[Epidemiological analysis on the hospitalization from neurological diseases in the Province of Pavia (Lombardy Region, Northern Italy)]. / Analisi epidemiologica dei ricoveri per patologie neurologiche in Provincia di Pavia.

OBJECTIVES: to evaluate time and spatial distribution of hospitalization due to neurological diseases in the province of Pavia (Lombardy Region, Northern Italy). DESIGN: ecological study. SETTING AND PARTICIPANTS: the study was performed on aggregate data of people residing in the province of Pavia in the period 2005-2014. MAIN OUTCOME MEASURES: hospital discharge records of neurological diseases and raw and standardized hospitalization rates. RESULTS: hospitalization due to neurological diseases in the Province of Pavia showed a slight decreasing trend in time. For the year 2014, the spatial analysis of hospitalizations highlights excesses of risk in the Lomellina district, both in males and in females. CONCLUSION: spatial analysis confirms previous results on specific neurological diseases and suggests more detailed analysis on hospitalization excesses in Lomellina area.

Gender differences among cancer nurses' stress perception and coping: an Italian single centre observational study.

OBJECTIVES: The literature on gender differences in stress perception and coping has been produced diverse results, and there is a shortage of studies on this topic among cancer nurses. For this reason, the aim of this study was to describe the gender differences related to cancer nurses' stress perception and coping. METHODS: This study had a cross-sectional design, using a secondary data analysis on dataset (sample = 126 cancer nurses, 74% females). The stress perception and the coping strategies were assessed using Burnout Potential Inventory (BPI) and Health Profession Stress and Coping Scale, nurses' version (HPSCS). RESULTS: Female cancer nurses perceived more stress from personal attacks than males. Indeed, female over 45 years had a significant higher perception of stress, but they used the request for social support (functional coping) as a coping strategy more than males. CONCLUSIONS: Our results could help to clearly understand what are the main gender differences in coping and in perceiving stress among Italian cancer nurses, and to incentive more research.

A fuzzy 'boater' model to detect fouling and spreading risk of non-indigenous species by recreational boats.

Recreational boating is an unregulated and underestimated vector of spread of non-indigenous species (NIS) in marine environments. The risk of a single boat to spread NIS depends not only on the local environmental context, but also on the type of boat and on the boat owner's behaviour (hull cleaning and painting frequency, travel history). In this paper we present a model to assess the risk of fouling and spreading of NIS and its application to data derived from a questionnaire given to Italian boat owners. The model uses a two-levels fuzzy logic approach: (1) the first level assesses the risk of hull fouling and risk of spreading separately; (2) the second level combines the two separate risks in an overall index ranging from 0 (null risk) to 100 (highest risk) and measures the global risk of NIS introduction and spread through recreational boating. The questionnaire and the fuzzy model allow for a simple and rapid assessment of boats most likely to be infested. The proposed fuzzy model can be easily edited and adapted to context-specific ecological and social conditions. The results of this Italian study showed that 53.9% of the respondents were in the very-low and low risk categories, and 46.1% in the medium, high and very-high risk categories. Possible associations between some boaters habits and the fouling and spreading risk were explored using logistic regression analyses. The results indicate a high-risk profile of boat owner as an experienced sailor who visits many marinas during the summer season. Biosecurity guidelines, containment measures and awareness raising programmes should be implemented to prevent and avoid further spread of NIS in marine environments, and such management actions would benefit from the early detection of high-risk boats, and from the identification of profiles of boaters upon which these initiatives should be prioritized.

[Snow trauma: comparison between skiers and snowboarders]. / I traumi della neve: sci e snowboard a confronto.

OBJECTIVE: skiing is practiced by million of persons every year, while snowboard is an emerging sport. This study compares the types of injury produced by the two sports. DESIGN: an observational study based on current data concerning traumas in skiing and snowboard. 1,264 skiers and 228 snowboarders injured were studied. STATISTICAL ANALYSIS: Student's t test and chi-square test, logistic regression. SETTING: snow injuries occurring in the ski resorts of agordino (Belluno), Arabba-Marmolada, Alleghe and Falcade between December 2006 and April 2007. Data were collected from the database of the Agordo Public Hospital, of the 118 Emergency service of Pieve di Cadore, and of several ski resorts. MAIN OUTCOMES MEASURES: age, sex, country area, kind of injury, numbers, severity and type of trauma, injury time, prognosis, part of the body injured. RESULTS: the two sports differ with regard to trauma types: sprains and distortions are more frequent in skiers, whereas fractures (breaks) are more frequent in the snowboard. Lower limbs (knee) in ski and upper limbs (wrist) in snowboard are the main lesion sites. With regard to the ankle's injuries, no difference was found between the two sport: this contrasts with previous findings reported in the literature. Severity of trauma is not related to the kind of sport. CONCLUSIONS: the results of the present study agree with previous findings with regard to the type of lesions observed in the two sports. Among snowboarders, it is possible that recent materials and equipments reduce ankle injury risk. In spite of the differences in equipment and gestures, the consequences of injury are similar in the two sports.

[Human risk factors and injuries due to road accidents: analysis of current data]. / Fattori di rischio umani e infortuni conseguenti agli incidenti stradali: analisi di dati correnti.

OBJECTIVES: several studies have shown that most road accidents are due to human factors, and that these are strongly linked to a drive's age and sex. The aim of this study is to test the role that some human factors play in road accidents by analysing current road accident data in the Province of Pavia, in Northern Italy. DESIGN: road accidents that occurred in 2004 were analysed by integrating the paper database of the vehicle licensing office, properly computerised, with the 911 database of the Province of Pavia. This study has been carried out by analysing 1.347 road accidents and the associated 2.908 drivers of motorised vehicles. SETTING: Northern Italy, the Province of Pavia. RESULTS: the death rate of drivers of 2-wheeled vehicles is almost nine times higher than that of 4-wheeled vehicles. Analysis shows that females are twice as exposed to road accidents than males; it also shows the benefits of extensive road education training and of being aged 30-64 and older. Drivers who have already been punished and have had their driving license scores reduced are likely to respond rapidly when in a dangerous situation and also to be without blame after an accident. Motorcycle riders are 25 times more likely to suffer serious injury than drivers of cars. Additionally, the risk of a woman being seriously injured is higher than for a man. CONCLUSION: females, young drivers and motorcycle riders who have not previously been penalised for a previous traffic violation have a higher risk of being seriously injured; females and motorcycle riders are also at greater risk of being seriously injured. We hope that this analysis will be used to improve preventative interventions for road accidents.r.

Risk factors for long-term care after hemiplegia from cancer-related brain surgery: a pilot study for new prediction model.

BACKGROUND: Hemiplegia is a worldwide-represented neurological condition leading to long-term disability. The most common cause of hemiplegia is stroke; 25% to 50% of stroke survivors require some assistance after hospital discharge; approximately half of them become dependent, while only 14% achieve full recovery of activities of daily living (ADL). Cancer and cancer-related surgery are other causes of hemiplegia and rehabilitation in cancer patients has been recognized as important factor in order to help maintaining quality of life as long as possible. Many studies have been done in order to assess a reliable prediction about outcome of hemiplegia from stroke, but outcome prediction for cancer-related hemiplegia still remains a challenge and no clinical prediction tool has been developed being better than physician's informal prediction. AIM: Aim of this pilot study was: a) to detect risk factors associated with need for long-term care for patients suffering from hemiplegia due to cancer-related brain surgery, b) to build an algorithm-based model from detected risk factors in order to predict the need for long-term care after rehabilitation 3) to assess the feasibility of a subsequent study on a larger sample of subjects, in order to validate of the model. The subsequent study will be considered feasible if the model developed by the pilot study will be able to correctly predict more than 85% of patients needing or not long-term care after rehabilitation. DESIGN: Observational retrospective study. SETTING: Neurorehabilitation Unit. POPULATION: Inpatients affected by hemiplegia due to cancer-related surgery. METHODS: The observational retrospective study involved 158 subjects affected by hemiplegia due to cancer-related brain surgery. All of the subjects underwent rehabilitation therapy, while radio /chemotherapy was administered if needed. Stroke prognostic factors and other clinical variables were recorded for all subjects. The endpoint variable was Functional Independence Measure (FIM®) Score at discharge after rehabilitation. Variables were then associated with patient's FIM Score <61 at discharge after rehabilitation, as predictor of long-term care at home. RESULTS: After statistical evaluation, age, comorbidity Charlson Index >3, complete absence of motricity of the affected limbs, hypoesthesia, trunk-control deficit, dysphagia, language disorder, urinary or fecal incontinence were found to be risk factors for FIM Score <61 at discharge. From detected factors an algorithm-based model was built in order to estimate patient's overall probability to need or not an intensive long-term care after rehabilitation. CONCLUSIONS: The model developed by the pilot study allowed correct positive or negative prediction for long-term care need after rehabilitation for 90.6% of the patients suffering from cancer-related hemiplegia. A subsequent study on a larger sample of subjects resulted therefore feasible because overall correct prediction was higher than 85%. CLINICAL REHABILITATION IMPACT: Risk factors for intensive care at home (complete absence of motricity of affected limbs, trunk control deficit, fecal incontinence, dysphagia and comorbidity Charlson Index >3) can be useful to evaluate patients suffering from hemiplegia due to cancer-related brain surgery, at admission into Rehabilitation Unit. The algorithm-based model seems to be a promising tool to estimate the probability of intensive home care for that type of hemiplegic patients.

[A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery]. / Un nuovo test (VITTORIO Test) per la valutazione dell'efficienza fisica in soggetti ammessi a programmi di riabilitazione dopo intervento di chirurgia cardiaca.

An adequate assessment of physical function (PF) in Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients' ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7 +/- 6.3 days after cardiac surgery) and a final test (T2) after an in-hospital intensive training program (mean length 16.8 +/- 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs.