Global cross-cultural validation of a brief measure for identifying potential suicide risk in 42 countries.

OBJECTIVES: This study aimed to examine the psychometric properties of the P4 suicide screener in a multinational sample. The primary goal was to evaluate the reliability and validity of the scale and investigate its convergent validity by analyzing its correlation with depression, anxiety, and substance use. STUDY DESIGN: The study design is a cross-sectional self-report study conducted across 42 countries. METHODS: A cross-sectional, self-report study was conducted in 42 countries, with a total of 82,243 participants included in the final data set. RESULTS: The study provides an overview of suicide ideation rates across 42 countries and confirms the structural validity of the P4 screener. The findings indicated that sexual and gender minority individuals exhibited higher rates of suicidal ideation. The P4 screener showed adequate reliability, convergence, and discriminant validity, and a cutoff score of 1 is recommended to identify individuals at risk of suicidal behavior. CONCLUSIONS: The study supports the reliability and validity of the P4 suicide screener across 42 diverse countries, highlighting the importance of using a cross-cultural suicide risk assessment to standardize the identification of high-risk individuals and tailoring culturally sensitive suicide prevention strategies.

Sustainability of the Italian Healthcare System and of the presently active hospitals: a methodological proposal for a systematic assessment of humanization of paedi-atric care and areas.

Introduction: In paediatrics, the word "humanization" means to care for the whole patient's family. It is vital to preserve a balanced relationship between family members to help the healing process for the young sufferer. How do we ensure that all the strategies adopted up to now have positively reached their objectives of humanization? How then can we measure hospital users' perception? The purpose of this research project is to identify the main factors that influence users' opinion about the quality of environment in paediatrics through a qualitative analysis on users' well-being. Monitoring the humanization level achieved by hospitals and testing the effectiveness of spaces devoted to host young people, may be considered essential phases in gathering new useful evidences as well as to identify potential emerging guidelines. Methods: Operative measurements were supported by the LpCp-tool, an effective tool that includes a questionnaire-based investigation and a processing software. The tool was then adapted to the specific explored field. The investigation was applied in three hospitals in Lombardy Region (Italy). Results: The most influent factors in users' perception were the space comfort and the standards of security services. Hospital staff generally had a worse opinion than patients/visitors on all items. Under no circumstances must users' involvement relevance be overlooked. Conclusions: The research highlights the relevance of the environmental well-being and involvement of users' in the decision-making processes, as well as the absolute requirement of a multicultural context.

Moderate-to-severe atopic dermatitis in adolescents treated with dupilumab: A multicentre Italian real-world experience.

BACKGROUND: Moderate-to-severe atopic dermatitis (AD) in the adolescence is a high burden disease, and its treatment can be very challenging due to paucity of approved systemic drugs for this age and their side-effects. Dupilumab was recently approved for treatment of adolescent AD. OBJECTIVES: A multicentre, prospective, real-world study on the effectiveness and safety of dupilumab in adolescents (aged from ≥12 to <18 years) with moderate-to-severe AD was conducted. The main AD clinical phenotypes were also examined. METHODS: Data of adolescents with moderate-to-severe AD treated with dupilumab at label dosage for 16 weeks were collected. Treatment outcome was assessed by EASI, NRS itch, NRS sleep loss and CDLQI scores at baseline and after 16 weeks of treatment. The clinical scores were also evaluated according to clinical phenotypes. RESULTS: One hundred and thirty-nine adolescents were enrolled in the study. Flexural eczema and head and neck eczema were the most frequent clinical phenotypes, followed by hand eczema and portrait-like dermatitis. Coexistence of more than 1 phenotype was documented in 126/139 (88.5%) adolescents. Three patients (2.1%) contracted asymptomatic SARS-CoV-2 infection and 1 of the discontinued dupilumab treatment before the target treatment period. A significant improvement in EASI, NRS itch, NRS sleep loss and CDLQI was observed after 16 weeks of treatment with dupilumab. This outcome was better than that observed in clinical trials. Dupilumab resulted effective in all AD phenotypes, especially in diffuse eczema. Twenty-eight (20.1%) patients reported adverse events, conjunctivitis and flushing being the most frequent. None of patients discontinued dupilumab due to adverse event. CONCLUSIONS: Dupilumab in adolescent AD showed excellent effectiveness at week 16 with consistent improvement of all clinical scores. Moreover, dupilumab showed a good safety profile also in this COVID-19 pandemic era.

SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities.

Abstract: Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades. It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials. Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems' management and filters' efficiency. In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach.

BACKGROUND: World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues. METHODS: The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects. RESULTS: The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc. CONCLUSION: The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

Towards an update of the Italian Ministerial Decree July 5th, 1975.

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare.

BACKGROUND: Healthcare environments are one of the most complex and demanding fields of work. Scientific, technological and research developments along with new discoveries within health promotion and prevention strategies are increasingly requiring a multidisciplinary and interdisciplinary approach. Therefore, it is likely that the current professions will need to be significantly adapted to accommodate new and more specialized roles. OBJECTIVES: To present an overview of the current educational and training courses of the emerging professions, such as hospital planner, physician-engineer, doctor-architect, nurse-architect or engineer, we review the present global training courses (BSc, MSc, specialization and PhD courses) related to healthcare design focusing on the fields of Medicine and Nursing, Architecture and Engineering sciences. RESULTS: The paper analyses the literature review and website analysis about active teaching programs and courses. Several academic institutions offer BSc, MSc and PhD degree programs in Healthcare Design, Environmental and Building Hygiene, and Public Health. In addition, there are several professional postgraduate courses, either in classroom, hybrid-based or online. CONCLUSIONS: A considerable number of international training experiences addresses the topic of training multidisciplinary professionals. Further in-depth investigations are needed to examine the content, teaching format and impact of the courses, student outcomes and professional careers, fields of interest and the degree of collaborations with other institutions.

Using ERPs to explore the impact of affective distraction on working memory stages in schizophrenia.

Research on individuals with schizophrenia (SCZ) shows a variety of emotional and cognitive deficits. We examined the hypothesis that ineffective emotional interference control may impact working memory (WM) performance by disrupting information encoding, maintenance, or retrieval in SCZ. Twenty-eight SCZ and 28 matched healthy controls (HC) performed the visual and verbal delayed-matching-to-sample task (DMST) with trials preceded by negative and nonemotional visual distractors. Event-Related Potentials associated with affective stimuli processing (Late Positive Potential-LPP) and WM-encoding (target-P3), maintenance (Negative Slow Wave-NSW), and retrieval (probe-P3) were analyzed. Patients showed overall worse DMST accuracy than HC. Emotional distraction negatively impacted accuracy during the verbal DMST in both groups combined. Both groups also displayed similar LPP modulation during the presentation of emotional distractors. HC showed enhanced NSW after presentation of a negative distraction, whereas this did not occur in SCZ. Comparable effects of emotional distraction were found for WM-encoding and retrieval in both groups. While emotional and neutral stimuli differentially impacted WM-maintenance on the neural level in HC, we did not observe this effect in SCZ, even though both groups showed similar behavioral and neurophysiological reactions to affective stimuli. Deficits in inhibitory mechanisms in SCZ may be responsible for this effect and may have particular relevance for WM-maintenance difficulties.

Social and nonsocial affective processing in schizophrenia - An ERP study.

BACKGROUND: Despite social cognitive dysfunction that may be observed in patients with schizophrenia, the knowledge about social and nonsocial affective processing in schizophrenia is scant. The aim of this study was to examine neurophysiological and behavioural responses to neutral and negative stimuli with (faces, people) and without (animals, objects) social content in schizophrenia. METHODS: Twenty-six patients with schizophrenia (SCZ) and 21 healthy controls (HC) completed a visual oddball paradigm with either negative or neutral pictures from the Nencki Affective Picture System (NAPS) as targets while EEG was recorded. Half of the stimuli within each category presented social content (faces, people). RESULTS: Negative stimuli with social content produced lower N2 amplitude and higher mean LPP than any other type of stimuli in both groups. Despite differences in behavioural ratings and alterations in ERP processing of affective stimuli (lack of EPN differentiation, decreased P3 to neutral stimuli) SCZ were still able to respond to specific categories of stimuli similarly to HC. CONCLUSIONS: The pattern of results suggests that with no additional emotion-related task demands patients with schizophrenia may present similar attentional engagement with negative social stimuli as healthy controls.

Comparative analysis of markers of cell proliferation in canine mast cell tumours according to current classifications.

The study aimed at immunohistochemical analysis of various markers of cell proliferation and comparison of the results with canine mast cell tumours grading systems according to the Patnaik and Kiupel. Tissue sections were stained using classical technique with haematoxylin and eosin, and immunohistochemical studies were performed with Ki-67, PCNA and MCM-3 antibodies. Additionally the mitotic index was assessed. Statistical analysis including rank correlation Spearman's and ANOVA Friedman analysis was performed. The significance was set at p<0.05. Expression of all examined antigens was detected. The results obtained allow concluding that there is a strong relationship between all the cell markers. However, due to the very strong response and positive reaction in the majority of tumours PCNA is not recommended as a prognostic indicator. Ki-67 and MCM-3 can be successfully used in the evaluation of canine mast cell tumours.

Clinical efficacy of two topical corticosteroids in the management of chronic hand eczema.

AIM: The aim of this study was to evaluate efficacy, tolerability and safety of a combination treatment with fluticasone propionate 0.05% cream and clobetasole ointment 0.05% in patients suffering from chronic hand eczema. METHODS: The study examined 30 patients with a clinical diagnosis of chronic hand eczema. RESULTS: The treatment with topical corticosteroids resulted effective and topical corticosteroids proved their efficacy in mild and moderate hand eczema. CONCLUSION: In according to the severity of the disease, authors suggest two different clinical strategies in the management of hand eczema.

Gluten-free diet as a therapeutic approach in psoriatic patients: if yes, when.

Since most of the studies are mainly confined to cases reporting coincidence of psoriasis and celiac disease, the authors want to underline the utility of investigating the possible presence of an underlying celiac disease in normal practice for a better approach to the patient. It is necessary to carry out controlled studies on a large number of patients to evaluate the association between these two diseases and the benefits of a gluten-free diet, even when the intestinal symptomatology is not evident.

Nail improvement during alitretinoin treatment: three case reports and review of the literature.

Alitretinoin is an endogenous vitamin A derivative, 9-cis-retinoic acid. Its anti-inflammatory and immunomodulatory efficacy results from controlling leukocyte activity and cytokine production in keratinocytes. We describe three patients with severe chronic hand eczema accompanied by nail dystrophy, which was treated with alitretinoin 30 mg. Clinical evaluation at 6 months showed complete or almost complete clearing of the nail lesions. We also briefly review the literature reporting on nail dystrophy and alitretinoin treatment. There is some evidence of the clinical effect of retinoids on nail formation, owing to the presence of retinoid receptors on the nail matrix. Further studies are required to better understand the impact of alitretinoin in nail diseases. Our observation supports alitretinoin as a treatment option in retinoid-responsive dermatoses associated with nail involvement.

Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: results from Italy.

BACKGROUND: Data on the epidemiological impact and clinical characteristics of chronic hand eczema in Southern Europe are lacking. OBJECTIVES: To estimate the prevalence of chronic hand eczema in its different stages of severity and refractoriness to standard therapy in patients accessing Italian dermatological reference centres, and to evaluate sociodemographic and clinical factors associated with each stage. METHODS: A cross-sectional multicentre study was conducted. Adult patients with hand eczema, consecutively accessing 14 centres over a 6-month period, were enrolled. Patients were classified according to disease duration, severity and response to standard therapy with potent topical corticosteroids. Logistical regression was performed to investigate the relationship between sociodemographic and clinical data with different stages of eczema. RESULTS: The total number of participants was 981. Hand eczema was chronic in 83·5% of patients; 21·3% had severe eczema, with 62·0% of these patients refractory to standard therapy. Food processing and related work, the health professions, craft and related trade works (building, plumbing, electrical), hairdressing/beauty and handicraft work were most frequently associated with chronic hand eczema. Severe chronic hand eczema was more likely to be seen in men, older patients and those with less education. Severe and refractory hand eczema was also more likely among the unemployed and patients with allergic rhinitis and/or atopic dermatitis. CONCLUSIONS: Chronic hand eczema is frequent among patients with hand eczema accessing dermatology centres. Many patients were severe and refractory to standard therapy. The appropriate identification of hand eczema is the first step in implementing effective and efficient treatments.

Making hospitals healthier: how to improve sustainability in healthcare facilities.

BACKGROUND: Debate about sustainable development has reached a peak, as it is now recognized worldwide by public opinion and, in general, by governments' political agendas. New hospitals need to be made more sustainable and existing ones must improve their standards: e.g. in Italy, more than 50% of all healthcare facilities were built before the Nineties, without any attention to environmental, social or economic sustainability. METHODS: Thanks to a sustainability evaluating system (environmental, social and economic) designed by the Milanese University 'Politecnico di Milano', two healthcare facilities were analyzed and compared. Both structures have approximately 600 beds and are located in the Lombardy region but they were built in different decades: one was built in the Sixties while the other one was built very recently. The analysis focused on underlining criticalities, implementing redevelopment measures for sustainability and eventually understanding whether attention was truly being given to those topics. RESULTS: A need to evaluate the sustainability parameters emerged from the comparison between the two case-studies. This is the only way of identifying strategic non-invasive and cheaper solutions that could directly influence sustainability. Following the above-mentioned comparison, a first look - albeit not an adequate one - was given to sustainability aspects. CONCLUSIONS: The assessment tool turned out to be efficient and could also prove effective in resource management and operational planning, whenever applied to any territorial facility.

Clinical evaluation and assessment of the therapeutic efficacy of alitretinoin in a group of patients with chronic hand eczema refractory to topical steroid therapy.

AIM: We examined and evaluated the clinical characteristics of patients who had come to the Allergological and Occupational Dermatology unit in Florence with severe CHE refractory to potent topical corticosteroids. We evaluated the efficacy and safety of alitretinoin and we analyzed the response in the three months of follow-up in the group of patients who completed the cycle of therapy. Improvement in clinical signs and symptoms was assessed using mTLSS and PGA. METHODS: All patients were treated daily with single 30-mg doses of oral alitretinoin for 3 to 5 months. The study examined 15 patients with a clinical diagnosis of severe CHE. We found the treatment to be efficient in nine of 13 patients (69%) who were assessed as having "clear" or "almost clear" hands according to PGA. RESULTS AND CONCLUSION: Even if the number of patients we analyzed was limited and lacked a control group the study allowed us to confirm the efficacy of alitretinoin used in a "real life" clinical experience. In addition, thanks to the adoption of proper emollient therapy and avoidance of any relevant allergens or irritants, no recurrence of the condition was observed among the patients who completed therapy with a PGA value of "mild", "almost clear", or "clear" during three months after treatment.