Hip chronic pain: ultrasound guided ablation of anterior articular branches plus posterior neurolysis of the nerve to the quadratus femoris versus the alone anterior approach-a retrospective observational study

INTRODUCTION

Chronic hip pain is a common painful condition in the elderly population. A mini invasive technique that is increasingly being considered for management of CHP is the percutaneous denervation of hip articular branches via radiofrequency ablation. We described a new ultrasound-guided technique based on the combination of 90° ultrasound-guided anterior radiofrequency ablation of the articular branches of femoral nerve, accessory obturator nerve and obturator nerve for anterior hip, combined with 90° ultrasound-guided ablation of the articular branches of the nerve of the quadratus femoris for posterior pericapsular neurolysis of the hip.

MATERIAL E METHODS

We retrospectively analyzed the medical records of patients from September 2022 to September 2023 treated for chronic hip pain in the ambulatory of Pain Management, identifying 22 patients who underwent ultrasound guided radiofrequency denervation of anterior hip articular branches alone (Group B); and 22 patients in which was also applied a radiofrequency denervation of the posterior articular branches, in addition to the anterior denervation (Group A). We analysed the pain intensity of both groups measured with numeric rating scale.

RESULT

The combined anterior plus posterior approach ensured that the results obtained were maintained 6 months after the procedure (T3) with excellent pain control and an average NRS of 1455 for group A. While for the group B, with the anterior approach alone, the NRS at six months showed an upward trend with an average NRS of 3818. The dual approach is more effective in pain relief at 6 months with a statistically significant difference in NRS values (p < 0.001).

CONCLUSION

This retrospective observational study highlighted the greater impact of the double approach (anterior plus posterior) in the denervation of the hip joint, compared to anterior neurolysis alone.

Assessing the Physical and Psychological Well-being of Construction Workers During the COVID-19 Pandemic: A Prospective Study in Italy

OBJECTIVE

This prospective study aimed to assess the physical and psychological health of construction workers and examine the relationship between their well-being and the preventive measures implemented against SARS-CoV-2.

METHODS

During occupational visit, the workers were invited to participate the survey. Two measurements were made and compared: after the Italian lockdown and on the second wave of COVID-19 pandemic.

RESULTS

Fifty-three workers participated in the study. The percentage of workers who considered themselves in good health increased from 66.0% to 81.1%, and there was a significant decrease in the 12-item General Health Questionnaire score (16.8 vs 14.0, P = 0.0003). This reduction was associated with a higher perception of security by preventive measures.

CONCLUSIONS

The study highlights the importance of addressing the health and safety concerns of construction workers during the pandemic, and the positive impact of effective preventive measures.

Occupational risk perception of construction workers: a cross sectional study

Introduction

Construction workers are often exposed to significant injury risk. The aim of our study is to assess their occupational hazards and injury risk perception.

Methods

We administered 256 questionnaires to construction workers. The survey was aimed at collecting information regarding occupational risk and hazard exposure perception, risk control and behavioral self-assessment. We analyzed the data obtained in order to highlight any associations between injury risk perception and anamnestic, occupational, behavioral or perceptual factors.

Results

Participants were prevalently males (92.37%) aged 21-60 years (94%). They showed a job seniority level of 21.3 (11.51) on average and, ranging from a 1 to 10 score, a danger awareness of 6.8 (2.9), a lack of prevention measures 6.0 (3.3), an improper behavior of 7.3 (2.7), an unpredictable fate of 6.0 (2.9). These factors resulted significantly associated with the injury risk perception. Multivariable analysis highlighted that the injury risk perception was associated with the lack of prevention measure and unpredictable fate. On the other hand, we found a negative association with the workers' improper behaviors.

Conclusion

Workers' perception showed fairly uniform average values even when occupational risk was demonstrated. Our analysis suggests a positive correlation between injury risk perception and the idea that injuries are due both to fate and to chance; it also shows a negative correlation between injury risk perception and the idea that injuries are due to improper behavior. A lack of fully comparable studies confirms the need for further studies on the injury risk perception of construction workers.

Factors associated with chronic pelvic pain in women with endometriosis: A national study on clinical and sociodemographic characteristics, lifestyles, quality of life, and perceptions of quality of care, during the COVID-19 pandemic

BACKGROUND

Endometriosis is a persistent inflammatory condition that affects women of reproductive age and causes pelvic pain. Chronic pelvic pain is a chronic regional pain syndrome involving the pelvic area.

OBJECTIVES

This survey aimed to characterize the clinical and sociodemographic characteristics, lifestyles, quality of life, and perceptions of quality of care in women with endometriosis who reported chronic pelvic pain during the Covid pandemic.

DESIGN

We conducted a cross-sectional survey among the Italian population from July to September 2021.

METHODS

Snowball sampling was used to interview a large sample of adult women who reported a diagnosis of endometriosis, through a self-reported questionnaire. Univariate and multivariable logistic regression analyses were performed to identify the factors associated with chronic pelvic pain. The primary outcome was describing women who reported chronic pelvic pain.

RESULTS

A total of 661 out of 1045 (63%) women who responded to the survey reported chronic pelvic pain. The multivariable analysis evidenced that chronic pelvic pain was related to physical and mental quality perception, pelvic floor disorders (adjusted odds ratio = 1.58; 95% CI = 1.10-2.27; p = 0.012), dyspareunia (adjusted odds ratio = 1.87; 95% CI = 1.31-2.65; p < 0.001), adhesions syndrome (adjusted odds ratio = 1.49; 95% CI = 1.05-2.11; p = 0.026), and the delay in diagnosing endometriosis (adjusted odds ratio = 1.04; 95% CI = 1.00-1.09; p = 0.034). The only social factor associated with chronic pelvic pain was marital status (adjusted odds ratio = 0.66; 95% CI = 0.46-0.93; p = 0.019).

CONCLUSION

In the pandemic period, there was a very high prevalence of chronic pelvic pain in women with endometriosis in Italy. The pandemic highlighted the need for careful attention to diagnose endometriosis and the need for psychological and partner support, which would allow better pain management and prevent chronicity.

Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade III Hemorrhoidal Disease: The EMODART3 Multicenter Study

BACKGROUND

Over the past few decades, several surgical approaches have been proposed to treat hemorrhoids.

OBJECTIVE

This multicenter study aimed to compare transanal hemorrhoidal artery ligation and conventional excisional hemorrhoidectomy for grade III hemorrhoidal disease.

DESIGN

Multicenter retrospective study.

SETTINGS

Any center belonging to the Italian Society of Colorectal Surgery in which at least 30 surgical procedures per year for hemorrhoidal disease were performed was able to join the study.

PATIENTS

Clinical data from patients with Goligher's grade III hemorrhoidal disease who underwent excisional hemorrhoidectomy or hemorrhoidal artery ligation were retrospectively analyzed after a 24-month follow-up period.

MAIN OUTCOME MEASURES

The primary aims were to evaluate the adoption of 2 different surgical techniques and to compare them in terms of symptoms, postoperative adverse events, and recurrences at a 24-month follow-up.

RESULTS

Data from 1681 patients were analyzed. The results of both groups were comparable in terms of postoperative clinical score by multiple regression analysis and matched case-control analysis. Patients who underwent excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted OR = 1.58; p = 0.006). A secondary analysis highlighted that excisional hemorrhoidectomy performed with new devices and hemorrhoidal artery ligation reported a significantly lower risk for complications than excisional hemorrhoidectomy performed with traditional monopolar diathermy. At the 24-month follow-up assessment, recurrence was significantly higher in the hemorrhoidal artery ligation group (adjusted OR = 0.50; p = 0.001). A secondary analysis did not show a higher risk of recurrences based on the type of device.

LIMITATIONS

The retrospective design and the self-reported nature of data from different centers.

CONCLUSIONS

Hemorrhoidal artery ligation is an effective option for grade III hemorrhoidal disease; however, it is burdened by a high risk of recurrences. Excisional hemorrhoidectomy performed with newer devices is competitive in terms of postoperative complications.HEMORROIDECTOMÍA POR ESCISIÓN VERSUS DESARTERIALIZACIÓN CON MUCOPEXIA PARA EL TRATAMIENTO DE LA ENFERMEDAD HEMORROIDAL DE GRADO 3: EL ESTUDIO MULTICÉNTRICO EMODART3ANTECEDENTES:En las últimas décadas se han propuesto varios abordajes quirúrgicos para el tratamiento de las hemorroides.OBJETIVO:Este estudio multicéntrico tiene como objetivo comparar la ligadura de la arteria hemorroidal transanal y la hemorroidectomía por escisión convencional para la enfermedad hemorroidal de grado III.DISEÑO:Estudio retrospectivo multicéntrico.ÁMBITO:Cualquier centro perteneciente a la Sociedad Italiana de Cirugía Colorrectal en el que se realizaron al menos 30 procedimientos quirúrgicos por año para la enfermedad hemorroidal pudo participar en el estudio.PACIENTES:Los datos clínicos de pacientes con enfermedad hemorroidal de grado III de Goligher que se sometieron a hemorroidectomía por escisión o ligadura de arterias hemorroidales se analizaron retrospectivamente después de un período de seguimiento de 24 meses.PRINCIPALES MEDIDAS DE RESULTADO:Los objetivos primarios fueron evaluar la adopción de dos técnicas quirúrgicas diferentes y compararlas en términos de síntomas, eventos adversos posoperatorios y recurrencias a los 24 meses de seguimiento.RESULTADOS:Se analizaron datos de 1681 pacientes. Los 2 grupos resultaron ser comparables en términos de puntuación clínica posoperatoria mediante análisis de regresión múltiple y análisis de casos y controles emparejados. Los pacientes sometidos a hemorroidectomía excisional tuvieron un riesgo significativamente mayor de complicaciones posoperatorias (odds ratio ajustado = 1,58; p = 0,006). Un análisis secundario destacó que la hemorroidectomía por escisión realizada con nuevos dispositivos y la ligadura de la arteria hemorroidal informaron un riesgo significativamente menor de complicaciones que la hemorroidectomía por escisión realizada con diatermia monopolar tradicional. En la evaluación de seguimiento de 24 meses, la recurrencia fue significativamente mayor en el grupo de ligadura de la arteria hemorroidal (razón de probabilidad ajustada = 0,50; p = 0,001). Un análisis secundario no mostró un mayor riesgo de recurrencias según el tipo de dispositivo.LIMITACIONES:El diseño retrospectivo y el carácter autoinformado de los datos de diferentes centros.CONCLUSIÓN:HAL es una opción efectiva para la enfermedad hemorroidal grado III; sin embargo, se ve afectado por un alto riesgo de recurrencias. La hemorroidectomía por escisión realizada con dispositivos más nuevos es competitiva en términos de complicaciones posoperatorias. (Traducción-Dr Yolanda Colorado ).

The Perception of the Quality of Professional Healthcare Assistance for the Management of Endometriosis: Findings from a National Survey in Italy

(1) Background: endometriosis is included in the list of chronic and disabling pathologies. This study aimed to examine patients' points of view about the quality of care for endometriosis during the COVID-19 pandemic; (2) Methods: we conducted a survey on knowledge about endometriosis, management of endometriosis, perceived mental and physical well-being, and perceived changes in the quality of care during the pandemic; (3) Results: out of 1065 participants, 875 were included in the analysis, with an average age of 34. Overall, patients had positive perceptions of care accessibility and cleanliness (95%), but less satisfaction with visit hours (86%). Those with better physical and psychological health were more satisfied with service hours, while those treated at specialised centres were more content with cleanliness. Satisfaction with clarity was linked to specialist treatment, and perceived availability to listen correlated with age, complications, and overall health status; (4) Conclusions: patients' perspectives are crucial for patient education and advocate for specialised interdisciplinary networks to support endometriosis management and patients' well-being. These findings highlight the importance of considering patient viewpoints, particularly in the context of the COVID-19 pandemic's impact on healthcare systems and suggest a need for further research from the patient's perspective.

Safety and effectiveness of prilocaine for spinal anesthesia in day surgery setting: a retrospective study on a sample of 3291 patients

Spinal anesthesia is considered safe and reliable for most surgical procedures involving the lower part of the body, but its use in the ambulatory setting requires drugs with rapid onset and regression of the motor and sensory block-like prilocaine.The purpose of this study is to retrospectively analyze data from 3291 procedures recorded in our institutional database, to better define the safety profile of spinal prilocaine and the incidence of complications and side effects.All clinical data, prospectively collected from 2011 to 2019 in an Italian tertiary hospital, of patients treated with spinal anesthesia performed with 40 mg of hyperbaric 2% prilocaine, according to our internal protocol of day surgery, were analyzed.Surgical procedures included saphenectomy (28.5%, n = 937), knee arthroscopy (26.8%, n = 882), proctologic surgery (15.16%, n = 499), and inguinal canal surgery (14.9%, n = 491).Anesthesia-related complication was represented by urinary retention (1.09%, n = 36), lipotimia (0.75%, n = 25), and postoperative nausea (0.33%, n = 11); arrhythmic events were uncommon (0.18%, n = 6). One case of persistent hypotension and 2 cases of persistent hypertension were reported.Persistent motor or sensory block (lasting more than 5 h) was experienced by 7 patients. One patient (0.03%), who underwent knee arthroscopy, experienced pelvic pain lasting for 6 h, compatible with a transient neurological symptom.Proctologic surgery was a factor associated with unplanned admission due to anesthesia-related complications (OR = 4.9; 95% CI: 2-14%).The number of complications related to the method was low as well as the need for hospitalization. This drug is valid and safe for the most performed day surgery procedures; however, further trials are needed to investigate the incidence of complications in the days following the procedure.

Emotional arousal and valence in patients with fibromyalgia: a pilot study

The pathogenesis of pain in fibromyalgia is still not completely understood. A disrupted emotional modulation could affect the physiology of nociception and contributes to an altered perception of pain. The aim of this study was to test the role of emotional arousal and valence in pain susceptibility in fibromyalgia using the International Affective Picture System (IAPS) paradigm and the Fibromyalgia Severity Scale (FSS). The study focused on comparing emotional arousal and valence between patients with fibromyalgia and the control group. The secondary objective was to examine the correlation between emotional indices and scores on the FSS and the duration of the disease. The 20 patients with fibromyalgia enrolled showed a higher mean arousal score for all the stimuli, including a higher score for unpleasant and socially unpleasant stimuli. The valence scores for social-relevant stimuli were also higher. Increased arousal to unpleasant and socially unpleasant images and increased valence of them correlated with the duration of the disease and the severity of symptoms and could reflect impairment in social cognition and marked sensitivity to pain in interaction with central nociceptive dysregulation.

Empathy at school project: Effects of didactics of emotions® on emotional competence, cortisol secretion and inflammatory profile in primary school children. A controlled longitudinal psychobiological study

Background

There is mounting evidence of the presence of chronic stress among children during primary school: girls and boys under the age of 15 years often experience anxiety, irritability and sleeping problems with negative consequences on scholastic climate and the spread of bullying and dropping out of school. The promotion of emotion regulation within school environment through innovative didactic methodologies represents a valuable tool for teachers and parents to reduce emotional distress and associated risk behaviours and to promote wellbeing.

Aim

Our research aims to explore the psychological and biological consequences of teaching emotional training in an experimental group of Italian Primary School children.

Methods

A sample of pupils (81 children aged between 6 and 8) was divided into an experimental group (33 subjects) and a control group (30 subjects). A further advanced group of 18 subjects, who have experienced the method in the previous school year, was also included. The experimental study lasted one school year (from October 2021 to May 2022). The following psychological tests were administered to all groups: TEC (Test of Emotion Comprehension) to measure the children's different emotional abilities and the Projective test (PT) 'A person in the rain', to identify the coping skills of children in a stressful condition. Morning salivary cortisol, IL-6 and TNF-alpha assays were conducted in all three groups. Psychological and biological tests were administered at the beginning of the study and at the end of the study.

Results

The MR-Anova model for TEC score showed that there was not a significant group effect [Fgroup = 2.24, p = 0.114]. Pairwise comparisons showed that mean score significantly increased only in the Experimental group (pB < 0.001) and at the end of the project there was a significant difference between Experimental group and Control group (pB = 0.012). The mean score of PT test increased significantly from baseline to the end of the project for the Experimental group (pB < 0.001) and for the Advanced group (pB = 0.004). At the end of the project, there were significant differences between the Experimental group and the Control group (pB = 0.004) and between the Advanced group and the Control group (pB < 0.001). Salivary cortisol analysis revealed a significant effect between subjects [Fgroup = 9.66; p < 0.001] and significant effects within subjects with the main effect of the time [Ftime = 35.41; p < 0.001] and the significant interaction "time x group" [Ftimexgroup = 3.38; p = 0.040]. Pairwise comparisons showed that cortisol levels decreased significantly over time only in the Experimental group (pB < 0.001). Regarding to IL-6 levels, there was not a significant effect between subjects [Fgroups = 0.0481; p = 0.953]. The mean level decreased significantly for each group from baseline to post project (pB < 0.001). With respect to TNF-alpha levels, the mean levels decreased over time for all groups (pB = 0.006 for Experimental group; pB < 0.001 either for the Advanced or Control group).

Conclusion

the results documented in the experimental groups who experienced didactics of emotion for at least one school year show a significant increase in children's ability to cope with reality, stress and anxiety, and an improvement of their emotional competence. Meanwhile, a significant reduction in the amount of salivary cortisol was observed in the experimental group at the end of the scholastic year; meantime a stable reduced amount of salivary cortisol in advanced group throughout the project was also observed. These findings show that an intervention through an emotional education program is able to regulate interpersonal skills and the stress axis response.

Health Status Perception and Psychological Sequelae in Buried Victims: An Observational Study on Survivors of the Earthquake in Amatrice (Italy), Three Years Later

INTRODUCTION

The extrication from rubble is particularly critical for the survival of the victims of an earthquake. Early repeated infusion of sedative agents (SAs) in the acute trauma phase may interfere with neural processes leading to posttraumatic stress disorder (PTSD).

STUDY OBJECTIVE

This study aimed to analyze the psychological status reported by the buried victims of the earthquake in Amatrice (August 24, 2016; Italy) by considering type of the SAs administered during the extrication maneuvers.

METHODS

This was an observational study on data from 51 patients directly rescued under the rubble during the earthquake in Amatrice. During extrication maneuvers, a moderate sedation was administered by titrating ketamine (0.3-0.5mg/kg) or morphine (0.1-0.15mg/kg) with respect to the Richmond Agitation and Sedation Scale (RASS; between -2 and -3) in buried victims.Three years following the rescue, the survivors were interviewed on their perceived health status and stress using a questionnaire which consisted of 17 items: the standard four-item set of healthy days core questions (CDC HRQOL-4); the 12-item General Health Questionnaire (GHQ-12); and in addition, survivors were asked if they had a diagnosis for anxiety, depression, or for PTSD.

RESULTS

The study analyzed data from the complete clinical documentation of 51 survivors; 30 were males and 21 females, with an average age of 52 years. Twenty-six (26) subjects were treated with ketamine, while 25 were treated with morphine, during the extrication procedures. Concerning the quality-of-life analysis, only 10 survivors out of 51 perceived their health status as good; the others reported psychological disorders. The GHQ-12 scores showed that all survivors had psychological distress with a mean total score of 22.2 (SD = 3.5). Eighteen (18) victims declared to have had a diagnosis of generalized anxiety (35%), while 29 were treated for depression (57%) and PTSD (57%) by a specialist. With regards to the perceived distress level and the anxiety disorder, this analysis showed significant associations with SAs used during extrication, with a better performance for ketamine than for morphine.

CONCLUSION

These findings suggest investigating whether early sedation with ketamine directly in the disaster setting may promote the prophylaxis and reduce the risk of developing trauma-related disorders (TRDs) on the buried victims of major natural disasters in future studies.

Community pharmacists' perceptions and experiences of stress during COVID-19

BACKGROUND

Pharmacists play a crucial role in the COVID-19 pandemic scenario, performing frontline roles for the community, and supporting the healthcare system. This study aimed at investigating stress and its correlates among this category of workers at a high risk of SARS-CoV-2 infection.

METHODS

The participants for this study were employees of the "Municipal Pharmaceutical Company" of L'Aquila (Italy). Data were collected using an anonymous, web-based, self-administered questionnaire. Two independent surveys were conducted, from June to July 2020, and in January 2021.

RESULTS

Two separate groups of respondents were involved: a total of 37 workers participated in the first survey (mean age 44.9 ± 10.7, 75.7% women) and 18 in the second survey (mean age 45.9 ± 9.2, 94.4% women). The average total scores of the perceived stress (GHQ-12 score) increased significantly from 15.5 to 18.2 (p = 0.0438), showing a moderate level of stress in the category investigated.

CONCLUSIONS

We observed a strong emotional exhaustion in the study sample of pharmacists, who reported high-risk perceptions and fear. A comprehensive assistance should be granted to support the well-being of healthcare workers who provide an essential service, despite the high risk of infection.

Does Quality of Care (QoC) Perception Influence the Quality of Life (QoL) in Women with Endometriosis? Results from an Italian Nationwide Survey during Covid Pandemic

(1) Background: Endometriosis is a chronic and progressive illness that generates a slew of issues, lowering the quality of life of women. The purpose of this study was to look at the quality of life in women with endometriosis and how it relates to the quality of care. (2) Methods: This study is an online survey performed in Italy during the COVID pandemic using the Italian version of the Health Questionnaire SF-36 and a questionnaire for assessing the quality of care received. (3) Results: 1052 women with a self-reported diagnosis of endometriosis participated in the survey. The mean levels of Physical Component Summary (PCS) and Mental Component Summary (MCS) were 38.89 ± 10.55 and 34.59 ± 11.17, respectively. A total of 77% of women judged the services they received positively, and 51% considered the coordination between healthcare professionals to be satisfactory. The satisfaction index mean was 23.11 ± 4.80. PCS was positively related to Occupation, high educational level, physical activity, and health care satisfaction. MCS was positively related to higher age, physical activity, and health care satisfaction. (4) Conclusions: The study indicated that satisfaction with health care was a significant predictor of QoL in women with endometriosis, for both physical and mental health.

Pain in critically ill COVID-19 patients: An Italian retrospective study

We retrospectively analyzed the data from patients admitted to the intensive care unit (ICU) of the Hospital of L'Aquila during the first and second waves of pandemic to identify pain related to COVID-19. Pain was evaluated by using the Numerical Rating Scale, and the assessment for neuropathic disturbances of pain was performed with von Frey's hair and Lindblom tests. Pain increased significantly during hospitalization (from 48% at hospital admission to 94.3% at ICU discharge). Female patients were affected by somatic pain in 32.8% of the cases and by somatic pain and pain with neuropathic features (NFs) in 23.5% of the cases, during the ICU stay. Somatic pain and pain with NFs affected more frequently patients with cardiological and respiratory comorbidities. Patients treated with continuous positive airway pressure via helmet had a higher frequency of somatic pain and pain with neuropathic disturbances (84 and 74%, respectively). The frequency of somatic pain and pain with neuropathic disturbances was lower in patients sedated with propofol combined with ketamine. Females have been associated with a higher risk of somatic pain and pain with NFs. Patients with cardiological and respiratory comorbidities undergoing noninvasive ventilation had higher levels of pain. As conclusion, ketamine may reduce the promotion or the worsening of pain in COVID-19 patients.

Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies

BACKGROUND

Non-invasive ventilation may alter the morphology and histology of the upper airway mucosa. This study aimed to investigate the alterations of hypopharynx and oropharynx mucosa, identified during oro-tracheal intubation procedure via video-assisted laryngoscopy, in severe acute respiratory syndrome Coronavirus 2 related, treated by non-invasive ventilation via full-face mask or helmet.

METHODS

Data of patients affected by Coronavirus 2 admitted to COVID Hospital of L'Aquila (Italy), presenting hypopharynx and oropharynx morphology alterations, requiring oro-tracheal intubation for invasive ventilation and initially treated with non-invasive ventilation were included in the study. The study aimed to investigate the upper airway mucosa alterations using oropharyngeal and hypopharyngeal images and biopsies taken during video-assisted-laryngoscopy. Data from the hypopharynx and oropharynx morphology and histology alterations between non-invasive ventilation via a full-face mask or helmet used during hospitalization were compared.

RESULTS

From 220 data recorded, 60 patients were included in the study and classified into non-invasive ventilation full-face mask group (30/60) and via helmet group. Comparing data between groups, significant differences were found with respect to hyperemia (77% vs. 20%), laryngeal bleeding ulcerations (87% vs. 13%), and vocal cord edema with >50% narrowing of the tracheal lumen (73% vs. 7%), respectively. The histology examination revealed fibrin-necrotic exudate with extensive necrotic degenerative changes in the sample tissue of the groups. There were not any differences in the duration time of non-invasive ventilation, time from hospitalization and the start of ventilation between groups.

CONCLUSIONS

The data from this research suggested that there were differences in airway mucosa damages among patients treated with a full-face mask or helmet. Further studies should be planned to understand which non-invasive ventilation support may mitigate upper airway mucosa damages when oro-tracheal intubation is requested for invasive respiratory support.

Where Am I? Searching for the Tangle in the Developmental Topographical Disorientation

The Developmental Topographical Disorientation (DTD) is a pathological condition that impairs an individual’s ability to orient in space, even in the most familiar environments. It is a lifelong selective condition in individuals without brain damage or without impaired general cognitive functions. Here, we aimed at characterizing 54 individuals with DTD identified in a previous study, aged between 18 and 35 years and assessed through a 4-year-long online survey. To this purpose, we compared them with 54 matched healthy participants. We described the demographics, sense of direction, town knowledge, navigational strategies, left-right confusion as well as agnosic disorders (for landmarks, faces and objects). This novel study attempts to characterize the phenotype of DTD, providing an important contribution to the worldwide definition of a condition that was first described only 13 years ago, but which, considering the growing number of cases complaining of the disorder, deserves continuous and increasing attention.

E-Learning Satisfaction, Stress, Quality of Life, and Coping: A Cross-Sectional Study in Italian University Students a Year after the COVID-19 Pandemic Began

(1) Background: The objective was to investigate e-learning satisfaction in a sample of university students by evaluating quality of life, stress sociality, and coping. (2) Methods: This was an online survey involved 471 students attending the University of L′Aquila from June to July 2021. The primary goal was estimating the e-learning satisfaction as measured by the E-learning Satisfaction Scale, while the secondary outcomes were studying its relationship with demographic factors, the perception of quality of life, sociality, stress, and coping strategies using a hierarchical regression model. (3) Results: A total of 136 participants were males (29%); the mean age was 25 years. The results revealed that the satisfaction score was 30.6, and the mean stress level was 19.4. Students suffered psychologically and physically for 14 days a month. The sociality score was 36. With respect to coping strategies, students reported higher scores for “Acceptance” (6.0), “Active coping” (6.2), and “Planning” (6.4). E-learning satisfaction was significantly related to age and course attendance. It was positively associated with the social presence score and coping strategies such as self-blame and religion, while it was inversely related to stress and unhealthy days. (4) Conclusions: The students revealed a positive propensity to use e-learning despite the end of quarantine. Sociality, stress, quality of life, and coping seemed to play an important role in student′s e-learning satisfaction.

The Prevalence of PTSD in a Forensic Psychiatric Setting: The Impact of Traumatic Lifetime Experiences

Background

Several studies have identified traumatic history among forensic patients and its association with criminal behaviors and psychiatric diagnoses. Post-traumatic stress disorder (PTSD) is highly prevalent in forensic settings causing a serious deterioration of the primary psychiatric disorder.

Aims

Our study aims to evaluate the prevalence of PTSD and the role of traumatic experiences and abuse in the development of severe psychiatric disorders in a sample of psychiatric offenders.

Methods

Fifty-three patients admitted in Italian high intensity therapeutic facilities-the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS)-were evaluated with the Trauma Experience Checklist (TEC) and the Millon Clinical Multiaxal Inventory (MCMI-III) to study lifetime traumatic memories and general psychopathology, respectively.

Results

Preliminary findings show that about 41% (N = 22) of psychiatric offenders were affected by PTSD, often not due to a single episode but to multiple lifetime traumas. Therefore, lifetime traumatic experiences and specifically sexual abuse are significant risk factors for the development of a personality disorder, which is present in the 38% (N = 20) of the sample.

Conclusions

The high PTSD prevalence and the strong association found between trauma and abuse with the development of a personality disorder emphasizes the importance of an early evaluation and intervention on traumatic experiences in this difficult population of psychiatric patients; in fact, the treatment of psychiatric offenders is actually vague and devoid of scientific evidence. Our results open up the perspective on the use of known and specific interventions for trauma, such as EMDR and Mindfulness.

Proctologic Surgery Prioritization After the Lockdown: Development of a Scoring System

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has shown a very critical impact on surgical procedures all over the world. Italy faced the deepest impact from the beginning of March 2020. Elective operations, screening, and follow-up visits had been suspended giving priority to urgent and oncologic surgery.

Patients

An observational study was carried out in the Surgical Coloproctology Unit of the Val Vibrata Hospital on 152 patients awaiting a proctological surgical treatment during the national lockdown.

Methods

In order to monitor the health status of patients and reschedule postlockdown surgical activities, patients were interviewed by telephone submitting a questionnaire based upon the judgment of an expert senior clinician. Following the interview, we calculated a severity index for all the proctologic diseases (hemorrhoidal disease, anal fissure, anal sepsis, slow transit or obstructed defecation, incontinence), classifying the patients according to the score. Mean age of patients was 53 (±16) years, and there were 84 males (55.3%) and 68 females (44.7%). In total, 31% of our patients suffered from anal fissure, 28% suffered from hemorrhoidal disease, 14% suffered from anal sepsis, and the remaining patients suffered from benign anorectal diseases to a lesser extent.

Results

A total of 137 patients were available and divided into three classes: priority surgery (PS) with 49 patients (36.2%), deferrable surgery (DS) with 25 patients (18.1%), and long-term surgery (L-TS) with 63 patients (45.6%). There was a significant correlation between the perceived health status reported during the interview and the priority class index (Spearman's rho = 0.97, p < 0.001).

Differences related to age and sex were not significant (F-test = 0.43, p = 0.653; chi-squared test = 0.693, p = 0.707). 49 patients in class PS needed a prompt surgical treatment, while 24 patients allocated in class DS and 65 patients allocated in class L-TS could wait for a new ride plan for surgery.

Conclusion

New tools, such as this simple score obtained during the telephone interview, can be useful for prioritization of patients on the waiting list for surgical coloproctology after the lockdown without further clinical examination and hospital access.

Prevalence of HEV infection in acute non-ABC hepatitis and prognostic role of extrahepatic manifestations

Background

HEV-3 and HEV-4 are emerging cause of zoonotic acute hepatitis in high-income countries. In Europe the disease is underdiagnosed but hyperendemic areas have been identified. We describe a population with acute non-ABC (n-ABC) hepatitis in Abruzzo, the Italian region with the highest seroprevalence reported. The study was included in the surveillance of acute hepatitis E by the Italian Institute of Public Health started in 2004 and implemented in 2015.

Methods

Patients with n-ABC hepatitis during 2004-2018 in all Abruzzo Infectious Disease Departments were tested for HEV-IgM (Wantai^®) and HEV-RNA (ORF3). Positive samples were sequenced (Beckman Coulter^®) and phylogenetic tree (MEGA 6.06 software) obtained. Clinical data were retrospectively collected and an alimentary risk factors-questionnaire was administered. Categorical and quantitative variables were compared (Chi square test or Fisher test and Wilcoxon test).

Results

97 hospitalized patients were tested, most cases (91.7%) after 2015. Overall, HEV-IgM resulted positive in 36% and HEV-RNA detectable in 33.3%. All 24 sequences obtained were HEV-3, with two small groups of closely related strands. L'Aquila was the Province with higher positivity rate (44%). Retrospective clinical data were acquired in 86.5% of patients, no one having liver failure. Higher ALT-levels (1282.34 vs 893.25, p=0.0139) and extrahepatic symptoms (OR 16.69, p=0.0018) were strongly associated with HEV-IgM presence. Two small outbreaks are described.

Conclusions

More than one third of n-ABC hepatitis in all Abruzzo are HEV-related. Extrahepatic symptoms correlate with HEV aetiology. Implementing surveillance is mandatory to really understand the extent of the disease.

Quality of Life among Pediatric Neurocognitive, Speech, and Psychomotor Rehabilitation Professionals during the COVID-19 Pandemic: A Longitudinal Study on an Italian Sample

Objective: The aim was to estimate the perceived quality of life and its relationship with sociodemographic and professional factors, perception of susceptibility to COVID-19, and stress. Design: It was a longitudinal study. Subjects: Professionals, working in Italian centers for pediatric neurocognitive, speech, and psychomotor rehabilitation. Methods: Participants were interviewed online twice during the COVID-19 outbreak in Italy. The questionnaire included: (i) The measures of health-related quality of life to perform the Summary Index of Unhealthy Days, (ii) modified items from the “Standard questionnaire on risk perception of an infectious disease outbreak” and (iii) the items of the General Health Questionnaire. Results: One hundred and thirty professionals out of 130 participated in the first interview, while only 50 therapists took part in the second interview (dropout rate: 61%). The Summary Index of Unhealthy Days was 8 days at the first interview, and it decreased to 6 days at the second interview; however, the reduction was not significant (F = 3.22; p = 0.079). The multivariable analysis showed that the rehabilitation providers with moderate or severe stress level were more likely to have a negative perception of the quality of life (ORadj = 7.155; 95% CI: 2.8–18.2), and this result was confirmed at the second interview. Conclusions: Our results showed that in a severe public health emergency, the mental health and quality of life of rehabilitation professionals must be a topic of focus to enhance psychological resilience, to prevent burnout and to reduce rehabilitation errors.

Anti-AT1R autoantibodies and prediction of the severity of Covid-19

The stimulation of AT1R (Angiotensin II Receptor Type 1) by Angiotensin II has, in addition to the effects on the renin-angiotensin system, also pro-inflammatory effects through stimulation of ADAM17 and subsequent production of INF-gamma and Interleukin-6. This pro-inflammatory action stimulate the cytokine storm that characterizes the most severe forms of SARS-CoV-2 infection. We studied the effect of AT1Rab on the AT1R on 74 subjects with SARS-CoV-2 infection with respiratory symptoms requiring hospitalization. We divided the patients into 2 groups: 34 with moderate and 40 with severe symptoms that required ICU admission. Hospitalized subjects showed a 50% reduction in the frequency of AT1Rab compared to healthy reference population. Of the ICU patients, 33/40 (82.5%) were AT1Rab negative and 16/33 of them (48.5%) died. All 7 patients positive for AT1Rab survived. These preliminary data seem to indicate a protective role played by AT1R autoantibodies on inflammatory activation in SARS-CoV-2 infection pathology.

The impact of covid-19 pandemic on emergency services

Background

The SARS-Cov-2 pandemic has placed enormous strain on the global healthcare system. The strict containment measures have adversely affected population movements and mobility, daily activities, and the patterns of healthcare-seeking behavior. Although the Emergency and Admission Departments (EADS) activity has never been disrupted, the pandemic had a significant impact on the routine healthcare delivery. This study aims to assess the changes in healthcare delivery, with a focus on the elderly as a vulnerable component of the general population.

Design of the study

Retrospective study.

Methods

All non-COVID visits to the EAD of the Local Health Unit (ASL1) in Abruzzo (Italy) from 9 March to 3 May 2020 were analyzed. These were compared to the hospital admissions recorded in the same period of the previous year.

Results

We found a 60.4% reduction in overall visits during the study period and an increase in the hospitalization rate from 30% to 39%. Emergency department visits have declined markedly for less acute medical conditions, while we have observed a statistically significant increase in the hospitalization rates for all age groups. Moreover, in 2020 we recorded a decrease in the ratio non-urgent/non-deferrable medical conditions for each age group; while the percentage of hospitalizations for each registered red code increased for each group, particularly for the 65-74 age group.

Conclusions

The COVID-19 pandemic has significantly affected the care-seeking behavior of patients. During the COVID-19 epidemic, total hospital admissions have decreased, particularly for less severe illnesses, whereas the percentage of hospitalizations has increased. During 2020, hospital admissions for mild cases decreased, and patients presented to the EAD only in cases of acute medical condition, selecting those in need for more intensive care. However, several patients may have deferred necessary medical care even for potentially urgent conditions. Such reluctance to seek medical care may have caused delays in diagnosis. The impact of deferred care on patients' health is difficult to estimate at this time. This information will serve as a starting point for further research to improve healthcare management not only during emergency but also in non-emergency periods.

Laboratory parameters related to severe disease and death in SARS-CoV-2 pneumonia: Retrospective analysis

The clinical evolution of coronavirus disease 2019 (COVID-19) is highly variable and hospitalized patients can rapidly develop conditions requiring oxygen support, intensive care unit (ICU) or high dependency unit (HDU) care. Early identification of high-risk patients is mandatory. We retrospectively collected the medical history, symptoms, radiological, and laboratory findings of COVID-19 patients hospitalized between February and April 2020. Laboratory data were collected at the first, last, and middle times of hospitalization. We used arterial oxygen partial pressure and fractional inspired oxygen ratio (P/F) to evaluate respiratory status. Outcomes considered were death and ICU/HDU admission. We used the χ2 or Fisher's exact test to examine differences between categorical variables. Continuous variables were analyzed using the Wilcoxon matched pairs signed-ranks test and Mann-Whitney test sample test. Of 71 patients admitted, 92% had interstitial pneumonia, and 17% an unfavorable outcome. Negative predictors were age, cerebrovascular disease, obesity, and chronic obstructive pulmonary disease. Baseline P/F was strongly associated with all outcomes. Markers linked to immunological dysregulation like elevated neutrophil-to-lymphocyte ratio exhibited prognostic significance over time. A validated prognostic score comprehensive of all these conditions for early staging and management of COVID-19 patients is urgently needed. Further studies are desirable to evaluate whether laboratory tests can target early treatment in high-risk patients.

Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors

Summary

Objective. The purpose of the study was to describe the characteristics of patients experiencing hypersensitivity reactions (HRs) to iodinated contrast media (ICM) in a large Italian population and to investigate potential risks factors in order to obtain a risk stratification, helpful in the management of these patients. Methods. Data of 407 patients investigated in 9 Italian Allergy Centers for suspected HRs to ICM were analyzed and compared with a control group of 152 subjects that tolerated one or more ICM-enhanced examinations. The univariate and multivariate logistic regression model was used to evaluate associated factors. Results. The mean age of reactive patients was 61 years and 60% were female; 67% of patients reported immediate reactions and 35% experienced the reaction, more frequently with immediate onset, at the first examination in life. Iomeprol, iopromide and iodixanol were the most frequent culprit agents and 20% of patients showed a positive skin test result. Previous adverse reactions to ICM were reported by 15.6% of patients, whereas 35% of subjects experienced the reaction, more frequently immediate, after the first ICM-enhanced examination in their life. The multivariate analysis showed that male gender and age > 65 were associated with ICM reactions as protective factors [OR_adja = 0.51; 95% CI: 0.33-0.77 and OR_adja = 0.60; 95% CI: 0.39-0.92 respectively]. Cardio-vascular disease [OR_adja = 2.06; 95% CI: 1.22-3.50)], respiratory allergy [OR_adja = 2.30; 95% CI: 1.09-4.83)] and adverse drug reactions [OR_adja = 1.99; 95% CI: 1.05-3.77)] were identified as risk factors for ICM reactions. Food allergy was not significantly associated with reactions [OR_adja = 1.51; 5% CI: 0.41-5.56]. Conclusions. This is the largest study on Italian patients experiencing hypersensitivity reactions to ICM. Most results are in line with other studies, showing some association with factors that could influence the incidence of hypersensitivity reactions but not allowing an easy risk stratification.

Knowledge and attitudes of Italian medical oncologists and palliative care physicians toward medical use of cannabis in cancer care: a national survey

PURPOSE

Despite advances in supportive care, cancer-related symptoms tend to be persistent regardless of cancer type, stage of disease, or treatment received. There is an increasing prescription for complementary and alternative medicines, such as medical cannabis (MC). Knowledge and attitudes of Italian medical oncologists and palliative care physicians toward medical cannabis in cancer care remain unknown.

METHODS

We conducted a cross-sectional study to investigate the knowledge and attitude toward MC prescription among cancer care professionals in Italy. All invited participants received an email with the electronic questionnaire accessible through a direct link.

RESULTS

Among the 2616 members who received the invitation, 475 replied to the questionnaire and were considered for the survey analysis. The most prescribed formulations among those available in Italy were cannabis FM2. The most frequent clinical indications for the use of MC were pain, gastrointestinal, and mood disorders. Only 9 responders reported MC-related side effects like anxiety insomnia and muscle spasms. The question regarding the normative references for MC prescription and use in Italy had conflicting results: only 14% indicated the exact legislative reference.

CONCLUSION

Our study highlights a significant discrepancy between personal attitudes, prescription levels, and actual knowledge on MC. This represent a critical issue that should be systemically faced, building educational programs and national guidelines that sublimate personal physicians' beliefs and predispositions, resulting in a robust science-based MC practice. Only through coordinated interventions on science and health policy of MC, there will be success of safety and efficacy, ensuring the best knowledge for the best outcomes.

From the "real-world evidence" to prevention strategies: health inequalities in immigrants residing in an Italian Local Health Unit

OBJECTIVES

to assess the health inequalities of immigrants in the Local Health Unit (LHU) n.1 of the Abruzzo Region with a real-world approach. In particular, 4 main categories of hospitalisation (MDC) linked to health risk behaviours and social determinants were analysed.

DESIGN

retrospective study on hospital discharge data (HDD).

SETTING AND PARTICIPANTS

resident population in the LHU n.1 of the Abruzzo Region between 2010 and 2018. Hospital discharge forms (HDFs) of the hospitals under the administration of the LHU No. 1 of the Abruzzo Region, which includes three geographical areas (Marsica, Peligno-Sangrina, L'Aquila), in the years 2010-2018 were analysed.

MAIN OUTCOME MEASURES

crude hospitalisation trends for immigrants and Italians; comparison of standardised hospitalisation rates in the main immigrant communities.

RESULTS

overall, 26,570 SDO were analysed. Average age of inpatients was 40 years (±16) and average hospital stay was 4 days (±7). Immigrants showed a lower tendency to hospitalisation than Italians with a decreasing trend from 2010 to 2018, contrary to the Italians. The Romanian population has a hospitalisation risk for alcohol abuse/drugs and induced organic mental disorders about twice as much as the Italian population. Women from Morocco experienced caesarean section with complications about four times more than the Italian women.

CONCLUSIONS

the analysis of routine data highlighted excesses of hospitalisation by some causes and birthplaces. A real-world approach can be useful and timely to the implementation of preventive strategies for specific diseases in defined local areas.

Coronavirus (Covid-19) pandemic: How may communication strategies influence our behaviours?

A novel Corona virus (SARS-CoV-2), started in Wuhan China, caused an outbreak of viral pneumonia to subsequently spread throughout the world. Italy has been one of the most affected countries in the world and the increasing number of cases and deaths has created strong emotional reactions in people. This study has aimed at evaluating public attention to this emerging disease through the use of Google Trends. Public attention, measured as the volume of internet search activity, was correlated with Health Communication Strategies and official COVID-19 data. At the moment of the study analysis, Italy was by far the first country in terms of search volume for "coronavirus" and the highest peak of searches was reached on February 23, 2020. We have found that there was a correlation between public attention to coronavirus disease and communications from Public Health policies: we observed spikes in search volumes on the days of Presidential Decree publications. Furthermore, this attention was also correlated with Case Fatality Rate (CFR). Even if CFR data are continuously updated and can be affected by patient histories, the correlation found suggests that the increase in mortality has generated growing interest in the disease and its risk perception. This study shows that tracking searches through Google Trends as a public focus indicator is a useful tool for decision-makers in guiding communication strategies and should as well stimulate a more transparent media and policy making reporting.

A systematic review of contralateral carotid stenosis progression after carotid endarterectomy

OBJECTIVE

Progression of contralateral carotid artery stenosis after carotid endarterectomy (CEA) has been described by several authors. The aim of this study is to determine such disease progression and its related transient ischemic attacks (TIAs) or strokes by reviewing the existing literature.

METHODS

We performed a systematic literature review to select randomized controlled trials and observational studies reporting outcomes of patients treated by CEA and with concomitant contralateral carotid stenosis, regardless its degree of stenosis. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42019127595). The primary study end point was the progression of contralateral carotid artery stenosis after CEA, and the secondary end point was incidence of TIAs and strokes owing to contralateral carotid stenosis.

RESULTS

Seventeen studies were retrieved, reporting data on a total of 7679 patients who had undergone CEA, in particular they were one post hoc analysis of a randomized controlled trial, nine prospective, and seven retrospective observational studies. Among these patients, follow-up information on the contralateral carotid artery was available for 5454 cases. Disease progression was observed in 18% of patients: single class progression from mild (<50%) and from moderate (50%-70%) stenosis was observed in 15% and 23% of cases, respectively. We found 105 TIAs (4%) and 88 strokes (3%) among 2781 patients with stenosis progression, based on result from 11 studies.

CONCLUSIONS

We found a progression of contralateral carotid stenosis in a significant number of patients treated with CEA and with baseline carotid stenosis. This systematic literature review suggests that patients with moderate contralateral carotid stenosis demonstrate more rapid progression to significant or symptomatic stenosis than patients with mild contralateral stenosis.

Intermediate Cervical Plexus Block in the Management of Persistent Postoperative Pain Post Carotid Endarterectomy: A Prospective, Randomized, Controlled, Clinical Trial

BACKGROUND

The mechanisms of persistent postoperative pain (PPP) with neuropathic features after carotid endarterectomy (CEA) are multifaceted and are incompletely understood.

OBJECTIVES

The aim of this research was to assess whether the ultrasound-guided (USG) intermediate cervical plexus block (ICPB) could provide better control of PPP and neuropathic disturbances (NPDs) after CEA than the USG superficial cervical plexus block (SCPB).

STUDY DESIGN

Prospective, randomized, controlled, clinical trial.

SETTING

This clinical trial was conducted at the SS Filippo and Nicola Academic Hospital of Avezzano (L'Aquila, Italy).

METHODS

Patients who were scheduled for primary CEA were chosen. In the experimental group, the USG-ICPB was performed unilaterally, at the level of the third cervical vertebra. The needle was inserted into the deep lamina of the deep fascia of the neck, between the posterior border of the middle scalene muscle and the anterior border of the posterior scalene muscle. Three milliliters saline solution was injected into the opening of the deep lamina, and 20 mL 0.375% levobupivacaine was injected. In the control group, the anesthetic target was located at the inferior border of the sternocleidomastoid muscle at the level of the third cervical vertebra. The needle was superficially inserted below the skin, and 2 to 3 mL saline solution was injected into the opening of the superficial lamina of the deep fascia of the neck. A total of 20 mL 0.375% isobaric levobupivacaine was subsequently injected.The primary outcome measure was the proportion of patients with PPP on movement and at rest 3 months after surgery. The secondary outcome measures were NPD assessment scores using the von Frey hair test and the Lindblom test, opioid and pregabalin consumption. Adverse effects were also recorded.

RESULTS

A total of 98 consecutive patients were enrolled and randomized to receive either a USG-SCPB (control group, n = 49) or a USG-ICPB (experimental group, n = 49). The sensory blockade was longer in the experimental group. Three months after surgery, the proportions of patients with PPP on movement were significantly different between the experimental and control groups (33%, 95% confidence intervals [CI], 20%-47% vs. 71%, 95% CI, 57%-83%; P < 0.001), whereas there were no differences in the proportions of patients with pain at rest between groups (31%, 95% CI, 18%-45% vs. 49%, 95% CI, 34%-64%; P = 0.063). The proportions of patients with NPDs were not different between the groups, whereas the sizes of the areas of interest (cm2) were significantly different.

LIMITATIONS

A limitation of this study is that we assessed NPDs for only 3 months using the von Frey hair test and the Lindblom test without additional instrumental techniques. Additionally, there are many risk factors for NPDs after CEA. For this reason, another limitation of this research is that we neglected to consider the relationship between the choice of anesthetic block and the presence of these risk factors.

CONCLUSIONS

The USG-ICPB provided long-lasting analgesia during the postoperative period and might mitigate the development of NPDs, thereby decreasing the analgesic drug requirement.

KEY WORDS

Carotid endarterectomy, intermediate cervical plexus block, myofascial planes of neck, neuropathic disturbances, persistent postoperative pain, superficial cervical plexus blocks, ultrasound guidance, vascular disease.

Prevalence of depressive symptoms among Italian medical students: The multicentre cross-sectional "PRIMES" study

Background

Four percent of the world’s population suffers from depression, which is a major public health issue. Medical students are at risk, as their depressive symptoms (DS) prevalence is reported to be approximately 27% worldwide. Since few data on Italian medical students exist, this study aimed to estimate their DS prevalence and assess risk and protective factors.

Methods

The PRIMES was a multicentre cross-sectional study performed in 12 Italian medical schools. Questionnaires were self-reported and included 30 sociodemographic items and the Beck Depression Inventory-II (BDI-II). The primary outcome was the presence of DS (BDI-II score≥14). The main analyses were chi-squared tests and multivariable logistic regressions with a p-value<0.05 considered significant.

Results

The number of collected questionnaires was 2,513 (117 BDI-II incomplete). Females accounted for 61.3% of the respondents, and the median age was 22 years (IQR = 4). The prevalence of DS was 29.5%. Specifically, 14.0% had mild depression, 11.1% had moderate depression, and 4.5% had severe depression. The main risk factors for DS were age, being female, bisexual/asexual orientation, living with partner/housemates, poor economic status (worsened by living far from home), less than 90 min of weekly exercise, relatives with psychiatric disorders, personal chronic disease, judging medical school choice negatively, unsatisfying friendships with classmates, competitive and hostile climate among classmates, thinking that medical school hinders specific activities and being worried about not measuring up to the profession. Protective factors included family cohesion, hobbies, intellectual curiosity as a career motivation and no worries about the future.

Conclusion

Italian medical students are at high risk of reporting DS, similar to the global population of medical students’. Medical schools must make efforts to implement preventive and treatment interventions by offering counselling and working on modifiable factors, such as lifestyle and learning climate.

Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives

Local infiltration and continuous infusion of surgical wound with anesthetics are parts of multimodal analgesia for postoperative pain control. The techniques, given the simplicity of execution that does not increase the timing of the intervention and does not require additional technical skills, are applied in several kinds of surgeries. The continuous wound infiltration can be used for days and a variety of continuous delivery methods can be chosen, including patient-controlled analgesia, continuous infusion or intermittent bolus. The purpose of this narrative review is to analyze the literature, in particular by researching the safety, efficacy and current perspectives of continuous wound infiltration for postoperative pain management in different surgical settings. We have identified 203 articles and 95 of these have been taken into consideration: 17 for the lower limb surgery; 7 for the upper limb surgery, 51 for the laparotomy/laparoscopic surgery of the abdominopelvic area, 13 studies regarding breast surgery and 7 for cardiothoracic surgery. The analysis of these studies reveals that the technique has a variable effectiveness based on the type of structure involved: it is better in structures rich in subcutaneous and connective tissue, while the effectiveness is limited in anatomic districts with a greater variability of innervation. However, regardless the heterogeneity of results, a general reduction in pain intensity and in opioid consumption has been observed with continuous wound infiltration: it is an excellent analgesic technique that can be included in the multimodal treatment of postoperative pain or represents a valid alternative when other options are contraindicated.

Psychoneuroendocrinoimmunology-based meditation (PNEIMED) training reduces salivary cortisol under basal and stressful conditions in healthy university students: Results of a randomized controlled study

BACKGROUND

Meditation represents an effective and safe practice to lower distress and promote well-being. PsychoNeuroEndocrinoImmunology-based Meditation (PNEIMED) is a validated method that can reduce stress-related symptoms and salivary cortisol secretion. To date, few randomised controlled trials (RCTs) have assessed cortisol levels through salivary samples, collected both in the morning phase and during acute mental stress elicitation, in healthy young subjects following brief meditation training.

AIM

The present study aims to investigate, in healthy young undergraduate students, the effects of a brief PNEIMED training course on HPA axis by measuring salivary cortisol levels.

METHODS

Forty students attending the Faculty of Psychology, without comorbidities and previous experience of meditation, were enrolled in the study. Twenty subjects were randomly assigned to 30 h of PNEIMED training (intervention group, IG), and twenty subjects were randomly assigned to 30 h of academic lessons (control group, CG). Salivary cortisol measures included basal morning (t0 = baseline time, collected 30 min after waking) and under stress-eliciting task values. Cortisol measurement under the stress-eliciting task was provided through the Subtraction Stress Task (SST) at scheduled time intervals (t1 = 5 min pre-SST, t2 = 10 min post-SST, t3 = 30 min = post-SST). Salivary cortisol was measured among all subjects (IG + CG) at the beginning (pre-test) and at the end (post-test, four days later) of the study.

RESULTS

ANOVA between-group analysis of basal diurnal salivary cortisol showed a significant hormone deflection in the IG at the end of the PNEIMED course (post-test) when compared to the CG (IG post-test 5.64 ± 4.2 vs CG post-test 9.44 ± 4.9; F_1,38 = 6.838; p = 0.013). RM-ANOVA within-group analysis for the IG also showed that time and condition effects were statistically significant, with Ftime = 5.438; p = 0.002 and Fcondition = 10.478; p = 0.004, respectively. The IG group presented a significant reduction in basal morning cortisol at the end of the PNEIMED course (post-test) compared to the salivary concentration at baseline (pre-test) (IG pre-test 9.42 ± 6.0 vs IG post-test 5.64 ± 4.2; F_1,38 8,354; p = 0.009). RM-ANOVA for the control group showed only the main effect of time (F_1,38 = 40.348; p < 0.001). Regarding cortisol measures under the SST-stress eliciting task, ANOVA between-groups analysis showed higher cortisol levels in the IG than in the CG before the PNEIMED course, with significant differences between groups at time t2 and time t3. After the PNEIMED course, the cortisol levels in the IG had decreased, although the differences between groups were not significant. Interestingly, ANOVA within-groups analysis showed that in the IG, the cortisol levels post-test (after the PNEIMED course) were lower than at pre-test (before the PNEIMED course), showing a significant difference of cortisol salivary concentration between conditions at t3 (F = 5.326; p = 0.032). In the control group, the post-hoc analyses for pairwise comparisons between conditions (pre-test vs post-test) did not show significant differences.

CONCLUSION

Although the low number of subjects enrolled in the study does not allow for definitive conclusions to be drawn, the present findings confirmed the capability of the PNEIMED method to lower stress hormone secretion both at baseline and under acute mental stimulation in a group of young naïve practitioners and make a contribution to the existing literature by increasing the number of published RCTs about the topic.

What cancer patients actually know regarding medical cannabis? A cross-sectional survey with a critical analysis of the current attitudes

BACKGROUND

In Italy medical cannabis is a prescription drug since 1998. Even though it could not be considered a therapy as such, it is indicated as a symptomatic treatment also in cancer patients, to cure iatrogenic nausea/vomiting and chronic pain.

PATIENTS AND METHODS

We conducted a knowledge survey about medical cannabis among cancer patients referred to two outpatient cancer care centers and a home care service.

RESULTS

From February to April 2018, 232 patient were enrolled; 210 patients were on active disease-oriented treatment (90.5%), while 22 (9.5%) not. Eighty-one percent of the patients have heard about medical cannabis, but only 2% from healthcare professionals. Thirty-four percent of responders thought about using cannabis to treat one or more of their own health problems, especially pain (55%). Despite that, 18% of the participants believe that medical cannabis could have negative effects on their own symptoms. Patients with high educational level better knew cannabis (odds ratio = 3.52; 95% confidence interval: 1.07-11.53), and medical cannabis (odds ratio = 3.21; 95% confidence interval: 1.48-6.98), when compared to patient with low educational level. Patients who were on active disease-oriented treatment better knew medical cannabis (odds ratio = 3.91; 95% confidence interval: 1.26-12.11) compared to "out of treatment" patients. Metastatic patients were less informed about medical cannabis compared to patients on adjuvant treatment.

CONCLUSIONS

Our survey shows that most of Italian cancer patients know medical cannabis and a third of them have considered using cannabis to treat one (or more) of their own health problems. In the same time, they are poorly informed and do not tend to ask for information about medical cannabis to healthcare professionals.

Dialectical behaviour therapy (DBT) for forensic psychiatric patients: An Italian pilot study

BACKGROUND

Several previous randomised controlled trials of dialectical behaviour therapy (DBT) since Linehan's original have shown that it has an advantage over standard care or other psychological treatments, but focus is usually on suicide-related behaviours, and little is known about its effect with offender-patients.

AIMS

To evaluate DBT with a group of offender-patients in the Italian high intensity therapeutic facilities-the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS), established under the Italian Law 81/2014.

METHODS

Twenty-one male forensic psychiatric in-patients with borderline personality disorder were enrolled and randomly assigned to 12 months of standard DBT together with all the usual REMS treatments (n = 10) or usual REMS treatments alone (n = 11). All participants completed the same pretreatment and posttreatment assessments, including the Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), and Toronto Alexithymia Scale 20 (TAS-20).

RESULTS

Men receiving DBT showed a significantly greater reduction in motor impulsiveness, as measured by the BIS-11, and emotional regulation, as reflected by the DERS total score, than the controls. There were no significant differences between groups in alexithymia scores.

CONCLUSIONS

Italy has innovative forensic psychiatric facilities with a new recovery-rehabilitation approach, but the ambitious goals behind these cannot be achieved by pharmacology alone. For the first time in clinical forensic settings in Italy, there has been limited access to DBT. This small pilot study suggests this is likely to help ameliorate traits associated with violent and antisocial behaviours, so a full-scale randomised controlled trial should follow.

Impact of dance therapy on children with specific learning disability: a two-arm cluster randomized control study on an Italian sample

BACKGROUND

Dance therapy can improve the quality of life of a person with several conditions, especially psychological well-being and quality of life, in the short and long-term. The aim of the study was to examine the effects of the dance therapy (DT) on specific learning disability (SLD) children. We wanted to test the impact on cognitive and emotional patterns on children with learning disorders.

METHODS

A two-arm cluster randomized control study was applied comparing 2 groups of SLD children (treated vs. non-treated). All children have been measured applying psychological battery before and at the end of the experimental protocol.

RESULTS

Our data revealed significant differences between groups for auditory and visual recognition, for interpersonal relationships and for emotions recognition. DT seemed to provide positive evidence as an educational intervention for children with SLDs.

CONCLUSIONS

Our results confirmed that DT protocol was an effective way to improve self-esteem, attention and concentration and emotional recognition in SLD children.

Impact of dance therapy on children with specific learning disability: a two-arm cluster randomized control study on an Italian sample

BACKGROUND

Dance therapy can improve the quality of life of a person with several conditions, especially psychological well-being and quality of life, in the short and long-term. The aim of the study was to examine the effects of the dance therapy (DT) on specific learning disability (SLD) children. We wanted to test the impact on cognitive and emotional patterns on children with learning disorders.

METHODS

A two-arm cluster randomized control study was applied comparing 2 groups of SLD children (treated vs. non-treated). All children have been measured applying psychological battery before and at the end of the experimental protocol.

RESULTS

Our data revealed significant differences between groups for auditory and visual recognition, for interpersonal relationships and for emotions recognition. DT seemed to provide positive evidence as an educational intervention for children with SLDs.

CONCLUSIONS

Our results confirmed that DT protocol was an effective way to improve self-esteem, attention and concentration and emotional recognition in SLD children.

Trend analysis and factors associated with biological injuries among health care workers in Southern Italy

Background:

Biological injuries are the most common and serious among health care workers.

Objectives:

This study aims to estimate the injuries’ incidence, job distribution and temporal trend in a hospital in Southern Italy.

Methods:

Data on accidents, collected from January 2010 to December 2016, were analyzed. Poisson distribution was used to calculate incidence rates and respective 95% confidence intervals. Trends were analyzed using the Joinpoint regression model. A multiple logistic regression model was used to identify factors associated with injuries.

Results:

Three hundred and thirty-five injuries were reported from 2010 to 2016, occurring mainly in the morning (54%) and frequently caused by needlestick (70%). We observed a significant decline in the incidence rates of the total amount of injuries (ACP=-11.3; 95% CI: -16.3 - -5.9), for nurses (ACP=-15.7; 95% CI: -24.3 - -6.2) and for health and social care assistants (ACP=-13.2; 95% CI: -23.1 - -2.0). Among male physicians the risk of biological accident was higher than female physicians (OR=3.67; 95% CI:1.9-7.1), while among male nurses the risk was lower than among female nurses (OR=0.31; 95% CI: 0.17-0.59). For the nursing category, “afternoon” and “night” represented risk factors with OR=2.19 (95% CI: 1.2-3.7) and OR=8.8 (95% CI: 3.4-22.8) respectively. For physicians, surgical intervention was a risk factor (OR=7.71; 95% CI: 3.2-18.4).

Conclusions:

Our findings confirm the need for continuous monitoring and improved control of work-related exposures, both for health and the associated costs.

Continuous wound infusion and local infiltration analgesia for postoperative pain and rehabilitation after total hip arthroplasty

BACKGROUND

Total hip arthroplasty is one of the most common procedures in orthopedic surgery. We hypothesized that local infiltration of analgesia and continuous wound infusion of anesthetics in the first 72 hours after surgery could provide more effective postoperative analgesia with better rehabilitation.

METHODS

A double-blind, randomized, controlled study was conducted with 96 patients who underwent total hip arthroplasty. The patients were randomized to receive either a local infiltration analgesia and continuous wound infusion of anesthetics or a local infiltration analgesia and continuous wound infusion of saline solution. The patients in both groups received subarachnoid anesthesia and a local infiltration analgesia. A multihole catheter was placed next to the implant and connected to an electronic pump containing a 300-mL solution of 0.2% levobupivacaine (experimental group) or saline (control group).

RESULTS

A total of 96 consecutive patients were enrolled and randomized. Of these, 48 patients received local infiltration analgesia and continuous wound infusion of local anesthetics, and the remainder received local infiltration analgesia and continuous wound infusion of saline solution. The analysis showed a significant main effect of treatment on the postoperative incident of pain (Ftreat(1,93)=22.62, P=0.000) and on resting pain during the post-surgery follow-up (Ftreat(1,93)=15.62, P=0.0002). The pain scores during the rehabilitation period were significantly less in the experimental group. Analgesic consumption was less in the experimental group.

CONCLUSIONS

The addition of continuous wound infusion of anesthetics to local infiltration analgesia provided an extended analgesic effect associated with good rehabilitation performance.

Prevalence and factors associated with problematic internet use: an Italian survey among L’Aquila students

AIM

In this study we examined the prevalence of internet addiction (IA) and its associated factors in a sample of Italian students.

MATERIALS AND METHODS

This is an observational study that involved 1403 students aged 15-24 and conducted in L’Aquila, Italy. 1129 students accepted to participate in our study and completed the Internet Addiction Test: 41% were male and the mean age of total sample was 19±2.8 years.

RESULTS

The prevalence of “average user” was 51% (95% CI: 48-54). The prevalence of “problematic user” was 23% (95% CI: 21-26). Among the students with a problematic use, 8 were addicted, the 0.7% in the whole sample. There was a significant age difference (p=0.029), but no gender difference (p=0.311) between “average users” and “problematic users”. The association of internet use and educational level (School or University) was not significant (p=0.704).

DISCUSSION

Our results showed that about one student out of 100 had an IA. Gender and educational level were not significantly associated with IA. Instead, we found a strong association with age: there was not a decrease of internet use during a lifetime, with negative consequences on quality of life.

CONCLUSION

Our study reported a percentage of 30% of problematic internet use among students. These findings suggest the importance of early detection among youth and of structured interventions that should be carried out to prevent abnormal global life functioning.

Are ventrolateral and dorsolateral prefrontal cortices involved in the computerized Corsi block-tapping test execution? An fNIRS study

The Corsi block-tapping test (CBT) is an old neuropsychological test that, requiring the storage and the reproduction of spatial locations, assesses spatial working memory (WM). Despite its wide use in clinical practice, the specific contribution of prefrontal cortex (PFC) subregions during CBT execution has not been clarified yet. Considering the importance of spatial WM in daily life and the well-known role of ventrolateral-PFC/dorsolateral-PFC (VLPFC/DLPFC) in WM processes, the present study was aimed at investigating, by a 20-channel functional near-infrared spectroscopy (fNIRS) system (including four short-separation channels), the hemodynamic response of the VLPFC/DLPFC during a computerized version of the CBT. Thirty-nine university students were asked to perform CBT standard version (CBTs), block-suppression CBT (CBTb), and control task (CBTc). A VLPFC activation during CBTs and a DLPFC activation during CBTb were hypothesized. The results of the Bayesian analysis have not shown a delineated specific activation of VLPFC/DLPFC during either CBTs or CBTb. These results together with the related ones obtained by others using fMRI are not sufficient to definitively state the role of the PFC subregions during CBT execution. The adoption of high-density diffuse optical tomography would be helpful in further exploration of the PFC involvement in spatial WM tasks.

Selection Bias in Colorectal Surgery in a Non-Tertiary Hospital: Laparoscopic Versus Open Surgery

INTRODUCTION

Laparoscopy is used increasingly to treat malignant and benign colorectal surgical diseases. However, this practice is still not offered to all patients. Many barriers halt the widespread use of laparoscopic colorectal surgery. Both surgeon's and patient's factors contribute to limit a wider use of laparoscopy in colorectal surgery.

MATERIALS AND METHODS

We retrospectively analyzed 408 consecutive colorectal resections in a 4-year period, to find out if a selection bias exists in using laparotomy or laparoscopy for colorectal surgical diseases, and which factors are associated with a poor use of laparoscopy or to a preferred laparotomy.

RESULTS

In our practice, advanced disease, American Society of Anesthesiologist class III and IV, and emergency status are all patient-related factors associated with laparotomy. Surgeon's age more than 52 years and lack of laparoscopic training are surgeon-related factors that negatively affect the chance of being operated on with the laparoscopic technique.

CONCLUSIONS

An extensive laparoscopic colorectal training and a supporting environment, especially during the night shift, are needed to facilitate the use of laparoscopy in colorectal surgery avoiding a bias in selecting surgical candidates to one technique or another.

The effect of voluntary termination of pregnancy on female sexual and emotional well-being in different age groups

INTRODUCTION

To evaluate the impact of voluntary termination of pregnancy (VTOP) on the psycho-sexological well-being of females before/six months after the abortion.

METHODS

A sample of 194 women was recruited from three obstetrics and gynaecological divisions. The women were evaluated for the variables "sexual functioning" with the Female Sexual Function Index (FSFI), "depression" with the Beck Depression Inventory (BDI-II), and "anxiety state" with the Self-Rating Anxiety Scale (SAS) at time 0 (the beginning of the abortion procedure) and time 1 (six months after the abortion). Since 24 women refused to fill out the questionnaires, the final sample was composed of 170 women.

RESULTS

The women showed a slight although significant improvement in the mean FSFI score from time 0 (16.7 ± 12.9) to time 1 (20.9 ± 13.8) (p < 0.001) which paralleled with a slight decrease in the incidence of clinically significant sexual dysfunction [49% (84/170) (time 0) versus 34.1% (58/170) (time 1)], (McNemar's test; p = 0.0241). The sub-group of younger women (18-25) showed a lesser increase in FSFI score from time 0 to time 1. In addition, both depression (p = 0.048) and anxiety (p < 0.001) significantly decreased over time. However, the female sexuality remained impaired since more than two thirds (69.5%) of women were sexually dysfunctional six months after VTOP.

DISCUSSION

Voluntary TOP may influence the sexuality of younger females differently from how it influences that of older women. Hence, the sexuality of younger female should be regularly supervised in follow-up examinations.

Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women

The aim of this study was to evaluate accuracy, tolerability and side effects of office hysteroscopic-guided chromoperturbations in infertile women without anaesthesia. Forty-nine infertile women underwent the procedure to evaluate tubal patency and the uterine cavity. Women with unilateral or bilateral tubal stenosis at hysteroscopy with chromoperturbation, and women with bilateral tubal patency who did not conceive during the period of six months, underwent laparoscopy with chromoperturbation. The results obtained from hysteroscopy and laparoscopy in the assessment of tubal patency were compared. Sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value were used to describe diagnostic performance. Pain and tolerance were assessed during procedure using a visual analogue scale (VAS). Side effects or late complications and pregnancy rate were also recorded three and six months after the procedure. The specificity was 87.8% (95% CI: 73.80-95.90), sensitivity was 85.7% (95% CI 57.20-98.20), positive and negative predictive values were 70.6% (95% CI: 44.00-89) and 94.7% (95% CI: 82.30-99.40), respectively. Pregnancy rate (PR) within six months after performance of hysteroscopy with chromoperturbation was 27%. Office hysteroscopy-guided selective chromoperturbation in infertile patients is a valid technique to evaluate tubal patency and uterine cavity.

Moderate Depression Promotes Posttraumatic Growth (Ptg): A Young Population Survey 2 Years after the 2009 L'Aquila Earthquake

Background:

Earthquakes can result in a range of psychopathology and in negative and positive consequences for survivors.

Objective:

To examine the association between clinical aftereffects (anxiety and depressive symptoms) and post-traumatic growth (PTG) among young survivors of the 2009 L’Aquila earthquake, Italy.

Method:

316 young earthquake survivors enrolled in the University of L’Aquila were evaluated two years after the natural disaster. Participants completed three main questionnaires, including Patient Health Questionnaire-9 items (PHQ-9), Self-Rating Anxiety Scale (SAS), and Posttraumatic Growth Inventory (PTGI).

Results:

59.6% of the student sample showed different levels of depression, whereas 13.3% reported anxiety symptoms. In both clinical dimensions (anxiety and depression), gender differences were found: female gender was confirmed risk factor for a clinical post-traumatic response. Personal PTG, demonstrated by 18% of the L’Aquila youths included in our sample, was predicted by moderate levels of depression (O.R. 2.7). In our model, gender, age, and anxiety did not show any predictive value.

Conclusion:

In a post-traumatic setting, the development of individual cognitive strategies is crucial, whereas after a natural disaster, paradoxically, a moderate depressive condition and the related distress could promote the drive to overcome the psychological consequences of the traumatic event.

Transversus Abdominis Plane Block in the Management of Acute Postoperative Pain Syndrome after Caesarean Section: A Randomized Controlled Clinical Trial

BACKGROUND

The international literature is unclear regarding the analgesic efficacy of the transversus abdominis plane block (TAPB) after a Caesarean section (CS).

OBJECTIVES

The aim of this study was to determine whether a correctly performed ultrasound-guided TAPB (USG-TAPB) could provide better control of acute postoperative pain during the first 72 hours after CS and if it could provide a faster postoperative recovery.

STUDY DESIGN

A double-blind, randomized, controlled clinical trial on pregnant women who underwent CS.

SETTING

Pain clinic and Anesthesia and Intensive Care Unit in an academic hospital.

METHODS

A double-blind, randomized, controlled study was conducted with 96 patients who underwent CS. The patients in both groups received subarachnoid anesthesia (SAB) with 13 mg of 0.5% isobaric levobupivacaine. The patients were randomized so that some received USG-TAPB with local anesthetic, and the remainder received USG-TAPB with saline. The patients' demographic information and data regarding anesthesia, hemodynamic changes, side effects, acute rest and incident postoperative pain, painkiller consumption, recovery time of bowel function, and the time of hospital discharge were recorded.

RESULTS

Our data reinforce the assumption that if TAP block is performed correctly and is part of a multimodal analgesic scheme, effective pain control is possible both for somatic and visceral acute pain. Furthermore, the need for painkillers is reduced, and their related side effects are moderate, yielding a positive benefit/cost ratio.

LIMITATIONS

USG-TAPB provides good analgesia for acute postoperative somatic pain, but opiates were still needed for the management of visceral acute postoperative pain.

CONCLUSIONS

These results could confirm the assumption that the correct performance of an USG-TAPB as part of a multimodal analgesic treatment could represent a viable alternative to common analgesic procedures performed for acute postoperative pain control after a CS.Key words: Bowel function, Caesarian section, incident pain, local anesthetics, multimodal analgesic treatment, postoperative recovery, rest pain, ultrasound-guided TAP block.

[Behavioural risk factors in L'Aquila (Central Italy) 3-5 years after the 2009 earthquake]

OBJECTIVES

to evaluate the long-term impact on the health of the general population of L'Aquila earthquake that occurred on April 6th, 2009.

DESIGN, SETTING AND PARTICIPANTS

three consecutive surveys were performed on samples of the population of 18-69 years resident in L'Aquila and in the other towns affected by the earthquake. Data on health-related quality of life, depressive disorders, behaviour risk factor, and adoption of preventive measures were collected through telephone interviews in 2007-2008, in 2010, and in 2011-2014.

RESULTS

the prevalence of individuals who declared to have economic difficulties increased after 3-5 years from the earthquake (8% in 2010 vs. 14% in 2011-2014). Nevertheless, health-related quality of life improved (decrease of unhealthy days: 7 in 2010 vs. 5 in 2011-2014), while the prevalence of depressive symptoms decreased so that it reached the national average rates (16% in 2010 vs. 7% in 2011-2014). Lack of physical activity, a serious consequence of the first period after the earthquake, became less habitual (39% in 2010 vs. 27% in 2011-2014), probably due to an improvement in the urban redevelopment. The prevalence of smoking and harmful use of alcohol is high (34% and 21%), mostly among young adults.

CONCLUSIONS

3-5 years after the earthquake of L'Aquila, compared to 2010 the quality of life related to health is improved (except in people with at least one chronic disease), and the frequency of depressive symptoms decreased, a sign of an extended recovery from conditions caused by the earthquake, despite of an increasing economic difficulties. On the other hand, we must emphasize critical elements, such as the high prevalence of smoking and consumption of alcoholic beverages other than as part of the meals, especially among young people, and very frequent physical inactivity, particularly among the elderly, although lower than in 2010. Finally, adherence to preventive measures and screening for cancer, and adoption of road safety devices could be improved.

Energy drinks consumption in Italian adolescents: preliminary data of social, psychological and behavioral features

BACKGROUND

The aim of this study was to investigate the prevalence of energy drink (ED) consumption and the associations with social, psychological and behavioral features among an Italian adolescent sample.

METHODS

A cross-sectional prevalence study of 450 Italian adolescents attending middle school was conducted. The Italian versions of the European Food Safety Authority's adolescent Energy Drinks Questionnaire and of the Depression and Anxiety in Youth Scale (DAYS) were administered to evaluate ED use and its psychological correlates. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a logistic model to estimate the associations between ED consumption and socio-demographic characteristics, psychological factors and risky behaviors.

RESULTS

The prevalence of ED consumers was 57%, of whom 49% used alcohol mixed with ED. A total of 9% exhibited high chronic consumption, 31% average chronic consumption and 8% high acute consumption. Males were significantly more likely to use ED (OR=2.7, 95% CI: 1.8-4.0, P=0.00) and to engage in high acute consumption (OR=4.0, 95% CI: 1.1-13.8, P=0.03). Regular smoking was associated with ED use (OR=3.4, 95% CI: 1.2-9.1, P=0.02). No relationship was observed between ED use and depression (OR=1.6, 95% CI: 0.9-3.0, P=0.10) and anxiety (OR=0.8, 95% CI: 0.5-1.4, P=0.44), although those who were depressed with a suggestive but not statistically significant increased risk of acute ED use (OR=2.7, 95% CI: 1.0-7.4, P=0.06).

CONCLUSIONS

The prevalence of ED consumption among middle school Italian students was high and it was associated with another risky behavior, smoking, but not with anxiety or depression. About half of ED consumers used alcohol mixed with ED.