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Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Purpose Health and social care professionals are ideally placed to identify and address gender-based violence (GBV), yet research continues to demonstrate that the subject is being poorly covered at undergraduate level. This qualitative study explored health and social care students’ and educators’ views on GBV education, with a view to identifying ‘best practice’. We aimed to capture students’ and educators’ experiences and perceptions of GBV education across participating countries; how participants thought GBV should be taught/learned within their curricula; and their views on how GBV education might be ‘optimized’. Methods We conducted nine focus group discussions and one semi-structured interview with 23 students and 21 academic staff across the UK, Australia and Chile. Results Thematic analysis yielded three themes: (1) GBV addressed in all but name, (2) Introduce sooner, explore later and (3) A qualitative approach to learning. Educators and students indicated that GBV is largely being overlooked or incompletely addressed within curricula. Many participants expressed a wish for the subject to be introduced early and revisited throughout their study, with content evolving as cohorts mature. Lastly, our findings indicate that GBV education could benefit from adopting a ‘qualitative’ approach, prioritizing survivor narratives and incorporating dialogue to facilitate student engagement. Conclusion Though time constraints and competing demands within undergraduate curricula are frequently cited as barriers to moving away from traditional didactic methods, our findings suggest that teacher-centered strategies are insufficient and, in some regards, inappropriate for GBV education. The need for a paradigm shift in GBV education is discussed.

Aims: To investigate the occurrence of myopathy with oral glucose-lowering drugs (OGLDs) and statins, with a focus on dipeptidyl peptidase-4 inhibitors (DPP4-is). Methods: The FDA adverse event reporting system (FAERS) was queried (2004–2016) to compare the proportion of adverse events with OGLDs, alone and in combination with statins, using the reporting odds ratio (ROR) with relevant 95% confidence interval (95%Cl), adjusted for sex, age and concomitant presence of other OGLDs/lipid-lowering drugs. Drug–drug interaction is claimed whenever the frequency of an event is enhanced by combination treatment. Consistency/robustness of findings was tested by applying additive/multiplicative models and accounting for competition bias (i.e., adverse events previously known to be associated with OGLDs were removed). Results: Over a 13-year period, we retrieved 142,888 cases of myopathy. The use of DPP4-is alone was not associated with higher reporting of myopathy (no. of cases = 4898; adjusted ROR = 1.00; 95%CI = 0.96–1.04), with the notable exclusion of vildagliptin (262; 1.64; 1.42–1.88). No increased occurrence emerged when used in combination with statins, with consistent findings from additive/multiplicative models for all DPP4-is. Likewise, no increased reporting was found for other OGLDs (28,964; 0.64; 0.62–0.67); data on the interaction with statins were consistent/robust across analyses only for sulfonylureas (the interaction is likely and biologically plausible) and sodium glucose cotransporter-2 inhibitors. Conclusions: Real-world FAERS data do not raise concern for muscular toxicity with DPP4-is in combination with statins, making a drug interaction very unlikely.

Dopo un periodo in cui la pianificazione urbana e dei trasporti ha riconosciuto molta importanza alla velocità dello spostamento, al trasporto privato motorizzato e, più recentemente, a quello pubblico di massa, nel campo degli studi urbani e dei trasporti crescente attenzione è rivolta alla mobilità pedonale (walking) e alla pedonalità (walkability) degli ambienti urbani, ossia alla possibilità dei luoghi di essere raggiunti, fruiti, attraversati e visitati a piedi (Colleoni et al., 2017). In questo quadro, il contributo presenta i risultati di una ricerca sulle percezioni della pedonalità delle aree turistiche di un campione di residenti con 65 anni e più, residenti nel comune di Milano. L’obiettivo è di analizzare il rapporto tra tourist attractiveness e pedestrian friendliness dei territori e di individuare i gruppi di over 65 più vulnerabili sotto il profilo della pedonalità. Nella prima parte, verrà presentata una breve rassegna del rapporto tra popolazioni anziane, attrattività turistica e accessibilità pedonale e delle determinanti della pedonalità. In seguito, verranno presentati il metodo e i risultati per discutere, in sede conclusiva, il contributo dello studio per le politiche turistiche urbane che mirino a costruire città a misura d’anziano., After a period in which transport and urban planning attribute great importance to motorized private transport and, more recently, to public transport, nowadays increasing attention is paid to walking and the walkability of urban environments, namely the possibility of places and destinations to being reached, used, crossed and visited on foot. Walking is indeed crucial to be studied as it is an important mean for increasing the quality of life in cities, given its potential role in countering car-dependent urban development, improving the health status of citizens, and increasing the attractiveness and vitality of public spaces, accessibility to opportunities, social inclusion, and neighborhoods’ social relations. Research generally showed the relevance of environment’s characteristics such as land-use, urban design and furniture, landscape, etc. However, it is crucial to consider that the features enhancing the urban environments’ walkability may vary according to the needs, preferences, and perceptions of different urban populations, as in the case of tourists and the elders. The paper presents the results of a research on the perceptions about tourist areas’ pedestrian friendliness of a sample of over 65 years old residents living in Milan. The results show a general assonance between tourist attractiveness and the elderly people’ perceptions and a dissonance, namely in the case of women and oldest-old respondents. In this sense, we argue the need for urban policies and tourist policies to improve different walkability assessments in order to guarantee an increasing attractiveness and inclusiveness of the city of Milan.

Background: The anti-hepatitis B immunization campaigns launched in the early 1990s were a major public health breakthrough and targeted various populations (at-risk adults, newborns, adolescents). However, debate is still active about a possible link between this vaccine and central demyelination. This study provides a pooled estimate of this risk based on a comprehensive review and meta-analysis of all available epidemiologic studies. Methods: A systematic review was conducted in Medline, Embase, ISI Web of Science and the Cochrane Library from database inception to 10 May 2017. Grey literature was searched and snowballing was also undertaken. Only observational studies including a control group were retained. Primary outcome was multiple sclerosis diagnosed by recognized criteria. Study selection was performed by two independent reviewers with disagreements solved through discussion. This meta-analysis based on crude, adjusted estimates, or risks limited to the 3 months following immunization was performed using a generic inverse variance random-effect model. Heterogeneity was investigated; sensitivity and subgroup analyses were performed when necessary. This study followed the PRISMA statement and the MOOSE reporting guideline (Study protocol registered in PROSPERO: CRD42015020808). Findings: Of the 2804 references reviewed, 13 studies with a control group were analysed. None of the pooled risk estimates for either multiple sclerosis or central demyelination following HB immunization reached statistical significance. When considering adjusted risk ratios, the following non-significant figures were obtained: 1.19 (95%CI: 0.93 – 1.52) and 1.25 (95%CI: 0.97 – 1.62), for multiple sclerosis and central demyelination, respectively. Conclusions: No evidence of an association between hepatitis B vaccination and central demyelination was found.

Approved in 2006, human papillomavirus (HPV) vaccines were initially targeted for girls aged 9–14 years. Although the safety of these vaccines has been monitored through post-licensure surveillance programmes, cases of neurological events have been reported worldwide. The present study aimed to assess the risk of developing demyelination after HPV immunization by meta-analysing risk estimates from pharmacoepidemiologic studies. A systematic review was conducted in Medline, Embase, ISI Web of Science and the Cochrane Library from inception to 10 May 2017, without language restriction. Only observational studies including a control group were retained. Study selection was performed by two independent reviewers with disagreements solved through discussion. This meta-analysis was performed using a generic inverse variance random-effect model. Outcomes of interest included a broad category of central demyelination, multiple sclerosis (MS), optic neuritis (ON), and Guillain-Barré syndrome (GBS), each being considered independently. Heterogeneity was investigated; sensitivity and subgroup analyses were performed when necessary. In parallel, post-licensure safety studies were considered for a qualitative review. This study followed the PRISMA statement and the MOOSE reporting guideline. Of the 2,863 references identified, 11 articles were selected for meta-analysis. No significant association emerged between HPV vaccination and central demyelination, the pooled odds ratio being 0.96 [95% CI 0.77–1.20], with a moderate but non-significant heterogeneity (I2 = 29%). Similar results were found for MS and ON. Sensitivity analyses did not alter our conclusions. Findings from qualitative review of 14 safety studies concluded in an absence of a relevant signal. Owing to limited data on GBS, no meta-analysis was performed for this outcome. This study strongly supports the absence of association between HPV vaccines and central demyelination.

The authors explore real estate financing by analysing its technical form, purpose, collateral and the case of default of the borrower.