Preliminary analysis of the Respiratory Disease, based on Hospital Discharge Records, in the Province of L'Aquila, Abruzzo, Italy.

BACKGROUND: The hospital discharge records (HDRs), integrated by other electronic health archives, besides some contra, can be a valuable and low-cost tool for monitoring public health. METHODS: Throughout a retrospective cohort study, we analyzed all hospitalizations in ordinary regime from the HDRs database of the residents in the province of L'Aquila, with the exception of day hospital, rehabilitation and long-hospital stay between 2008 and 2013, with a principal diagnosis of respiratory disease of 460 to 519, according to the ICD-9-CM. We calculated number and standard hospitalization rate (SHR) for respiratory diseases in groups of diagnoses: Pneumonia, Asthma, COPD and Respiratory Insufficiency, Other diseases in the general population in the pediatric population and the over 65s, in the Province of L'Aquila and in the three areas of L'Aquila, Marsica and Peligno-Sangrina. RESULTS: We observed different trends in SHRs in the different areas and for some of the different groups. CONCLUSIONS: Diverse possible causes of the different trends are discussed, with a specific focus on a possible relation with the earthquake of the 6th April 2009, since coherent with the related scientific literature.

Oral contraceptives versus physical exercise on cardiovascular and metabolic risk factors in women with polycystic ovary syndrome: a randomized controlled trial.

BACKGROUND: Although oral contraceptives (OCs) are one the most widespread therapy in young polycystic ovary syndrome (PCOS) women and physical exercise represents a crucial first step in the treatment of overweight and obese PCOS, no studies were performed to compare the effects on cardiovascular risk (CVR) of OCs and physical exercise in PCOS. OBJECTIVE: To compare the effects of OCs administration and physical exercise on the CVR, clinical, hormonal and metabolic parameters in PCOS women. METHODS: One hundred and fifty PCOS women were enrolled and were randomized to OCs (3 mg drospirenone plus 30 µg ethinyloestradiol), structured exercise training programme (SETP) or polyvitamin tablets. The intervention phase study was of 6 months. Primary outcome was intima-media thickness (IMT) and flow-mediated dilation (FMD). Secondary outcomes were clinical, hormonal and metabolic changes. RESULTS: A significant reduction of IMT and a significant increase of FMD were observed in the SETP group after treatment. Compared to baseline, in the SETP group, a significant improvement in anthropometric measures, insulin sensitivity indexes, lipid profile, cardiopulmonary function, inflammatory markers and frequency of menses was observed. Oral contraceptives use was associated with a significant decrease of hyperandrogenism and a significant improvement of frequency of menses. Further, OCs use had a neutral effect on CVR risk factors. CONCLUSION: OCs effectively treat hyperandrogenism and menstrual disturbances, while SETP is more effective in improving cardiometabolic profile and cardiopulmonary function in PCOS.

First array of enriched Zn[Formula: see text]Se bolometers to search for double beta decay.

The R&D activity performed during the last years proved the potential of ZnSe scintillating bolometers to the search for neutrino-less double beta decay, motivating the realization of the first large-mass experiment based on this technology: CUPID-0. The isotopic enrichment in [Formula: see text]Se, the Zn[Formula: see text]Se crystals growth, as well as the light detectors production have been accomplished, and the experiment is now in construction at Laboratori Nazionali del Gran Sasso (Italy). In this paper we present the results obtained testing the first three Zn[Formula: see text]Se crystals operated as scintillating bolometers, and we prove that their performance in terms of energy resolution, background rejection capability and intrinsic radio-purity complies with the requirements of CUPID-0.

Double-beta decay investigation with highly pure enriched [Formula: see text]Se for the LUCIFER experiment.

The LUCIFER project aims at deploying the first array of enriched scintillating bolometers for the investigation of neutrinoless double-beta decay of [Formula: see text]Se. The matrix which embeds the source is an array of ZnSe crystals, where enriched [Formula: see text]Se is used as decay isotope. The radiopurity of the initial components employed for manufacturing crystals, that can be operated as bolometers, is crucial for achieving a null background level in the region of interest for double-beta decay investigations. In this work, we evaluated the radioactive content in 2.5 kg of 96.3 % enriched [Formula: see text]Se metal, measured with a high-purity germanium detector at the Gran Sasso deep underground laboratory. The limits on internal contaminations of primordial decay chain elements of [Formula: see text]Th, [Formula: see text]U and [Formula: see text]U are respectively: [Formula: see text]61, [Formula: see text]110 and [Formula: see text]74 [Formula: see text]Bq/kg at 90 % C.L. The extremely low-background conditions in which the measurement was carried out and the high radiopurity of the [Formula: see text]Se allowed us to establish the most stringent lower limits on the half-lives of the double-beta decay of [Formula: see text]Se to 0[Formula: see text], 2[Formula: see text] and 2[Formula: see text] excited states of [Formula: see text]Kr of 3.4[Formula: see text]10[Formula: see text], 1.3[Formula: see text]10[Formula: see text] and 1.0[Formula: see text]10[Formula: see text] y, respectively, with a 90 % C.L.

Post traumatic stress disorder and coping in a sample of adult survivors of the Italian earthquake.

The aim was to investigate the prevalence of post traumatic stress disorder (PTSD) in people who had left their damaged homes and were still living in temporary housing more than a year after the April 2009 L'Aquila (Italy) earthquake. In addition, we evaluated the differences in coping strategies implemented by persons who had and who did not have PTSD. A cross-sectional prevalence study was carried out on a sample of 281 people aged >18 years and living in temporary housing after the earthquake. The questionnaires used include the Davidson Trauma Scale and the Brief Cope. The prevalence of PTSD was 43%. Women and the non-employed were more vulnerable to PTSD, while, age and level of education were not associated with PTSD. Those with PTSD symptoms often employed maladaptive coping strategies for dealing with earthquake and had the highest scores in the domains of denial, venting, behavioral disengagement, self-blame. By contrast, those without PTSD generally had more adaptive coping mechanisms. Adults who were living in temporary housing after the earthquake experienced high rates of PTSD. The difference in coping mechanisms between those who have PTSD and those who do not also suggests that they influence the likeliness of developing PTSD.

TeO[Formula: see text] bolometers with Cherenkov signal tagging: towards next-generation neutrinoless double-beta decay experiments.

CUORE, an array of 988 TeO[Formula: see text] bolometers, is about to be one of the most sensitive experiments searching for neutrinoless double-beta decay. Its sensitivity could be further improved by removing the background from [Formula: see text] radioactivity. A few years ago it was pointed out that the signal from [Formula: see text]s can be tagged by detecting the emitted Cherenkov light, which is not produced by [Formula: see text]s. In this paper we confirm this possibility. For the first time we measured the Cherenkov light emitted by a CUORE crystal, and found it to be 100 eV at the [Formula: see text]-value of the decay. To completely reject the [Formula: see text] background, we compute that one needs light detectors with baseline noise below 20 eV RMS, a value which is 3-4 times smaller than the average noise of the bolometric light detectors we are using. We point out that an improved light detector technology must be developed to obtain TeO[Formula: see text] bolometric experiments able to probe the inverted hierarchy of neutrino masses.

Vitamin D and thyroid disease: to D or not to D?

The main role of vitamin D is to maintain calcium and phosphorus homeostasis, thus preserving bone health. Recent evidence has demonstrated that vitamin D may also have a role in a variety of nonskeletal disorders such as endocrine diseases and in particular type 1 diabetes, type 2 diabetes, adrenal diseases and polycystic ovary syndrome. Low levels of vitamin D have also been associated with thyroid disease, such as Hashimoto's thyroiditis. Similarly, patients with new-onset Graves' disease were found to have decreased 25-hydroxyvitamin D concentrations. Impaired vitamin D signaling has been reported to encourage thyroid tumorigenesis. This review will focus on the role of vitamin D in thyroid diseases, both autoimmune diseases and thyroid cancer, and will summarize the results of vitamin D supplementation studies performed in patients with thyroid disorders. Although observational studies support a beneficial role of vitamin D in the management of thyroid disease, randomized controlled trials are required to provide insight into the efficacy and safety of vitamin D as a therapeutic tool for this dysfunction.

Burden of celiac disease in Europe: a review of its childhood and adulthood prevalence and incidence as of September 2014.

BACKGROUND: Recent epidemiological studies have demonstrated that coeliac disease (CD) prevalence is still underestimated both in Europe and in Mediterranean regions. Here we review the latest data on CD prevalence and incidence in the European Union (EU) as of September 2014. METHODS: The current epidemiological scenario of CD prevalence and incidence was investigated by searching PubMed for papers in English using the following key words: "celiac disease", "celiac disease plus prevalence" (limits: 1990-2014), "incidence" (limits: 1970-2014), and "frequency", plus "in Europe". Another search was performed with the same key words plus the name of each European country. Only prevalence data obtained by serology using anti-gliadin antibodies (AGA), EMA test, tTG test, and/or duodenal biopsy were included. The study designs considered were retrospective and prospective studies: population-based (PB), cross-sectional, case-control and cohort studies. RESULTS: Extensive research based on serological screening has demonstrated that 0.5-1% of the EU population suffers from undiagnosed CD, whereas the highest estimate reported in PB studies is approximately 1%. Considering data from different periods, incidence seems to range from 0.1 to 3.7/1000 live births in the child population and from 1.3 to 39/100,000/year in the adult population. CONCLUSIONS: The present data disclose marked geographical variation in CD incidence and prevalence in different European countries. Here we document rising CD occurrence in recent decades in European countries due partly to the advent of improved serological testing (tTG + EMA) and partly to increased awareness of its clinical presentation.

Lifestyle changes in the management of adulthood and childhood obesity.

Adulthood and childhood obesity is rapidly becoming an epidemic problem and it has a short and long term impact on health. Short term consequences are mostly represented by psychological effects, in fact obese children have more chances to develop psychological or psychiatric problems than non--obese children. The main long term effect is represented by the fact that childhood obesity continues into adulthood obesity and this results in negative effects in young adult life, since obesity increases the risk to develop morbidity and premature mortality. The obesity--related diseases are mostly represented by hypertension, type 2 diabetes, dyslipidaemia, cardiovascular diseases. Medical treatment should be discouraged in childhood because of the side effects and it should be only reserved for obese children with related medical complications. Lifestyle changes should be encouraged in both adulthood and childhood obesity. This review focuses on the management of obesity both in adulthood and in childhood, paying particular attention to lifestyle changes that should be recommended.

Colorectal cancer prevention in Europe: burden of disease and status of screening programs.

Colorectal cancer is a major public health challenge worldwide. In Europe it is the first malignancy in terms of incidence and the second in terms of mortality in both genders. Despite evidence indicating that removal of premalignant and early-stage cancer lesion scan greatly reduce mortality, remarkable differences are still found among countries both in terms of organized screening programs and of the tests used. In 2003 the European Council recommended that priority be given to activation of organized cancer screening programs, and various states have been making significant efforts to adopt effective prevention programs with international quality standards and centralizing screening organization and result evaluation. After a 2008 European Union report on the state of screening program, activation highlighted that little more than 50% (12/22) of Member States had colorectal cancer screening programs, Screening programs have been adopted or earlier pilot projects have been extended nationwide. This paper examines the state of activation and the screening strategies of colorectal cancer screening programs in EU States as of July 2013.

Quality of life, psychological wellbeing and resilience: a survey on the Italian population living in a new lodging after the earthquake of April 2009.

OBJECTIVE: The aim of this study is to estimate the quality of life and the psychological wellbeing as a result of the earthquake which occurred the 6th of April 2009 and that struck the population of the city of L'Aquila. METHODS: A random sample of 281 subjects, from the population that had the possibility of living in a temporary lodging provided by the State, were interviewed after the earthquake, during the period between July and October 2010. Two self-administered questionnaires were used: the Psychological General Well-Being Index (PGWBI) and the Dispositional Resilience Scale (DRS II). RESULTS: The women's health status is worse than the men's, this is true both on a general level (79,24 vs 70,55), and on different estimated dimensions. Health status is significantly worse in older age groups (F2;245=4,34, p=0,0140): the elderly appear to be more depressed (F2;245=6,52, p=0,0017) and to have less self-control (F2;245=3,06, p=0,0487) than the younger. CONCLUSIONS: Generally women tend to experience greater emotional involvement in social and interpersonal relationships. Although many months have passed since the catastrophic event, feelings of disease and a sense of impotence (about life) are still persistent in people, even though they generally are hopeful about the future.

Alcohol consumption and awareness of the risks related in alcohol-abuse in high school students: evidence from a Health Education program.

BACKGROUND: The unceasing and widespread increase of alcohol consumption represents an important problem for the European Union. For this reason, we wanted to investigate the patterns of alcohol consumption among high-school students of Rieti, a city in central Italy, and of surrounding rural areas. Furthermore, the study intends to investigate students' awareness on alcohol-related health risks and on the consequences of driving in a state of intoxication. METHODS: In the investigation 7 schools including senior high schools and technical schools were involved, for a total of 669 students aged between 15 and 19 years. As part of a program of health education, a self-administered anonymous questionnaire was proposed to each student. A descriptive and multivariate analysis was carried out. RESULTS: The prevalence of usual drinkers was equal to 12.7 per cent. The logistic regression analysis showed a statistically significant association between usual consumption of alcohol and the attendance of Technical Institutes (OR=3.43; 95% IC: 2.07 - 5.69), and the residence in rural areas (OR=2.19; 95% IC: 1.38 - 3.47). The area of residence in the multivariate analysis loses significance. Only 54.6 % of the students answered the questions regarding the state of driving under the effect of alcohol; of these, 11.0 % declared of having driven at least once under the effect of alcohol, whereas 18.0 % declared that they had been passengers of a driver who was drunk. The answer to the question whether the consumption of alcohol is harmful to health was "no" for 15.7 % of usual drinkers against 2.2 % of the non drinkers or occasional (episodic) drinkers. CONCLUSIONS: Our study shows that the drinking habits of high school students of Rieti are worse for those attending technical schools. Usual drinkers show lower consciousness of alcohol-related harm. Our study may provide clues useful for the identification of the target population at high risk for alcohol abuse in order to create targeted prevention programs.

Request for ethics support in healthcare practices. Reasons and characteristics of Ethics Consultation Service users.

BACKGROUND: Ethical problems in healthcare practices are increasing. Therefore, healthcare professionals encounter difficult ethical problems more frequently in their professional activities. For this reason, in several countries Ethics Consultation Services have been created, and a debate concerning their role and organization model has developed. Despite the great interest of healthcare professionals in ethics support, Ethics Consultation Services are scarcely diffused in Italy. METHODS: A survey was conducted to identify the levels of the nurses' experience and knowledge in the field of ethics and to assess their willingness to use a consultation service to approach ethical issues in healthcare. A questionnaire was administered and completed personally by 374 nurses appropriately instructed beforehand on its use. They were recruited from post-basic training courses at the Faculty of Medicine and Surgery of the University of L'Aquila. RESULTS: The willingness to recur to an ethical consultation, indicated by 90.3% of respondents, would confirm the hypothesis that the increasing ethical difficulties encountered in healthcare activities determined a greater interest towards this kind of service. The results of the study underline both the need and expectations the nurses have for ethics consultation and support to face ethical difficulties in patient care, and describe the characteristics of potential users. CONCLUSION: In our country the delay in approaching such problems is in contrast with the marked interest the healthcare professionals have for a possible request for support to face ethical problems in patient care. The study shows the respondents' high degree of appreciation of the contents of an ethics consultation activity and, consequently, it is desirable that the creation of an Ethics Consultation Service takes into consideration the indications given by the potential users, in addition to the experiences coming from other countries.

Effects of physical exercise on the female reproductive system.

The excess in physical activity could be closely linked to considerable negative consequences on the whole body. These dysfunctions called as "female athlete triad"' by the American College of Sports Medicine (ACSM) include amenorrhea, osteoporosis and disorder eating. The female athlete triad poses serious health risks, both on the short and on the long term, to the overall well-being of affected individuals. Sustained low energy availability can impair health, causing many medical complications within skeletal, endocrine, cardiovascular, reproductive and central nervous system. On the contrary, several studies have shown, that physical activity improves cardiovascular risk factors, hormonal profile and reproductive function. These improvements include a decrease in abdominal fat, blood glucose, blood lipids and insulin resistance, as well as improvements in menstrual cyclicity, ovulation and fertility, decreases in testosterone levels and Free Androgen Index (FAI) and increases in sex hormone binding globulin (SHBG). Other studies reported that physical activity improved self-esteem, depression and anxiety. Thus, the aim of this review is to elucidate the effect of physical exercise on female reproductive system and viceversa the impact of hormonal status on physical activity and metabolism. In addition this review supports the idea that physical exercise is a helpful tool for the management of obesity, prevention of cardiovascular, metabolic diseases and female reproductive organs related diseases (e.g. breast cancer). When the excess in physical activity leads up to the female athlete triad, it is imperative to treat each component of the triad by employing both pharmacological and non pharmacological treatments.

Endocrine changes (beyond diabetes) after bariatric surgery in adult life.

Bariatric surgery is nowadays an effective therapeutic option for morbid obesity. Endocrinologists may thus have a growing opportunity to diagnose and treat obese patients eligible for surgery in pre- and post-operative phase. This requires a better understanding of endocrine changes caused by either obesity or weight loss surgery. Despite the large number of studies available in literature, only limited well-designed clinical trials have been performed so far to investigate changes of endocrine axes following bariatric procedures. There are still areas of unclear results such as female and male fertility, however, weight loss after bariatric surgery is considered to be associated with favorable effects on most endocrine axes. The aim of this clinical review is to overview the available literature on the effects of weight loss after bariatric surgery on the endocrine systems to suggest the most appropriate pre- and post-operative management of obese patients undergoing bariatric surgery in terms of "endocrine" health.

Prevalence and correlates for self-reported sleep problems among nursing students.

INTRODUCTION: University students report significantly worse sleep quality than the general population. Sleep problems are related to increased health concerns, irritability, depression, fatigue, attention and concentration difficulties, along with poor academic performance. The aim of this paper is to conduct a survey based on a questionnaire that would characterize night time and daytime habits in nursing students to estimate the prevalence of chronic insomnia, sleep disturbance and their correlates. METHODS: We conducted a cross-sectional survey among 364 nursing students of the University of L'Aquila, in Italy. Self-reported sleep data were derived from Sleep and Daytime Habits Questionnaire" (S&DHQ) that covered sleep and daytime habits and academic progress. Anxiety and depression symptoms were assessed by the Mental Health Inventory-5 (MHI-5) questionnaire. A supplement includes information about lifestyle, health status and physical activity. RESULTS: The overall prevalence of insomnia was 26.7%. It increased significantly from 10.3% for students aged < 20 years to 45.5% for those aged > 40 years. The prevalence of sleep problems were 9.4% for disorders of initiating sleep, 8.3% for disrupted sleep, 7.7% for early morning awakening and subjectively poor quality of sleep 22.3%. Multiple logistic regression analysis showed that greater age was significantly associated with an increased risk of insomnia. Other risk predictors of insomnia were headache, severe depression and self perception of poor quality of life. Daytime sleepiness and morning tiredness were significantly associated with current smoking habit and painful physical condition. The risk of unsatisfactory academic progress increased significantly in students reported poor sleep quality. DISCUSSION: Our study demonstrates that sleep problems are very common among students, and supports the need to assess sleep problems and identify students at risk regarding school achievement.

Six weeks of structured exercise training and hypocaloric diet increases the probability of ovulation after clomiphene citrate in overweight and obese patients with polycystic ovary syndrome: a randomized controlled trial.

BACKGROUND: Clomiphene citrate (CC) is the first-line therapy for the induction of ovulation in infertile women with polycystic ovary syndrome (PCOS), but ∼20% of patients are unresponsive. The aim of the current study was to test the hypothesis that a 6-week intervention that consisted of structured exercise training (SET) and hypocaloric diet increases the probability of ovulation after CC in overweight and obese CC-resistant PCOS patients. METHODS: A cohort of 96 overweight and obese CC-resistant PCOS patients was enrolled consecutively in a three-arm randomized, parallel, controlled, assessor-blinded clinical trial. The three interventions were: SET plus hypocaloric diet for 6 weeks (Group A); 2 weeks of observation followed by one cycle of CC therapy (Group B); and SET plus hypocaloric diet for 6 weeks, with one cycle of CC after the first 2 weeks (Group C). The primary end-point was the ovulation rate. Other reproductive data, as well as anthropometric, hormonal and metabolic data, were also collected and considered as secondary end points. RESULTS: After 6 weeks of SET plus hypocaloric diet, the ovulation rate was significantly (P =0.008) higher in Group C [12/32 (37.5%)] than in Groups A [4/32 (12.5%)] and B [3/32 (9.4%)] with relative risks of 3.9 [95% confidence interval (CI) 1.1-8.3; P = 0.035] and 4.0 (95% CI 1.2-12.8; P = 0.020) compared with Groups A and B, respectively. Compared with baseline, in Groups A and C, a significant improvement in clinical and biochemical androgen and insulin sensitivity indexes was observed. In the same two groups, the insulin sensitivity index was significantly (P < 0.05) better than that in Group B. CONCLUSIONS: In overweight and obese CC-resistant PCOS patients, a 6-week intervention of SET and a hypocaloric diet was effective in increasing the probability of ovulation under CC treatment. The study was registered at Clinicaltrials.gov:NCT0100468.

[Research Ethics Committees in Abruzzo: criticisms and prospects for developments]. / I Comitati etici abruzzesi: criticità rilevate e prospettive di sviluppo.

The first legislative bills on Ethics Committee (EC) activity were adopted across the Italian Regions simultaneously (1998). This widespread implementation meant it was necessary to define new qualitative and quantitative standards (Decree Law, 12th May 2009), creating expectations about the EC's role in research and clinical practice and its potential to improve the quality of medical assistance. The present paper presents the results of a descriptive survey that maps out the framework, organization and operating methods of ECs in the Abruzzo Region in Italy. Differences between ECs have been outlined, with special concern for differences in organization and way of operating. It was found that interaction between the EC and the experimenter is limited to the authorization phase of the research protocol, with low level involvement in the planning and execution phases. Additionally, the exchange of information between the co-ordinating EC and EC practitioners is not well organized in multicentre experimentation. A certain amount of criticism emerged regarding those areas of activity that would help to place the EC at the centre of the cultural growth process with regards to Bioethics and Clinical Research (e.g. education, on-line news on Bioethics topics).These criticisms are part of the reality of the Abruzzo Region that lacks economic and structural resources which penalizes EC activity.