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Aims: Patient-reported outcomes (PROs) are increasingly important for assessing patient satisfaction with diabetes technologies. PROs must be assessed with validated questionnaires in clinical practice and research studies. Our aim was to translate and validate the Italian version of the continuous glucose monitoring (CGM) Satisfaction (CGM-SAT) scale questionnaire. Methods: Questionnaire validation followed MAPI Research Trust guidelines and included forward translation, reconciliation, backward translation, and cognitive debriefing. Results: The final version of the questionnaire was administered to 210 patients with type 1 diabetes (T1D) and 232 parents. The completion rate was excellent, with almost 100% of items answered. The overall Cronbach’s coefficient was 0.71 and 0.85 for young people (patients) and parents indicating moderate and good internal consistency, respectively. Parent–young people agreement was 0.404 (95% confidence interval: 0.391–0.417), indicating moderate agreement between the two assessments. Factor analysis identified that factors assessing the “benefits” and “hassles” of CGM accounted for 33.9% and 12.9% of score variance in young people and 29.6% and 19.8% in parents, respectively. Discussion: We present the successful Italian translation and validation of the CGM-SAT scale questionnaire, which will be useful for assessing satisfaction with Italian T1D patients using CGM systems.

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years.

Hepatitis C virus (HCV) infection has a worldwide incidence of 1.1%. In Italy, 60% of people who inject drugs (PWIDs) and are receiving assistance for substance use disorder are infected with HCV. However, this subset of patients has extremely limited access to care due to multiple factors, including alcohol abuse, psychological comorbidities, and homeless status.To describe the impact of our HCV-dedicated service for substance use disorder (SSUD) service on PWIDs receiving anti-HCV therapy.A dedicated, multidisciplinary team was set up at the SSUD of Trento in October 2020 to provide antiviral treatment to HCV RiboNucleic Acid-positive patients with an active or previous history of substance abuse. The treatment was followed by a health education program. Patients were treated with Direct-Acting Antivirals (DAAs). Data were retrospectively analyzed to assess the efficacy of our dedicated program in terms of therapy completion, HCV eradication, and compliance (primary endpoint). The rate of HCV reinfection and DAA-related toxicity were also assessed (secondary endpoints).A total of 40 patients were enrolled in the study: 28 (70.0%) were treated with Sofosbuvir/Velpatasvir, while 12 (30.0%) received Glecaprevir/Pibrentasvir. At the time of inclusion in the study, 36 patients were receiving opioid agonist maintenance therapy, whilst another 4 had just finished the treatment. 37.5% had a history of alcoholism and 42.5% received concomitant psychiatric treatment. All 40 patients (100.0%) completed the therapy cycle and 92.5% of patients adhered to the program. All patients tested negative for viral load at the end of the treatment. There were no significant drug interactions with common psychiatric treatments and no side effects were observed. The sustained virological response was achieved in 92.5% of cases with good tolerability, although two patients discontinued treatment temporarily. After HCV eradication, one patient died from an overdose, another from complications of cirrhosis, and one reinfection occurred.Very high adherence to therapy and good tolerability was observed in our series of HCV patients treated at the SSUD, regardless of the substance abuse condition. Further validation in a larger population is required.

Purpose This study aims to describe the TreC Oculistica novel smartphone App that facilitated the clinical practice of pediatric ophthalmology and strabismus during the COVID-19 pandemic and to report on the validation of visual acuity tests in a home setting. Methods The Trec Oculistica smartphone App was prescribed to eligible patients at the Pediatric Ophthalmology and Strabismus Clinic, Ophthalmology Unit of Rovereto Hospital between September 2020 and March 2022. Four key indicators were identified for monitoring visual and visuo-motor functions remotely: visual acuity, ocular motility, head posture, and color vision. Clinicians selected few mobile applications (iOS, Android) and printable materials within the Trec Oculistica App: the Snellen Chart Visual Acuity App, the 9Gaze App, the eyeTilt App, the Color Blind test App, the LEA Symbols pdf, and the Snellen Chart pdf. All patients, aged 4 and older, were screened at home for visual acuity at 3 meters and later in the clinic (LEA Symbols cabinet or Snellen computerized optotype).The 9Gaze, the eyeTilt, and the Color Blind test Apps were only recommended to a subset of patients based on clinical suspicion or diagnosis. The Wilcoxon signed rank sum test and Weighted Cohen's kappa coefficient were applied to compare pairs of scores from different settings. Results The Trec Oculistica App was downloaded and activated by 97 patients or their caregiver. 40 patients were tested at home using the 9Gaze App, 7 used the eyeTilt App, and 11 used the Color-Blind test App. Families reported that all the Apps were easy and intuitive to use; clinicians reported that measurements were reliable. 82 eyes of 41 patients (mean age 5.2 years, SD ± 0.4, range 4.4-6.1) were tested for visual acuity using the self-administered LEA Symbols pdf . 92 eyes of 46 patients (mean age 11.6 years, SD ± 5.2, range 6-35) were evaluated using the self-administered Snellen Chart Visual Acuity App or the Snellen Chart pdf. Home median visual acuity score was statistically different from that registered in clinical setting for both the LEA Symbols pdf (P-value 0.0074) and the Snellen Chart App and pdf (P-value 0.0001). The strength of agreement was 0.12 (slight) for the LEA Symbols pdf, 0.50 (moderate) for the Snellen Chart Visual Acuity App, and 0.69 (substantial) for the Snellen Chart pdf. Conclusions The novel TreC Oculistica smartphone App was a useful tool for facilitating the clinical practice of pediatric ophthalmology and strabismus during the COVID-19 pandemic. In the follow-up of strabismus patients and patients with suspected inherited retinal diseases, the 9Gaze, eyeTilt, and Color Blind test applications were deemed to be intuitive and easy to use by families, and were considered reliable by clinicians. In a home setting, visual acuity tested by means of Snellen Charts was moderately congruent with the in-office examination. On the contrary, agreement was poor in younger children tested with the LEA Symbols pdf.

Background The impact of a faecal immunochemical test-based colorectal cancer (CRC) screening program in terms of patient prognosis could be affected by lead-time bias, which artificially increases the survival of screen-detected patients due to the early diagnosis. Aims To provide a description of the impact of the CRC screening program in the Trentino Region (Italy), including the Cure Fraction (CF), a prognostic indicator not affected by lead-time bias. Methods The program started in 2008, inviting the resident population aged 50–69 years. In this retrospective cohort study, 1,697 CRC diagnosed between 2003 and 2014 in patients aged 50–69 years were classified as pre-screening (PS), screen-detected (SD), interval cancers (IC) and not-screen-detected (NSD). We compared groups by stage at diagnosis and CF. Trends in CRC mortality were reported. Results The proportion of stage I among SD cases was 51%, higher than PS (19%; OR 4.66, 95%CI 3.50–6.20), NSD (20.6%; OR 3.96, 95%CI 2.95–5.32) and IC (33.3%; OR 2.11, 95%CI 1.10–4.04). The CF of PS, NSD and SD cases was respectively 57% (95%CI 54–60%), 60% (95%CI 58–63%) and 93% (95%CI 89–96%). CRC mortality dropped from 40.7 to 25.6\100,000. Conclusion The program significantly improved the prognosis of patients, decreasing CRC mortality and incidence of advanced CRCs.

Purpose To evaluate the clinical outcomes, toxicity and prognostic factors conditioning survival of reirradiation with Proton therapy for recurrent meningiomas. Methods Recurrent meningioma who failed after radiotherapy were re-irradiated with active scanning proton therapy with a median dose of 54 GyRBE (range 50.4-60 GyRBE). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The log rank test was performed to compare the entire survival experience between groups (significant p-value ≤ 0.05). Associations between qualitative variables were analyzed with the Fisher exact test (significant p-value ≤ 0.05). Results Thirty-two patients were re-irradiated with Proton therapy (10 grade I, 22 grade II-III). Median tumor volume at the time of re-irradiation was 43 cc (range 1.2-225.5) and median time from prior RT to reirradiation was 66 months (range 4-288). At a median follow-up of 27 months, 1-yr and 2-yr PFS were 89.4% and 74.5% (1-yr and 2-yr PFS were 100% for grade I, 100% and 76% for grade II, 66% and 50% for grade III). 1-yr and 2-yr OS were 86.6% and 83.0% (2-yr OS were 87% for grade I, 86% for grade II, 66% for grade III). Local recurrence rate was 34% with a median time of recurrence of 13.4 months. Five patients (14%) developed radionecrosis with a median time of 3.4 months from the end of PT (range 3-8.8). Conclusions Re-irradiation with proton therapy seems to be a safe and effective treatment in patients with recurrent meningioma, also for large volume and aggressive lesions (grade II-III).

Objective: to evaluate the incidence of anastomotic leakage (AL), risk factors and utility of drainage and stoma in patients undergoing intestinal surgery for ovarian cancer in a single institution and in a review of the literature. Methods: retrospective study that includes consecutive patients undergoing debulking surgery with en bloc pelvic resection with rectosigmoid colectomy for ovarian cancer between 1 November 2011 and 31 December 2021. Data regarding patient and tumour characteristics, surgical procedure, hospitalisation, complications and follow-up were recorded and analysed. The PubMed database was explored for recent publications on this topic. Results: Seventy-five patients were enrolled in the study. All anastomoses were performed at a distance of >6 cm from the anal margin, with negative leak tests and tension-free anastomosis. Diverting stoma were performed in just three patients (4%). At least one perianastomotic pelvic drain was positioned in 71 patients (94.7%) and was removed on average on postoperative day 7. Four patients (5.3%) experienced AL. In all cases, the drain content was not the only sign of complication, as the clinical signs were also highly suggestive. Just one patient received conservative treatment. Average postoperative hospitalisation was 14.6 days (SD: ±9.7). There were no deaths at 30 and 60 days after surgery. Between the AL and non-AL groups, statistically significant differences were observed for age, Charlson Comorbidity Index, length of the intestinal resection and fitness for chemotherapy at 30 days. In ovarian cancer, rectosigmoid resection is a standardised procedure with comparable results for AL, and risk factors for AL are discretely homogeneous. What is neither homogeneous nor standardised according to the literature is the use of stomas and/or drains. Conclusion: use in the future of protective stoma and/or intra-abdominal drains is to be explored in selected and standardised situations to verify their preventive role.

To compare the estimates of preterm birth (PTB; 22-36 weeks gestational age, GA) and stillbirth rates during COVID-19 pandemic in Italy with those recorded in the three previous years.A population-based cohort study of liveborn and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (March 1Poisson regressions were run in each Region and meta-analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021.The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32-36 weeks' GA), very PTB (32 weeks' GA), and extremely PTB (28 weeks' GA), overall and stratified into singleton and multiples.The pandemic period compared with the historical one was associated with a reduced risk for PTB (Risk Ratio: 0.91; 95% Confidence Interval, CI: 0.88, 0.93), late PTB (0.91; 0.88, 0.94), very PTB (0.88; 0.84, 0.91), and extremely PTB (0.88; 0.82, 0.95). In multiples, point estimates were not very different, but had wider CIs. No association was found for stillbirths (1.01; 0.90, 1.13). A linear decreasing trend in PTB rate was present in the historical period, with a further reduction after the lockdown.We demonstrated a decrease in PTB rate after the introduction of COVID-19 restriction measures, without an increase in stillbirths.

To test the reliability and accuracy of the 2Win Refractometer Corneal Reflexes App (CR App) in detecting manifest strabismus in pediatric patients. Prospective study involving 167 children with suspected strabismus (mean age 7.6 years; SD = 3.0, range 2–14 years) undergoing the CR App ocular alignment assessment (Pediatric Ophthalmologist) versus the alternate cover test with prism ocular alignment assessment for distance (Orthoptist) as the gold standard. The AAPOS 2013 guidelines for the detection of manifest strabismus in primary position (> 8 PD) were used. Total sensitivity, specificity, PPV, and NPV for the CR App were 79.2%, 86.2%, 86.4%, and 78.9%, respectively. The overall inconclusive rate was 17.9%, but was 36.3% in children younger than 5. Sensitivity and PPV for vertical deviations were poor (33.3% and 12.5%, respectively). The accuracy of the CR App regarding the degree (in prism diopters) of manifest deviations was tested with the Wilcoxon signed rank sum test: correlation with the gold standard was good for esodeviations (p value = 0.765, not statistically significant) and poorer for exodeviations (p value = 0.056, still not statistically significant), whereas a significant difference (p value = 0.0001) was observed for vertical deviations. The CR App showed good sensitivity, specificity, PPV, and NPV for manifest strabismus > 8PD in accordance with the AAPOS 2013 guidelines; sensitivity and PPV were poor for vertical deviations. The accuracy of the CR App was good for horizontal deviations, but poor for vertical deviations. The inconclusive result rate was high in younger children.

Objective. To compare the estimates of preterm birth (PTB; 22-36 weeks gestational age, GA) and stillbirth rates during COVID-19 pandemic in Italy with those recorded in the three previous years. Design. A population-based cohort study of liveborn and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (March 1st, 2020-March 31st, 2021, N= 362,129) to an historical period (January 2017- February 2020, N=1,117,172). The cohort covered 84.3% of the births in Italy. Methods. Logistic regressions were run in each Region and meta-analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021. Main Outcome Measures. The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32-36 weeks’ GA), very PTB (

Surgical treatment of diastasis recti is still a matter of debate. Open approaches such as abdominoplasty, which offer the possibility to combine reparation of the diastasis with abdominal cosmetic surgery, are challenged by the emerging less-invasive laparoscopic or robotic techniques that offer shorter recovery for patients. However, evidence in favour of one of the two approaches concerning both short- and long-term complications and functional results is still lacking. In this paper, we analysed clinical and functional results of a new endo-laparoscopic technique for midline reconstruction (THT technique) in patients with primary abdominal wall defects associated with diastasis recti. Prospective observational study on 110 consecutive patients was submitted to endo-laparoscopic reconstruction of the abdominal wall with linear staplers. Morbidity and relapse rates with clinical and radiological follow-up were recorded at 1, 6, 12, and 24 months after the operation. Data regarding the impact of surgery on patients’ quality of life (EuraHSQol) on chronic low back pain (Oswestry Disability Index, ODI) and urinary stress incontinence (Incontinence Severity Index, ISI) were gathered. After a mean follow-up of 14 months, the morbidity rate was 9.1% and no recurrences were recorded. 6-month follow-up ultrasound showed a rectus muscles mean distance of 6.7 mm; EuraHSQol, ODI, and ISI scores significantly improved in 93%, 77%, and 63% of the cases, respectively. The THT technique proved to be a feasible, safe, and effective alternative for corrective surgery of primary midline hernias associated with diastasis recti. Short- and mid-term results are encouraging but need to be confirmed by further studies with longer follow-up. The achieved midline reconstruction offers a significant improvement of patients' perceived quality of life through reduction of abdominal wall pain, bulging, low back pain, and urinary stress incontinence.

Despite the recent growing interest of the scientific community, there is still no consensus on the actual applicability and effectiveness of sentinel lymph node (SL) procedure in colon cancers. This study aims to quantify feasibility, detection rate, negative predictive value, and accuracy of the SL identified with fluorescent dye in early colon cancers (ECC). This study conducted a consecutive sampling of 95 patients with non-metastatic colorectal cancer who have been treated with laparoscopic colon resection and complete mesocolic excision after a 25-mg indocyanine green peritumoral laparoscopic injection and SL identification with a near-infrared camera. The SL was later isolated and sent to ultra-staging. Ninety-five patients with an average age of 71 (range 37–90) and a mean BMI of 25 (range 18–39) have been recruited. On the patient sample (92 Pts), an average of 1.49 SL (range 1–5) and a mean time of 4 min were identified. The detection rate was 96.8% and the negative predictive value and accuracy rates were 96.2% and 93.4%, respectively. Mapping the SL with fluorescent dye can play an important role in the treatment of colon cancers, particularly those at early stages, and can lead to ultra-conservative surgery.

Atopic eczema (AE) is the most common inflammatory skin disease in infancy and its prevalence is rising worldwide. It has a wide social impact on the affected children and their families’ lives. AE can have a chronic and heterogeneous course, with periods of remission and relapse of the clinical manifestations. For this reason, its severity assessment through standardized outcome measures becomes a fundamental guide for health professionals, who can manage AE following evidence-based medicine principles in their everyday clinical practice or in clinical trials.Several scoring systems have been recognized to assess the clinical manifestations of AE, both from the physician’s and the patient’s point of view. Despite the scoring systems standardized for adults, there are very few published options about the expression of a patient/caregiver-centered global severity assessment specifically for pediatric AE. For this reason, the aim of our study was to evaluate a new, quick, user-friendly and feasible caregiver-reported global severity assessment for pediatric AE. Based on a 0–10 numerical rating scale in pediatric AE, we named this scoring system the Comano score.We carried out a cross-sectional observational study enrolling a total of 867 patients aged from 1 to 16 years (males 49.5%, mean patient’s age 5.9 years, standard deviation ±3.6 years) with a previous doctor-confirmed diagnosis of AE, who underwent balneotherapy at Comano Thermal Center (Comano, Trentino, Italy). A strong correlation between Comano score and SCORing Atopic Dermatitis (SCORAD) was observed (r = 0.74, p According to our results, the Comano score may be a promising new tool for the expression of a caregiver-reported global severity assessment in pediatric AE. However, further data are needed to confirm our preliminary findings before health professionals can use this scoring system in their everyday clinical practice to manage pediatric AE. Still, as a patient-focused measure, the Comano score may facilitate delivering person-centered care so as to define a measure for a clinical impact that can be meaningful to the subject, which is gaining importance in modern medicine.

Data about sleep quality and quantity are not available in patients with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM). We questioned whether the isCGM with alarms could fragment sleep in patients and parents, compared to isCGM without alarms.A prospective, observational study including 47 child-adolescents with T1D who had experience with isCGM without alarms (Freestyle Libre 1-FSL1). They were asked to wear the isCGM with alarms (Freestyle Libre 2-FSL2) for 14 days. Patients enrolled and their caregiver (s), during a 14 day period with FSL1 and the following 14 days with FSL2, completed psychosocial and sleep-related questionnaires. Furthermore they wore an actigraph that was downloaded to a web platform and processed by the validated and certified algorithm "DormiBy the switch to the alarmed FSL2 we found about a 5% increase in Time In Range (from 62.5 to 67.8%), a reduction in time spent in hypoglycemia, number of weekly hypoglycemic events, and coefficient of variation. We did not find significant differences in sleep parameters in patients and their parents; therefore, alarms did not worsen the duration and quality of sleep. A significant improvement in the Quality of Life was perceived by parents using FSL2.Introduction of alarms in isCGM systems gives, in the short term, an improvement in metabolic control in terms of time in range and reduction in hypoglycemia, without worsening duration and quality of sleep, measured by actigraphy, in children-adolescent and their parents.

The evaluation of the isocitrate dehydrogenase (IDH) mutation status in the glioma decision-making process has diagnostic, prognostic and therapeutic implications. The aim of this study was to evaluate whether conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) can noninvasively predict the most common IDH mutational status (R132H) in GIII-astrocytomas and the overall survival (OS). Hence, twenty-two patients (9-F, 13-M) with a histological diagnosis of GIII-astrocytoma and evaluation of IDH-mutation status (12-wild type, 10-mutant) were retrospectively evaluated. Imaging studies were reviewed for the morphological feature and mean ADC values (ADCm). Statistics included a Fisher&rsquo, s exact test, Student&rsquo, s t-test, Spearman&rsquo, s Test and receiver operating characteristic analysis. A p &le, 0.05 value was considered statistically significant for all the tests. A younger age and a frontal location were more likely related to mutational status. IDH-wild type (Wt) exhibited a slight enhancement (p = 0.039). The ADCm values in IDH-mutant (Mut) patients were higher than those of IDH-Wt patients (p &lt, 0.0004). The value of ADC &ge, 0.99 &times, 10&minus, 3 mm2/s emerged as a &ldquo, cut-off&rdquo, to differentiate the mutation state. In the overall group, a positive relationship between the ADCm values and OS was detected (p = 0.003, r = 0.62). Adding quantitative measures of ADC values to conventional MR imaging could be used routinely as a noninvasive marker of specific molecular patterns.

a high body mass index (BMI) during pregnancy has been associated with an increased risk of complications and adverse outcomes for both mother and infant.to analyse the main adverse maternal and neonatal outcomes associated with maternal excess weight and obesity.retrospective epidemiological study.data extrapolated from the Birth Attendance Certificate information flow of the Autonomous Province of Trento (Northern Italy) between 2015 and 2019. A total of 20,756 women with data regarding maternal height and weight at the start of pregnancy were included in the analysis.gestational outcome variables studied were gestational diabetes, hypertensive disorders, premature birth, and still births. Outcomes considered during labour and delivery were type of delivery, induction, episiotomy and post-partum haemorrhage. Neonatal outcomes were birth weight, Apgar score, need for resuscitation, and hospitalisation in the neonatal intensive care unit (NICU). Lastly, exclusive breastfeeding at discharge was analysed.considering the population of pregnant women, 68.3% of women were classified as normal-weight, 9.5% as underweight, 16.0% as overweight, and 6.3% as obese. Maternal excess weight and obesity were seen to be associated with an increased risk of gestational diabetes, gestational hypertension, preeclampsia, caesarean section, induction, post-partum bleeding, foetal macrosomia, and the need for neonatal resuscitation and hospitalisation in the NICU. Infants born to overweight and obese mothers were also less likely to be breastfed.excess weight and obesity are important risk factors for health and contribute to the onset of complications during pregnancy and adverse perinatal and long-term outcomes. Programming and implementing public health promotion schemes aimed at preventing excessive weight gain in the reproductive age could significantly improve maternal and foetal health.

BackgroundAtopic dermatitis (AD) is the most common immune-mediated skin disease in childhood. Several treatment options for pediatric AD, both topical and systemic, are currently available. We carried out a single-center observational study with the aim of describing characteristics and treatment patterns in pediatric AD patients.MethodsThe study included 867 patients aged ≤16 years (females 50.5%, mean patient’s age 5.9 years, standard deviation ±3.6 years) with a previous doctor-confirmed diagnosis of AD who underwent balneotherapy at the Comano Thermal Spring Water Center (Comano, Trentino, Italy) from April to October 2014.ResultsAmong the patients included in the study, 41.2% had mild (SCORing Atopic Dermatitis, SCORAD 0-15), 43.6% moderate (SCORAD 16–40) and 15.2% severe AD (SCORAD > 40). A higher occurrence of reported food allergy was observed among children with more severe AD(p p = 0.15 and 0.92, respectively). Emollients (55.1%) and topical corticosteroids (TCS; 45.7%) were the main treatment options used in the previous month. The use of oral steroids and topical calcineurin inhibitors (TCI) was considerably less common (6.3 and 4.5%, respectively), while no patients were on systemic agents other than steroids. Among patients with severe AD, 9.8% had not used TCS, TCI or any systemic treatments. Moreover, 20.0% of the patients in the study population had followed elimination diets, although only 27.2% of them had a reported food allergy.ConclusionsA significant difference in the prevalence of reported food allergy emerged across the different AD severity categories. Furthermore, although further data are necessary to confirm our findings, undertreatment in children with AD appeared to be very common, at least among those attending the Comano Thermal Spring Water Center. Moreover, many patients followed elimination diets in the absence of reported food allergy.

Background Several studies have investigated the efficacy of balneotherapy in atopic dermatitis (AD), including a pediatric open randomized clinical trial conducted at the Comano thermal spring water center, which showed a significant reduction in AD severity and an improvement of the quality of life. However, so far many studies on balneotherapy in pediatric AD have included relatively small populations without identifying patients’ characteristics associated with their response. The aim of the present study was to identify any features associated with the clinical response to the Comano thermal spring water balneotherapy in a large cohort of pediatric AD patients. Methods An observational study was conducted on 867 children aged ≤16 years (females 50.5%, mean patient’s age 5.9 years, standard deviation ±3.6 years) with mild to severe AD who underwent balneotherapy at the Comano thermal spring water center (Comano, Trentino, Italy) from April to October 2014. Patients were stratified according to their disease severity, which was evaluated using five SCORing Atopic Dermatitis (SCORAD) categories before and immediately after a thermal spring water balneotherapy course. Potential characteristics associated with the patients’ clinical response to Comano thermal spring water balneotherapy were investigated. Results A statistically significant improvement in AD severity was observed after Comano thermal spring water balneotherapy (p p p p p Conclusions Comano thermal spring water balneotherapy is a safe complementary treatment for pediatric patients with AD, as it was able to reduce the disease severity, especially in children ≤4 years old, with early onset AD, severe AD or concomitant food allergies.

Background The purpose of this study was to identify which clinicopathological features of early-stage rectal cancer (ESRC) are significantly correlated with the risk of local-regional lymph node metastases (LNM) and to quantify the strength of this association through a novel scoring system. According to several case studies, about 20% of operated ESRC are found with occult lymph nodal metastases at the histological examination. The low frequency of local recurrence in these tumours treated with total mesorectal excision (TME) compared to transanal approaches highlights the role of mesorectal lymph nodes as a site of metastatic location. Methods 386 consecutive patients with ESRC treated with radical resection and TME were examined in a retrospective, observational multi-centric study, operated between 2007 and 2019 in seven centres. Demographic and tumour related clinicopathological characteristics were identified, collected and analysed. Each variable was specifically weighted based on the strength of its association with the presence of nodal metastases. A scoring system using these weighted variables was developed. Results Six variables were found to be significantly associated with local regional LNM: lymphatic invasion combined with vascular invasion, poor differentiation (G3), stage T2, age ≥60 years, male sex, perineural invasion. A novel scoring system weighted on the presence of each of these variables able to quantify the risk of LNM in ESRC was developed. Conclusions The proposed scoring system is a good predictor of the risk of LNM and should be of help in the decision-making process for ESRC cases diagnosed either by local excision or endoscopic biopsy.

Background: Embryonal tumors represent a heterogeneous entity of brain tumors that need a multidisciplinary treatment including cranio-spinal irradiation (CSI), with a known impact on the acute toxicity. Proton therapy (PT) boasts a reduction in acute hematological toxicity. Methods: We retrospectively examined 20 pediatric patients affected by high-risk medulloblastoma and other rare embryonal brain tumors subjected to CSI with PT from September 2016 to April 2020. Before CSI, all patients received induction chemotherapy, and three patients additionally received two high-dose courses with thiotepa, followed by an autologous haemopoietic stem cell transplantation. We recorded the total white blood cell count, absolute neutrophil count, platelets, and hemoglobin levels for all patients during PT. Results: Leucocytes and neutrophils decreased directly after the beginning of treatment, reaching a complete recovery at the end of treatment. Hemoglobin values remained constant over the treatment course. The median platelet value decreased until reaching a plateau around halfway through therapy, followed by a slow increase. No cases of febrile neutropenia or severe infections were reported. No treatment discontinuation due to hematological toxicity was necessary. Conclusions: CSI with PT was proven to be safe in this setting of pediatric patients. Our study showed that despite all patients having undergone chemotherapy prior to irradiation, no serious hematological toxicity was reported at the end of the treatment with PT, and, therefore, no treatment was discontinued or delayed.

Background: Evidence for the efficacy of radiation therapy for primary liver cancer is growing. In this context, proton therapy (PT) can potentially improve the therapeutic ratio, as demonstrated by recent clinical studies. Here we report the first European clinical experience on the use of PT for primary liver cancer. Methods: All patients treated for primary liver cancer in our center entered the analysis. Patients were simulated during deep expiration breath-hold. A 15-fraction treatment schedule was adopted using active scanning PT. Clinical outcome and toxicity were retrospectively analyzed. Results: Between January 2018 and December 2019, 18 patients were treated. Fourteen patients had hepatocellular carcinoma (HCC), three patients had intrahepatic cholangiocarcinoma (ICC), and one patient had synchronous ICC-HCC. The Child-Pugh score was A5 in the majority of patients with HCC (71.4%). Median prescription dose was 58.05 Gy (range, 50.31–67.5). Median follow-up was 10 months (range, 1–19). The majority of deaths occurred from liver tumor progression. One-year overall survival (OS) was 63%. A significant correlation between worse OS and patient performance status, vascular invasion, and tumor stage was recorded. One-year local control was 90%. Toxicity was low, with a decrease in Child-Pugh score ⩾2 points detected in one patient. No cases of classic radiation-induced liver disease occurred. Conclusions: Our initial results of active scanning PT for primary liver cancer demonstrated the feasibility, safety, and effectiveness of this advanced technique in this setting. The potential of the combination of PT with other locoregional therapies is under evaluation.

Objective The present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse (POP). Study design A prospective cohort study on 125 patients with vaginal bulge and apical +/− anterior prolapse scheduled for LLS who consecutively underwent LLS between April 2013 and January 2017 in Gynecologic Department of Santa Chiara Hospital in Trento and University of Pisa. The main outcome measure was anatomic and symptomatic POP outcome; the secondary outcomes measures were recurrence, reoperation rate, de novo posterior POP and complications. Percentage distribution of the pre- and postoperative POP-Q stages was compared at mean follow-up. Wilcoxon signed rank sum test was used to compare preoperative POP-Q stage and postoperative POP-Q stage ate mean follow up, for each patient (paired data) and for each type of prolapse. Results 120 patients were included in the study. At 2 years 89 % of patients were asymptomatic and anatomic success rate was 94.2 % for the anterior compartment, 94.9 % for the apical compartment. Concerning posterior compartment prolapse 2 (1.7 %) patients referred stage 3 de novo prolapse during follow-up. The complication rate of Clavien-Dindo >3 was 0,8 %. Repeat surgery for POP occurred in 6.4 % of cases. The appearance of POP-Q recurrences was concentrated at 6 months follow-up. BMI > 25 was correlated with de novo posterior compartment appearance during follow-up. Conclusions LLS for the treatment of apical and anterior POP is a technique with optimal results in term of safety and effectiveness after 2 years follow-up.

INTRODUCTION The aims of the study were to evaluate quality of life, cosmetic results and surgical outcomes of robotic single-site and robotic multiport total laparoscopic hysterectomy with sentinel lymph node mapping in women treated for low-risk endometrial cancer. MATERIAL AND METHODS The study is a prospective, multicenter, case-control study conducted at Ospedale Santa Chiara in Trento and Novara and Pavia University Hospitals. Seventy-six consecutive patients with a biopsy-confirmed diagnosis of low-risk endometrial cancer or atypical endometrial hyperplasia who between January 2017 and January 2019 had undergone robotic total laparoscopic hysterectomy and sentinel lymph node mapping were included. Data on surgical outcomes, quality of life and cosmetic results were prospectively collected and analyzed based on the surgical approach with robotic single-site vs robotic multiport assistance. Patients' clinical characteristics, intra-operative parameters, sentinel lymph node mapping results and postoperative findings were prospectively recorded. Clinical follow up was performed 4 weeks and 6 and 12 months after surgery. Fifty-one patients underwent a robotic multiport procedure and 25 patients a robotic single-site surgery. RESULTS There was one significant difference between the two groups in terms of patient characteristics: mean body mass index (BMI) in the multiport group was 29 kg/m2 vs 24.8 kg/m2 in the single-site group (P value

There are few prospective data about the use of surveillance colonoscopy and the risk of recurrent neoplasia in first degree relatives (FDRs) of colorectal cancer (CRC) patients. We examined the use and yield of surveillance colonoscopy in a population-based screening program (Trentino, Italy) METHODS: 1252 FDRs have been included in this study. We calculated compliance (percentage of FDRs who underwent surveillance colonoscopy among those eligible), appropriateness of colonoscopy (appropriate if performed within 6 months of the guidelines recommended interval) and diagnostic yield for neoplasia. We compared these data with those of 765 individuals without a family history (FH) of CRC who underwent screening colonoscopy in the same period (controls).Compliance and appropriateness were higher in FDRs than in controls (93.0% vs. 48.0%; p 0.001; 59.6% vs. 18.8%; p 0.0001, respectively). Younger age, female sex, FH of CRC and both non-advanced adenomas (nAA) and advanced adenomas (AA) at screening colonoscopy were predictors of appropriate surveillance. The cumulative incidence of nAA and AA was similar in FDRs and controls (31.7% and 4.9% in FDRs, including three invasive cancers; 32.4% and 5.8% in controls, respectively).FH does not increase the risk of AA in a 5-year follow-up; appropriate surveillance practices in FDRs could be highly expected in an organized screening program.

Rubella, syphilis, toxoplasmosis, cytomegalovirus (CMV), hepatitis B (HBV) and C (HCV), HIV, and Group B Streptococcus (GBS) infections may have very severe outcomes during pregnancy, and for this reason, monitoring of infections in pregnant women is a requirement of prenatal assistance.To describe coverage and outcome of the screening for rubella, syphilis, toxoplasmosis, CMV, HBV, HCV, HIV, and Group B Streptococcus in pregnancy in the Autonomous Province of Trento, Northern Italy (538,600 inhabitants).We analysed the coverage and outcome of the above-mentioned screenings among women who delivered in the hospitals of the Province of Trento between 2007 and 2014 (N = 38,712). Screenings were grouped according to characteristics such as recommendation by national and local guidelines, scheduling of the tests, operating methods, and charge. We also estimated odds ratios (ORs) for missing screening for selected infections through multiple logistic regression.Estimated uptake of antenatal screening was 99.7% for rubella, 99.3% for syphilis, 99.7% for toxoplasmosis, 98.1% for HIV infection, 99.0% for HBV, 98.9% for HCV, 94.0% for GBS infection, and 75.4% for CMV infection. The overall prevalence of immunity was 94.1% for rubella, 24.2% for toxoplasmosis, and 64.2% for CMV. The rate of seroconversion in pregnant women was 0.02% for rubella, 0.29% for toxoplasmosis, and 0.75% for CMV. The overall prevalence of infection was 0.94% for HBV, 0.53% for HCV, 22.3% for GBS, 0.29% for syphilis, and 0.13% for HIV. We found a significant positive association for all screening tests, between lack of testing and late first medical examination in pregnancy (ORs ranging from 1.20 to 1.66 for the first medical visit in the second trimester and ORs ranging from 1.60 to 5.88 for the first medical visit in third trimester, compared to early medical visit in the first trimester). Compared to Italian citizenship, foreign citizenship of the mother was also positively associated with absence of screening (ORs ranging from 1.30 to 1.53). A significant inverse association was observed for calendar year of delivery (ORs ranging from 0.71 to 0.97, for 1 year increment). Less educated mothers and pluriparae were also at higher risks of not being tested. Analysis of the association with mother age showed different heterogeneous effects.Our study indicates that the attention to screening and detecting infected cases is growing over the time. In addition, care delivered during pregnancy has a leading role in determining coverage of the examinations. Immigrant, pluriparous and less educated women need particular attention.

Early discharge (ED) of healthy term infants has become a common practice due to current social and economic needs. The primary objective of the present study was to evaluate trends in early discharge of healthy term neonates (≥ 37 gestational weeks) by delivery method (cesarean and vaginal) in maternity units in the Province of Trento. The secondary objective was to identify the socio-demographic characteristics (including the area of residence and distance from the designated hospital) and clinical characteristics of mothers whose infants were discharged early. This retrospective study reviewed records of live births from 2006 to 2016, for a total of 45, 314 healthy term infants. The trend for ED grew significantly during the period 2006-2016, for both cesarean and vaginal deliveries. The multiple logistic regression analysis shows how the determinants of ED are maternal age, birth order, citizenship of mother, maternal smoking, maternal employment status, and the number of births at the hospital on the day of birth.The post-partum length of stay should be adjusted based on the characteristics and needs of the mother-infant dyad, identifying the criteria for safe discharge. In Trento, various procedures and programs are becoming more uniform today with the intention to provide family assistance service. What is Known: • Admission for childbirth is one of the primary causes of hospitalization in industrialized countries. • The length of stay for childbirth has been steadily declining in recent decades, with the aim of reducing costs while also demedicalizing pregnancy. What is New: • A higher rate of early discharge (ED) was recorded for neonates of women having foreign citizenship, 30 years, pluriparous, smoked during pregnancy, housewife, and, if emplyed, entrepreneurs, self-employed professionals or managers. • ED was more common when the new mother gave birth on a day in which there was a higher number of births at the hospital, indicating overcrowding in the maternity unit.

Background The monitoring of breastfeeding during a child's first year of life is highly recommended. The proportion of children who are exclusively breastfed for at least six months is a strong indicator of breastfeeding promotion in the community. The objectives of the study were to survey the exclusive breastfeeding of children during the first year of life for cohorts born in Trentino (north-eastern Italy) in 2009 to 20013, to evaluate the decrease of exclusive breastfeeding at 6 months and to analyze possible relationships between the maintenance of breastfeeding up to the age of 6 months and certain maternal socio-demographic characteristics, as well as clinical aspects of the pregnancy and birth. Methods Cohorts born in Trentino between 2009 and 2013 were studied, calculating the proportion of infants who were breastfed upon discharge from the hospital (source: data on the CedAP informative flow, that is the Italian Certificate of Delivery Assistance data-base). The data provided on the 12-Month Health Evaluation Form found in the Pediatric Health Booklet, completed by regional family pediatricians, was linked with that of the respective CedAP (96.7% linkage). The trend for exclusive breastfeeding and its monthly decrease was analyzed. The maintenance of exclusive breastfeeding until the age of 6 months was analyzed in relation to citizenship, area of residence, maternal education level and employment status, parity, single or multiple birth, infant exposure to passive smoke and attendance or non-attendance of a state-promoted childbirth preparation course. This final variable was studied solely for primiparous women, who are generally most likely to attend a childbirth preparation course. All results were adjusted for the following potential confounding variables: "birth type," "prematurity" and "feeding method upon discharge from the hospital." Results CedAP data revealed that 83.5% of live infants were exclusively breastfed and that this percentage decreased to 34.7% by the age of 6 months (35.4% among full-term infants and 27% among premature infants). Data from the Province of Trento demonstrates that exclusive breastfeeding up to the age of 6 months is influenced by the mother's citizenship, area of residence and education level, but not by her employment status. In addition, the study revealed a significant association with parity, passive smoke exposure and attendance of a childbirth preparation course. Conclusions The Pediatric Health Booklet with its information on the state of health of children (in combination with data from the CedAP) offers a valid tool for monitoring breastfeeding during the first year of life. Data confirmed a decrease in the rate of breastfeeding between birth and the first month of life and between the first and sixth months of living at home. The results regarding the conditions that favour and discourage breastfeeding suggest potential public health care measures to improve children's health.

Purpose To test the accuracy and validity of the 2Win and the plusoptiX A12R refractometers in detecting amblyopia risk factors. Methods Children were screened using both devices, using two sets of referral criteria each, and underwent complete ophthalmic examination, including cycloplegic refraction. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Median values for the pairs of refractometers were compared using the Wilcoxon signed-rank sum test for sphere, cylinder, and power vectors J0 and J45 for axis (both eyes). Results A total of 284 eyes of 142 children (mean age, 37.9 ± 19.8 months) were included. Comparison of mean cycloplegic and manifest refractometer measurements provided statistically significant differences in both eyes. For sphere, the means were lower and for cylinder, higher, for both devices, and both correlated well with the gold standard for astigmatic power vectors J0 and J45. Using referral criteria 1, the sensitivity, specificity, PPV and NPV, and inconclusive results were 67.4%, 83.7%, 87.9%, 59.4%, and 4.9%, respectively, for the 2Win, with sensitivity of 13% in the hyperopia group; 73.1%, 95.9%, 96.6%, 69.1%, and 10.6%, respectively, for the plusoptiX A12R, with a sensitivity of 33.3% in the hyperopia group. Using criteria 2, the values were 98.8%, 38.8%, 73.9%, and 95.0% (2Win) and 94.9%, 65.3%, 81.3%, and 88.9% (plusoptiX A12R). Conclusions In manifest conditions, the accuracy of the 2Win and plusoptiX A12R refractometers is low in hyperopia and astigmatism, but the devices are well correlated with each other, and both have high specificity and low sensitivity in hyperopia, resulting in the underestimation of hyperopic refractive error. The optional Plusoptix sensitive referral criteria seems to be appropriate for the A12R. The 2Win provided fewer inconclusive results and was preferred for use with younger and developmentally delayed children.

Background Esophageal atresia (EA) is a congenital malformation of the upper gastrointestinal tract with an estimated prevalence varying from 1 in 2500 to 1 in 4500 births. The aim of this study was to describe the epidemiology of EA between 1981 and 2012 and evaluate patients' survival. Methods This study used data from a population-based Italian Congenital Malformation Registry. The survival status was ascertained by linking the registry records, vital records and the regional registries of patients. Kaplan-Meier methods were used to estimate survival probabilities up to 25 years and Cox proportional hazards regression was used to evaluate factors that affected survival. Results A total of 407 cases of EA were identified among 1,417,724 total births. After the exclusion of cases with chromosomal anomalies, 49.9% of the patients presented with at least one associated congenital anomaly. The 25-year survival probability was 85.1% (95% confidence interval [CI], 80.8–89.4), with most deaths occurring during the first months of life. Patients' characteristics associated with decreased survival probability were low birth weight (hazard ratio, 3.7; 95% CI, 1.7–8.3) and presence of additional major defects (hazard ratio, 2.8; 95% CI, 1.3–6.0). A significant improvement in survival over the decades was observed for patients with nonisolated EA. Conclusion This study detected a significant improvement in survival of individuals with EA over the past decades and identified the strongest predictors of mortality. These results will be important for the planning of the clinical management and formulation of prognosis when EA is diagnosed in a newborn. Birth Defects Research (Part A) 106:542–548, 2016. © 2016 Wiley Periodicals, Inc.

to quantify and identify the proportion of miscarriages in the province of Trento (Trentino-Alto Adige Region, Northern Italy) in 2010-2016, managed exclusively at the emergency room (ER).population surveillance study.comparison between the Trentino computerized database of registration to the ER for miscarriage and the flow D-11 of the Italian National Statistics Institute (Istat) on hospitalized miscarriages in the period 2010-2016.for each year, the proportion of women seen at the ER for miscarriage and then hospitalized and the cases exclusively managed in ER were calculated. The two groups were compared on the basis of the following variables: age, citizenship, gestational week, calendar year, and ER of admission.the proportion of miscarriages managed exclusively in ER in the province of Trento varies from 31.3% in 2010 to 60.5% in 2016. There are no differences in the proportion of hospitalization in relation to the age of women, while a higher proportion of hospitalizations was observed among foreign women compared to the Italians and in the ER of Trento compared to the peripheral ERs. A growing trend of hospitalization clearly appears with increasing gestational age, while the calendar year is inversely proportional to the increase in hospitalization.since the therapeutic diagnostic path of women with miscarriage has changed, it could be useful to have a representation as close as possible to the reality of the phenomenon to evaluate if an integration of the Istat D-11 flow on the cases hospitalized with those cases managed exclusively in ER is feasible or opportune. This opportunity should be considered in local, multicentre or national epidemiological studies.

BACKGROUND The aim of this study was to analyse the occurrence of specific maternal, obstetric or neonatal factors, by performing a comparison between children with refractive error, strabismus and/or amblyopia (cases) and unaffected children (controls) in the province of Trento (north-east Italy). METHODS In 2012-2014, 14,346 children attending the second year of nursery school were assessed through the pre-school orthoptic screening scheme (covering 91% of the pre-school population). Record linkage was performed between the orthoptic screening database and birth records (birth confirmation certificate database) for the corresponding birth cohorts (2008-2010), to examine specific maternal factors (age, smoking, nationality/race), obstetric factors (type of delivery) and neonatal factors (gestational age, weight at birth, Apgar score, congenital birth defects, hospitalisation at birth). The correlations were investigated using univariate and multivariate analysis in accordance with the logistic regression method. RESULTS During orthoptic screening, 6.4% of children were found to have at least one refractive error, with astigmatism being the most common condition (5.1%). 1.9% of children were found to have strabismus and 1.8% amblyopia. Multivariate logistic regression analysis showed that the risk of developing a refractive error is associated with: maternal age ≥45 years, foreign nationality, vacuum-assisted delivery and neonatal weight

Estimates of childhood overweight and obesity for the Province of Trento provided by the 2014 "OKkio alla SALUTE" survey (Italian national surveillance system for weight and nutrition in children) were compared with estimates provided by paediatric health forms. The Province of Trento is the only region that makes use of the information gathered through these forms, which are completed by primary care paediatricians as part of the 6-year health evaluation. OKkio alla SALUTE data for children, obtained from students enrolled in the third year of primary school in 2014 (845 children aged 8-9 years), were compared with data collected at the age of 6 for cohorts born in 2006, evaluated in 2012-2013 (3101 subjects). The following prevalence figures were obtained from OKkio alla SALUTE and the 6-year paediatrician evaluation respectively: overweight, 17.4% vs 11.7%; obese, 4.1% vs 4.5%; severely obese, 1.4% vs 1.0%. The two information sources provide similar estimates, suggesting the potential for their integrated use.

To evaluate the efficacy of photodynamic therapy (PDT) compared with intravitreal vascular endothelial growth factor (VEGF) inhibitors alone or combined with PDT in the treatment of choroidal neovascularization (CNV) secondary to chronic central serous chorioretinopathy (CSCR).Retrospective study of a consecutive series of 34 white patients (34 eyes) with angiographic evidence of choroidal neovascularization secondary to chronic central serous chorioretinopathy, divided into two groups followed for at least 12 months: 16 were treated with full fluence PDT (PDT group) and 18 with vascular endothelial growth factor inhibitors (intravitreal [IVT] group).In the PDT group, mean best-corrected visual acuity (BCVA) was 20/40 (0.30 ± 0.69 logMAR) at baseline and did not change after 12 months (20/40; 0.30 ± 0.49 logMAR [P = 0.49]). In the IVT group mean, best-corrected visual acuity was 20/40 (0.30 ± 0.69 logMAR) at baseline and also did not change at the 12-month follow-up (20/32; 0.20 ± 0.49 logMAR [P = 0.20]). There was no statistically significant difference between the two groups in terms of best-corrected visual acuity. A statistical significance difference was found in central macular thickness between the two groups with a better reduction of the thickening in the PDT group (P = 0.05); moreover, indocyanine green angiography analysis revealed that 50% of the polypoidal lesions were closed after PDT and 25% of the polypoidal lesions disappeared after anti-vascular endothelial growth factor therapy at 12-month follow-up.PDT and IVT inhibitors alone or combined show similar clinical effects in chronic central serous chorioretinopathy eyes with choroidal neovascularization.

Background. Psychopathology is a risk factor for suicidal behavior. It is likely that psychiatrists will have to deal with an attempted or completed suicide by a patient at some point in their careers. The goal of this study was to assess psychiatrists' emotional reactions to patients' suicidal behavior. Methods. Data were collected using a questionnaire that was administered to psychiatrists after a completed or attempted suicide by one of their patients. Results. Thirty-four psychiatrists participated in the study and reported on 62 attempted suicides and 11 completed suicides. All of the participants reported at least one emotion following the event. After an attempted suicide, trainees were more likely than consultants to experience psychological pain, guilt, self-doubt, and frustration. Being a trainee was also associated with psychological pain, guilt, fear, self-doubt, and frustration in regression analysis. Shock, disbelief, fear, self-doubt, and embarrassment were associated with completed rather than attempted suicides. Conclusions. Attempted and completed suicides have a significant impact on psychiatrists. The impact of an attempted suicide is usually less severe. The patterns of reaction differ between consultant and trainee psychiatrists. (Journal of Psychiatric Practice 2012;18:94-108). Language: en

This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy). Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis. The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient’s local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation). For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.

Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) are common, serious lung diseases in preterm infants. Polymorphism of the genes involved in basic lung function and alveolar stability, lung differentiation and pulmonary host defense may influence the risk. Natural selection has refined the genes responsible for cardiopulmonary adaptation and resistance against pneumonia in term and near-term infants. Before the era of antibiotics, however, virtually all very preterm infants died of asphyxia, respiratory failure or infections. Today, the degree of prematurity plays a dominant role in susceptibility to serious lung disease. In addition, genetic polymorphism and constitution modulate the risk of RDS and BPD that have different, partly overlapping predisposition. According to twin studies, the genetic impact on the risk of RDS and BPD among preterm and very preterm infants is 35–65%. Individual disease genes generally have low penetrance. Large-scale genetic studies are required as part of neonatal and perinatal research in order to learn about the risk factors and to investigate pharmacogenetics. The aim in the future is to individualize therapies.

to outline the attendance rate of antenatal classes (ANCs) among women resident in Trentino Region (North-Eastern Italy) during the period 2000-2012; to identify the main sociodemographic characteristics of women who do not attend ANCs and to measure the effectiveness of ANCs attendance.cohort study with a retrospective data collection.by the computerised database of Trentino Certificates of delivery care, primiparous mothers living in Trentino presenting a physiological pregnancy and birth at term (≥37 weeks of gestation) were selected. Temporal trends of ANCs attendance were also studied for all mothers living in Trentino, all primiparous residents, all multiparous residents and all residents with foreign citizenship.possible associations between the probability of not attending ANCs and sociodemographic variables concerning mothers were analysed: age, professional status, educational level, marital status, citizenship and residence in an area served by a maternal and child health (MCH) clinic or not. Significant relationships between ANCs attendance and variables related to course of pregnancy, childbirth and neonatal outcomes were identified.ANCs coverage has a statistically significant increasing trend over time for each group of women living in Trentino. Among the selected primiparous pregnant women, the principal barriers to ANCs access are being foreign, having an age ≤30 years, in particular ≤20 years, being housewives or unemployed, presenting a medium-low educational level, and residing in an area not served by a MCH clinic. ANCs-not-attending women show a lower awareness of the importance of performing serological tests for Syphilis and Cytomegalo-virus and they declare smoking in pregnancy. Benefits of ANCs attendance do not affect neonatal outcomes, but they concern a higher probability of vaginal birth and a higher breastfeeding predisposition.data about ANCs attendance in Trentino Region appear higher than other national-regional studies. However, there are significant differences in access to ANCs regarding women's sociodemographic characteristics and resources distribution and MCH clinics measurement. In Italy, an evaluation about the accessibility of MCH clinics and their functioning criteria is desirable, focusing on marketing practices towards lower classes women. In Trentino, virtuosos MCH clinics have introduced elastic times in the ANCs planning and they have involved cultural mediators and private gynaecologists. Younger pregnant women are included in the ANCs after a preliminary meeting or by individual paths.