Naturalistic Parental Pain Management During Immunizations over the First Year of Life: Observational Norms from the OUCH Cohort

No research to date has descriptively catalogued what parents of healthy infants are naturalistically doing to manage their infant's pain over immunization appointments across the first year of life. This knowledge, in conjunction with an understanding of the relationships different parental techniques have with infant pain-related distress, would be useful when attempting to target parental pain management strategies in the infant immunization context. This study presents descriptive information about the pain management techniques parents have chosen, and examines the relationships these naturalistic techniques have with infant pain-related distress over the first year of life. 760 parent-infant dyads were recruited from three pediatrician clinics in Toronto, Canada, and were naturalistically followed and videotaped longitudinally over four immunization appointments across the infant's first year of life. Infants were full-term, healthy babies. Videotapes were subsequently coded for infant pain-related distress behaviours and parental pain management techniques. After controlling for preceding infant pain-related distress levels, parent pain management techniques accounted for, at most, 13% of the variance in infant pain-related distress scores. Across all age groups, physical comfort, rocking, and verbal reassurance were the most commonly used non-pharmacological pain management techniques. Pacifying and distraction appeared to be most promising in reducing needle-related distress in our sample of healthy infants. Parents in this sample seldom used pharmacological pain management techniques. Given the psychological and physical repercussions involved with unmanaged repetitive acute pain and the paucity of work in healthy infants, this paper highlights key areas for improving parental pain management in primary care

Risk factors associated with healthcare utilization for spine pain

OBJECTIVE: This study examined potential risk factors associated with healthcare utilization among patients with spine (i.e., neck and back) pain. METHODS: A two-stage sampling approach examined spine pain episodes of care among veterans with a yearly outpatient visit for six consecutive years. Descriptive and bivariate statistics, followed by logistic regression analyses, examined baseline characteristics of veterans with new episodes of care who either continued or discontinued spine pain care. A multivariable logistic regression model examined correlates associated with seeking continued spine pain care. RESULTS: Among 331,908 veterans without spine pain episodes of care during the two-year baseline observation period, 16.5% (n = 54,852) had a new episode of care during the following two-year observation period. Of those 54,852 veterans, 37,025 had an outpatient visit data during the final two-year follow-up period, with 53.7% (n = 19,865) evidencing continued spine pain care. Those with continued care were more likely to be overweight or obese, non-smokers, Army veterans, have higher education, and had higher rates of diagnoses of all medical and mental health conditions examined at baseline. Among several important findings, women had 13% lower odds of continued care during the final two-year observation period, OR 0.87 (0.81, 0.95). CONCLUSIONS: A number of important demographics and clinical correlates were associated with increased likelihood of seeking new and continued episodes of care for spine pain; however, further examination of risk factors associated with healthcare utilization for spine pain is indicated

Catalogo completo della sequenza sismica di Amatrice-Visso-Norcia (Italia centrale, Bollettino Sismico Italiano 2016-2018)

In questo lavoro presentiamo il catalogo completo delle localizzazioni dei terremoti appartenenti alla più importante sequenza sismica avvenuta in Italia negli ultimi 30 anni, ovvero la sequenza sismica di Amatrice-Visso-Norcia (AVN) iniziata il 24 Agosto del 2016 in Appennino centrale. Si tratta di 102582 eventi sismici registrati dalle 129 stazioni della Rete Sismica Nazionale (RSN, http://doi.org/10.13127/SD/X0FXNH7QFY) e della rete temporanea installata nella regione epicentrale (Moretti et al., 2016), dal 14 agosto 2016 al 31 agosto 2018 e analizzati manualmente dagli analisti del Bollettino Sismico Italiano (BSI, http://cnt.rm.ingv.it/bsi). Le fasi P ed S e le ampiezze di questi terremoti, stimate in tempo reale nella sala di sorveglianza dell’Istituto Nazionale di Geofisica e Vulcanologia (INGV) di Roma, sono state successivamente riviste in dettaglio, per tutti gli eventi di M≽ 2.3, con l’intento di aumentare la qualità dei parametri di localizzazione e della stima della magnitudo. Gli analisti hanno inoltre inserito le fasi P ed S osservate a quelle stazioni che il sistema di acquisizione non aveva eventualmente incluso nelle soluzioni automatiche in real-time. Per i primi mesi della sequenza l'analisi ha riguardato anche l’integrazione delle registrazioni di 9 stazioni temporanee standalone che non entravano automaticamente nelle localizzazioni della sala sismica; per i giorni nei quali si sono verificati gli eventi di M≽ 5.5 la revisione è stata particolarmente accurata anche per eventi di magnitudo inferiore a 2.3 (Improta et al. 2019) Il dataset così costruito consiste in 25496 terremoti rivisti dagli analisti del bollettino (versione 1000) e 77426 eventi elaborati dai turnisti in sala sismica (versione 100). Le 1705987 fasi P che ne sono derivate, e le 1271757 fasi S, sono disponibili nel database ISIDe (DOI: 10.13127/ISIDe). Tutte le letture dei tempi di arrivo sono state utilizzate per localizzare gli ipocentri della sequenza utilizzando il codice di inversione non lineare NonLinLoc (NLL, Lomax et al., 2001): l’utilizzo di questa tecnica ha migliorato, rispetto ai lavori precedenti, la stima dei parametri ipocentrali fornendo delle soluzioni più robuste ai fini della ricostruzione sismotettonica dell’area interessata dalla sequenza sismica AVN. Rispetto ai dati forniti in tempo reale dal personale in servizio di sorveglianza sismica dell’INGV, questo nuovo catalogo presenta un notevole miglioramento in termini di omogeneità della stima della ML, almeno nel range definito dalla soglia inferiore di revisione pari a ML≽ 2.3. Questa maggiore omogeneità del catalogo permetterà ulteriori analisi per la stima della Mc (Magnitudo di completezza). Inoltre, all’interno del catalogo sono presenti 75 terremoti con ML≽4.0: per 47 di questi eventi sismici abbiamo calcolato il meccanismo focale a partire dalle prime polarità utilizzando il codice FPFIT (Reasenberg and Oppenheimer, 1985). Un catalogo di questo tipo, di alta qualità, basato quindi su un imponente numero di fasi e ampiezze riviste manualmente, ha una particolare importanza e può essere un valido riferimento per l’applicazione per esempio di tecniche di detection basate sulla crosscorrelazione di registrazioni di terremoti templates, per la validazione di cataloghi composti da letture automatiche dei tempi di arrivo, o anche per l’ottimizzazione di algoritmi di picking automatici. La qualità delle localizzazioni dei mainshocks e degli aftershocks della sequenza sismica AVN diventa fondamentale per capire l'analisi dell'evoluzione spazio-temporale della sismicità, anche di bassa magnitudo, e le complesse geometrie delle faglie attivate durante la sequenza sismica, contestualmente alle relazioni tra esse esistenti.PublishedRoma - Italia4IT. Banche dat

Bollettino Sismico Italiano: Analisys of Early Aftershocks of the 2016 MW 6.0 Amatrice, MW 5.9 Visso and MW 6.5 Norcia earthquakes in Central Italy

The Amatrice-Visso-Norcia seismic sequence is the most important of the last 30 years in Italy. The seismic sequence started on 24 August, 2016 and still is ongoing in central Apennines. At the end of February 2017 more than 57,000 events were located, 80,000 events up to the end of September 2017 (Fig. 1). The mainshocks of the sequence occurred on 24 August 2016 (Mw 6.0 and Mw 5.4), 26 October 2016 (Mw 5.4 and Mw 5.9), 30 October 2016 (Mw 6.5), 18 January 2017 (four earthquakes Mw≥ 5.0). In this seismic sequence, all the waveforms recorded by temporary stations deployed by the SISMIKO emergency group (stations T12**; Moretti et al., 2016) where available in real- time at the surveillance room of INGV. Because of the high level of seismicity and the dense seismic network installed in the region, more than 150 events per day were located at the end of February 2017; still 60 events per day were located up to the end of August 2017.The Amatrice-Visso-Norcia is the most important seismic sequence since 2015, the time when the analysis procedures of the BSI group (Bollettino Sismico Italiano) were revised (Nardi et al., 2015). BSI is now available every four months on the web: bulletins contain revised earthquakes (location and magnitude) with ML≥ 1.5, quasi-real time revision of ML≥ 3.5 earthquakes and phase arrivals from waveforms recorded on seismic stations available from the European Integrated Data Archive (EIDA), (Mazza et al., 2012). These last procedures allow the integration of signals from temporary seismic stations (Moretti et al., 2014) installed by the emergency group SISMIKO (Moretti and Sismiko working group, 2016), even when they are not in real time transmission, if they are rapidly archived in EIDA, together with real time signals from the seismic stations of the permanent INGV network. The analysis strategy of the BSI group for the Amatrice -Visso - Norcia seismic sequence (AVN.s.s in the following) was to select the earthquakes located in the box with min/max latitude: 42.2/43.2 - and min/max longitude: 12.4/14.1 to prepare a special volume of BSI on the seismic sequence.PublishedTrieste, Italy1SR. TERREMOTI - Servizi e ricerca per la Societ

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

Objective: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. Design: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. Methods: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. Results: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. Conclusion: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age

Bollettino Sismico Italiano: maggio - agosto 2016

Il 24 agosto 2016 un terremoto di magnitudo 6.0 ha dato inizio ad una sequenza sismica in Italia centrale, che ha generato decine di migliaia di eventi sismici. Per l’analisi e revisione di questa sequenza si rimanda ad un uscita speciale del BSI prevista per fine 2017(S_BSI_CI). In questo quadrimestre e nel successivo gli eventi nella zona della sequenza sono quelli localizzati nella sala di sorveglianza. Solo gli eventi con M>= 3.5, e pochi altri (vedi Marchetti et al. Annals of Geophys. DOI: 10.4401/ag6116) sono stati rivisti dal BSI.Nel secondo quadrimestre 2016 si sono verificati sedici eventi di magnitudo superiore a 4.0 (ML) rivisti dagli analisti del BSI uno vicino alle coste tunisine quindi fuori dal territorio nazionale; l’evento di Mw 4.1 che è avvenuto il 30 maggio in provincia di Terni vicino al Lago di Bolsena (lat=42.7, lon=11.98 ad una profondità di 8 km) e 14 eventi nella zona della sequenza nell’ultima settimana del quadrimestre: il 24 agosto 2016 si è verificato l’evento di magnitudo ML=6.0 (Mw=6.0) che ha iniziato una sequenza sismica per la quale sono stati localizzati decine di migliaia di terremoti e che alla fine di ottobre 2016 ha generato eventi persino più forti (fino a Mw=6.5) della prima scossa.Istituto Nazionale di Geofisica e Vulcanologia - Dipartimento di Protezione CivilePublished4IT. Banche dat

Bollettino Sismico Italiano gennaio – aprile 2019

Nel periodo che va dal 1 gennaio al 30 aprile 2019, gli analisti del BSI hanno revisionato tutti gli eventi di magnitudo M≥1.5, mentre i parametri dei terremoti di magnitudo inferiore a tale soglia di revisione sono stati calcolati in tempo reale, nella sala di sorveglianza sismica di Roma.Istituto Nazionale di Geofisica e Vulcanologia - Dipartimento di Protezione CivilePublished4IT. Banche dat

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Bollettino Sismico Italiano gennaio – aprile 2018

Nel primo quadrimestre 2018 si sono verificati in Italia cinque eventi di magnitudo superiore o uguale a 4.0, di cui nessuno di magnitudo superiore a 5.0. Due di essi, avvenuti il 4 (MW 4.0) e il 10 aprile (MW 4.6), hanno interessato la zona della sequenza dell’Italia centrale, in provincia di Macerata. Un terremoto di magnitudo MW 4.3 è avvenuto in provincia di Campobasso, il 25 aprile, ad una profondità di 29 km. Infine due terremoti profondi, avvenuti il 12 febbraio (ML 4.4, con profondità di 379 km) e il 7 marzo (ML 4.0, con profondità di 294 km), hanno interessato il Tirreno Meridionale, al largo della costa calabra.Istituto Nazionale di Geofisica e Vulcanologia - Dipartimento di Protezione CivilePublished4IT. Banche dat