Promoting Universal Equitable Accessibility: An Overview on the Impact of Assistive Technology in the UN, UNICEF, and WHO Web Portals

The number of people with disabilities and frailties who need support and assistance is increasing. Assistive technologies (ATs) are increasingly playing a central role in supporting people with disabilities and frailties. The study investigated the impact of the ATs on the websites of the UN, UNICEF, and WHO in terms of proposed activities and actions. The methodology proposed was based on two points of view: (1) A formal process to directly select elements in the institutional webs of the UN, UNICEF, and WHO. (2) A formal process for a complementary literature narrative review based on an umbrella review of Pubmed and Scopus. A standard checklist and a qualification process were applied. The outcome reported 35 documents from the direct search on the web and 19 systematic reviews for the complimentary literature overview. The direct search returned documents related to initiatives focused on the following: The tailoring of the ATs to a person based on international guidelines and specific monitoring initiatives of the AT introduction/access based on surveys both at the population and system/government level with the publication of the data/metadata in an observatory. Dissemination initiatives of both the culture of ATs (e.g., catalog, guidelines, reports, congresses) and of recommendations. The literature overview contributed more specifically to the use and effectiveness of categories of ATs. Both direct research and the literature overview have shown a consistent growth in interest in ATs. The initiatives of the UN, UNICEF, and WHO have been consistent with the institutional role and aimed at improving the diffusion of ATs through capillary monitoring, which is not free from obstacles, and a diffusion of the culture and rational use of ATs. The narrative review shows also the important role of research in monitoring the development, use, and effectiveness of devices, strategies, and support of international institutional initiatives. Important initiatives have been launched internationally on AT in terms of monitoring, dissemination, and improvement in access. However, it is necessary to consider and face the obstacles that limit these initiatives.

Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021

Background

Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19.

Methods

We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility.

Results

Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively.

Conclusions

In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.

Development and early results of a comprehensive sexuality education experience in Italian schools

Background

Comprehensive sexuality education (CSE) is an integrated approach to sexual health and wellbeing promotion, especially effective when performed in school settings, but it is not included in Italian school curricula. This study describes the creation and early results of a pilot experience targeting students attending 20 lower secondary schools (LSS) in 4 Italian regions within EduForIST project, funded by the Ministry of Health.

Methods

A literature review and a national survey were used to collect guidelines and best practices in the field of sexuality education (SE), along with focus groups and multisectorial expert consultations. The results informed the development of 4 modules of 2 hours each, addressing: changes in adolescence; emotions and relationships; sexual identities and diversity; sexual consent, pregnancy and sexually transmitted infection (STI) prevention, sexual health services. A final session was dedicated to evaluation.

Results

The pre-test results referred to 14 classrooms of 5 schools within 2 Regions, for a total of 266 students. A high level of uncertainty was reported, regarding the topics of personal identity development (37,4%), experiencing intense emotions during adolescence (18,1%), the definitions of gender identity, sexual orientation and stereotype (42,1%), STI symptoms (58,7%) and prevention (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p<.05) for 12/15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with positive results.

Conclusions

Preliminary results revealed knowledge gaps and high levels of uncertainty among LSS students. Early pre/post evaluation suggested that the pilot activity was effective in enhancing knowledge and decreasing uncertainty in all domains. Evidence collected through this study will foster awareness among policy makers on the value and urgency of introducing CSE in Italian school curricula.

Key messages

Implementing a school-based comprehensive sexual health education intervention in Italy: experiences from the field

Introduction

This study describes the preliminary results of a School-based sexuality education (SBSE) pilot activity developed and implemented within EduForIST project, funded by the Italian Ministry of Health.

Methods

The pilot activity (5 modules of 2 hours each delivered per classroom) targeted lower secondary schools students. A total of 20 schools located in 4 different Italian regions participated. The educators were staff of several HIV/AIDS civil society organisations operating in Italy. A 2-days intensive workshop for educators was performed. Pre and post tests were conducted.

Results

At the time of submission, pre-test results were available from 14 classrooms of 5 schools within 2 Italian Regions, for a total of 266 students. Among these, 37,4% were unsure that personal identity is built through social comparison; 21,8% reported that emotions don't get more intense during adolescence, while 18,1% were unsure about the response; 42,1% reported a higher level of uncertainty concerning the definitions of gender identity, sexual orientation and stereotype. The highest level of uncertainty were reported for STIs symptoms (58,7%), impact of treatment on HIV+ people (61,9%) and efficacy of contraceptive pills in preventing STIs (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p < 0.05) for 12 of 15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with preliminary positive results.

Conclusions

Since activities are ongoing, further data will be soon available for more exhaustive analyses. Early pre/post evaluations suggested that the pilot experience was effective in enhancing knowledge and decreasing uncertainty in the different domains addressed in the pilot. Evidence collected through this study shall raise awareness among decision makers on the urgency of introducing CSE in Italian school curricula and inform future policy options.

Awareness and perception of accuracy of the Undetectable=Untransmittable message (U=U) in Italy: results from a survey among PLWHA, infectious-diseases physicians and people having unprotected sex

Evidences on the absence of risk of sexual transmission of HIV by persons living with HIV/AIDS (PLWHA) with undetectable plasma HIV-RNA (HIV-RNA <200 copies/ml) led to the worldwide campaign "U = U" (undetectable = untransmittable). The purpose of this study was to evaluate the perceived accuracy of this message among PLWHA, HIV-negative people having unprotected sex (PHUS) and infectious diseases' (ID) physicians in Italy. A nationwide survey has been conducted using three different anonymous questionnaires (for ID physicians, PLWHA and PHUS). A total of 1121 participants filled the questionnaires: 397 PLWHA; 90 physicians; 634 PHUS. Awareness of U = U message has been reported in 74%, 92% and 47% of PLWHA, ID physicians and PHUS, respectively. The perception of accuracy of the U = U message among those aware was reported as high in 80.4%, 79.5% and 67.3% of PLWHA, ID physicians and PHUS, respectively. Physicians perceived that 11% of PLWHA have a high rate of perception of U = U, whereas among PLWHA, only 34% reported definitive positive messages from physicians. Discrepancies between awareness and perception of accuracy of the message U = U in PLWHA and physicians have been found, suggesting still low confidence in the community regarding the message itself.

Ethics and Automated Systems in the Health Domain: Design and Submission of a Survey on Rehabilitation and Assistance Robotics to Collect Insiders’ Opinions and Perception

Background: The problem of the relationship between ethics and robotics is very broad, has important implications, and has two large areas of impact: the first is conduct in research, development, and use in general. The second is the implication of the programming of machine ethics. Purpose: Develop and administer a survey of professionals in the health domain collection of their positions on ethics in rehabilitation and assistance robotics. Methods: An electronic survey was designed using Microsoft Forms and submitted to 155 professionals in the health domain (age between 23 and 64 years; 78 males, mean age 43.7, minimum age 24, maximum age 64; 77 females, mean age 44.3, minimum age 23, maximum age 64) using social media. Results and discussion: The outcome returned: (a) the position on ethics training during university studies and in the world of work, (b) the organizational aspects hindered by ethics and those to be perfected in relation to ethics, (c) issues of ethical concern, (d) structured feedback on the usefulness of the methodology along with considerations of open text. Conclusions: An electronic survey methodology has allowed the structured collection of information on positions towards ethics in this sector. Encouraging feedback from the participants suggests the continuation of the study is beneficial. A continuation is expected, expanding the audience of professionals involved and perfecting the survey with the support of scientific companies.

Adapting the World Health Organization rapid Assistive Technology Assessment (rATA) to the Italian context: implementation of a TRAPD-based approach

BACKGROUND

Measuring access to assistive technology (AT) has become a global priority. Recently, the World Health Organization (WHO) has developed the rapid assistive technology assessment (rATA), a population-based household survey that measures the use, need, unmet need, and barriers to accessing AT.

OBJECTIVE

The aim of this paper is to report on the translation and adaptation process undertaken to implement the rATA survey in the Italian context.

METHOD

The Translate, Review, Adjudicate, Pretest, and Document (TRAPD) approach was used to translate and adapt the rATA from English to Italian. Eleven independent reviewers and 23 AT users were involved to validate the Italian translation of the rATA and pilot the survey, respectively.

RESULTS

The feedback provided by the first users of the rATA indicate that the data collected are reliable and well reflect the state of AT provision in Italy.

CONCLUSION

This study confirmed the applicability of the rATA survey to the Italian context. The Italian version of the rATA can be used to support the government, the health system as well as the civil society to monitor the current state of AT access (and abandonment) in the country.

Differences in the clinical characteristics of COVID-19 patients who died in hospital during different phases of the pandemic: national data from Italy

Background

Epidemiological data obtained during the initial wave of the COVID-19 epidemic showed that persons dying with COVID-19 were typically older men with multiple chronic conditions. No studies have assessed if the characteristics of patients dying with COVID-19 have changed in the second phase of the epidemic, when the initial wave subsided. The aim of the present study was to compare characteristics of patients dying with COVID-19 in Italy in the first ‘peak’ phase of the epidemic and in its second phase.

Methods

Medical charts of patients with COVID-19 who died while in hospital in Italy were reviewed to extract information on pre-existing comorbidities, in-hospital complications, and disease trajectories. The course of the epidemic was classified in two 3-month periods: March–May 2020 and June–August 2020.

Findings

Overall, in the Italian population, 34,191 COVID-19 deaths occurred in March–May 2020 and 1,404 in June–August 2020. Patients dying in March–May were significantly younger (80.1 ± 10.6 vs. 82.8 ± 11.1 years, p < 0.001) and less frequently female (41.9% vs. 61.8%, p < 0.001) than those dying in June–August. The medical charts of 3533 patients who died with PCR-confirmed SARS-CoV-2 infection in March–May 2020 (10.3% of all deaths occurring in this period) and 203 patients who died in June–August 2020 (14.5% of all deaths occurring in this period) were analysed. Patients who died in March–May 2020, compared to those who died in June–August 2020, had significantly lower rates of multiple comorbidities (3 or more comorbidities: 61.8% vs 74.5%, p = 0.001) and superinfections (15.2% vs. 52.5%, p < 0.001). Treatment patterns also substantially differed in the two study periods, with patients dying in March–May 2020 being less likely to be treated with steroids (41.7% vs. 69.3%, p < 0.001) and more likely to receive antivirals (59.3% vs. 41.4%, p < 0.001). Survival time also largely differed, with patients dying in March–May 2020 showing a shorter time from symptoms onset to death (mean interval: 15.0 vs. 46.6 days, p < 0.001). The differences observed between the two periods remained significant in a multivariate analysis.

Interpretation

The clinical characteristics of patients dying with COVID-19 in Italy, their treatment and symptom-to-death survival time have significantly changed overtime. This is probably due to an improved organization and delivery of care and to a better knowledge of disease treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-020-01764-0.

Computer Vision Tools for 3D Modelling in Archaeology

In archaeological Cultural Heritage study 3D modelling has become a very useful process to obtain indispensable data for documentation and visualization. Nowadays the continuous request to achieve photorealistic 3D models has led to testing different techniques and methodologies to speed up both data acquisition and the data processing phase. There are many examples of surveys conducted with the use of range-based and image-based techniques, but, in the last few years, the scientific research has been increasingly moving towards automatic procedures using Computer Vision approach to reduce time during data processing. Computer Vision approach offers a great opportunity for archaeological survey since it can be very easily used by existing Computer Vision interfaces such as 3D web services and open source or low cost software. The aim of this work is to evaluate the performance offered by Computer Vision interfaces for 3D survey of archaeological ruins using some 3D web-service tools and a low cost software like PhotoScan package. Some tests have been performed to analyze the geometric accuracy of 3D models obtained by 3D web-service tools and PhotoScan package through the comparison with a 3D model achieved by laser scanning survey.

General and specific mortality among the elderly during the 2003 heat wave in Genoa (Italy)

The effects of heat waves on health can be serious for elderly persons, especially those in urban areas. We investigated in-depth the mortality excess during the 2003 heat wave among elderly persons (>74 years) in the City of Genoa (Italy). The excess in general mortality was calculated for the period July 16-August 31, as the ratio of observed to expected deaths. To evaluate "harvesting", we compared observed and expected mortality in the period September 2003-April 2004. We also studied the relationship between mortality and climatic conditions considering daily maximum temperature and Humidex discomfort degrees, as well as "lag-time". For cause-specific mortality, we considered all pathologies reported on the death certificate. The excess in general mortality was significant and was greatest in the first half of August. During Summer 2003, in Genoa the climatic conditions (described in terms of maximum temperature and Humidex Index) were extremely hot; regarding lag-time, the greatest correlation between the number of observed deaths and the maximum temperature values was observed for the three preceding days (rho=0.568; significance level<0.01). The prominent causes of death, for which an excess was observed, were cerebrovascular diseases, severe respiratory diseases, severe renal diseases, dementia; moreover, certain pathologic conditions and symptoms, usually not lethal, were also frequent causes of death (e.g., hypovolemia, hyperpyrexia, decubitus ulcers and immobilization syndrome). The results of this study confirm the relationship between the heat waves and death among elderly, stressing that, because of their poorer physical health and the prevalence of cognitive disturbances that hinder risk perception, it is necessary to properly care for them during heat waves.

Epidemiologic study of mortality during the Summer 2003 heat wave in Italy

INTRODUCTION

It is widely recognized that extreme climatic conditions during summer months may constitute a major public health threat. Owing to what is called the "urban heat island effect," as well as to the consequences of heat waves on health, individuals living in cities have an elevated risk of death when temperature and humidity are high compared to those living in suburban and rural areas. Studies on heat wave-related mortality have further demonstrated that the greatest increases in mortality occur in the elderly. Following the unusually hot summer of 2003 and the dramatic news from neighboring countries such as France, the Italian Minister of Health requested the Istituto Superiore di Sanita-Bureau of Statistics to undertake an epidemiologic study of mortality in Italy during Summer 2003 to investigate whether there had been an excess of deaths, with a particular focus on the elderly population.

MATERIALS AND METHODS

Communal offices, which maintain vital statistics, were asked for the individual records of death of residents registered daily during the period 1 June-31 August 2003 and during the same period of 2002 for each of the 21 capitals of the Italian regions. As it was necessary to obtain mortality data quickly from many municipalities and to make the analysis as soon as possible, the method adopted was comparison of mortality counts during the heat wave with figures observed during the same period of the previous year.

RESULTS

Compared with 2002, between 1 June and 31 August 2003, there was an overall increase in mortality of 3134 (from 20,564 to 23,698). The greatest increase was among the elderly; 2876 deaths (92%) occurred among people aged 75 years and older, a more than one-fifth increase (21.3%, from 13.517 to 16.393%). The highest increases were observed in the northwestern cities, which are generally characterized by cold weather, and in individuals 75 years and older: Turin (44.9%), Trento (35.2%), Milan (30.6%), and Genoa (22.2%). Of note are also the increases observed in two southern cities, L'Aquila (24.7%) and Potenza (25.4%), which are located, respectively, at 700 and 800 m above see level. For Bari and Campobasso, both in the South, with a typically hot summer climate, the increase during the last 15 days of August was 186.2 and 450%, respectively.

CONCLUSIONS

The relationship between mortality and discomfort due to climatic conditions as well as the short lag time give a clear public health message: preventive, social, and health care actions must be administered to the elderly and the frail to avoid excess deaths during heat waves.

[Epidemiologic Study of Mortality during summer 2003 in Italy]

Following the unusually hot summer this year and the dramatic news from neighboring countries such as France, the Italian Minister of Health requested an epidemiologic mortality study during summer 2003, to investigate whether there had been an excess of deaths in Italy, particularly for the elderly population. Communal offices, which provide vital statistics, were asked for the number of deaths among resident people, occurred from June 1 to August 31, for 2003 and 2002, for the 21 Italian regions capitals. A mortality increase of 3,134 deaths was observed for 2003; most of them (92%) were people aged 75 years and older. The highest increases were observed in the North Western cities (Turin, Milan, Genoa). The relationship between mortality and climatic indexes (T. max, Humidex) was investigated and a clear correlation was observed.

Serum cotinine as a marker of environmental tobacco smoke exposure in epidemiological studies: the experience of the MATISS project

To describe serum cotinine levels in a rural Italian population and to examine its usefulness as an epidemiologic biomarker of nicotine exposure, cross-sectional data collected in 1993 for the MATISS Project (2098 men and 1352 women, aged 20-79 years) were used. The study population consisted of 977 current smokers, 882 nonsmokers reporting exposure to environmental tobacco smoke (ETS) and 1520 nonsmokers reporting no ETS exposure. Mean values of serum cotinine measured by radioimmunoassay for never smokers, ex-smokers and current smokers (including four categories of cigarette consumption), and for categories of ETS exposure in all nonsmokers were calculated. In univariate analysis, there was a positive association between self-reported nicotine exposure and serum cotinine levels in all groups. Using self-reported status as truth, sensitivity and specificity for various cotinine cutoff points were estimated to distinguish nonsmokers from smokers. The value of 15 ng/mL represented the best combined levels of sensitivity (95%) and specificity (96%). Using this cutoff point, the overall misclassification rate for self-reported nonsmokers was 2.1% and about two times greater for the more vs. the less educated. In multivariate analysis, reported ETS exposure among nonsmokers was significantly associated with serum cotinine even after adjusting for age, socio-demographic and behavioural factors, though the strength of the association was not strong. In conclusion, serum cotinine represents a reliable epidemiological marker of nicotine intake and may be helpful when studying ETS exposure. Improved information collection is needed to reduce misclassification among nonsmokers and enhance our understanding of the relationship between ETS and cotinine measures.

[Cardiovascular risk factors in women in menopause]

BACKGROUND

During menopause, women are more exposed to cardiovascular risk factors, some of them can be easily modified by primary and secondary prevention. This paper describes some demographic indicators and cardiovascular risk factors among Italian women.

METHODS

This study describes the Italian women's cardiovascular risk, using the data collected and updated at the end of the 1990s, within the Cardiovascular Epidemiological Observatory, an Italian Collaborative Project of the Istituto Superiore di Sanità and the Italian Association of Cardiologists.

RESULTS

Women aged 60 years and over represent 13% of the population; regional differences on mean values of cardiovascular risk factors are evident. Hypertension, hypercholesterolemia, diabetes and obesity are prevalent particularly in Southern Italy and among the social classes in the lowest education level.

CONCLUSIONS

The data confirm the importance of the main objectives stated by the National Health Plan 1998-2000: promotion of healthier dietary habits, of physical activity, and reduction of smoking habits. This requires specific action to improve women's health condition, to provide for their special needs and to create awareness among women about the importance of preventive action also during the aging process.

Reproductive male-mediated risk: spontaneous abortion among wives of pesticide applicators

This study was conducted among 32 pesticide applicators occupationally exposed to pesticides to determine whether paternal exposure is associated with an increased risk of spontaneous abortion. The ratio of abortion was compared between applicators and a group of 51 food retailers (control population). The ratio of abortions/pregnancies for applicators was 0.27 and for retailers 0.07. OR for spontaneous abortion adjusted for age of wife and smoking of parents is 3.8 times greater than for the control population in the multiple logistic regression model and 7.6 times with interaction effects model.

[Study of the health status of subjects born with medical-assisted reproduction: the connexion between epidemiology and bioethics]

The knowledge of the newborns' health status from medical assisted procreation techniques represents the main objective of public health in this field. It is not acceptable, in fact, the use of fertilisation and artificial insemination techniques without a correct evaluation of these newborns' health status. As probable risks exist in medical protocols of treatments (mothers' exposition to hormonal drugs, manipulations of gametes, embryo development in growing coculture with different animal cells, cryopreservation, lack of natural selection of spermatozoa in intracytoplasmatic sperm injection techniques), a check of the results of these techniques is extremely necessary. Newborns' health status must be detected not only at delivery time but also in the following period to evaluate the right physical and psychological development. To estimate infertility risk that these children might run after their mothers' hormonal treatment, it is necessary to follow these subjects till adult age.

[Activity of the Istituto Superiore di Sanitá regarding medically assisted reproduction]

In vitro fertilization and embryo transfer, embryo cryo-preservation, multiple pregnancies, embryo reduction, embryo and gamete donation: each of these questions deserves an articulate ethical and medical discussion. In Italy until this moment we do not have a legislation for the regulation of medically assisted reproduction. One of the most suitable means to monitoring large scale initiatives for medically assisted procreation is through registries that collect standardized information on all treatment cycles performed. In 1992, the Italian national registry on medically assisted procreation was established at the Istituto Superiore di Sanità (ISS, the Italian National Health Institute). The Registry collects data sent voluntarily by centers to the ISS for each cycle of treatment started and for each outcome. The data collected can be used to conduct an adequate statistical-epidemiological analysis and to better evaluate results of specific techniques.

Anophthalmia and benomyl in Italy: a multicenter study based on 940,615 newborns

Following the report on clusters of anophthalmia and microphthalmia in England and Wales and their possible relation to the pesticide Benomyl, we analyzed the situation in Italy for the period 1986 to 1990 using data from the Italian registries of congenital malformations and national data on Benomyl use. Of 940,615 consecutive births, 33 cases of clinical anophthalmia and 78 cases of microphthalmia were reported (birth prevalence: 0.35 and 0.83/10,000). Birth prevalence by region for 18 of Italy's 20 political regions was evaluated for the two malformations, grouped together after exclusion of defects associated with chromosomal anomalies, no dishomogeneity in space or time among registries or among regions was observed for the study period. In no region was a statistically significant difference identified between observed and expected overall birth prevalence. Correlation analysis between the prevalence of micro/anophthalmia and Benomyl use by region showed a negative, nonsignificant coefficient, and an inverse correlation was found when the 18 regions were divided into four groups by increasing levels of Benomyl use. Parental occupation in agriculture did not seem to be associated with micro/anophthalmia when compared to a control group affected with isolated prearicular tags (odds ratio 0.63; CL 0.07-2.52). On the basis of these results, though the limits intrinsic to ecologic correlation studies must be taken into account, an association between Benomyl use and congenital micro/anophthalmia appears to be unlikely.

The prediction of coronary heart disease in different population samples

Two population samples of men aged 46-65 years were examined for the measurement of some cardiovascular risk factors and followed up for 6.5 years. The two groups were: 1) 3338 men belonging to occupational groups examined in Rome (ROG) in 1979-81 and 2) 1543 men belonging to two demographic samples of rural areas located in northern and central Italy (IRA) examined in 1965. In men free from previous myocardial infarction the rate of fatal coronary events was 18.0 in the ROG group and 17.5 per 1000 in the IRA group. Five established risk factors (age, systolic blood pressure, serum cholesterol, cigarette consumption and body mass index) were used in a multivariate model for predicting coronary deaths. The coefficients of the multiple logistic function were similar in the two populations group. However, when the IRA coefficients were applied to the ROG factors, they predicted 43 events instead of 58 (under-estimation of 26%; p < 0.05), whereas the ROG coefficients predicted 31 events instead of 26 in the IRA sample (over-estimation of 19%; p = n.s.). A model which included the pool of the two populations and a dummy-variable for the identification of each of them, suggested that being a member of the ROG group is accompained, everything else being equal, by an extra risk of 26%.

Effect of acute or chronic administration of imipramine on spinal and supraspinal micturition reflexes in rats

Acute imipramine administration (15 mg/kg i.p. 60 min before) increased the threshold for activating the spinal but not the supraspinal vesico-vesical micturition reflex in urethane-anesthetized rats. On the other hand, "chronic" imipramine administration (15 mg/kg i.p./day for 5 consecutive days) increased selectively the threshold of the supraspinal micturition reflex. Intravenous administration of cumulative doses of imipramine (up to 14 mg/kg) exerted a progressive inhibitory effect on the supraspinal reflex and voiding efficiency, possibly related to direct inhibition of muscular contractility at the bladder level. However, with the dose regimen used to compare the action of imipramine on spinal and supraspinal reflexes (15 mg/kg i.p., 60 min before), imipramine did not affect the volume-pressure curve or myogenic activity in decentralized bladders (bilateral removal of pelvic ganglia). The effect of acute imipramine on threshold of the spinal vesico-vesical reflex was absent in rats receiving oral p-chlorophenylalanine to deplete 5-hydroxytryptamine stores in the central nervous system. On the other hand, p-chlorophenylalanine pretreatment did not prevent the action of chronic imipramine administration on the supraspinal reflex. Acute administration of desipramine, the major metabolite of imipramine, increased threshold of the spinal but not supraspinal micturition reflex. These findings indicate that the ability of imipramine to modulate vesico-urethral motility at the central nervous system level may involve different mechanisms. Inhibition of 5-hydroxytryptamine reuptake in nerve terminals may be important for the acute modulatory effect of imipramine on the spinal reflex.

The effect of SC-19220, a prostaglandin antagonist, on the micturition reflex in rats

SC-19220 (5-20 mg/kg i.v.), a competitive receptor antagonist of PGE, increased the bladder capacity and reduced the voiding efficiency of micturition (elicited by slow transvesical filling) of urethane-anesthetized rats. The effect of SC-19220 was prevented by indomethacin pretreatment, whereas indomethacin per se mimicked the effects of SC-19220. SC-19220 produced a competitive rightward shift of the dose-response curve for the contractile effect induced by PGE2 on strips of rat detrusor muscle in vitro, whereas the amplitude of nerve-mediated twitches was unaffected. These findings support the hypothesis that endogenous PGE2 is physiologically involved in the regulation of vesicourethral motility in this species by facilitating attainment of the micturition threshold during the collection phase of the cystometrogram.

Prostanoids modulate reflex micturition by acting through capsaicin-sensitive afferents

Topical application of exogenous prostanoids (PGE2, TBX B2) on the serosal surface of the urinary bladder of urethane-anaesthetized rats activated reflex micturition. Likewise, intravesical instillation of PGE2 during the cystometrogram lowered the threshold for reflex micturition. Both effects were prevented by systemic capsaicin desensitization (50 mg/kg s.c., 4 days before). Indomethacin pretreatment and systemic capsaicin desensitization each increased the micturition threshold without affecting the amplitude of micturition contraction. However, the effect of the two treatments combined was not greater than the effect of either alone. These findings support the idea that endogenous prostanoids facilitate reflex micturition by stimulating or sensitizing, directly or indirectly, the subset of bladder mechanoreceptors which is capsaicin-sensitive in adult rats.

The effects of baclofen on spinal and supraspinal micturition reflexes in rats

1. The effect of (+/-)-baclofen on micturition reflexes was investigated in urethane-anaesthetized rats. A 'low' dose of (+/-)-baclofen (0.5 mg/kg i.v.) barely affected the early phase of the transurethral cystometrogram (CMG) which involves activation of a spinal vesico-vesical excitatory reflex. 2. At a higher dose (2.5 mg/kg i.v.) (+/-)-baclofen suppressed both the spinal and supraspinal components of the bladder response to transurethral saline filling. 3. When the bladder was filled by the transvesical route a series of regular voiding cycles was obtained which are due to activation of a supraspinal vesico-vesical excitatory reflex. In this model, voiding efficiency of the rat bladder was markedly reduced even after a low dose of (+/-)-baclofen (0.5 mg/kg) and almost suppressed at 2.5 mg/kg. 4. (+/)-Baclofen reduction of voiding efficiency was mainly ascribable to an inhibitory effect on the expulsive phase of the voiding cycle which, in rats, depends critically upon the activation of a reflex which induces a twitch-like contraction of urethral/periurethral skeletal muscles. 5. (+/-)-Baclofen produced a small inhibition of the pinching-induced somatovesical excitatory reflex. (+/-)-Baclofen (2.5 mg/kg i.v.) produced also a marked but transient inhibition of bladder contractions induced by preganglionic nerve stimulation. However the time course of this effect was markedly shorter as compared to the long lasting suppression of voiding cycle observed with this same dose of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)