Predictors of Bluetongue development in Sardinia (Italy) identification, using multilevel logistic mixed model

Objectives: The Bluetongue Virus is one of the most studied ruminant diseases, affecting particularly sheep and goats. This study aims to identify, for the first time, the specific risk factors influencing the disease development in Sardinia, using multilevel logistic regression model, in order to give a contribution to the sanitary programs and favour the early detection.   Methods: The data of the present retrospective study, collected from informatics systems of Istituto Zooprofilattico della Sardegna, are referred to all 15,780 Sardinian sheep farms observed for 3 years (2012-2014). The outcome of interest was dichotomous and defined the development of Bluetongue outbreak, after serological test or clinical signs. The effect of several region-specific prognostic factors on disease spread was investigated. Results: The final model indicated that Bluetongue development was significantly associated with an increase in number of animals (P < 0.0001), number of cattle around farm (P  < 0.0001), water surface area (P =0.002), and amount of rainfall in the previous days (P < 0.0001). Furthermore, the altitude over 450 MASL (P < 0.0001), the vaccination prophylaxis (P < 0.0001) and the previous outbreak event (P < 0.0001) had a protective effect against the outcome. Conclusion: The results of this study indicated that number of animals and the amount of rainfall were the most important risk factors that affected the Bluetongue development, while the vaccination prophylaxis was found to be an effective measure in decelerating the disease spread.&nbsp

A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery

Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients’ ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs

A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery

Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients' ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs

Health impact of the emissions from a refinery: case-control study on the adult population living in two municipalities in Lomellina, Italy

Background: In the municipalities of Sannazzaro de’ Burgondi and Ferrer Erbognone (District of Lomellina, Pavia, Lombardy, Italy), an oil refinery is operating since 1963. In 2008, the company running the plant (eni S.p.A.) asked the competent bodies the permission for building a new facility (“EST”). The present work is aimed at evaluating the ante-operam health impacts of the existing facility refinery. Methods: A case-control study design was implemented. Cases were subjects admitted to hospital in 2002-2014 due to acute respiratory, cardiovascular or gastrointestinal conditions. Controls were selected among those who had not been hospitalised in that timespan. Cases and controls had to be alive at enrolment, aged 20-64 years, and were frequency-matched by age, gender and municipality. Data were extracted from the health insurance registry and from Hospital Discharge Records (ATS Pavia). Enrolled subjects were asked to complete a mailed survey. Environmental exposure was the fallout of refinery emissions (PM10) at participants’ homes, as predicted by an AERMOD model. Results: 541 respondents (125 cases, 416 controls) were included in the analyses. Response bias was excluded. Individual PM10 exposure was not significantly different between cases and controls, while it was significantly associated with municipality (being higher in Sannazzaro). The crude effect estimate of PM10 over case/control status indicated a not-significant excess of hospitalisation with the increase in PM10 exposure. Multivariate analyses confirmed those results. Conclusion: Findings indicate a possible excess of hospitalisation risk in most exposed people, but the effect is not statistically significant and may be affected by bias

Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum TimeCourse

Introduction: Increased cardiovascular (CV) morbidity and mortality is observed in inflammatory joint diseases (IJDs) such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, the management of CV disease in these conditions is far from being well established.Areas covered: This review summarizes the main epidemiologic, pathophysiological, and clinical risk factors of CV disease associated with IJDs. Less common aspects on early diagnosis and risk stratification of the CV disease in these conditions are also discussed. In Europe, the most commonly used risk algorithm in patients with IJDs is the modified SCORE index based on the revised recommendations proposed by the EULAR task force in 2017.Expert opinion: Early identification of IJD patients at high risk of CV disease is essential. It should include the use of complementary noninvasive imaging techniques. A multidisciplinary approach aimed to improve heart-healthy habits, including strict control of classic CV risk factors is crucial. Adequate management of the underlying IJD is also of main importance since the reduction of disease activity decreases the risk of CV events. Non-steroidal anti-inflammatory drugs may have a lesser harmful effect in IJD than in the general population, due to their anti-inflammatory effects along with other potential beneficial effects.This research was partially funded by FOREUM—Foundation for Research in Rheumatolog

Il protocollo “CardioLavoro” per la valutazione del reinserimento lavorativo dopo evento cardiaco acuto: dati a 12 mesi

A multidisciplinary protocol (“CardioWork”) for work resumption after cardiosurgery (for ischaemic heart disease or valvulopathy) and cardiological rehabilitation was applied. 101 patients (93% males; 7% females) in working age (mean 50 years) were enrolled. The education level was medium-high. The patients underwent psychological and occupational medicine evaluation collecting personal data, cardiovascular risk factors, comorbility, cardiologic and occupational history. The jobs were classified as multiples of basal metabolism (METS), according to the entity of physical strain: in the 71% of patients the tasks were defined as sedentary (< 2 METS) or light (2-4 METS). These data were integrated with those obtained from instrumental cardiological evaluation (24 hours Holter ECG, echocardiography, treadmill ergometric testing) to formulate indications regarding the timing and modality of work resumption, and possible limitations to job fitness. The patients have been re-evaluated after 12 months: 84% of them have resumed working. Among these, only 8% required a change of the previous tasks. A very high compliance (almost 100%) with our indications was observed. These data strongly confirm that the intervention of the occupational physician in the rehabilitative process after cardiosurgery may optimize the evaluation of the patients’ ergonomic capacity aimed at work resumption

A fuzzy ‘boater’ model to detect fouling and spreading risk of non-indigenous species by recreational boats

Recreational boating is an unregulated and underestimated vector of spread of non-indigenous species (NIS) in marine environments. The risk of a single boat to spread NIS depends not only on the local environmental context, but also on the type of boat and on the boat owner's behaviour (hull cleaning and painting frequency, travel history). In this paper we present a model to assess the risk of fouling and spreading of NIS and its application to data derived from a questionnaire given to Italian boat owners. The model uses a two-levels fuzzy logic approach: (1) the first level assesses the risk of hull fouling and risk of spreading separately; (2) the second level combines the two separate risks in an overall index ranging from 0 (null risk) to 100 (highest risk) and measures the global risk of NIS introduction and spread through recreational boating. The questionnaire and the fuzzy model allow for a simple and rapid assessment of boats most likely to be infested. The proposed fuzzy model can be easily edited and adapted to context-specific ecological and social conditions. The results of this Italian study showed that 53.9% of the respondents were in the very-low and low risk categories, and 46.1% in the medium, high and very-high risk categories. Possible associations between some boaters habits and the fouling and spreading risk were explored using logistic regression analyses. The results indicate a high-risk profile of boat owner as an experienced sailor who visits many marinas during the summer season. Biosecurity guidelines, containment measures and awareness raising programmes should be implemented to prevent and avoid further spread of NIS in marine environments, and such management actions would benefit from the early detection of high-risk boats, and from the identification of profiles of boaters upon which these initiatives should be prioritized