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Aims.: Maternal mental disorders have been associated with the risk of attention-deficit/hyperactivity disorder (ADHD) in children. Within the context of a mother–child cohort, we examined whether maternal anxiety, depression and sleep disorders are associated with pre-school ADHD symptoms. Methods.: The study included 3634 singletons from the Italian NINFEA (Nascita e INFanzia: gli Effetti dell'Ambiente') cohort. Maternal doctor-diagnosed anxiety, depression and sleep disorders before and during pregnancy were assessed from the questionnaires completed during pregnancy and 6 months after delivery. Mothers rated child ADHD symptoms at 4 years of age, according to the Diagnostic and Statistical Manual of Mental Disorders. Hyperactive–impulsive (ADHD-H), inattentive (ADHD-I) and total ADHD scores were analysed in the models adjusted for child's gender, first-born status, maternal age, education, alcohol consumption and smoking during pregnancy. Results.: The total ADHD score at age 4 was associated with maternal lifetime anxiety (17.1% percentage difference in score compared with never; 95% CI 7.3–27.9%), sleep disorders (35.7%; 95% CI 10.7–66.5%) and depression (17.5%; 95% CI 3.2–33.8%). Similar positive associations were observed also for ADHD-H and ADHD-I traits, with slightly attenuated associations between maternal sleep disorders and child ADHD-I score, and maternal depression and both ADHD scores. All the estimates were enhanced when the disorders were active during pregnancy and attenuated for disorders active only during the pre-pregnancy period. Conclusions.: Maternal anxiety, depression and sleep disorders are associated with a relative increase in the number of ADHD-H, ADHD-I and total ADHD symptoms in preschoolers. [ABSTRACT FROM AUTHOR]

In epidemiologic analytical studies, the primary goal is to obtain a valid and precise estimate of the effect of the exposure of interest on a given outcome in the population under study. A crucial source of violation of the internal validity of a study involves bias arising from confounding, which is always a challenge in observational research, including life course epidemiology. The increasingly popular approach of meta-analyzing individual participant data from several observational studies also brings up to discussion the problem of confounding when combining data from different populations. In this study, we review and discuss the most common sources of confounding in life course epidemiology: (i) confounding by indication, (ii) impact of baseline selection on confounding, (iii) time-varying confounding and (iv) mediator–outcome confounding. We also discuss the issue of addressing confounding in the context of an individual participant data meta-analysis. [ABSTRACT FROM AUTHOR]

Tocilizumab (TCZ) is used for treating moderate-to-severe Covid-19 pneumonia by targeting interleukin-6 receptors (IL-6Rs) and reducing cytokine release. Yet, in spite of this therapy, patients with vs. patients without diabetes have an adverse disease course. In fact, glucose homoeostasis has influenced the outcomes of diabetes patients with infectious diseases. Of the 475 Covid-19-positive patients admitted to infectious disease departments (University of Bologna, University Vanvitelli of Napoli, San Sebastiano Caserta Hospital) in Italy since 1 March 2020, 31 (39.7%) hyperglycaemic and 47 (60.3%) normoglycaemic patients (blood glucose levels ≥ 140 mg/dL) were retrospectively evaluated at admission and during their hospital stay. Of note, 20 (64%) hyperglycaemic and 11 (23.4%) normoglycaemic patients had diabetes (P < 0.01). At admission, hyperglycaemic vs. normoglycaemic patients had fivefold higher IL-6 levels, which persisted even after TCZ administration (P < 0.05). Intriguingly, in a risk-adjusted Cox regression analysis, TCZ in hyperglycaemic patients failed to attenuate risk of severe outcomes as it did in normoglycaemic patients (P < 0.009). Also, in hyperglycaemic patients, higher IL-6 plasma levels reduced the effects of TCZ, while adding IL-6 levels to the Cox regression model led to loss of significance (P < 0.07) of its effects. Moreover, there was evidence that optimal Covid-19 infection management with TCZ is not achieved during hyperglycaemia in both diabetic and non-diabetic patients. These data may be of interest to currently ongoing clinical trials of TCZ effects in Covid-19 patients and of optimal control of glycaemia in this patient subset. [ABSTRACT FROM AUTHOR]

Background: Although guidelines do not recommend computerised tomography (CT), positron emission tomography (PET) or magnetic resonance imaging (MRI) for the staging or follow-up of asymptomatic patients with non-metastatic breast cancer, they are often requested in routine clinical practice. The aim of this study was to determine the staging and follow-up patterns, and relative costs in a large population of breast cancer patients living and treated in a Southern Italian region.Methods: We analysed the clinical computerised information recorded by 567 primary-care physicians assisting about 650 000 inhabitants in the Campania region. Patients with non-metastatic breast cancer were identified and divided into calendar years from 2001 to 2010. The number of diagnostic tests prescribed per 100 patients (N/Pts) and the mean cost per patient was determined 3 months before diagnosis and up to 1 year after diagnosis. Costs are expressed in constant 2011 euros.Results: We identified 4680 newly diagnosed cases of asymptomatic non-metastatic breast cancer. N/Pts increased significantly (P<0.0001) from 2001 to 2010. The mean number of prescribed mammograms, bone scans, abdominal ultrasound and chest X-rays ('routine tests'), and costs was unchanged. However, the number of CT, PET scans and MRI ('new tests')prescriptions almost quadrupled and the mean cost per patient related to these procedures significantly increased from [euro ]357 in 2001 to [euro ]830 in 2010 (P<0.0001).Conclusions: New test prescriptions and relative costs significantly and steadily increased throughout the study period. At present there is no evidence that the delivery of new tests to asymptomatic patients improves breast cancer outcome. Well-designed clinical trials are urgently needed to shed light on the impact of these tests on clinical outcome and overall survival. [ABSTRACT FROM AUTHOR]

The interannual variability of the South Adriatic Gyre and its relation to the wind vorticity and the large-scale climatic pattern (North Atlantic Oscillation – NAO) was studied using the time series of satellite altimetric data and ocean surface wind products. The cyclonic circulation observed in the southern Adriatic area was partly sustained by the local wind forcing, as suggested by the positive correlation between the rate of change of the current vorticity and the wind-stress vorticity. Nevertheless, the influence of vorticity advection from the adjacent area (northern Ionian Sea) cannot be ignored and it is more significant during the anticyclonic phase of Adriatic–Ionian Bimodal Oscillation System. The geostrophic current vorticities of the southern Adriatic and northern Ionian seas are correlated with a time lag of 14 months, which approximately corresponds to an advection speed of ~1 cm s-1. The different wind patterns observed during two NAO phases in the winter revealed a stronger positive vorticity during the negative NAO phase. Conversely, during the wintertime positive NAO phase the wind vorticity is characterized by lower positive or slightly negative values. Despite a statistically significant negative correlation between the NAO index and the wind vorticity, no unequivocal relationship between large climatic system and the interannual variability of the South Adriatic Gyre intensity was found due to additional effects of the vorticity advection from the Ionian. This can be explained by the fact that the Ionian circulation mode does not depend on the NAO variations. Therefore, the main result of this study is that the interannual variability of the southern Adriatic cyclonic circulation is a result of the combined influence of the vorticity advection from the Ionian and the local wind-curl effect. [ABSTRACT FROM AUTHOR]

The interannual variability of the South Adriatic Gyre and its relation to the wind vorticity and the large-scale climatic pattern (North Atlantic Oscillation -- NAO), was studied using the time-series of satellite altimetry data and ocean surface wind products. The cyclonic circulation observed in the South Adriatic area was mainly sustained by the local wind forcing, as suggested by the positive correlation between the rate of change of the current vorticity and the wind-stress vorticity. Nevertheless, the influence of vorticity advection from the adjacent area (North Ionian Sea) cannot be ignored and it is more significant during the anticyclonic phase of Adriatic-Ionian Bimodal Oscillation System. The geostrophic current vorticities of the South Adriatic and North Ionian Seas are correlated with a time lag of 15 months, which corresponds to an advection speed of ~ 1 cms-1. The different wind patterns observed during the two NAO phases revealed a stronger positive vorticity during the negative NAO phase. Conversely, during the positive NAO phase the wind vorticity is characterized by lower positive values. Subsequently, the calculated positive linear correlation between the NAO index and the frequency of the cold and dry northerly wind suggests the strengthening of the winter convection, and of the consecutive deep water formation, during the positive NAO phases. As a consequence of the winter deep convection, Southern Adriatic area is characterized by the late winter/early spring algal blooms. Relationship between the spatially averaged surface chlorophyll concentrations and the northerly wind frequencies revealed that the two biological productivity regimes likely exist: the subtropical one and the subpolar one depending on the frequency of windy days. We also showed that the bloom timing is a linear function of the wind frequency and can vary within the range of almost two months. This study thus contributes to our understanding of the possible impact of climate change on the SAG circulation and its ecosystem. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the dispersion of passive pollutants associated with the Tiber discharge into the Tyrrhenian Sea using numerical marine dispersion models and satellite data. Numerical results obtained in the simulation of realistic discharge episodes were compared with the corresponding evolution of the spatial distributions of MODIS diffuse light attenuation coefficient at 490 nm (K490), and the results were discussed with reference to the local climate and the seasonal sub-regional circulation regime. The numerical model used for the simulation of the sub-tidal circulation was a Mediterranean sub-regional scale implementation of the Princeton Ocean Model (POM), nested in the large-scale Mediterranean Forecasting System. The nesting method enabled the model to be applied to almost every area in the Mediterranean Sea and also to be used in seasons for which imposing climatological boundary conditions would have been questionable. Dynamical effects on coastal circulation and on water density due to the Tiber discharge were additionally accounted for in the oceanographic model by implementing the river estuary as a point source of a buoyant jet. A Lagrangian particle dispersion model fed with the POM current fields was then run in order to reproduce the effect of the turbulent transport of passive tracers mixed in the plume with the coastal flow. Two significant episodes of river discharge in both winter and summer conditions were discussed in this paper. It was found that the winter regime was characterized by the presence of a strong coastal jet flowing with the ambient current. In summer the prevailing wind regime induced coastal downwelling conditions, which tended to confine the riverine waters close to the shore. In such conditions sudden wind reversals due to local weather perturbations, causing moderate local upwelling, proved to be the only effective way to disperse the tracers offshore, moving the plume from the coast and detaching large pools of freshwater. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) recently has been identified as a risk factor associated with type 2 diabetes. However, the evidence derives from cross-sectional observational studies, retrospective studies, or short-term prospective studies. This long-term prospective study of a large cohort of women with PCOS, followed from youth to middle age, aimed at estimating, for the first time, the incidence and potential predictors of type 2 diabetes in this population. A total of 255 women with PCOS were followed for at least 10 years (mean follow-up 16.9 years). Six women were patients with diabetes at baseline, and another 42 women developed type 2 diabetes during the follow-up. The incidence rate of type 2 diabetes in the study population was 1.05 per 100 person-years. The age-standardized prevalence of diabetes at the end of follow-up was 39.3%, which is significantly higher with respect to that of the general Italian female population of a similar age (5.8%). The likelihood of developing type 2 diabetes significantly increased as BMI, fasting glucose, and glucose area under the curve at baseline increased and significantly decreased as sex hormone-binding globulin (SHBG) levels at follow-up increased. This study demonstrates that the risk of type 2 diabetes is markedly elevated in middle-aged women with PCOS and suggests including BMI, glucose, and SHBG-circulating levels in the risk stratification. [ABSTRACT FROM AUTHOR]

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Objective: We aimed to determine whether second-trimester abortion using isosorbide mononitrate (IMN) in addition to gemeprost is more effective and reduces side effects compared with gemeprost alone.Study Design: Eighty women who were age 13 to 23 weeks' gestation were randomly assigned to receive per vaginam either IMN 40 mg (group 1, 40 women) or placebo (group 2, 40 women) in addition to gemeprost 1 mg up to 3 times daily 3 hours apart for 2 days. Analysis of variance, a chi 2 test, and a multivariate analysis were performed.Results: Of the 72 women analyzed, 68% (group 1) and 38% (group 2) underwent abortion within day 1 (P < .05). However, group 1 was associated with more headache (18% of women) 3 hours after induction compared to group 2 (0% of women, P = .038).Conclusion: IMN in addition to gemeprost is effective for second-trimester abortion, but is associated with more headache compared with gemeprost alone. [ABSTRACT FROM AUTHOR]

Background: Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients.Methods: We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6).Results: The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5x, of a ex-SPECT-Tc is 3.1x, of a ex-ECG is 3.5x, of cTnI is x3.8, of cTnT is x3.9 and of a CA is 56.3x.Conclusion: Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void. [ABSTRACT FROM AUTHOR]