Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

open7PURPOSE: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. SETTING: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). METHOD: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. RESULTS: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. CONCLUSION: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.Purpose: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. Setting: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). Method: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. Results: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. Conclusion: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.openBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, VincenzoBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, Vincenz

Acute effects of a combat sport environment on self-control and pain perception inhibition: a preliminary study in a new ecological framework

Intense sports activities affect cognitive, perceptual, and physiological domains, possibly concurring in reducing pain perception and anxiety. Within a framework for a new socio-ecological narrative that considers opposition (such as fighting) and collaboration (cooperative learning) as carriers of self-control and pain perception inhibition, we investigated the acute effects of a judo-specific session on cognitive (inhibitory control and simple reaction time), perceptual (pain and fatigue), affective (anxiety) and physiological (hormone profile) domains. Eleven male black belt judokas (age 39.0 ± 13.9 years; training experience: 23.2 ± 14.4 years) were recruited and tested before and after judo randori and resting sessions. Inhibitory control and simple reaction time were assessed via the Flanker task and clinical reaction time test, pain and fatigue were assessed using Borg’s category-ratio scale (CR-10), and the state–trait anxiety inventory Y-1 test assessed anxiety. Glucose, insulin, cortisol, creatinine, and irisin levels were measured. Cognitive performance, perception of fatigue and physiological variables increased after randori bouts, while pain decreased. Inhibitory control, perception of pain, perception of fatigue and glucose, cortisol, and creatinine significantly differed (p < 0.05) between randori and resting sessions. A high-intensity randori may induce acute beneficial effects on cognitive, perceptual, and physiological domains. Further studies should compare the results with the outcomes from a collaborative and non-agonist environment and confirm the socio-ecologic framework

Multimorbidity and Hospital Admissions in High-Need, High-Cost Elderly Patients

Objective: The aim was to clarify which pairs or clusters of diseases predict the hospital-related events and death in a population of patients with complex health care needs (PCHCN). Method: Subjects classified in 2012 as PCHCN in a local health unit by ACG\uae (Adjusted Clinical Groups) System were linked with hospital discharge records in 2013 to identify those who experienced any of a series of hospital admission events and death. Number of comorbidities, comorbidities dyads, and latent classes were used as exposure variable. Regression analyses were applied to examine the associations between dependent and exposure variables. Results: Besides the fact that larger number of chronic conditions is associated with higher odds of hospital admission or death, we showed that certain dyads and classes of diseases have a particularly strong association with these outcomes. Discussion: Unlike morbidity counts, analyzing morbidity clusters and dyads reveals which combinations of morbidities are associated with the highest hospitalization rates or death

WATZON: the Italian network of ecohydrology and critical zone observatories

The Italian initiative WATZON (WATer mixing in the critical ZONe) is a network of instrumented sites, bringing together six pre-existing long-term research observatories monitoring different compartments of the Critical Zone - the Earth's permeable near-surface layer from the tops of the trees to the bottom of the groundwater. These observatories cover different climatic and physiographic characteristics over the country, providing information over a climate and eco-hydrologic transect connecting the Mediterranean to the Alps. With specific initial scientific questions, monitoring strategies, databases, and modeling activities, the WATZON observatories and sites is well representative of the heterogeneity of the critical zone and of the scientific communities studying it. Despite this diversity, all WATZON sites share a common eco-hydrologic monitoring and modelling program with three main objectives: 1) assessing the description of water mixing process across the critical zone by using integrated high-resolution isotopic, geophysical and hydrometeorological measurements from point to catchment scale, under different physiographic conditions and climate forcing; 2) testing water exchange mechanisms between subsurface reservoirs and vegetation, and assessing ecohydrological dynamics in different environments by coupling the high-resolution data set from different critical zone study sites of the initiative with advanced ecohydrological models at multiple spatial scales; 3) developing a process-based conceptual framework of ecohydrological processes in the critical zone to translate scientific knowledge into evidence to support policy and management decisions concerning water and land use in forested and agricultural ecosystems. This work provides an overview of the WATZON network, its objectives, scientific questions, and data management, with a specific focus on existing initiatives for linking data and models based on WATZON data

Assessing root water uptake transit time by simulating isotope transport in Hydrus-1D

Stable isotopes (2H and 18O) are common natural tracers for the investigation of water transport in the soil-plant-atmosphere continuum. Isotopic data can be coupled with soil water content data to inversely estimate soil hydraulic and transport parameters. The calibration of a hydrological model by inverse modelling is a prerequisite to determine the temporal origin of xylem water taken by roots. In this study, we used isotopic data to calibrate Hydrus-1D via inverse modelling to simulate one-dimensional water flow and isotope transport in a controlled soil-plant-atmosphere system. We propose the following protocol i) to estimate root water uptake transit time of irrigation water, and ii) to assess the sensitivity of the transit time distribution to the variation in the water available for root uptake. The dataset was obtained from an isotope-tracing experiment carried out between May and July 2018 on an olive tree placed in a pot inside a glasshouse. Meteorological variables and sap flow were monitored at 5-minute intervals, whereas shallow soil moisture (0-6 cm depth) was measured manually with an impedance probe at the daily timescale. The olive tree was irrigated with water of known isotopic composition. The pot surface was covered by a plastic sheet to avoid evaporation. Soil at different depths, twigs, wood cores and root samples were collected weekly for isotopic analyses. Water from soil and the xylem tissues was extracted by cryogenic vacuum distillation. Based on the results of a previous study carried out on the same dataset, we considered that no isotopic fractionation occurred during the water uptake and the transport within the olive tree. We used soil water content and δ18O data at different soil depths to optimize flow (soil hydraulic and root water uptake parameters) and transport (longitudinal dispersivity) parameters. Numerical simulations of isotope transport were validated with sap flow data (compared to actual transpiration) and δ18O in xylem water. Given that the timing of irrigation water for plant transpiration is fundamental for assessing the vulnerability of olive trees to drought, we will be proposing various scenarios based on different irrigation events to mimic drought periods. Based on these scenarios, we will be evaluating the sensitivity of the root water uptake transit time to the different water availability in the soil profile. Afterwards, the same protocol will be exploited to determine the root water uptake transit time for different tree species under various environmental conditions

Twenty-three unsolved problems in hydrology (UPH) – a community perspective

This paper is the outcome of a community initiative to identify major unsolved scientific problems in hydrology motivated by a need for stronger harmonisation of research efforts. The procedure involved a public consultation through on-line media, followed by two workshops through which a large number of potential science questions were collated, prioritised, and synthesised. In spite of the diversity of the participants (230 scientists in total), the process revealed much about community priorities and the state of our science: a preference for continuity in research questions rather than radical departures or redirections from past and current work. Questions remain focussed on process-based understanding of hydrological variability and causality at all space and time scales. Increased attention to environmental change drives a new emphasis on understanding how change propagates across interfaces within the hydrological system and across disciplinary boundaries. In particular, the expansion of the human footprint raises a new set of questions related to human interactions with nature and water cycle feedbacks in the context of complex water management problems. We hope that this reflection and synthesis of the 23 unsolved problems in hydrology will help guide research efforts for some years to come