Malcontented agents : from the novellas to Much Ado about Nothing and The Duchess of Malfi

Shakespeare’s Much Ado about Nothing (c.1598) and Webster’s The Duchess of Malfi (c. 1613) are two plays in which Matteo Bandello’s portrayal of evil agents in his novellas exert a constant, even if not immediately obvious, influence. Remote from each other chronologically and generically, Shakespeare’s comedy and Webster’s tragedy make common use of a distinctive character-type, which has an equivalent in the Bandello source: the melancholy, embittered, and vindictive outsider known at the time, as well as by modern critics, as the malcontent (Nigri, The Origin of Malcontent). Comparing how and to what purpose each dramatist duplicated, altered or expanded the figures he found in the source story provides an insight into his way of working and informs our understanding of the plays

Sceptical responses in early modern plays : from self-knowledge to self-doubt in Marston’s The Malcontent and Middleton’s The Revenger’s Tragedy

Defined for the first time by Sir Thomas Elyot as a «secte of Phylosophers, whiche affirmed nothynge» (1538), the term ‘scepticism’ appears in all its variants only too rarely in the drama of the period. Chadwyck Healey databases (Early English Books Online and Literature Online) record only four different occurrences (Tomkis 1607; Jonson 1640; Cartwright 1651; Massinger 1655), in a span of time which runs from 1550 to 1655, although scepticism as a way of participating in, and responding to, life is registered on the London stages as an increasingly popular critical attitude. Vindice’s «I’m in doubt whether I’m myself or no» is evidence of that suspension of judgment which is envisaged by the sceptics as the only viable answer in a world governed by the relativism of human knowledge. Against a theoretical and philosophical background which investigates the relationship between self-knowledge and scepticism, the article looks at how this early modern revival of scepticism – so profoundly influenced by the translation of Montaigne’s essays – can couple with, and go beyond, an emergent awareness of inwardness, as the one hinted at in Marston’s The Malcontent and Middleton’s The Revenger’s Tragedy. In particular, the essay examines the interplay between the revengers’ responses to the adoption of different masks and the dictum of a philosophy which demands the deferment of any epistemological verdict. A discussion of the rhetorical strategies which better testify to the contradictions at the heart of this ontological impasse will then follow

Italian immunization calendar implementation: Time to optimize number of vaccination appointments?

In the Italian vaccination schedule, at least six vaccination appointments are scheduled in the first year of life. This implies more discomfort for both the patient and the parents. This was particularly evident during the COVID-19 pandemic, during which several appointments were missed. A UK experience with three injectable vaccines and an oral one co-administered at the same appointment (4-in-1) at 2 and 4 months of age showed interesting results. The vaccination coverage was high, consistent with previous practice, and no relevant increase in adverse events was reported. Translating the UK experience into the Italian context would not be immediate, due to several organizational and social issues. Nevertheless, this option warrants some further considerations, which are discussed in this manuscript

Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study

Background: Child abuse and neglect, or maltreatment, is a serious public health problem, which may cause long-term effects on children's health and wellbeing and expose them to further adulthood vulnerabilities. Studies on child maltreatment performed in Europe are scarce, and the number of participants enrolled relatively small. The aim of this multi-national European pilot study, was to evaluate the level of understanding and perception of the concepts of child abuse and neglect by European paediatricians working in different medical settings, and the attitude toward these forms of maltreatment in their practice. Methods: The study was performed by a cross-sectional, descriptive, online survey, made available online to European paediatricians members of 50 national paediatric, who belonged to four different medical settings: hospital, family care, university centres and private practice. The questionnaire, designed as a multiple choice questions survey, with a single answer option consisted of 22 questions/statements. Frequency analyses were applied. Most of the data were described using univariate analysis and Chi-squared tests were used to compare the respondents and answers and a significance level of p ≤ 0.05 applied. Results: Findings show that European paediatricians consider the training on child maltreatment currently provided by medical school curricula and paediatric residency courses to be largely insufficient and continuing education courses were considered of great importance to cover educational gaps. Physical violence was recognized by paediatricians mostly during occasional visits with a significant correlation between detecting abuse during an occasional visit and being a primary care paediatrician. Results also showed a reluctance by paediatricians to report cases of maltreatment to the competent judicial authorities. Conclusions: Data of this study may provide useful contribution to the current limited knowledge about the familiarity of European paediatricians with child maltreatment and their skills to recognize, manage and contrast abusive childhood experiences in their practice. Finally, they could provide local legislators and health authorities with information useful to further improve public health approaches and rules able to effectively address shared risk and protective factors, which could prevent child abuse and neglect from ever occurring

Diagnostic delay does not influence survival of pancreatic cancer patients

Background: Most pancreatic ductal adenocarcinoma patients present with advanced disease. Whether it is possible to increase survival by earlier diagnosis is unclear. Objective: The purpose of this study was to investigate the association between presenting complaints and risk factors for pancreatic cancer with diagnostic delay, stage and survival. Methods: This was a single-centre retrospective cohort study. Consecutive patients were interviewed and data on demographics, medical history, risk factors and complaints leading to pancreatic ductal adenocarcinoma diagnosis and disease stage were recorded. Diagnostic delay was considered as time between first complaint and diagnosis. Patients received appropriate treatments and their outcome was recorded in a dedicated database. The Chi-square test for comparison of categorical variables and the Mann–Whitney test for continuous variables were employed with Bonferroni corrections. Correlation between continuous variables was evaluated by means of the Spearman correlation coefficient. Survival analysis was performed with the Kaplan–Meier method and a log-rank test. Results: The median diagnostic delay for 477 pancreatic ductal adenocarcinoma patients was two months (interquartile range 1–5), being significantly shorter for patients presenting with jaundice compared with those with pain, weight loss, diabetes (p < 0.001). The global rate of metastatic disease at diagnosis was 40%, being only 22% in those presenting with jaundice. The median diagnostic delay, however, was not significantly different among disease stages but was significantly longer in patients with a body mass index>25 kg/m2. The median survival time was seven months. Factors associated with worse survival at the multivariable analysis were older age (hazard ratio 1.02 per year), metastatic disease (hazard ratio 2.12) and pain as presenting complaint (hazard ratio 1.32), while diagnostic delay was not. Conclusion: While some complaints are associated with a shorter diagnostic delay and less advanced disease stage, we could not demonstrate that delay is associated with survival, possibly suggesting that prevention rather than early recognition is important to tackle pancreatic cancer lethality

Lifelong Negative Influence of School Violence on Children.

violence in the school environment is a constant concern for educators and parents and is a serious and often lifelong burden for the young victims. School violence is not just a limited problem, variously affecting specific or isolated communities in economic advantaged or disadvantaged areas, but a global modern phenomenon involving, to various degrees, one of the core social institutions of our society.The European Paediatric Association-Union of National European Paediatric Societies and Associations (EPA/UNEPSA), through the working group on social pediatrics, supported by its European national pediatric societies members, is currently developing dedicated projects to investigate the physical, psychological, and social impacts of school violence on European children and its possible lifelong risks. The purpose of this commentary is to raise awareness on this issue among healthcare professionals involved in childcare and to emphasize the importance of their participation in programs that are developed to monitor and prevent the negative, personal, and social impact

Impact of sarcopenia on outcomes after pancreatectomy for malignancy

Background: Sarcopenia, which is a subclinical loss of skeletal muscle mass as measured by cross-sectional imaging, is commonly observed in patients with malignancy. Few studies have examined the association between the presence of sarcopenia and outcome following surgery. The aim of this study is to evaluate the prevalence of sarcopenia and to investigate its impact on short- and long-term outcomes in patients who underwent pancreatectomy for malignancy. Materials and Methods: A retrospective review of a pancreatectomy database was performed. Skeletal muscle index (SMI) was measured on preoperative cross-sectional imaging in 144 patients undergoing pancreatectomy for cancer between 2007 and 2014. Sarcopenia was defined, according to the international consensus, as an SMI <52.4 cm2 /m2 and <38.9 cm2 /m2 for men and women respectively. The prevalence and impact of sarcopenia on morbidity, mortality, disease-free and overall survivals was assessed relative to other clinicopathological factors. Results: Mean age was 67.15 years and 51% was female. Pancreatic adenocarcinoma represents 66.7% of all cases. Pancreaticoduodenectomy was performed in 114 cases (79.2%). Margin status was R0 in 76.9%. Mean BMI was 24.85 Kg/m2 and mean SMI was 35,43 cm2 /m2 . One hundred and eight (74.5%) were sarcopenic, 37 (43.5%) were overweight/ obese and 43 (29.7%) were both (p = 0.041). Sarcopenia was significantly related to histology, sex, BMI and albumin. Overall morbidity and 90-days mortality were 50.7% and 9.1% respectively. The median follow up was 21 months. Overall and disease-free survival rate were 25,44 months and 11,84 months respectively. Sarcopenia was associated to a not statistically significant increased risk of overall morbidity, mortality and shorter disease- free and overall survivals after pancreatic surgery for cancer. Conclusions: Sarcopenia was found in 74.5% of cancer patients underwent pancreatectomy. It is an occult condition in overweight/obese patients but can be identified using CT scans. This condition, as defined by international consensus, is not associated with worse short-term and long-term outcomes after surgery

The Health Risks of Electronic Cigarettes Use in Adolescents

The aim of this article is to rise the awareness on knowledge and perceptions of possible risks and benefits of electronic cigarettes (ECs) impacts adolescents’ decisions to use these products. ECs trend is becoming increasingly popular, not only among adults, but also among the youngest