designed on most buildings of the Arsenale of Venice, the Venetian republic’s shipyard, a very large complex of docks and sheds of peculiar construction characteristics. These renovation interventions are required in view of new uses for the revitalizing of that area, which is currently almost completely neglected. In the paper, after a general presentation of the main properties and of the most relevant deterioration phenomena of the principal parts of the monumental area, the methodology that is being used for the structural diagnosis, for the implementation of guidelines for the future interventions and for the maintenance of the restored conditions are presented. Some preliminary results, given by experimental tests performed both in situ and in laboratory on materials and structural elements, and by FE simulations, are discussed. [Copyright &y& Elsevier]

• At current costs, SOFC is economically convenient only with subsidies. • Germany, Italy and UK seem are the most suitable markets for this technology. • At target costs SOFC becomes the most attractive solutions to produce energy. • At target cost, RPBT is 5 years in Italy and Germany and 4 years in UK. • With 1 stack replacement in 15 years, there is a reduction in RPBT up to 7 years. This work studies the technical and economic feasibility of the introduction of a SOFC-based cogeneration system to supply non-residential buildings with electricity and heat. The techno-economic evaluation is performed for the hotel and hospital sectors, by introducing real hourly load profiles (electrical and thermal) for the buildings. The analysis considers different countries in terms of energy intensity (and load profiles), cost of energy and regulations/incentives. Results are achieved by comparing the SOFC scenario with a benchmark one where electricity is supplied by the grid and heat by a natural gas fed boiler and evaluating the relative payback time between the two solutions. The analysis showed that, despite the current high investment cost of the SOFC system, in countries such as Germany, Italy and UK (where electricity prices are among the highest in Europe), the option is yet advisable if supported by effective subsidies (already existing for cogeneration systems), and it could offer a competitive alternative to traditional systems, especially in the hospital sector, where the relative payback time is achieved in the 10th year for UK, and in the 14th year for Germany and Italy. A cost reduction scenario has also been analyzed: results show that the SOFC is the best option in most of the locations, both economically and in terms of environmental impact (pollutants emissions reduction). [ABSTRACT FROM AUTHOR]

Purpose of Investigation: To evaluate the correlation between fetal movement revealed in cardiotocography and fetal-neonatal well-being as well as to assess the value of cardiotocography in our clinical practice., Methods: Retrospective analysis of 3,805 pregnancies followed at Parma General Hospital. Exclusion criteria were cesarean section, preterm delivery, and stillbirth. We analyzed the predictive power of actography during the dilating and expulsive phases of labor by establishing a correlation between number of fetal movements and our neonatal indexes of well being, i.e., cardiotocographic score, Apgar index and neonatal pH value. Statistical tests used were Fisher's test, chi-square test (X2), Pearson correlation and Spearman Rho; p value was considered significant if it was less than 0.05., Results: We considered 2,389 vaginal deliveries. Analyzing the correlation between fetal movement and cardiotocographic score in the two different phases of labor, the comparison among subpopulations identified by different cardiotocograph scores revealed no statistical difference., Conclusion: Cardiotocography is reconfirmed as a good instrument to evaluate neonatal outcome, while actigraphy cannot be used alone to define fetal well-being, mainly due to the inability to standardize assessment of the actographic study.

Objective: Season of birth influences the rate of several psychiatric disorders. In this study, we investigated whether climacteric symptoms and, in particular, psychological and somatic symptoms of postmenopausal women were influenced by their season of birth., Design: This retrospective multicenter study was performed on 2,541 women in natural menopause, free of hormone therapy. The score of the Greene Climacteric Scale and of its vasomotor, psychological (anxiety and depression), and somatization subscales were stratified by season of a woman's birth. Data were controlled for possible confounders, such as age, years since menopause, body mass index, education occupation, smoking habits, and season of evaluation., Results: The Greene Climacteric Scale appeared to be associated with the season of birth, with the lowest scores being observed in women born in autumn and the highest scores in women born in spring (+2.11; 95% CI, 0.67-3.56; P = 0.01), and summer (+2.22; CI, 0.82-3.63; P = 0.01). Lowest scores in autumn and highest scores in spring were also observed for psychological symptoms subscaled as anxiety and depression (+1.43; CI, 0.54-2.32; P = 0.01) and somatic symptoms (+0.59; CI, 0.15-1.04; P = 0.01)., Conclusions: In this study, we found a relationship between season of birth and some menopause-associated symptoms. Further study is needed to confirm these relationships and examine possible mechanisms.

Objective: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy., Methods: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper., Results: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms., Conclusions: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

Objective: To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause., Subjects: Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms., Methods: Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year., Results: Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73)., Conclusions: This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

Objective: To identify the determinants of age at menopause in an Italian population, using data from the Italian Climacteric Research Group Study (ICARUS)., Methods: ICARUS is a prospective study of the effect of menopause on women's health that has been running in menopause clinics throughout Italy since 1995. A total of 4300 women with spontaneous menopause, aged 55 years or more and observed for the first time at the participating centres are included in the present analysis., Results: The mean age at menopause in the total population was 50.9 years. After taking into account potential covariates, the women reported smoking, had a slightly lower mean age at menopause than non smokers 50.4 versus 50.9 years; P = 0.01. The mean age at menopause in nulliparae was 50.0 years, and, respectively 50.4, 50.6, 50.9, 51.2 and 50.9 years in those reporting 1, 2, 3, 4 and 5 or more births (P < 0.01). A low body mass index and an early age at menarche were associated with early menopause in the crude analysis, but these associations disappeared after taking into account the confounding factors., Conclusions: This study offers an estimate of the mean age at menopause of women attending menopause clinics in Italy, on the basis of the data obtained from a large sample. It also indicates that smoking and nulliparity are associated with early menopause.

There is increasing evidence from epidemiological studies that exogenous estrogen (hormone replacement therapy) protects against the elevated risk of cardiovascular disease in women after the menopause. However, it is still uncertain whether the postmenopausal decrease in endogenous estrogen in itself contributes significantly to this increase in risk. Most of the studies that have provided evidence linking cardiovascular disease with menopause have involved North American women, who may differ significantly from Europeans in terms of lifestyle and diet. ICARUS (Italian Climacteric Research Group Study) is an observational study that involves Italian Menopause Clinics, with the objective of collecting observational data on menopause and its management. The results of a cross-sectional analysis of 9309 women, free from any hormonal treatment and enrolled up to March 1997, are reported here. Data show that the menopause has a marked effect on the circulating levels of lipids and lipoproteins. From pre- to post-menopause there are significant increases in total cholesterol (6.9% before and 4.4% after adjustment for covariates including chronological age, educational level, center, BMI, smoking habits, hypertension and diabetes, previous contraceptive use, and time since menopause), LDL (7.5% before, 4.0% after), and triglycerides (9.0% before, 3.2% (ns) after). However, there is no significant change in HDL. Among postmenopausal women, no effect on lipid profile of time since menopause was observed.

Objectives: To assess the efficacy and tolerability of a new matrix patch delivering 0.05 mg estradiol per day (Estraderm MX 50) in postmenopausal women with moderate to severe postmenopausal symptoms., Methods: A multicenter, double-blind, randomized, between-patient, placebo controlled trial in 109 postmenopausal women was carried out. Patches were applied twice weekly for 12 weeks. Patients were assessed at 4, 8 and 12 weeks of treatment. The primary efficacy variable was change from baseline in mean number of moderate to severe hot flushes (including night sweats) per 24 h during the last 2 weeks of treatment. Other variables included Kupperman Index, local and systemic tolerability. Plasma concentrations of estradiol (E2), estrone (E1) and estrone sulfate (E1S) were determined before and after treatment., Results: Estraderm MX was significantly superior to placebo (P < 0.001) in reducing mean number of moderate to severe hot flushes (including night sweats) per 24 h after 4, 8 and 12 weeks of treatment. The estimate of treatment group differences after 12 weeks was 4.2 hot flushes (95% confidence interval: 2.6-5.8). Estraderm MX also significantly reduced Kupperman Index at all time points compared to placebo (P < 0.001). Estraderm MX induced increases in mean E2, E1 and E1S plasma levels as expected (E2: baseline 2.7 pg/ml, 12 weeks 38.9 pg/ml; E1: baseline 18.8 pg/ml, 12 weeks 41.6 pg/ml; E1S: baseline 235.6 pg/ml, 12 weeks 765.1 pg/ml). Overall rates of adverse experiences were similar for Estraderm MX and placebo. The number of patients reporting skin irritation was low and similar in both groups., Conclusions: Estraderm MX 50, a new matrix patch, offers an effective and well tolerated dosage form for transdermal delivery of 0.05 mg E2 per day.

We have evaluated the occurrence of postpartum thyroid dysfunction (PPTD) in a group of 372 women residing in area of mild iodine deficiency. Thyroid function and autoimmune status were evaluated by means serum T4, T3, TSH measurement and detecting the presence of positive antithyroglobulin antibodies (AbTg), antimicrosomal antibodies (AbM) and thyroid-peroxidase antibodies (AbTPO) titers in women at parturition, at 1, 3, 6 and 12 months postpartum. New onset transient hypothyroidism occurred in 6.4% of women whereas transient thyrotoxicosis in only 1.8% of women. Transient hypothyroidism was not preceded by thyrotoxicosis as indicated by thyroid function tests and serum Tg concentrations. At parturition, the positivity of AbM and AbTPO titers and the presence of goiter appeared to be a risk factors for the development of PPTD.