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The study's aim was to determine the prevalence of depression and anxiety in children with Beckwith–Wiedemann syndrome (BWS) and their effects on social relationships and family acceptance. The Pediatric Symptom Checklist—35 items (PSC-35), Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Vineland Adaptive Behavior Scale Second Edition (VABS-II) were administered to the children. The parental Acceptance Rejection/Control Questionnaire (PARQ/Control) and Zarit Burden Inventory (ZBI) were administered to parents. In total, 6 patients and 10 parents were included. Patients showed a significant presence of internalizing behavior in PSC-35 (mean, 7.66 ± 3.67), anxiety symptoms (SCARED: mean, 46.33 ± 17.50) and socialization difficulties (mean, 90.83 ± 10.09). Parents reported a perceived good acceptance (mean, 56.33 ± 1.03) and a moderate control (mean, 24.17 ± 1.83), but the burden level was ranked moderate to severe (mean, 59.33 ± 16.78). It was found that the severity of the burden level reported by parents was related to internalizing behavior (OR = 2.000; 95% CI = 0.479–3.521; p = 0.022) and anxiety symptoms (SCARED total score: OR = 3.000; 95% CI = 1.479–4.521; p = 0.005) of children. During psychological counseling in the context of BWS treatment, it is important to identify specific resources that can support patients and families in dealing with stress and identify any critical areas that could hinder the adaptation process. [ABSTRACT FROM AUTHOR]

From the initial COVID-19 outbreak, Italy was the first Western country to be seriously affected by the pandemic. Understanding vaccine hesitancy can help efforts to achieve broad vaccination coverage. The objectives of this research were to determine the extent of vaccine hesitancy in Italy and to understand the characteristics of those segments of the population with some hesitancy. Between January and February 2021, 41,473 subjects answered the second questionnaire delivered in phase II of the web-based EPICOVID19 survey. Among the included adult volunteers living in Italy, 4653 (11.2%) reported having previously received at least one dose of the COVID-19 vaccine. In the sample of 36,820 respondents, all not vaccinated (age 51.1 ± 13.5; 59.7% female; 63.6% high level of education), the comparison between hesitant and inclined participants was accompanied by percentages and odds ratios. A total of 2449 individuals were hesitant (6.7% of the unvaccinated ones). Hesitancy was higher among women (OR = 1.48; 95%CI: 1.36–1.62); it was highest in the 50–59 and 40–49 age groups and among those with a lower educational level. A higher level of education was associated with a lower proportion of hesitancy (5.54%) compared with 9.44% among respondents with a low level of education (OR = 0.56; 95%CI: 0.46–0.68). Hesitancy was most common in subjects who did not report fear of infection (12.4%, OR = 4.0; 95%CI: 3.46–4.61). The results can guide the design of tailored information and communication campaigns through considering objective and subjective characteristics. [ABSTRACT FROM AUTHOR]

Strongyloidiasis is a clinical issue both in humans and in dogs. Moreover, there are concerns about its zoonotic potential. We aimed to explore Strongyloides stercoralis epidemiology in Southern Italy in humans and dogs sharing the same environment in three different settings: (1) kennels (group K); (2) livestock farms (group L) and (3) agricultural farms (group A). For humans, a commercial ELISA test was used for screening. RT-PCR on faecal samples was done for people testing positive or equivocal at serology. On dog's faecal samples, Baermann test and RT-PCR were performed. A total of 145 dogs and 139 persons were tested. Based on faecal tests in dogs and serology in humans, a S. stercoralis positivity of 4.1% and 6.5% was revealed, respectively. The sites where cases were found were different for animals and humans. In dogs the highest positivity was in group K (6.7% against 2% and 0% in L and A). Differently, in humans the proportion of positive results was similar between the groups (p = 0.883). Fifty percent (3/6) of positive dogs were healthy; the other dogs presented weight loss and/or diarrhoea. ELISA-positive persons (n=9) were all in health, but abdominal pain (37.5%), urticaria (22.2%) and asthma (22.2%) were reported, resolving after treatment with oral ivermectin 200 μg/kg. RT-PCR performed on 13 human faecal samples resulted negative. These findings suggest that strongyloidiasis is present in humans and dogs in Southern Italy, and screening in larger cohorts would be needed for more accurate estimates. [ABSTRACT FROM AUTHOR]

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This paper discusses socio-cultural developments in central and southern Italy between the late 3rd and the early 1st millennia BC, particularly focussing on settlement patterns. Over this span of time, the foundations were laid for the process towards urbanisation that occurred in various Italian regions at the threshold of the historic period. Two major settlement patterns are recognised, each having specific variations on a regional scale and depending on environmental conditions: 1) small hamlets, often forming definite clusters, which had a long tradition and tended to be resilient to socio-cultural changes; 2) larger settlements, devoted to exchange activities and craft production, which were mostly naturally/artificially fortified, long-lasting and more prone to internal changes. These latter in particular developed from the 18th century BC onwards. Some ceased at the beginning of the 1st millennium BC, but others instead grew, existing alongside new-established flourishing centres that based their success on both their agricultural and military potentials, so enabling their fast demographic growth. [ABSTRACT FROM AUTHOR]

During the last decades in Italy the wine sector focused on the environmental sustainability of the production processes, including the agricultural, the agro-industrial and the packaging phases. Recent surveys highlighted that the wine consumers are interested in the environmental certifications, even if they are not familiar with them. Several environmental pressures can be evaluated in the viticulture phase, but an elevated number of the analysed impacts require the collection of a large set of input data and significant efforts during the elaboration phase. Therefore, the aim of the present work was the identification of the inventory data and impacts, which mainly describe the environmental pressures associated with the viticulture phase. Particularly, the results of the life cycle assessment (LCA) were integrated with those of a model and a simplified approach for evaluating the risks due to the pesticides use. The LCA identified three phases, which are responsible of 70-80% of the CO2eq (CO2 equivalent), the cumulated energy utilisation, the acidification potential (expressed in SO2 equivalent) and the eutrophication (expressed in PO4 equivalent), i.e. the harvesting, the crop protection and the ligature. The phase of the pesticides use was analysed also through the pesticides risk indicator (PERI) model and a simplified approach elaborated by the Regional Agency for the Environment Protection in Tuscany, Italy. Results concerning the environmental risk showed that the PERI model, the Arpat approach and the LCA were coherent for the pesticide mix highlighting that the associated environmental risk is more than doubled from 2004 to 2010. Finally, some operative indications were elaborated in order to reduce the impacts and improve the local and global environmental sustainability of the viticulture phase. [ABSTRACT FROM AUTHOR]

Objective. Pain prevalence data for patients at various stages after stroke. Design. Repeated cross-sectional, observational epidemiological study. Setting. Hospital-based multicenter study. Subjects. Four hundred forty-three prospectively enrolled stroke survivors. Methods. All patients under went bedside clinical examination. The different types of post-stroke pain (central post-stroke pain, musculoskeletal pains, shoulder pain, spasticity-related pain, and headache) were diagnosed with widely accepted criteria during the acute, subacute, and chronic stroke stages. Differences among the three stages were analyzed with v2 -tests. Results. The mean overall prevalence of pain was 29.56% (14.06% in the acute, 42.73% in the subacute, and 31.90% in the chronic post-stroke stage). Time course differed significantly according to the various pain types (P< 0.001). The prevalence of musculoskeletal and shoulder pain was higher in the subacute and chronic than in the acute stages after stroke; the prevalence of spasticity-related pain peaked in the chronic stage. Conversely, headache manifested in the acute post-stroke stage. The prevalence of central post-stroke pain was higher in the subacute and chronic than in the acute post-stroke stage. Fewer than 25% of the patients with central post-stroke pain received drug treatment. Conclusions. Pain after stroke is more frequent in the subacute and chronic phase than in the acute phase, but it is still largely undertreated. [ABSTRACT FROM AUTHOR]

Background: Cheese is considered to increase the total cholesterol levels (CH) due to the high-saturated fat content. New models are needed to measure the relationship between cholesterol and cheese. Methods: Thirty different cheeses produced in Val Brembana, Italy ('furmai da mut', 'caprino' and 'stracchino'), were added to the diet of 30 groups of 4 rats. Cheeses were analyzed to differentiate the volatile organic compounds (VOCs) and the cholesterol content (Chf). The body weight, CH, urine volume and oxidative balance were measured. Three new indexes in relation to CH were calculated: OI (oxidative index), PI (protective index) and OBRI (oxidative balance risk index). Results: None of the cheeses increased CH. Some of the 'furmai de mut' were significantly decreasing CH and improved the oxidative balance. Chf was not affecting the CH levels in plasma. In terms of VOCs, the acetic acid content was correlated (p < 0.05) with the CH reduction and PI improvement. OBRI was reduced mainly in the 'stracchino group'. Conclusions: The model shows that some cheese can reduce significantly CH levels and improve the antioxidant capacity. [ABSTRACT FROM AUTHOR]

The main aim of this study was to explore Italian, Norwegian and Spanish consumers' sensory perception of dry-cured ham. Six samples of dry-cured ham, two Italian, two Norwegian and two Spanish, were profiled by trained panels in the three countries. Consumer samples of 30 respondents in each country elicited sensory descriptors for the six hams and subsequently rated the intensity of individual descriptors. Perceptual consensus product maps were derived from the Generalized Procrustes Analysis. Results revealed that all the four sensory modalities are important for the perception of dry-cured ham and demonstrated a relatively large variation in vocabulary used for sensory description of hams in the three countries. Because of less familiarity with dry-cured ham and a different eating culture, Norwegian consumers have a relatively limited vocabulary and do not agree well on the concepts for given descriptors. Attributes that were most frequently used across panels and countries were: red color, marbling, ripe/cured flavor and odor, saltiness, sweetness, firmness and tenderness. Practical Applications Food preferences and description of sensory properties in foods vary across cultures. Considering the global character of today's food market, it is crucial for the food industry to use proper and meaningful words to communicate their products. Moreover, communication of sensory product attributes to consumers creates both sensory-based and hedonic-based expectations to the sensory quality. It is essential that these expectations are met during consumers eating experience. Finding in this study demonstrate a relatively large variation in vocabulary used for description of dry-cured ham in Norway, Italy and Spain. This is mainly due to differences in familiarity with the product and different cultural eating experiences. Accordingly, it is important to tailor the communication of products according to the relevant consumer segment. [ABSTRACT FROM AUTHOR]

Abstract: The NIO1 (Negative Ion Optimization phase 1) experiment, whose construction has started in 2010 at Consorzio RFX in Padova in collaboration with INFN-LNL, is a radio frequency Hydrogen negative ion source designed to produce a beam current of 130mA with 60keV particle energy. The aim of the experiment is to provide a highly flexible system to test material properties of source components and to benchmark simulation codes for beam optics and plasma behavior. The paper focuses on a conceptual design for NIO1 power supply system on the basis of given operational and performance requirements. The requested ratings fall well within those of products available on the market and the design includes standard commercial solutions for the individual power supplies. The ion source operates at −60kV with respect to ground, leading to a number of design issues at system level and related to mutual connection between power supplies and load, layout and grounding. These aspects, along with the crucial point of ensuring protection to the arc prone beam source, are reviewed and discussed. The study leads to a scheme integrating high voltage power supplies, high current power supplies and a possible solution for passive protection components at the power supply output. [Copyright &y& Elsevier]

An alternative validated analytical protocol for the determination of 63Cu/65Cu isotopic ratios viaICP-QMS is here proposed. Preliminary experiments and a careful evaluation of the instrumental performances have led us to propose a markedly different protocol from methods reported in literature: a modified bracketing method was chosen over the utilization of a long-term standard bracketing approach or the utilization of internal standards. As a result, accurate ratios with relative standard deviations as low as 0.025% can be obtained within an overall machine time (samples, blanks and standards) of 1 h per sample. Noticeably, this precision is only 2–5 times higher than the one attainable for 63Cu/65Cu ratio determinations with sector-field multi-collector machines. The required machine time is markedly lower than the one necessary for typical standard bracketing protocols (1 h vs.2–4 h per sample, respectively). In contrast with internal standard based methods, the required machine time is definitely lower, but with our protocol no time consuming sample purification pretreatments are needed. The protocol has been validated and used for the determination of 63Cu/65Cu isotopic ratios on various copper minerals coming from historical mines spread along the Italian Apennines and Alps. [ABSTRACT FROM AUTHOR]

Background: Concerns about the hepatitis C virus (HCV) are due to the high risk of chronic liver disease and poor treatment efficacy. Synthesizing evidence from multiple data sources is becoming widely used to estimate HCVinfection prevalence. This paper aims to estimate the prevalence of HCV infection, and the hepatic and extrahepatic sequelae in at-risk groups, using routinely collected data in the Lazio region, Italy. Methods: HCV laboratory surveillance and dialysis, hospital discharge, and drug-user registers were used as information sources to identify at-risk groups and to estimate HCV prevalence and sequelae. Full name and birth date were used as linkage keys for the various health registries. Prevalence was estimated as the percentage of cases within the general population and the at-risk groups, with 95% confidence intervals (95% CI) from 1997 to 2001. The risk of sequelae was estimated through a follow-up of hospital discharges up to December 31, 2004 and calculated as the prevalence ratio in HCV-positive and HCV-negative people, within each at-risk group, with 95% CI. Results: There were 65,127 HCV-infected people in the study period; the prevalence was 1.24% (95%CI = 1.23%-1.25%) in the whole population, higher in males and older adults. Drug users (35.1%; 95%CI = 34.6-35.7) and dialysis patients (21.1%; 95%CI = 20.2%-22.0%) showed the highest values. Medical procedures with little exposure to blood resulted in higher estimates, ranging between 1.3% and 3.4%, which was not conclusively attributable to the surgical procedures. Cirrhosis, hepatocellular carcinoma and encephalopathy were the most frequent hepatic sequelae; cryoglobulinaemia and non-Hodgkin's lymphoma were the most frequent extrahepatic sequelae. Conclusions: Synthesising data from multiple routine sources improved estimates of HCV prevalence and sequelae in dialysis patients and drug users, although prevalence validity should be assessed in survey and sequelae need a welldefined longitudinal approach. [ABSTRACT FROM AUTHOR]

Abstract: This paper, which illustrates some results of the project SO.L.E.AGRI. (“Wood-energy chain sustainability in agricultural sector”) funded by Provincia di Siena and of the PRIN 2005–2006 “Study of the biomass-energy chains in Italy” funded by the Italian Ministry of Instruction, University and Research, highlights that the use of agricultural residuals as renewable energy source is economically and environmentally convenient. This work firstly looks at the energy use of agricultural residuals harvested, and then it considers their packaging and supply management. The main objective of the production of the solid bio-fuels originated from pruning residuals is the reduction of harvesting and transport costs; therefore, experimental tests have been carried out in different farms using an innovative shredding machine that simultaneously permits harvesting, shredding and packaging of pruning residuals. These trials have been undertaken in olive groves and vineyards, on stony and hilly terrain. The machine has obtained good results under different operative conditions: intensive mechanisation of harvesting implies lower costs and simultaneous packaging assures a better organisation of the whole energy chain. [Copyright &y& Elsevier]

Invasive infections by group B streptococci (iGBS) are the leading cause of sepsis and meningitis in the first three months of life worldwide. The clinical and microbiological characteristics of neonatal and infant iGBS in Italy during the years 2015–2019 were investigated. Voluntary-based surveillance reported 191 cases (67 early-onset (EOD) and 124 late-onset disease (LOD)) and 89 bacterial isolates were received. The main clinical manifestations were sepsis (59.2%) followed by meningitis (21.5%), bacteremia (12.0%) and septic shock (6.3%). Hospitalized preterm babies accounted for one third of iGBS and constituted the most fragile population in terms of mortality (8.2%) and brain damage (16.4%). GBS serotype III was predominant in EOD (56%) and caused almost all LOD (95%). The rate of resistance to clindamycin reached 28.8%. Most of clindamycin-resistant GBS strains (76%) were serotype III-ST17 and possessed the genetic markers of the emerging multidrug resistant (MDR) CC-17 sub-clone. Our data revealed that iGBS is changing since it is increasingly reported as a healthcare-associated infection (22.6%), mainly caused by MDR-CC17. Continuous monitoring of the clinical and microbiological characteristics of iGBS remains of primary importance and it represents, at present, the most effective tool to support prevention strategies and the research on the developing GBS vaccine. [ABSTRACT FROM AUTHOR]

Presents information on a study which investigated the incidence of Streptococcus pneumoniae antimicrobial susceptibility in Italy. Methods; Results; Discussion.

• Ancient charred bread can be preserved, maintaining microstructures of cereals. • Bread found in seven archaeological sites in Northern Italy was analysed. • Optical and scanning electron microscopy are used to study microstructural elements. • Infrared spectroscopy can be used to support microscopy. • Raw materials and methods of preparation were identified. This study examines charred bread-like samples found in several archaeological sites across northern Italy and dating from the Early Bronze Age to the Early Middle Ages, some of which are included amongst the UNESCO World Heritage Sites. The aim is to investigate differences and homogeneities in bread production processes in different eras and cultures. Bread was a staple food in many ancient societies, but has rarely been found amongst the materials that survive in archaeological sites. When it is found, it is usually because the bread was charred by accidental combustion (falling into the oven during baking) or deliberate combustion (for ritual purposes). The literature on the issue is not abundant, but has been growing over the past decade. There is, therefore, room to propose new study methodologies at this time. We studied eight samples of charred bread-like products and we used optical and scanning electron microscopy to identify plant tissue remains attributable to cereal caryopses, partly modified by bread-making processes. Energy dispersive X-ray spectroscopy and, for the first time, infrared spectroscopy in attenuated total reflectance mode (FTIR-ATR) were also used to investigate the composition and preparation methods of the different types of bread-like products. In particular, FTIR-ATR analysis can give indications about the presence of starch, gluten and lignin in the sample under investigation and it can, therefore, be used as a screening to guide subsequent SEM analysis in the search for specific cereal residues in the dough. In some cases, the different techniques used also revealed the presence of minerals such as silicates and carbonates, probably due to grinding residues or poor sample cleaning. During SEM observations, phytoliths, diatoms and framboids were also found in some of the samples. [Display omitted] [ABSTRACT FROM AUTHOR]

The 6Li+89Y experiment was conducted at the Legnaro National Laboratory in Italy to explore the influence of breakup and transfer reactions on the fusion process induced by the weakly bound projectiles. Due to the competition between neutron and proton evaporation, complete and incomplete fusion might produce identical residues, leading to the difficulties in identification of different reaction process. In this work, the High-Purity-Germanium (HPGe) detector array (GALILEO) was employed to measure γ rays, and the silicon detector array (EUCLIDES) was utilized to capture light charged particles. Exclusive measurements of prompt γ rays from residuals with various light charged particles at an energy near the Coulomb barrier are reported. In the p − γ coincident measurements, observed 91Nb, 92Nb, and 93Nb is considered from neutron evaporation channel in complete fusion reaction, and 90Y is generated through 1n stripping reaction. A two-step, breakup followed by fusion, in case of the capture of α is inferred to be the dominant mechanism to yield the 92Nb and 91Nb in the deutron coincident exclusive measurement. [ABSTRACT FROM AUTHOR]

Introduction: Peer relationships play a critical role in the development of adolescents, not only for the acquisition of social skills but also for the sense of personal identity and competence. Thus the quality of peer relationships influences actual and future mental health of the adolescent. Objectives: SEYLE (Saving and Empowering Young Lives in Europe) is a randomized controlled trial, funded by the EU, evaluating interventions for mental health promotion and suicide prevention. The study comprised 12,395 high-school students from 11 European countries. Aims: We investigated the differences on psychological problems between students with poor and good peer relationships. Methods: 1,195 adolescents (mean age 15.3±0.6; 68% females) from the Molise region constituted the Italian sample. Adolescents were identified as with poor peer relationships if they never or just sometimes get along with people of their age, feel that peers like having them in the group and feel that peers were kind and helpful. Psychometric measures were used to assess mental health problems such as depression (Beck Depression Inventory II), anxiety (Zung Self-Assessment Anxiety Scale), well-being (WHO-5) and suicidal ideation (Paykel Suicide Scale). Results: Adolescents who reported poor peer relationships scored significantly higher (p <.005) on the scales assessing depression, anxiety and suicidal ideation and significantly lower (p <.001) on the WHO-5. Conclusions: Particularly in adolescence peer relationships may influence psychological well-being and vice versa mental health influences the openness to the others. So promoting mental health and contemporary improve social skills could lead adolescents to a better life. [Copyright &y& Elsevier]

The number of children eligible for Paediatric Palliative Care has dramatically increased over the years, with few tools that can help with early identification. The Paediatric Palliative Screening Scale is a dedicated German, English, and Portuguese screening tool. We aimed to translate and perform a cultural adaptation to the Italian setting of the Paediatric Palliative Screening Scale. This paper was a descriptive observational cross-sectional study. We carried it out in two consecutive steps: (1) translation and back translation and (2) cultural adaptation through a Delphi process. Twenty Paediatric Palliative Care national experts were invited to judge the content and structure of the translated scale and to assess the appropriateness and clarity of each question. Consensus was defined as 70% or more of experts agreeing with each item's appropriateness and clarity. The Italian version of the Paediatric Palliative Screening Scale was obtained after two rounds of Delphi. After the second round of consultation, a substantial increase in experts' consensus was found, especially for questions 1.1, 3.2 and 3.3 (from 56.3 to 93.8%), and reaching more than 83% for all the revised items., Conclusions: The Paediatric Palliative Screening Scale is a reliable tool that can assist in timely evaluating children who qualify for Paediatric Palliative Care. The tool can be used in Italian healthcare settings with its cultural adaptation., What Is Known: • Despite the lack of early diagnosis techniques, there is a significant increase in the number of children entitled to Paediatric Palliative Care. • A specific screening tool called the Paediatric Palliative Screening Scale determines a child's suitability for paediatric palliative treatment., What Is New: • The Paediatric Palliative Screening Scale is necessary to assess the psychosocial needs of patients eligible for Paediatric Palliative Care. The Italian scale has good content and face validity ensuring equivalence between the original and target populations., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To determine the use of avoidable medications in end-of-life patients living at home when they were moved from the general practice setting to the palliative medicine physician (T 1 ) and before death (T 2 )., Methods: This retrospective longitudinal study describes the prevalence of end-of-life patients cared for at home between April 2016 and December 2018 receiving preventive and symptomatic drug treatments. Socio-demographic data, diagnosis and drug treatments for each patient were collected in a web-based Case Report Form., Results: The study sample comprised 1565 end-of-life patients with a median age (25-75 percentile) of 79.8 (72.5-85.3 years). All patients were treated with symptomatic drugs, and there were significantly fewer patients from T 1 to T 2 with at least one preventive medication at end of life (92.1% and, 60.8%, p < 0.0001). There was a significant variability between the palliative care physicians in the mean numbers of avoidable preventive medication (1.5-3.9 at T 1 and 0.4-2.7 at T 2 , p = 0.06) prescribed., Conclusion: More than half end-of-life patients living at home still receive avoidable medications. Drug prescription needs to be improved and palliative care setting could have an important role in reducing potentially inappropriate prescriptions. Emphasizing the positive aspects of stopping medicines, shared criteria with de-prescribing guidelines for potentially inappropriate medication in end-of-life patients and multidisciplinary discussion with involvement of patient and family caregivers could be useful to rationalize drug therapy.

Introduction: Relationship between age and dementia at extreme old ages is still an open question, yet population-based studies in this high-risk age segment are rare., Methods: The Monzino 80-plus is a population-based study among residents 80 years and older in the Varese province, Italy. Of 1371 eligible individuals, 1294 (94.4%), of whom 64 are centenarians, were included in the incidence study., Results: Since 2002, 584 new cases of all-cause dementia were identified over 15 years. The overall incidence rate was 7.9 per 100 person-years. Dementia risk rose with age (IRR: 1.06), with the cubic model providing the best fit (R 2  = 0.91-0.96). Cumulative incidences of dementia unadjusted and adjusted for competing mortality risk progressively diverged with age., Conclusion: Dementia incidence also keeps rising in nonagenarians and centenarians. Slowing down in growing risk of developing dementia with age is mainly attributable to increasing competing risk of death and resulting selective survival of individuals at lower risk of dementia., (© 2019 the Alzheimer's Association.)

Background: The aim of pharmacotherapy in people at the end of life should be symptom control, more than prolonging life. Drugs for disease prevention should therefore be discouraged, but this is not the usual practice. The prevalence of unnecessary preventive drugs at the end of life is not well described, although some studies suggest it is common., Methods: This retrospective longitudinal study describes the prevalence of patients receiving preventive and symptomatic drug treatments at admission (T 1 ) and before death (T 2 ) in an Italian hospice. All adults admitted to the VIDAS hospice between March 2015 and February 2017 were included in the analysis., Results: The study sample comprised 589 end-of-life patients with a mean age of 75.3 (12.1) years. The mean number of drugs decreased from admission to the hospice to the time of death (mean [standard deviation]: 9.7 [3.4] and 8.7 [3.0]). All patients were appropriately treated with symptomatic drugs at T 1 and T 2 , while there were significantly fewer patients from T 1 to T 2 with at least 1 preventive medication that could be considered for deprescription at the end of life (511, 86.8% and 286, 48.6%; P < .0001)., Conclusions: Hospice admission can be associated with a definite reduction in the use of commonly prescribed preventive medications. However, about half of end-of-life patients can be prescribed avoidable medications. Drugs for peptic ulcer and gastroesophageal reflux disease and antithrombotics were the potentially avoidable preventive medications most frequently prescribed at admission to the hospice and before death.

Background: Epidemiological studies commonly include too few of the oldest old to provide accurate prevalence rates of dementia in older age groups. Estimates of the number of those affected, necessary for healthcare planning, are thus flawed. The objective is to estimate the prevalence of dementia and levels of dementia severity in a very large population of oldest old and to investigate the relation between age and dementia prevalence in the extreme ages., Methods: The Monzino 80-plus is a population-based study among residents 80 years or older in Varese province, Italy. Dementia cases were identified using a one-phase design. The survey was conducted in the participant's place of residence, whether home or institution. Both participants and informants were interviewed. Information was available for 2504 of the 2813 residents (89%)., Results: In all, 894 individuals (714 women and 180 men) met the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) criteria for dementia, for a standardized prevalence of 25.3% (95% confidence interval [CI]: 23.4, 27.2%), 28.5% (95% CI: 26.2, 30.9) in women and 18.6% (95% CI: 15.2, 21.9) in men. Age-specific prevalence estimates of dementia increased with age from 15.7% at age 80 to 84 years to 65.9% at age 100 years and higher. For women, prevalence continued to rise after age 100 years, from 64.8% at age 100 to 101 years to 76.1% at age 102 to 107 years. After age 85 years prevalence rates tended to rise linearly, on average 2.6% per year in women and 1.8% in men. About 80% of the cases were moderate or severe. The frequency of mild dementia decreased and that of severe dementia increased with age., Conclusion: One-quarter of 80-plus year olds are affected by dementia, mostly moderate or severe. Prevalence rates of dementia do not level off, but continue to rise gradually even in the extreme ages., (Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Background: Despite being the fastest growing and the most cognitively impaired age group, the oldest olds are under-represented in clinical research. The purpose of this study was to describe the design, methods, and baseline characteristics of the survey population and investigate possible differences in demographic, cognitive, functional, and behavioral characteristics between oldest old with and without any performance on cognitive tests and between oldest old alive and those deceased prior to the interview., Methods: The Monzino 80-plus Study is a prospective door-to-door population-based survey among 80 years or older residents in the municipalities in the province of Varese, Italy. Dementia cases were identified with a one-phase design. Trained psychologists interviewed both the subject and a proxy informant. The interview included a comprehensive standardized questionnaire together with an array of rating scales and a multidomain cognitive battery to assess cognitive and functional ability, behavioral disturbances and mood., Results: Information was available for 2,139 of the 2,428 registered individuals aged 80 years or older. Main baseline characteristics of the population are reported and discussed. In comparison with those living, elderly persons who had died before the first visit were older, had twice the rate of institutionalization, poorer cognitive performance and competence, and significantly greater instrumental and basic functional disability. The percentage of elderly persons, alive at baseline, without Mini-Mental State Examination rose rather evenly with age. Moreover, they had significantly worse cognitive competence and functional ability, and reported higher prevalences of depressive symptoms and problem behaviors than those with Mini-Mental State Examination., Conclusions: Prospective investigation of a large population of oldest old can contribute significantly to understanding the relations between age, cognitive decline, and dementia occurrence. Use of informant-based instruments in surveys in the oldest old is crucial in assessing everyday functioning and changes, especially in participants with no cognitive test performance available. Failure to include information on deceased elderly would underestimate, increasingly with age, the prevalence of cognitive and functional disability in the elderly population.

Background: Hemoglobin concentrations slightly below the lower limit of normal are a common laboratory finding in the elderly, but scant evidence is available on the actual occurrence of mild anemia despite its potential effect on health. The objectives of this study were to estimate the prevalence and incidence of mild grade anemia and to assess the frequency of anemia types in the elderly., Design and Methods: This was a prospective, population-based study in all residents 65 years or older in Biella, Italy., Results: Blood test results were available for analysis from 8,744 elderly. Hemoglobin concentration decreased and mild anemia increased steadily with increasing age. Mild anemia (defined as a hemoglobin concentration of 10.0-11.9 g/dL in women and 10.0-12.9 g/dL in men) affected 11.8% of the elderly included in the analysis, while the estimated prevalence in the entire population was 11.1%. Before hemoglobin determination, most mildly anemic individuals perceived themselves as non-anemic. Chronic disease anemia, thalassemia trait, and renal insufficiency were the most frequent types of mild anemia. The underlying cause of mild anemia remained unexplained in 26.4% of the cases, almost one third of which might be accounted for by myelodysplastic syndromes. In a random sample of non-anemic elderly at baseline (n=529), after about 2 years, the annual incidence rate of mild anemia was 22.5 per 1000 person-years and increased with increasing age., Conclusions: The prevalence and incidence of mild anemia increase with age and mild anemia affects more than one out of ten elderly individuals. Unexplained anemia is common and may be due to myelodysplastic syndromes in some cases.

Introduction: Within the framework of the GIMEMA Study Group, the characteristics of acute lymphoid leukemia and acute myeloid leukemia occurring in patients who have suffered a previous malignancy were studied. Assessment was also made of the clinical course, laboratory features and overall outcome of these conditions., Materials and Methods: A four-year, multi-center retrospective study was conducted to evaluate the effect of treatment for previous hematological malignancy on the development of secondary leukemia. The study collected in the GIMEMA Archive of Adult Acute Leukemia 3934 new cases of acute leukemia (2964 AML, 901 ALL, 60 acute biphenotypic leukemia). Among these cases, data were evaluated from patients with a personal history of a previous malignancy, and included inquiring into demographic data, history of neoplastic diseases in the 1st degree relatives, type and treatment of the previous malignancy, latency until the development of a secondary acute leukemia diagnosis, laboratory features, treatment and outcome at the onset of secondary acute leukemia., Results: Approximately 200 (5.1%) patients presented a previous malignancy. Twenty-one were affected by ALL and 179 by AML. The proportion of patients with secondary AML was higher than that of patients with secondary ALL (179/2964 vs 21/901, O.R. 2.69-95% C.I. 1.66-4.39, P<0.001). The median latency, from the onset of the previous malignancy to the development of secondary ALL was 27 months and to the development of secondary AML was 52 months (P<0.05). Furthermore, of patients who previously received chemotherapy more developed a second AML (66/127 sAML vs 5/21 sALL; O.R. 3.46-95% C.I. 1.10-11.56, P<0.01)., Conclusion: In most cases, chemotherapy treatment for a previous malignancy can play a role in the development of secondary AML. In almost all cases of secondary ALL, the role of previous drugs does not appear to be relevant. On the basis of our analysis, performed systematically for the first time on a large adult series of acute leukemia, we conclude that in these patients a biological predisposition to cancer may be suspected.

Acute promyelocytic leukaemia (APL) exhibits peculiar epidemiological, clinical, cytogenetic and molecular features, compared to the other acute myeloid leukaemias (AML). Data on epidemiology and occupational risk factors for APL desumed from the GIMEMA archive are reported and compared with those of the other AML. An exploratory case-case study was designed on AML patients from 56 haematology centres in Italy. Overall, 4296 patients older than 15 yr with a new diagnosis of acute leukaemia were recorded between July 1992 and July 1997. Of these, 335 were classified as APL, and 2894 as other AML. The median age of APL patients was 43 compared to 59 yr for the other AML (p < 0.00001). In order to identify peculiar risk factors for APL development, different parameters were compared in the 2 groups. After adjusting by age no significant differences were observed with regard to education, lifetime prevalence of cancer among siblings and previous diseases in the patient's history. Occupational exposure as a possible risk factor for APL showed no increased risk compared to other AML among farmers, builders and leather workers. A significant association was found in electricians (OR=4.4, 95% CI=2.0-9.7) and a weak association was found in wood workers (OR=3.2, 95% CI=0.8-10.8). The proportion of APL with respect to other AML was significantly higher in the north east of Italy compared to the rest of the country (OR=1.7, 95% CI=1.3-2.2). These data confirm the younger age of APL patients compared to the other AML. A possible role of electromagnetic fields is suggested by the higher risk of APL in electrical workers and in the more industrialized areas of the country.