Short-term efficacy of high intensity group and individual education in patients with type 2 diabetes: a randomized single-center trial.

PURPOSE: The aim of this randomized study was to examine the efficacy of two high intensity educational programs: the conversation maps-based (CM™) education and the individual education (IE), compared to usual care (UC) in a cohort of type 2 diabetic (T2DM) patients. METHODS: Ninety T2DM outpatients (30 per group) were randomized and 79 finished the study and were analyzed. The CM™ and IE groups received four educational sessions at 0, 4, 8 and 12 weeks, while the UC group received two brief individual sessions at 0 and 12 weeks. We evaluated glycemic control (HbA1c), diabetes treatment, body mass index (BMI) and carried out a questionnaire survey at three time points (before intervention, at 12 and at 32 weeks) to assess patients' satisfaction, attitudes toward diabetes and dietary knowledge. RESULTS: All the three groups showed a significant and comparable reduction of both HbA1c and BMI. Diabetes therapy needed to be reinforced in a higher percentage of cases (39.3%) among UC patients compared to the IE (14.8%; p = 0.04) and the CM™ (8.3%; p = 0.01) groups. At 32 weeks Diabetes Treatment Satisfaction (DTSQ Q1 + Q4-8) significantly improved in the CM™ group (25.8 ± 4.5 vs. 22.4 ± 6.0; p < 0.01) and attitudes toward diabetes (ATT19) significantly improved in the IE group (58.0 ± 4.7 vs. 55.3 ± 5.1; p = 0.02). CONCLUSIONS: Our trial provides preliminary data regarding the efficacy of structured group and individual education on achieving better glyco-metabolic control without drug therapy reinforcement and with positive effects on patients' attitude and treatment satisfaction.

Influence of early-life and parental factors on childhood overweight and obesity.

PURPOSE: We recently reported that a high BMI and high waist circumference prevalence is present in Sicilian children and that the male gender is associated with a significant risk of obesity. Early-life and parent-related risk factors were investigated 1521 Sicilian children (752 females and 769 males, aged 9.0-14.0 years) to identify biological and environmental factors that can contribute to obesity onset. METHODS: Anthropometric measurements of children, their urban vs rural area provenience, birth weight and neonatal feeding were collected. In addition, the BMI and educational level of their parents and the perception of their child weight status were investigated. RESULTS: In the study cohort, the prevalence of overweight and obesity was 27.2 and 14.1 %, respectively, significantly (p < 0.05) higher in males than in females. Breastfeeding emerged as a protective factor (OR 0.64; p < 0.0005), while risk factors for developing childhood obesity were a birth weight ≥4.0 kg (OR 1.83; p < 0.05), an overweight or obese mother (OR 2.33; p < 0.0001) or father (OR 1.68; p < 0.0001) and a mother with a low/medium education level (OR 1.72; p < 0.005). CONCLUSION: Understanding risk factors for pediatric obesity is a prerequisite to identify children at highly risk of being obese and to predispose early intervention strategies.

Nanowire-based field effect transistors for terahertz detection and imaging systems.

The development of self-assembled nanostructure technologies has recently opened the way towards a wide class of semiconductor integrated devices, with progressively optimized performances and the potential for a widespread range of electronic and photonic applications. Here we report on the development of field effect transistors (FETs) based on semiconductor nanowires (NWs) as highly-sensitive room-temperature plasma-wave broadband terahertz (THz) detectors. The electromagnetic radiation at 0.3 THz is funneled onto a broadband bow-tie antenna, whose lobes are connected to the source and gate FET electrodes. The oscillating electric field experienced by the channel electrons, combined with the charge density modulation by the gate electrode, results in a source-drain signal rectification, which can be read as a DC signal output. We investigated the influence of Se-doping concentration of InAs NWs on the detection performances, reaching responsivity values higher than 100 V W⁻¹, with noise-equivalent-power of ∼10⁻9 W Hz(⁻½). Transmission imaging experiments at 0.3 THz show the good reliability and sensitivity of the devices in a real practical application.

[Occupational risk by the pine processionary moth Thaumetopoea pityocampa in the forestry workers of Verona]. / Rischio professionale da processionaria del pino nero (Thaumetopoea pityocampa) nei forestali di Verona.

Pine processionary moth (Thaumetopoea pityocampa) is a lepidopteran living in the Mediterranean countries whose mature larvae have microscopic hairs that can be released and carried far from the source. The hairs are responsible of urticating symptoms on the exposed areas although systemic manifestation might be involved. The study involved 94 forestry workers (92 M, 2 F) of the Regional Forest Service of Verona and the objective was to determine the prevalence of skin and respiratory disorders due to exposure to this insect. 21 chainsaw operators and 2 labourers experienced symptoms on exposed skin areas; 3 of them reported also ocular and respiratory symptoms. The chainsaw operators resulted most at risk whereas individual already suffering from others allergies do not seem to be affected. The results highlight the importance of risk assessment to Thaumetopoea pityocampa in forestry workers and the need for instruments to assess the allergic sensitization in medical surveillance.

[Work-related stress and psychological distress assessment in urban and suburban public transportation companies]. / Valutazione del rischio stress lavero correlato e del distress psichico in aziende di trasporto pubblico urbane ed extraurbano.

The risk of work-related stress has been determined in bus drivers and workers employed in the service department of two urban and suburban public transportation companies. The INAIL evaluation method (Check list and HSE indicator tool) was used. The GHQ-12 questionnaire, which is widely used to assess the level of psychological distress, was also employed. 81.9% of workers involved in the survey answered both the HSE indicator tool and the GHQ-12 questionnaire. The Check list evaluation showed an increase in quantifiable company stress indicators while close examination using the HSE indicator tool demonstrated critical situations for all the subscales, with the control subscales more problematic in bus drivers. The demand, manager's support, relationships and change subscales were most associated with psychological distress in bus drivers, while relationships, role, change and demand subscales were negatively related in workers of the service department.

[Mental disorders related to persistent negative working conditions]. / Disturbi psichici associabili a condizioni di lavoro negative persistenti.

BACKGROUND: Mental disorders are common in our industrialised society and inevitably affect the working population. Over the last few years greater attention has been focussed on work-related psychopathologies due to an increasing number of studies regarding workplace bullying. OBJECTIVES: This study reports our observations on patients with mental disorders who came to our Occupational Health Centre because they perceived themselves to be victims of negative working conditions. An indepth analysis of their working conditions led us to the conclusion that many of these disorders were to be attributed to the workplace. METHODS: Between 2004 and 2010, 449 workers attended our Occupational Health Centre, most suffering from mental disorders which they ascribed to negative working conditions. All patients had an initial consultation session with an occupational physician which focused on the environmental and relational characteristics of their place of work. Thereafter, patients underwent a second clinical evaluation with a psychologist including several psychological tests. At the end of diagnostic process, the occupational physician and the clinical psychologist drew their clinical conclusions and defined the possible relationship with the working condition. RESULTS: For 379 out of 449 patients/workers, a positive and causal relationship between medical disorders and working conditions was established. The mental disorders observed in these groups of workers were: mixed anxiety and depressive disorder (53.6%), depressive disorder (16.2%), adaptation disorder (15.9%), anxiety disorder (13%) and only 1.3% post-traumatic stress disorder. The working conditions favouring the mental disorders were: workplace bullying, such as person-related bullying (30.1%) and task-related bullying (14.8%), adverse situations causing work distress (38.2%) or non-specific work discomfort (16,9%). CONCLUSIONS: Our experience showed that not only workplace bullying can cause different psychiatric disorders but also adverse situations that favour work distress and non-specific work discomfort often give raise to the same disorders. Negative working conditions can play a significant role in the development of psychological-psychiatric disorders: such disorders related to occupational conditions are on the increase in many industrialised countries.

Xenobiotic action on steroid hormone synthesis and sulfonation the example of lead and polychlorinated biphenyls.

OBJECTIVES: In the present study, the metabolism of steroid hormones has been investigated to determine whether and how xenobiotics like lead (Pb) and polychlorinated biphenyls (PCBs) interfere with steroid hormone biotransformation in humans. METHODS: Three groups of subjects were tested for concentration of urinary total steroids, 17-ketosteroids (n = 5), pregnane derivates (n = 6), 17-hydroxycorticosteroids (n = 11) and their sulfonated compounds: 14 workers exposed to lead, with a mean Pb blood concentration (PbB) of 29.21 microg/dl; 15 subjects exposed to PCBs, with a mean PCB blood concentration (PCBB) of 61.69 microg/l; a control group (n = 25). RESULTS: The urinary concentrations of 17-ketosteroids and 17-hydroxycorticosteroids were significantly lower in the PCB-exposed groups. There were significantly fewer sulfonated 17-hydroxycorticosteroids in the subjects exposed to PCBs as compared to the controls, while the percentage of sulfonated steroids was lower for both 17-ketosteroids and 17-hydroxycorticosteroids in the PCB-exposed subjects, but only for the 17-hydroxycorticosteroids in the group of subjects exposed to Pb (P < 0.05). Pregnane derivate urinary concentrations did not differ between the three groups. CONCLUSION: Our results suggest that PCBs and Pb act on steroid hormone metabolism with different effects and only partially using the same hormone pathways; they may cause changes in endogenous hormone homeostasis and interfere with the xenobiotic phase II of detoxification. PCBs interfere on a larger number of steroids and cause more significant effects than Pb. It is likely that different mechanisms are involved in steroid hormone metabolism interference.

[Follow up of person-related bullying and work-related bullying: evaluation of effectiveness of interventions]. / Follow up di lavoratori vittime di molestie morali protratte e costrittività organizzativa: valutazione dell'efficacia degli interventi messi in atto.

Person-related bullying is regarded as a form of stress capable of cause negative effects on workers' health, potentially leading to psycho-physical symptoms, alterations of mood and personality, psychiatric disorders such as anxiety-depression disorder, chronic adjustment disorder and posttraumatic stress disorder. At the Centre for the study of psychosocial risks and pathologies at work of Verona the health state of victims of person-related bullying and work-related bullying and their working conditions are periodically evaluated. On a regular bases these workers receive psychological support and, if necessary, psychiatric treatment; at the same time interventions on working environment are undertaken when possible. Verification of effectiveness is then carried out by means of interviews starting six months after the first consultation. Two questionnaires are used; a specific one for the assessment of working environment and health conditions, and Goldberg's General Health Questionnaire--G.H.Q-12. Improvement of health state related to better working conditions was obtained in general.

Clinically applicable optical imaging technology for body size and shape analysis: comparison of systems differing in design.

BACKGROUND/OBJECTIVES: Recent advances have extended anthropometry beyond flexible tape measurements to automated three-dimensional optical devices that rapidly acquire hundreds of body surface dimensions. Three new devices were recently introduced that share in common inexpensive optical cameras. The design, and thus potential clinical applicability, of these systems differ substantially leading us to critically evaluate their accuracy and precision. SUBJECTS/METHODS: 113 adult subjects completed evaluations by the three optical devices (KX-16 (16 stationary cameras), Proscanner (1 vertically oscillating camera), and Styku scanner (1 stationary camera)), air displacement plethysmography (ADP), dual-energy X-ray absorptiometry (DXA) and a flexible tape measure. Optical measurements were compared to reference method estimates that included results acquired by flexible tape, DXA and ADP. RESULTS: Optical devices provided respective circumference and regional volume estimates that overall were well-correlated with those obtained from flexible tape measurements (for example, hip circumference: R2, 0.91, 0.90, 0.96 for the KX-16, Proscanner, and Styku scanner, respectively) and DXA (for example, trunk volume: R2, 0.97, 0.97, and 0.98). Total body volumes measured by the optical devices were highly correlated with those from the ADP system (all R2s, 0.99). Coefficient of variations obtained from duplicate measurements (n, 55) were larger in optical than in reference measurements and significant (P<0.05) bias was present for some optical measurements relative to reference method estimates. CONCLUSIONS: Overall, the evaluated optical imaging systems differing in design provided body surface measurements that compared favorably with corresponding reference methods. However, our evaluations uncovered system measurement limitations, such as discrepancies in landmarking, that with correction have the potential to improve future developed devices.

Changing patterns in the surgical management of renal masses.

OBJECTIVE: To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision. MATERIALS AND METHODS: A total of 646 patients were treated by surgery for clinically localised renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN. RESULTS: During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011-2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011-2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all P<.05). CONCLUSIONS: At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen.

Accuracy evaluation of the Kinect v2 sensor during dynamic movements in a rehabilitation scenario.

In this paper, the accuracy evaluation of the Kinect v2 sensor is investigated in a rehabilitation scenario. The accuracy analysis is provided in terms of joint positions and angles during dynamic postures used in low-back pain rehabilitation. Although other studies have focused on the validation of the accuracy in terms of joint angles and positions, they present results only considering static postures whereas the rehabilitation exercise monitoring involves to consider dynamic movements with a wide range of motion and issues related to the joints tracking. In this work, joint positions and angles represent clinical features, chosen by medical staff, used to evaluate the subject's movements. The spatial and temporal accuracy is investigated with respect to the gold standard, represented by a stereophotogrammetric system, characterized by 6 infrared cameras. The results provide salient information for evaluating the reliability of Kinect v2 sensor for dynamic postures.

Genetic and Environmental Determinants of Otitis Media in an Indigenous Filipino Population.

OBJECTIVE: To identify genetic and environmental risk factors for otitis media in an indigenous Filipino population. STUDY DESIGN: Cross-sectional study. SETTING: Indigenous Filipino community. SUBJECTS AND METHODS: Clinical history and information on breastfeeding, tobacco smoke exposure, and swimming were obtained from community members. Heads of households were interviewed for family history and personal beliefs on ear health. Height and weight were measured. Otoscopic findings were described for the presence and character of perforation or discharge. An A2ML1 duplication variant that confers otitis media susceptibility was Sanger sequenced in all DNA samples. Co-occurrence of middle ear bacteria detected by 16S rRNA gene sequencing was determined according to A2ML1 genotype and social cluster. RESULTS: The indigenous Filipino population has a ~50% prevalence of otitis media. Young age was associated with otitis media (4 age strata; P = .004); however, age was nonsignificant as a bistratal or continuous variable. There was no association between otitis media and sex, body mass index, breastfeeding, tobacco exposure, or deep swimming. In multivariate analyses, A2ML1 genotype is the strongest predictor of otitis media, with an odds ratio of 3.7 (95% confidence interval: 1.3-10.8; P = .005). When otitis media diagnoses were plotted across ages, otitis media was observed within the first year of life, and chronic otitis media persisted up to adulthood, particularly in A2ML1-variant carriers. CONCLUSION: Among indigenous Filipinos, A2ML1 genotype is the primary risk factor for otitis media and main determinant of disease progression, although age, the middle ear microbiome, and social clusters might modulate the effect of the A2ML1 genotype.

A tool for home-based rehabilitation allowing for clinical evaluation in a visual markerless scenario.

This work deals with the design of an interactive monitoring tool for home-based physical rehabilitation. The software platform includes a video processing stage and the exercise performance evaluation. Image features are extracted by a Kinect v2 sensor and elaborated to return the exercises score. Furthermore the tool provides to physiotherapists a quantitative exercise evaluation of subject's performances. The proposed tool for home rehabilitation has been tested on 5 subjects and 5 different exercises and results are presented. In particular both exercises and relative evaluation indexes were selected by specialists in neurorehabilitation.

Exposure to mutagenic airborne particulate in a rubber manufacturing plant.

Epidemiological studies conducted in the 1980s revealed that people working in the rubber manufacturing industry had an increased risk of cancer. Even now, workers employed in rubber processing are still at risk despite the measures adopted to improve their working conditions. The aim of the study was to evaluate the presence of a genotoxic risk in a rubber industry and to verify whether or not it was possible to locate the most dangerous position among the different rubber-working processes. The mutagenic activity of airborne particulate was evaluated in samples collected in the mixing department of a rubber manufacturing plant. Ambient air samples were taken over 3-h period in two stable positions near the mixing (Banbury mixer) and calendering areas. Personal air samples were taken over 2-h period during a normal workday from five workers employed in different rubber processing operations (mixing, weighing, calendering, compounding and extruding). The mutagenic activity of the air samples was determined by plate incorporation assay using Salmonella typhimurium strains (TA 98, TA 98NR, TA 100, YG 1021) with and without metabolic activation. Polycyclic aromatic hydrocarbon (PAH) concentrations were determined by high-performance liquid chromatography (HPLC); the presence of other presumable contaminants were carried out by gas chromatography-mass spectrometry (GC-MS). The results showed substantial direct and indirect frameshift mutagenicity in both ambient and personal samples. No mutagenic activity was present in S. typhimurium TA 100, except in the personal sample from a worker employed on the Banbury mixer. HPLC analysis revealed very low concentrations of PAHs. GC-MS analysis showed the presence of compounds such as azulene derivative, 1,2-dihydro-2,2,4-trimethylquinoline, N-methyl N-phenylbenzenamine, diphenylamine, bis(2-ethylhexyl)phthalate and bis(methyl-propyl)phthalate. We conclude that the high levels of mutagenic activity in ambiental and personal samples indicate the presence of substances with high genotoxic potency; no substantial differences were seen among the several rubber processing operations. PAHs were not involved in indoor pollution. GC-MS analysis revealed the presence of compounds which may be produced by high temperatures to which the raw materials are subjected during rubber manufacturing processes. These substances are potential carcinogen though their mutagen properties have not been clearly determined.

Tentative reference values for some elements in broncho-alveolar lavage fluid.

The concentrations of Fe, Mn, Pb and Cr have been determined in broncho-alveolar lavage (BAL) fluid of 25 subjects without occupational or abnormal environmental exposure to metals, using the AAS method. The numerous factors which can interfere with the results in pre-analytical and in analytical phases are stressed. Metals concentrations in BAL are expressed in micrograms/l. They were not correlated with the volume of fluid recovered, the total cells, alveolar macrophages and erythrocytes. The results were not modified by stratification considering age and sex. Iron concentrations were higher than others, probably due to higher environmental exposure and partly to its essential role in humans. The diagnostic significance of element determination in BAL fluid and the relationship with exposure and lung load is discussed.

Benzene in blood as a biomarker of low level occupational exposure.

The occupational airborne exposure to benzene of 150 workers employed in petrol stations and a refinery plant was assessed using personal sampling pumps. All workers provided blood samples after the end of work and on the following morning before resuming work. Benzene concentrations in the blood of 243 non-occupationally-exposed subjects were also measured. The median occupational benzene exposure for all 150 workers studied was 80 micrograms/m3. Overall median blood benzene of all workers was 251 ng/l at the end of the shift, and 174 ng/l the following morning. The benzene concentrations measured in blood collected the following morning proved to be significantly lower than those measured at the end of the shift. Median blood benzene for the 243 'normal' subjects was 128 ng/l, which was significantly lower than that measured in the workers before a new work shift. The median blood benzene concentration was significantly higher in smokers than in non-smokers, both in the general population (210 ng/l vs. 110 ng/l) and in the exposed workers at the end of the shift (476 ng/l vs. 132 ng/l) and the following morning (360 ng/l vs. 99 ng/l). End-of-shift blood benzene correlated significantly with environmental exposure; this correlation was better in the 83 non-smokers than in the 67 smokers. In non-smokers with the median benzene occupational exposure of 50 micrograms/m3, no difference was found in blood benzene concentration in exposed and non-exposed subjects.

Alteration of steroid hormone sulfation and D-glucaric acid excretion in lead workers.

The capability of lead to interfere with the first and/or second phase of enzymatic reaction of biotransformation has been investigated in ten lead workers and in ten controls by studying the steroid hormone sulfation and D-glucaric acid (GA) urinary excretion. No statistical differences have been found for the total amount of urinary steroids, whereas a decrease of about 50% was observed for the sulfated fraction in lead workers. The mean value for the GA excretion in the exposed subjects (1.8 +/- 0.7 mmol/mol creatinine) was significantly lower than in the control group (4.4 +/- 0.8 mmol/mol creatinine). In spite of the small number of investigated subjects, it can be hypothesized that an interaction of lead with sulfotransferase exists. The decreased GA excretion does not prove an altered activity of microsomal enzymes, although inhibition of microsomal activity following lead exposure was previously reported.

[Carcinoma and fibroadenoma of the breast]. / Carcinoma y fibroadenoma de mama.

Eight cases of breast carcinoma coexisting with fibroadenoma were retrieved from the files of the Division of Pathology from 1957 to 1987. In 3 patients (Group I) the lesion was within the fibroadenoma and in the remaining 5 patients, adjacent to it (Group II: synchronic carcinomas). All patients were females. During the same period, 987 fibroadenomas and 2004 carcinomas were diagnosed: 0.30% of the fibroadenomas developed carcinoma within the epithelial component and 0.15% of the carcinomas originated in the fibroadenoma's epithelium. The mean age was 39 years for in situ lesions and 45.5 years for infiltrating carcinoma with a general mean age of 43.3 years, 20 years older than the peak age of fibroadenoma. In Group I, there were 3 in situ lesions, 1 lobular and 3 ductal (Table 1). Two of the three patients had another coexisting gynecologic malignancy. In Group II all cases had infiltrating carcinomas, one lobular, 3 ductal and 1 mixed lobular and ductal (Table 1). The adjacent breast tissue showed associated pathology in all cases: multiple fibroadenomas, fibrocystic diseases, sclerosing adenosis, infiltrating ductal carcinoma and/or lobular hyperplasia. Different hypotheses from the literature were analysed concerning an association between carcinoma and fibroadenoma. A casual association is suggested by the low percentage of carcinomas developing in fibroadenomas as well as the low percentage of carcinomas originating from fibroadenomas.

Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients.

OBJECTIVE: To identify left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. METHODS: We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography RESULTS: We identified three left ventricular geometric patterns: 1) concentric hypertrophy, in 25% of the patients; 2) concentric remodeling, in 25%; and 3) normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001). Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007). Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively). CONCLUSIONS: Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.