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Background Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. Methods For each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. Results Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62–7.03) and intrapartum cases (OR 6.64, CI95% 2.61–17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06–3.36) and were more frequent before term (OR 1.86, CI95% 1.11–3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61–17.02). Conclusions Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.

Background: Family caregivers of patients with dementia are at high risk of stress and burden, and quarantine due to the coronavirus disease 2019 (COVID-19) pandemic may have increased the risk of psychological disturbances in this population. The current study was carried out during the national lockdown declared in March 2020 by the Italian government as a containment measure of the first wave of the coronavirus pandemic and is the first nationwide survey on the impact of COVID-19 lockdown on the mental health of dementia informal caregivers.Methods: Eighty-seven dementia centers evenly distributed on the Italian territory enrolled 4,710 caregiver–patient pairs. Caregivers underwent a telephone interview assessing classical symptoms of caregiver stress and concern for the consequences of COVID-19 infection on patient’s health. We calculated prevalence of symptoms and regressed them on various potential stress risk factors: caregivers’ sociodemographic characteristics and lifestyle, patients’ clinical features, and lockdown-related elements, like discontinuity in medical care.Results: Approximately 90% of caregivers reported at least one symptom of stress, and nearly 30% reported four or more symptoms. The most prevalent symptoms were concern for consequences of COVID-19 on patient’s health (75%) and anxiety (46%). The main risk factors for stress were identified as a conflicting relationship with the patient and discontinuity in assistance, but caregiver’s female sex, younger age, lower education, and cohabitation with the patient also had an impact. Availability of help from institutions or private individuals showed a protective effect against sense of abandonment but a detrimental effect on concern about the risk for the patient to contract COVID-19. The only protective factor was mild dementia severity, which was associated with a lower risk of feeling isolated and abandoned; type of dementia, on the other hand, did not affect stress risk.Conclusion: Our results demonstrate the large prevalence of stress in family caregivers of patients with dementia during the COVID-19 pandemic and have identified both caregivers and situations at a higher risk of stress, which should be taken into account in the planning of interventions in support of quarantined families and patients.

Introducci��n: El colectivo de a��o acad��mico universitario (CAAU) es la instancia de direcci��n universitaria donde se concretan los objetivos institucionales y convergen los procesos sustantivos universitarios para conducir el proceso docente-educativo; sus funciones se orientan a la formaci��n integral del futuro profesional; sin embargo, existen dificultades en la concreci��n y articulaci��n coherente de sus acciones educativas. M��todos: Se utilizaron m��todos emp��ricos, te��ricos y estad��sticos-matem��ticos, se asumi�� la modelaci��n sist��mico estructural ��� funcional y la experimentaci��n para validar la hip��tesis planteada. Resultado: Se devel�� la l��gica te��rica-funcional de la gesti��n organizacional del CAAU con el objetivo de favorecer las influencias educativas en la formaci��n de los estudiantes, la cual se expres�� a trav��s de las relaciones e interacciones entre el proceso prescriptivo del contexto organizacional, el proyectivo de su estructura organizacional y el valorativo de la toma de decisiones colegiadas, lo cual permite alcanzar la sostenibilidad formativa en dicha gesti��n. Conclusiones: Con la implementaci��n de la estrategia propuesta se mejoraron los mecanismos de coordinaci��n para la materializaci��n de las acciones educativas que se generaban en los diferentes escenarios formativos del CAAU, con la din��mica y la actuaci��n arm��nica que propici�� el protagonismo estudiantil y las transformaciones progresivas de los estudiantes, lo que promovi�� el crecimiento, tanto individual como colectivo de estudiantes y profesores.

COVID-19 has rapidly become a pandemic emergency, distressing health systems in each affected country. COVID-19 determines the need for healthcare in a large number of people in an extremely short time and, like a tsunami wave, overruns emergency, infectious diseases, and pneumology departments as well as intensive care units, choking healthcare services. Rehabilitation services are also affected by this epidemic which forces radical changes both in the organization and in the operating methods. In the absence of reference literature on this issue, this report aims to provide a background documentation to support physicians and healthcare personnel involved in neurorehabilitation and rehabilitation care.

Positive Youth Development theoretical perspective posits that youth involvement in actions aiming to promote societal change (i.e. social activism) is a marker of their optimal growth. In particular, it claims that immigrant adolescents' engagement in initiatives that foster the progress of host communities is a clear evidence of their positive adjustment. From the PYD standpoint, it is necessary to identify individual and ecological factors that boost youth civic engagement. Among them, multiple social identities and connection seem to play a key role, particularly in those ambiguous contexts, such as the Italian one, in terms of immigration policies and inclusion of foreigners in civic participation. On the basis of these premises, the current study tested a model in which multiple social identities positively influence youth social activism through the mediating role of multiple social connection. This model has been hypothesized to be invariant for Italian and immigrant adolescents who grow up in the same, general developmental context, although they experience different life circumstances. Eighty-six immigrant adolescents (57% male; Mage=17.12, DS=1.73) and 114 Italian adolescents (52% male; Mage=16.68, DS=1.68) took part in the research. They were high school students and they were from southern Italy. Self-report questionnaires were administered including three measures of social identity (national, religious, ethnic/regional), three measures of social connection (perceived legitimacy of authorities, connection with Italian society and the religious group) and one measure of social activism. Data analysis provided for the estimation of alternative mediation models (total and partial) and the invariance between immigrant and Italian adolescents. Results suggest that multiple social connection fully mediate the relationship between multiple social identities and social activism in a sort of process that promotes positive civic engagement among both autochthonous and immigrant youths. Findings provide useful insights that might help in the planning of educational interventions that not only incite adolescents to explore they several social identities but also encourage them to feel part of larger communities and to promote societal change in a constructive way.

Background Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. Aim The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. Design Cross sectional study. Setting Inpatient rehabilitation centers. Population The study included data from 586 sABI patients. Methods Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient's characteristics on rehabilitative take in charge was explored. Results Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysis showed that severe neurological and clinical conditions, acute organ failure, cardio-respiratory instability and paroxysmal sympathetic hyperactivity significantly limit access to rehabilitative sessions. Conclusions In sABI patients clinical comorbidities requiring elevated care assistance are frequent at admission in rehabilitation from acute wards and may interfere with rehabilitative take in charge. Clinical rehabilitation impact The knowledge of clinical complexity of sABI patients may improve their care pathways, promoting early and appropriate transition from acute care to rehabilitation settings.

Neuropsychological testing is a key diagnostic tool for assessing people with dementia and mild cognitive impairment, but can also help in other neurological conditions such as Parkinson’s disease, stroke, multiple sclerosis, traumatic brain injury and epilepsy. While cognitive screening tests offer gross information, detailed neuropsychological evaluation can provide data on different cognitive domains (visuospatial function, memory, attention, executive function, language and praxis) as well as neuropsychiatric and behavioural features. We should regard neuropsychological testing as an extension of the neurological examination applied to higher order cortical function, since each cognitive domain has an anatomical substrate. Ideally, neurologists should discuss the indications and results of neuropsychological assessment with a clinical neuropsychologist. This paper summarises the rationale, indications, main features, most common tests and pitfalls in neuropsychological evaluation.

The functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent (BOLD) signal is regularly used to assign neuronal activity to cognitive function. Recent analyses have shown that the local field potential (LFP) gamma power is a better predictor of the fMRI BOLD signal than spiking activity. However, LFP gamma power and spiking activity are usually correlated, clouding the analysis of the neural basis of the BOLD signal. We show that changes in LFP gamma power and spiking activity in the primary visual cortex (V1) of the awake primate can be dissociated by using grating and plaid pattern stimuli, which differentially engage surround suppression and cross-orientation inhibition/facilitation within and between cortical columns. Grating presentation yielded substantial V1 LFP gamma frequency oscillations and significant multi-unit activity. Plaid pattern presentation significantly reduced the LFP gamma power while increasing population multi-unit activity. The fMRI BOLD activity followed the LFP gamma power changes, not the multi-unit activity. Inference of neuronal activity from the fMRI BOLD signal thus requires detailed a priori knowledge of how different stimuli or tasks activate the cortical network.

In the Protected Marine Area of Porto Cesareo (Lecce, Italy) various submerged and semi-submerged evidences have been highlighted/picked out by some recent notifications and preliminary surveys carried out by the Dipartimento di Beni Culturali – Università del Salento, in close collaboration with the Protected Marine Area: - a navis lapidaria wreck, with a cargo of monumental marble columns from Eubea (Greece), of the Roman Imperial age; - various scattered and decontextualized finds (amphorae, anchor stocks, pottery sherds); - a beached wreck, probably Medieval, at - 2 m.s.l. and 150 m from the coastline; - some submerged structures, located between the Scalo di Furno promontory and the opposite islet, at - 2.20 m.s.l; according to the building technique and the morphology, to the presence of Middle Bronze age ware, and mostly to the sea level relative rising values, we could identify them with the submerged part of the Bronze age Scalo di Furno settlement on the headland; - remains of structures (walls, buildings, burial areas) and finds of Roman age along the shoreline of T. Chianca headland and the close peninsula, partially submerged and eroded. The last three evidences allow us to hypothesize an ancient coastal landscape significantly different and a “dynamic” outline during the centuries.

In recent years, bullying has been examined in relation to the growth in the use of Information and Communication Technologies (ICT) by adolescents, opening up a new line of research on “cyberbullying”. Two relevant issues in cyberbullying research are the relationship between cyberbullying and traditional bullying and the nature of cyberbullying phenomenon, with its links to the accessibility and characteristics of the technologies involved. According to national surveys, Italy shows a puzzling access to ICT, and a few studies have investigated with comparable tools the diffusion of cyberbullying across different areas of the Country. In this study we aimed at describing the diffusion of traditional bullying (direct and indirect) and cyberbullying (mobile and Internet) among Italian middle school students from different geographical areas of Italy with respect to the roles of bully and victim. A second aim was to examine the predictors of direct, indirect, mobile and Internet victimization focusing on sociodemographic and contextual variables such as gender, Region, mother’s and father’s level of education and school climate, and for cyberbullying victimization the access to ICTs and the event of being a victim or a bully in traditional bullying. A questionnaire was administered to 1000 Italian adolescents (mean age = 12.3 years) from three Italian regions (Emilia Romagna, Tuscany and Calabria). Findings showed higher percentages of adolescents involved in indirect bullying, followed by direct bullying, cyberbullying via mobile phone and via the Internet. Logistic regression analyses showed that gender was significantly predictive of victimization but with different trends across bullying types: males were more likely to be victims of direct bullying, females of indirect bullying and mobile cyberbullying, while this variable had not a predictive role on Internet victimization. A negative school climate perception was a significant predictor for direct, indirect and mobile victimization, but not for Internet victimization. Moreover, being involved as a bully or a victim in traditional bullying increases the risk of being victim of cyberbullying (both via mobile phone and via the Internet). These results point out that bullying and cyberbullying were diffuse in Italy across different regions, with a relevant continuity between traditional bullying and cyberbullying in particular between indirect and mobile bullying, suggesting that virtual contexts may reflect social interactions that preadolescents may have in personal offline relationship.

Il fenomeno delle prepotenze tra pari, conosciuto come bullying o bullismo, è stato oggetto di studio in Italia ed in Europa negli ultimi decenni (Lo Feudo, Palermiti, Costabile, 2003; Fonzi, Genta, Menesini, Bacchini, Bonino, Costabile, 1999; Sutton et al., 1999; Smith et al., 1999) da qualche anno, la diffusione di un fenomeno di prevaricazione di tipo elettronico, definito cyberbullying ha posto l’accento sui media, principali strumenti attraverso i quali il fenomeno si manifesta (computer, internet, telefoni cellulari). La preadolescenza e l’adolescenza caratterizzano un periodo delicato della crescita di ogni individuo segnato soprattutto da una progressiva trasformazione e ridefinizione dei rapporti con i coetanei. Durante questo periodo, l’instaurarsi di relazioni positive con i pari è ritenuto importante al fine di promuovere uno sviluppo psicosociale adeguato (Hartup, 1993). Negli ultimi anni i contesti elettronici e virtuali hanno assunto un’importanza crescente nella vita sociale dell’adolescente (Williams e Guerra, 2007). In pochi anni Internet è diventato uno dei principali strumenti di socializzazione e di svago per bambini e adolescenti italiani: ben il 77% dei ragazzi italiani di entrambi i sessi utilizza in modo abituale la rete come strumento di comunicazione (Rivoltella, 2006). Internet, per gli adolescenti, rappresenta un mondo affascinante e fantastico in quanto offre la possibilità, oltre che di raccogliere e scambiare informazioni con i pari, di interagire con altre persone mantenendo l’anonimato, di sperimentare nuove identità e, in alcuni casi, di provare un senso di comunità e di accettazione sociale. Può succedere, tuttavia, che da un semplice svago la navigazione in Internet possa virare verso forme di utilizzo più problematiche, fino a diventare una vera e propria dipendenza. Secondo i dati presenti in letteratura, la prevalenza dell’uso problematico di Internet nella popolazione adolescenziale varia dal 7,5% al 70% circa (Morahan- Martin e Schumacher, 2000). Obiettivo Il campione della ricerca è composto da 600 studenti di età compresa tra i 12 ed i 13 anni frequentanti la seconda classe delle scuole medie inferiori delle regioni Calabria e Toscana. Obiettivo del lavoro è : - rilevare differenze tra bullismo tradizionale e bullismo elettronico; - individuare differenze di genere; - analizzare le possibili analogie e differenze dei due campioni: nord e sud. Metodo La metodologia utilizzata si basa sulla somministrazione di un questionario anonimo per rilevare il bullismo sia nelle forme tradizionali (diretto e indiretto) che nelle nuove forme (uso di cellulare e di internet). Il questionario pone domande sul bullismo agito e subito e sulle reazioni emotive suscitate dai comportamenti prevaricatori. Inoltre, il questionario indaga sulla diffusione delle nuove tecnologie e sul clima scolastico percepito dagli alunni. Il questionario è stato somministrato collettivamente all’intero gruppo classe senza la presenza dei docenti che avrebbe potuto costituire motivo di inibizione da parte dei ragazzi. Risultati Dai primi dati ottenuti si evince che il fenomeno del bullismo elettronico è diffuso anche in Italia ed è presente nelle nostre scuole. Il 13% dei ragazzi afferma di essere stato vittima di prevaricazioni attuate mediante le nuove tecnologie negli ultimi due mesi, anche se le percentuali più alte si riferiscono al bullismo elettronico occasionale (8.6%) rispetto al bullismo elettronico grave (3.4%).La presenza del fenomeno rappresenta un elemento di preoccupazione sia per i bulli che per le vittime. Il 26,3% dei ragazzi di età compresa tra i 12 ed i 13 anni dichiara di aver compiuto atti di aggressione tramite telefono cellulare ed il 20,5% tramite internet. Rispetto alla variabile genere, una differenza significativa si rileva per le ragazze che assumono più spesso il ruolo di vittima subendo atti di aggressione sia tramite telefono cellulare (55.9%) che tramite internet (56.1%). I raga...