Environmental Temperature, Other Climatic Variables, and Cardiometabolic Profile in Acute Myocardial Infarction

Objectives: To evaluate CV profiles, periprocedural complications, and in-hospital mortality in acute myocardial infarction (AMI) according to climate. Methods: Data from 2478 AMI patients (1779 men; mean age 67 ∓ 13 years; Pasquinucci Hospital ICU, Massa, Italy; 2007-2018) were retrospectively analyzed according to climate (LAMMA Consortium; Firenze, Italy) by using three approaches as follows: (1) annual warm (May-October) and cold (November-April) periods; (2) warm and cold extremes of the two periods; and (3) warm and cold extremes for each month of the two periods. Results: All approaches highlighted a higher percentage of AMI hospitalization for patients with adverse CV profiles in relation to low temperatures, or higher periprocedural complications and in-hospital deaths. In warmer times of the cold periods, there were fewer admissions of dyslipidemic patients. During warm periods, progressive heat anomalies were characterized by more smoker (approaches 2 and 3) and young AMI patient (approach 3) admissions, whereas cooler times (approach 3) evidenced a reduced hospitalization of diabetic and dyslipidemic patients. No significant effects were observed for the heat index and light circulation. Conclusions: Although largely overlapping, different approaches identify patient subgroups with different CV risk factors at higher AMI admission risk and adverse short-term outcomes. These data retain potential implications regarding pathophysiological mechanisms of AMI and its prevention.

Temperature-humidity index monitoring during two summer seasons in dairy cow sheds in Mugello (Tuscany)

Many studies have reported that the impact of high temperatures affects physiology, welfare, health, and productivity of farm animals, and among these, the dairy cattle farming is one of the livestock sectors that suffers the greatest effects. The temperature-humidity index (THI) represents the state of the art in the evaluation of heat stress conditions in dairy cattle but often its measurement is not carried out in sheds. For this reason, the aim of this study was the monitoring of the THI in three dairy cattle farms in Mugello (Tuscany) to understand its influence on dairy cows. THI values were calculated using meteorological data from direct observation in sheds and outdoor environments. Data relating to the animal's behavior were collected using radio collars. The Pearson test and Mann-Kendall test were used for statistical analysis. The results highlighted a significant (P < 0.001) upward trend in THImax during the last 30 years both in Low Mugello (+ 1.1 every 10 years) and in High Mugello (+ 0.9 every 10 years). In Low Mugello sheds, during the period 2020-2022, more than 70% of daytime hours during the summer period were characterized by heat risk conditions (THI > 72) for livestock. On average the animals showed a significant (P < 0.001) decrease in time spent to feeding and rumination, both during the day and the night, with a significant (P < 0.001) increase in inactivity. This study fits into the growing demand for knowledge of the micro-climatic conditions within farms in order to support resilience actions for protecting both animal welfare and farm productivity from the effects of climate change. This could also be carried out thanks to estimation models which, based on the meteorological conditions forecast, could implement the thermal stress indicator (THI) directly from the high-resolution meteorological model, allowing to get a prediction of the farm's potential productivity loss based on the expected THI.

A potential wearable solution for preventing heat strain in workplaces: The cooling effect and the total evaporative resistance of a ventilation jacket

The increase in average seasonal temperatures has an impact in the occupational field, especially for those sectors whose work activities are performed outdoors (agricultural, road and construction sectors). Among the adaptation measures and solutions developed to counteract occupational heat strain, personal cooling garments represent a wearable technology designed to remove heat from the human body, enhancing human performance. This study aims to investigate the effectiveness and the cooling power of a specific cooling garment, i.e. a ventilation jacket, by quantifying the evaporative heat losses and the total evaporative resistance both when worn alone and in combination with a work ensemble, at three adjustments of air ventilation speed. Standardised "wet" tests in a climatic chamber were performed on a sweating manikin in isothermal conditions considering three clothing ensembles (single jacket, work ensemble and a combination of both) and three adjustments of fan velocity. Results showed a significant increase (p < 0.001) in evaporative heat loss values when the fan velocity increased, particularly within the trunk zones for all the considered clothing ensembles, showing that fans enhanced the dissipation by evaporation. The cooling power, quantified in terms of percent changes of evaporative heat loss, showed values exceeding 100% when fans were on, in respect to the condition of fans-off, for the trunk zones except for the Chest. A significant (p < 0.01) decrease (up to 42.3%) in the total evaporative resistance values of the jacket, coupled with the work ensemble, was found compared to the fans-off condition. Results confirmed and quantified the cooling effect of the ventilation jacket which enhanced the evaporative heat losses of the trunk zones, helping the body to dissipate heat and showing the potential for a heat adaptation measure to be developed.

Workers’ Perception Heat Stress: Results from a Pilot Study Conducted in Italy during the COVID-19 Pandemic in 2020

Many workers are exposed to the effects of heat and often to extreme temperatures. Heat stress has been further aggravated during the COVID-19 pandemic by the use of personal protective equipment to prevent SARS-CoV-2 infection. However, workers’ risk perception of heat stress is often low, with negative effects on their health and productivity. The study aims to identify workers’ needs and gaps in knowledge, suggesting the adaptation of measures that best comply with the needs of both workers and employers. A cross-sectional online questionnaire survey was conducted in Italy in the hottest months of 2020 (June–October) through different multimedia channels. The data collected were analyzed using descriptive statistics; analytical tests and analysis of variance were used to evaluate differences between groups of workers. In total, 345 questionnaires were collected and analyzed. The whole sample of respondents declared that heat is an important contributor to productivity loss and 83% of workers did not receive heat warnings from their employer. In this context, the internet is considered as the main source of information about heat-related illness in the workplace. Results highlight the need to increase workers’ perception of heat stress in the workplace to safeguard their health and productivity. About two-thirds of the sample stated that working in the sun without access to shaded areas, working indoors without adequate ventilation, and nearby fire, steam, and hot surfaces, represent the main injuries’ risk factors.

Performances of Limited Area Models for the WORKLIMATE Heat-Health Warning System to Protect Worker's Health and Productivity in Italy

Outdoor workers are particularly exposed to climate conditions, and in particular, the increase of environmental temperature directly affects their health and productivity. For these reasons, in recent years, heat-health warning systems have been developed for workers generally using heat stress indicators obtained by the combination of meteorological parameters to describe the thermal stress induced by the outdoor environment on the human body. There are several studies on the verification of the parameters predicted by meteorological models, but very few relating to the validation of heat stress indicators. This study aims to verify the performance of two limited area models, with different spatial resolution, potentially applicable in the occupational heat health warning system developed within the WORKLIMATE project for the Italian territory. A comparison between the Wet Bulb Globe Temperature predicted by the models and that obtained by data from 28 weather stations was carried out over about three summer seasons in different daily time slots, using the most common skill of performance. The two meteorological models were overall comparable for much of the Italian explored territory, while major limits have emerged in areas with complex topography. This study demonstrated the applicability of limited area models in occupational heat health warning systems.

A Web Survey to Evaluate the Thermal Stress Associated with Personal Protective Equipment among Healthcare Workers during the COVID-19 Pandemic in Italy

The pandemic has been afflicting the planet for over a year and from the occupational point of view, healthcare workers have recorded a substantial increase in working hours. The use of personal protective equipment (PPE), necessary to keep safe from COVID-19 increases the chances of overheating, especially during the summer seasons which, due to climate change, are becoming increasingly warm and prolonged. A web survey was carried out in Italy within the WORKLIMATE project during the summer and early autumn 2020. Analysis of variance (ANOVA) was used to evaluate differences between groups. 191 questionnaires were collected (hospital doctor 38.2%, nurses 33.5%, other healthcare professionals 28.3%). The impact of PPE on the thermal stress perception declared by the interviewees was very high on the body areas directly covered by these devices (78% of workers). Workers who used masks for more than 4 h per day perceived PPE as more uncomfortable (p < 0.001) compared to the others and reported a greater productivity loss (p < 0.001). Furthermore, the study highlighted a high perception of thermal stress among healthcare workers that worn COVID-19-PPE and this enhances the need for appropriate heat health warning systems and response measures addressed to the occupational sector.

Surface urban heat islands in Italian metropolitan cities: Tree cover and impervious surface influences

Land surface temperature (LST) predictors, such as impervious and vegetated surfaces, strongly influence the urban landscape mosaic, also changing microclimate conditions and exacerbating the surface urban heat island (SUHI) phenomenon. The aim of this study was to investigate the summer daytime SUHI phenomenon and the role played by impervious and tree cover surfaces in the 10 Italian peninsular metropolitan cities. Summer daytime LST values were assessed by using MODIS data referred to the months of June, July and August from 2016 to 2018. High spatial resolution (10 m) of impervious surface and tree cover layers was calculated based on open-data developed by the Italian National Institute for Environmental Protection and Research. A novel informative urban surface landscape layer was developed combining impervious surfaces and tree cover densities and its mapping for metropolitan cities was performed. Summer daytime SUHI rose significantly, increased especially in inland cities, by increasing the size of areas with low tree cover densities in the metropolitan core (or decreasing areas with low tree cover densities outside the metropolitan core), further increasing its intensity when the impervious density grew. A mitigating effect of the sea on daytime LST and SUHI was observed on coastal cities. The most intense SUHI phenomenon was observed in Turin (the largest Italian metropolitan city): for every 10% increase in areas with highly impervious surfaces and low tree cover densities in the metropolitan core, the SUHI significantly (p < 0.001) increased by 4.0 °C. Increased impervious surfaces combined with low tree cover densities represented the main driving process to increase the summer daytime SUHI intensity in most studied cities. These findings are useful to identify summer daytime LST critical areas and to implement the most efficient urban-heat-island mitigation strategies in order to safeguard the vulnerable urban environment and enhance quality of life for the population.

Health vs. wealth: Employer, employee and policy-maker perspectives on occupational heat stress across multiple European industries

Successful implementation of cooling strategies obviously depends on identifying effective interventions, but in industrial settings, it is equally important to consider feasibility and economic viability. Many cooling interventions are available, but the decision processes affecting adoption by end-users are not well elucidated. We therefore arranged two series of meetings with stakeholders to identify knowledge gaps, receive feedback on proposed cooling interventions, and discuss factors affecting implementation of heat-health interventions. This included four meetings attended by employers, employees, and health and safety officers (n = 41), and three meetings attended primarily by policy makers (n = 74), with feedback obtained via qualitative and quantitative questionnaires and focus group discussions. On a 10-point scale, both employers and employees valued worker safety (9.1 ± 1.8; mean±SD) and health (8.5 ± 1.9) as more important than protecting company profits (6.3 ± 2.3). Of the respondents, 41% were unaware of any cooling strategies at their company and of those who were aware, only 30% thought the interventions were effective. Following presentation of proposed interventions, the respondents rated "facilitated hydration", "optimization of clothing/protective equipment", and "rescheduling of work tasks" as the top-three preferred solutions. The main barriers for adopting cooling interventions were cost, feasibility, employer perceptions, and legislation. In conclusion, preventing negative health and safety effects was deemed to be more important than preventing productivity loss. Regardless of work sector or occupation, both health and wealth were emphasized as important parameters and considered as somewhat interrelated. However, a large fraction of the European worker force lacks information on effective measures to mitigate occupational heat stress. List of abbreviations: OH-Stress: Occupational heat stress; WBGT: Wet Bulb Globe Temperature.

Heat warning and public and workers' health at the time of COVID-19 pandemic

The humanity is currently facing the COVID-19 pandemic challenge, the largest global health emergency after the Second World War. During summer months, many countries in the northern hemisphere will also have to counteract an imminent seasonal phenomenon, the management of extreme heat events. The novelty this year concerns that the world population will have to deal with a new situation that foresees the application of specific measures, including adjunctive personal protective equipment (i.e. facemasks and gloves), in order to reduce the potential transmission of the SARS-CoV-2 virus. These measures should help to decrease the risk of the infection transmission but will also represent an aggravating factor to counteract the heat effects on the population health both at occupational and environmental level. The use of a specific heat health warning system with personalized information based on individual, behavioural and environmental characteristics represents a necessary strategy to help a fast adaptation of the population at a time where the priority is to live avoiding SARS-CoV-2 infection.

Heat-related productivity loss: benefits derived by working in the shade or work-time shifting

Purpose

Agricultural workers represent an important part of the population exposed to high heat-related health and productivity risks. This study aims to estimate the heat-related productivity loss (PL) for moderate work activities in sun and shady areas and evaluating the economic cost locally in an Italian farm and generally in the whole province of Florence. Benefits deriving by working in the shade or work-time shifting were provided. Comparisons between PL estimated in Mediterranean (Florence, Italy) and subtropical (Guangzhou, China) areas were also carried out.

Design/methodology/approach

Meteorological data were collected during summers 2017–2018 through a station installed in a farm in the province of Florence and by two World Meteorological Organization (WMO)‐certified meteorological stations located at the Florence and Guangzhou airports. These data were used to calculate the wet-bulb globe temperature and to estimate the hourly PL and the economic cost during the typical working time (from 8 a.m. to 5 p.m.) and by advancing of 1 h and 2 h the working time. Significant differences were calculated through nonparametric tests.

Findings

The hourly PL and the related economic cost significantly decreased (p < 0.05) by working in the shade and by work-time shifting. Higher PL values were observed in Guangzhou than in Florence. The decrease of PL observed by work-time shifting was greater in Florence than in Guangzhou.

Originality/value

Useful information to plan suitable heat-related prevention strategies to counteract the effects of heat in the workplace are provided. These findings are essential to quantify the beneficial effects due to the implementation of specific heat-related adaptation measures to counter the impending effects of climate change.

An Occupational Heat-Health Warning System for Europe: The HEAT-SHIELD Platform

Existing heat–health warning systems focus on warning vulnerable groups in order to reduce mortality. However, human health and performance are affected at much lower environmental heat strain levels than those directly associated with higher mortality. Moreover, workers are at elevated health risks when exposed to prolonged heat. This study describes the multilingual “HEAT-SHIELD occupational warning system” platform (https://heatshield.zonalab.it/) operating for Europe and developed within the framework of the HEAT-SHIELD project. This system is based on probabilistic medium-range forecasts calibrated on approximately 1800 meteorological stations in Europe and provides the ensemble forecast of the daily maximum heat stress. The platform provides a non-customized output represented by a map showing the weekly maximum probability of exceeding a specific heat stress condition, for each of the four upcoming weeks. Customized output allows the forecast of the personalized local heat-stress-risk based on workers’ physical, clothing and behavioral characteristics and the work environment (outdoors in the sun or shade), also taking into account heat acclimatization. Personal daily heat stress risk levels and behavioral suggestions (hydration and work breaks recommended) to be taken into consideration in the short term (5 days) are provided together with long-term heat risk forecasts (up to 46 days), all which are useful for planning work activities. The HEAT-SHIELD platform provides adaptation strategies for “managing” the impact of global warming.

Heat Stress Perception among Native and Migrant Workers in Italian Industries-Case Studies from the Construction and Agricultural Sectors

Climate change will increase the frequency and severity of hazard events such as heat waves, with important effects in several European regions. It is of importance to consider overall effects as well as specific impact on vulnerable population groups such as outdoor workers. The agricultural and construction sectors represent two strategic occupational fields that in relatively recent years involve an increasing number of migrant workers, and therefore require a better management of cultural aspects, that may interact with and impact on heat-related health risk. For this reason, the present study evaluated heat-stress perception and management among native and immigrant workers in Europe. As part of the EU’s Horizon 2020 HEAT-SHIELD project (grant agreement No. 668786), two agricultural and one construction companies, traditionally employing migrant workers, were evaluated with a questionnaire survey during the summer months of 2017. The data collected (104 case studies) were analyzed using descriptive statistics (Chi-squared tests) and the analysis of variance was performed with ANOVA test. From the results, migrant workers declared that work required greater effort than do native Italian workers (χ² = 17.1, p = 0.001) but reported less impact from heat on productivity (χ² = 10.6; p = 0.014) and thermal discomfort. In addition, migrant workers were mainly informed through written or oral communications, while native workers received information on heat-health issues through training courses. These findings are of importance for future information and mitigation actions to address socio-cultural gaps and reduce heat-stress vulnerability.

Evaluation of the impact of heat stress on the occurrence of occupational injuries: Meta-analysis of observational studies

BACKGROUND

Growing evidence indicates that the exposure to high heat levels in the workplace results in health problems in workers. A meta-analysis was carried out to summarize the epidemiological evidence of the effects of heat exposure on the risk of occupational injuries.

METHODS

A search strategy was conducted to retrieve studies on the effects of climate change on occupational injury risk. Among the 406 identified, 5 time-series and 3 case-crossover studies were selected for meta-analysis.

RESULTS

Pooled risk estimates for time-series and case-crossover studies combined, and then separated, were 1.005 (95%CI: 1.001-1009), 1.002 (95%CI: 0.998-1.005), and 1.014 (95%CI: 1.012-1.017), respectively. Subgroup analyses found increased risks (not statistically significant) for male gender, age <25 years and agriculture.

CONCLUSIONS

The present findings can orient further research to assess the effects of heat at workplace and consequently to establish better health policies for managing such exposure in at-risk regions.

Wild ungulates and environmental temperature: analysis on the possible utilization of data from sensor placed on GPS collars

GPS collars for wildlife provide a large amount of spatio-temporal location data and are frequently equipped with sensors that record the animal-level environmental temperature at a schedulable sampling frequency. The simultaneous collection of environmental temperature and animal location may contribute not only to deepen the understanding of animal behavior in different climatic conditions, but also to increase the knowledge of climate features in inaccessible areas. The measurement of environmental temperature provided by the sensors, however, can be biased by several factors (e.g., surface temperature of the animal, direct solar radiation, precipitation), so in-depth studies are required to verify the correlation. The aim of this study was to identify an equation for correcting the collar-recorded temperature data, allowing to improve and refine the results obtained by the analysis of spatial data and to highlight the environmental factors having the greatest impact on the accuracy of the measures. Temperature data from GPS collars were obtained within a research on spatial behavior on 11 hinds while spatialized temperature data were obtained from LAMMA-IBIMET dataset. These data showed high correlation and an identical trend, although the GPS collar temperature data was always higher. This model could represent a tool to obtain an accurate measurement of temperatures in complex geographical areas with wild animals but low density of weather stations. The availability of corrected temperature data, recorded simultaneously with the animal location, could be useful for a more accurate comprehension of animal behavior in free-ranging conditions, both in case of forthcoming studies and to valorize existing datasets.

Aspects of Biocompatibility of Two Different Dialysis Membranes: Cuprophane and Polysulfone

Intradialytic hypoxemia, leukopenia and coagulation system activation were monitored in 9 uremic patients during hemodialysis with cuprophane (Cu) and polysulfone (Psf) membranes, using the following parameters: polymorphonuclear count (PMN), elastase alpha-1 proteinase inhibitor (EI-α1PI) complex, platelet count, β-thromboglobulin (BTG), fibronectin (FN) and arterial oxygen tension (PaO2).

Our results indicate that 1) intradialytic hypoxemia observed with both membranes does not seem to be exclusively related to the well-known membrane-dependent leukopenia; 2) platelet activation, as demonstrated by the plasma BTG increase, appears to be an exclusive cellulosic membrane-related phenomenon; 3) at the same time platelet activation seems to be the major factor responsible for high FN levels, the highest FN levels occurring concurrently with the lowest platelet count.

Nationwide study of headache pain in Italy shows that pain assessment is still inadequate in paediatric emergency care

Aim

Italian national guidelines on pain management were published in 2010, but there is little information on how effective pain management is in paediatric emergency care, with other countries reporting poor levels. Using headache as an indicator, we described pain assessment in Italian emergency departments and identified predictors of algometric scale use.

Methods

All Italian paediatric and maternal and child hospitals participated, plus four general hospitals. Data on all children aged 4–14 years admitted during a one‐month period with headache as their chief complaint were abstracted from clinical records. Multivariable analyses identified predictors of algometric assessment, taking into account the cluster study design.

Results

We studied 470 admissions. During triage, pain was assessed using a standardised scale (41.5%), informally (15.5%) or was not recorded (42.9%). Only 32.1% of the children received analgesia in the emergency department. The odds ratios for predictors of algometric assessment were non‐Italian nationality (3.6), prehospital medication (1.8), admission to a research hospital (7.3) and a more favourable nurses‐to‐admissions ratio of 10.8 for the highest versus lowest tertile.

Conclusion

Despite national guidelines, paediatric pain assessment in Italian emergency care was suboptimal. Hospital variables appeared to be stronger predictors of adequate assessment than patient characteristics.

The impact of built-up surfaces on land surface temperatures in Italian urban areas

Urban areas are characterized by the very high degree of soil sealing and continuous built-up areas: Italy is one of the European countries with the highest artificial land cover rate, which causes a substantial spatial variation in the land surface temperature (LST), modifying the urban microclimate and contributing to the urban heat island effect. Nevertheless, quantitative data regarding the contribution of different densities of built-up surfaces in determining urban spatial LST changes is currently lacking in Italy. This study, which aimed to provide clear and quantitative city-specific information on annual and seasonal spatial LST modifications resulting from increased urban built-up coverage, was conducted generally throughout the whole year, and specifically in two different periods (cool/cold and warm/hot periods). Four cities (Milan, Rome, Bologna and Florence) were included in the study. The LST layer and the built-up-surface indicator were obtained via use of MODIS remote sensing data products (1km) and a very high-resolution map (5m) of built-up surfaces recently developed by the Italian National Institute for Environmental Protection and Research. The relationships between the dependent (mean daily, daytime and nighttime LST values) and independent (built-up surfaces) variables were investigated through linear regression analyses, and comprehensive built-up-surface-related LST maps were also developed. Statistically significant linear relationships (p<0.001) between built-up surfaces and spatial LST variations were observed in all the cities studied, with a higher impact during the warm/hot period than in the cool/cold ones. Daytime and nighttime LST slope patterns depend on the city size and relative urban morphology. If implemented in the existing city plan, the urban maps of built-up-surface-related LST developed in this study might be able to support more sustainable urban land management practices by identifying the critical areas (Hot-Spots) that would benefit most from mitigation actions by local authorities, land-use decision makers, and urban planners.

Weather-Related Flood and Landslide Damage: A Risk Index for Italian Regions

The frequency of natural hazards has been increasing in the last decades in Europe and specifically in Mediterranean regions due to climate change. For example heavy precipitation events can lead to disasters through the interaction with exposed and vulnerable people and natural systems. It is therefore necessary a prevention planning to preserve human health and to reduce economic losses. Prevention should mainly be carried out with more adequate land management, also supported by the development of an appropriate risk prediction tool based on weather forecasts. The main aim of this study is to investigate the relationship between weather types (WTs) and the frequency of floods and landslides that have caused damage to properties, personal injuries, or deaths in the Italian regions over recent decades. In particular, a specific risk index (WT-FLARI) for each WT was developed at national and regional scale. This study has identified a specific risk index associated with each weather type, calibrated for each Italian region and applicable to both annual and seasonal levels. The risk index represents the seasonal and annual vulnerability of each Italian region and indicates that additional preventive actions are necessary for some regions. The results of this study represent a good starting point towards the development of a tool to support policy-makers, local authorities and health agencies in planning actions, mainly in the medium to long term, aimed at the weather damage reduction that represents an important issue of the World Meteorological Organization mission.

Sedoanalgesia in paediatric intensive care: a survey of 19 Italian units

AIM

To analyse the methods used to manage and monitor sedoanalgesia at Italian paediatric intensive care units (ICUs).

METHODS

Data were collected by administering a questionnaire that aimed to investigate whether ICUs adopted a validated protocol to manage sedoanalgesia.

RESULTS

The results revealed that a majority of the ICUs adopt a protocol for dealing with sedation and analgesia, but this protocol is implemented with difficulty or not at all in routine clinical practice. The most often used pharmacological combination, is midazolam and fentanyl. Several weaknesses remain in terms of the methods used to assess sedoanalgesia, which are generally not standardized, but rather based on recording the patient's physiological parameters.

CONCLUSION

Sedation and analgesia are priority issues in the management of critically ill children. None of the numerous drugs available is ideal and the protocols currently used in clinical practice involve the combined use of different drugs. There is currently no shared and validated approach as to which is the most effective and safest sedoanalgesic regimen in critically ill children.

Type II sialidosis: review of the clinical spectrum and identification of a new splicing defect with chitotriosidase assessment in two patients

Sialidosis is a lysosomal storage disease caused by the deficiency of alpha-N-acetyl neuraminidase-1 (NEU1). Sialidosis is classified into two main clinical variants: Type I, the milder form of the disease, and Type II, which can in turn be subdivided into three forms: congenital, infantile and juvenile. We report herein the clinical, biochemical and molecular characterisation of two patients with Type II sialidosis exhibiting the congenital (P1) and infantile forms (P2). We also review clinical data on the rare Type II forms of sialidosis in the hope of improving understanding of the disorder and facilitating its diagnosis. The genetic characterization of the two patients showed one known [c. 679G > A (p.G227R)] NEU1 missense mutation (detected in P2), and the new c.807 + 1G > A splicing defect (detected in P1), a genetic lesion that is extremely rare in this disease. Interestingly, P2 presented an extremely elevated level of chitotriosidase in plasma. This is the first pathological detection of chitotriosidase in sialidosis patients.

Pain knowledge among doctors and nurses: a survey of 4912 healthcare providers in Tuscany

BACKGROUND

The purpose of this investigation was to get an overview of the understanding of doctors and nurses on pain experienced by patients in the hospitals of Tuscany in order to plan education in the weakest areas.

METHODS

A questionnaire was distributed to assess the knowledge of pain: it included 13 questions intended for 3631 nurses and 1281 doctors throughout all the hospitals and sanitary concerns in Tuscany. The total percentage of right answers corresponded to 70.2% with a variability among questions ranging between 30.5% and 95.6%.

RESULTS

There is a statistically significant difference between the mean number of correct answers of doctors (9.57/13) and nurses (8.87/13). For doctors working in critical areas, the mean is statistically significant in comparison with other areas. For nurses, those working in the surgical and critical areas show a statistically significant difference in comparison to the nurses of the general practice and other areas.

CONCLUSION

The data show that general knowledge of patient pain is good (86.5%), but that great gaps exist in the field of opiates (51.4%). Thus, education should focus on this area, as well as on prejudices concerning pain reported from 50.9% of healthcare providers.

[Preoperatory anxiety in children: psychological evaluation of premedication and parental presence efficacy]

OBJECTIVES

The induction of anaesthesia for surgery is a stressful event for child. To treat pre-operative anxiety in children pharmalogical methods (premedication) and behavioural methods (the presence of parents during the induction of anesthesia) are used in combination with each other. The purpose of this investigation was to study the effect of two interventions to alleviate preoperative anxiety of 39 children who are undergoing minor surgery. We studied the influence of some psichological and social characteristics of child and parents on operative period.

METHODS

We studied 39 italian speaking children aged 2-14 years ASA 1. We used STAI, a semi structured interview, with questions in the social-demographical area, a valuation scale of the behaviour of the child completed by the anesthesist, a questionaire after surgery for the parent. The descriptive analysis has been performed taking into account the nature of variables (frequency distributions for nominal and ordinal variables; means and standard deviations for cardinal variables).

RESULTS

The results show that the age of the child is strongly conditional to the level of stress: negative reactions are more usual in children of pre-school age. The sedative premedication is not an important factor in relieving anxiety, and this result contrasts with published studies, stating the premedication is more effective than presence of a parent. We obtained interesting results by relating the level of stress in the child with other variables: which parent, the level of stress according to the STAI, level of education, type of residence of parents.

CONCLUSIONS

Mother's presence during induction resulted of paramount importance. This study shows that the premedication alone is not effective. Some social-demographical factors of the parents have influence.

Redox Status in Very-Low Birth-Weight Newborns

Inborn metabolic diseases, such as disorders in pyruvate metabolism, in gluconeogenesis or in the respiratory chain, may present with lactic acidosis in newborn infants. A simple tool to screen for the efficacy of mitochondrial oxidation reduction activity is the detection of the redox status through simultaneous measurements of plasma lactate, pyruvate and ketone bodies, which are strongly influenced by feeding and stress. We present the redox status values of 55 very-low birth-weight infants under different nutritional conditions. We were able to demonstrate that the redox status values are not dependent on the type of nutrition (oral feeding or continuous enteral nutrition). Instead we observed a strong difference between newborns with intrauterine growth retardation and newborns with appropriate growth. Newborns with intrauterine growth retardation show lower preprandial values of glucose and ketone bodies than newborns with appropriate weight, but higher levels of lactate and pyruvate; nevertheless the lactate/pyruvate and beta-hydroxybutyrate/acetoacetate ratios are normal. The results of the redox status study could suggest the reduced activity of gluconeogenesis and, probably, of beta-oxidation in very-low birth-weight newborns with intrauterine growth retardation.

Developments in the treatment of postoperative pain in paediatrics

Although appreciation of pain has long been ignored, and even denied, in children its prevention and treatment is now an integral part of standard patient management. The current state of strategies of pain management in infants and children are detailed in this article and we focused on new trends and future developments.

[Percutaneous catheterization of the newborn: control of pain and easy insertion with brachial plexus block]

The increasingly prolonged survival of extremely premature infants who required long-term venous access means that this is often a major problem in modern neonatal unit. The insertion of central venous catheters has become an established practice and the development of silastic catheters inserted by newer percutaneous techniques through a peripheral vein is, now, the choice technique in awake non sedated critically-ill infants. Such technique has an high percentage of failure. We have undertaken a retrospective study to determine whether the brachial plexus block performed via the axillary approach could improve the success rate for the insertion of central venous catheter from a peripheral vein of the upper limb in infants minimizing physical and emotional stress to the neonates. Data from 157 low and very low birthweight infants, submitted or not submitted to the axillary block, were examined. The failure rate for the insertion of the central venous catheter was 27% without using the brachial plexus block vs. 9% in the patients that underwent the block. Use of the brachial plexus block via the axillary route, although retrospectively evaluated, improves the success rate and the pain control for the insertion of small diameter central venous silicon catheter from a peripheral vein of the upper limb in low and very low birthweight infants.

Percutaneous central venous catheterization in small infants: axillary block can facilitate the insertion rate

Central venous cannulation through a peripheral vein is the technique of choice in awake nonsedated critically ill infants. Such a technique has a high failure rate. We undertook a retrospective study to determine whether a brachial plexus block performed via the axillary approach could improve the success rate for the insertion of a central venous catheter from a peripheral vein of the upper limb in small infants. Data from 128 infants, submitted or not submitted to the axillary block, were analysed. The failure rate for insertion of the central venous catheter was 27% in the group without the use of the axillary block and 9% with the axillary block (P<0.05). The use of brachial plexus block via the axillary route, although evaluated retrospectively, improves the success rate for the insertion of small diameter central venous silicon catheter from a peripheral vein of the upper limb in small infants.

Comparison of ropivacaine with bupivacaine for paediatric caudal block

In a double-blind, multicentre study 245 children aged 1-10 yr undergoing elective minor surgery as inpatients were randomly allocated to receive a single caudal extradural injection of 1 ml kg-1 of either 0.25% bupivacaine or 0.2% ropivacaine after induction of light general anaesthesia. The groups were comparable for age, weight, vital signs and duration of surgery. The onset time was similar for ropivacaine and bupivacaine (9.7 vs 10.4 min). Further analgesia was not required in 40% of children. The mean time to first analgesia in the remainder was 233 min in the bupivacaine group and 271 min in the ropivacaine group. No motor block was measurable in either group. Ropivacaine 2 mg kg-1 was as effective as bupivacaine 2.5 mg kg-1 for caudal analgesia in children.

Comparison of two application techniques of EMLA and pain assessment in pediatric oncology patients

BACKGROUND AND OBJECTIVES

The study was designed to compare the analgesic efficacy of the local anesthetic EMLA when applied as a patch and as a cream in combination with a Tegaderm dressing to pediatric oncology patients undergoing repeated lumbar punctures.

METHODS

The analgesic effect of the two products was assessed by a continuous or discrete visual analog scale in 24 children 3-16 years old, during two lumbar punctures. Distress was rated by use of the Observational Scale of Behavioral Distress.

RESULTS

No significant differences were found between the pain and distress scores for the different preparations of EMLA.

CONCLUSION

The EMLA patch and the EMLA cream are equally effective in alleviating pain associated with lumbar puncture. The EMLA patch simplifies and speeds up the application of EMLA. It also allows for control of the dose administered per application, thus preventing both over- and underdosing.

The lumbosacral epidural block: a modified Taylor approach for abdominal urologic surgery in children

We describe the lumbosacral epidural approach in 97 children undergoing abdominal urologic surgical procedures. Due to the rudimentary spinous process of the first sacral vertebra and the less prominent sacral angle, an appropriate upward inclination of the Tuohy needle in the midline is always possible in infants and small children. A catheter was easily inserted in every case and the technique was shown to be useful and safe for providing adequate intraoperative and postoperative pain control.

Aspects of biocompatibility of two different dialysis membranes: cuprophane and polysulfone

Intradialytic hypoxemia, leukopenia and coagulation system activation were monitored in 9 uremic patients during hemodialysis with cuprophane (Cu) and polysulfone (Psf) membranes, using the following parameters: polymorphonuclear count (PMN), elastase alpha-1 proteinase inhibitor (EI-alpha 1PI) complex, platelet count, beta-thromboglobulin (BTG), fibronectin (FN) and arterial oxygen tension (PaO2). Our results indicate that 1) intradialytic hypoxemia observed with both membranes does not seem to be exclusively related to the well-known membrane-dependent leukopenia; 2) platelet activation, as demonstrated by the plasma BTG increase, appears to be an exclusive cellulosic membrane-related phenomenon; 3) at the same time platelet activation seems to be the major factor responsible for high FN levels, the highest FN levels occurring concurrently with the lowest platelet count.