Campania and cancer mortality: An inseparable pair? The role of environmental quality and socio-economic deprivation

The region of Campania in Southern Italy features high levels of socio-economic deprivation and low levels of environmental quality. A vast strand of the scientific literature has tried to verify whether poor environmental quality and widespread socio-economic deprivation might explain the high cancer mortality rates (CMRs) observed, especially in the municipalities – infamously labelled as the ‘Land of Fires’ – that were hit most severely by the crisis. While some studies managed to identify links between these two confounding factors and cancer mortality, the evidence is overall mixed. Interesting information may be drawn from the observation of municipal data: in spite of previous claims, some municipalities featuring high environmental quality and low socio-economic deprivation also display high CMRs, while other Campanian municipalities facing disastrous environmental and socio-economic conditions are characterised by low CMRs. These figures, in contrast to common sentiment and previous studies, need to be investigated thoroughly in order to assess the exact role of the confounding factors. In this work, we aim to identify the municipalities where confounding factors act as driving forces in the determination of high CMRs through an original multi-step analysis based on frequentist and Bayesian analysis. Pinpointing these municipalities could allow policymakers to design targeted and effective policy measures aimed at reducing cancer mortality

Cross-cultural adaptation and validation of the Italian version of the Western Ontario Rotator Cuff (WORC) index

: The aim of the study was to accomplish translation, cross-cultural adaptation and validation of the Western Ontario Rotator Cuff (WORC) Index questionnaire for its use in Italy. The WORC original version was translated and cross-culturally adapted into Italian. Subsequently, it was administered to a population of 60 patients suffering from rotator cuff disease to evaluate the validity and reliability of the Italian version. The content validity evaluated the correlation between questions and total score of each domain through Pearson's correlation coefficient. The construct validity was similarly assessed through Pearson's correlation coefficient by testing the correlation between the Italian WORC and the Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Reliability was assessed using two methods: internal consistency by calculating the Cronbach's alpha coefficient for each domain; and test-retest by means of the intraclass correlation coefficient (ICC). The translation and cross-cultural adaptation of the Italian version did not reveal any major problems. No significant floor or ceiling effects were found. All the questions were linearly related to the concept expressed by the domain of belonging. Overall correlation with the DASH score was 0.75. Internal consistency was very high overall (α = 0.93) as well as reliability (overall ICC = 0.87). The Italian version of the WORC questionnaire is a valid and reproducible measuring instrument and can be considered a valid tool for the evaluation of the effectiveness of a treatment in terms of quality of life, in Italian patients affected by rotator cuff diseases.Level of evidence Diagnostic study, level II

Knotless PEEK and double-loaded biodegradable suture anchors ensure comparable clinical outcomes in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study

Purpose: To compare the clinical outcome of arthroscopic capsulolabral repair for traumatic anterior shoulder instability with PEEK knotless and knotted biodegradable suture anchors. Methods: Arthroscopic stabilization was performed in 78 patients with recurrent traumatic anterior shoulder instability. They were divided into 2 groups of 39 patients each, according to suture anchors used: knotless PEEK anchors in group 1, and biodegradable anchors in group 2. Exclusion criteria were: instability without dislocation, posterior or multidirectional instability, glenoid bone loss > 20%, off-track lesions, concomitant rotator cuff tears and previous surgery. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire. Secondary outcomes were: Work-DASH, Sport-DASH, Rowe score, recurrent instability and subsequent surgery. The following independent variables were considered: age, gender, dominance, generalized ligamentous hyperlaxity, duration of symptoms, age at first dislocation, number of dislocations, type of work, type of sport, sports activity level, capsule-labral injury pattern, SLAP lesion and number of anchors. Differences between groups for numerical variables were analyzed by use of the Student’s t-test or Mann–Whitney U-test. Fisher’s exact test was used for analysis of categorical variables. Significance was set at p < 0.05. Results: Seven patients (9%) were lost at follow-up, 5 from group 1 and 2 from group 2. Follow-up ranged from 36 to 60 months (median: 44; IQR: 13). Comparison between groups did not show significant differences for each independent variable considered. No differences could be found either for DASH (n.s.) or Rowe (p = n.s.) scores between the two groups. Overall recurrence rate was 7%. Three re-dislocations were reported in group 1 and two in group 2 (n.s.). Only one patient in each group underwent re-operation. Conclusions: The study showed no significant differences in clinical outcomes after arthroscopic treatment of traumatic anterior shoulder instability using PEEK knotless or biodegradable knotted anchors at mid-term follow-up. Level of evidence: I

SPADA: A project to study the effectiveness of shielding materials in space

The SPADA (SPAce Dosimetry for Astronauts) project is a part of an extensive teamwork that aims to optimize shielding solutions against space radiation. Shielding is indeed an irreplaceable tool to reduce exposure of crews of future Moon and Mars missions. We concentrated our studies on two flexible materials, Kevlar R� and Nextel R,� because of their ability to protect human space infrastructures from micrometeoroids. We measured radiation hardness of these shielding materials and compared to polyethylene, generally acknowledged as the most effective space radiation shield with practical applications in spacecraft. Both flight test (on the International Space Station and on the Russian FOTON M3 rocket), with passive dosimeters and accelerator-based experiments have been performed. Accelerator tests using high-energy Fe ions have demonstrated that Kevlar is almost as effective as polyethylene in shielding heavy ions, while Nextel is a poor shield against high-charge and -energy particles. Preliminary results from spaceflight, however, show that for the radiation environment in low-Earth orbit, dominated by trapped protons, thin shields of Kevlar and Nextel provide limited reduction

Soft tissue non-Hodgkin lymphoma of shoulder in a HIV patient: a report of a case and review of the literature

The risk of developing lymphoma is greatly increased in HIV infection. Musculoskeletal manifestations of the human immunodeficiency virus (HIV) are common and are sometimes the initial presentation of the disease. Muscle, bone, and joints are involved by septic arthritis, myopathies and neoplasms. HIV-related neoplastic processes that affect the musculoskeletal system include Kaposi's sarcoma and non-Hodgkin's lymphoma, the latter being mainly localized at lower extremities, spine and skull

Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

PURPOSE: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). METHODS: a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. RESULTS: the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears. CONCLUSIONS: painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion. LEVEL OF EVIDENCE: level I, validating cohort study with good reference standards

Economic cycle, labour market and pro-environmental behaviours. The case of separate waste collection in Italy

Pro-environmental behaviours have been studied extensively in the economic literature, with particular regard to the effects induced by unemployment. A key element that was little investigated in previous contributions consists in intrahousehold dynamics. This work provides a novel microeconomic framework describing the interaction between economic cycle and intrahousehold time allocation that is ultimately responsible for the adoption of pro-environmental behaviours. Intrahousehold differences in productivity represent a key assumption in this framework. The theoretical model is then tested empirically on recent Italian observations using Data Envelopment Analysis. Our results indicate that the most efficient allocations are attained in periods when joint drops in unemployment and female labour market participation (added worker effect) lead to intrahousehold specialisation

Scapulothoracic arthroscopy for symptomatic snapping scapula: A prospective cohort study with two-year mean follow-up

Background: Snapping scapula is characterized by crepitus between the scapula and the chest wall due to abnormal tissue at this site. Surgical treatment, when needed, may be either open or arthroscopic. The aim of this study was to evaluate prospectively the clinical outcomes of arthroscopic decompression in ten subjects with symptomatic snapping scapula. Patients and methods: Ten subjects, five men and five women, mean age 24 years, were treated by arthroscopy after unsuccessful conservative management for 6 months. Clinical outcomes were evaluated with the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score (CS), and simple shoulder test (SST). Follow-up was at 3 and 6 months; the final evaluation was conducted at a mean interval of 24 months. The final and preoperative X-rays were compared. Results: The WORC index increased significantly at 3 (p < 0.05), 6 (p < 0.01), and 24 months (p < 0.01). Similar outcomes were found for the CS at all 3 follow-up points (3 months, p < 0.05; 6 months, p < 0.01; 24 months, p < 0.01). Mean "yes" responses on the SST were 9.8 ± 1.4 at 3 months (p < 0.05), 10.2 ± 1.2 at 6 months (p < 0.01), and 10.6 ± 1.2 at 24 months (p < 0.01). X-ray examination depicted flattening of the anterior surface of the superior-medial angle of the scapula in the five patients who had had bone resection, whereas no significant difference with preoperative imaging was detected in the five patients who were managed by bursectomy and debridement alone. Conclusions: Arthroscopy is a feasible and minimally invasive treatment for painful snapping scapula syndrome. Comparative clinical trials are needed to collect conclusive data to state that it is the most suitable treatment for this condition. © 2014 Istituto Ortopedico Rizzoli