Prevalence and clinical correlates of sarcopenia in institutionalized older people: Cross-sectional study of a nursing home population

Background & aims. Sarcopenia is a common condition among institutionalized older people which leads to increased risk of adverse outcomes such as disability and death. We investigated the prevalence and clinical correlates of sarcopenia in older institutionalized adults in Italy, while also evaluating the interchangeability and adequacy of two definitions of sarcopenia (EWGSOP and FNIH) for this geriatric setting. Methods. Cross-sectional analysis of 97 participants enrolled in a nursing home facility in Italy. Since 97% of the study subjects resulted either unable to walk or “slow walkers”, we assessed sarcopenia presence ignoring the walking speed criterion: sarcopenia was assessed as low appendicular skeletal mass index plus low grip strength (EWGSOP criteria) and as weakness plus low lean mass (FNIH criteria). Skeletal muscle mass was estimated using bioimpendance analysis. Results. In this population of 97 institutionalized older people (age 83.2 ± 9.4 years, women 73.2%), according to both EWGSOP and FNIH criteria 13 participants (13.4%) were identified as affected by sarcopenia; however, only 5 subjects were identified as sarcopenic according to both definitions simultaneously. The prevalence of sarcopenia was directly correlated with male sex and comorbidity level, while being inversely correlated with Body Mass Index. Conclusions. According to EWGSOP and FNIH criteria, prevalence of sarcopenia is significant among institutionalized older people, and it’s strongly related to male sex, BMI and comorbidity level. EWGSOP and FNIH criteria identified as sarcopenic different individuals and therefore cannot be used interchangeably. Assessment of walking speed might be unfeasible in institutionalized older subjects

Drug intake and actinic keratosis: A case-control study

Background: Actinic keratosis (AK) is a form of premalignant keratinocyte dysplasia. Recently, the ABSTRACT role of photosensitizing drugs in the development of AK has been postulated. Objective: This study evaluated a possible association between the use of photosensitizing drugs and the development of AK. A secondary aim was to identify a possible association between any medication other than those primarily examined and AK. Methods: A single-center, case-control study assessed the cumulative drug exposure of 90 patients with AK and 90 controls visiting a dermatology service for other skin ailments. Before the visit, patients were interviewed to collect data on daily therapy and the lag-time of discontinued drugs within the last 2 years, and to record the drug's active ingredient, dosage, and duration of therapy. In addition, sociodemographic characteristics including age, sex, educational level, skin phototype, and cumulative sun exposure habits were gathered. Results: By logistic regression, exposures to angiotensin II receptor blockers (ARBs) and antiplatelet agents were identified as independent risk factors for the development of AK. ARB intake was associated with AK only at high exposure (OR = 13.6; 95% CI, 2.0-93.8). The use of antiplatelet drugs was borderline, yet not significant, at low exposure (OR = 3.31; 95% CI, 0.86-12.7), but increased in a dose-dependent manner. The strongest correlation was found at the highest cumulative dose (>1100 dose unit-years (OR = 4.38; 95% CI, 1.16-16.6). Conclusions: High exposure to ARBs and antiplatelet agents may promote AK carcinogenesis in at-risk patients

Are psychological status and trust in information related to vaccine hesitancy during COVID-19 pandemic? A latent class and mediation analyses in Italy

Despite the recognized benefits of the COVID-19 vaccination, vaccine hesitancy (VH) remains one of the biggest challenges of the mass vaccination campaign. Most studies investigating VH determinants focused on socio-demographics and direct relationships. In this study, we aimed at: 1) identifying subgroups of people differently affected by the pandemic, in terms of psychological status; 2) investigating the role of psychological status and trust in information as possible mediators of the relationship between individual characteristics and VH. To this purpose, a latent class analysis (LCA) followed by a mediation analysis were carried out on data from a survey conducted in January 2021 on 1011 Italian citizens. LCA identified four different subgroups characterized by a differential psychological impact of the pandemic: the extremely affected (21.1%), the highly affected (49.1%), the moderately affected (21.8%) and the slightly affected (8%). We found that VH decreased with the increase of psychological impact (from 59.3% to 23.9%). In the mediation analysis, past vaccination refusal, age 45-54 years and lower-than-average income, were all indirectly related to higher VH through mistrust in COVID-19 information. Differently, the psychological impact counteracted the greater VH in females, the negative effect of social media among youngest (<35 years) and the negative effect of mistrust in the lower-than-average-income subgroup. Knowledge of psychological profile of hesitant individuals, their level of trust and the sources of information they access, together with their sociodemographic characteristics provides a more comprehensive picture of VH determinants that can be used by public health stakeholders to effectively design and adapt communication campaigns

Volume control of the lower limb with graduated compression during different muscle pump activation conditions and the relation to limb circumference variation

Background: The literature supports the use of graduated compression stockings (GCS) for leg edema. Nevertheless, there is a paucity of data on the GCS effect on limb edema related to sitting, standing, and walking. Data of different limb shapes and their impact on GCS-exerted pressure are lacking. This investigation provides evidence-based information on the effect of GCS on edema reduction and the impact of limb circumference gradients on GCS pressure. Methods: Thirty healthy individuals (15 men and 15 women; mean age, 32 ± 5 years) were included. All the participants underwent lower limb volume (Kuhnke formula) measurement, before and after sitting for 30 minutes, wearing below-ankle noncompressive socks. The same assessment was repeated 7 days later, in the same participants, but with wearing of below-knee 16 to 20 mm Hg GCS. At 7-day intervals, 1 week with below-ankle noncompressive socks and 1 week with below-knee 16 to 20 mm Hg GCS, all the participants repeated the same protocol including standing and walking. Ten participants underwent bioimpedance assessment (Biody Xpert II; eBIODY, La Ciotat, France) before and after sitting, standing, and walking. In the same group, B and B1 interface pressure values were measured. Results: Data collection was completed in all 60 limbs. Sitting or walking without GCS led to no significant volume changes, whereas volume was decreased by the use of GCS (−4.8% [P <.00001] and −4.4% [P <.00001], respectively). Standing up without GCS led to an increase in volume (2.7%; P <.0001), whereas limb volume was decreased (4.6%; P <.0001) by use of GCS. Bioimpedance showed extracellular water reduction only while walking with GCS (from 40.55% ± 1.66% to 40.45% ± 1.71%; P <.017). Mean interface pressure was 19 ± 5 mm Hg (B) and 16 ± 5 mm Hg (B1). The interface pressure variation from B to B1 was not homogeneous among participants (mean percentage variation of −13% ± 25%, ranging from −54% to 16%). A negative linear trend between pressure variation and circumference percentage increase was found; the subanalysis excluding the two outliers showed a strong negative linear correlation (Pearson coefficient r = −0.96). Conclusions: GCS led to a significant limb volume reduction irrespective of limb position and muscle pump function. However, extracellular fluid is mobilized only during muscle contraction while walking with GCS. Interestingly, different lower limb circumference variations influence the interface pressure gradient, indicating the importance of proper fitting of both B and B1 during prescription. These data provide a foundation to future investigations dealing with GCS effect on fluid mobilization and with limb geometry impact on compression performance

Bridging the gap between 3D navigation and semantic search. The INCEPTION platform

The paper presents the main outcomes and future development of the INCEPTION project, “Inclusive Cultural Heritage in Europe through 3D semantic modelling”, funded by the European Commission under the Horizon 2020 Work Programme Europe in a changing world – inclusive, innovative and reflective Societies (Call Reflective-7-2014, Advanced 3D modelling for accessing and understanding European cultural assets) and completed in May 2019. In particular, the key-targeted project achievement will be presented: a specific cloud-based platform conceived to accomplish the main objectives of accessing, understanding and strengthening European Cultural Heritage by means of enriched 3D models. The need for digital data interpretation, in addition to documentation, guided the overall process of the cross-disciplinary work methodology, based on new methods and tools for 3D surveying and H-BIM modelling, new approaches and methodologies for Cultural Heritage 3D data inclusive access and exploitation by means of the Platform

Bridging the gap between 3D navigation and semantic search. The INCEPTION platform

The paper presents the main outcomes and future development of the INCEPTION project, “Inclusive Cultural Heritage in Europe through 3D semantic modelling”, funded by the European Commission under the Horizon 2020 Work Programme Europe in a changing world – inclusive, innovative and reflective Societies (Call Reflective-7-2014, Advanced 3D modelling for accessing and understanding European cultural assets) and completed in May 2019. In particular, the key-targeted project achievement will be presented: a specific cloud-based platform conceived to accomplish the main objectives of accessing, understanding and strengthening European Cultural Heritage by means of enriched 3D models. The need for digital data interpretation, in addition to documentation, guided the overall process of the cross-disciplinary work methodology, based on new methods and tools for 3D surveying and H-BIM modelling, new approaches and methodologies for Cultural Heritage 3D data inclusive access and exploitation by means of the Platform

Semantic Web Technologies Meet BIM for Accessing and Understanding Cultural Heritage

Within the EU funded project INCEPTION – Inclusive Cultural Heritage in Europe through 3D semantic modelling, the key-targeted achievement is the development of a specific cloud based platform, in order to accomplish the main objectives of accessing, understanding and strengthening European Cultural Heritage by means of enriched 3D models. The whole INCEPTION project is based on the close connection between state-of-the-art architectural modeling technologies (BIM, Building Information Modeling) and the latest cutting-edge web technologies. The platform is grounded on semantic web technologies and makes extensive use of WebGL and RESTful APIs, in order to enrich heritage 3D models by using Semantic Web standards. The INCEPTION platform will be a space for interchange of information and for the dialogue among professionals, students, scholars, curators, non-expert users, etc. Furthermore, the Semantic Web structure interlinks the platform with external Cultural Heritage available linked data and makes it gradually enhanced by specific flexible data structures provided as project specific ontologies. The paper will describe solutions based on the match between BIM, Cloud and Semantic Web

Forced expiratory volume in one second: A novel predictor of work disability in subjects with suspected obstructive sleep apnea

Whether the association of work disability with obstructive sleep apnea (OSA) is mainly due to the disease, i.e. the number and frequency of apneas-hypoapneas, or to coexisting factors independent from the disease, is not well-established. In this study, we aim to evaluate work ability in a group of subjects undergoing OSA workup and to identify the major contributors of impaired work ability. In a cross-sectional study, we enrolled 146 consecutive subjects who have been working for the last five years and referred to the sleep disorders outpatients’ clinic of the University-Hospital of Ferrara, Italy, with suspected OSA. After completing an interview in which the Work Ability Index (WAI) and the Epworth Sleepiness Scale (ESS) questionnaires were administered to assess work ability and excessive daytime sleepiness, respectively, subjects underwent overnight polysomnography for OSA diagnosing and spirometry. Of the 146 subjects, 140 (96%) completed the tests and questionnaires and, of these, 66 exhibited work disability (WAI < 37). OSA was diagnosed (apnea-hypopnea index 5) in 45 (68%) of the 66 subjects. After controlling for confounders, a lower level of forced expiratory volume at 1 second (FEV1), [odds ratio 0.97 (95% CI 0.95–1.00)], older age [1.09 (95% CI 1.03–1.15)], excessive daytime sleepiness [3.16 (95% CI 1.20–8.34)] and a worse quality of life [0.96 (95% CI 0.94–1.00)], but not OSA [1.04 (95% CI 0.41–2.62)], were associated with work disability. Patients with a higher number of diseases, in which OSA was not included, and a lower quality of life had an increased probability of absenteeism in the previous 12 months. In subjects with suspected OSA, FEV1 can be an important predictor of work disability

Sociodemographic and health service organizational factors associated with the choice of the private versus public sector for specialty visits: Evidence from a national survey in Italy

Introduction Although Italy\u2019s NHS is funded through general taxation, the private sector plays an important role in health service provision and financing. The aim of this paper was to identify the sociodemographic and health service organizational factors associated with the propensity to seek specialist care in the private sector. Materials and methods Data were retrieved from the national Istat survey \u201cHealth conditions and use of health services\u201d carried out in 2012\u20132013. We selected adults with a specialty visit in the previous 12 months in the four most frequent medical specialties: ophthalmology, cardiology, obstetrics/ gynecology and orthopedics. The study outcome was the choice to use a private service. In order to investigate the determinants of private use, we adopted the socio-behavioral model by Andersen and Newman, making a distinction between sociodemographic and healthcare organizational factors. The associations with the outcome were analyzed using chi-squared test, t-test and multivariable logistic regression analysis. Results and discussion Use of private care varied widely, from 26.3% for cardiology to 53.6% for obstetrics/gynecology. Females, patients with higher educational levels and patients with higher self-reported economic resources sought more frequently private healthcare for all specialties; younger patients and employed patients were more likely to seek private care for ophthalmic conditions. Exemption from copayment for public services reduced more than half the propensity to seek private care. Trust in this healthcare service was the main reason for private users (52.5%) followed by waiting time (26.7%) and physician choice (20.1%). Conclusion The attitude of the population to use private services for specialist visits is linked both to sociodemographic and health services organizational factors: the former are unmodifiable while the latter are susceptible to managerial and health policy actions. In a public-financed, universal coverage system, policy makers may act upon the organizational factors that make private health facilities more attractive in order to reduce private care use

Effects of a Robot-Assisted Arm Training Plus Hand Functional Electrical Stimulation on Recovery After Stroke: A Randomized Clinical Trial

Objective: To compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation with intensive conventional therapy for restoring arm function in survivors of subacute stroke. Design: This was a single-blinded, randomized controlled trial. Setting: Inpatient rehabilitation university hospital. Participants: Patients (N=40) diagnosed as having ischemic stroke (time since stroke <8wk) and upper limb impairment were enrolled. Interventions: Participants randomized to the experimental group received 30 sessions (5 sessions/wk) of robot-assisted arm therapy and hand functional electrical stimulation (RAT+FES). Participants randomized to the control group received a time-matched intensive conventional therapy. Main Outcome Measures: The primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity, and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment, and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline. Results: Both groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation (<30d post stroke) demonstrated the greatest clinical improvements. Conclusions: RAT+FES was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery