Measuring the expected increase in cycling in the city of Milan and evaluating the positive effects on the population’s health status: a Community-Based Urban Planning experience

BACKGROUND: It's scientifically known that inactivity is one of the major risk factors for Non-Communicable Diseases. One of the elements affecting the choice of transport mode, regarding circulation in the city, is the cities' urban morphology, i.e. the infrastructural facilities for the slow mobility service. Cyclability, in fact, can help to increase daily physical activity level, therefore becoming a protective factor for individual health. METHODS: After a literature review about the state of the art regarding the correlation between built environment, active transport and quantification of the physical activity level, we have developed a specific questionnaire to collect information about current and forecast use of bicycle, in case of improvement and implementation of the cycling network. The questionnaire also investigated social and health aspects concerning the anamnesis of the interviewees (age, gender, health status, sport activity performed, etc) and users' opinions about existing infrastructure and planned interventions, designed to promote cycling mobility. Aim of the research was to quantify the increase of physical activity people would have realized in front of an improvement of the specific infrastructures, and the expected positive effects in terms of health. RESULTS: The collected data (343 interviewed in a district of Milan, named "Zona 7") demonstrate that through the implementation of the cycle network, there would be more cyclists to practice the 150 minutes weekly of physical activity recommended by WHO: time spent in cycling, indeed, would increases by 34.4% compared to the current level of cyclability, as detected by our survey. CONCLUSIONS: The investigation confirmed that urban interventions, especially those in small-scale, could play a key role in the promotion of healthy lifestyles, inducing therefore important positive effects on the population health. It was also carried out an application of the WHO "Health Economic Assessment Tool" to evaluate the benefits in terms of Non-Communicable Diseases' reduction, specifically a provisional quantification of deaths saved

Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background: Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods: The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results: Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions: Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence: Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Analisi degli incidenti pedonali per la riprogettazione degli attraversamenti urbani

La situazione attuale presenta dati preoccupanti in termini di sicurezza stradale e, in particolare, di sicurezza per i pedoni. Prendendo come riferimento i dati ISTAT dell’ultimo decennio, emerge come sia aumentato il rischio di essere investiti nonostante un miglioramento della sicurezza stradale in generale (–19,6% di incidenti tra il 2001 e il 2011). Ogni giorno almeno 22 pedoni muoiono sulle strade europee, circa 8.000 ogni anno; in Italia, dal 2001 al 2011, i pedoni morti sono oltre 8.000 e 205.000 i feriti (Fanara, 2012). I pedoni sono coinvolti nel 15% dei sinistri stradali e il 25% delle volte (ovvero una volta ogni quattro) questi incidenti avvengono proprio su un attraversamento pedonale (ACI, 2011). Questi dati, oltre a sottendere gravissimi risvolti sociali per le moltissime famiglie, implicano anche un rilevante costo economico. Ogni anno in Italia la sola incidentalità tra veicoli e pedoni (morti e feriti) “costa” al Paese, tra spese sanitarie, mancata produttività e spese amministrative varie, quasi 2 miliardi di Euro, circa il 9% dei costi totali generati dall’incidentalità complessiva (elaborazioni proprie dai dati dello studio del Ministero delle Infrastrutture e dei Trasporti, 2011). La presente memoria è parte di un più articolato lavoro di ricerca e progettazione focalizzato sulla mobilità pedonale, in particolare negli attraversamenti stradali. Nella ricerca sono state analizzate le geometrie e le funzionalità degli attuali attraversamenti pedonali al fine di supportare una nuova proposta progettuale

Urban health and Physical Activity: how urban design can improve cycling

Introduction It is well-known that physical inactivity is among the main risk factors that increases chronic degenerative diseases. The emergency is relevant in urban contexts, where, most transfers have a distance of less than 5 km, easily done by foot or bicycle. They would ensure an adequate daily physical activity. An increase of cycling would also lead to several other positive effects on the urban environment (air quality, less traffic, noise, etc.). Therefore, it is necessary to investigate which characteristics of the cycling and walking infrastructures encourage or not adequate lifestyles. Methods Starting from an analysis of the State of the Art related to the correlation among active transport, physical activity and health, a questionnaire was handed out to collect data on the current level of urban cycling and to quantify the expected increase in case of the improvement of the bicycle path network. The questionnaire was circulated through on-line and paper forms (1675 users), for a period of 3 months in the city of Milan. The aim was to quantify the increase in physical activity related to a provisional improvement of the infrastructures. Results The data collected subdivided into 9 districts show that the choice to use the bicycle, as an active means of transport, would significantly increase both in frequency and in duration: for example in the expected scenario 76.5% of the sample (over 21% more than the current one) would reach 150 minutes of physical activity per week, as WHO suggests. The main reasons for daily use or non-use of the bicycle were also identified. Conclusions The survey conducted highlighted the direct correlation between urban planning and active mobility. Actions related to mobility redesign, especially small-scale ones, could play a key-role in reducing physical inactivity with positive effects on health. The methodology could be replicated in other realities in order to highlight the specific strategies to be adopted

Trattamento mininvasivo del laparocele con parietex : Risultati preliminari e analisi della letteratura

Conventional surgery for incisional hernia carries a postoperative morbidity and recurrence rate of more than 12%. The aim of this study was to report our experience with the laparoscopic treatment of incisional hernia with the use of a composite mesh (Parietex, Sofradim, Celbio). The median duration of the operation was 135 minutes. In one patient peritonitis from small bowel perforation occurred on postoperative day 2 and required emergency surgery. The median postoperative hospital stay was 3 days. No complications were observed over a median follow-up period of 12 months. The goal of the laparoscopic treatment of incisional hernia is to decrease the incidence of local complications and the recurrence rate which are seen with traditional open surgery. To this should be added all the advantages of minimally invasive surgery in terms of decreased postoperative pain, length of hospital stay, and sick leave

Urban health and Physical Activity: how urban design can improve cycling

Introduction It is well-known that physical inactivity is among the main risk factors that increases chronic degenerative diseases. The emergency is relevant in urban contexts, where, most transfers have a distance of less than 5 km, easily done by foot or bicycle. They would ensure an adequate daily physical activity. An increase of cycling would also lead to several other positive effects on the urban environment (air quality, less traffic, noise, etc.). Therefore, it is necessary to investigate which characteristics of the cycling and walking infrastructures encourage or not adequate lifestyles. Methods Starting from an analysis of the State of the Art related to the correlation among active transport, physical activity and health, a questionnaire was handed out to collect data on the current level of urban cycling and to quantify the expected increase in case of the improvement of the bicycle path network. The questionnaire was circulated through on-line and paper forms (1675 users), for a period of 3 months in the city of Milan. The aim was to quantify the increase in physical activity related to a provisional improvement of the infrastructures. Results The data collected subdivided into 9 districts show that the choice to use the bicycle, as an active means of transport, would significantly increase both in frequency and in duration: for example in the expected scenario 76.5% of the sample (over 21% more than the current one) would reach 150 minutes of physical activity per week, as WHO suggests. The main reasons for daily use or non-use of the bicycle were also identified. Conclusions The survey conducted highlighted the direct correlation between urban planning and active mobility. Actions related to mobility redesign, especially small-scale ones, could play a key-role in reducing physical inactivity with positive effects on health. The methodology could be replicated in other realities in order to highlight the specific strategies to be adopted. Key messages Questionnaires for improving cycling in urban contexts. Data analysis on citizens’ lifestyles for encouraging active mobility