Italian translation and cultural adaptation of the communication assessment tool in an outpatient surgical clinic

The aim of the study is to translate and cross-culturally adapt, for use in the Italian context, the Communication Assessment Tool (CAT) developed by Makoul and colleagues

Road traffic pollution and childhood leukemia: a nationwide case-control study in Italy

Background The association of childhood leukemia with traffic pollution was considered in a number of studies from 1989 onwards, with results not entirely consistent and little information regarding subtypes. Aim of the study We used the data of the Italian SETIL case-control on childhood leukemia to explore the risk by leukemia subtypes associated to exposure to vehicular traffic. Methods We included in the analyses 648 cases of childhood leukemia (565 Acute lymphoblastic–ALL and 80 Acute non lymphoblastic-AnLL) and 980 controls. Information on traffic exposure was collected from questionnaire interviews and from the geocoding of house addresses, for all periods of life of the children. Results We observed an increase in risk for AnLL, and at a lower extent for ALL, with indicators of exposure to traffic pollutants. In particular, the risk was associated to the report of closeness of the house to traffic lights and to the passage of trucks (OR: 1.76; 95% CI 1.03–3.01 for ALL and 6.35; 95% CI 2.59–15.6 for AnLL). The association was shown also in the analyses limited to AML and in the stratified analyses and in respect to the house in different period of life. Conclusions Results from the SETIL study provide some support to the association of traffic related exposure and risk for AnLL, but at a lesser extent for ALL. Our conclusion highlights the need for leukemia type specific analyses in future studies. Results support the need of controlling exposure from traffic pollution, even if knowledge is not complete

PharmaCare 2018

[Italiano]: Il farmaco, nella sua accezione più ampia e generale, può essere ritenuto un bene sociale, la cui valenza simbolica e curativa varia in relazione alla dimensione ambientale e culturale nel quale si inserisce. In tal senso, le prescrizioni farmaceutiche rappresentano un indicatore privilegiato per la conoscenza del sistema salute di un determinato territorio, poiché costituiscono un punto di intersezione ideale tra la prospettiva medica e quella di mercato. Siffatte considerazioni hanno sollecitato l’elaborazione di questo Report che si pone, come obiettivi dichiarati, quello di essere uno strumento utile alla pianificazione di interventi di sanità pubblica, quanto quello di svolgere analisi approfondite sulle caratteristiche dei soggetti che usano i farmaci e sulle modalità di trattamento degli stessi, permettendo studi di appropriatezza prescrittiva su specifiche aree di rilevanza clinica e su specifiche coorti di soggetti. “PharmaCaRe Report 2018” è stato realizzato dal CIRFF (Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione) dell’Università degli Studi di Napoli Federico II, in collaborazione con la Direzione Generale della Tutela della Salute della Regione Campania, per delineare un quadro dettagliato circa il consumo e la prescrizione dei farmaci in Campania nel 2018. Questo Report intende infatti fornire una fotografia dettagliata dell’utilizzo che, in Campania, viene fatto dei farmaci in termini di spesa, volumi e tipologia. Le analisi dei dati prodotte offrono spunti importanti per correlare la prevalenza delle patologie nel territorio con il corrispondente utilizzo dei farmaci e suggeriscono un’interpretazione dei principali fattori che influenzano la variabilità nella prescrizione. La disponibilità di una banca dati che copre una popolazione assistibile di circa sei milioni di abitanti è d’altronde un potente strumento di ricerca per studiare gli effetti dell’utilizzo dei farmaci in condizioni di Real-World. La conoscenza delle dinamiche prescrittive, in termini qualitativi (appropriatezza d’uso), oltre che quantitativi (volumi di utilizzo) è la condizione necessaria per inquadrare in un contesto razionale la politica del farmaco, anche sotto il profilo della valutazione degli effetti degli interventi che il mercato, le normative o la cultura del farmaco sviluppano nel tempo. Per tali ragioni, “PharmaCaRe Report 2018” rappresenta un utile quanto prezioso supporto ai decisori per individuare strategie volte a ottimizzare l’allocazione delle risorse, nonché migliorare i percorsi di cura attraverso un monitoraggio costante, la promozione di più elevati standard di cura e l’uso sicuro, efficiente ed efficace dei farmaci ./[English]: In its broadest and most general sense, the drug can be considered a public resource, whose symbolic and curative value varies in relation to the environmental and cultural dimension in which it is embedded. In this sense, pharmaceutical prescriptions represent a privileged indicator for the knowledge of the health system of a given territory, since they constitute an ideal intersection point between the medical and the market perspective. Such considerations prompted the preparation of this Report. “PharmaCaRe Report 2018” has been produced by CIRFF (Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione) of the Federico II University of Naples, in collaboration with the Directorate-General for Health Protection of the Campania Region, to provide a detailed overview of the pharmaceutical consumption and prescriptions in Campania in 2018. This Report aims to provide a detailed picture of the use of medicines in the general population in Campania, in terms of expenditure, volumes and type. The analyses of the data produced offer important clues for correlating the prevalence of diseases in this area with the respective use of medicines and suggest an interpretation of the main factors influencing prescriptions' variability. The availability of a database covering a patient population of around six million is a powerful research tool for studying the effects of drug use in Real-World conditions. Knowledge of the dynamics of prescription, in qualitative terms (appropriateness of use), as well as quantitative (volumes of use) is the necessary condition to frame the drug policy in a rational context, also in terms of evaluating the effects of the interventions that the market, regulations or drug culture develop over time. For these reasons, “PharmaCaRe Report 2018” represents a useful and valuable tool for political decision-makers in identifying strategies aimed at optimizing the allocation of resources, as well as improving care pathways through constant monitoring, the promotion of higher standards of care and safe, efficient and effective use of drugs

Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

BACKGROUND: As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. METHODS: Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. RESULTS: Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients 64aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446). CONCLUSIONS: The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged 6470 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor

A Stochastic Model for Unsaturated Steady Flow in Bounded Heterogeneous Formations

Unsaturated steady flow in three dimensional bounded heterogeneous formations is modelled by considering the hydraulic parameters of the conductivity curve as stationary Random Space Functions (RSFs). The corresponding stochastic governing equations are solved by means of a perturbation approach which regards the variances of the logarithms of the saturated hydraulic conductivity (Ks), and the pore scale distribution of the Gardner (1958) model as small quantities. Analytical closed forms (requiring only few quadratures) for the spatial moments of the pressure head are derived, without invoking the unit mean hydraulic assumption. It is found that the flow variables are nonstationary near the boundary (i.e. the water table), and approach stationarity as the vertical distance from the water table increases. The stationary limits and the critical vertical distance at which stationarity is attained depend on soil types as well as infiltrating rates. The smaller the rate is, the larger the critical distance; and the coarser the soil texture is, the smaller the distance. Our results generalize the study of Indelman et al. (1993), and provide a general methodology to tackle more complex unsaturated flows

Una soluzione analitica per il trasporto nei suoli di soluti reattivi in presenza di ridistribuzione

Il presente lavoro illustra una soluzione analitica di tipo perturbativo che descrive il trasporto di soluti reattivi in suoli in presenza di ridistribuzione. La soluzione di tipo perturbativo viene ricavata assumendo che lo scambio di massa tra il suolo e la soluzione circolante sia sufficientemente rapido. A causa della natura singolare del problema considerato, la soluzione perturbata standard è accettabile solo localmente e, di conseguenza, è necessario determinare una seconda soluzione di tipo perturbativo che permetta di descrivere il fenomeno lì dove la soluzione standard non è valida. Le due soluzioni vengono poi raccordate opportunamente per ottenere un’unica espressione valida uniformemente nello spazio e nel tempo

Modelling Water Flow and Solute Transport in Heterogeneous Unsaturated Porous Media

New results concerning flow velocity and solute spreading in an unbounded three dimensional partially saturated heterogeneous porous formation are derived. Assuming that the effective water content is a uniformly distributed constant, and dealing with the recent results of Severino and Santini (2005) on mean vertical steady flows, first order approximation of the velocity covariance, and concurrently of the resultant macrodispersion coefficients are calculated. Generally, the velocity covariance is expressed via two quadratures. These quadratures are further reduced after adopting specific (i.e. exponential) shape for the required (cross)correlation functions. Two particular formation structures which are relevant for the applications, and lead to significant simplifications of the computational aspect are also considered. It is shown that the rate at which the Fickian regime is approached is an intrinsic medium property, whereas the value of the macrodispersion coefficients is also influenced by the mean flow conditions as well as the (cross)variances σ² of the input parameters. For a medium of given anisotropy structure, the velocity variances reduce as the medium becomes drier (in mean), and it increases with σ². In order to emphasize the intrinsic nature of the velocity autocorrelation, it is shown the good agreement between our analytical results and the velocity autocorrelation as determined by Russo (1995a) when accounting for groundwater flow normal to the formation bedding. In a similar manner, the intrinsic character of attainment the Fickian regime is demonstrated by comparing the scaled longitudinal macrodispersion coefficients D₁₁(t)/D₁₁(∞) as well as the lateral displacement variance X₂₂(t)/X₂₂(∞)=X₃₃(t)/X₃₃(∞) with the same quantities derived by Russo (1995a) in the case of groundwater flow normal to the formation bedding

Unsaturated Transport with Linear Kinetic Sorption Under Unsteady Vertical Flow

We consider transport of a solute obeying linear kinetic sorption under unsteady flow conditions. The study relies on the vertical unsaturated flow model developed by Indelman et al. [J. Contam. Hydrol. 32 (1998), 77–97] to account for a cycle of infiltration and redistribution. One of the main features of this type of transport, as compared with the case of a continuous water infiltration, is the finite depth of solute penetration. In the infiltration stage an analytical solution that generalizes the previous results of Lassey [Water Resour. Res. 24 (1988), 343–350] and Severino and Indelman [J. Contam. Hydrol. 70 (2004), 89–115] is derived. This solution accounts for quite general initial solute distributions in both the mobile and immobile concentration. When the redistribution is also considered, two timescales become relevant, namely: (i) the desorption rate k−1, and (ii) the water application time tap. In particular, we have assumed that the quantity ε =(k tap)−1 can be regarded as a small parameter so that a perturbation analytical solution is obtained. At field-scale the concentration is calculated by means of the column model of Dagan and Bresler [Soil Sci. Soc. Am. J. 43 (1979), 461–467], i.e. as ensemble average over an infinite series of randomly distributed and uncorrelated soil columns. It is shown that the heterogeneity of hydraulic properties produces an additional spreading of the plume. An unusual phenomenon of plume contraction is observed at long times of solute propagation during the drying period. The mean solute penetration depth is studied with special emphasis on the impact of the variability of the saturated conductivity upon attaining the maximum solute penetration depth