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to geocode all residence addresses from Lazio Health Information System in order to obtain a geographical regional database.a semiautomatic and multistep geocoding procedure using several tools and software.all residence addresses of resident population of Lazio Region (Central Italy) in 2020.geographic coordinates at residence addresses and accuracy level of geocoding procedure for more than 1 million of addresses.the 99% of residence addresses in the Lazio Region have been geocoded thanks to the purposed procedure; almost 94% of the addresses have been geocoded with a good level of accuracy (more than 56% at civic number level). In the province of Rome, the percentage of addresses geocoded with a good level of accuracy is higher (97.1%), while in the province of Rieti and Frosinone is lower (82.7% and 84.2%, respectively).this method is useful to obtain accurate geographic coordinates of residences of the entire regional population. This database will be useful for several epidemiological studies in the Region.

to estimate the impact of the COVID-19 epidemic on total and cause-specific mortality in people residing and dead in the Municipality of Rome (Italy) in 2020, and to describe the causes of death of subjects with SARS-CoV-2 infection confirmed by molecular test.descriptive analysis of total and cause-specific mortality in 2020 in Rome and comparison with a reference period (2015-2018 for total mortality and 2018 for cause-specific mortality); descriptive analysis of cause-specific mortality in the cohort of SARS-CoV-2 infected subjects.27,471 deaths registered in the Lazio mortality-cause Registry, relating to people residing and died in the municipality of Rome in 2020, 2,374 of which died from COVID-19.MAIN OUCOME MEASURES: all-cause mortality by month, gender, age group and place of death, cause-specific mortality (ICD-10 codes).in the municipality of Rome in 2020, an excess of mortality from all causes equal to +10% was observed, with a greater increase in the months of October-December (+27%, +56%, and +26%, respectively) in people aged 50+, with the greatest contribution from the oldest age groups (80+) who died in the nursing homes or at home. Lower mortality was observed in the age groups 0-29 years (-30%) and 40-49 years (-13%). In 2020, COVID-19 represents the fourth cause of death in Rome after malignant tumours, diseases of the circulatory system, and respiratory diseases. Excess mortality was observed from stroke and pneumonia (both in men and women), from respiratory diseases (in men), from diabetes, mental disorders, dementia and Parkinson's disease (in women). On the contrary, mortality is lower for all cancers, for diseases of the blood and haematopoietic organs and for the causes of the circulatory system. The follow-up analysis of SARS-CoV-2 positive subjects residing in Rome shows that a share of deaths (about 20%) reports other causes of death such as cardiovascular diseases, malignant tumours, and diseases of the respiratory system on the certificate collected by the Italian National Statistics Institute.the 2020 mortality study highlighted excesses for acute and chronic pathologies, indicative of possible delays in the diagnosis or treatment of conditions indirectly caused by the pandemic, but also a share of misclassification of the cause of death that is recognized as COVID-19 death.

ObjectivesTo examine association of conception by assisted reproductive technology (ART) with offspring cardio-metabolic health outcomes, and whether these differ by offspring age.DesignMulti-cohort study.SettingFourteen population-based cohort studies with offspring from the UK, Ireland, France, the Netherlands, Portugal, Greece, Italy, Norway, Singapore, and Australia for meta-analysis of various ages. Four cohorts (three European and one Singaporean) with repeated measures for pooled age-change (from 3 to 26 years) trajectory analysis.ParticipantsYoung people sampled from the general population with complete data on mode of conception, confounders, and ≥1 cardio-metabolic outcome measured after birth.ExposuresConception by ART versus natural conception (NC).Main outcome measuresSystolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides (TG), glucose, insulin, and glycated haemoglobin (HbA1c).ResultsBetween 35,780 (605 ART) and 4,502 (67 ART) offspring were included in meta-analysis of various ages for each outcome. Mean age at outcome assessment ranged from 13 months to 27.4 years, with most cohorts ((11/14) having mean age mmHg; 95%CI: -1.91 to 0.14), DBP (−0.50mmHg; -1.65 to 0.66), and HR (0.02beats/min; -1.00 to 1.03). Cholesterol measures were higher in ART-conceived than NC offspring, for TC (mean % difference: 2.54%; 0.46 to 4.61), HDLc (4.17%; 1.79 to 6.56), and LDLc (4.95%; 0.99 to 8.92), whereas triglycerides were similar (−1.53%; -6.19 to 3.13). No clear differences were seen for glucose (0.25%; -1.38 to 1.88), insulin (−5.04%; -13.20 to 3.12), or HbA1c (−0.07%; -0.14 to 0.00). Trajectory models in up to 17,244 (244 ART) offspring showed that early life trajectory differences were consistent with the above pooled results and showed higher SBP emerging from mid-adolescence to adulthood with ART (e.g., predicted mean difference in SBP at age 26 years for ART versus NC was 5.06mmHg; 1.76 to 8.35).ConclusionsChildren conceived through ART had higher cholesterol and similar blood pressure and hyperglycaemic/insulin resistance measures compared with NC children. Whilst overall this is reassuring, our trajectory analysis in a sub-group of cohorts suggested that those conceived by ART may go on to develop higher blood pressure in early adulthood. Our study shows the importance of follow-up into adulthood and requires validation by independent studies with different study designs including within-sibship and mechanistic studies.

Objectives Unintentional injuries such as falls, are particularly frequent in early childhood. To date, epidemiological studies in this field have been carried out using routine data sources or registries and many studies were observational studies with a cross-sectional design. The aims of the study are to describe unintentional injuries in the first two years of life in the Piccolipiù birth cohort, and to investigate the association between mother and children characteristics and the First Event of Raised surface Fall (FERF). Methods This longitudinal observational study included 3038 children from an Italian birth cohort. Data on socio-demographic factors, socio-economic indicators, maternal health and lifestyle characteristics and child’s sleeping behavior, obtained from questionnaires completed at birth, 12 and 24 months of age, were considered in the analyses as potential risk factors of FERF. Time of occurrence of FERF was analyzed using the Kaplan-Meier method. The multivariable analysis for time to event was carried out using a Cox proportional hazards model. Results Falls from raised surfaces are the leading cause of unintentional injuries in the cohort with 610 (21.1%) and 577 (20.0%) cases among children during the first and second year of life, respectively. An increased risk of FERF was associated with several risk factors: maternal psychological distress (HR 1.41, 95%CI 1.10–1.81), maternal alcohol intake (HR 1.26, 95%CI 1.10–1.45), and child’s sleeping problems (HR 1.28, 95%CI 1.09–1.51). Children with older aged mothers (HR 0.98, 95%CI 0.96–0.99) and living in northern Italy (HR 0.64, 95%CI 0.55–0.75) had a lower risk of FERF. Conclusion The results of the study suggest that a higher risk of FERF is associated with socio-demographic factors, maternal characteristics and child sleeping behavior that could hinder parent empowerment.

Introduction Patients with burn injuries are at an increased risk of venous thromboembolism (VTE). This predisposition is secondary to the endothelial injury, hyper-coagulable state and stasis (Virchow’s triad) associated with burn injury. Although the true incidence of VTE in burn patients has not been adequately quantified, symptomatic VTE occurs in 0.2–7% of this population. VTE prophylaxis has proven clinical effectiveness and affords a reduction in the morbidity associated with such events, but the benefits and risk of complications need to be balanced in order to provide the best quality of care. Owing to the lack of prospective data on VTE in burns, practice varies greatly, not only internationally, but also between local burns services. Our aim was to better understand current VTE practice within United Kingdom (UK) burn care services by performing a comprehensive survey. Methods We contacted all the inpatient burn care services in the UK and collected data on current VTE practice via a standardised questionnaire. Services were given the choice to complete the survey by telephone or email and a follow-up plan was formulated. Results Twenty-five burn care services were contacted and 23 agreed to participate (92% response rate). Responding services treated adults, children or both and lead burn nurses or senior medical staff familiar with current VTE practice were interviewed. Routine VTE prophylaxis was provided in 84% of burn services and the majority utilised a combination of chemoprophylaxis and thromboembolic deterrent stockings (TEDS). All used low molecular weight heparin (LMWH) as their choice of chemoprophylaxis. Of those treating adults, all used a VTE prophylaxis protocol, but none of these applied to children. Only 56% of services treating children had such a protocol. The majority discontinued prophylaxis once patients were mobile. Discussion and conclusion Although the true burden of VTE in burn patients is unknown, we recognise that they are a population at risk. In addition to changes in the inflammatory and clotting pathways associated with thermal injury, prolonged hospital stay, ventilatory support, multiple surgeries, numerous central venous cannulations and reduced mobility all multiply this risk. The risk associated with the administration of heparin (bleeding complications and heparin-induced thrombocytopaenia) is low and can be reduced even further to 0.1% by the use of LMWH. The risk of symptomatic VTE is far greater, therefore the benefits of VTE prophylaxis would seem to outweigh the risks of not undertaking prophylactic measures. A higher LMWH dose and routine monitoring of anti-factor Xa levels are useful for acute burn patients. Two previous surveys, performed in Canada and the United States of America (USA), found routine administration of VTE prophylaxis to be 50% and 76% respectively. Of the 71 centres in the USA participating in the survey, 30% used a combination of sequential compression devices (SCD) and heparin and 24% did not provide VTE prophylaxis at all. A lack of prospective data on VTE in burn patients appears to be associated with diverse practice, and consensus on this topic could ensure that the potential morbidity caused by VTE is reduced. A clinical tool for identifying patients at risk and guidelines for management will standardise practice, which in turn should allow us to improve and maintain high quality care for burn patients.

Acute management of a severely burned patient is an infrequent and stressful situation that requires medical knowledge as well as immediate coordinated action. Many adverse events in health care result from issues related to the application of 'non-technical' skills such as communication, teamwork, leadership and decision making rather than lack of medical knowledge. Training in these skills is known as Crisis Resource Management (CRM) training. In order to create well-prepared burn teams, it is critical to teach CRM principles through high-fidelity simulation (HFS). While CRM teaches foundational non-technical skills, HFS incorporates lifelike, whole-body, fully-responsive mannequins in order to provide a realistic emergency situation. The aim of the study is to describe the development of a novel high-fidelity simulation course called "SIMBurns: High Fidelity Simulation Program for Emergency Burn Management" that uses CRM as its foundation and is focused on management of burn injuries. The course was designed by a panel of simulation and burns experts from Meyer Children's Hospital in Italy and Birmingham Children's Hospital in the U.K. Simulation Program experts were certified by Boston Children's Hospital's Simulation Program. In this paper, we describe the course's design, development, structure, and participant's assessment of the course. Since the creation of the SIMBurns course in 2013, 9 courses have been conducted and 101 participants have attended the course. The course was well-received and its "Overall Satisfaction" was rated at 4.8/5. The primary objective in the SIMBurns course - to teach teamwork and CRM skills to medical staff involved in emergency burn care - was also met at 4.8/5. Participants felt that the course developed their ability to interact with other team members, further improved their understanding of how to appropriately use resources, emphasized the importance of role clarity and developed their communication skills. Additional quantitative and qualitative analyses obtained from participants were also reviewed after each course. The SIMBurns course aims to contribute to the education of those in healthcare in order to improve patient safety and to continue advancing the education of our emergency burn care teams.

one of the most affected European countries by the COVID-19 epidemic is Italy; data show the strong geographical heterogeneity of the epidemic.to propose an analysis strategy to ascertain the non-random nature of the spatial spread of COVID-19 cases infection and identify any territorial aggregations, in order to enhance contact tracing activities in specific areas of the Lazio Region (Central Italy) and a large urban area as Rome.all cases of COVID-19 of the Lazio Region notified to the Regional Service for Epidemiology, Surveillance, and Control of Infectious Diseases (Seresmi) with daily updates from the beginning of the epidemic to April 27, 2020 were considered. The analyses were carried out considering two periods (the first from the beginning of the epidemic to April 6 and the second from the beginning of the epidemic to April 27) and two different levels of spatial aggregation: the entire Lazio region excluding the Municipality of Rome, where the 377 municipalities represent the area units, and the Municipality of Rome, where the area units under study are the 155 urban areas (ZUR). The Scan statistic of Kulldorff was used to ascertain the non-random nature of the spatial spread of infected cases and to identify any territorial aggregations of cases of COVID-19 infection, using a retrospective spatial analysis in two overlapping periods.analysis was conducted at regional level in the two survey periods and revealed the presence of 7 localized clusters. In the Municipality of Rome, a single cluster (Historic Centre) was identified in the first period which includes 7 urban areas, while in the second period two distinct clusters (Omo and Farnesina) were observed.Scan statistics are an important surveillance tool for monitoring disease outbreaks during the active phase of the epidemic and a useful contribution to epidemiological surveillance during the COVID-19 epidemic in a specific territory.

Introduction There is evidence of improvement on mental health and well-being due to contact with green spaces, through various mechanisms and with potentially differential impacts in different populations. Many of these studies have been conducted among adults, while children have not been sufficiently investigated. This study aimed to evaluate the association between residential exposure to greenness and cognitive development at age 7 and to evaluate nitrogen dioxide (NO2) as a potential mediator of this association.Methods This longitudinal study was based on a cohort of newborns enrolled at delivery in two large obstetric hospitals in Rome. We assessed cognitive development at 7 years of age through the Wechsler Intelligence Scale for Children-III edition (WISC-III). We estimated residential surrounding greenness, using satellite derived Normalized Difference Vegetation Index (NDVI), within 300m and 500m buffers around each residential address at birth. We applied weighted multiple linear regression analyses to study the association between NDVI and the WISC-III cognitive scores, using the inverse probability weighting methodology to correct for potential selection bias. We performed a mediation analysis to evaluate the mediating role of NO2 in the association under study.Results We enrolled 719 children at birth and performed our analyses only on 465 children with data on exposure and outcome. The results were not consistent for the average residential surrounding greenness in 300m buffer. For an IQR increase in greenness within 500m buffer around home addresses at birth we found a progress in Arithmetic subtest (β:0.39; 90% CI: 0.11-0.6), a test concerning with attention, concentration and numerical reasoning, apart from an indication of the positive association with Full scale IQ and Verbal IQ. This association was partly mediated by reduction in NO2, since adding this pollutant in our model explained 35% (90% CI: 7%-62%) of our estimate.Conclusions Our findings showed an association between residential surrounding greenness within 500m and better scores on attention tests at 7 years of age. The observed association between Arithmetic subtest and NDVI was mediated, in part, by a reduction in NO2. This topic has important public health implications in supporting green urban planning policies and promoting children's well-being.

Overestimation of burn size especially in children is common. It is unclear if this may cause harm. This study was designed to assess the accuracy of burn size estimation by referring non-burn clinicians and investigate whether inaccurate estimates caused any harm. Three and a half years retrospective review of pediatric resuscitation burns (ie, ≥10% TBSA) referred to a tertiary burns center from other hospitals was performed. This included basic demographics, data from referring emergency departments (initial TBSA estimations and fluid volumes prescribed), and data on arrival to the burn center (actual burn TBSA sustained, fluid volumes given prior to arrival, and actual fluid volumes required). Clinical parameters at 8 and 24 hr after injury were also examined. Forty-six patients were identified. Mean age was 3.9 years and weight 18 kg. Mean time to arrival from initial burn injury to our tertiary center was 5 hr. Thirty-two children (70%) had their burns overestimated, seven (15%) underestimated, and another seven (15%) were correctly estimated. After accurate calculations of the burn size and the required resuscitation fluids on arrival to the burns center, only five children of the entire cohort of 46 patients (11%) had received more fluids than required. These five children were in the overestimated burn size group. Only three children received the appropriate amount of fluid prior to arrival to the burns center. There were no mortalities or significant clinical adverse events in any of the children. Overestimation led to overprescription of fluid volumes, but this did not translate into over-resuscitation, and in most cases was in fact associated with inadequate fluid administration. Although 70% of the children in our cohort had the burn size overestimated, only 11% had actually received more fluids than required before arrival. None of these children went on to have any significant complications as a result of overestimation. Training and education is essential for clinicians in emergency departments. However, estimation of size in pediatric burns, in particular scalds, is challenging and the importance of early transfer to a specialist service cannot be overemphasized.

This case report describes the clinical course of a child who developed staphylococcal scalded skin syndrome (SSSS) after a burn injury. The intent is to aid other units in recognizing the presentation of SSSS after a pediatric burn and to optimize subsequent management. The main clinical finding was of rapid, progressive, superficial epidermal loss at sites separate from the original burn, involving 55% of the total body surface area, 13 days after a 6% scald burn to the face, neck, and chest. Diagnosis was confirmed by multidisciplinary team clinical assessment and histopathology of an intraoperative skin biopsy. This confirmed epidermal cleavage at the granular cell layer. These findings were later supported by Staphylococcus aureus cultured from the burn wound, and a positive epidermolytic toxin A assay. Management was with general medical supportive care, clindamycin and flucloxacillin intravenous antibiotic therapy, and cleansing and dressing of the areas of epidermal loss. Key learning points from this case were that SSSS presented after a burn injury and that 13 days elapsed between the burn and SSSS. Factors differentiating it from toxic epidermal necrolysis are described, including the value of histopathology in confirming the diagnosis. The prompt use of antibiotics and attentive wound care are advocated as an effective management strategy.

Objectives Studies on the effect of temperature on rates of work-related injuries (WRIs) are very recent, and are evolving in depth and scope. However, less is known about potential effects of air pollutants. Our objective was to analyse the association between WRI and NO2, PM10 and air temperature in three major Italian cities, and to identify groups of workers more at risk in Italy. Design Time-stratified case-crossover study. Settings Milan, Turin, Rome, years 2001–2010. Participants A total of 468 816 WRI occurred between 2001 and 2010 in Milan, Turin and Rome were extracted from the Italian national workers’ compensation authority database. Main outcomes Associations between WRI and temperature, PM10, NO2, separately in the warm and in the cold season (WS, May–September; CS, November–February). Effect modification was studied by economic sector, occupational activity and indoor/outdoor job activity. Results Exposure to NO2 (lag 0–8) showed the highest effect on the risk of WRI, with ORs ranging from 1.20 (95% CI 1.16 to 1.24) in Milan to 1.30 (95% CI 1.24 to 1.37) in Turin in the WS. The effect of exposure to PM10 was milder but consistent across all cities: ORs from 1.09 (95% CI 1.05 to 1.12) in Turin to 1.15 (95% CI 1.11 to 1.18) in Rome. Temperature was associated with risk of WRI only among those working in construction (highest association in Rome 1.06; 95% CI 1.01 to 1.12), transportation (highest association in Milan 1.05; 95% CI 0.96 to 1.14) and the energy industry (highest association in Milan 1.57; 95% CI 1.03 to 2.38) in the WS in all cities. A weak effect of low temperatures was observed in the CS only in Rome. Conclusions Exposures to NO2 resulted as strongest hazard for WRIs, mainly in warm months, while the independent effect of temperature was significant only in specific subgroups of workers. These results could be considered to better plan safety prevention programmes.

The endocrine system is frequently altered after a major burn trauma. Besides the endocrine response to stress characterized by hypercortisolism, several hypothalamus-hypophysis-target gland axes are rapidly perturbed within a few days. These alterations can persist in the long term and deserve an appropriate treatment. Disturbances in water clearance and glucidic metabolism are also common and need to be diagnosed and corrected to decrease morbidity in such patients. Bone and mineral metabolism is deeply compromised and requires correction of mineral abnormalities in order to improve symptoms and prevent bone loss. No large prospective and/or intervention trials are available to date to elaborate age-related, evidence-based recommendations to monitor and treat burn-related endocrine alterations.

Background Exposure to air pollution during the first 1000 days of life (from conception to the 2nd year of life) might be of particular relevance for long-term child health. Changes in molecular markers such as DNA methylation and telomere length could underlie the association between air pollution exposure and pollution-related diseases as well as serve as biomarkers for past exposure. The objective of this systematic review was to assess the association between air pollution exposure during pregnancy and the first two years of life and changes in DNA methylation or telomere length in children. Methods PubMed was searched in October 2020 by using terms relative to ambient air pollution exposure, DNA methylation, telomere length and the population of interest: mother/child dyads and children. Screening and selection of the articles was completed independently by two reviewers. Thirty-two articles matched our criteria. The majority of the articles focused on gestational air pollution exposure and measured DNA methylation/telomere length in newborn cord blood or placental tissue, to study global, candidate-gene or epigenome-wide methylation patterns and/or telomere length. The number of studies in children was limited. Results Ambient air pollution exposure during pregnancy was associated with global loss of methylation in newborn cord blood and placenta, indicating the beginning of the pregnancy as a potential period of susceptibility. Candidate gene and epigenome-wide association studies provided evidence that gestational exposure to air pollutants can lead to locus-specific changes in methylation, in newborn cord blood and placenta, particularly in genes involved in cellular responses to oxidative stress, mitochondrial function, inflammation, growth and early life development. Telomere length shortening in newborns and children was seen in relation to gestational pollutant exposure. Conclusions Ambient air pollution during pregnancy is associated with changes in both global and locus-specific DNA methylation and with telomere length shortening. Future studies need to test the robustness of the association across different populations, to explore potential windows of vulnerability and assess the role of the methylation and telomere length as mediators in the association between early exposure to ambient air pollutants and specific childhood health outcomes.

Background and objective Children are potentially vulnerable to hot ambient temperature. However, the evidence on heat-related children's morbidity is still scarce. Our aim was to examine the association between temperatures in summer (May to September) and children's hospitalizations in two Mediterranean cities, Rome and Valencia, during the period 2001–2010. Methods Quasi-Poisson generalised additive models and distributed lag non-linear models were combined to study the relationship between daily mean temperature and hospital admissions for all natural, respiratory and gastrointestinal diseases in children under 15 years of age. Associations were summarised as the percentage of change (Ch%) in admissions at 50th, 75th, 90th, 95th and 98th percentiles of temperature in summer compared to 1.) the 50th percentile in the whole year (50th(y)) and 2.) the preceding percentile in the previous series. Cumulated risks were obtained for groups of lags showing a similar pattern: 0–1, 2–7, 8–14 and 15–21 days. Results Almost whatever increase of temperature from 50th(y) was significantly associated with an increase of paediatric hospitalizations by all natural diseases at short term (lag 0–1), while small increases at high temperatures only had a delayed effect on this outcome. The same pattern was observed in Rome for respiratory admissions, while in Valencia only a delayed association (days 8–14) was observed. The increase of temperature from 50th to 75th percentiles was associated at short time to an increase of gastrointestinal admissions in both cities. Conclusion Children's hospitalizations rose with heat in Rome and Valencia. Patterns of delays and critical windows of exposure mainly varied according the outcome considered.

Background/aim Evidence of the impact of green spaces on pregnancy outcomes is still limited. We analysed green spaces and socio-economic position (SEP) as effect modifiers of the effect of high temperatures and air pollutants (PM10, NO2 and O3) on the risk of preterm birth (PB). Methods A cohort of new-borns in Rome, from April to October, 2001–2013, were analysed. Pre-terms, identified through the Certificate of Delivery Care Registry, were defined as births between the 22nd and the 36th week of gestation. A time series approach was used, with maximum apparent temperature (MAT), PM10, NO2 and O3 as exposure variables. We used a lag of 0–2 days for all exposure when analysing preterm births, except for PM10 (lag of 12–22 days). As green indicators we considered both the distance between mothers’ residence address and green spaces and the Normalised Difference Vegetation Index (NDVI) within a 100 m buffer centred on woman’s residence address. Women were also classified according to age, SEP and education level. Results We enrolled 56 576 total births, 5.1% of which PB. In our cohort 24% of women were younger than 30 years, 36% had a low SEP and 33% completed primary school. We observed a 2.0% (95% CI: 0.7 to 3.2) increase in the daily number of PB per 1°C increase in MAT, adjusting by PM10. Among pollutants only PM10 was associated to a significant increase in PB (+0.7%; 95% CI: 0.1 to 1.3) per 1 mg/m3 increase in PM10 (adjusted by MAT). SEP was an effect modifier for both MAT/PB and PM10/PB relationship; MAT increased the risk of PB only among women of medium or low SEP while PM10 among those of high SEP. Green was an effect modifier of MAT/PB relationship, with the highest effect of MAT on PB among women living very close to green spaces (within 100 m). Conclusion Socio-economic position resulted to be an important effect modifier for both MAT/PB and PM10/PB relationship. In particular we found the highest effect of temperature on preterm birth risk in women with low socio-economic position and living very close to green areas. How green acts in modifying this association should be further investigated.

Introduction We have carried out a systematic review of epidemiological studies about the association between extreme weather conditions and work-related injuries (WRI). Furthermore, we have analysed the association between extreme temperature, air pollutants and WRI in three Italian cities identifying more susceptible workers’ categories by the means of a case cross over study. Methods We have performed a systematic review of epidemiological studies concerning the risk of WRI for extreme temperature. All occupational injuries between 2001–2010 in Milan, Turin and Rome have been extracted from the Italian workers compensation claims archives. Associations between temperature (T), air pollutants (PM10, NO2, O3) and WRI have been estimated using a time-stratified case-crossover study, separately in May-September (warm season, WS) and November-February (cold season, CS). Results The epidemiological studies for estimating the association between extreme temperature and WRI appeared to be few and conducted with different methodologies. In our study exposure to NO2 (lag 0–8) showed the highest positive effect on the risk of WRI ranging, in the warm season, between +20% (CI 95%: 1.16–1.24) in Milan and +30% (CI 95%: 1.24–1.37) in Turin. Temperature, in WS, was associated to an increased risk of WRI among those working in construction, transport and energy industry with bricklayer, metalworker, mechanic, and asphalter as the most involved workers’ categories. Conclusions The findings of our study should be considered for planning health and safety prevention programs and correctly identifying measure targeted to risk mitigation for specific categories of workers.

The infection of a wound is one of the major contributors to delays in healing and tissue regeneration. As multi-drug resistance to antibiotics is becoming a serious threat, research in this field has focused on finding new agents and strategies to fight infection and additionally to reduce healing times. The topical use of autologous Platelet Rich Plasma (PRP) as a biological accelerator of the healing process, has been safely used as a form of treatment for wounds since the 1990s. Although the presence or absence of leucocytes in PRP preparation was previously neglected, in the last decade more attention has been paid to their role and several studies have been conducted to explore both their immuno-metabolic effects and their antimicrobial properties. In this review, we aim to summarise the literature on the contribution of leucocytes included in PRP preparations in terms of their antimicrobial properties. This should help to inform clinical practice and additional research in this promising field.

We developed an algorithm to select incident cases of lymphatic and haematopoietic system in children, in order to create a timely and accurate database of incident cases to answer the needs of cluster analysis. This group of cancers is by far the most frequent in the paediatric age. The procedure has been applied to identify incident cases in children aged 0-14 years, resident in Rome (Central Italy), and diagnosed between 2000 and 2011. The algorithm links hospital discharge records (SDO), the hospital registry of the Italian Association of paediatric haematology and oncology (AIEOP), and the Population Registry. We identified 391 cases of cancers of lymphatic and haematopoietic system; among them, the most frequent pathology is the lymphoid leukaemia, which represents 52% of total cases, followed by non-Hodgkin lymphoma (21% of total cases). Results correspond to data from literature and to the estimates from the Italian Association of cancer registries (AIRTUM), giving value to the used procedure.

The relationship between extreme temperature and population health has been well documented. Our objective was to assess the evidence supporting an association between extreme temperature and work related injuries.We carried out a systematic search with no date limits using PubMed, the Cochrane central register of controlled trials, EMBASE, Web of Science and the internet sites of key organizations on environmental and occupational health and safety. Risk of bias was evaluated with Cochrane procedure.Among 270 studies selected at the first step, we analyzed 20 studies according to inclusion criteria (4 and 16 referring to extreme cold and heat temperature, respectively).Despite the relevance for policy makers and for occupational safety authorities, the associations between extreme temperature and work related injuries is seldom analyzed. The estimation of risk, the identification of specific jobs involved and the characterization of the complex mechanisms involved could help to define prevention measures.

the Italian National Institute of Statistics (Istat) estimated an increase in mortality in Italy of 11.3% between January and August 2015 compared to the previous year. During summer 2015, an excess in mortality, attributed to heat waves, was observed.to estimate the excess mortality in 2015 using data from the rapid mortality surveillance system (SiSMG) operational in 32 Italian cities.time series models were used to estimate the excess in mortality among the elderly (65+ years) in 2015 by season (winter and summer). Excess mortality was defined as the difference between observed daily and expected (baseline) mortality for the five previous years (2009- 2013); seasonal mortality in 2015 was compared with mortality observed in 2012, 2013, and 2014. An analysis by cause of death (cardiovascular and respiratory), gender, and age group was carried out in Rome.data confirm an overall estimated excess in mortality of +11% in 2015. Seasonal analysis shows a greater excess in winter (+13%) compared to the summer period (+10%). The excess in winter deaths seems to be attributable to the peak in influenza rather than to low temperatures. Summer excess mortality was attributed to the heat waves of July and August 2015. The lower mortality registered in Italy during summer 2014 (-5.9%) may have contributed to the greater excess registered in 2015. In Rome, cause-specific analysis showed a higher excess among the very old (85+ years) mainly for cardiovascular and respiratory causes in winter. In summer, the excess was observed among both the elderly and in the adult population (35-64 years).results suggest the need for a more timely use of mortality data to evaluate the impact of different risk factors. Public health measures targeted to susceptible subgroups should be enhanced (e.g., Heat Prevention Plans, flu vaccination campaigns).

Few studies have evaluated the significance of associated urological anomalies in vesicoureteral reflux (VUR). The aim of our study was to determine the incidence of associated urological anomalies in patients with high grade VUR and to assess their impact on renal parenchymal scarring. We retrospectively reviewed the hospital records of 1,765 consecutive cases diagnosed with high grade VUR (Grade III–V) at our hospital between 1998 and 2010. The diagnosis of VUR was made by a voiding cystourethrogram (VCUG). Renal scarring was evaluated by dimercapto-succinic acid (DMSA) scintigraphy and classified into three groups: mild (focal defects in uptake between 40 and 45%), moderate (uptake of renal radionuclide between 20 and 40%), and severe (shrunken kidney with relative uptake

Objective We present our experience in the treatment of distal hypospadias using a modified Koff procedure, emphasizing the importance of patient selection for a good outcome. Materials and methods In 2003–2008, 90 patients, mean age 52.1 months, underwent surgical repair of distal hypospadias using urethral advancement according to Koff, modified with a Ψ incision on the tip of the glans. Meatal defect was glanular in six (8%), subglanular in 24 (26%) and coronal in 60 (66%) cases. Mild chordee was present in 19 patients (21%). Follow-up was 8–66 months. All patients were evaluated in terms of cosmetic results, and early and late postoperative complications. Results All patients showed excellent cosmetic results with urethral meatus on the tip. There was only one postoperative fistula due to extensive use of electrocautery during urethral mobilization that was surgically corrected 8 months after appearance. One patient had a postoperative meatal stenosis treated conservatively. No cases of residual chordee were detected. Conclusions Successful use of the modified Koff procedure depends on careful selection of patients. Good candidates are those with distal or mid-shaft hypospadias, presenting with: (1) absence or low degree of ventral chordee; (2) distal plate of urethra well developed; (3) distance between meatus and tip of glans at most 10–12 mm; and (4) glanular morphology preserved.

Introduction: Children constitute a subgroup of potential high vulnerability to heat. However, few studies have specifically focused on it. Our aim was to examine the association between summer tem...

Growing evidence has shown the promise of mesenchymal stromal cells (MSCs) for the treatment of cutaneous wound healing. We have previously demonstrated that MSCs seeded on an artificial dermal matrix, Integra (Integra Lifesciences Corp., Plainsboro, NJ) enriched with platelet-rich plasma (Ematrix) have enhanced proliferative potential in vitro as compared with those cultured on the scaffold alone. In this study, we extended the experimentation by evaluating the efficacy of the MSCs seeded scaffolds in the healing of skin wounds in an animal model in vivo. It was found that the presence of MSCs within the scaffolds greatly ameliorated the quality of regenerated skin, reduced collagen deposition, enhanced reepithelization, increased neo-angiogenesis, and promoted a greater return of hair follicles and sebaceous glands. The mechanisms involved in these beneficial effects were likely related to the ability of MSCs to release paracrine factors modulating the wound healing response. MSC-seeded scaffolds, in fact, up-regulated matrix metalloproteinase 9 expression in the extracellular matrix and enhanced the recruitment of endogenous progenitors during tissue repair. In conclusion, the results of this study provide evidence that the treatment with MSC-seeded scaffolds of cutaneous wounds contributes to the recreation of a suitable microenvironment for promoting tissue repair/regeneration at the implantation sites.

Introduction Acute Lymphoblastic Leukemia (ICD9-CM:204, ALL) tendency to clusters has been widely analyzed with no conclusive evidences. Objectives We conducted a childhood ALL’s cases clustering a...

Background: Climate change is projected to increase the number and intensity of extreme weather events, for example heat waves. Heat waves have adverse health effects, especially for the elderly, since chronic diseases are more frequent in that group than in the population overall. The aim of the study was to investigate mortality during heat waves in an adult population aged 50 years or over, as well as in susceptible subgroups of that population in Rome and Stockholm during the summer periods from 2000 to 2008. Methods: We collected daily number of deaths occurring between 15th May and 15th September each year for the population above 50 as well as the susceptible subgroups. Heat wave days were defined as two or more days exceeding the city specific 95th percentile of maximum apparent temperature (MAT). The relationship between heat waves and all-cause non-accidental mortality was investigated through time series modelling, adjusting for time trends. Results: The percent increase in daily mortality during heat waves as compared to normal summer days was, in the 50+ population, 22% (95% Confidence Interval (CI): 18-26%) in Rome and 8% (95% CI: 3-12%) in Stockholm. Subgroup specific increase in mortality in Rome ranged from 7% (95% CI:–17-39%) among survivors of myocardial infarction to 25% in the COPD (95% CI:9-43%) and diabetes (95% CI:14-37%) subgroups. In Stockholm the range was from 10% (95% CI: 2-19%) for congestive heart failure to 33% (95% CI: 10-61%) for the psychiatric subgroup. Conclusions: Mortality during heat waves increased in both Rome and Stockholm for the 50+ population as well as in the considered subgroups. It should be evaluated if protective measures should be directed towards susceptible groups, rather than the population as a whole. Daniel Oudin Åström was funded by a grant from The Swedish Council for Working Life and Social Research (FAS:2009–0454) awarded to Professor Bertil Forsberg. This work was carried out within the EU project “Public Health Adaptation Strategies to Extreme weather events–PHASE” (contract number EAHC 20101103). the EU project “Public Health Adaptation Strategies to Extreme weather events–PHASE” (contract number EAHC 20101103)

Objective. To evaluate whether public reporting of performance data was associated with a change over time in quality indicators for acute myocardial infarction (AMI) in Italian hospitals. Design. Pre–post evaluation of AMI indicators in the Lazio region, before and after disclosure of the Regional Outcome Evaluation Program, and a comparative evaluation versus other Italian regions not participating in the program. Setting/data sources. Nationwide Hospital Information System and vital status records. Participants. 24 800 patients treated for AMI in Lazio and 39 350 in the other regions. Intervention. Public reporting of the Regional Outcome Evaluation Program in the Lazio region. Main Outcome Measure. Risk-adjusted indicators for AMI. Results. The proportion of ST-segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary interventions (PCI) within 48 h in Lazio changed from 31.3 to 48.7%, before and after public reporting, respectively (relative increase 56%; P < 0.001). In the other regions, the proportion increased from 51.5 to 58.4% (relative increase 13%; P < 0.001). Overall 30-day mortality and 30-day mortality for patients treated with PCI did not improve during the study period. The 30-day mortality for STEMI patients not treated with PCI in Lazio was significantly higher in 2009 (29.0%) versus 2006/07 (24.0%) (P = .002). Conclusions. Public reporting may have contributed to increasing the proportion of STEMI patients treated with timely PCI. The mortality outcomes should be interpreted with caution. Changes in AMI diagnostic and coding systems should also be considered. Risk-adjusted quality indicators represent a fundamental instrument for monitoring and potentially enhancing quality of care.

Osteogenesis and bone remodeling are complex biological processes that are essential for the formation of new bone tissue and its correct functioning. When the balance between bone resorption and formation is disrupted, bone diseases and disorders such as Paget's disease, fibrous dysplasia, osteoporosis and fragility fractures may result. Recent advances in bone cell biology have revealed new specific targets for the treatment of bone loss that are based on the inhibition of bone resorption by osteoclasts or the stimulation of bone formation by osteoblasts. Bisphosphonates, antiresorptive agents that reduce bone resorption, are usually recommended as first-line therapy in women with postmenopausal osteoporosis. Numerous studies have shown that bisphosphonates are able to significantly reduce the risk of femoral and vertebral fractures. Other antiresorptive agents indicated for the treatment of osteoporosis include selective estrogen receptor modulators, such as raloxifene. Denosumab, a human monoclonal antibody, is another antiresorptive agent that has been approved in Europe and the USA. This agent blocks the RANK/RANKL/OPG system, which is responsible for osteoclastic activation, thus reducing bone resorption. Other approved agents include bone anabolic agents, such as teriparatide, a recombinant parathyroid hormone that improves bone microarchitecture and strength, and strontium ranelate, considered to be a dual-action drug that acts by both osteoclastic inhibition and osteoblastic stimulation. Currently, anti-catabolic drugs that act through the Wnt-β catenin signaling pathway, serving as Dickkopf-related protein 1 inhibitors and sclerostin antagonists, are also in development. This concise review provides an overview of the drugs most commonly used for the control of osteogenesis in bone diseases.

Since DX/HA was approved by the Food and Drug Administration in 2001 as an acceptable tissue-augmenting substance for subureteral injection, endoscopic treatment has become increasingly popular for treating vesicoureteral reflux (VUR). However, most paediatric urologists still continue to recommend ureteral reimplantation as the treatment of choice in the management of grade V VUR. The purpose of this study was to prospectively evaluate the effectiveness of endoscopic subureteral injection of DX/HA in the treatment of grade V reflux.During 2001-2009, 56 children (35 males, 21 females) with primary grade V VUR underwent endoscopic treatment using DX/HA. Their ages ranged from 4 months to 11 years. Forty-nine patients had unilateral grade V VUR, and seven had bilateral grade V (63 refluxing ureters including 17 duplex systems). Renal scarring on dimercaptosuccinic acid was observed in 39 kidneys (mild scarring 13, moderate scarring 14 and severe scarring 12). In all patients, endoscopic injection was made after inserting the needle within the wide ureteral orifice. Renal ultrasound and voiding cystourethrogram was performed 3 months after the endoscopic treatment. If VUR had not resolved, the patient was considered for further endoscopic treatment. After the VUR was resolved, children were followed with renal ultrasound at 1 year and every 2 years thereafter.The VUR completely resolved after first injection of DX/HA in 33 (52.4%) ureters and downgraded to grade I VUR in 7 (11.1%) ureters. 19 (30.2%) ureters required a second injection, and 4 (6.3%) ureters required a third injection to resolve VUR. No children in this series needed reimplantation of ureters or presented with ureteral obstruction during follow-up.Endoscopic treatment with DX/HA is effective in eradicating grade V primary reflux. This simple and minimally invasive treatment should be offered to all parents of children with grade V VUR as an alternative to ureteral reimplantation.

Introduction: Although the prevalence of preterm births ranges from 5 to 13% and represents the leading cause of perinatal mortality and morbidity in developed countries, the etiology of preterm birth remains uncertain. We aimed to evaluate the effect of short-term exposure to high and low temperatures and air pollution on preterm delivery and to identify socio-demographic and clinical maternal risk factors enhancing individual susceptibility. Methods: We analyzed all singleton live births by natural delivery that occurred in Rome in 2001–2010. A time-series approach was used to estimate the effect of exposure to minimum temperature, maximum apparent temperature, heat waves, particulate matter with an aerodynamic diameter of 10 μm or less (PM10), ozone, and nitrogen dioxide in the month preceding delivery; the analysis was conducted separately for cold and warm seasons. Socio-demographic and clinical risk factors were included as interaction terms. Results: Preterm births comprised nearly 6% of our cohort. An increase of 1.9% (95% confidence interval (CI) 0.86–2.87) in daily preterm births per 1 °C increase in maximum apparent temperature in the 2 days preceding delivery was estimated for the warm season. Older women, women with higher education levels, and women with obstetric or chronic pathologies reported during delivery had a lower effect of temperature on the risk of preterm birth, while women with a chronic disease in the two years before delivery and mothers

Colorectal carcinoma (CRC) represents the most frequent malignancy of the gastrointestinal tract in the Western world in both genders. There is a wide variation of incidence rate for both colonic and rectal cancer among the populations of different countries: up to a 30-40fold difference is seen between North America (Canada, Los Angeles, San Francisco), NewZealand (non–Maori), Northern Italy (Trieste), Northern France (Hautand Bas-Rhin) in which the rate of CRC is around 50/100,000 inhabitants, and India (Madras, Bangalore, Tri‐ vadrum, Barshi, Paranda, Bhum, Karunagappally), Algeria (Setif), and Mali (Bamako) in which the rate is around 3/100,000 [1]. It is estimated that approximately 6% of the United States population will eventually develop a CRC, and that 6 million of American citizens who are living will die of CRC [2].

Objective To evaluate the incidence of febrile urinary tract infection (UTI) after successful endoscopic correction of intermediate and high-grade vesicoureteral reflux (VUR). Study design Medical records of 1271 consecutive children (male, 411; female, 903) who underwent successful endoscopic correction of VUR were reviewed. Factors potentially influencing postoperative UTIs, such as history of presentation, age, sex, grade of VUR, renal scarring, and agent used for the endoscopic injection, were analyzed. Results Febrile UTI developed in 73 children (5.7%) after successful endoscopic correction of VUR. Thirty-nine children had a single episode of UTI, and 34 children had two or more episodes at 1 month to 5.9 years (median, 1 year) after correction of VUR. With multivariate analysis, female sex ( P P = .005), and BBD after endoscopic correction ( P = .001) were revealed to be the most important independent risk factors for a febrile UTI after successful correction of VUR. Conclusions The incidence of febrile UTIs after successful correction of intermediate and high grade VUR is low. Female sex and BBD were the most important risk factors in the development of febrile UTI. Our data supports the importance of assessing bladder and bowel habits in older children with febrile UTIs after endoscopic correction of VUR.

Purpose Urinary Tract Infection(UTI)is the most common clinical presentation of vesicoureteral reflux(VUR).However,VUR has also been reported in children with voiding disorders with or without history of UTI.The aim of this study was to determine the prevalence of VUR in children presenting with urinary incontinence without a history of UTI among a large group of patients with intermediate and high grade VUR. Material and Methods The medical records of 1432 children diagnosed with intermediate and high grade VUR(Grade III to V)during 1998 to 2008 were reviewed. VUR was diagnosed in all patients by voiding cystourethrogram(VCUG).Renal parenchymal scarring was evaluated by DMSA scans and classified into three groups:mild with relative uptake between 40%and45%,moderate with relative uptake between 20%and40% and severe with relative uptake Results Of the 36patients with urinary incontinence,11children had day and night incontinence,6 had only daytime wetting and 19 had only bedwetting at night.There were 19boys and 17girls and their ages ranged from 4years to 12.1years(median age 6.5years).24children had unilateral VUR and 12 bilateral with a total of 48 refluxing units.VUR was grade II in 2ureters,grade III in 30ureters,grade IV in 15 and grade V in 1.Both patients with grade II VUR had a higher grade VUR on the contralateral side.11(30.5%) patients demonstrated renal scarring on DMSA scans.Scarring was mild in 5 patients,moderate in 5 and severe in 1patient. Conclusions Our large series of intermediate and high grade VUR has identified a small but definite subgroup of patients whose sole presenting symptom is urinary incontinence.We recommend VCUG in all children beyond the age of toilet training who present with urinary incontinence without UTI but sonographic evidence of pelvicalyceal and ureteral dilatation.

Purpose Urinary tract infection (UTI) is a relatively common cause of fever in infants. The association of VUR, UTI and renal parenchymal scarring (RPS) is well recognised. Susceptibility to RPS in VUR varies according to age and gender, with male infants under one year of age reported to be at greatest risk. The aim of this study was to determine the incidence of RPS and risk factors for RPS in a large cohort of male infants who were diagnosed to have VUR after first documented febrile UTI. Material and Methods Between 1985 and 2008, 363 consecutive male infants were diagnosed to have primary VUR on voiding cystourethrogram (VCUG). 308 (85%) infants were hospitalised with the first documented febrile UTI and 55 (15%) infants with febrile UTI were managed as outpatients. Age at diagnosis in the 363 infants was defined as patient's age at the time of the first VCUG. RPS was evaluated by 99mtechnetium-DMSA scan performed at least 3months after the UTI. Results Among the 363 infants (median age 7 months),reflux was unilateral in 132 infants and bilateral in 231 resulting in 594 refluxing ureters. VUR was grade II in 19 (3.2%) ureters, grade III in 217(36.5%), grade IV in 276 (46.5%) and grade V in 82(13.8%) ureters. RPS was observed in 109 (34%) of the 321 patients who had DMSA scan. RPS was mild in 43 (39.4%) infants, moderate in 51 (46.8%) and severe in 15 (13.8%) infants. Ninety nine (90.8%) of the 109 infants with RPS had grade IV or V VUR. Conclusions Our data show that primary VUR in male infants diagnosed following a febrile UTI is often bilateral, high grade and associated with a high incidence of renal parenchymal scarring. Early identification and treatment of VUR in male infants may prevent UTI-related renal parenchymal damage and progression of renal damage in congenital reflux nephropathy.