Risk for Depression, Burnout and Low Quality of Life Among Personnel of a University Hospital in Italy is a Consequence of the Impact One Economic Crisis in the Welfare System?

BACKGROUND: Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers. OBJECTIVES: To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital. METHOD: Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals). RESULTS: The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians (i.e. those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory. CONCLUSION: Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

Use of different statistical models to predict direct genomic values for productive and functional traits in Italian Holsteins.

One of the main issues in genomic selection was the huge unbalance between number of markers and phenotypes available. In this work, principal component analysis is used to reduce the number of predictors for calculating direct genomic breeding values (DGV) for production and functional traits. 2093 Italian Holstein bulls were genotyped with the 54 K Illumina beadchip, and 39,555 SNP markers were retained after data editing. Principal Components (PC) were extracted from SNP matrix, and 15,207 PC explaining 99% of the original variance were retained and used as predictors. Bulls born before 2001 were included in the reference population, younger animals in the test population. A BLUP model was used to estimate the effect of principal component on deregressed proof (DRPF) for 35 traits and results were compared to those obtained by using SNP genotypes as predictors either with BLUP or with Bayes_A models. Correlations between DGV and DRPF did not substantially differ among the three methods except for milk fat content. The lowest prediction bias was obtained for the method based on the use of principal component. Regression coefficients of DRPF on DGV were lower than one for the approach based on the use of PC and higher than one for the other two methods. The use of PC as predictors resulted in a large reduction of number of predictors (approximately 38%) and of computational time that was approximately 2% of the time needed to estimate SNP effects with the other two methods. Accuracies of genomic predictions were in most of cases only slightly higher than those of the traditional pedigree index, probably due to the limited size of the considered population.

Coping with the crisis: people with severe mental disorders acting for social change through sustainable energy.

BACKGROUND: The aim of the study was to examine the efficacy of a vocational training program on renewable energy sources in reducing disabilities of people with chronic psychosis (CP). The innovative element was that the project could produce major advantages regarding the economic needs of the whole area involved. METHODS: Experimental Cohort, 26 subjects with CP (EC); Control Cohort1, 130 subjects with CP following pharmacotherapy plus other rehabilitation activities (CIC); Control Cohort2, 101 subjects with CP following the usual treatment (pharmacotherapy) (CUC). Study tool: Health of the Nation Outcome Scales (HoNOS). Assessment made at the start of the study (T0) and after three months (T1). Statistical analysis made by MANOVA. RESULTS: Improvement in HoNOS total score in both groups (F=7.574, p=0.000) with non-significant differences between groups over time (F=1.336, p=0.252) was found comparing EC vs. CIC. Greater improvement in EC vs. CIC was shown in the HoNOS "impairment" scale (F=4.910, p=0.028). EC vs. CUC: both groups improved in HoNOS total score (F=9.440, p=0.000) but the improvement was greater in EC (F = 2.273, P=0.048). CONCLUSIONS: Work inclusion, as well as other rehabilitation treatments, reduces the social needs of people with chronic psychosis. Work inclusion in a project with real relevance for the area where these people live, produces more improvement of cognitive, physical and somatic disabilities, probably related to a better outcome in self-efficacy.

Prediction of genomic breeding values for dairy traits in Italian Brown and Simmental bulls using a principal component approach.

The large number of markers available compared with phenotypes represents one of the main issues in genomic selection. In this work, principal component analysis was used to reduce the number of predictors for calculating genomic breeding values (GEBV). Bulls of 2 cattle breeds farmed in Italy (634 Brown and 469 Simmental) were genotyped with the 54K Illumina beadchip (Illumina Inc., San Diego, CA). After data editing, 37,254 and 40,179 single nucleotide polymorphisms (SNP) were retained for Brown and Simmental, respectively. Principal component analysis carried out on the SNP genotype matrix extracted 2,257 and 3,596 new variables in the 2 breeds, respectively. Bulls were sorted by birth year to create reference and prediction populations. The effect of principal components on deregressed proofs in reference animals was estimated with a BLUP model. Results were compared with those obtained by using SNP genotypes as predictors with either the BLUP or Bayes_A method. Traits considered were milk, fat, and protein yields, fat and protein percentages, and somatic cell score. The GEBV were obtained for prediction population by blending direct genomic prediction and pedigree indexes. No substantial differences were observed in squared correlations between GEBV and EBV in prediction animals between the 3 methods in the 2 breeds. The principal component analysis method allowed for a reduction of about 90% in the number of independent variables when predicting direct genomic values, with a substantial decrease in calculation time and without loss of accuracy.

The impact of the rank of marker variance-covariance matrix in principal component evaluation for genomic selection applications.

In genomic selection (GS) programmes, direct genomic values (DGV) are evaluated using information provided by high-density SNP chip. Being DGV accuracy strictly dependent on SNP density, it is likely that an increase in the number of markers per chip will result in severe computational consequences. Aim of present work was to test the effectiveness of principal component analysis (PCA) carried out by chromosome in reducing the marker dimensionality for GS purposes. A simulated data set of 5700 individuals with an equal number of SNP distributed over six chromosomes was used. PCs were extracted both genome-wide (ALL) and separately by chromosome (CHR) and used to predict DGVs. In the ALL scenario, the SNP variance-covariance matrix (S) was singular, positive semi-definite and contained null information which introduces 'spuriousness' in the derived results. On the contrary, the S matrix for each chromosome (CHR scenario) had a full rank. Obtained DGV accuracies were always better for CHR than ALL. Moreover, in the latter scenario, DGV accuracies became soon unsettled as the number of animals decreases, whereas in CHR, they remain stable till 900-1000 individuals. In real applications where a 54k SNP chip is used, the largest number of markers per chromosome is approximately 2500. Thus, a number of around 3000 genotyped animals could lead to reliable results when the original SNP variables are replaced by a reduced number of PCs.

Stem/progenitor cells in the developing human cerebellum: an immunohistochemical study.

The aim of this study was to analyze, by immunohistochemistry, the occurrence of stem/progenitor cells localized in the different niches of the developing human cerebellum. To this end, cerebellar samples were obtained from 3 fetuses and 3 newborns ranging, respectively, from 11 to 24 and from 30 to 38 weeks of gestation. Specimens were 10% formalin-fixed, routinely processed and paraffin-embedded; 3 µm-tick sections were immunostained with anti-SOX2 and PAX6 antibodies. Our study evidenced SOX2 and PAX6 immunoreactivity in precursors cells in all six developing human cerebella. SOX2 was expressed in precursors of different neural cell types, including Purkinje neurons, stellate cells, basket cells and Golgi cells. In the cerebellar cortex, SOX2 expression changed during gestation, being highly expressed from the 20th up to the 24th week, whereas at the 30th and at the 34th week SOX2 immunoreactivity was restricted to the Purkinje cell layer and the inner zone. Cerebellar human cortex was negative at the 38th week of gestation. PAX6 immunoreactivity was restricted to granule cell precursors in the external granule layer (EGL), being detected at all gestational ages. Our study indicates SOX2 and PAX6 as two useful markers of stem/progenitor cells that highlight the different germinative zones in the developing human cerebellum.

The "ultraperipheral" revascularization in arteriosclerotic obstruction of tibial vessels. Experimental study.

In arteriosclerotic obstruction of the main tibial arteries, the tibial collateral vessels are usually patent, and about 70% of these arteries are potentially suitable for surgical revascularization. The present study aimed at investigating the practical feasibility of a selective revascularization procedure on these tibial muscular arteries (ultraperipheral revascularization). Six lower limbs amputated at thigh level for arteriosclerotic gangrene with complete obstruction of the main tibial arteries, were studied: the tibial collateral muscular vessels showed patency in 65% of cases. The authors propose a surgical technique for the revascularization of these peripheral vessels with the use of a vascular prosthesis. The "post-operative" angiographic studies showed that revascularization of these peripheral muscular arteries was possible.

[Vascular access for hemodialysis. Clinical experience]. / Accesso vascolare per emodialisi. Una esperienza clinica.

Seventy-nine arteriovenous fistulas for periodic hemodialysis were created in 62 uremic patients: 64 primary vascular accesses and 15 salvage operations for malfunctioning fistulas. Sixty-three distal and 1 proximal arteriovenous fistulas between the radial artery and the cephalic vein, were created as primary vascular access. The utilization time of the primary arteriovenous fistulas was longer than 5 years in 34%, 3-4 years in 25% and 0-2 years in 41% of cases. Eleven fistulas evidenced thrombosis: a salvage operation (resection-anastomosis) was possible for 9 (89%). A salvage operation was possible for 100% of poor flow fistulas. The utilization's time of the salvage fistulas is longer than 5 years in 15%, 3-4 years in 15% and 0-2 years in 70% of cases.

[The solitary thyroid nodule. Diagnostic and therapeutic problems]. / Il nodulo solitario della tiroide. Problemi diagnostici e terapeutici.

The records of 93 patients who underwent surgery for solitary thyroid nodule were reviewed. It is emphasized no findings or diagnostic studies currently available which are sufficiently specific to differentiate benign from malignant lesions. All solitary nodules should be removed by excision of the involved thyroid lobe followed pathological examination: operative complications are rare.

[Collateral effects of 9-alpha-fluor-prednisolone acetate and kanamycin, administered by nasal spray. Clinical experience and experimental data]. / Effetti collaterali da 9-alfa-fluor-prednisolone acetato e kanamicina, somministrati mediante spray nasale. Esperienze cliniche e dati sperimentali.

Iatrogenic pathology due to treatment with steroid drugs used by systemic route is well known. On the contrary iatrogenic pathology due to topical use of these drugs is rarely reported. Two cases of abuse of 9-alpha- fluor-prednisolone and kanamycin administered by endonasal route are reported. The same treatment has been carried out in patients and rabbits. Clinical and bio-humoral data in patients and anatomo-pathological findings in rabbits are reported. The risks, sometimes underestimated, of an overdose of corticosteroid and antibiotic drugs used by endonasal route are pointed out.

[Embolism of the superior mesenteric artery. A clinical experience]. / L'embolia dell'arteria mesenterica superiore. Un'esperienza clinica.

The Authors report their clinical experience in superior mesenteric artery embolism: 10 arterial embolisms (71%) collected from a series of 14 obstructions of the superior mesenteric artery. The main interval from the beginning of the symptomatology to hospital admission was 48 h. Laparotomy was performed in all ten patients; gangrenous bowel was resected in 2 and 2 had an embolectomy of the superior mesenteric artery without intestinal resection. The remaining 6 patients had laparotomy alone and died. The Authors emphasize the difficulty in recognizing the disease at an early stage and suggest to contemplate in patients at risk with a persistent abdominal pain, the possibility of a superior mesenteric artery embolism.

[Recovery after amputation for arteriosclerosis. Follow-up study]. / Il recupero dell'arteriopatico amputato. Studio a distanza.

Clinical follow-up of 71 patients subjected to major amputation of the lower extremities for atherosclerotic arteriopathy has been analysed for the purpose of ascertaining real possibilities of functional recovery and quality of life. Research results show that only a small number of patients (38%) can achieve an acceptable quality of life. The reasons have been identified in the objective difficulty of adequate physical and psychotherapeutic rehabilitation owing to structural shortcomings or the presence of associated pathology or the advance in the basic condition which does not permit application or frustrates results.

[Complementary profundoplasty. Clinical experience]. / Profundoplastica "complementare". Esperienza clinica.

The Authors report a 68% overall success rate in a three years follow-up study of 45 "complementary" profundoplasties. The key factors with a significant prognostic effect on the clinical surgical results are the early postoperative increase of the resting ankle pressure index (I.W.) and the angiographic preoperative patency of the tibial arteries. An early postoperative increase of I.W. has been always associated with good results whereas an unchanged postoperative I.W. has always been associated with poor results; an angiographic tibial run-off (one or two or three patient tibial arteries) has been associated with significant better clinical results (p less than 0.001).

[Endarterectomy of the internal carotid. Clinical experience]. / La disostruzione della carotide interna. Esperienza clinica.

The authors report a clinical experience on 37 internal carotid endarterectomies of 33 patients classified as: group A (asymptomatic patients); 4 patients (13%), group B (RIA); 9 patients (27%), group C (stabilized neurological lesions); 19 patients (56%), group D (acute cerebral ischemia): 1 patient (3%). Sixteen thromboendarterectomies (43%) were carried on for the prophylaxis of neurological lesions, 20 (54%) to increase and balance the cerebral blood flow in patients with stable neurological lesions, 1 (3%) for acute cerebral ischemia. The overall operative mortality was 6%, the operative morbidity was 22%. The clinical follow-up concerned 26 patients: the overall mortality was 19%: in survivors the late results were excellent. The rate of postoperative stenosis was 18%: 80% of these arteries had been treated without a patch angioplasty.

Fetal programming of the human brain: is there a link with insurgence of neurodegenerative disorders in adulthood?

In recent years, evidence is growing on the role played by gestational factors in shaping brain development and on the influence of intrauterine experiences on later development of neurodegenerative diseases including Parkinson's (PD) and Alzheimer's disease (AD). The nine months of intrauterine development and the first three years of postnatal life are appearing to be extremely critical for making connections among neurons and among neuronal and glial cells that will shape a lifetime of experience. Here, the multiple epigenetic factors acting during gestation - including maternal diet, malnutrition, stress, hypertension, maternal diabetes, fetal hypoxia, prematurity, low birth weight, prenatal infection, intrauterine growth restriction, drugs administered to the mother or to the baby - are reported, and their ability to modulate brain development, resulting in interindividual variability in the total neuronal and glial burden at birth is discussed. Data from recent literature suggest that prevention of neurodegeneration should be identified as the one method to halt the diffusion of neurodegenerative diseases. The "two hits" hypothesis, first introduced for PD and successfully applied to AD and other neurodegenerative human pathologies, should focus our attention on a peculiar period of our life: the intrauterine and perinatal periods. The first hit to our nervous system occurs early in life, determining a PD or AD imprinting to our brain that will condition our resistance or, alternatively, our susceptibility to develop a neurodegenerative disease later in life. In conclusion, how early life events contribute to late-life development of adult neurodegenerative diseases, including PD and AD, is emerging as a new fascinating research focus. This assumption implies that research on prevention of neurodegenerative diseases should center on events taking place early in life, during gestation and in the perinatal periods, thus presenting a new challenge to perinatologists: the prevention of neurodegenerative human diseases.

Use of principal component approach to predict direct genomic breeding values for beef traits in Italian Simmental cattle.

In the current study, principal component (PC) analysis was used to reduce the number of predictors in the estimation of direct genomic breeding values (DGV) for meat traits in a sample of 479 Italian Simmental bulls. Single nucleotide polymorphism marker genotypes were determined with the 54K Illumina beadchip. After edits, 457 bulls and 40,179 SNP were retained. Principal component extraction was performed separately for each chromosome and 2466 new variables able to explain 70% of total variance were obtained. Bulls were divided into reference and validation population. Three scenarios of the ratio reference:validation were tested: 70:30, 80:20, 90:10. Effect of PC scores on polygenic EBV was estimated in the reference population using different models and methods. Traits analyzed were 7 beef traits: daily BW gain, size score, muscularity score, feet and legs score, beef index (economic index), calving ease direct effect, and cow muscularity. Accuracy was calculated as correlation between DGV and polygenic EBV in the validation bulls. Muscularity, feet and legs, and the beef index showed the greatest accuracies; calving ease, the least. In general, accuracies were slightly greater when reference animals were selected at random and the best scenario was 90:10 and no substantial differences in accuracy were found among different methods. Principal component analysis is entirely based on the factorization of the SNP (co)variance matrix and produced a reduced set of variables (6% of the original variables) which may be used for different phenotypic traits. In spite of this huge reduction in the number of independent variables, DGV accuracies resulted similar to those obtained by using the whole set of SNP markers. Accuracies of direct genomic values found in the present work were always greater than those of traditional parental average (PA). Thus, results of the present study may suggest a possible advantage of use of genomic indexes in the preselection of performance test candidates for beef traits. Moreover, the relevant reduction of variable space might allow genomic selection implementation also in small populations.

Use of partial least squares regression to predict single nucleotide polymorphism marker genotypes when some animals are genotyped with a low-density panel.

High-density single nucleotide polymorphism (SNP) platforms are currently used in genomic selection (GS) programs to enhance the selection response. However, the genotyping of a large number of animals with high-throughput platforms is rather expensive and may represent a constraint for a large-scale implementation of GS. The use of low-density marker (LDM) platforms could overcome this problem, but different SNP chips may be required for each trait and/or breed. In this study, a strategy of imputation independent from trait and breed is proposed. A simulated population of 5865 individuals with a genome of 6000 SNP equally distributed on six chromosomes was considered. First, reference and prediction populations were generated by mimicking high- and low-density SNP platforms, respectively. Then, the partial least squares regression (PLSR) technique was applied to reconstruct the missing SNP in the low-density chip. The proportion of SNP correctly reconstructed by the PLSR method ranged from 0.78 to 0.97 when 90% and 50%, respectively, of genotypes were predicted. Moreover, data sets consisting of a mixture of actual and PLSR-predicted SNP or only actual SNP were used to predict genomic breeding values (GEBVs). Correlations between GEBV and true breeding values varied from 0.74 to 0.76, respectively. The results of the study indicate that the PLSR technique can be considered a reliable computational strategy for predicting SNP genotypes in an LDM platform with reasonable accuracy.