Trends in influenza coverage rates in five consecutive immunisation seasons in the Local Health Unit of Ferrara (North Italy).

Seasonal influenza epidemics yearly affects 5-15% of the world’s population, resulting in 3-5 million serious cases and up to 650,000 deaths. Elderly, pregnant women and individuals with underlying conditions are at increased risk of complications. According to the Italian National Immunization Prevention Plan 2017-2019, these categories benefit from free vaccination. Influenza coverage rate in Italy are not optimal. The study investigated the coverage rate in five consecutive influenza seasons (2010/2011-2014/2015) in Local Health Unit (LHU) of Ferrara (Italy). The amount of delivered vaccinations was not constant, with a decreasing trend. An increase in coverage with increasing age was observed, but in no immunisation seasons the 75% target of over-65 years old individuals immunised was achieved. As number of delivered doses and coverage rates decreased, the percentage of immunisations delivered by the General Practitioners (GPs) increased. The District with the lowest vaccination coverage was the Western District. In elderly, coverage rates in South-Eastern and North-Central District were higher with a statistically significant difference compared to Western District. Higher levels of immunisation were observed in South-Eastern District in the pediatric age and in North-Central District in adult age group with a statistically significant difference. The trend in the LHU of Ferrara was similar to regional and national data, conditioned in the 2014/2015 season by the spreading of worrying news, although unfounded, on the safety of the vaccine. The GPs were essential in ensuring vaccine uptake, growing the percentage of delivered doses and achieving as much as possible effective elderly immunisatio

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian Consensus Conference on Pain in Neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens

AIMS: This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). METHODS AND RESULTS: All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50–1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40–2.23), diabetes (AOR: 1.52; 1.05–2.18), CVD (AOR: 1.88; 1.32–2.70) and COPD (AOR: 1.88; 1.11–3.20). Only gender, age and diabetes also predicted very severe/lethal disease. CONCLUSION: No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians

PRIN 2015 la filiera corta nel settore biomasse legno: innovazione per la bioedilizia e l’efficienza energetica

L’idea del progetto nasce da un incremento della richiesta di prodotti in legno in edilizia sia per uso strutturale che non strutturale. Nel nostro Paese, come è noto, la maggior parte della materia prima viene importata dall'estero e negli ultimi tempi per diverse ragioni si assiste ad una diminuzione di qualità degli assortimenti legnosi originari ed una perdita di know-how e di mestieri negli ambiti regionali e locali. Obiettivo del progetto è pertanto quello di valorizzare il concetto di filiera locale biomassa-legno, promuovendo la definizione di buone pratiche per la mobilizzazione delle biomasse legnose e sviluppando soluzioni tecnologiche per la bioedilizia e l’efficienza energetica, mediante innovazioni di prodotto per l’impiego del legno con funzioni strutturali e non strutturali

Reti ecologiche: una chiave per la conservazione e la gestione dei paesaggi frammentati. Pubblicazioni del Corso di Cultura in Ecologia, Atti del XL Corso

Per interpretare un paesaggio bisognerebbe vederlo dall\u2019alto. Solo cosi\u300 si puo\u300 intuire il tessuto che lo compone. Solo cosi\u300 si puo\u300 osservare la manifestazione visibile e fisica delle reti ecologiche: gli alberi e i corridoi arborei immersi nel deserto della matrice. Ma la rete funzionale non e\u300 costituita di unita\u300 discrete, o almeno non solo di esse. I corridoi possono essere \u201cdiffusi\u201d e difficili da identificare. Il paesaggio identico in tutto il suo cerchio, monotono e senz\u2019alberi, potrebbe cosi\u300 non essere del tutto privo di reti ecologiche. Il concetto di rete ecologica e\u300 stato applicato recentemente. A scala planetaria, solo nel 1974, l\u2019UNESCO ha riconosciuto, nel Programma per l\u2019Uomo e la Biosfera, la necessita\u300 di conciliare la conservazione delle aree di valore con gli usi del paesaggio locali attraverso l\u2019individuazione nelle Riserve della Biosfera (attualmente oltre 350) di core areas, buffer areas e zone di transizione. Per questo motivo, forse, esistono ancora molti dubbi sulla loro efficacia. Non si puo\u300 tuttavia trascurare l\u2019importante ruolo che rivestono nella pianificazione. La comprensione e la valutazione di come gli organismi si muovono attraverso i paesaggi eterogenei, ovvero frammentati, sia attraverso i corridoi, che attraverso la matrice, e\u300 una componente chiave del processo che conduce alla comprensione delle risposte degli organismi ai mosaici spaziali, cioe\u301 dell\u2019argomento centrale dell\u2019ecologia del paesaggio. Perche\u301 esistono? Cosa aggiungono al processo di protezione delle risorse naturali? Che specie le sfruttano? Come si puo\u300 stimare il loro valore? Cos\u2019e\u300 stato fatto sinora? A queste domande il 40\ub0 Corso di Cultura in Ecologia tenta di dare una risposta. L\u2019esistenza delle reti ha radici genetiche: il trasferimento di informazioni genetiche rappresenta il tessuto invisibile della rete, quello piu\u300 ostico da studiare, perche\u301 meno percepibile. Degli aspetti genetici, tutti gli altri sono dei surrogati. Il contributo di M. Lucchin e\u300 rivolto, in questo senso, a chiarire le basi conoscitive: la materia prima di cui sono costruite le reti ecologiche. Gli organismi che sfruttano le reti possono essere animali o vegetali. Gli animali e i vegetali occupano habitat: per questo la rete puo\u300, prima di proteggere le specie, proteggere gli habitat o gli ecosistemi, cui le specie, e quindi gli ecoidi, sono legati. D. Zorzi e S. Mattedi presentano gli strumenti per ridurre, a scala locale, gli impatti del traffico stradale sulla dispersione delle specie della fauna selvatica, mentre D. McCollin e J. Jackson presentano l\u2019uso che dei corridoi fanno le specie vegetali nemorali, patrimonio disperso nella matrice priva di copertura naturale, tipica dell\u2019agricoltura intensiva e delle aree urbanizzate. Una presentazione del concetto di rete ecologica, a scala di paesaggio, e delle sue applicazioni in ambito europeo e nazionale, sono svolti, rispettivamente, da R. Jongman e D. Franco. R. Gambino presenta invece gli sviluppi piu\u300 recenti in tema di cultura e tutela ambientale del territorio e le richieste della societa\u300 cui le reti ecologiche possono dare risposta. La valutazione della qualita\u300 dei corridoi ecologici che si manifestano a piu\u300 grande scala, cioe\u301 le siepi del paesaggio agrario e una serie di indici sintetici e\u300 proposta da T. Sitzia. Pochi sono gli esempi di normative nazionali o regionali tese a tradurre i concetti e le evidenze sperimentali in realta\u300: uno di questi e\u300 la Legge Regionale 13/2003 del Veneto che costruisce le graduatorie dei beneficiari di incentivi pubblici all\u2019impianto di boschi di pianura, non solo in base al loro status giuridico o alla presenza di aree protette nelle vicinanze, ma anche, come raramente viene fatto, sulla base della vicinanza a boschi relitti, ragionando in termini di rete ecologica. F. Correale ne da\u300 una presentazione. I Sistemi Geografici Informativi, ormai irrinunciabili nello studio del paesaggio, trovano nelle reti ecologiche un campo di applicazione importante, che A. Fiduccia, L. Fonti, M. Funaro, L. Gregari, S. Rapicetta e S. Reniero presentano nel loro contributo. Infine non basta ragionare di fauna e flora, occorre individuare idonei strumenti di progettazione e pianificazione; G. De Togni affronta quelli a piccola scala, ovvero quelli urbanistici, G. Mezzalira affronta quelli a grande scala, ovvero la progettazione. L'organizzazione del Corso ha impegnato, oltre ai componenti del Comitato Organizzativo e a quelli del Comitato Scientifico anche I. Dainese e A. Tosatto, che hanno svolto il fondamentale supporto di segreteria presso il Dipartimento, e il personale del Centro Studi per l'Ambiente Alpino di S. Vito di Cadore: F. Fontanella, R. Menardi e C. Filoso, ai quali tutti va un caloroso ringraziamento