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 ).

Arterial Blood Gas and Rotational Thromboelastometry Parameters in Healthy Rescuers Incidentally Exposed to Nitroglycerin, Nitrogen Compounds, and Combustion Products.

INTRODUCTION: Acute exposure to nitrogen compounds combined with a massive inhalation of air pollutants can influence respiratory and cardiovascular symptoms and coagulation abnormalities in accidentally exposed healthy adults during cave detonation operations. METHODS: Italian alpine and cave rescuers widened a cave in the Abisso Luca Kralj in Trieste, Italy. Volunteers inside the cave were accidentally exposed to the fumes from an uncontrolled detonation of blasting gelatin microcharges. We performed a retrospective cohort study on the clinical data, arterial blood gas analysis, and rotational thromboelastometry parameters from the rescuers involved in the accident. RESULTS: Ninety-three healthy rescuers were involved in the uncontrolled detonation: 47 volunteers handled a mixture of nitrogen compounds (blaster group), and 46 volunteers did not (nonblaster group). After the accident, statistically significant differences (P<0.05) in arterial blood gas values were observed between the groups, with a pattern of mild respiratory acidosis with hypercapnia in the nonblaster group and severe mixed acid-base disorder with hypoxia and hypercapnia in the blaster group. Mild hyperfibrinolysis was observed in 44 volunteers in the blaster group, as were associated bleeding symptoms in 34 volunteers; no significant coagulation modifications were recorded in the nonblaster group. CONCLUSIONS: Respiratory acidosis with hypoxia, hypercapnia, a compensatory metabolic response, and mild hyperfibrinolysis were probably related to the combined effect of nitrogen compounds and the inhaled toxic products of detonation. Therefore, each element exerts a determinant effect on promoting the biological toxicity of the others.

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.

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.

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.

The PERSONS score: A new tool for cancer patients' symptom assessment in simultaneous care and home care settings.

BACKGROUND: Scientific societies recommend early interaction between oncologic and supportive care, but there is still a lack of systematic evaluations regarding symptoms from the perspective of oncologists. PATIENTS AND METHODS: The aim of this prospective study was to evaluate the PERSONS score, in both "simultaneous care" and "supportive care" settings using the Edmonton Symptom Assessment Scale (ESAS) as a comparator. RESULTS: From November 2017 to April 2018, 67 and 110 consecutive patients were enrolled in outpatient and home care cohorts, respectively. The final study population comprised 163 patients. There were no significant changes over time in the total PERSONS scores and total ESAS scale. The intra-interviewer reliability (ICC2,1) and inter-interviewer reliability (ICC2,k) showed good reproducibility (test-retest) in each group of patients: 0.60 (0.49-0.70) and 0.82 (0.75-0.87), respectively, for the home care patients and 0.73 (0.62-0.81) and 0.89 (0.83-0.93), respectively, for the outpatient cohort. There were high correlations between PERSONS and ESAS, both at the baseline and final assessments. The mean PERSONS and ESAS scores between the home care patients and outpatients were not different at the baseline and final assessments. Receiver operating characteristics (ROC) curve for the PERSONS total score revealed good diagnostic ability. Area under the curve (AUC) was 0.825 and 0.805 for improvement and deterioration, respectively. CONCLUSIONS: The PERSONS score is an easy to apply tool for symptom assessment. Importantly, the PERSONS score showed high concordance with the established ESAS scale and, therefore, provides an alternative for everyday use in supportive care assessment.

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.

Endovenous Laser Ablation with 1,470-nm Diode with Tumescence Anesthesia and Saphenofemoral Ligation: Propensity Score Match Comparison.

BACKGROUND: The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA). METHODS: Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology, Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery. RESULTS: A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12 months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P = 0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P = 0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52-6.01). CONCLUSIONS: Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470 nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.

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.

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.

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.

[Behavioural risk factors in L'Aquila (Central Italy) 3-5 years after the 2009 earthquake]. / Fattori di rischio comportamentali all'Aquila 3-5 anni dopo il terremoto del 2009.

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.

[Health status and access to health services by the population of L'Aquila (Abruzzo Region, Italy) six years after the earthquake]. / Stato di salute e accesso alle prestazioni sanitarie nella popolazione terremotata del comune di L'Aquila. Un bilancio a sei anni dal sisma.

Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services.

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.

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.

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.

Investigating Unhealthy Behaviors Associated with SF-36 Domains in Women with Endometriosis-Findings from a Web-Based Survey Data Set.

Unhealthy behaviors may contribute to the development and the progression of chronic diseases with negative consequences on patients' quality of life. The present study aimed to investigate the relationship between unhealthy behaviors (physical inactivity, tobacco consumption, and alcohol consumption) and health-related quality of life, measured with the SF-36 questionnaire, in women with endometriosis. To achieve this, data from a previous cross-sectional web survey among Italian adult women were analyzed. A total of 1045 responses were included in the analysis. Among the SF-36 subscales, the lowest score was recorded in the energy/fatigue domain: mean = 35.536 (Standard Deviation = 18.452). Smoking and physically inactive women had lower scores than non-smoking and physically active women, respectively, in each SF-36 domain. Women who drank more than one unit of alcohol a day, on average, reported lower scores than women with an alcohol intake <1 unit a day, for the following SF-36 domains: role limitations due to physical health, role limitations due to emotional problems, and emotional well-being. The multivariable analysis evidenced that employment, physical inactivity, and tobacco consumption were significant predictors for each SF-36 domain (p < 0.05). Physical inactivity and tobacco consumption had negative effects on the SF-36 subscales. Our results showed the need to monitor unhealthy behaviors to improve the overall well-being of women with endometriosis. Tailored strategies addressing smoking cessation, promoting physical activity, and moderating alcohol intake may aid in enhancing health-related quality of life in this vulnerable population.

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.