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Abstract Aims The identification of subjects at higher risk for incident heart failure (HF) with preserved ejection fraction (EF) suitable for more intensive preventive programmes remains challenging. We applied phenomapping to the DAVID‐Berg population, comprising subjects with preclinical HF, aiming to refine HF risk stratification. Methods The DAVID‐Berg study prospectively enrolled 596 asymptomatic outpatients with EF > 40% with hypertension, diabetes mellitus or known cardiovascular disease. In this cohort, we performed an unsupervised cluster analysis on 591 patients, including clinical, laboratory, electrocardiographic and echocardiographic parameters. We tested the association between each cluster and a composite outcome of HF/death. Results The median age was 70 years, 55.5% were males and the median EF was 61.0%. Phenomapping provided three different clusters. Subjects in Cluster 3 were the oldest and had the highest prevalence of atrial fibrillation, the lowest estimated glomerular filtration rate (eGFR), the highest N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and the largest left atrium. During a median follow‐up of 5.7 years, 13.4% of subjects experienced HF/death events (N = 79). Compared with Clusters 1 and 2, Cluster 3 had the worst prognosis (log‐rank test: Cluster 3 vs. 1 P 40% who deserve more efforts to prevent clinical HF.

Abstract Background Numerous studies have explored the impact of pre- and post-migration factors on the overall health of migrant populations. The objective of this study is to enhance our understanding of additional determinants affecting migrants' health by examining the impact of the migration phase and related journeys in the European context. Methods We conducted a systematic review of studies published in the MEDLINE, Embase, and Scopus databases from 2003 up to January 5, 2024. We included observational studies reporting information on the health status of migrant populations recorded upon arrival in a country situated in Europe, and on the transit phase, including specific risk factors experienced during the journey or its characteristics. Title and abstract screening were performed using active learning techniques provided by ASReview software. The results of the included studies were presented qualitatively, with a focus on publications that formally assessed the association between the journey and the investigated health outcomes. The systematic review was registered on PROSPERO, CRD42024513421. Results Out of 11,370 records screened, we ultimately included 25 studies, all conducted since 2017. Most adopted a cross-sectional design and a quantitative approach, with relatively small sample sizes. The majority of the studies were conducted in Serbia and Italy. Only 14 of them formally assessed the association between different exposures in the transit phase and health outcomes, including mental health, well-being and quality of life, infectious and non-communicable diseases. Conclusion Epidemiological research focusing on the transit phase in Europe remains limited, with few available studies facing challenges related to data collection, study design and analysis, thereby limiting the interpretability and generalisability of their results. These findings underscore the need for action, prompting the development of adequate and feasible strategies to conduct additional studies focusing on migrant populations during migration journeys.

Abstract The work addresses the topic of the thermal study of high-voltage power cables installed inside plastic pipes in the absence of filling. The presence of air inside the pipe creates an insulating layer that does not favor heat exchange and makes the calculation of the flow rate more complex, as it is necessary to take into account the thermal phenomena of natural convection and radiation between the surface of the cable and the internal surface of the tube. The numerical model based on the finite element calculation was compared with the experimental results obtained on a simulacrum in which the temperatures on the different layers of the cable were measured. After this validation, some typical installation configurations of single and double energy transport triads were analyzed.

Abstract HPV-positive and HPV-negative head and neck squamous cell carcinoma (HNSCC) are recognized as distinct entities. There remains uncertainty surrounding the causal effects of smoking and alcohol on the development of these two cancer types. Here we perform multivariable Mendelian randomization (MR) to evaluate the causal effects of smoking and alcohol on the risk of HPV-positive and HPV-negative HNSCC in 3431 cases and 3469 controls. Lifetime smoking exposure, as measured by the Comprehensive Smoking Index (CSI), is associated with increased risk of both HPV-negative HNSCC (OR = 3.03, 95%CI:1.75-5.24, P = 7.00E-05) and HPV-positive HNSCC (OR = 2.73, 95%CI:1.39-5.36, P = 0.003). Drinks Per Week is also linked with increased risk of both HPV-negative HNSCC (OR = 7.72, 95%CI:3.63-16.4, P = 1.00E-07) and HPV-positive HNSCC (OR = 2.66, 95%CI:1.06-6.68, P = 0.038). Smoking and alcohol independently increase the risk of both HPV-positive and HPV-negative HNSCC. These findings have important implications for understanding the modifying risk factors between HNSCC subtypes.

Abstract The significant impact of acute respiratory tract infections on healthcare systems is well-documented, given their contribution to emergency department admissions, hospitalizations, and increased use of antibiotics and other medications. However, further research is needed to understand the burden of acute respiratory tract infections in pediatric community care to develop effective public health interventions and improve child health outcomes. Real-world data were retrieved from Pedianet, an Italian network of over 200 family pediatricians. Acute respiratory tract infection visits were identified and analysed using an infection-duration algorithm to extract individual cases. The number of follow-up visits per 100 cases was calculated to assess the burden on the Italian National Health Service. Comparisons were made overall and stratified by type of acute respiratory tract infections and epidemiological season. A total of 1,402,953 acute respiratory infections-related visits were recorded, with an overall rate of 12 visits per 100 cases. Upper respiratory tract infections had an average of 9 visits per 100 cases. Lower respiratory tract infections exhibited a higher burden, with 29 visits per 100 cases. Pneumonia showed a declining trend in the pre-pandemic era (62 to 48 visits) but rebounded in the post-COVID-19 years (32 to 42 visits). This study underscores the importance of monitoring and managing acute respiratory infections, especially lower respiratory tract infections, in pediatric care.

Abstract The High Magnetic Passive Loop (HMCPL) technique is proposed as an innovative passive shielding system to mitigate the undesired dispersion of the magnetic field produced by a wireless power transfer (WPT) system, thus reducing the risk of hazardous human exposure. The magnetic structure is described both in terms of lumped parameters circuit, useful for sizing, and in terms of a geometrical representation solved by finite element method, useful to assess the field attenuation effects. Sizing of the resonance capacitors in the shielded WPT structure is approached as a Pareto optimization problem and solved via genetic algorithm. HMCPL shielding design guidance is provided to reduce the magnetic field emission in the surrounding environment. Furthermore, the influence of the shielding on the performance of the WPT system is also evaluated.

Objetivo: Evaluar la percepción de autoeficacia para brindar cuidados humanizados por parte del personal de enfermería de una institución sanitaria especializada en rehabilitación de la Ciudad de Buenos Aires, Argentina durante el primer semestre del 2023. Metodología: Estudio descriptivo, transversal y cuantitativo. Se implementó el instrumento Caring Efficacy Scale de Coates en su versión en español con un alfa de Cronbach de 0,91. Se implementó el consentimiento informado y no se recolectaron datos filiatorios. Resultados: Los encuestados tuvieron una media de edad de 38,29 años (DE:8,00), y eran mayormente mujeres, solteras, con hijos, con formación de tecnicatura en Enfermería, desempeñaban actividades asistenciales y tenían más de 5 años de experiencia laboral. El ítem con mejor valoración fue “Si pienso que un cliente/paciente está incómodo o puede necesitar ayuda, me acerco a esa persona” con una media de 5,07 (DE:1,52) categorizado como “Moderadamente de acuerdo”, mientras, el ítem con peor valoración fue “A menudo encuentro difícil transmitir mi punto de vista a los pacientes/clientes cuando lo necesito” con una media de 2,44 (DE:1,56) categorizado como “Moderadamente en desacuerdo”. La media de autoeficacia para brindar cuidados humanizados fue de 148,13 (DE:23,75) categorizado como moderadamente positivo. Conclusión: La percepción de autoeficacia para brindar cuidados humanizados fue positiva y se relacionó negativamente con la realización de actividades asistenciales. Se amerita de implementar estrategias para prevenir la deshumanización en el personal de enfermería, así como implementar actividades de capacitación para mejorar la atención.

The presence of statues in two of d’Annunzio’s tragedies (La Gioconda and La figlia di Jorio) will be analysed, proposing a comparison between examples of ‘living statues’ from ancient times and the late nineteenth‐early twentieth century period. In the second part, reference will be made to the scientist culture of the late nineteenth century. Here, we will make use of a theory according to which they could be two fetishes that direct the flow of thoughts of the protagonists against their opponents.

Abstract Background Experience‐Based Co‐Design (EBCD) is a multi‐stage participatory action research process which was developed originally to increase patient involvement in service improvement initiatives. This viewpoint article serves as a reflection on the researchers' experiences, focusing on the application and feasibility of participatory approaches, particularly co‐design, in the specific context of early‐phase clinical trials. Methods We reflect on the opportunities and challenges of applying EBCD in a new context of early‐phase clinical trials in oncology where experimental treatments are increasingly perceived as a therapeutic option and, in certain instances, their efficacy may lead to accelerated approval facilitating a swifter integration into standard care. Results We propose that the opportunity of applying EBCD in such trials lies in improving the delivery of person‐centered care, care coordination, and support during the transition from experimental to standard care. Three potential challenges when applying EBCD in early‐phase clinical trials are discussed related to: the need for standardization in trial processes; planning EBCD in a context of high uncertainty; and vulnerability of patient populations. Conclusion Integrating EBCD into early‐phase oncology trials presents an opportunity to enhance person‐centered care and can lead to simultaneous improvements in care processes and therapeutic development. Patient or Public Contribution This article has been developed with the collaboration of a patient partner who serves on the advisory board of our ongoing EBCD study in early clinical trials.

A caucasian 62-year-old woman, diagnosed with biphasic pleural mesothelioma (PM) of II stage and BAP1 loss, was treated with therapies included in clinical trial and Early Access Programmes (EAP). During her clinical history, radiological images presented an unusual representation of the disease, with a pseudo progression discussed many times by several specialists. The patient's overall survival improved as a result of the multidisciplinary team and the availability of medicines outside of clinical practice.

Introduction: Long-term contamination of tap water and groundwater by perfluoroalkyl and polyfluoroalkyl substances (PFASs) has been documented in the Veneto region of northern Italy. This study aimed to assess the exposure of individuals residing in the contaminated area and to test several toxicokinetic (TK) models of varying complexities to identify an efficient method for predicting perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) concentrations in human serum using observed data.The ultimate goal is to provide public health officials with guidance on selecting the appropriate TK model for specific contexts, a reliable and rapid tool to support human bio-monitoring (HBM) studies. Methods: Two simpler empirical TK models and a more complex multi-compartment physiologically based toxicokinetic (PBTK) model were compared with individual and aggregate data from an HBM study. In addition, the PBPK model was modified by adjusting input parameters and introducing new terms into the equations within the original model code. These modifications aimed to optimize the results compared to the original model, with some versions incorporating adjustments to account for the influence of menstruation in women. All models were evaluated to understand their strengths and weaknesses, providing guidance on the appropriate model to use according to specific scenarios. Results: The results obtained from the tested models were quite similar, with significant improvements observed only in the modified models. Simpler models also provided satisfactory results in scenarios involving low PFOS serum concentrations and recent exposure cessation. In many cases, predictions demonstrated high accuracy, particularly at the aggregate level and for women. Conclusions: These findings suggest that environmental protection agencies and health authorities may benefit from employing the tested models at the aggregate level as an initial step in HBM studies, rather than conducting more invasive and expensive screening campaigns.

Background: In middle-income countries, costs limit widespred use of left ventricular assist device (LVAD) as a strategy for end-stage heart failure. We aim to describe the experience of a LVAD program in a middle-income country in a hub-and-spoke model. Methods: Patients fulfilling strict inclusion and exclusion criteria were referred from different centers in Brazil for LVAD implantation through a philanthropy program financed via a Brazilian Federal Government tax exemption structure. LVAD implantation was performed in a hub-and-spoke model with a single implanting center. Data were collected retrospectively using hospital records and telephone contact with other centers. Patients who received LVAD implants external to the philanthropic program, either at this or other Brazilian centers, were not included. Results: Between January 1, 2013 and December 31, 2020, 20 adult patients underwent long-term continuous flow LVAD implantation with decentralization of postimplant patient care in regional centers. Patients were referred from 11 centers from 7 states in Brazil and underwent LVAD implantation through a philanthropy program. The median age was 52.5 years and 85% were Interagency Registry for Mechanically Assisted Circulatory Support profile 3 patients. Two patients had Chagas cardiomyopathy. The overall survival censored for competing risks at 1 and 2 years were 90% and 84%, respectively. Three patients (15%) underwent heart transplantation in the first 2 years after LVAD implantation. Twelve patients returned to their original centers and were followed remotely. Conclusions: This study presents a successful LVAD implantation program in a hub-and-spoke model in Brazil. Centralization of LVAD implantation with decentralization of postimplant patient care in regional centers is feasible and safe, enabling optimal allocation of resources in middle-income countries.

Objetivo: Determinar las habilidades y conocimientos sobre las tecnologías de la información y la comunicación (TIC) de los ingresantes a la carrera de Licenciatura en Enfermería de una institución superior pública de Bahía Blanca, Provincia de Buenos Aires, Argentina. Metodología: Estudio observacional, descriptivo, transversal y cuantitativo. Se implementó un instrumento conformado por 59 preguntas con opciones de respuesta cerrada orientado a valorar las competencias digitales en los ingresantes a la carrera. Resultados: Participaron 386 ingresantes, mayormente de género femenino (85.49 %), del primer ciclo (74.35 %) y con 20 años o menos de edad (47.15 %). El 98.19 % tenía acceso a internet, el 79.27 % tiene computadora y más del 80 % tiene un amplio uso de redes sociales (WhatsApp, Instagram) y correo electrónico. Los ingresantes se autoevaluaron competentes en el programa MS Word, mientras que en MS Excel se declararon menos competentes. Hay desconocimiento y bajo desarrollo de habilidades para generar contenido, y un amplio despliegue de habilidades para buscar y descargar información de la web. La edad, el género, el tiempo diario de uso de internet y el ciclo de ingreso mostraron relación con el dominio de las herramientas digitales aplicadas a la educación. Conclusiones: Se identificó un desarrollo intermedio de competencias digitales aplicadas a la educación, lo que podría ameritar el diseño de programas que nivelen estas habilidades durante el proceso de ingreso o durante la formación.

La pandemia COVID-19 obligó a migrar de manera rápida de una formación esencialmente presencial a una mediada por tecnología. Diversos estudios fueron realizados para valorar el nivel de desarrollo de competencias ante esta modalidad, concluyendo la existencia de marcadas dificultades para alcanzar los objetivos propuestos en la malla curricular ante la virtualización completa de los contenidos y actividades. Posterior a la pandemia muchas instituciones retomaron con la formación presencial resaltando las bondades del trabajo en aula, espacios de simulación y centros sanitarios, mientras, otras decidieron implementar grados variables de virtualidad y evaluar el desempeño del alumnado, de modo de asegurar la calidad formativa. En la actualidad las opiniones sobre la implementación de las modalidades de formación mediadas por tecnología (híbrida y semipresencial) son disimiles, tomándose como una amenaza a la calidad formativa, muchas veces haciendo a un lado los beneficios potenciales y la evidencia científica que da soporte a estas modalidades. El documento realiza una reflexión respecto a los beneficios y elementos a tener en cuenta al momento de considerar su inclusión en la oferta académica.

Background: The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used self-report measure of eating styles, i.e., emotional, restrained, and external. A short and reliable version is useful for screening, routine assessments, and multipurpose surveys. Objective: The short version of the DEBQ by Bailly et al. (2012) was validated in the Italian context in two studies. Concurrent criterion validity was tested by considering gender, body mass index, self-esteem, eating self-efficacy, and snacking habits. Method: Data were collected via online questionnaires administered to two convenience samples of university students ( n = 613, n = 856). Results: The three-factor structure of the short version of the DEBQ was supported and was invariant across genders. Correlations among the three eating styles, gender, body mass index, self-esteem, eating self-efficacy, and snacking habits followed the expected pattern. Conclusion: The short form of the DEBQ is psychometrically sound and can be used to investigate eating styles among Italian university students.

Introducción: Resulta indispensable el análisis de la autovaloración de los estudiantes sobre sus capacidades para brindar cuidados humanizados y relacionarse con sus pacientes, siendo un elemento que permite la identificación de áreas para priorizar en la formación, así como para identificar las fortalezas en este proceso. Objetivo: Evaluar la percepción de autoeficacia para brindar cuidados humanizados de los estudiantes del último año de la carrera de Licenciatura en Enfermería de una institución de educación superior de carácter privado de Buenos Aires, Argentina. Métodos: Estudio descriptivo, cuantitativo y transversal. Se encuestó a 67 estudiantes utilizando el cuestionario Caring Efficacy Scale en su versión en español. Resultados: La media de edad de los encuestados fue de 35,54 años (DE=7,89), y estos fueron mayormente de género femenino (74,63%), solteros (58,21%), con hijos (64,18%), trabajan en áreas abiertas (68,66%), tienen una antigüedad laboral de entre 6 y 10 años (34,33%), un empleo (82,09%), entre 3 y 5 pacientes a cargo por turno (46,27%) y perciben una elevada carga de trabajo (55,22%). Se identificó que la percepción de los estudiantes sobre su autoeficacia para brindar cuidados humanizados y relacionarse con el paciente fue mayormente positiva y alta en un 68,66%. Conclusión: Se identificaron relaciones entre las variables sociodemográficas y laborales y algunos ítems del instrumento. Las variables edad, género, tenencia de hijos, área de trabajo, cantidad de pacientes a cargo, percepción de la carga de trabajo y antigüedad laboral inciden sobre la percepción de autoeficacia para brindar cuidados humanizados.

BackgroundChildhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. ObjectiveThis study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. MethodsAn Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ≥3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ≤5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. ResultsAmong 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend

Background: Inflammatory bowel diseases (IBDs) have a peak incidence between the second and fourth decades of life and can affect women’s reproductive life. Objectives: Our study aimed to assess the impact of IBD on the reproductive life of female patients with this condition. Design: Cross-sectional study. Methods: Women with IBD followed at our IBD Unit and a group of healthy controls were enrolled. Data on reproductive life were collected using a dedicated questionnaire. Results: The study included 457 women, of whom 228 had IBD, and 229 age-matched healthy controls. No differences were found in the use of contraceptives, infertility, and endometriosis. The risk of spontaneous and voluntary abortions was significantly higher in IBD patients than in healthy controls [odds ratio (OR) 2 and 3.62, respectively]. The risk of obstetrical complications in the IBD population was more than six times higher in patients who experienced disease reactivations during pregnancy than in those with persistent remission [OR 6.9, 95% confidence interval (CI) 1.51–31.28]. Finally, we found that the chances of breastfeeding were 66% lower in patients with IBD than in controls (OR 0.44, 95% CI 0.22–0.91). Conclusion: Our study underlines the negative impact of IBD on women’s reproductive life, supporting the need for proactive preconception counseling.