Paediatric ambulatory care sensitive hospitalisation and Italian deprivation index. Retrospective multilevel analysis of administrative data from 2008 to 2018 in the Abruzzo Region (Southern Italy)

OBJECTIVES: to estimate and analyse the trend of paediatric hospitalisations for Ambulatory Care Sensitive Conditions (ACSCs) from 2008 to 2018 in a region of southern Italy and to assess the association with the socio-economic deprivation index (DI). DESIGN: retrospective observational study. SETTING AND PARTICIPANTS: ACSC hospitalisations in children (<=18 years) were identified. Discharges for ACSC of the Abruzzo Region from 2008 to 2018 were selected and the deprivation index of the municipality of residence was assigned to the hospital discharge record where the patient's residence was reported. MAIN OUTCOME MEASURES: the rate of paediatric preventable admissions (PPHs) related to ACSC, standardized by age and gender with the direct method, was calculated for the years of observation. The average annual percentage change (AAPC) was calculated with a trend analysis. In addition, the odds ratios (ORs) of hospitalisation for ACSC were calculated using a hierarchical logistic regression model. RESULTS: 252,513 hospitalisations were examined, of which 16,264 (6.4%) attributable to ACSC. During the study period, the hospitalisation rate decreased from 8.59 per 1,000 to 6.12 per 1,000 residents, with an AAPC of -3.7, which was statistically significant (p<0.05). Furthermore, an association was highlighted between hospitalisations related to ACSC and the deprivation of the municipality of residence. Using as a comparison people residing in the municipalities belonging to the first quintile, the least deprived, the strength of the association between PPHs and DI increased from the third quintile (OR 1.13; CI95% 1.02-1.24) up to the fifth quintile, most deprived (OR 1.14; CI95% 1.01-1.30). CONCLUSIONS: paediatric patients residing in Abruzzo have a risk of undergoing a preventable hospitalisation associated with an ACSC which depends on the deprivation index of the municipality of residence. Although it is difficult to evaluate the mechanisms involved in the relationship between economic deprivation and hospitalisation, DI can be useful to identify the areas which are most at risk on which to prioritize public health interventions

Altered fetal skeletal muscle nutrient metabolism following an adverse in utero environment and the modulation of later life insulin sensitivity

The importance of the in utero environment as a contributor to later life metabolic disease has been demonstrated in both human and animal studies. In this review, we consider how disruption of normal fetal growth may impact skeletal muscle metabolic development, ultimately leading to insulin resistance and decreased insulin sensitivity, a key precursor to later life metabolic disease. In cases of intrauterine growth restriction (IUGR) associated with hypoxia, where the fetus fails to reach its full growth potential, low birth weight (LBW) is often the outcome, and early in postnatal life, LBW individuals display modifications in the insulin-signaling pathway, a critical precursor to insulin resistance. In this review, we will present literature detailing the classical development of insulin resistance in IUGR, but also discuss how this impaired development, when challenged with a postnatal Western diet, may potentially contribute to the development of later life insulin resistance. Considering the important role of the skeletal muscle in insulin resistance pathogenesis, understanding the in utero programmed origins of skeletal muscle deficiencies in insulin sensitivity and how they may interact with an adverse postnatal environment, is an important step in highlighting potential therapeutic options for LBW offspring born of pregnancies characterized by placental insufficiency

Contraceptive methods and knowledge of sexually transmitted diseases in nursing students. Results from a survey conducted at the University of Palermo

Background: The main purpose of the study was to evaluatesexual habits, sexual relations and knowledge of sexually transmitted infections (STIs) among the students in the nursing science course of University of Palermo, and to evaluate the use of contraceptive methods.Methods: In April 2019, a survey was provided to students who attend daily lessons in the nursing science course of University of Palermo, that investigate primarily about sexual habits, sexual relations and knowledge of sexually transmitted diseases. A multivariable logistic regression was performed.Results: The sample size consists of 405 students. The average age of the sample is 21.65 years, 69.63% of the interviewees are women. In relation to the question "Do you think you are sufficiently informed to be able to avoid risks of infection from sexually transmitted diseases? No", the analysis shows that this independent variable is significantly associated with the following independent variables: female gender (aOR 3.11, 95% CI 1.01 - 9.65); "how would you define your knowledge about contraceptive methods? - Poor" (aOR 5.38, 95% CI 1.79 - 16.20); "have you ever received information on sex education and/or sexually transmitted diseases? - No" (aOR 11.59, 95% CI 2.26 - 59.42); "do you know the human papillomavirus (HPV) vaccination? - yes, but I'm not vaccinated" (aOR 3.09, 95% CI 1.12 - 8.51); "do you know that men can also undergo HPV vaccination? - No" (aOR 2.67, 95% CI 1.01 - 7.04).Conclusion: Based on our findings, it is necessary to implement sexual education programs for the improvement of knowledge in terms of STIs and the promotion of health. Improving sexual health outcomes for young people is a priority for the public health

The Impact of COVID-19 on doctors well-being: Results of a web survey during the lockdown in Italy

OBJECTIVE: On March 12, 2020, the World Health Organization (WHO) declared the outbreak of a new Coronavirus disease (COVID-19), to be a pandemic. From the be- ginning, Italy (in particular the Northern re- gions) was the first large European country to be hit and one of the most affected coun- tries worldwide. This had a significant impact on the workload and psychological health of health workers. The aim of this web-based cross-sectional study is to assess the con- sequences of the COVID-19 pandemic on Ital- ian doctors’ well-being and psychological dis- tress, in respect of demographic and occu- pational characteristics, lifestyle and habits during the lockdown period.PATIENTS AND METHODS: We conducted a web-based cross-sectional survey based on Google® Forms to collect data. The participa- tion was available during the lockdown period that started in Italy on March 9, 2020 and it was voluntary and anonymous. The question- naire explored demographic and occupational variables, lifestyle and habits during the lock- down, perceived well-being and psychological distress. Multivariate logistic regression models were fitted. RESULTS: Our study reported the very alarm- ing psychological conditions of Italian doctors, especially among those who worked in the most affected regions, where a level of psychological distress of 93.8% and poor well-being of 58.9% were registered. These percentages were even higher in the case of female hospital workers with low job seniority, and those caring for COVID-19 patients. CONCLUSIONS: Our findings reported a sig- nificant psychosocial impact of the COVID-19 outbreak on Italian doctors, particularly among those working in the most affected regions of the country. Further studies are necessary to better understand the effects of the COVID-1

Emergency Department as an epidemiological observatory of Human Mobility: the experience of the Moroccan population

We conducted a retrospective study of the accesses to the Emergency Department registered from January 2000 to December 2014 in 5 major hospitals in the Metropolitan Area of Rome. We extrapolated data relating to patients of Moroccan origin from about 5 million total accesses, so we compared with Italians data which, in the same period, came to ED. The Moroccan population is distinguished by a larger number of diagnoses belonging to the ICD-9 code of Infectious Diseases and, more precisely, to Respiratory Infectious Diseases. There are also no differences in the assignment of such diagnoses to Moroccans with Italian citizenship, and this led to think that this could play an important role in the use of the ED and moreover that enrollment to the National Health Service may reduce its inappropriate use. Regarding to Degenerative Disorders, the result of our analysis is quite emblematic, showing that the accesses to the ED is due to Cardiovascular Diseases: 6.33% of Italians' accesses against 1.81% of Moroccans and 2.36% of Moroccans with Italian citizenship. The main explanation for this difference is, obviously, due to the age of the population: about 60% of Moroccans who accessed to ED was less than 40 years old. It is interesting how, in the field of ​​Cardiovascular Diseases, Moroccans have a lower percentage of diagnosis compared to Italians for acute diseases and a greater percentage of diagnoses for chronic diseases, suggesting once again that accesses to ED for migrants often is due to the inability to use the general services of the National Health Service. In conclusion, from the point of view of the Emergency Department, Migration Medicine still has Infectious Diseases as the main reason for access. Degenerative Disorders remain a prerogative of the Italians, but we could certainly assume that the Moroccan population would develop at some point with the aging

Alcohol consumption and employment: a cross-sectional study of office workers and unemployed people

Background. Alcohol is a psychoactive substance with toxic and addictive properties. Biomarkers like GGT, AST, ALT and MCV are influenced by excessive ethanol consumption. Alcohol consumption represents a health risk and it has been linked to unemployment. The aim of this study how working status predict alcohol consumption through a cross sectional study comparing alcohol-related biomarkers levels in office workers and unemployed people. Methods. This study includes 157 office workers and 157 unemployed people, who were recruited from January to December 2018. A propensity score matching procedure was applied to obtain two homogenous groups in terms of age and gender. A non- parametric analysis was performed on serum biomarkers that are generally altered by alcohol consumption. Logistic regression models were designed to evaluate how working status predict abnormal biomarker levels related with alcohol consumption. Results. No differences in median biomarker values were found between groups. Lo- gistic regression analysis showed that office work is a negative predictor of pathological biomarker levels. Office workers had a significant relation with the levels of GGT (OR 0.48; 95% CI [0.28-0.84]), AST (OR 0.42; 95% CI [0.22-0.78]), ALT (OR 0.39; 95% CI [0.23-0.66]), and MCV (OR 0.37; 95% CI [0.19-0.70]). Conclusion. Office workers had lower absolute frequencies of pathological values of alcohol consumption biomarkers, after matching for age and gender compared with unemployed people. In addition, a significant negative association between office work is a negative predictor of biomarker levels of alcohol consumption. These results showed that work is an important determinant of health and that can represent a benefit for workers in terms of reducing the risk of consuming alcohol

Pharmacists' mental health during the SARS-CoV-2 pandemic in Italy

OBJECTIVE: The year 2020 was characterized by the outbreak of a new pandemic caused by a novel coronavirus named SARSCoV- 2. To face the pandemic, many countries worldwide imposed general lockdowns, closing all non-essential businesses. As primary care services, pharmacies had to remain open, thus putting pharmacy staff at significant risk of viral infection and overwork. This study aimed to assess the mental health of Italian Pharmacists, considering demographic and occupational characteristics, lifestyle, and habits, during the SARS-CoV-2 outbreak and the subsequent lockdown period (March-May 2020). MATERIALS AND METHODS: A web-based survey was created using Google® Forms to collect data from March 30, 2020, to June 1, 2020. The questionnaire consisted of three sections investigating: (1) demographic and occupational variables, (2) lifestyle and habits variables, (3) psychological distress and perceived well-being. RESULTS: A total of 401 participants completed the questionnaire. Older workers and those with more work experience reported more psychological stress. Older and female workers, who felt lonely at home and reported psychological stress, perceived poor well-being. CONCLUSIONS: Our findings demonstrate that the Sars-CoV-2 outbreak and subsequent lockdown rules affected pharmacists' mental health and that it is important to put in place preventive measures against the occurrence of mental disorders among them

Biosafety Studies of a Clinically Applicable Lentiviral Vector for the Gene Therapy of Artemis-SCID

Genetic deficiency of the nuclease DCLRE1C/Artemis causes radiosensitive severe combined immunodeficiency (RS-SCID) with lack of peripheral T and B cells and increased sensitivity to ionizing radiations. Gene therapy based on transplanting autologous gene-modified hematopoietic stem cells could significantly improve the health of patients with RS-SCID by correcting their immune system. A lentiviral vector expressing physiological levels of human ARTEMIS mRNA from an EF1a promoter without post-transcriptional regulation was developed as a safe clinically applicable candidate for RS-SCID gene therapy. The vector was purified in GMP-comparable conditions and was not toxic in vitro or in vivo. Long-term engraftment of vector-transduced hematopoietic cells was achieved in irradiated Artemis-deficient mice following primary and secondary transplantation (6 months each). Vector-treated mice displayed T and B lymphopoiesis and polyclonal T cells, had structured lymphoid tissues, and produced immunoglobulins. Benign signs of inflammation were noted following secondary transplants, likely a feature of the model. There was no evidence of transgene toxicity and no induction of hematopoietic malignancy. In vitro, the vector had low genotoxic potential on murine hematopoietic progenitor cells using an immortalization assay. Altogether, these preclinical data show safety and efficacy, and support further development of the vector for the gene therapy of RS-SCID

Treatment-free remission in chronic myeloid leukemia patients treated front-line with nilotinib: 10-year followup of the GIMEMA CML 0307 study

We report the final analysis, with a 10-year follow-up, of the phase II study GIMEMA CML 0307 (NCT 00481052), which enrolled 73 adult patients (median age 51 years; range, 18-83) with newly diagnosed chronic-phase chronic myeloid leukemia to investigate the efficacy and the toxicity of front-line treatment with nilotinib. The initial dose was 400 mg twice daily; the dose was reduced to 300 mg twice daily as soon as this dose was approved and registered. The 10-year overall survival and progression-free survival were 94.5%. At the last contact, 36 (49.3%) patients were continuing nilotinib (22 patients at 300 mg twice daily, 14 at lower doses), 18 (24.7%) patients were in treatment-free remission, 14 (19.2%) were receiving other tyrosine-kinase inhibitors and four (5.5%) patients have died. The rates of major and deep molecular responses by 10 years were 96% and 83%, respectively. The median times to major and deep molecular response were 6 and 18 months, respectively. After a median duration of nilotinib treatment of 88 months, 24 (32.9%) patients discontinued nilotinib while in stable deep molecular response. In these patients, the 2-year estimated treatment-free survival was 72.6%. The overall treatment-free remission rate, calculated on all enrolled patients, was 24.7% (18/73 patients). Seventeen patients (23.3%), at a median age of 69 years, had at least one arterial obstructive event. In conclusion, the use of nilotinib front-line in chronic phase chronic myeloid leukemia can induce a stable treatment-free remission in a relevant number of patients, although cardiovascular toxicity remains of concern

Observational study of chronic myeloid leukemia italian patients who discontinued tyrosine kinase inhibitors in clinical practice

It is judged safe to discontinue treatment with tyrosine kinase inhibitors (TKI) for chronic myeloid leukemia (CML) in experimental trials on treatment-free remission (TFR). We collected a total of 293 Italian patients with chronic phase CML who discontinued TKI in deep molecular response. Seventy-two percent of patients were on treatment with imatinib, and 28% with second generation TKI at the time of discontinuation. Median duration of treatment with the last TKI was 77 months [Interquartile Range (IQR) 54;111], median duration of deep molecular response was 46 months (IQR 31;74). Duration of treatment with TKI and duration of deep molecular response were shorter with second generation TKI than with imatinib (P<0.001). Eighty-eight percent of patients discontinued as per clinical practice, and reasons for stopping treatment were: toxicity (20%), pregnancy (6%), and shared decision between treating physician and patient (62%). After a median follow up of 34 months (range, 12-161) overall estimated TFR was 62% (95%CI: 56;68). At 12 months, TFR was 68% (95%CI: 62;74) for imatinib, 73% (95%CI: 64;83) for second generation TKI. Overall median time to restart treatment was six months (IQR 4;11). No progressions occurred. Although our study has the limitation of a retrospective study, our experience within the Italian population confirms that discontinuation of imatinib and second generation TKI is feasible and safe in clinical practice