Suicide mortality among the elderly population in Italy: A nationwide cohort study on gender differences in sociodemographic risk factors, method of suicide, and associated comorbidity.

OBJECTIVES: This study aimed at investigating gender differences in the relationship between sociodemographic factors and suicide mortality, as well as in the method used for suicide and the presence of comorbidities in an older population in Italy. METHODS/DESIGN: We conducted a historical cohort study based on individual record linkage across the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides among people aged 75 years or older from 2012 to 2017 were analyzed. Crude mortality rates were computed, and cause-specific mortality rate ratios were estimated using negative binomial regression models. Chi-square tests were used to evaluate significant gender differences in suicide methods and comorbidities associated with suicide. RESULTS: The study included 9,686,698 individuals (41% men, 59% women). Compared to living alone, living with children or partners reduced suicide mortality, especially among men. Having high or medium educational levels was associated with lower mortality than low educational levels among men. Foreign citizens had lower mortality among men, but not among women. Living in urban areas was associated with lower suicide rates in men and higher rates in women. Methods of suicide significantly differed by gender: leading methods were hanging, strangulation, and suffocation in men, and falling from height in women. Mental comorbidity was significantly more frequent among women, especially at ages 75-84 years. CONCLUSIONS: We believe that our findings might help to promote public health strategies taking gender differences in old age into account to improve social support and quality of life of older men and women.

Food waste reduction and economic savings in times of crisis: The potential of machine learning methods to plan guest attendance in Swedish public catering during the Covid-19 pandemic.

Food waste is a significant problem within public catering establishments in any normal situation. During spring 2020 the Covid-19 pandemic placed the public catering system under greater pressure, revealing weaknesses within the system and generation of food waste due to rapidly changing consumption patterns. In times of crisis, it is especially important to conserve resources and allocate existing resources to areas where they can be of most use, but this poses significant challenges. This study evaluated the potential of a forecasting model to predict guest attendance during the start and throughout the pandemic. This was done by collecting data on guest attendance in Swedish school and preschool catering establishments before and during the pandemic, and using a machine learning approach to predict future guest attendance based on historical data. Comparison of various learning methods revealed that random forest produced more accurate forecasts than a simple artificial neural network, with conditional mean absolute prediction error of < 0.15 for the trained dataset. Economic savings were obtained by forecasting compared with a no-plan scenario, supporting selection of the random forest approach for effective forecasting of meal planning. Overall, the results obtained using forecasting models for meal planning in times of crisis confirmed their usefulness. Continuous use can improve estimates for the test period, due to the agile and flexible nature of these models. This is particularly important when guest attendance is unpredictable, so that production planning can be optimized to reduce food waste and contribute to a more sustainable and resilient food system.

Suicide among adolescents in Italy: a nationwide cohort study of the role of family characteristics.

Suicide is a leading cause of death among adolescents and is recognized as a serious public health problem. This study aimed to investigate the relationship between family characteristics and the risk of suicide among adolescents in Italy using nationwide official data. We carried out a cohort study based on the record linkage between the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides in adolescents aged 10-19 years from 2012 to 2016 were analyzed. Hazard ratios of mortality from suicide were estimated through a multivariable Cox regression model using time-on-study as the time scale. We included 8,284,359 children and adolescents (51% males, 49% females). Over the 5-year follow-up, we registered 330 deaths from suicides (74% males), mostly occurred in the age class 15-19 years (86%). The suicide rate was 1.71 per 100,000 person-years among males and 0.65 among females. We found some familial characteristics associated with a higher risk of dying by suicide, including: living in single-parent or reconstructed families (among boys), a 40-year or more age gap between mother and child (among girls), having highly educated parents, an age difference between parents greater than 5 years. Furthermore, the study showed a lower risk for boys living in urban areas and for both boys and girls living in South Italy. Our results could help in identifying adolescents at high risk of suicide who could benefit from the planning of targeted intervention strategies.

[Impact of the implementation of ICD-10 2016 version and Iris software on mortality statistics in Italy]. / Impatto dell'implementazione della versione 2016 dell'ICD-10 e del software Iris sulle statistiche di mortalità in Italia.

OBJECTIVES: to assess the impact of coding causes of death with the ICD-10 2016 version and the software Iris on Italian official statistics on mortality. DESIGN: coding of a sample of death certificates with two different coding systems (bridge coding). SETTING AND PARTICIPANTS: a sample of 63,525 deaths occurred throughout 2015 among people aged over one year, already coded using the ICD-10 2009 version and the Mortality Medical Data System (MMDS) software, was re-coded through the ICD-10 2016 version and the Iris software. MAIN OUTCOME MEASURES: the transition matrix between the two coding systems was realized and the agreement percentages between the two coding systems, the comparability ratios, and the relative 95% confidence intervals were calculated. Comparability ratios have been calculated for both the underlying cause of death and the multiple causes. RESULTS: overall, 79% of deaths showed exactly the same underlying cause of death (ICD-10 code, 4 digits) in the two coding systems. On the three-digit level, the agreement was 89%; on ICD-10 chapter level, the agreement was 95%. At the chapter level, the most important changes were observed for: • certain infectious and parasitic diseases (-18% in ICD-10 2016/Iris); • diseases of the genitourinary system (-17%); • diseases of the respiratory system (+7%); • diseases of the nervous system and sense organs (+5%); • external causes of morbidity and mortality (+5%). Analyzing the multiple causes, the most important changes were observed for: • certain infectious and parasitic diseases (-19% in ICD-10 2016/Iris); • external causes of morbidity and mortality (+28%); • symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (+7%). CONCLUSION: the results are very useful to explain any change in the Italian statistics on mortality comparing 2015 with the following years.

[Deaths from noncommunicable diseases attributable to behavioral risk factors in Italy and Italian regions, 2016]. / Decessi per patologie non trasmissibili attribuibili a stili di vita in Italia e nelle regioni italiane nel 2016.

OBJECTIVES: to estimate the number of deaths from noncommunicable chronic diseases (NCD) attributable to behavioural risk factors (tobacco smoking, unhealthy nutrition, physical inactivity, overweight, and excessive alcohol use) in 2016 for Italy and for the Italian regions. DESIGN: descriptive study. SETTING AND PARTICIPANTS: mortality data were obtained by the Italian National Institute of Statistics. Causes of deaths from NCD associated with the five RFs were selected. Italian attributable fractions were obtained by the 2016 estimates of the Global Burden of Disease Study and applied to the mortality data. Regional prevalence of risk factors was obtained by the national surveillance system PASSI for the years 2013-2016. MAIN OUTCOME MEASURES: absolute number of attributable deaths, joint attributable fraction, proportion of total deaths attributable to RFs (MAprop). RESULTS: about 191,000 out of 614,307 deaths occurred in Italy in 2016 were attributable to combined RFs (about 37% in males; 26% in women). Joint MAprop was between 33% in men (24% in women) from Val d'Aosta and 40% in men (31% in women) from Campania. In Italy, 17% and 6% of the total amount of deaths were attributable to smoking in men and women, respectively; 6% and 3% to alcohol abuse; 7% and 8% to overweight; 13% and 12% to dietary RFs, and 2% and 3% to low physical activity. The higher proportion of attributable deaths by age-group was recorded in people aged 40-59 years (43% in men; 28% in women). Regional differences in attributable deaths are confirmed by regional RF prevalence recorded by the PASSI surveillance system for the years 2013-2016. CONCLUSIONS: these are the first estimates of the number of deaths due to NCDs attributable to behavioural RFs estimated for each region and for Italy as a whole. Effective primary prevention policies should be reinforced, since these RFs are potentially modifiable.

Italian Atlas of mortality inequalities by education level. / Atlante italiano delle disuguaglianze di mortalità per livello di istruzione.

OBJECTIVES: To evaluate the geographical and socioeconomic differences in mortality and in life expectancy in Italy; to evaluate the proportion of mortality in the population attributable to a medium-low education level through the use of maps and indicators. DESIGN: Longitudinal design of the population enrolled in the 2011 Italian Census, following the population over time and registering any exit due to death or emigration. SETTING AND PARTICIPANTS: The study used the database of the Italian National Institute of Statistics (Istat) developed by linking the 2011 Census with the Italian National Register of Causes of Death (2012-2014) for 35 groups of causes of death. Age, sex, residence, and education level information were collected from the Census. MAIN OUTCOME MEASURES: Life expectancy at birth was calculated by sex, Italian region, and education level. For the population aged 30-89 years, the following items were developed by sex: 1. provincial maps showing, for each cause of death, the distribution in quintiles of smoothed standardized mortality ratio (SMR), adjusted for age and education level and estimated with Bayesian models for small areas (spatial conditional autoregressive model); 2. regional maps of population attributable fraction (PAF) for low and medium education levels, calculated starting from age-standardized mortality ratios; 3. tables illustrating for each region standardized mortality rates and standardized years of life lost rate by age (standardized YLL rate), and mortality rate ratios standardized by age (MMRs). RESULTS: Males with a lower education level throughout Italy show a life expectancy at birth that is 3 years less than those with higher education; residents in Southern Italy lose an additional year in life expectancy, regardless of education level. Social inequalities in mortality are present in all regions, but are more marked in the poorer regions of Southern Italy. Geographical differences, taking into account the different population distributions in terms of age and education level, produce mortality differences for all causes: from -15% to +30% in women and from -13% to +26% in men, compared to the national average. Among the main groups of causes, the geographical differences are greater for cardiovascular diseases, respiratory diseases, and accidents, and lower for many tumour sites. A clear mortality gradient with an excess in Southern Italy can be seen for cardiovascular diseases: there are some areas where mortality for people with higher education level is higher than that for residents in Northern Italy with low education level. The gradient for "All tumours", instead, is from South to North, as it is for most single tumour sites. Population attributable fraction for low education level in Italy, taking into account the population distribution by age, is 13.4% in women and 18.3% in men. CONCLUSIONS: The study highlighted important geographical differences in mortality, regardless of age and socioeconomic level, with a more significant impact in the poorer Southern regions, revealing a never-before-seen health advantage in the regions along the Adriatic coast. A lower education level explains a considerable proportion of mortality risk, although with differing effects by geographical area and cause of death. There are still mortality inequalities in Italy, therefore, representing a possible missed gain in health in our Country; these inequalities suggest a reassessment of priorities and definition of health targets. Forty years after the Italian National Health Service was instituted, the goal of health equity has not yet been fully achieved.

Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data.

BACKGROUND: With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death. METHODS: In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased's demographic characteristics, place of death, healthcare supply. RESULTS: i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in the Netherlands to 90.9% in South Korea. The least common places were hospice facility (3.3%-5.7%), nursing home (0%-17.6%) and home (5.9%-26.3%).iii) Age-standardised relative risks found those with HIV less likely to die at home and more likely to die in hospital compared with cancer patients, and in most countries more likely to die in a nursing home. iv) Multivariate analysis found that men were more likely to die at home in UK, Canada, USA and Mexico; a greater number of hospital beds reduced the likelihood of dying at home in Italy and Mexico; a higher number of GPs was associated with home death in Italy and Mexico. CONCLUSIONS: With increasing comorbidity among people ageing with HIV, it is essential that end-of-life preferences are established and met. Differences in place of death according to country and diagnosis demonstrate the importance of ensuring a "good death" for people with HIV, alongside efforts to optimise treatment.

Place of death of people living with Parkinson's disease: a population-level study in 11 countries.

BACKGROUND: Most people prefer to receive end-of-life care in familiar surroundings rather than in hospital. This study examines variation in place of death for people dying from Parkinson's disease (PD) across 11 European and non-European countries. METHODS: Using death certificate data of 2008 for Belgium, France, Italy, Hungary, Czech Republic, New Zealand, USA, Canada, Mexico, South Korea and Spain for all deaths with PD as an underlying cause (ICD-10 code: G20) cross-national differences in place of death were examined. Associations between place of death and patient socio-demographic and regional characteristics were evaluated using multivariable binary logistic regression analyses. RESULTS: The proportion of deaths in hospital ranged from 17% in the USA to 75% in South Korea. Hospital was the most prevalent place of death in France (40%), Hungary (60%) and South Korea; nursing home in New Zealand (71%), Belgium (52%), USA (50%), Canada (48%) and Czech Republic (44%); home in Mexico (73%), Italy (51%) and Spain (46%). The chances of dying in hospital were consistently higher for men (Belgium, France, Italy, USA, Canada), those younger than 80 years (Belgium, France, Italy, USA, Mexico), and those living in areas with a higher provision of hospital beds (Italy, USA). CONCLUSIONS: In several countries a substantial proportion of deaths from PD occurs in hospitals, although this may not be the most optimal place of terminal care and death. The wide variation between countries in the proportion of deaths from PD occurring in hospital indicates a potential for many countries to reduce these proportions.

Deaths related to post-COVID in Italy: a national study based on death certificates.

Introduction: SARS-CoV-2 infection has been associated with the onset or persistence of symptoms in the long-term after the acute infection is resolved. This condition known as Post-COVID, might be particularly severe and potentially life-threatening. However, little is known on the impact of post-COVID condition on mortality. Aim of the present study is to assess and quantify Post-COVID deaths in Italy in years 2020 and 2021, based on an analysis of death certificates. Methods: Data from the Italian National Cause of Death Register were analyzed. ICD-10 code U09.9, released by the World Health Organization in September 2020, was used to identify the 'Post-COVID' condition. Numbers of post-COVID deaths from October 2020 to December 2021 were analyzed. Rates of post-COVID deaths were calculated for the year 2021. Results: Between October 2020 and December 2021, 4,752 death certificates reporting post-COVID condition were identified. Of these, 14.9% (n = 706) occurred between October and December 2020 and 85.1% (n = 4,046) in 2021. In 46.0% of post-COVID-related deaths, the underlying cause of death was COVID-19. Other frequent underlying causes were heart disease (14.3% of cases), neoplasms (9.2%), cerebrovascular diseases (6.3%) and Alzheimer's disease and other dementias (5.5%). The mortality rate related to post-COVID conditions in year 2021 was 5.1 deaths per 100 thousand inhabitants and it increased with increasing age. Men showed a higher mortality rate than women (4.3 deaths per 100 thousand in women and 6.0 deaths per 100 thousand in men). Discussion: Post-COVID conditions contributed to a substantial number of deaths in Italy. Strategies to identify the population at risk of severe long-term consequences of SARS-CoV-2 infection and interventions aimed at reducing this risk must be developed.

Drug driving in Italy. The results of the first roadside drug testing service utilizing on-site confirmatory analysis between 2019 and 2022.

BACKGROUND: Drug driving represents a public safety concern, and the size of this issue in Italy is not fully known. Drug testing is composed of two steps: 1) screening and 2) confirmatory analysis. The second step, and the associate medical examination to assess the state of impairment, usually are not performed right after the screening as they require specialized personnel and instrumental equipment that are not historically available at roadblocks. These pitfalls make this process both complicated and time-consuming. METHODS: A mobile laboratory was set up in 2019 by the Forensic Lab Service S.r.l. (limited liability company) to improve roadblock timing, planning, as well as to shed light on the extent of the drug driving issue in Italy. Drug screenings were performed using DrugWipe® Saliva testing. Confirmatory analysis was performed on oral fluids by liquid chromatography coupled with tandem mass spectrometry. A dedicated room of the mobile laboratory was also designed for drug driving medical assessment. RESULT: 2082 samples were collected during 88 road safety services held in different locations across Italy. In total, 9 % of the tested subjects were positive to both the screening and the confirmatory analysis. The most prevalent illicit drugs found in this study were THC (72 %), followed by cocaine (41 %). Drug drivers were mostly male (93 %) and younger than 30 years of age (58 %). CONCLUSIONS: The prevalence of drivers testing positive for illicit drugs resulted to be higher compared to the results obtained in the DRUID project and to other surveys previously performed in Italy. These data demonstrate the need for control services to improve road safety in regards to drug driving.

Suicide mortality in Italy during the first year of the COVID-19 pandemic.

BACKGROUND: Italy was severely hit by COVID-19 during 2020 and great concern about the possible increase of suicide rates in the population has arisen since early pandemic phases. Analyses limited to March-April have shown a drop in suicides in both sexes. This study aims to analyze suicide mortality in Italy during the whole 2020 making comparisons with the pre-pandemic period 2015-19, by sex, age and geographic area. METHODS: Official cause-of-death data with national coverage were used to analyze suicide mortality by sex, month, age class and geographic area in the population aged ≥10 years (54,595,179). The monthly number of suicide deaths in 2020 was compared to the average number in 2015-19. Age-specific and age-adjusted suicide rates in 2020 and in 2015-19 were compared using rate-ratios with 95 % confidence intervals. RESULTS: Compared to 2015-19 a non-significant reduction of the overall suicide rate was observed during 2020, both in males (-3 %) and females (-7 %). Suicide rates non-significantly decreased in most age groups; an increase, although not statistically significant, was found among males aged ≥75 years and females aged ≥85 years. Suicide deaths reduced mainly in Central-Southern areas and the Islands, while they slightly increased in the North especially among males. LIMITATIONS: Study limitations include accuracy of death certification and the relatively brief observation period. CONCLUSIONS: The study contributes to the analysis of early effects of the COVID-19 pandemic on suicide mortality in the whole population highlighting sex, age and territorial differences and suggesting to monitor possible increases in a longer observation period.

The Economic Perspective of Food Poverty and (In)security: An Analytical Approach to Measuring and Estimation in Italy.

The UN Sustainable Development Goals have set clear targets on global poverty, hunger and malnutrition to be achieved by 2030, which have prompted academics and policymakers to identify useful strategies and drivers. Moreover, the COVID19 pandemic has exacerbated inequalities at national and sub-national levels thus hampering the achievement of these goals. On considering the multifaceted nature of poverty, a recent research strand focuses on food poverty and insecurity issues in terms of economic access to food and healthy diet consumption, with moderate and extreme food insecurity affecting almost 9% of the population in Europe and North America. This paper aims to analyse food poverty and insecurity at regional level in Italy. Using micro-data from the Italian Household Budget Survey carried out by ISTAT, an analytical approach was proposed to define and measure the different degree of food poverty and insecurity. Moreover, to obtain insights into whether food poverty and insecurity can afford population healthy nutrition, inequality of the distributions of food expenditure categories are estimated. The results provided us with information on other important aspects of the poverty. Indeed, in Italy individuals who are at-risk-of-food-poverty or food insecure amount to 22.3% of the entire population. Furthermore, the at-risk-of-food-poverty-rate varies at regional level from 14.6% (Umbria) to 29.6% (Abruzzo), with high levels of food consumption inequalities observed above all for vegetables, meat and fish. All these issues could help policy makers to define economic intervention policies aimed at reducing social exclusion and achieving more equitable and sustainable living conditions for the entire population.

Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment.

Aim and objective: Multifocal fractures of the humerus are rare. The aim of our study is to evaluate the effectiveness of surgical treatment and propose a modification to the Maresca-Pascarella classification. A flowchart for surgical treatment is provided. Materials and methods: Thirty-one patients with multifocal humeral fractures were treated and evaluated. The Maresca-Pascarella classification was used. All were treated using with either plates and screws, external fixation or intramedullary nailing. Functional outcomes were evaluated using the QuickDASH test, the University of California - Los Angeles (UCLA) shoulder score and the Mayo elbow performance score (MEPS). Results: There were 12 Type A, 17 Type B, 1 Type C and 1 of combined fractures of the proximal and distal epiphysis. Of the 31 patients, 5 were lost to the follow-up (FU), 1 died of pulmonary embolism (PE) and the remaining 25 had a mean FU of 19.8 (7-35) months. Three patients had radial nerve damage and 1 went to a non-union that required further surgical intervention. The mean QuickDASH score was 15.7, the average UCLA shoulder score was 26.3 and the mean MEPS elbow score resulted to be 83.0. Conclusion: Although multifocal fractures are severe injuries, patients are able to recover good functionality if treated judiciously. Clinical significance: We proposed a standardised surgical approach based on the fracture characteristics, site and a modified Maresca-Pascarella classification. How to cite this article: Scaglione M, Casella F, Ipponi E, et al. Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment. Strategies Trauma Limb Reconstr 2022;17(2):81-87.

Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation.

INTRODUCTION: Although Total Knee Arthroplasty (TKA) is a successful procedure, a significant number of patients are still unsatisfied, reporting instability at the mid-flexion range (Mid-Flexion Instability-MFI). To avoid this complication, many innovations, including load sensors (LS), have been introduced. The intraoperative use of LS may facilitate the balance of the knee during the entire range of motion to avoid MFI postoperatively. The objective of this study was to perform a Gait Analysis (GA) evaluation of a series of patients who underwent primary TKA using a single LS technology. METHODS: The authors matched and compared two groups of patients treated with the same posterior stabilized TKA design. In Group A, 10 knees were intraoperatively balanced with LS technology, while 10 knees (Group B) underwent standard TKA. The correct TKA alignment was preoperatively determined aiming for a mechanical alignment. Clinical evaluation was performed according to the WOMAC, Knee Society Score (KSS) and Forgotten Joint Score, while functional evaluation was performed using a state-of-the-art GA platform. RESULTS: We reported excellent clinical results in both groups without any statistical difference in patient reported outcome measurements (PROMs); from a functional standpoint, several GA space-time parameters were closer to normal in the sensor group when compared to the standard group, but a statistically significant difference was not reached. CONCLUSIONS: Gait Analysis represents a valid method to evaluate TKA kinematics. This study, with its limitations, showed that pressure sensitive technology represents a valid aid for surgeons aiming to improve the postoperative stability of TKA; however, other factors (i.e., level of intra-articular constraint and alignment) may play a major role in reproducing the normal knee biomechanics.

Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data.

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015-2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015-2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases.

Guest attendance data from 34 Swedish pre-schools and primary schools.

This data article describes 34 datasets, compiled into one table, describing guest attendance at lunch meal servings in Swedish public schools and preschools. Fifteen of the schools and all 16 of the preschools covered belong to one municipality, while the remaining three schools belong to two other municipalities, all located in central Sweden. Data on number of plates was used as a proxy of the number of guests eating lunch. Number of used plates was recorded from late August 2010 to early June 2020, i.e. covering the period both before and during the initial phase of the Covid-19 pandemic, so that making possible to evaluate changes in guest attendance during the pandemic. Since these were real data, all data elements pertaining to exact canteens or staff identity have been removed. There is a scarcity of real business data for scientific and educational purposes, so these datasets can play an important role in research and education within catering management, consumption pattern analysis, machine learning, data mining and other fields.

A quantitative and non-invasive vibrational method to assess bone fracture healing: a clinical case study.

Orthopaedics needs a robust diagnostic tool that can help or even replace traditional radiography in bone healing assessment, thus reducing patient exposure to ionizing radiation. We used a vibrational method to assess the healing of a complex fracture treated with external fixation, exploiting a quantitative and non-invasive procedure. Callus stiffening was monitored from the time of surgery until the fixator was removed. Our approach overcomes previous limitations and involves a longer period of healing monitoring (about 9 months), very frequent tests (bi-weekly), and the analysis of a single test configuration. The healing process was monitored by analysing the percentage increments of the squared resonant frequencies (SFIs), related to the stiffness variation and the changes in the frequency response functions. The results were validated by X-rays images, and revealed that the most sensitive parameter to quantify the healing was the SFI of the first resonant frequency which increased by about 20% per month during the formation of the woven callus and up to about 50% at the end of healing completion. This study confirms the potential of the vibrational method as an alternative to radiography in fracture healing assessment.

The effect of viscosupplementation on early-stage knee osteoarthritis: Clinical evaluation and assessment of cartilage in vivo with 7 T MRI.

INTRODUCTION: Viscosupplementation is a well-known strategy for managing early stages knee Osteoarthritis. However, despite its effectiveness in reducing symptoms, it has not yet been found to have an effect on joint cartilage. The aim of this study is to evaluate the clinical efficacy of a new product with gel-like behaviour and its in vivo effects on joint cartilage. METHODS: 20 patients were treated by 2 consecutive injections of hyaluronan derivative Hymovis® at one-week interval. Clinical evaluation was performed before the treatment and at each time point during the follow-up using WOMAC and VAS. A 7 T magnet was used for cartilage evaluation at each MRI time point: T2 Relaxation Time (RT), T2∗ RT and cartilage parameters were evaluated before the first injection, after 45 days and at 6 months follow-up. Statistical analysis was obtained for each reported data. RESULTS: We report significantly reduction in symptoms with an increase in knee and global activity functions. The T2 RT for lateral tibial compartment and T2∗ RT for Patello-Femoral compartment significantly decreased. A T2 RT reduction was observed in all knee compartments except for the medial tibial one, while a T2∗ RT reduction was observed in all knee compartments. We report an increase in cartilage volume and thickness in most of patients with a reduction of cartilage defects in 9 patients, but we didn't find MRI signals clearly referable to cartilage regeneration. CONCLUSIONS: MRI results have confirmed the possibility to employ 7T magnets to evaluate early changes in cartilage structure in vivo. HA VS has provided good clinical outcomes and an improvement in the global assessment of the knee joint, but it doesn't seem to significantly modify the cartilage over the time.

Use of a Plasma-Sprayed Titanium-Hydroxyapatite Femoral Stem in Hip Arthroplasty in Patients Older than 70 Years. Is Cementless Fixation a Reliable Option in the Elderly?

BACKGROUND: Although cementless implants are increasing in popularity, the use of cementless femoral stems for total hip arthroplasty (THA) and hip hemiarthroplasty (HH) in elderly patients remains controversial. The aim of this study was to report the outcomes of a cementless stem used in a large multicentric cohort of elderly patients receiving elective THA and HH for displaced femoral neck fracture. METHODS: A total of 293 patients (301 hips) aged 70 years or older (mean age, 78 years; range, 70-93) who received the same cementless plasma-sprayed porous titanium-hydroxyapatite stem were retrospectively evaluated after primary THA and HH to investigate stem survival, complications, and clinical and radiographic results. RESULTS: Cumulative stem survival was 98.5% (95% CI, 96.4-99.4%; 91 hips at risks) with revision due to any reason as the end-point at 10-year follow-up (mean 8.6 years, range 4-12). No stem was revised due to aseptic loosening. The mean Forgotten Joint Score was 98.7. Radiographically, the implants showed complete osseointegration, with slight stress-shieling signs in less than 10% of the hips. CONCLUSION: The use of cementless stems was proven to be a reliable and versatile option even in elderly patients for elective THA and HH for femoral neck fracture.

Acute Effects of Particulate Matter on All-Cause Mortality in Urban, Rural, and Suburban Areas, Italy.

BACKGROUND: Short-term exposure to particulate matter (PM) has been related to mortality worldwide. Most evidence comes from studies conducted in major cities, while little is known on the effects of low concentrations of PM and in less urbanized areas. We aim to investigate the relationship between PM and all-cause mortality at national level in Italy. METHODS: Daily numbers of all-cause mortality were collected for all 8092 municipalities of Italy, from 2006 to 2015. A satellite-based spatiotemporal model was developed to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and mortality at province level, and then, results were pooled with a random-effects meta-analysis. Associations were estimated by combination of age and sex and degree of urbanization of the municipalities. Flexible functions were estimated to explore the shape of the associations at low PM concentrations. RESULTS: We analyzed 5,884,900 deaths (40% among subjects older than 85 years, 60% occurring outside the main urban areas). National daily mean (interquartile range) PM10 and PM2.5 concentrations were 23 (14) µg/m3 and 15 (11) µg/m3, respectively. Relative increases of mortality per 10 µg/m3 variation in lag 0-5 (average of last six days since death) PM10 and PM2.5 were 1.47% (95% Confidence Intervals (CI): 1.15%, 1.79%) and 1.96% (1.33%, 2.59%), respectively. Associations were highest among elderly and women for PM10 only, similar between rural and urbanized areas, and were present even at low concentrations, e.g., below WHO guidelines. CONCLUSIONS: Air pollution was robustly associated with peaks in daily all-cause mortality in Italy, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines (2021) for PM10 and PM2.5 are not sufficient to protect public health.