Impact of Built Environment and Neighborhood on Promoting Mental Health, Well-being, and Social Participation in Older People: an Umbrella Review.

Background: The built environment, especially in the context of the neighborhood, affects older people's health. This umbrella review aims to summarize the associations between factors and interventions in the built environment as regards modifying or improving mental health, well-being, social inclusion and participation in the elderly. Methods: We searched articles in the following databases: PubMed, Embase, Cochrane Library, Scopus, Avery Index, Sage, Web of Science, Health Evidence, and Google Scholar, without any time limits. The factors and interventions examined have been classified into three categories (urban infrastructure, green infrastructure, built environment), and we have assessed their relationships with each of the health outcomes. Results: Eight reviews have been included. The results show a positive association between factors and interventions and health outcomes, even though this tends to differ with respect to some of the elements (study design, sample size, built environment and health outcome measurements, and the quality of the primary studies included in the reviews) in the selected studies. Conclusions: In conclusion, the present study suggests and confirms that acting on the built environment has a positive impact on mental health and social inclusion.

Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population-based surveys in a low-resource setting.

OBJECTIVE: To describe caesarean section rates and neonatal mortality to assess change in access to life-saving interventions in a rural low-resource setting between 2007 and 2013. DESIGN: Population-based cross-sectional study. SETTING: Southern Tanzania. POPULATION: A total of 34 063 women from 384 549 households who gave birth in the previous year. METHODS: Using data collected in two geo-referenced household surveys conducted in 2007 and 2013 in the context of two cluster-randomized controlled trials, we describe trends in caesarean section and neonatal mortality in obstetric risk groups inspired by the 10-group Robson classification. MAIN OUTCOME MEASURES: Rates of self-reported birth by caesarean section and neonatal mortality. RESULTS: Population-based caesarean section rates increased from 4.0% in 2007 to 6.4% in 2013. In 2013, the lowest caesarean section rate was found in multipara whose labour was not induced or augmented [4.4%, 95% confidence interval (CI) 3.9-4.9], a group that showed a rate increase of over 50% from 2007 [adjusted prevalence ratio 1.57 (95% CI 1.34-1.82)]. Nullipara whose labour was not induced or augmented had rates of 6.2% in 2007 and 8.5% in 2013. Caesarean rates in multiple pregnancies were low at 8.1% (95% CI 5.6-10.5) in 2007, and 14.6% (95% CI 9.4-19.8) in 2013. Overall neonatal mortality was high: 3.5% in 2007 and 3.2% in 2013, with rates being lowest in multiparous women whose labour was not induced or augmented: 2.4% (95% CI 2.2-2.7) and 1.7% (95% CI 1.4-2.0) in 2007 and 2013, respectively. CONCLUSION: Although use of caesarean section remains insufficient, and higher rates do not necessarily imply better quality of care, our analysis highlights improvements in reaching women with caesarean section. Rates in multiple birth remained low compared with high-income settings. TWEETABLE ABSTRACT: In Southern Tanzania caesarean section rates increased over time, but the rate in high-risk births remained alarmingly low.

Open inguinal hernia repair with self-gripping Parietex ProGrip mesh: a retrospective study of 204 cases.

Chronic pain and recurrence rates are the main challenge in modern inguinal hernia surgery. Several trials have investigated the role of self-adhesive mesh repair for inguinal hernia, with special attention to the incidence of chronic postoperative inguinal pain and recurrence. The purpose of our study was to retrospectively evaluate the early and long-term results using a self-gripping mesh (Parietex Progrip® , Covidien) in our institution. A total of 204 patients, mean age 50.3 standard deviation (SD) 15.3, was included in the study. The repair was performed under local anaesthesia in 159 (78%) cases and locoregional anaesthesia in remaining 45 (22%). Mean operative time was 39 ± 20 minutes. The time for self-gripping mesh placement ranged from 5 to 9 minutes (mean 7 ± 2 minutes). There were no intraoperative complications. Clinical follow-up was performed at 1 month, 1 year and 2 years and consisted in the evaluation of complications, discomfort/pain and recurrence. One case of cutaneous infection and three cases of seroma were observed at one-month follow-up and were all treated conservatively. 8 patients were lost at one year follow-up, and another 4 were lost at 2 years. 3 patients died for other causes during follow-up. At 1 year and 2 years follow-up no cases of seroma, testicular complications or mesh infection were observed. Two cases of recurrence were recorded at 2 years follow up. No patient reported VAS score > 2 at one month, 1 year and 2 years follow-up. There were no readmissions, systemic complications or death during 2 years follow-up. Lichtenstein open repair using Parietex Progrip® mesh is a simple, rapid, effective and safe method for inguinal hernia repair. The main advantage of self-fixing mesh is the reduced operative time. A suturless fixation seems to prevent the development of postoperative chronic pain, without increasing recurrence rate in the majority of the trials.

Allergy in urban elderly population living in Campania region (Southern Italy). A multicenter study.

Given the increasing life expectancy observed in Western countries, there is a marked interest to know more about how aging could influence respiratory health. The aim of our study was to assess the prevalence, clinical characteristics and age of onset of allergic sensitization and clinical symptoms in a sample of atopic elders living in Campania region area (Southern Italy). Fourteen Allergy units or Centres examined a total of 462 patients. In this context 215 (46.53%) had positive skin prick tests (SPTs) to at least one allergen and were diagnosed with respiratory allergy. Parietaria represents the most common sensitizing agent in elders living in Campania region, followed by dust mites, grass pollen and Olea europaea. A relatively high percentage of atopic subjects suffered from respiratory symptoms at a fairly advanced age, namely 8.3% at 60-64 years, 10.2% at 65-70 and 5.7% at > 70 years. In conclusion, the prevalence and clinical significance of airway allergic sensitization in the elderly living in Campania region is more significant than expected in latter stages of life. Physicians should not neglect the role of atopy as a risk factor for the onset of allergic respiratory symptoms even in elderly patients.

Roles and responsibilities in newborn care in four African sites.

OBJECTIVES: To explore roles and responsibilities in newborn care in the intra- and postpartum period in Nigeria, Tanzania and Ethiopia. METHODS: Qualitative data were collected using in-depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. RESULTS: We found that birth attendants were the main decision-makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first-time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision-maker in the family. CONCLUSION: Interventions should move beyond a focus on the mother-child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

What could be the role of molecular-based allergy diagnostics in detecting the risk of developing allergic sensitization to furry animals?

Although this highly refined diagnostic approach has been used in several fields of allergy diagnosis, we noticed the scarcity of data on the role of CDR in detecting current sensitization to the allergens of common pets (cat / dog) and, especially, its potential usefulness in predicting the risk of sensitization to other furry animals. Reported data suggest that cross-reacting mechanisms might play an important role in a significant proportion of allergic sensitizations to furry animals (common pets and unusual / exotic mammals) especially in the absence of any possible direct / indirect contact. In this context an evaluation of specific IgE by using the micro-array technique ImmunoCAP ISAC (Thermofisher Scientific - Immuno-Diagnostics, Sweden) for lipocalins (Can f 1, Can f 2, Equ c 1, Fel d 4, Mus m 1) and albumins (Bos d 6, Can f 3, Equ c 3, Fel d 2) might be very useful to evaluate the possibility of cross-reactions between the allergens of different animals. In fact, allergic sensitization without animal exposure is a relevant risk for patients, because they are not aware about the possibility that even severe respiratory symptoms may develop after an occasional animal contact. This aspect should be taken into account by susceptible individuals before acquiring new pets, after removal of common pets or beginning a contact for working / leisure activity with a common as well as uncommon animal.

Anatomic variations of paranasal sinuses-clinical case report.

This article describes the clinical case of an 86-year-old female patient with an asymptomatic clinical condition, without presenting a history of previous traumatisms. When routine radiographic exam-panoramic radiograph-was performed, the following extensions of the paranasal sinuses were found: maxillary sinus (palate), sphenoid sinus (pterygoid process, major wing, and anterior clinoid process), and supraorbital portion of the frontal sinus. Thus computerized tomography was performed to confirm the diagnosis.

The understanding of congruent and incongruent referential gaze in 17-month-old infants: an eye-tracking study comparing human and robot.

Several studies have shown that the human gaze, but not the robot gaze, has significant effects on infant social cognition and facilitate social engagement. The present study investigates early understanding of the referential nature of gaze by comparing-through the eye-tracking technique-infants' response to human and robot's gaze. Data were acquired on thirty-two 17-month-old infants, watching four video clips, where either a human or a humanoid robot performed an action on a target. The agent's gaze was either turned to the target (congruent) or opposite to it (incongruent). The results generally showed that, independent of the agent, the infants attended longer at the face area compared to the hand and target. Additionally, the effect of referential gaze on infants' attention to the target was greater when infants watched the human compared to the robot's action. These results suggest the presence, in infants, of two distinct levels of gaze-following mechanisms: one recognizing the other as a potential interactive partner, the second recognizing partner's agency. In this study, infants recognized the robot as a potential interactive partner, whereas ascribed agency more readily to the human, thus suggesting that the process of generalizability of gazing behaviour to non-humans is not immediate.

Utility of continuous intraoperative neural monitoring in thyroid surgery in a low volume centre.

This retrospective study, of a single surgeon's experience, evaluates the role of intraoperative neuromonitoring (IONM) for total thyroidectomy, in a low-volume district general hospital. 128 patients with normal preoperative vocal fold function underwent thyroid surgery with routine use of nerve monitoring. Patients were followed for 6 months after surgery, and postoperative Romanerve function was determined by fiberoptic laryngoscopy. One (0,8%) patient was found to have a unilateral vocal fold paralysis, but after 6 months this patient had regained vocal fold motion. The technique of intraoperative neuromonitoring in thyroid surgery is safe and reliable in excluding postoperative recurrent laryngeal nerve palsy; it has high accuracy, specificity, sensitivity and negative predictive value. Neuromonitoring is useful to identify the recurrent laryngeal nerve and it can be a useful adjunctive technique for reassuring surgeons of the functional integrity of the nerve. Its application can be particularly recommended for low-volume thyroid operation centres.

Can Longo stapled haemorrhoidopexy for haemorroids be a day-case procedure?

We retrospectively collected data of 100 consecutives elective Longo's procedures for third- and fourth-degree simptomatic haemorroids, classified ASA grade I and II. All patients stayed overnight, because discharge was scheduled the day after the operation. 98 were discharged the day after the operation. Two patients were not discharged the day after because mild and severe bleeding respectively occurred during the first night after the operation which settled conservatively. All the patients were discharged on oral NSAID and stool softeners. None required rehospitalisation. Our retrospective study, pointing out that, in general patients did not require active intervention on the first postoperative night, represents an encouragement to introduce day-case stapled procedure for haemorroids.

Amyand's hernia with acute phlegmonous appendicitis: case report.

Any inguinal hernia containing the vermiform appendix is called Amyand's hernia. Amyand hernias are very rare and even rarer is the association of Amyand hernia with acute appendicitis. Due to the rarity of this entity, it constitutes a challenging case in terms of diagnosis and treatment. The surgical management is not yet standardized and there are no clear guidelines. There are some controversies regarding whether to perform an appendectomy if appendix appears normal or whether mesh can be used for the hernia repair if appendectomy is performed. We describe a case of Amyand hernia in a 90-year old man with acute appendicitis and we review current literature regarding surgical strategy.

Open Veress Assisted technique. Results in 2700 cases.

AIM: The risks of specific complications of the laparoscopic technique, caused by pneumoperitoneum and by insertion of the first trocar, although rare, are frequently reported in literature. METHODS: A retrospective study of the complications we had in the period from October 1998 to December 2006 was made on 2700 patients who did not need any trocars in the umbilicus or with scars due to previous surgery, who were treated with a particular technique of pneumoperitoneum induction and the insertion of the first trocar, named ''Open Veress Assisted'' (OVA). RESULTS: We had two visceral complications (0,07%) (ileal perforations). CONCLUSION: Although no surgical technique is without risks, we believe that the use of our technique is safer than a blind insertion of the first trocar, especially among the patients with scars due to previous surgery.

Evaluation of the accuracy of linear measurements on multi-slice and cone beam computed tomography scans to detect the mandibular canal during bilateral sagittal split osteotomy of the mandible.

The aim of this study was to compare the accuracy of linear measurements of the distance between the mandibular cortical bone and the mandibular canal using 64-detector multi-slice computed tomography (MSCT) and cone beam computed tomography (CBCT). It was sought to evaluate the reliability of these examinations in detecting the mandibular canal for use in bilateral sagittal split osteotomy (BSSO) planning. Eight dry human mandibles were studied. Three sites, corresponding to the lingula, the angle, and the body of the mandible, were selected. After the CT scans had been obtained, the mandibles were sectioned and the bone segments measured to obtain the actual measurements. On analysis, no statistically significant difference was found between the measurements obtained through MSCT and CBCT, or when comparing the measurements from these scans with the actual measurements. It is concluded that the images obtained by CT scan, both 64-detector multi-slice and cone beam, can be used to obtain accurate linear measurements to locate the mandibular canal for preoperative planning of BSSO. The ability to correctly locate the mandibular canal during BSSO will reduce the occurrence of neurosensory disturbances in the postoperative period.

Effects of the EQUIP quasi-experimental study testing a collaborative quality improvement approach for maternal and newborn health care in Tanzania and Uganda.

BACKGROUND: Quality improvement is a recommended strategy to improve implementation levels for evidence-based essential interventions, but experience of and evidence for its effects in low-resource settings are limited. We hypothesised that a systemic and collaborative quality improvement approach covering district, facility and community levels, supported by report cards generated through continuous household and health facility surveys, could improve the implementation levels and have a measurable population-level impact on coverage and quality of essential services. METHODS: Collaborative quality improvement teams tested self-identified strategies (change ideas) to support the implementation of essential maternal and newborn interventions recommended by the World Health Organization. In Tanzania and Uganda, we used a plausibility design to compare the changes over time in one intervention district with those in a comparison district in each country. Evaluation included indicators of process, coverage and implementation practice analysed with a difference-of-differences and a time-series approach, using data from independent continuous household and health facility surveys from 2011 to 2014. Primary outcomes for both countries were birth in health facilities, breastfeeding within 1 h after birth, oxytocin administration after birth and knowledge of danger signs for mothers and babies. Interpretation of the results considered contextual factors. RESULTS: The intervention was associated with improvements on one of four primary outcomes. We observed a 26-percentage-point increase (95% CI 25-28%) in the proportion of live births where mothers received uterotonics within 1 min after birth in the intervention compared to the comparison district in Tanzania and an 8-percentage-point increase (95% CI 6-9%) in Uganda. The other primary indicators showed no evidence of improvement. In Tanzania, we saw positive changes for two other outcomes reflecting locally identified improvement topics. The intervention was associated with an increase in preparation of clean birth kits for home deliveries (31 percentage points, 95% CI 2-60%) and an increase in health facility supervision by district staff (14 percentage points, 95% CI 0-28%). CONCLUSIONS: The systemic quality improvement approach was associated with improvements of only one of four primary outcomes, as well as two Tanzania-specific secondary outcomes. Reasons for the lack of effects included limited implementation strength as well a relatively short follow-up period in combination with a 1-year recall period for population-based estimates and a limited power of the study to detect changes smaller than 10 percentage points. TRIAL REGISTRATION: Pan African Clinical Trials Registry: PACTR201311000681314.

Prevalence of tuberculosis infection among teen-agers in Tuscany.

INTRODUCTION: In Tuscany, Tuberculosis incidence is more than triplicate from 1982 to the beginning of the third millennium. The impact of this trend on open population is not known, as updated studies on Tuberculosis prevalence are not available. Tuberculin skin test provides the currently most widely used tool for assessing Tuberculosis transmission in a community and the prevalence of infection as well. The objective of this investigation was the evaluation of tuberculin index by means of the Mantoux test in adolescents eighteen-years old. RESULTS: The study was carried out in 21 secondary schools of Siena and its Province; 1,138 students participated to this survey. The overall prevalence of subjects with a skin reaction size > 5 mm was 1.6%; if the standard cut-off of 10 mm was used, the overall prevalence of a positive skin reaction was 0.4%. Risk factors for a doubtful or positive reaction were previous immunization with BCG and migration from high-endemicity countries. DISCUSSION: In Italy, studies on tuberculin index in young adults are scanty and controversial: our results show a very low Tuberculosis prevalence and an epidemiological pattern typical of countries with low Tuberculosis endemicity. CONCLUSIONS: The slightly increase in Tuberculosis incidence has no impact on the prevalence of latent Tuberculosis infection on our geographical area. We conclude that skin-test screening for Tuberculosis should be addressed to high risk population as migrants from Countries reporting high transmission rate, those recently exposed to an infectious case and health-workers.

Sensitization to Common and Uncommon Pets or Other Furry Animals: Which May Be Common Mechanisms?

Exposure to animal allergens constitutes a relevant risk factor for the development of allergic sensitization. Moreover, an increasing number of people become owners of less common animals. In this article we summarize aspects related to sensitization to cat/dog which may be applied also to uncommon pets or other furry animals. The data discussed here suggest that several different factors may induce allergic sensitization to furry animals with or without previous contact. Allergic sensitization without animal exposure is a relevant risk for patients because they are not aware about the possibility that even severe respiratory symptoms may develop after an occasional animal contact. This aspect should be taken into account by susceptible individuals before acquiring pets or beginning a contact for working/leisure activity with a common as well as uncommon animal. As a consequence, skin prick test and/or evaluation of specific IgE antibodies (by classic ImmunoCAP or micro-array technique ImmunoCAP ISAC) also to less common ("new") mammalian allergens could be recommended in individuals already sensitized to common pets to identify the occurrence of allergic sensitization and consequently to avoid future exposures to uncommon animal allergens.

Treatment of primary inguinal hernias by "held in mesh repair": our experience related to 3,520 cases.

In the last 15 years, a rapid evolution occurred from the traditional hernioplasties toward prosthetic techniques, in Italy. Outpatient procedures under local anaesthesia are now most commonly performed. We report our experience with a personal modification of the sutureless mesh repair, called "held in mesh repair". From 1990 to 2003 we treated 3,520 cases of primary hernia with the "held in mesh repair". 2,370 patients were affected by a unilateral hernia and 575 by a bilateral one. Local anaesthesia was used in 92% of the cases, loco-regional in 6% and general in 2%. Sixteen (0.4%) hernias recurred after 2 years, while two further recurrences (total 0.5%) were observed after 3 years; three femoral pseudo-relapses (0.08%) occurred before the first postoperative year. An overall incidence of 1.3% of major complications were observed. One mortality case (0.02%) occurred 3 days after the operation for cardiovascular complications. The favourable results of the "held in mesh repair" and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias.

Measuring the meaning of life for patients with incurable cancer: the life evaluation questionnaire (LEQ).

Clinical observation, systematic research and popular anecdote indicate that, when confronted by death, people change the criteria by which they evaluate their lives. Questionnaires used routinely to assess quality of life in people with poor-prognosis cancer tend to be symptom-based and do not assess factors which become important when confronted by fatal illness, such as the meaning of life and the degree to which life has been enriched by the illness. To develop a questionnaire which would be sensitive to these areas, patients with incurable cancer and carers of such patients were interviewed in depth. Responses were reviewed by a panel of patients, clinicians and carers and formed into an inventory which was completed by 200 similar patients. Principal components analysis identified five dimensions: clearer perception of the meaning of life; freedom versus restriction of life; resentment of the illness; contentment with past and present life; past and present social integration. Only the most symptom-oriented scales (freedom, resentment) correlated with the Rotterdam Symptom Checklist. Scale scores showed that younger patients were more resentful of their illness, but also gained a clearer perception of the meaning of life. This questionnaire can evaluate psychological needs of people with incurable cancer which are neglected by existing instruments.