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Despite the implementation of preventive measures to counteract the obesity epidemics, the prevalence of childhood obesity is still alarming all over the world. Childhood obesity is the most common risk factor for both cardiovascular and metabolic diseases. In fact, an earlier onset of obesity can cause a greater risk of adiposity tracking across the lifespan and consequently a longer exposure to cardiometabolic risk factors. Accumulating evidence provided by prospective and intervention studies demonstrated the link between pediatric obesity and selected subclinical signs of cardiovascular damage (atherosclerosis and left ventricular hypertrophy), or fatal and not fatal cardiovascular events as early as 40 years of age. The numerous guidelines and scientific documents published in the last years demonstrate the relevance of assessing cardiometabolic risk factors in children and adolescents with OB. This Position paper, released by experts of the "Childhood Obesity study group" within the Italian Society for Pediatric Endocrinology and Diabetology, aims to review the assessment of cardiometabolic risk factors and comorbidities in children and adolescents with OW/OB on the light of the most recent scientific evidence. The main recommendations are: (a) early detection of comorbidities, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, polycystic ovary syndrome, inactivity, obstructive sleep apnea and decline in kidney function; (b) weight loss treatment, which is associated with a reduction of all cardiometabolic risk factors; (c) specific treatment of comorbidities, through lifestyle modifications or pharmacological treatment added to lifestyle for suitable individuals; d). monitoring comorbidities for mitigating future morbidity and mortality. [ABSTRACT FROM AUTHOR]

Summary: Background: The diagnosis of monogenic obesity is burdened by frequent variants of uncertain significance (VUS). We describe our real‐life approach of variant reassessment over time and we assess whether inconclusive variants are decreasing in monogenic obesity. Methods: We tested for monogenic obesity (genes: LEPR, POMC, ADCY3, PCSK1, CARTPT, SIM1, MRAP2, LEP, NTRK2, BDNF, KSR2, MAGEL2, SH2B1, MC4R, MC3R) in 101 children/adolescents (11.7 [7.3–13.7] years, 3.6 [3.3–4.0] z‐BMI) in Verona and 183 (11.3 [8.4–12.2] years, 3.2 [2.7–3.9] z‐BMI) in Naples from January 2020 to February 2023. In March–July 2024 we reassessed the baseline variants by updated software interpretation and literature renavigation. Results: We initially found 20 VUS, 4 Likely Pathogenic (LP), 5 Likely Benign (LB) and 1 benign variant in 33 individuals. At follow‐up, 6 VUS were reclassified as benign/LB, one LP as pathogenic and 3 LB as benign. Overall, 10/30 variants (6/18 in Verona, 3/11 in Naples and a variant found in both centres) were reclassified, leading to a less uncertain report for 13 of 33 variant‐carrying patients. Monogenic obesity was diagnosed in 3 probands in Verona and 4 in Naples, carrying variants at MC4R or NTRK2. Conclusion: Our variant reassessment was effective to improve classification certainty for the 39% of patients and suggested that the molecular diagnosis of monogenic obesity is becoming more accurate over time. [ABSTRACT FROM AUTHOR]

Background: The progressive aging of the population and the increasing complexity of health issues contribute to a growing number of older individuals seeking emergency care. This study aims to assess the state of the art of care provided to older people in the Emergency Departments of Lombardy, the most populous region in Italy, counting over 2 million people aged 65 years and older. Methods: An online cross-sectional survey was developed and disseminated among emergency medicine physicians and physicians affiliated to the Lombardy section of the Italian Society of Geriatrics and Gerontology (SIGG), during June and July 2023. The questionnaire covered hospital profiles, geriatric consultation practices, risk assessment tools, discharge processes and perspectives on geriatric emergency care. Results: In this mixed method research, 219 structured interviews were collected. The majority of physicians were employed in hospitals, with 54.7% being geriatricians. Critical gaps in older patient's care were identified, including the absence of dedicated care pathways, insufficient awareness of screening tools, and a need for enhanced professional training. Conclusions: Tailored protocols and geriatric educational programs are crucial for improving the quality of emergency care provided to older individuals. These measures might also help relieve the burden on the Emergency Departments, thereby potentially enhancing overall efficiency and ensuring better outcomes. [ABSTRACT FROM AUTHOR]

The aim of this study was to retrospectively evaluate the direct costs of OSCC treatment and postsurgical surveillance in a tertiary hospital in northeast Italy. Sixty-three consecutive patients surgically treated for primitive OSCC at S. Orsola Hospital in Bologna (Italy) between January 2018 and January 2020 were analyzed. Billing records of the Emilia Romagna healthcare system and institutional costs were used to derive specific costs for the following clinical categories: operating theatre costs, intensive and ordinary hospitalization, radiotherapy, chemotherapy, postsurgical complications, visits, and examinations during the follow-up period. The study population comprised 17 OSCC patients classified at stage I, 14 at stage II, eight at stage III, and 24 at stage IV. The estimated mean total direct cost for OSCC treatment and postsurgical surveillance was €26 338.48 per patient (stage I: €10 733, stage II: €19 642.9, stage III: €30 361.4, stage IV: €39 957.2). An advanced diagnosis (stages III and IV), complex surgical procedure, and loco-regional recurrences resulted in variables that were significantly associated with a higher cost of OSCC treatment and postsurgical surveillance. Redirection of funds used for OSCC treatment to screening measures may be an effective strategy to improve overall health outcomes and optimize national health resources. [ABSTRACT FROM AUTHOR]

A survey was conducted from 2018 to 2023 to assess the presence of Salmonella in 280 hunted wild boar (carcasses after evisceration and skinning, N = 226; liver, N = 258; and fecal samples, N = 174). The overall prevalence was 2.86% (confidence interval 95%, 1.45–5.45%) with five positive samples detected in carcasses, three in the liver, and one in a fecal sample. This prevalence was in line with those found in nearby areas denoting a low number of positive samples. Positive animals were over 24 months of age and weighed, before skinning, 59.00 ± 9.11 Kg and no difference was detected in microbial loads between samples positive and negative for Salmonella (aerobic colony count of 4.59 and 4.66 log CFU/400 cm2, and Enterobacteriaceae count of 2.89 and 2.73 log CFU/400 cm2 (mean values) in positive and negative subjects, respectively). Salmonella Stanleyville was the most frequently isolated serotype. A semiquantitative risk assessment was conducted for the first time in game meat considering two products, meat cuts intended for cooking and fermented dry sausages. Only proper cooking can reduce the risk of ingestion of Salmonella to the minimum for consumers, whereas ready-to-eat dry sausages constitute risk products in terms of foodborne Salmonellosis (risk score of 64 out of 100). [ABSTRACT FROM AUTHOR]

With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during the pandemic era. [ABSTRACT FROM AUTHOR]

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse stressful experiences, which may result in an altered temperamental profile. The serotonin transporter gene ("SLC6A4"), which has been linked to infant temperament, is susceptible to epigenetic regulation associated with early stressful experience. This study examined a moderation model in which the exposure to NICU-related stress and "SLC6A4" methylation moderated infant temperament at 3 months of age. "SLC6A4" methylation at 20 CpG sites was quantified in preterm infants (N = 48) and full-term infants (N = 30) from Italian middle-class families. Results suggested that in preterm infants NICU-related stress might be associated with alterations of serotonergic tone as a consequence of "SLC6A4" methylation, which in turn, might associate with temperamental difficulties assessed at 3 months of age.

Humans and dogs commonly share the same domestic environment. Europe, and Italy specifically, have a substantial and growing dog population. Potentially zoonotic parasites may be harbored even by dogs receiving regular veterinary care. Thus, transmission of zoonotic or potentially zoonotic parasites to owners and their families should not be underestimated. Frequently, endoparasite infections occur as a subclinical infection and clinicopathological alterations have been documented including anemia, hypoalbuminemia, and eosinophilia. The aim of this large retrospective secondary data study was to analyze coprological endoparasite results and putative risk factors obtained from owned dogs, through a 9-year-period (2011–2019). Possible associations between diagnosed endoparasites and sex, age, seasonality, and year of examination were evaluated. Additionally, parasitological diagnoses were combined to complete blood count parameters and biochemical profiles, when available, to check for any possible hematological alteration from parasitism. A total of 1,972 dogs were evaluated for endoparasites using common fecal diagnostic tests over a 9-year period. The overall proportion of endoparasite-positive animals was 10%. The most common endoparasites detected were Cystoisospora spp. (3%), Toxocara canis (2.8%), Giardia duodenalis (1.6%), and Trichuris vulpis (1.2%). Of these parasites detected, Toxocara poses the greatest zoonotic risk, while Giardia species are considered to have a low potential to be zoonotic. There was no significant diagnostic trend across the years through the study period. Dogs were more frequently diagnosed endoparasite-positive when young and during cold seasons compared to the baselines of mature dogs and warm seasons. The clinicopathological profiles indicated that parasitized dogs had mild hematological alterations. The frequency of detected potentially zoonotic endoparasites in this study highlights that the risk should not be underestimated. Parasitic infection was found to be mostly dependent on age and season. Having this information may help clinicians to develop anthelmintic protocols to reduce the risk of transmission. [ABSTRACT FROM AUTHOR]

The monophasic variant of S. Typhimurium 4,[5],12:i:- (MVST) is the third most commonly reported Salmonella serovar involved in human infections (8.8%) in the EU and ranks after S. Enteritidis (54.6%) and S. Typhimurium (11.4%). In Italy, in contrast, the MVST has achieved peculiar epidemiological and ecological success which has allowed it to be, since 2011, the serovar most frequently isolated from humans. In the summer of 2022, a foodborne outbreak of the MVST involving 63 people occurred in the Marche Region (Central Italy). A common food exposure source among some human cases was a roasted, ready-to-eat (RTE) pork product, porchetta, which is a typical product of Central Italy. This paper describes the results of investigations conducted to clarify this outbreak. The porchetta was produced by a local manufacturing plant and distributed to at least two local retail stores, one of which was the retail outlet for the manufacturing plant. The MVST was isolated from surface samples collected at the porchetta manufacturing plant and at both local retail stores via bacterial analysis, and the porchetta sampled at one store contained the MVST. These data confirm this type of RTE pork product can be a source of Salmonella infection in humans. [ABSTRACT FROM AUTHOR]

Background: Pleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in diagnostic and therapeutic options, such as Indwelling Pleural Catheters (IPCs), have simplified PD treatment, allowing an effective outpatients management. Therefore, dedicated pleural services can improve PD care, guaranteeing specialized management and optimizing time and cost. We aimed to provide an overview on MPE management in Italy, mainly focused on distribution and characteristics of pleural services and IPCs use. Methods: A nationwide survey, endorsed by the Italian Thoracic Society, was distributed by email to members of selected subgroups in 2021. Results: Ninety (23%) members replied, most of whom being pulmonologists (91%). MPE resulted the most common cause of pleural effusion and was managed with heterogenous approaches, including talc pleurodesis via slurry (43%), talc poudrage (31%), repeated thoracentesis (22%) and IPCs insertion (2%). The setting of IPC insertion was inpatient care in 48% of cases, with a predominance of draining frequency every other day. IPC management mainly relied on caregivers (42%). The presence of a pleural service was reported by 37% of respondents. Conclusions: The present study provides an extensive overview of MPE management in Italy, showing a highly heterogeneous approach, a scarce prevalence of out-patient pleural services, and a still limited adoption of IPCs, mainly due to lack of dedicated community care systems. This survey emphasizes the need of promoting a higher spreading of pleural services and an innovative healthcare delivery with more favourable cost-benefit ratio. [ABSTRACT FROM AUTHOR]

Simple Summary: Tapeworm infections are among the most relevant parasitic diseases in both human and animal health. Several tapeworms rely on wild animals to complete their life cycle, among them, taeniids from the Genus Echinococcus are particularly important as they are the causative agents of cystic and alveolar echinococcosis. The study's aim was to perform a molecular screening of fecal samples collected from carcasses of wild carnivores from Central Italy using a multiplex PCR and Sanger sequencing approach. Out of 279 samples, 134 tested positive for either Taenia spp. Or Echinococcus granulosus sensu lato. Sanger sequencing was performed on every positive sample to produce a taxonomical attribution of the parasitic DNA. Echinococcus granulosus sensu stricto (genotype G3) was detected in only one Apennine wolf, whereas no sample tested positive for E. multilocularis. Other tapeworms that were commonly found in the sample pool were: Mesocestoides corti (syn. M. vogae), M. litteratus, Taenia serialis, and T. hydatigena. The results of the survey suggest that Echinococcus infections in the study area do not seem to be sustained by sylvatic cycles. The survey corroborates, yet again, the importance of passive surveillance of wild animals that can serve as reservoirs for zoonotic pathogens. Tapeworm infections are among the most relevant parasitic diseases in humans and animals. Tapeworms from the Genus Echinococcus are particularly important as they can cause cystic or alveolar echinococcosis. A molecular screening was performed on 279 fecal samples collected from carcasses of wild carnivores from Central Italy using PCR targeting diagnostic fragments of nad1, rrnS, and nad5 genes. Samples positive for either Taenia spp. or Echinococcus granulosus were sequenced to taxonomically identify the parasitic DNA. Of the 279 samples, 134 (48.0%) gave positive results in the multiplex PCR. Only one (0.4%) sample from an Apennine wolf tested positive for Echinococcus granulosus sensu stricto (genotype G3), whereas no sample tested positive for E. multilocularis. The most frequently detected tapeworms were: Mesocestoides corti (syn M. vogae) (12.9%), M. litteratus (10.8%), Taenia serialis (9.3%), and T. hydatigena (6.5%), other tapeworms were rarely detected. The results suggest that Echinococcus infections in Central Italy do not seem to be sustained by sylvatic cycles, confirming the absence of E. multilocularis in Central Italy. The survey corroborates, yet again, the importance of passive surveillance of wild animals that can serve as reservoirs for zoonotic pathogens, especially on wild canids that in other areas are strongly implicated in the transmission of E. granulosus and E. multilocularis. [ABSTRACT FROM AUTHOR]

The definition of metabolic syndrome (MetS) in childhood is controversial. Recently, a modified version of the International Diabetes Federation (IDF) definition was proposed using reference data from an international population for high waist circumference (WC) and blood pressure (BP), while the fixed cutoffs for lipids and glucose were not changed. We analyzed MetS prevalence using this modified definition (MetS-IDFm) and its association with non-alcoholic fatty liver disease (NAFLD) in 1057 youths (age 6–17 years) with overweight/obesity (OW/OB). A comparison with another modified definition of MetS according to the Adult Treatment Panel III (MetS-ATPIIIm) was performed. The prevalence of MetS-IDFm was 27.8% and 28.9% by MetS-ATPIIIm. The Odds (95% Confidence Intervals) of NAFLD was 2.70 (1.30–5.60) (p = 0.008) for high WC, 1.68 (1.25–2.26)(p = 0.001) for MetS, 1.54 (1.12–2.11)(p = 0.007) for low HDL-Cholesterol, 1.49 (1.04–2.13)(p = 0.032) for high triglycerides and 1.37 (1.03–1.82)(p = 0.033) for high BP. No substantial difference was found in the prevalence of MetS-IDFm and frequency of NAFLD compared to Mets-ATPIIIm definition. Our data demonstrate that one third of youths with OW/OB have MetS, whichever was the criterion. Neither definition was superior to some of their components in identifying youths with OW/OB at risk for NAFLD. [ABSTRACT FROM AUTHOR]

Objective: Alternatives to conventional acute hospitalizations have been particularly useful during the COVID-19 pandemic. However, little is known on the management and outcomes of COVID-19 in older patient admitted to non-acute settings. The main aim of this study was to determine the effect of geriatrics syndromes on functional outcomes in older COVID-19 patients cared in sub-acute units. Methods: Prospective multicenter observational cohort study of patients aged 65 years and older with COVID-19, admitted to sub-acute units in Italy and Spain. Multivariable logistic regression models were used to test the association between geriatric syndromes and other clinical variables, and the functional status at discharge, defined by a Barthel Index > = 80. Results: A total of 158 patients were included in the study with a median age of 82 [Interquartile Range 81, 83]; of these 102 (65%) patients had a Barthel Index ≥ 80 at discharge. In the main multivariable logistic regression model a higher severity of frailty-measured with the Clinical Frailty Scale—(OR 0.30; CI 0.18–0.47), and the presence of delirium (OR 0.04; CI 0.00–0.35) at admission were associated with lower odds of a higher functional status at discharge. Other variables associated with lower functional status were female gender (OR 0.36; CI 0.13–0.96), and a higher number of comorbidities (OR 0.48; CI 0.26–0.82). Conclusion: The study reports a relatively high prevalence of functional recovery for older COVID-19 patients admitted to sub-acute units. Additionally, it underlines the importance of targeting geriatrics syndromes, in particular frailty and delirium, for their possible effects on functional recovery. [ABSTRACT FROM AUTHOR]

Objective: Most previous research on the antecedents of healthy food choice has not investigated the links between these antecedents and has focused on specific food choice rather than on an overall diet. In the present study, we tested the plausibility of an integrated theoretical model aiming to explain the role of different psychosocial factors in increasing the intention to adhere to the Mediterranean Diet (MeDiet). Design: An online survey measured participants' attitude and perceived behavioural control (i.e. rational antecedents), subjective norm (i.e. social antecedent), positive and negative anticipated emotions (i.e. emotional antecedents), food choice health and mood motives (i.e. motivational antecedents), past adherence to the MeDiet (i.e. behavioural antecedent), and intention to adhere to the MeDiet. Setting: Italy. Participants: 1940 adults: 1086 females; 854 males; mean age = 35·65; sd = 14·75; age range = 18–84. Results: Structural Equation Modelling (sem) analyses confirmed the plausibility of the proposed model. Perceived behavioural control was the strongest rational antecedent of intention, followed by the emotional (i.e. anticipated emotions) and the social (i.e. subjective norm) antecedents. Mediation analysis showed that motivational antecedents had only an indirect impact on intention via emotional antecedents. Finally, multigroup sem analysis highlighted that past adherence to the MeDiet moderated the hypothesised paths among all the study variables. Conclusions: The above findings advance our comprehension of which antecedents public communication might leverage to promote an increase in the adherence to the MeDiet. [ABSTRACT FROM AUTHOR]

Recent earthquakes as the 2012 Emilia earthquake sequence showed that recently built unreinforced masonry (URM) buildings behaved much better than expected and sustained, despite the maximum PGA values ranged between 0.20–0.30 g, either minor damage or structural damage that is deemed repairable. Especially low-rise residential and commercial masonry buildings with a code-conforming seismic design and detailing behaved in general very well without substantial damages. The low damage grades of modern masonry buildings that was observed during this earthquake series highlighted again that codified design procedures based on linear analysis can be rather conservative. Although advances in simulation tools make nonlinear calculation methods more readily accessible to designers, linear analyses will still be the standard design method for years to come. The present paper aims to improve the linear seismic design method by providing a proper definition of the q-factor of URM buildings. These q-factors are derived for low-rise URM buildings with rigid diaphragms which represent recent construction practise in low to moderate seismic areas of Italy and Germany. The behaviour factor components for deformation and energy dissipation capacity and for overstrength due to the redistribution of forces are derived by means of pushover analyses. Furthermore, considerations on the behaviour factor component due to other sources of overstrength in masonry buildings are presented. As a result of the investigations, rationally based values of the behaviour factor q to be used in linear analyses in the range of 2.0–3.0 are proposed. [ABSTRACT FROM AUTHOR]

The lakeshore site of La Marmotta is one of the most important Early Neolithic sites of Mediterranean Europe. The site is famous for the exceptional preservation of organic materials, including numerous wooden artefacts related to navigation, agriculture, textile production, and basketry. This article presents interdisciplinary research on three of the most complete and well-preserved sickles recovered from the site, yet unpublished. All the components of the tools are analysed: the stone inserts, the wooden haft and the adhesive substances used to fix the stones inside the haft. Our innovative methodology combines use-wear and microtexture analysis of stone tools through confocal microscopy, taxonomical and technological analysis of wood, gas chromatography–mass spectrometry analysis of the adhesive substances, and pollen, non-pollen palynomorphs, and phytolith analysis of the remains incorporated within the adhesive. This multiproxy approach provides a significant insight into the life of these tools, from their production to their use and abandonment, providing evidence of the species of harvested plants and the conditions of the field during the harvesting. [ABSTRACT FROM AUTHOR]

Simple Summary: The poultry red mite Dermanyssus gallinae is a blood-sucking ectoparasite responsible for serious animal health and welfare concerns in egg-laying hen facilities, with impacts on productivity and public health. Traditionally, its control is based on the use of synthetic acaricides. Their extensive use has resulted in the development of acaricide resistance. While industrial farms are under strict legislative control, amateur breeders tend to use cheaper pesticides such as phoxim (licensed in poultry) but potentially also unauthorized pesticides, such as fipronil. The aim of this study was to evaluate the in vitro acaricidal activity of different concentration of these two molecules on field populations of D. gallinae, collected from ornamental chicken farms in Italy. Their effectiveness was significantly associated with the dose used, but a great variability of lethality rate was observed for fipronil with the increase in dilution. For phoxim, some outliers, with apparently lower sensitivity, were observed particularly in one farm, suggesting that a resistance phenomenon was triggered in this mite population. For this reason, it is necessary to underline the importance of the utilization of authorized products at correct dosages and times of treatment and the need for alternative molecules to avoid the onset of drug resistance phenomena. The poultry red mite Dermanyssus gallinae is the most important blood-sucking ectoparasite in egg-laying hen facilities. The aim of this study was to evaluate the in vitro acaricidal activity of different concentration of authorized (phoxim, ByeMite®, 500 mg/mL) and unauthorized (fipronil, Frontline® 250 mg/100 mL spray) molecules on 14 field isolates of D. gallinae collected from different ornamental poultry farms from different Italian regions. The sensitivity test was performed by contact exposure to four concentrations of each insecticide diluted at 1:5 (10,000-2000-400-80 ppm for phoxim, 500-100-20-4 ppm for fipronil) on a filter paper. The effectiveness of the treatment was significantly (p < 0.0001) associated with the dose of the pesticide used. Considering the mean lethality, phoxim has greater efficacy compared to fipronil (p < 0.001). A great variability of lethality rate was observed with the increase in fipronil dilution; conversely, for phoxim, some outliers were observed, particularly in one farm, suggesting the hypothesis that a certain degree of resistance in the mite population could occur possibly as a consequence of the continual contact with the molecule. This underlines the importance of the use of licensed products administered at correct dosages and the need for alternative molecules to avoid the onset of drug resistance phenomena. [ABSTRACT FROM AUTHOR]

High-elevation ephemeral waters are sentinels of climate change, as they quickly respond to decreasing precipitation levels and increasing air temperatures. Fairy shrimps are among the most threatened invertebrates in ephemeral waters, as they are extremely vulnerable to habitat loss. Chirocephalus sibyllae is a fairy shrimp endemic to the Palazzo Borghese temporary pond, located within Sibillini Mountains National Park (Central Italy). The aims of the present study were to: (i) evaluate the physicochemical characteristics of C. sibyllae habitat, with special reference to climate changes over twenty years; (ii) document the life history, size, and abundance of C. sibyllae; and (iii) document the coexisting zooplankton fauna in Palazzo Borghese pond. The zooplankton community was monitored fortnightly, during the filling phases of the pond, from April 2019 to June 2021, using an 80 μm mesh net, within transects of known length. On each sampling occasion, 13 physicochemical parameters were measured, and water-level fluctuations and pond surface area were recorded. Compared to what was reported in the literature, in the last two years the wet phase of the Palazzo Borghese pond was shorter, and the pool dried up much earlier than in the past. The water quality was good and reflected the typical characteristics of high-mountain oligotrophic ponds. Orthophosphates seem to play a key role in zooplankton population abundance, increasing over time during the filling period. According to the extreme unpredictability of environmental features, the zooplankton community was composed of a very limited number of species, adapted to face drought conditions for most of the year. C. sibyllae life-history traits showed a high number of cysts in the broodpouch of ovigerous females (mean ± SD = 66.0 ± 38.9), and a higher mean total length of adults (1.72 cm for females and 1.76 cm for males), in comparison to data reported in the literature. The year 2019 was configured as the season with the most favorable conditions for the development of C. sibyllae; in 2020, the short duration of the pond did not allow the species to complete its life cycle. Climate change seems to pose the main threat to the species, considering that the progressive increase in air temperatures and the decrease in snowfall will, likely, lead to increasingly shorter filling phases of its habitat. [ABSTRACT FROM AUTHOR]

Purpose: Clinical practice guidelines (CPGs) recommend against intensive follow-up in asymptomatic women with breast cancer (BC). The present study assessed the adherence to CPGs of diagnostic tests ordering during BC follow-up by exploring routinely collected health data through an algorithm developed to distinguish patients according to their status at follow-up. Patients and Methods: A retrospective population-based cohort study was performed monitoring the diagnostic tests ordered during 5 years of follow-up in all BC cases incident in 2013 in the Veneto Region, Italy. Data were extracted from the Veneto Tumour Registry, the Hospital Discharge Records and the Outpatients' Records of Diagnostic and Therapeutic Procedures. The algorithm was developed using information on infusion of anticancer agents, imaging exams ordered, and death. Results: The algorithm classified patients by status at follow-up in four groups: (i) probably no-evidence-of-disease (NED), (ii) suspicious signs of relapse not confirmed, (iii) increased risk of relapse and (iv) advanced disease at presentation or progressive disease. A total of 3930 consecutive incident cases were followed-up for 5 years, corresponding to 17,184 person-years, 15,345 of which pertaining to NED cases. In NED cases, 32,900 tumour markers and 15,858 imaging exams were ordered. Liver ultrasonography and chest radiography were most frequently ordered. Conclusion: In contrast with recommendations of CPGs, a substantial overordering of tumour markers and imaging exams occurred in NED BC patients. The developed algorithm can be repeatedly applied to routine health datasets for regular monitoring of the adherence to CPGs and of the impact of interventions to improve appropriateness. [ABSTRACT FROM AUTHOR]

This paper presents the comparison of the results of modal and nonlinear analyses carried out on a 2-story masonry building with rigid diaphragms, inspired by the Pizzoli's town hall (AQ, Italy). The case study is one of the Benchmark Structures (labeled BS6) in the "URM nonlinear modelling–Benchmark project" funded by the Italian Department of Civil Protection (DPC) within the framework of the ReLUIS projects. The building has been instrumented since 2009 with a permanent monitoring system by the Osservatorio Sismico delle Strutture (OSS) of the DPC and was hit by the 2016/2017 Central Italy earthquake sequence. In the research first phase, modal and nonlinear static analyses were carried out in a blind prediction, without any preliminary calibration of the models, but referring only to commonly made assumptions on materials and modelling. Five computer programs based on the Equivalent Frame Model (EFM) approach were used. Four different structural configurations were considered: with weak spandrels (A), with tie rods coupled to spandrels (B), with RC ring beams coupled to spandrels (C) and with "shear type" idealization (D). In the research second phase, two of the developed EFMs were calibrated in the elastic range using the results of available Ambient Vibration Tests (AVTs). The models were then validated in the nonlinear range by simulating the dynamic response of the structure recorded during the mainshocks of the 2016/2017 Central Italy earthquake. Recorded and numerical results were compared at both the global and local scale. [ABSTRACT FROM AUTHOR]

Introduction: Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods: The analyses were conducted employing the cross-sectional "Delirium Day" initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results: A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion: Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium. [ABSTRACT FROM AUTHOR]

The Formica rufa group comprises several ant species which are collectively referred to as "red wood ants" (hereafter RWA). These species have key roles in forest ecosystems, where they are ecologically dominant and greatly influence the dynamics of the habitat they colonise. Various studies have shown how their trophic activity may affect other organisms, which include both other invertebrates and plants. We can therefore hypothesize that their presence could affect the taxonomic and functional composition of epiphytes, despite clear information on such an effect is lacking. This study aimed to fill this research gap by evaluating whether the presence of red wood ants could affect the structure and composition of lichen communities. We selected two sites on the Apennine Mountains in Italy, where the red wood ant F. paralugubris was introduced from the Alps more than 50 years ago. In each site, lichen assemblages on Abies alba trees located within the colonised areas were compared to those from nearby, non-occupied areas. The results allowed for the identification of significant effects of F. paralugubris on the structure of lichen communities. Although there was no detectable impact on lichen species richness, a significant difference in their community composition between colonised and control sites was detected. Furthermore, ant presence seemed to be associated with specific lichen functional traits such as asexual reproduction. We argue that RWA could affect the lichen community either directly, e.g., by actively dispersing the species capable of asexual reproduction through their movements on trees (ant-mediated dispersion), or indirectly through herbivore exclusion. Finally, we also observed differences in ß-diversity among the colonised and non-colonised sites. [ABSTRACT FROM AUTHOR]

Background: Accountable care has changed organizational models adopted by health care organizations profoundly and, consequently, the skill set required for doctor-managers who have become middle managers and must deal with the operational management of their units. Doctor-managers must carryout clinical tasks as well as tasks related to budgeting, goal setting, and performance evaluation. The performance evaluation bias, defined as the misalignment between a ward unit's objective performance (as assessed by technical bodies or agencies) and self-assessed performance by the head of the unit, may have serious consequences for individuals and organizations. Purpose: The aim of this study was to identify determinants of performance appraisal bias based on themismatch between self-reported and official performance data. Specifically, we analyzed the role played by managerial behavior, training, engagement, and perceived organizational support at the individual level, as well as the particular unit's task diversity, complexity, and predictability. Methodology: We collected primary and secondary data referable to a population ofward unit heads in the Italian National Health Service. A linear regression model predicting performance appraisal bias was employed. Findings: High levels of engagement and perceived organizational support were associated with reduced performance appraisal bias, whereas high levels of predictability and task diversity were associated with increased degree of error. Doctor-managers attending training programs in health care management and ward unit task complexity did not affect bias significantly. Practice Implications: Policy makers and hospital managers should provide heads of units with tools that enable them to conduct ongoing monitoring and accurate appraisal of performance. Doctor-manager performance appraisal bias may be diminished by a perception of having support of the organization and direct superiors. Training programs can be revised to incorporate performance appraisal, and good performance may be incentivized with rewards. [ABSTRACT FROM AUTHOR]

Background although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients' 30-day survival. Design observational study nested in the Delirium Day project, with 30-day follow-up. Setting acute medical wards (n  = 118) and rehabilitation wards (n  = 46) in Italy. Subjects a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. Methods a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. Results overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45–1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41–1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27–2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33–2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28–2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. Conclusions in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality. [ABSTRACT FROM AUTHOR]

One of the main challenges in river management is the setting of nutrient thresholds that support good ecological status, which is the main objective to achieve for the European member states. This is a complex process, which needs an accurate analysis of the data collected so far for the ecological classification of rivers belonging to different typologies. We analysed the data of the multiannual monitoring concerning diatoms and nutrients in the upper Po River (NW Italy) with the aim of exploring the response of diatom community in terms of species composition, ecological guilds and indices. We considered data of 390 samples, of which 2/3 belonging to the "Central macrotype" (i.e., lowland stretches) and 1/3 to "Alpine siliceous". We performed a Principal Coordinate Analysis to detect community patterns with respect to water chemical classification and macrotypes highlighting species and ecological guilds characteristic of samples along a water quality gradient. We then performed a partial RDA to focus on the role of environmental and spatial factors in shaping the diatom community in each of the two macrotypes. Finally, we investigated the concordance between the Italian normative indices ICMi (for diatoms) and LIMECO (a chemical index of water quality). We found significant differences in the diatom communities of the two macrotypes and in their response to water quality and to spatial factors. Communities resulted as much more uniform in sites with a low water quality, with characteristic species such as Navicula gregaria, Nitzschia palea and Sellaphora nigri. On the other hands, moderately disturbed sites (in terms of trophic level) were characterised by the highest guild diversity. The RDA confirmed the importance of spatial factors in shaping the diatom assemblages, especially in Alpine streams where the physical barriers may condition species dispersion. The comparison between the two normative indices highlights that the correspondence in the classification is achieved in the 57% (Alpine macrotype) and 43% (Central macrotype) of samples. According to our findings, we suggest the revision of the ICMi, both class boundaries and reference value. In addition, we recommend to lower LIMECO threshold for total phosphorus: indeed, several studies have shown significant changes in the diatom community composition starting from very low values (below the current LIMECO threshold, i.e. 50 µgL--1). Moreover, the extension of our study to the whole Po River basin will complete our knowledge of species not yet included in the diatom indices and of the community response to nutrient levels also in other macrotypes. [ABSTRACT FROM AUTHOR]

Background: The aim of this Italian multicenter study was to evaluate the diagnostic performance of a minimally invasive method for the detection of oral squamous cell carcinoma (OSCC) based on 13‐gene DNA methylation analysis in oral brushing samples. Methods: Oral brushing specimens were collected in 11 oral medicine centers across Italy. Twenty brushing specimens were collected by each center, 10 from patients with OSCC, and 10 from healthy volunteers. DNA methylation analysis was performed in blindness, and each sample was determined as positive or negative based on a predefined cutoff value. Results: DNA amplification failed in 4 of 220 (1.8%) samples. Of the specimens derived from patients with OSCC, 93.6% (103/110) were detected as positive, and 84.9% (90/106) of the samples from healthy volunteers were negative. Conclusion: These data confirmed the diagnostic performance of our novel procedure in a large cohort of brushing specimens collected from 11 different centers and analyzed in blindness. [ABSTRACT FROM AUTHOR]

The essay presents to the reader, as a possible source for a well-rounded history of the school in Italy during Fascism, the curious Diario di una persona comune (Diary of an ordinary person), written by professor Alfredo Puerari in the aftermath of 25 July 1943 and published immediately after the war on the newspaper of the Ticino Liberal-Radical Party «Il Dovere», in the column Cultura e azione directed by Gianfranco Contini. The writing, which collects the impressions of a teacher of Italian, Latin and Art History of the Liceo Manin in Cremona, active in the ideal resistance to the regime, offers useful elements for the reconstruction of the teaching culture in the dark years of the dictatorship, as well as giving information on the first antifascist meeting organized in the shadow of Torrazzo after the fall of Mussolini. [ABSTRACT FROM AUTHOR]

As the novel coronavirus disease sweeps across the world, there is growing speculation on the role that atmospheric factors may have played on the different distribution of SARS-CoV-2, and on the epidemiological characteristics of COVID-19. Knowing the role that environmental factors play in influenza virus outbreaks, environmental pollution and, in particular, atmospheric airborne (particulate matter, PM) has been considered as a potential key factor in the spread and mortality of COVID-19. A possible role of the PM as the virus carrier has also been debated. The role of PM in exacerbating respiratory and cardiovascular disease has been well recognized. Accumulating evidence support the hypothesis that PM can trigger inflammatory response at molecular, cellular and organ levels. On this basis, we developed the hypothesis that PM may play a role as a booster of COVID-19 rather than as a carrier of SARS-CoV-2. To support our hypothesis, we analyzed the molecular signatures detected in cells exposed to PM samples collected in one of the most affected areas by the COVID-19 outbreak, in Italy. T47D human breast adenocarcinoma cells were chosen to explore the global gene expression changes induced by the treatment with organic extracts of PM 2.5. The analysis of the KEGG's pathways showed modulation of several gene networks related to the leucocyte transendothelial migration, cytoskeleton and adhesion system. Three major biological process were identified, including coagulation, growth control and immune response. The analysis of the modulated genes gave evidence for the involvement of PM in the endothelial disease, coagulation disorders, diabetes and reproductive toxicity, supporting the hypothesis that PM, directly or through molecular interplay, affects the same molecular targets as so far known for SARS-COV-2, contributing to the cytokines storm and to the aggravation of the symptoms triggered by COVID-19. We provide evidence for a plausible cooperation of receptors and transmembrane proteins, targeted by PM and involved in COVID-19, together with new insights into the molecular interplay of chemicals and pathogens that could be of importance for sustaining public health policies and developing new therapeutic approaches. [ABSTRACT FROM AUTHOR]

Biking is a means of sustainable transport and is expected to grow over the next few years. Cyclists are more vulnerable road users than car, bus, and truck drivers. This is a pilot study aimed at generating information on the use of bike safety equipment and high-visibility clothing among Italian adult cyclists and identifying factors associated with safety gear use. Data from a European study involving a web survey of 2,470 cyclists were analyzed. The sample was composed of 62% males, the sample median age was 54, and the proportion of those using a city bike was about 72%. The association between individual and bike characteristics and the use of bicycle safety equipment—light and reflectors—and high-visibility clothing were studied with regression logistic models. The results showed that cyclists who use conspicuous clothing were males, older, came from the South, rode more than 60 km, and used bike safety devices. Riders who used all or at least one item of safety gear rode city bikes and used high-visibility clothing. The data provided a first step in filling the gap in knowledge concerning individual-based safety measures and bike safety equipment use in Italy. [ABSTRACT FROM AUTHOR]

Objective: To assess the applicability in Italy of a community-based occupational therapy program (COTID) on occupational performance of persons with dementia and their caregivers. Methods: Prospective cohort study: twenty-seven older persons with mild-to-moderate dementia living in the community and their primary caregivers were included. Ten sessions of occupational therapy over 5 weeks were delivered. Main outcome measures were the level of performance and satisfaction perceived by people with dementia during the participation in significant activities assessed with the Canadian Occupational Performance Measure (COPM); caregiver burden assessed with the sense of competence questionnaire (SCQ). Results: The average age of the population was 80.59 ± 8.46 in persons with dementia and 57.78 ± 13.47 in the caregivers. There was a significant improvement in the caregivers' burden in the SCQ (pre treatment 77.19 ± 13.27 vs 82.56 ± 12.57 post treatment; p =.005). Persons with dementia showed a significant improvement in the COPM performance (4.56 ± 1.44 vs 6.68 ± 1.59; p =.000) as well as in the satisfaction (5.08 ± 1.84 vs 7.04 ± 1.71; p =.000). No significant variations were registered in the overall cognitive functions, behavioral and psychological symptoms of dementia, daily functioning, depressive symptoms, perceived quality of life and global health of people with dementia. There was also no difference in the quality of life, global health, depression or burden in the caregivers. Conclusions: The study shows that the COTID program is applicable in the Italian context. The findings suggest a positive effect on patients and caregivers providing a preliminary support for the program implementation at a national level. [ABSTRACT FROM AUTHOR]

Objective: Evidence about the role of nutritional status (NS) on functional outcomes (FO) after rehabilitation in older adults is scarce. Our aim was to analyze the association between NS and FO in older adults admitted to geriatric rehabilitation units. Methods: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) multicenter study enrolled patients aged ≥65 years admitted to geriatric rehabilitation units in Italy and Spain. FO were absolute and relative functional gain (AFG-RFG) in Barthel Index (BI) at 1 and 3 months after admission. The association between NS (Mini Nutritional Assessment-Short Form) and FO was explored using linear regression and mixed models, adjusted for potential confounders. Analyses were then stratified for diagnosis at admission. Results: We included 415 patients (mean age 81.4 years [SD: 7.7]; 67% female; 9.4% malnourished [MN], 42.7% at risk of malnutrition [RM], and 48% well nourished [WN]). Admission diagnoses were hip fracture (39.5%), elective orthopedic surgery (EOS) (29.5%), and stroke (31%). In an adjusted linear mixed model, MN and RM participants had lower BI compared to WN (MN: β: -8.47, p = 0.023; RM: β: -5.22, p = 0.031), and differences between groups remained stable over time. After stratification for admission diagnosis, only MN patients admitted after EOS had worse FO, both at 30 days (AFG: β adjusted: -13.54, p < 0.001; RFG: β: -32, p < 0.001) and 3 months (AFG: β adjusted: -17.79, p < 0.001; RFG: β: -26.77, p = 0.002). Conclusions: In our sample, poor NS is associated with worse BI in older adults admitted to geriatric rehabilitation units; in patients undergoing EOS, MN is associated with worse FO. Our results documented for the first time the importance of assessing nutritional status before EOS. [ABSTRACT FROM AUTHOR]

The work is an analysis of the recording, processing and presentation of the 3D data of two late roman towers inside the area of the Archaeological Museum of Milan, part of the city previously occupied by the Monastery of St. Maurizio and rich of historical and ancient monuments. The aim of this research is to examine the possibilities offered by digital technologies to record and enhance the archaeological heritage and to increase the divulgence and presentation with interactive products. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study is to investigate how delirium and adverse clinical events (ACE) contribute independently and in combination to functional outcomes in older patients admitted to rehabilitation settings after a hip fracture. Methods: This is a multicenter retrospective cohort study of patients aged ≥65 years admitted after hip fracture surgical repair to three Italian rehabilitation units. Delirium on admission was evaluated with the Confusion Assessment Method. ACE during the rehabilitation stay were recorded, including infections (i.e. urinary tract infections, other infections), non‐infectious ACE (i.e. cardiovascular events, respiratory failure, pulmonary embolism) and falls. A multivariable linear regression was used to evaluate the effect of ACE and delirium on functional outcome, adjusting for covariates determined a priori. Results: A total of 519 patients were included in the study. The mean ± SD age was 82.9 ± 9.4 years. ACE occurred in 277 patients (53.4%), delirium alone was present in 19 patients (3.6%). Both conditions were present in 58 patients (11.2%). Compared with patients without delirium or ACE, those with ACE or delirium were more likely to have a worse functional outcome (−6.7 Barthel Index points [−11.6; −1.7]; P = 0.008; −13.2 [−25.6; −0.8]; P = 0.038) at discharge, and patients with both conditions had an even lower Barthel Index score (−18.6 Barthel Index points [−26.9; −10.3]; P < 0.001). Conclusions: ACE and delirium are very common in older patients admitted to rehabilitation settings after hip fracture, and frequently coexist. As both ACE and delirium could impact on functional outcome, alone and in combination, a clinical geriatric approach is necessary for this population to minimize risks. Geriatr Gerontol Int 2019; 19: 404–408. [ABSTRACT FROM AUTHOR]

Purpose: The healthcare sector has been facing major reforms, among which the introduction of the Clinical Directorate (CD) model for hospitals. The purpose of this work is to explore the degree of implementation of innovative Human Resource Management (HRM) practices within CDs, in order to understand whether, after more than 15 years from their introduction, they have been able to transform their managerial approach concretely, in line with the CD model's objectives. The tools have been attributed to three main HR initiatives: training, control, and evaluation ones. Design and methods: During on-site visits in 33 Italian hospitals, data were collected by conducting semi-structured interviews with their CEOs and Clinical Directors. Data concerned both the mere adoption of HRM tools within CDs, as well as their effective degree of implementation. The answers to the questions were translated into a system of percentage scores, so as to detect mean percentages of implementation in each CD. Findings: The general degree of implementation of HRM practices is still somewhat distant from a theoretically excellent and full implementation, especially if we consider the important lag of time since the reforms affected the sector. Nevertheless, results open the way to important considerations about the effectiveness of the CD model. Original value: The original methodology and scoring system suggested in this work produce a concise evaluation of the development of an effective HRM system within CDs. Our framework of analysis allows interesting benchmarking activities among different CDs of an organization and, ultimately, among different organizations. Moreover, the methodology presented may constitute a valid source of information in order to carry out future research on the items able to affect the implementation of such tools. [ABSTRACT FROM AUTHOR]

Summary: Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for "deficiency"). An early 25(OH)D dosage may be advisable for this population. Introduction: Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units. Methods: We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models. Results: We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5–18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67–5.33]; Q3, OR [95% CI] = 4.01 [1.35–13.48]; Q4, OR [95% CI] = 2.18 [0.81–6.21]). Conclusions: In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery. [ABSTRACT FROM AUTHOR]

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium.Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients.Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment).Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia.Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents.Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence. [ABSTRACT FROM AUTHOR]

Background: Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation.Objective: The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults.Design: Multi-centric cohort study.Participanst and Settings: Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016.Measurements: The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission.Results: We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an orthopedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additionally, in both diagnostics groups, a better handgrip strength increased the chance of RFG.Conclusions: Among frailty-related variables, physical, cognitive and muscular function at admission could be relevant for functional improvement during geriatric reha-bilitation. If confirmed, this data might orient targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common geriatric syndrome. Few studies have been conducted in nursing home (NH) residents. The aim of this project was to perform a point prevalence study of delirium in Italian NHs. Methods: Data collected in 71 NHs are presented. Inclusion criteria were age ≥65 years and native Italian speaker. Exclusion criteria were coma, aphasia, and end-of-life status. Sociodemographic and medical data were recorded. Delirium was assessed using the Assessment Test for Delirium and Cognitive Impairment (4-AT). Patients with a 4-AT score ≥4 were considered to have delirium. Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS). Results: A total of 1,454 patients were evaluated (mean age 84.4 ± 7.4 years, 70.2% female), of whom 535 (36.8%) had delirium. In multivariate logistic regression analysis, variables significantly associated with delirium were education (OR 0.94, 95% CI 0.91–0.97), dementia (OR 3.12, 95% CI 2.38–4.09), functional dependence (OR 6.13, 95% CI 3.08–12.19 for ADL score 0; OR 1.99, 95% CI 1.03–3.84 for ADL score 1–5), malnutrition (OR 4.87, 95% CI 2.68–8.84), antipsychotics (OR 2.40, 95% CI 1.81–3.18), and physical restraints (OR 2.48, 95% CI 1.71–3.59). Conclusion: Delirium is common in older NH residents. Simple assessment tools might facilitate its recognition in this vulnerable population. [ABSTRACT FROM AUTHOR]

A three-year research project, called DRYSMES 4GRID, was recently funded by the Italian Minister of Economic Development, Italy. The project, which involves five Italian partners (companies, universities, and research institutes), is aimed to demonstrate the feasibility of cost-competitive SMES based on magnesium diboride (MgB2 ) with a cryogen-free cooling bymeans of the manufacturing and the testing of a demonstrator with an objective rating of 500 kJ/200 kW. This rating is deemed suitable for disclosing the critical technological aspects of all components in view of practical applications. A further goal of the project is the assessment of the technical and economic benefits that the SMES can bring to real-world electric grids. The general outline and technical objectives of the project are presented in this paper. Preliminary design assumptions and results concerning the MgB2 coil and the power condition system are also discussed. [ABSTRACT FROM AUTHOR]

A three-year research project, called DRYSMES 4GRID, was recently funded by the Italian Minister of Economic Development, Italy. The project, which involves five Italian partners (companies, universities, and research institutes), is aimed to demonstrate the feasibility of cost-competitive SMES based on magnesium diboride (MgB2 ) with a cryogen-free cooling bymeans of the manufacturing and the testing of a demonstrator with an objective rating of 500 kJ/200 kW. This rating is deemed suitable for disclosing the critical technological aspects of all components in view of practical applications. A further goal of the project is the assessment of the technical and economic benefits that the SMES can bring to real-world electric grids. The general outline and technical objectives of the project are presented in this paper. Preliminary design assumptions and results concerning the MgB2 coil and the power condition system are also discussed. [ABSTRACT FROM AUTHOR]

Background/Objectives: Delirium is underrecognized in clinical practice. The primary aim of the present multicenter study was to compare the ability of nurses to identify delirium features with a standardized assessment. The secondary aim was to identify predictors of missed or incorrect identifications of delirium by nurses. Design: Point prevalence study in 120 wards across Italy. Setting: “Delirium Day 2015.” Participants: Inpatients aged 65 and older (N = 1,867). Measurements: Participants and nurses were asked specific questions to investigate their perceptions of the presence of delirium features (acute cognitive change, inattention, cognitive fluctuations, impaired arousal). Delirium was identified according to the results of the Assessment Test for Delirium and Cognitive Impairment (4AT), completed by a physician. Comorbidities including dementia, disability, drug treatments, and delirium motor subtype according to the Delirium Motor Subtype Scale were recorded. Results: Delirium was present in 429 subjects (23%) according to the 4AT. Cognitive fluctuations was the delirium feature that the nurses most often recognized. Nurses’ perceptions of acute cognitive change, cognitive fluctuations, or impaired arousal had 84% sensitivity and 81% specificity for delirium. The nonmotor subtype of delirium was less likely to be recognized (80%) than the hyperactive (97%), mixed (92%), and hypoactive (90%) subtypes. Incorrect perception of delirium was more frequent in subjects with dementia (specificity 64%). Conclusions: The delirium feature that nurses were best able to recognize was cognitive fluctuations. The nonmotor subtype was associated with a lower recognition rate. Routine observation and registration of delirium features by nurses in clinical practice might be helpful to increase formal diagnosis of delirium. [ABSTRACT FROM AUTHOR]

Delirium is a severe neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction in the setting of an acute medical illness, medical complication, drug intoxication, or drug withdrawal. The most important risk factors are advanced age and dementia, whereas pain, dehydration, infections, stroke, metabolic disturbances, and surgery are the most common triggering factors. Although delirium is a common clinical syndrome in different settings of care (acute care hospitals, inpatient rehabilitation facilities, nursing homes, and hospices), it often remains under-recognized, poorly understood, and inadequately managed. There exists a clear need for improved understanding to overcome cultural stereotypes, and for the development and dissemination of a comprehensive model of implementation of general good practice points. A network of Italian national scientific societies was thus convened (1) to develop a collaborative multidisciplinary initiative report on delirium in elderly hospitalized patients, (2) to focus the attention of health care personnel on prevention, diagnosis, and therapy of patients suffering from delirium, and (3) to make the health services research community and policy-makers more aware of the potential risks of this condition providing a reference for training activities and data collection. [ABSTRACT FROM AUTHOR]

Introduction The financial cost of injuries sustained in road traffic crashes is high for victims, families and national budgets, but there is limited information on the cost of injury from the victims’ perspective, especially in terms of the hard-to-reach multi-trauma patient population such as those admitted to the intensive care units of hospitals. Materials and methods The current study received funding by the European Commission Directorate-General Mobility and Transport. It is a prospective, prevalence-based, cost-of-illness study. Participants admitted in the intensive care units of seven public hospitals in Greece, Germany and Italy because of injuries from road traffic crashes, during one year, were enrolled in the study. Patients were followed-up for one year after the intensive care unit admission to report emerging direct and indirect costs related to their injury. Results A total of 120 people were enrolled. Males, those aged 25–49, motorcyclists and those severely injured (Maximum Abbreviated Injury Scale (MAIS) 3+) with highest severity located at the central part of the body, accounted for the highest percentages of both the direct and indirect injury costs. The highest average direct costs were for females, those aged 50–64, pedestrians and those slightly injured (MAIS 1 or 2) with highest severity at the central region of the body. Males, patients aged 25–49, car passengers and truck drivers as well as those slightly injured (MAIS 1 or 2) with highest severity at multiple locations were over-represented in the average indirect costs. Conclusions Those groups that account for a high percentage of injury costs should be targeted in health policy initiatives. [ABSTRACT FROM AUTHOR]

Background: A small number of patients affected by Neutral Lipid Storage Diseases (NLSDs: NLSD type M with Myopathy and NLSD type I with Ichthyosis) have been described in various ethnic groups worldwide. However, relatively little is known about the progression and phenotypic variability of the disease in large specific populations. The aim of our study was to assess the natural history, disability and genotype-phenotype correlations in Italian patients with NLSDs. Twenty-one patients who satisfied the criteria for NLSDs were enrolled in a retrospective cross-sectional study to evaluate the genetic aspects, clinical signs at onset, disability progression and comorbidities associated with this group of diseases.Results: During the clinical follow-up (range: 2-44 years, median: 17.8 years), two patients (9.5%, both with NLSD-I) died of hepatic failure, and a further five (24%) lost their ability to walk or needed help when walking after a mean period of 30.6 years of disease. None of the patients required mechanical ventilation. No patient required a heart transplant, one patient with NLSD-M was implanted with a cardioverter defibrillator for severe arrhythmias.Conclusion: The genotype/phenotype correlation analysis in our population showed that the same gene mutations were associated with a varying clinical onset and course. This study highlights peculiar aspects of Italian NLSD patients that differ from those observed in Japanese patients, who were found to be affected by a marked hypertrophic cardiopathy. Owing to the varying phenotypic expression of the same mutations, it is conceivable that some additional genetic or epigenetic factors affect the symptoms and progression in this group of diseases. [ABSTRACT FROM AUTHOR]

Background: Body Mass Index Italian reference data are available for clinical and/or epidemiological use, but no study compared the ability of this system to classify overweight and obesity and detect subjects with clustered cardiometabolic risk factors with international standards. Therefore our aim was to assess 1) the agreement among the Italian Society for Pediatric Endocrinology and Diabetology (ISPED), the World Health Organisation (WHO) and the International Obesity Task Force (IOTF) Body Mass Index cut-offs in estimating overweight or obesity in children and adolescents; 2) the ability of each above-mentioned set of cut-points to detect subjects with cardiometabolic risk factors. Methods: Data of 6070 Italian subjects aged 5-17 years were collected. Prevalence of normal-weight, overweight and obesity was determined using three classification systems: ISPED, WHO and IOTF. High blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and impaired fasting glucose were considered as cardiometabolic risk factors. Results: ISPED and IOTF classified more subjects as normal-weight or overweight and less subjects as obese as compared to WHO (p <0.0001) in the whole sample and in groups divided by gender and age. The strength of agreement between the three methods compared to each other was excellent for overweight (including obesity) definition (k > 0.900), while it differed for obesity definition, ranging from the highest agreement between ISPED and IOTF (k 0.875) to the lowest between ISPED and WHO (k 0.664). WHO had the highest sensitivity, while ISPED and IOTF systems had the highest specificity, in identifying obese subjects with clustered cardiometabolic risk factors. Analogous results were found in subjects stratified by gender or age. Conclusions: ISPED and IOTF systems performed similarly in assessing overweight and obesity, and were more specific in identifying obese children/adolescents with clustered cardiometabolic risk factors; on the contrary, the WHO system was more sensitive. Given the seriousness of the obesity epidemic, we wonder whether the WHO system should be preferable to the national standards for clinical practice and/or obesity screening. [ABSTRACT FROM AUTHOR]

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy.Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints.Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not.Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys. [ABSTRACT FROM AUTHOR]

The genus Micipsella comprises three species of filariae to date identified in lagomorphs only, whereas the other genera belonging to the subfamily Splendidofilariinae are described as parasites of birds, reptiles and mammals. In the present study seven specimens of Micipsella numidica (Seurat, 1917), collected from the hare Lepus europaeus in Italy, were characterized genetically by molecular amplification of the mitochondrial genes (12S rDNA; cox1) and the 5S rDNA gene spacer region. Phylogenetic trees inferred using available sequences from filariae and those identified in this study evidenced a close relationship between M. numidica and Splendidofilariinae of other mammals and reptiles (Rumenfilaria andersoni and Madathamugadia hiepei). The present findings, apart from adding new data about the hosts in Italy, support the taxonomic position of M. numidica and highlight the substantial biological and molecular differences existing between Splendidofilariinae and other Onchocercidae. The study also contributes to our knowledge of the molecular/genetic diagnosis of filarial parasites of veterinary and medical concern in any vertebrate or invertebrate host. [ABSTRACT FROM AUTHOR]

Aims: To analyse the general and cause-specific mortality over the course of 30 years among subjects treated for alcohol use disorders (AUD) in Northern Italy. Methods: Cohort of 2499 subjects followed-up for mortality until 31 December 2012. Standardized mortality ratios (SMRs) and 95% confidence intervals (CI) were computed to compare the mortality in the cohort with the general population. Cox regression was used to study the effect of psychiatric disorders, burden of physical comorbidity and retention in treatment on mortality, controlling for socio-demographic factors. Results: During the follow-up, 435 deaths occurred. Compared with the general population, alcoholics experienced a 5-fold increased mortality (SMR: 5.53; 95% CI: 5.03, 6.07). Significant excess mortalitywas observed for a range of specific causes: infections, cancers, cardiovascular, respiratory and digestive system diseases as well as violent causes. In multivariate analysis, the hazard of dying was lower for female gender (hazard ratio [HR]: 0.62; 95% CI: 0.46, 0.84) and for increasing length of retention in treatment (HR for third tertile vs first tertile: 0.43; 95% CI: 0.32, 0.57). Burden of physical comorbiditywas associated with increased hazard of dying (HR for 3+ comorbidities vs no comorbidities: 4.40; 95% CI: 2.91, 6.66). Psychiatric comorbidity was not associated with mortality. Conclusions: Despite the harmful effect of AUD, retention in treatment represented a protective factor against death, suggesting that strategies supporting primary medical- and social-care may effectively reduce premature mortality. [ABSTRACT FROM AUTHOR]

The earthquake sequence started on May $$20$$ th 2012 in Emilia (Italy) affected a region where masonry constructions represent a large part of the existing building stock and the construction of new modern masonry buildings is a common practice. The paper is focused on the performance of common architectural configurations, typical for residential or business use. The large majority of old masonry buildings is made of fired clay bricks. The seismic performance of these buildings is particularly interesting since major past earthquakes in Italy affected areas with mainly stone masonry structures. Apart from examples showing systematic or peculiar structural deficiencies governing the vulnerability of several buildings, the overall seismic performance of these structures to repeated shaking, with PGA as large as 0.25-0.3 g was rather good, despite the major part of them were only conceived for carrying vertical loads. In fact, seismic design is mandatory in the area only since 2003. Modern low-rise masonry buildings erected after this date and incorporating seismic design and proper detailing resulted in most cases practically undamaged. The examples reported in the paper allow an evaluation of the superior performance of seismically designed modern masonry buildings in comparison to older ones. [ABSTRACT FROM AUTHOR]