A regional audit system for stillbirth: A way to better understand the phenomenon

Background: Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. Methods: For each stillbirth ( 65 22 weeks of gestation, 65 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. Results: Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62-7.03) and intrapartum cases (OR 6.64, CI95% 2.61-17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06-3.36) and were more frequent before term (OR 1.86, CI95% 1.11-3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61-17.02). Conclusions: Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures

RECENT SEA LEVEL VARIATIONS ALONG THE ITALIAN COAST WITH RESPECT TO THE FIRST ORDER LEVELLING NETWORK

For many coastal areas of Italy, it is essential to know the sea level at all times, for the hydraulic safety of the territory and for protection of the cultural and environmental patrimony, but also to establish the current mean value and to monitor its trend. At present, the elevation of any point of land in Italy is obtained from the first order levelling network and thus is referred to the Mean Sea Level (MSL) established at Genova from continuous tide gauge data collected in the period 1937-1946 (national vertical datum: called Genova 1942). By consequence till now the elevation of the coastal areas has not been related to the local sea level. Thanks to the National Tide Gauge Network (NTG), we have now complete 10-year series of sea level data along the Italian coast. Hence, it is possible to calculate the elevations of coastal areas also with respect to the local mean sea levels. Moreover thanks to the connection between the NTG and the first order levelling network, the differences between the heights of land referred to local mean sea level and to National vertical datum can be assessed. In this paper, we present the results of calculations of the local mean sea level with respect to the national vertical datum and of its trend of variation for all the NTG stations in the period 1999-2008. The procedure for quality control and processing of sea level data is based on international standards. A progressive decrease of the mean sea level from north to south is pointed out. Starting from ca. +0.08 m for Trieste and Venice, the level passes to and -0.26 m for Taranto and Otranto. A first interpretation of this result is attempted. Moreover the local trends obtained from monthly data show remarkable differences

Food recovery and food redistribution in Italy

The study investigates the operation of the Italian food bank with respect to supply, logistics, and redistribution. In addition, managers' and volunteers' perspectives on social aspects of food redistribution are explored. In July 2016, twelve in-depth interviews with food bank managers and volunteers were conducted. The interviews were audio-recorded, transcribed verbatim and analyzed using qualitative content analysis. Results show that the Italian food bank relies on three main food donors, the European Union, food wholesalers, and food retailers. These donations are redistributed to other charitable organizations. The charitable organizations adjust their operations to the beneficiaries' needs, taking into account refugees and different religious groups. Volunteers reported mixed emotions and experiences with foodbank beneficiaries. They explained that some food bank users show gratitude, other users feel ashamed because of their situation

Comparing German and Italian food banks: Actors’ knowledge on food insecurity and their perception of the interaction with food bank users

Purpose: The purpose of this paper is to investigate food bank actors’ knowledge of food insecurity in Germany and in Italy, as well as interactions between food bank actors and food bank users. The study builds on a knowledge framework from an educational context and applies it to food banks. Design/methodology/approach: The study uses a qualitative research approach. In all, 22 in-depth interviews were recorded, transcribed and analyzed through inductive qualitative content analysis. Findings: German and Italian food bank actors interviewed had at least situational knowledge on food insecurity. Some actors of the Italian food bank also showed procedural knowledge. Interactions between food bank personnel and users were affected by feelings of gratitude, shame, anger and disappointment. Originality/value: The study explores food bank personnel’s knowledge on food insecurity, which appears to be a knowledge gap, even though many prior studies were dedicated to food banks and food insecurity. The study contributes to knowledge systematization to provide best practice recommendations for volunteer-user interaction, and suggests how food bank managers and volunteers’ knowledge can be improved

La Stazione Mareografica Integrata di Porto Garibaldi (FE): caratteristiche ed elaborazione dati

Nel presente lavoro viene descritta la Stazione Mareografica Integrata di Porto Garibaldi (FE), recentemente realizzata dalla Provincia di Ferrara (2009) e pienamente operativa dall’inizio del 2010. Vengono descritte sommariamente le caratteristiche della Stazione e dei sensori installati. Viene inoltre illustrata la procedura individuata per l’elaborazione dei dati mareografici con l’applicazione di opportuni filtri per l’analisi di qualità del dato e l’estrazione dei livelli medio mare orario, giornaliero, mensile ed annuale

PCOS from Lifestyle to the Use of Inositol and Insulin Sensitizers

PCOS patients are typically characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries, and these aspects are frequent in a high percentage of women during the reproductive life. PCOS frequently show overweight and/or obesity and are characterized by a higher production of androgens and reduced sensitivity to insulin. In fact it is of great importance to note that more than 40–45% of all PCOS patients show overweight up to obesity and that these patients have a modest up to an exaggerated hyperinsulinism in response to the standard oral glucose tolerance test (OGTT). What is relevant to point out is that such reduced insulin sensitivity can be observed also in 10–15% of the normal weight PCOS, thus confirming that hyperinsulinism can show up not only in relation to obesity or to excess of fat tissue but also as an intrinsic abnormal ability to control glucose metabolism. Recent data clearly demonstrated that reduced insulin sensitivity can be gained with a specific attention to lifestyle, including not only a diet but also certain degree of physical activity. However, a specific effect on hyperinsulinemia can be achieved using glucose sensitizer drugs, such as metformin, so that to reduce the negative modulation exerted by hyperinsulinemia on the reproductive axis as well as on neuroendocrine control of reproduction with relevant effects also on adrenal function and neurosteroid production. The evolution of therapeutical approach to PCOS proposed in recent years the use of inositol in two of the isomers at present available, that is myo-inositol (MYO) and D-chiro-inositol (DCI). These two compounds are tightly linked one to the other since MYO is transformed by an epimerase in DCI, having each tissue its own conversion rate, likely due to the specific needs for the two different molecules. In general both these compounds work as specific modulators of the intracellular second messenger activated by the insulin linkage with its own membrane receptor. Recent data demonstrated also that integrative administration of MYO in lean PCOS ameliorated insulin response to OGTT and that both MYO and DCI reduced insulin response to OGTT in overweight or obese PCOS. Both isomers have been demonstrated to improve also ovarian function and LH response to GnRH stimulation, typically abnormal in PCOS patients. Though impossible to state what of the two isomers play the main role, it appears clear that the metabolic impairment(s) are great part of the casual factor(s) of the abnormal reproductive function in PCOS

La Stazione Mareografica Integrata di Porto Garibaldi

Nel presente lavoro viene descritta la Stazione Mareografica Integrata di Porto Garibaldi (FE), recentemente realizzata dalla Provincia di Ferrara, ed attualmente nella fase di calibrazione ed avvio di tutta la strumentazione installata. Vengono descritte sommariamente le caratteristiche della Stazione e dei sensori installati. Viene inoltre illustrata la procedura individuata per l’elaborazione dei dati mareografici con l’applicazione di opportuni filtri per l’analisi di qualità del dato e l’estrazione dei livelli medio mare orario, giornaliero, mensile ed annuale

Basilar arterio-venous pseudoparallelism due to persistence of embryonal venous pattern.

A vascular malformation, consisting of a venous vessel bridgeing the right inferior petrosal sinus and the anterior spinal veins, was found in the posterior fossa. The vessel presented a ring-like course around the right trigeminal root, and it was parallel and dorsal to the basilar artery. The malformation was associated with cutaneous and hepatic angiomas and peri-osteal lipomas. It had been clinically silent for 52 years, when it thrombosed causing death. The authors think that, within a general mesenchymopatic state, this is a result of the persistence of an embryonal cerebral venous pattern

PCOS and Insulin Resistance (IR): From Lifestyle to Insulin Sensitizers

PCOS patients are typically characterized by chronic anovulation, hyperandrogenism, polycystic ovaries and these aspects are frequent in a high percentage of women during the repruductive life. PCOS frequently show overweight and/or obesity and are characterized by a higher production of androgens and reduced sensitivity to insulin. In fact it is of great importance to note that up to 60% of all PCOS patients are with modest up to exagerated overweight and that most of these patients show a modest up to an exagerated hyperinsulinism in response to the standard oral glucose tollerance test (OGTT). This reduced insulin sensitivity can be modified by a specific attention to life style, including not only a diet but also certain degree of physical activity. However, a specific effect on hyperinsulinemia can be achieved using glucose sensitizer drugs, such as metformin, so that to reduce the negative modulation exerted by hyperinsulinemia on the reproductive axis as well as on neuroendocrine control of reproduction with relevant effects also on adrenal function and neurosteroid production. Also specific integrative compounds have been proposed in recent years to counteract insulin resistance: myo-inositol (MYO) and d-chiro-inositol (DCI). These 2 compounds are tightly linked one to the other since MYO is transformed by an epimerase in DCI, having each tissue its own conversion rate, likely due to the specific needs for the two different molecules. In general both these compounds works as specific modulators of the intra cellular second messanger activated by the insulin linkage with its own membrane receptor. It remains clear that only the combination of life-style (diet & physical exercise) with one of the above mentioned treatments is able to solve the metabolic/endocrine impairment of overweight/obese PCOS