Real-life use of ropeg-interferon α2b in polycythemia vera: patient selection and clinical outcomes

Ropeginterferon-alfa2b (ropegIFNα2b) is a long-acting IFN formulation with broad FDA/EMA approval as a therapy of polycythemia vera (PV) with no symptomatic splenomegaly. There is currently lack of information on the real-world patient selection, including the impact of local reimbursement policies, and drug management, particularly: type/timing of screening and follow-up tests; absolute/relative contraindications to therapy; ropegIFNα2b dose and combinations with hydroxyurea. As a sub-analysis of the PV-ARC retrospective study (NCT06134102), we here report our monocenter experience with ropegIFNα2b in the period from January 2021, corresponding to drug availability outside clinical trial, and December 2023. Among the 149 patients with EMA/FDA indication, only 55 (36.9%) met the local reimbursement criteria and 18 (12.1%) received ropegIFNα2b. Thanks to appropriate screening, relative/absolute contraindications to ropegIFNα2b were detected and managed in a multidisciplinary manner. Efficacy and safety of ropegIFNα2b was confirmed, with 3 cases of early molecular response. General use of low ropegIFNα2b dose, with frequent need for hydroxyurea combinations, was noted. This real-world experience suggests a significant impact of local regulations on drug prescription and the need for greater real-world data collection on ropegIFNα2b in PV patients. Also, it describes appropriate multidisciplinary screening and monitoring procedures during ropegIFNα2b therapy.

A self-repair history: compensatory effect of a de novo variant on the FANCA c.2778+83C>G splicing mutation

Introduction: Fanconi anemia (FA) is a genome instability condition that drives somatic mosaicism in up to 25% of all patients, a phenomenon now acknowledged as a good prognostic factor. Herein, we describe the case of P1, a FA proband carrying a splicing variant, molecularly compensated by a de novo insertion. Methods and Results: Targeted next-generation sequencing on P1's peripheral blood DNA detected the known FANCA c.2778 + 83C > G intronic mutation and suggested the presence of a large deletion on the other allele, which was then assessed by MLPA and RT-PCR. To determine the c.2778 + 83C > G splicing effect, we performed a RT-PCR on P1's lymphoblastoid cell line (LCL) and on the LCL of another patient (P2) carrying the same variant. Although we confirmed the expected alternative spliced form with a partial intronic retention in P2, we detected no aberrant products in P1's sample. Sequencing of P1's LCL DNA allowed identification of the de novo c.2778 + 86insT variant, predicted to compensate 2778 + 83C > G impact. Albeit not found in P1's bone marrow (BM) DNA, c.2778 + 86insT was detected in a second P1's LCL established afterward, suggesting its occurrence at a low level in vivo. Minigene assay recapitulated the c.2778 + 83C > G effect on splicing and the compensatory role of c.2778 + 86insT in re-establishing the physiological mechanism. Accordingly, P1's LCL under mitomycin C selection preserved the FA pathway activity in terms of FANCD2 monoubiquitination and cell survival. Discussion: Our findings prove the role of c.2778 + 86insT as a second-site variant capable of rescuing c.2778 + 83C > G pathogenicity in vitro, which might contribute to a slow hematopoietic deterioration and a mild hematologic evolution.

The history of antiphospholipid syndrome

Antiphospholipid Syndrome (APS) is an autoimmune disease which was defined in the early 1980s. The principal features include thromboembolic events and/or pregnancy losses in association with antiphospholipid antibodies (aPL). As an historical note, the full-blown picture of the syndrome resembles the illness suffered by Anne Stuart, Queen of England in the XVIII century, whose repeated miscarriages caused the end of the royal Stuart line and the Hanoverian succession. The identification of aPL started in the early XX century and was linked to the introduction of the serological test for the diagnosis of syphilis. This involves a reaction between an antibody (reagin) and a phospholipid antigen derived from bovine heart (cardiolipin). Later on, it was observed that not all subjects with a positive test had syphilis, and that the so called "false positive reaction" was often reported in patients with systemic lupus erythematosus. Different tests for the identification of aPL were subsequently developed: first lupus anticoagulant (1971) and then immunoassays for anticardiolipin (1983) and anti-beta2 glycoprotein I (1990) antibodies. In the same period the association between the presence of circulating aPL and thrombotic and obstetric events was established, both in patients with autoimmune diseases and in otherwise healthy subjects, leading to the identification of APS as a distinct autoimmune disease. This has allowed better diagnosis and more targeted treatment for many patients.

How to 'SAVE' antibiotics: effectiveness and sustainability of a new model of antibiotic stewardship intervention in the internal medicine area

BACKGROUND

Antibiotic stewardship (AS) is a cornerstone of the fight against antimicrobial resistance; however, evidence on the best practice to improve antibiotic prescription in various hospital settings is still scarce. This study aimed to measure the efficacy of a non-restrictive AS intervention in the internal medicine area of a tertiary-care hospital across a 3-year period.

METHODS

The intervention comprised a 3-month 'intensive phase' based on education and guidelines provision, followed by 9 months of audits and feedback activities. The primary outcome was the overall antibiotic consumption measured as days of therapy (DOTs) and defined daily doses (DDDs). Secondary outcomes were carbapenem and fluoroquinolone consumption, all-cause in-hospital mortality, length of stay, incidence of Clostridioides difficile and carbapenem-resistant Enterobacterales bloodstream infections (CRE-BSIs). All outcomes were measured in the intervention wards comparing the pre-phase with the post-phase using an interrupted time-series model.

RESULTS

A total of 145 337 patient days (PDs) and 14 159 admissions were included in the analysis. The intervention was associated with reduced DOTs*1000PDs (-162.2/P = 0.005) and DDDs*1000PDs (-183.6/P ≤ 0.001). A sustained decrease in ward-related antibiotic consumption was also detected during the post-intervention phase and in the carbapenem/fluoroquinolone classes. The intervention was associated with an immediate reduction in length of stay (-1.72 days/P < 0.001) and all-cause mortality (-3.71 deaths*100 admissions/P = 0.002), with a decreasing trend over time. Rates of Clostridioides difficile infections and CRE-BSIs were not significantly impacted by the intervention.

CONCLUSIONS

The AS intervention was effective and safe in decreasing antibiotic consumption and length of stay in the internal medicine area. Enabling prescribers to judicious use of antimicrobials through active participation in AS initiatives is key to reach sustained results over time.

Things come in threes: A new complex allele and a novel deletion within the CFTR gene complicate an accurate diagnosis of cystic fibrosis

Background

Despite consolidated guidelines, the clinical diagnosis and prognosis of cystic fibrosis (CF) is still challenging mainly because of the extensive phenotypic heterogeneity and the high number of CFTR variants, including their combinations as complex alleles.

Results

We report a family with a complicated syndromic phenotype, which led to the suspicion not only of CF, but of a dominantly inherited skeletal dysplasia (SD). Whereas the molecular basis of the SD was not clarified, segregation analysis was central to make a correct molecular diagnosis of CF, as it allowed to identify three CFTR variants encompassing two known maternal mutations and a novel paternal microdeletion.

Conclusion

This case well illustrates possible pitfalls in the clinical and molecular diagnosis of CF; presence of complex phenotypes deflecting clinicians from appropriate CF recognition, and/or identification of two mutations assumed to be in trans but with an unconfirmed status, which underline the importance of an in‐depth molecular CFTR analysis.

Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

Correlation between olfactory function, age, sex, and cognitive reserve index in the Italian population

Purpose

Loss of smell decreases the quality of life and contributes to the failure in recognizing hazardous substances. Given the relevance of olfaction in daily life, it is important to recognize an undiagnosed olfactory dysfunction to prevent these possible complications. Up to now, the prevalence of smell disorders in Italy is unknown due to a lack of epidemiological studies. Hence, the primary aim of this study was to evaluate the prevalence of olfactory dysfunction in a sample of Italian adults.

Methods

Six hundred and thirty-three participants (347 woman and 286 men; mean age 44.9 years, SD 17.3, age range 18–86) were recruited from 10 distinct Italian regions. Participants were recruited using a convenience sapling and were divided into six different age groups: 18–29 years (N = 157), 30–39 years (N = 129), 40–49 years (N = 99), 50–59 years (N = 106), > 60 years (N = 142). Olfactory function, cognitive abilities, cognitive reserve, and depression were assessed, respectively, with: Sniffin’ Sticks 16-item Odor Identification Test, Montreal Cognitive Assessment, Cognitive Reserve Index, and the Beck Depression Inventory. Additionally, socio-demographic data, medical history, and health-related lifestyle information were collected.

Results

About 27% of participants showed an odor identification score < 12 indicating hyposmia. Multiple regression analysis revealed that OI was significantly correlated with age, sex, and cognitive reserve index, and young women with high cognitive reserve index showing the highest olfactory scores.

Conclusion

This study provides data on the prevalence of olfactory dysfunction in different Italian regions.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Analysis of tumour microstructure estimation from conventional diffusion MRI and application to skull-base chordoma. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:3761-3764. [PMID: 34892054 DOI: 10.1109/embc46164.2021.9630129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Skull-base chordoma (SBC) is a rare tumour whose molecular and radiological characteristics are still being investigated. In neuro-oncology microstructural imaging techniques, like diffusion-weighted MRI (DW-MRI), have been widely investigated, with the apparent diffusion coefficient (ADC) being one of the most used DW-MRI parameters due to its ease of acquisition and computation. ADC is a potential biomarker without a clear link to microstructure. The aim of this work was to derive microstructural information from conventional ADC, showing its potential for the characterisation of skull-base chordomas. Sixteen patients affected by SBC, who underwent conventional DW-MRI were retrospectively selected. From mono-exponential fits of DW-MRI, ADC maps were estimated using different sets of b-values. DW-MRI signals were simulated from synthetic substrates , which mimic the cellular packing of a tumour tissue with well-defined microstructural features. Starting from a published method, an error-driven procedure was evaluated to improve the estimates of microstructural parameters obtained through the simulated signals. A quantitative description of the tumour microstructure was then obtained from the DW-MRI images. This allowed successfully differentiating patients according to histologically-verified cell proliferation information.Clinical Relevance - The impact on cancer management derives from the expected improvement of radiation treatment quality tailored to a patient-specific non-invasive description of tumour microstructure.

Development and validation of a new set-up simulator dedicated to ocular proton therapy at CNAO

An Eye Tracking System (ETS) is used at CNAO for providing a stable and reproducible ocular proton therapy (OPT) set-up, featuring a fixation light (FL) and monitoring stereo-cameras embedded in a rigid case. The aim of this work is to propose an ETS set-up simulation algorithm, that automatically provides the FL positioning in space, according to patient-specific gaze direction and avoiding interferences with patient, beam and collimator. Two configurations are provided: one in the CT room for acquiring images required for treatment planning with the patient lying on a couch, and one related to the treatment room with the patient sitting in front of the beam. Algorithm validation was performed reproducing ETS simulation (CT) and treatment (room) set-up for 30 patients previously treated at CNAO. The positioning accuracy of the device was quantified through a set of 14 control points applied to the ETS case and localizable both in the CT volume and in room X-ray images. Differences between the position of ETS reference points estimated by the algorithm and those measured by imaging systems are reported. The corresponding gaze direction deviation is on average 0.2° polar and 0.3° azimuth for positioning in CT room and 0.1° polar and 0.4° azimuth in the treatment room. The simulation algorithm was embedded in a clinically usable software application, which we assessed as capable of ensuring ETS positioning with an average accuracy of 2 mm in CT room and 1.5 mm in treatment room, corresponding to gaze direction deviations consistently lower than 1°.

The anorexia of aging: impact on health and quality of life

Malnutrition for the elderly is a serious threat to their health. An elderly malnourished person is more exposed to illness, to disability and to institutionalization. Among the causes of malnutrition there is also the reduction of food intake for reduced hunger. With aging many factors favor the prevalence of satiety with respect to the desire to eat. This condition has been defined as anorexia of aging. Gastric motility impairment, unbalanced central and gastrointestinal hormone and peptide dynamics, together with sensory deterioration, depression, social and iatrogenic factors may be found frequently among older person and cause anorexia. Reduced appetite and exaggerated feeling of satiety are also causes of deterioration of quality of life, due to the decrease in the pleasure of eating and the presence of unpleasant, early and prolonged sense of fullness. Understanding the mechanisms that facilitate anorexia could help eliminate reversible causes and reduce the effect of para-physiological changes at the basis of anorexia. With this approach, it would be possible to improve the nutritional status and, at the same time, the level of quality of life of aged people.

Can we reliably predict the level of anticoagulation after enoxaparin injection in elderly patients with renal failure?

OBJECTIVES

The aim of this study was to evaluate the activity of anti-activated factor X (anti-Xa) in patients with different degrees of chronic renal failure (CRF), treated with therapeutic doses of low molecular weight heparin.

DESIGN

This prospective study evaluated the effect of age, renal function, BMI, gender, in determining the efficacy and safety of treatment with enoxaparin, evaluated by assessing the anti-Xa. The therapeutic anticoagulant range was set between 0.20 and 0.70 U/mL.

SETTING

Two hospital geriatric units.

PARTICIPANTS

98 patients (64 men, 34 women, mean age 82 years) with CRF, treated with enoxaparin at therapeutic dosage, for deep vein thrombosis or acute coronary syndrome.

MEASUREMENTS

Anti-Xa was assessed 4 h after the third administration of LMWH using Chromogenix test. Renal function was assessed by calculating creatinine clearance according to Cockcroft formula.

RESULTS

The dose of enoxaparin ranged between 53 and 200 U/kg; total 4000-16000 U/day. The mean anti-Xa was 0.41 U/mL (95% CI 0.36-0.45). Multiple regression analysis selected only the dose of enoxaparin, but not age, creatinine clearance, BMI, gender, as a predictor of anti-Xa serum levels. In seven patients anti-Xa was above the range but none of them received more than 150 U/Kg enoxaparin (100 U/kg if creatinine clearance <30 mL/min). Ten patients (eight men, two women) showed suboptimal levels of anti-Xa, regardless enoxaparin dose or creatinine clearance.

CONCLUSION

Enoxaparin dose reduction according to renal function decreases the risk of overdosing and potentially the risk of bleeding. The risk of under dosing seems less predictable; therefore, anti-Xa assay may be useful in severe clinical situations that require higher anticoagulant activity.

Activation of Protein C in Human Trophoblasts in Culture and Downregulation of Trophoblast Endothelial Protein C Receptor by TNF-α

In mice, trophoblasts are equipped with a potent anticoagulant mechanism, the protein C pathway. In human placenta, no functional studies of the protein C pathway are available. Human first-trimester trophoblasts (CK(++) HLA-G(+/-) Vim(-)) were isolated and kept in culture for a maximum of 48 hours. Activation of protein C on trophoblasts was at least as efficient as in endothelial cells (4.43 × 10 (-) (7) nmol/L/min/cell). Endothelial protein C receptor (EPCR) was expressed in syncytiotrophoblasts and extravillous trophoblasts. Downregulation of the messenger RNA of trophoblast EPCR occurred when trophoblasts were challenged with tumor necrosis factor α, and it could be prevented by unfractionated heparin but not by low-molecular-weight heparin at therapeutic doses. In conclusion, there is a functional protein C pathway on human first-trimester trophoblasts which can be modulated by inflammation. This finding has implications for the pathogenesis and prevention of placenta-mediated obstetric complications.

Commissioning and Quality Assurance of an Integrated System for Patient Positioning and Setup Verification in Particle Therapy

In an increasing number of clinical indications, radiotherapy with accelerated particles shows relevant advantages when compared with high energy X-ray irradiation. However, due to the finite range of ions, particle therapy can be severely compromised by setup errors and geometric uncertainties. The purpose of this work is to describe the commissioning and the design of the quality assurance procedures for patient positioning and setup verification systems at the Italian National Center for Oncological Hadrontherapy (CNAO). The accuracy of systems installed in CNAO and devoted to patient positioning and setup verification have been assessed using a laser tracking device. The accuracy in calibration and image based setup verification relying on in room X-ray imaging system was also quantified. Quality assurance tests to check the integration among all patient setup systems were designed, and records of daily QA tests since the start of clinical operation (2011) are presented. The overall accuracy of the patient positioning system and the patient verification system motion was proved to be below 0.5 mm under all the examined conditions, with median values below the 0.3 mm threshold. Image based registration in phantom studies exhibited sub-millimetric accuracy in setup verification at both cranial and extra-cranial sites. The calibration residuals of the OTS were found consistent with the expectations, with peak values below 0.3 mm. Quality assurance tests, daily performed before clinical operation, confirm adequate integration and sub-millimetric setup accuracy. Robotic patient positioning was successfully integrated with optical tracking and stereoscopic X-ray verification for patient setup in particle therapy. Sub-millimetric setup accuracy was achieved and consistently verified in daily clinical operation.

Elevated risk of death and major cardiovascular events in subjects with newly diagnosed diabetes: findings from an administrative database

AIMS

To investigate the incidence of major cardiovascular complications and mortality in the first years of follow-up in patients with newly diagnosed diabetes.

METHODS AND RESULTS

We examined incidence rates of hospitalization for cardiovascular reasons and death among new patients with diabetes using the administrative health database of the nine million inhabitants of Lombardy followed from 2002 to 2007. Age and sex-adjusted rates were calculated and hazard ratios (HR) were estimated with a matched population without diabetes of the same sex, age (± 1 year) and general practitioner. There were 158,426 patients with newly diagnosed diabetes and 314,115 subjects without diabetes. Mean follow-up was 33.0 months (SD ± 17.5). 9.7% of patients with diabetes were hospitalized for cardiovascular events vs. 5.4% of subjects without diabetes; mortality rate was higher in patients with diabetes (7.7% vs. 4.4%). The estimated probability of hospitalization during the follow up was higher in patients with diabetes than in subjects without for coronary heart disease (HR 1.4, 95% CI 1.3-1.4), cerebrovascular disease (HR 1.3.95% CI 1.2-1.3), heart failure (HR 1.4, 95% CI 1.3-1.4) as was mortality (HR 1.4, 95% CI 1.4-1.4). Younger patients with diabetes had a risk of death or hospital admission for cardio-cerebrovascular events similar to subjects without diabetes ten years older.

CONCLUSIONS

The elevated morbidity and mortality risks were clear since the onset of diabetes and rose over time. These data highlight the importance of prompt and comprehensive patients care in addition to anti-diabetic therapy in patients with newly diagnosed diabetes.

Prevalence, incidence and mortality of diagnosed diabetes: evidence from an Italian population-based study

AIMS

To describe trends in diagnosed diabetes prevalence, incidence and mortality from 2000 to 2007 in the most heavily populated Italian region.

METHODS

We examined the prevalence and incidence rates of Type 1 and Type 2 diabetes and yearly mortality rates among individuals with diabetes from 2000 to 2007 using an administrative health database of prescription, disease-specific exemption and hospitalization records of more than 9 million inhabitants of Lombardy. Age- and sex-specific rates were calculated and temporal trends for subjects aged ≥ 30 years were analysed.

RESULTS

The crude point diabetes prevalence rose from 3.0% in 2000 to 4.2% in 2007, a 40% increase. The incidence remained stable during the study period with a rate of 4/1000 per year. Overall mortality declined from 43.2/1000 in 2001 to 40.3/1000 in 2007 (6.7% decrease) at a rate slightly higher than that of the general population (4.8% decrease). Our projection in subjects aged ≥ 30 years indicates that the prevalence will rise continuously over the next years, reaching 11.1% in 2030.

CONCLUSIONS

The prevalence of diabetes increased substantially between 2000 and 2007, mainly because there are more patients with a new diagnosis each year than those who die. The increase observed by 2007 almost reached the World Health Organization prediction for 2030. Our analyses suggest that the increase will continue over the next few decades. These data are important for defining the burden of diabetes in the near future, to help in planning health services and ensure proper allocation of resources.

Comparison of physical and psychological status in younger and older overweight-obese women

BACKGROUND AND AIM

Obesity prevalence is noticeably growing, even in the elderly. Most of the studies concerning the impact of obesity in the elderly evaluated physical co-morbidities, whilst very few data are available on psychological co-morbidities in people ≥ 60 years of age. The present study aimed to compare anthropometrical measures, physical co-morbidities and psychosocial factors correlated with overweight and obesity in younger and elderly people.

METHODS AND RESULTS

In 456 women in the age range of 18-59 years and 128 women in the age range of 60-80 years with body mass index (BMI) ≥ 25/kg m², body weight, height and waist and hip circumferences were measured. The presence of co-morbidities such as osteoarthritis, hypertension, type 2 diabetes and hypercholesterolaemia was assessed. The Obesity Related Well Being 97 Questionnaire (ORWELL 97), Body Uneasiness Test (BUT), Symptom Check List 90 (SCL 90) and Binge Eating Scale (BES) tests were used to evaluate psychometric variables. BMI was not significantly different between younger overweight-obese subjects and older overweight-obese subjects, whereas waist circumference and waist-to-hip ratio (WHR) were significantly higher in the elderly. Osteoarthritis, hypertension and hypercholesterolaemia were significantly more frequent in the elderly. Older overweight-obese subjects had better scores in most of the psychometric questionnaires.

CONCLUSIONS

Our results show that older overweight-obese subjects have generally more physical co-morbidities but a better psychological status than younger adults, despite similar BMI. These data may contribute to a better understanding of obesity consequences in the elderly and may help clinicians to differentiate obesity treatments in relation to patients' age.

Workshop: tuning the 'cough center'

The Workshop considered the mechanisms whereby the 'cough center' could be tuned by various afferent inputs. There were particular presentations on the effects of inputs from the nose, mouth, respiratory tract and lungs, cerebral cortex, somatic tissues and the pharynx. From all these sites cough induced from the lungs could be increased or decreased in its strength or modified in its pattern. Thus 'tuning' of cough could be due to the interaction of afferent inputs, or to the sensitization or desensitization of brainstem neural pathways. The pattern of response depended on the 'type' of cough being studied and, in some instances, on the timing of the sensory input into the brainstem. Cough inputs could also affect various 'non-cough' motor outputs from the brain, although this was not the main theme of the Workshop. The main conclusion was that cough is not a stereotyped output from the medullary 'cough center', but that its pattern and strength depend on many afferent inputs acting on the 'cough center'.

[Investigation of potential risk factors for Salmonella enterica subsp enterica serotype Napoli: a nested case-control study in Lombardia region]

Enter-net surveillance system has detected the re-emergence of Salmonella enterica subsp enterica serotype Napoli (S. Napoli) since 2002. Preliminary data show that food vehicle could not be the only one implicated in the transmission of this serotype. A nested case-control study has been conducted using data form a prospective cohort: for each salmonellosis notification in Lombardia from May 2004 to December 2005 an ad hoc epidemiological investigation has been performed. Cases have been defined as subjects affected by salmonellosis with a positive faecal sample for Salmonella serotype Napoli and controls as subjects affected by salmonellosis with a positive faecal sample for Salmonella serotype not Napoli. Among 2185 salmonellosis notifications collected by 12 of 15 Local Health Authorities, we identified 67 cases and 867 controls. Infection due to S. Napoli were significantly more common among subjects with exposure to surface water (adjusted Odds Ratio (OR) = 3,82; 95% Confidence Interval (C.I.)=1,03-14,19), to domestic animals (adjusted OR = 3,22; 95% C.I. = 1,28-8,10) and among person who practice activities connected to surface water (adjusted OR 3,88; 95% C.I.=1,15-13,05) compared to subjects not exposed to these factors. Hyperendemia of S. Napoli could be attributable to an animal reservoir not yet identified: surface water contamination may be a direct (waterborne infection) or indirect (foodborne infection) vehicle for transmission of S. Napoli. behaviour. Regarding the relations of the neuroendocrine parameters and driving behaviour, positive correlations were observed between dopamine levels and frequency of driving violations while a negative relationship was found between adrenaline levels and frequency of driving errors. In conclusion the identification of psycho-physiological variables related to driving risky behaviour might be a useful instrument to design traffic safety programs tailored to high risk subjects.

A national survey of the prevalence of childhood overweight and obesity in Italy

To estimate the prevalence of childhood overweight and obesity among Italian schoolchildren and to examine geographic differences and present and future implications for health care, we used data from a nationwide representative survey performed in May 2008 among third-grade students in 18 of Italy's 21 regions. Cluster sampling was used to identify classes for participation. The study population included all children aged 8-9 years whose parents agreed to opt-out consent. Parents, children and teachers completed brief questionnaires, and children were weighed and measured by trained staff using standardized equipment. Consent was obtained for 97% of 50 197 third-graders, of whom 44 676 (89%) met study inclusion criteria. Obesity levels (defined using International Obesity Task Force cut-offs) ranged from 7.5% (95% confidence intervals 6.7-8.2) in the north to 16.6% (95% confidence intervals 15.8-17.4) in the south. Behaviours known to be associated with obesity also showed geographic differences. The estimated burden of obesity-related pathologies also increased from north to south. These findings suggest the need for community as well as individual interventions in all areas of the country but with particular attention to the south.

Ureteroscopy of Ureteral Stones: Our Experience

Introduction and Objectives

ureteroscopy is now a widely used procedure in urology. Technological advances in endourology are used to manage the majority of ureteral stones (1). In this study we evaluated retrospectively our cases of ureteral lithiasis treated by ureteroscopy.

[Promotion of healthy life style and growth in primary school children (OKkio alla SALUTE)]

In October 2007, the Italian Ministry of Health, the Centre for Disease Control and the Regions entrusted the National Institute of Health with the coordination of the initiative "Okkio alla Salute"--Promotion of healthy lifestyle and growth in primary school children. This programme is linked to the European programme "Gaining health" and the National Plan for Prevention. The objective of the project was to develop and maintain a monitoring system for both the health services and the schools that could also be used to better target public health interventions. The first national survey to estimate the prevalence of overweight and obesity in children and to collect information on diet and physical activity has been conducted in close collaboration with the individual regions. In the first nine months of the project, 1025 health workers and approximately 1500 school teachers have received training, and, using standardised methods, they have collected data and weighed and measured nearly 45000 third grade students (median age 8.8 years) in 2000 schools throughout the country. Participation rates have exceeded 95%. The results obtained to date indicate that the methodology is sustainable using existing health and educational resources and can be adopted as a national surveillance system.

[Survey of the nutritional status and related risk factors in primary school children in two Italian health units]

During the months of May and June 2007 two prevalence studies were conducted in two local health units in Italy (Terni and Bari). The objectives of the studies were to test methods and procedures to be used in the nutritional surveillance in primary schools; to measure the prevalence of obesity and overweight in children from those schools; and to determine the prevalence of physical activity and sedentary behaviour A total of 1026 children were measured and interviewed. The refusal rate was 17% in Terni and 16% in Bari. In Terni 8% of children were obese, 24% overweight, while in Bari the corresponding values were 11% and 24%. A high prevalence of behavioural risk factors for obesity was registered such as: not eating breakfast, reduced physical activity and sedentary behaviour It was also demonstrated that parents are often unaware that their children were overweight. The results of these surveys were consistent with the high prevalence that has been registered in other studies on Italian children in the third grade. The results showed also the feasibility of surveys in schools on the nutritional situation of children in primary schools, that can be adopted as a tool for a national surveillance.