Molecular detection of Cyclospora in water, soil, vegetables and humans in southern Italy signals a need for improved monitoring by health authorities

To date, in Europe, there is scant information on the occurrence of Cyclospora in water from treatment plants and in humans, and no data are available on soil or fresh plant products. Here, we undertook the first molecular survey of Cyclospora in multiple biological matrices collected from the Apulia region of southern Italy. Samples of irrigation water from four municipal treatment plants, eight different types of vegetables or fruit (cucumber, lettuce, fennel, celery, tomato, melon, endive and chicory) and soil from the same farms on which these plants were grown, as well as faecal samples from humans living in the same region were tested by qPCR-coupled single-strand conformation polymorphism (SSCP) analysis and DNA sequencing. Cyclospora was detected in 15.5% of all 213 samples tested. Specifically, this protist was detected in (i) treated water (21.3% of 94 samples), well water (6.2% of 16), but not drinking water (0% of 3); (ii) soil (11.8% of 51 samples) and vegetables (12.2% of 49),with the highest prevalence (18.7%) on fennel; and (iii) human stools (27.5% of 40 samples). In environmental and food samples, Cyclosporawas detectedmainly in autumn and was significantly more prevalent in the faeces from humans of 40–50 years of age. This is the first comprehensive molecular survey of Cyclospora in environmental, food and human faecal samples in Europe. These data suggest that irrigation water, soil and vegetables might be contaminated by Cyclospora cayetanensis, which might represent a source of infection to humans in the study area and calls for monitoring by health authorities

Structured reporting of computed tomography in the staging of colon cancer: a Delphi consensus proposal

Background: Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports in colon cancer during the staging phase in order to improve communication between the radiologist, members of multidisciplinary teams and patients. Materials and methods: A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. Cronbach’s alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. Results: The final SR version was built by including n = 18 items in the “Patient Clinical Data” section, n = 7 items in the “Clinical Evaluation” section, n = 9 items in the “Imaging Protocol” section and n = 29 items in the “Report” section. Overall, 63 items were included in the final version of the SR. Both in the first and second round, all sections received a higher than good rating: a mean value of 4.6 and range 3.6–4.9 in the first round; a mean value of 5.0 and range 4.9–5 in the second round. In the first round, Cronbach’s alpha (Cα) correlation coefficient was a questionable 0.61. In the first round, the overall mean score of the experts and the sum of scores for the structured report were 4.6 (range 1–5) and 1111 (mean value 74.07, STD 4.85), respectively. In the second round, Cronbach’s alpha (Cα) correlation coefficient was an acceptable 0.70. In the second round, the overall mean score of the experts and the sum of score for structured report were 4.9 (range 4–5) and 1108 (mean value 79.14, STD 1.83), respectively. The overall mean score obtained by the experts in the second round was higher than the overall mean score of the first round, with a lower standard deviation value to underline greater agreement among the experts for the structured report reached in this round. Conclusions: A wide implementation of SR is of critical importance in order to offer referring physicians and patients optimum quality of service and to provide researchers with the best quality data in the context of big data exploitation of available clinical data. Implementation is a complex procedure, requiring mature technology to successfully address the multiple challenges of user-friendliness, organization and interoperability

What will our children do when we are gone? Italian legislature does not tackle the worries of parents of disabled children. Reflections on disability

Background: Over the last fifty years the concept of health has passed, hence from a humanitarian and charitable approach to an approach based on respect for human rights and the removal of obstacles and discrimination. This is an important change because of the need for legislature to address the necessities of disabled people. Legislation analysis: The Italian Law n. 112/2016 recognized the importance of a more ‘human’ relationship between seriously disabled people and the context in which they live. The law gave the power to severely disabled individuals to decide whether to continue to live in their apartment alone, or sharing the own apartments with others, or move to an assisted living structure, after their parents’ death. Conclusion: Unfortunately, a strong limitation of the law is that it is mainly designed only in favor of severely disabled individuals, thus excluding other people who have also the need and the right to better living conditions, and the choice of trust, which is expensive and not available to all families. This review aims to make a revision of national and international legislation on disability, underlining lights and shadows to provide insights for future implementations and improvements

To vaccinate or not: literacy against hesitancy

Background and aim: Vaccines currently represent the most efficient tool to prevent the spread of potentially life-threatening infectious diseases. However, in the Western world, the widespread nature of vaccinations has led to a reduction in the incidence of these diseases, with a consequent progressive decline in vaccination practice. This phenomenon is further fueled by the anti-vaccine movements which today find fertile ground thanks to the rapid dissemination of information through social media. The present review focuses on three different vaccination target groups, pregnant women, parents, and healthcare professionals, in order to analyze vaccine hesitancy factors and suggest strategies aimed at improving vaccination empowerment. Methods: The literature search was conducted on the PubMed database using the keywords “vaccine hesitancy”, “mandatory vaccination”, “vaccine acceptance”, “vaccination barriers”, “vaccine AND pregnancy”, “vaccine AND healthcare workers”, “vaccine AND parents”. Only publications in English and Italian were selected. A total of 51 articles were selected for this narrative review in relation to their relevance to the topic under study. Results and conclusion: This review highlights the heterogeneity of the reasons behind vaccine hesitancy. Poor adherence to vaccinations should not be interpreted exclusively as an unconditional refusal but rather as an indicator of the lack of information provided by health professionals. In this perspective, a need emerges to strengthen the therapeutic alliance between healthcare workers and patients. Considering the low vaccination coverage rates among health professionals, programs aimed at implementing both their vaccine education and trust in healthcare systems are essentia

End-of-Life in Italy: Critical and Bioethical Aspects of the Bill on Physician-Assisted Suicide

In Italy, on 10 March 2022, the Chamber of Deputies approved the bill “Dispositions in the matter of medical assisted voluntary death”, formulated on the base of the recent sentence of the Constitutional Court n. 242/2019. Our study aims to analyze the bill, to evaluate its concrete applicability and highlight bioethical aspects and medico-legal criticalities

Diagnostic protocols in oncology: workup and treatment planning. Part 1: the optimitation of CT protocol

: The increase in oncology knowledge and the possibility of creating personalized medicine by selecting a more suitable therapy related to tumor subtypes, as well as the patient's management with cancer within a multidisciplinary team has improved the clinical outcomes. Early detection of cancer through screening-based imaging is probably the major contributor to a reduction in mortality for certain cancers. Nowadays, imaging can also characterize several lesions and predict their histopathological features and can predict tumor behaviour and prognosis. CT is the main diagnostic tool in oncologic imaging and is widely used for the tumors detection, staging, and follow-up. Moreover, since CT accounts for 49-66% of overall patient radiation exposure, the constant reduction, optimization, dose inter- and intraindividual consistency are major goals in radiological field. In the recent years, numerous dose reduction techniques have been established and created voltage modulation keeping a satisfactory image quality. The introduction of CT dual-layer detector technology enabled the acquisition of spectral data without additional CT x-ray tube or additional acquisitions. In addition, since MRI does not expose the body to radiation, it has become a mainstay of non-invasive diagnostic radiology modality since the 1980s

Cervical Spine Manipulations: Role of Diagnostic Procedures, Effectiveness, and Safety from a Rehabilitation and Forensic Medicine Perspective: A Systematic Review

Background: Cervical spine manipulations (CSM) have been performed for centuries and are a widely practiced intervention to manage cervical spine musculoskeletal disorders. We aimed to perform an overview of the literature concerning the effects and the adverse events of CSM in the Physical and Rehabilitation Medicine (PRM) field with a forensic medicine perspective. Methods: A search in the scientific literature (PubMed, Google Scholar, PEDro and Cochrane) was carried out from inception until October 2020. Results: Fourteen articles were included in this narrative summary. The possible development of side effects requires a careful mandatory balance of benefits and risks even when there is an indication for this approach. Moreover, a qualified professional is essential to perform CSM–a non-invasive therapeutic procedure that can be potentially harmful. Conclusions: In conclusion, it is essential to perform the diagnosis, to treat, and to manage complications within the PRM field, both for the reduction of malpractice claims and, most importantly, for the safety of the patient