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Background: The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region., Methods: This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2-positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher's exact tests for dichotomous answers and χ 2 test for trends relative to the questions with 3 or more options., Results: This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2-positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients' planned treatment approach). The results from responders in Campania did not differ significantly from the national ones., Conclusion: Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: (1) To report the number and type of emotional expressions (cues/concerns) raised by breast cancer patients; (2) to identify the influence of setting, patient characteristics, and doctor-patient interaction on emotional expression., Methods: 308 Italian-speaking female patients were recruited at their first breast cancer consultation. The visits were audio-recorded and analysed for number and type of emotional expressions (VR-CoDES). Oncologists' interaction skills were rated by the VR-COPE. Socio-demographic, clinical and personality variables were gathered before the consultation. Clinical variables and oncologists' evaluations of the patient were collected after., Results: Breast cancer patients raised emotional issues mainly as cues. The setting (centre where the consultations took place), the oncologist's attribution of anxiety, regardless of anxiety test screening (STAI-X1) score before the consultation, and the oncologist's ability to pick up on patient's worries, handle emotional needs or understand psychosocial condition were all positively related with the number of emotional expressions. More tightly structured consultations had fewer emotional expressions., Conclusion: Both contextual and interactional aspects have an impact on patient emotional expressions., Practice Implications: Oncologists need to be trained to manage both the content and the process of medical consultation. Work organization of the consultation setting needs to be taken into account., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The paper deals with a multidimensional approach demonstrating a direct link between the entity of ongoing dentistry activity (number and kind of interventions) and specific pollution components. Simultaneously indoor/outdoor air concentrations of a set of volatile organic compounds (VOCs) and activity variables, describing the amount and nature of ongoing dentistry activities, were monitored over a year at a dental hospital located in an urban area. Principal Component Analysis (PCA) was used to single out mutually orthogonal pollution components which were then correlated to "pathology" factors arising from the analysis of dentistry activity indexes. The use of a multidimensional perspective allowed us to obtain a statistically significant model of the link between level of pollution and dentistry activity. In particular, the correlation approach linking pollution results to pathological variables allows us to establish a causative link even in the presence of sub-threshold concentrations of pollutants.

Background: To validate a structured interview designed to evaluate the healthcare and information needs of patients with heart failure (HF), who were also characterized by means of the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 36-item Short-Form Health Survey (SF-36)., Methods: Forty-five in- and outpatients with HF were administered a structured interview concerning their information and healthcare needs (together with the KCCQ and SF-36) with the aim of investigating the effects of healthcare models on their quality of life (QoL). Twenty-one patients were also involved in a one-week test-retest validity study carried out in order to verify reproducibility and stability by means of concordance and K statistics., Results: The reproducibility of the structured interview was good or very good for all items, with a mean Kw of 0.59; the clarity and acceptability of most of the questions were good. Positive judgements of hospital care inversely related to the patients' New York Heart Association class. The subjects about which the patients sought greater information were diet, sleep, therapies and physical exercise, with cardiologists and general practitioners (GPs) being more involved than nurses. The most frequently discussed subject was diagnostic examinations. The questionnaire scores of our patients were generally lower than those reported in the literature, possibly because of their advanced age. However, it is difficult to believe that the quality of care was extraneous to their generally worse health-related QoL., Conclusions: Our HF patients experienced a 'basic' healthcare model (hospitals, GPs, cardiologists) and judged them acceptable. Their ability to think critically about care was increasingly compromised as HF progressed and their health-related QoL decreased.

In step with the need to develop statistical procedures to manage small-size environmental samples, in this work we have used concentration values of benzene (C6H6), concurrently detected by seven outdoor and indoor monitoring stations over 12 000 minutes, in order to assess the representativeness of collected data and the impact of the pollutant on indoor environment. Clearly, the former issue is strictly connected to sampling-site geometry, which proves critical to correctly retrieving information from analysis of pollutants of sanitary interest. Therefore, according to current criteria for network-planning, single stations have been interpreted as nodes of a set of adjoining triangles; then, a) node pairs have been taken into account in order to estimate pollutant stationarity on triangle sides, as well as b) node triplets, to statistically associate data from air-monitoring with the corresponding territory area, and c) node sextuplets, to assess the impact probability of the outdoor pollutant on indoor environment for each area. Distributions from the various node combinations are all non-Gaussian, in the consequently, Kruskal-Wallis (KW) non-parametric statistics has been exploited to test variability on continuous density function from each pair, triplet and sextuplet. Results from the above-mentioned statistical analysis have shown randomness of site selection, which has not allowed a reliable generalization of monitoring data to the entire selected territory, except for a single "forced" case (70%); most important, they suggest a possible procedure to optimize network design.

With the aim of identifying intervention programmes within the framework of basic and permanent nursing training, we evaluated the knowledge of 187 nurses and nursing students concerning biological emergencies. A questionnaire was used to identify their knowledge of the pathogens that may be used in a terrorist attack and measures for containing them, and their perception of the danger to public health. Analysis of the responses showed that the undergraduates studying for the Triennial Degree were the best informed, and those studying for the specialist degree were the least informed. The question relating to the precautions adopted against transmission of Bacillus anthracis was the most predictive of the total score because it was the only one with a substantial number of correct answers (79/187). It seems that the information derived more from the generalist media than from academic training. We conclude that there is a need to train qualified personnel capable of responding to a possible emergency in terms of both preventive and interventional medicine.

A study was undertaken at the biggest dental hospital in Italy, the "George Eastman Dental Hospital", in order to assess the dentistry environment as it stands with current equipment and dental practice in use. In order to gain information on the possible presence of chemical pollutants from dentistry activity, a simultaneous consecutive 7-day sampling of volatile organic compounds (VOCs) at the dental chair (dentistry indoor) and at the related vicinity outdoor window (dentistry outdoor) was performed. Volatile organic compounds were identified; cyclohexane, benzene, n-eptane, methylcyclohexane, toluene, ethylbenzene, xylenes, trimethylbenzene and methylhexane were quantitatively determined. As a preliminary result, the dentistry indoor (I(D)) and outdoor (O(D)) volatile organic compounds concentrations ratios are always higher than 1 (I(D)/O(D) > 1), pointing to higher VOCs concentrations in dentistry indoor than in outdoor. It should be noted homes indoor/outdoor concentrations ratios (I(D)/O(H) > 1) are usually higher than 1 as well. For an in-depth study, aimed at assessing the level of VOCs in dentistry setting, instantaneous, hourly, daily, and weekly samplings and a greater number of samples are needed.

Context: In Italy, the surveillance of congenital hypothyroidism (CH) is performed by the Italian National Registry of Infants with CH (INRICH). Up to now, about 3600 infants with CH are recorded in the INRICH, and a high number of twins are included., Objective: Our objective was to estimate the risk of CH in multiple and single deliveries and to compare neonatal features of CH twins with twins from the general population., Design: The Italian population of CH infants recorded in the INRICH from 1989-2000 was investigated., Results: A more than 3-fold higher frequency of twins was found in the CH population than in the general population, and for the first time, it was possible to estimate the CH incidence in multiple (10.1 in 10,000) and single deliveries (3.2 in 10,000 live births). Significantly higher frequencies of in situ gland as well as lower TSH mean level at screening were found in twin than in singleton CH babies. The concordance rate for permanent CH was very low (4.3%) and due to only three concordant couples. However, a high recurrence risk for CH was estimated in siblings of affected babies recorded in the INRICH, including twins considered as siblings., Conclusions: The high CH incidence observed in twins is worthy of interest for the high number of induced pregnancies in Italy as well as in other Western countries. Moreover, the low concordance rate for CH among twins together with a high recurrence risk for the disease among siblings indicates that environmental risk factors may act as a trigger on a susceptible genetic background in the etiology of the disease.

Unlabelled: The prevalence of pressure sores (PS) ranges from 1 to 18% of in-patients and from 3 to 28% of those admitted to long-term settings. The aim of our study was to verify, a posteriori, how nutritional status influenced the evolution of PS in a population of elderly subjects hospitalised in a long-term care setting., Materials and Methods: The charts of 125 patients with ulcerative or necrotic pressure ulcers were evaluated retrospectively. For each subject we took note of: PS characteristics (stage, ulcer surface, evolution), clinical characteristics (comorbidity, adverse clinical events, cognitive, functional and nutritional status)., Results: In 58 patients (46.4%) there was overall healing of the lesions while in 39 patients (31.2%) we had however an "improvement" of PS. The course of PS was not significantly influenced by the patient's physiological characteristics, by cognitive status or by initial characteristics of PS. Instead, we noticed a significant difference in the course of PS as a function of the level of autonomy and clinical status. The course of PS, and in particular the Healing Index, were influenced by the Nutritional Status and, above all, by its course during the treatment period., Conclusions: The development of PS is multifactorial. Whereas, it is clear that factors other than nutrition influence the risk of developing PS, an important role for nutrition in the development and resolution of PS is suggested. Our data certainly confirm the "Quality indicators for prevention and management of pressure ulcers in vulnerable elders", especially were they say "if a vulnerable elder is identified as at risk for pressure ulcer development and has malnutrition, then nutritional intervention or dietary consultation should be instituted because poor diet, particularly low dietary protein intake, is an independent predictor of pressure ulcer development".

The purpose of this research is to analyse occupational, household, sport and traffic related injuries among adolescents aged 14 to 17, during the first half of the year 2000, in the city of L'Aquila (Italy). All the data have been collected from the files of the Emergency Department. The occurrences have been 557: therefore 86 out of 1000 inhabitants have suffered from the above listed injuries. Among these ones, sport related injuries show to be prevalent: car accidents, occasional, household and professional injuries follow. Traffic related and occupational injury rates increase in the eldest children. In fact the "risk profile" shows to be worse in younger children. The study shows a major risk in 14 year old children, it is therefore necessary to focus on prevention and improvement in the data standardization, collection and recording at the Emergency Departments.

Background: Frail elderly people, living in nursing homes, usually show a malnutrition state caused by an increased need of energy or an inadequate food intake. Among the causes leading to reduction of food intake in elderly people and consequently to malnutrition, is the loss of appetite, often marker of depression and alterations of taste and smell perception., Objective: The aim of this research is to verify the application of the AHSP Questionnaire and relate its score to nutritional state of a frail elderly population hospitalized in a geriatric rehabilitation care., Setting and Subjects: All patients of the "3rd Rehabilitation Department" of the Istituto Geriatrico "Villa delle Querce" Nemi (Rome-Italy)., Methods: Informations, number and type of medical conditions, prescribed drugs, other parameters that can affect taste, smell, hunger and nutritional status, mood, cognitive and nutritional status have been collected from the clinical folders. To assess appetite, hunger smell and taste perception had been submitted the AHSP Questionnaire., Results: The AHSP Questionnaire had been administered only to 44 of the 103 patients present at the survey because of the high prevalence of cognitive impairment. AHSP score is lower in presence of malnutrition assessed with MNA (Mini Nutritional Assessment). MNA, expressed as proportional score, seems to present a clear correlation with AHSP's (r=0.59; p=0.000)., Conclusion: The results achieved show the scarce adaptability of the AHSP Questionnaire to frail elderly people living in geriatric rehabilitation care. MNA is at the moment the most reliable tool to single out dietary deficiency on geriatrics population.

Objective: The aim of this study is to verify, in a sample of elderly subjects admitted to long-term care, the impact of malnutrition, according to the Mini Nutritional Assessment (MNA), on mortality and on the occurrence of Adverse Clinical Events in a 3-12 months follow-up study., Subjects: The survey included all patients admitted to a geriatric hospital--"Villa delle Querce", Nemi (Rome, Italy)--between January 1997 and April 2000, whose nutritional status we were able to monitor for over 3 months. The study comprised 167 elderly subjects, of which 125 women (74.9%) aged 83.3 8 years (60-95 years), and 42 men (25.1%) aged 79.6 9 years with an average follow-up period of 7.5 months., Methods: Upon admission and at every check we evaluated each subject's cognitive functions, functional status, co-morbidity, frailty, nutritional status (anthropometric and biochemical indices; MNA). During the follow-up we recorded Adverse Clinical Events. We calculated the predictive value of MNA, we correlated variations in MNA scores with variations of nutritional parameters., Results: MNA's predictive ability both upon admission and upon discharge was found to be excellent. The MNA score was found to be correlated-although not to a very high degree-with variations nutritional parameters. Even more than malnutrition, a low MNA score was found to be predictive of a greater incidence of Adverse Clinical Events during hospitalisation and of higher mortality.

Background: In a previous study we tested the predictive value of the Mini Nutritional Assessment (MNA) in an Italian population of frail elderly in long-term hospital care. The results of our study confirmed the MNA's excellent overall predictive value and sensitivity. Unfortunately we had a large number of false positive judgments, hence our study's low specificity, which we think was caused by two factors: 1. in most cases it was impossible to conduct a reliable subjective assessment of the patients' nutritional and health status. 2. most patients failed to respond to some of the MNA questions, which as a consequence received a "0" score. The result was an artificially low global MNA score even in well-nourished patients., Objective and Design: We tried to neutralize the effects of the defective answers by modifying the total score and the cut-off points of the test. Thus, we: 1. replaced the subjective assessment of health and nutritional status with an objective evaluation; 2. replaced the total score of MNA with the ratio of this value with the maximum of points that each subject can obtain without including the items for which we could not have a response. Similarly, the cut-off points (17 and 24) were replaced with the ratio of these values with the maximum of points obtainable by a complete MNA (30). Patients are classified as "malnourished" below 0.56, "at risk of malnutrition" between 0.56 and 0.79, and "well-nourished" from 0.8 up., Results: This way, the overall predictive value of MNA is increased from 80.3 to 85.4% and the specificity from 12.8 to 25%, whereas the sensitivity increase is modest (from 98 to 98.1%).

Adequate quantification of weight and stature is essential in order to determine levels of nutritional support and to monitor the effects of nutritional intervention. Traditional anthropometric techniques are difficult to apply in elderly or handicapped patients chair or bed-bound. The purpose of the present study is to elaborate regression equations for the estimation of stature in the italian elderly population from other anthropometric measures that can be more easily determined. We have found a single model valid for both sexes (in which the value of the variable "sex" equals 0 if woman and 1 if man) to predict stature in italian elderly: Stature = 94.87 + 1.58 knee-height - 0.23 age + 4.8 sex. Cross validation on a control sample of 30 males and 54 females yielded pure errors of 3.1 cm for men and 2.74 cm for women.

We have developed two different equations, for each sex of the elderly italian population to predict weight from selected measures of recumbent anthropometry, using data of 172 females (72.8 +/- 8 years old) and 113 males (73.4 +/- 8 years old). The independent variables for both sexes were knee stature. subscapular skinfold, arm and calf circumferences. Cross validation was conducted on a free-living sample of 54 females and 30 males. The recommended equations have a 95% probability of predicting the weight of an elderly man or woman to be within plus or minus 4.9 or 6.1 Kg respectively.

The present study concerns with anthropometric and nutritional data collected in the school population of a small rural town in Lazio. We studied 368 school-children of both sexes, belonging to the following age groups: from 7 to 8 years, 9 to 10 years, 11 to 12 years, 13 to 14 years. The technique of evaluation of obesity used in this paper is: weight 20% higher than the height-adjusted figure according to NCHS's curves and triceps skinfold higher than 90 degrees centile according to Tanner's curves. Dietary intake was assessed by a "24 hour-recall" on three consecutive days one of which of holiday. The prevalence of obesity is 17.7%. In all the age groups daily caloric intake is adjusted to that recommended by Italian 1987 Larn. On the other hand the single nutrient's assumption shows important differences from Larn. Particularly in all the age groups daily protein intake is high (14.6%-15.8% of the energy in a day), with an increased animal-vegetable protein ratio (1.5-2.1). Dietary lipids are higher than 35.9% of day's energy (35.9%-39.5%); the polyunsaturated/saturated fatty acids ratio is low (0.3-0.5). Cholesterol in the diet (231-347 mg/day) exceeds the level recommended. The daily intake of total carbohydrates (45.3%-48.5%) is low. Crude fiber intake increases with age from 2.8 g to 4.5 g/day. There is no statistical difference between obese and not obese subjects for what concerns energy intake or single nutrient's assumption.(ABSTRACT TRUNCATED AT 250 WORDS)

A group of 20 patients affected with thyroid carcinoma, all from Southern Italy, was typed for HLA-A, -B, -C and -DR antigens. Sixteen of them (80%) typed for DR1, while in the control group (120 unrelated healthy individuals from the same region) only 22 (18.3%) shared the same antigen (chi 2 = 32.96). The data indicate a highly significant association between the HLA-DR1 gene and the thyroid carcinoma.

The HLA antigen and gene frequencies (A, B and C loci) in the populations of the Bergamo area and of the Campania region are compared. Significant discrepancies were found between the two sets of data, as regards the distribution of single genes and the haplotype frequencies and deltas as well. Stone of the frequencies diverge significantly also from accepted data on European Caucasoid populations.

The HLA-A, -B and -C locus gene frequencies and the significant A, B and B, C haplotypes of the population of Campania (Southern Italy) are reported. From a comparison of gene frequencies and from an overall genetic distance evaluation with other European and Mediterranean populations the typical Mediterranean structure of the Campanian population is confirmed. While keeping several Middle Eastern features, it places itself as far from Northern Italy (Bergamo) as from the Spanish and the French populations. Among all the groups compared, including Turkish and Lebanese, the largest distance is measured from the English, the Danish and the German populations.