Sleep disorder, Mediterranean Diet and learning performance among nursing students: inSOMNIA, a cross-sectional study.

BACKGROUND: The International Classification of Sleep disorders, the International Classification of Diseases and the Diagnostic and Statistical manual of Mental Disorders defines insomnia as an experience of insufficient or poor sleep quality, characterized by at least one of the following symptoms: difficulty in initiating or maintaining sleep, early awakenings and poor restorative sleep. In Italy, the Morfeo 1 study detects a prevalence of 20% of insomnia and a 40% of cases with day-time symptoms. The chronic sleep deprivation is responsible for cognitive disorders with effects on social life. Being common knowledge, lifestyle can also influence sleep. Some of the "sleep hygiene rules" involve a control on smoking, coffee consumption and diet. The Mediterranean Diet (MD), thanks to its high level of tryptophan, has a positive influence on sleep and can protect against stress and anxiety. STUDY DESIGN: The aim of InSOMNIA study was to determine the prevalence of sleep disorders among nursing students of the University of Perugia and, therefore, to evaluate how lifestyle, eating habits, health status and academics performance are linked to night-time and daytime symptoms of the interrupted sleep. METHODS: We adopted a cross sectional survey, collecting data from "Sleep and Daytime Habits Questionnaire" to evaluate the sleep disorders and from PREDIMED questionnaire to assess the adherence to MD. RESULTS: We found a statistical significant association between PREDIMED score and BMI (p-value=0.0127), smoking habit (p-value = 0.0125), quality of life (p-value = 0.0480) and academic progress (p-value = 0.0092). CONCLUSIONS: We found a high prevalence of sleep disturbances statistically associated with diet and poor academic progress.

Double renal chimney graft using only femoral approach.

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment that can be offered to most patients with an aortic aneurysm. Patients who are rejected from standard EVAR often have more extensive aortic pathology and more medical comorbidities. The advent of fenestrated and branched stent grafts gives us an opportunity to treat the most demanding aortic aneurysms endovascularly. Fenestrated stent-grafts, however, are costly and time-consuming to manufacture, which limits their applicability, especially in the emergency setting. The chimney graft is a stent placed parallel to the aortic stent-graft to preserve flow to a vital aortic branch that was overstented to obtain an adequate seal. The technique can be used as a planned operation but also as a rescue procedure to salvage a side branch unintentionally covered during EVAR. As visceral branches of the aorta are usually directed caudally these vessels are, therefore, preferably catheterized from a brachial approach. We describe a case of a successful positioning of the chimney graft using only the femoral approach. The only femoral approach to position a renal chimney graft isn't recommended for the routine procedure but it is proved to be useful in selected case and when other treatment options are excluded.

[Asbestos fibre lung burden and exposure indices in asbestos-cement workers]. / Carico polmonare di fibre di asbesto e indici di esposizione cumulativa in lavoratori del cementoamianto.

BACKGROUND: In many previous studies, the asbestos fibres retained in the lung were regarded as a good index of cumulative occupational asbestos exposure. Twelve workers suffering from asbestos-related diseases and had been employed in an asbestos-cement factory operating from 1961 to 1994 underwent post mortem investigations in the course of a criminal law suit. OBJECTIVES: Samples of lung tissues were collected for electron microscopy analysis to measure the asbestos fibre burden of the lungs in workers with high exposure, and assess the possible correlation between asbestos fibre lung burden and the estimated levels of cumulative exposure. METHODS: Samples of lung parenchyma obtained from a consecutive series of 12 post-mortem examinations that were performed between 1994 and 2007and included 5 cases of malignant pleural mesothelioma, 4 lung cancers, 1 case of asbestosis and2 ofpleuralplagues, were collected, stored and analysed by SEM electron microscopy, according to the methods suggested by the current scientific literature. For each worker, all males, a detailed occupational history was reconstructed by means ofpersonal interviews; both the measurements of airborne asbestos fibresperformed by the factory in the 1970's and the duration of each single job in the plant were taken into account to estimate an individual cumulative exposure index. RESULTS: A wide variation of total asbestos fibre concentrations in the lung (1,320-118 million) was observed; in all 12 workers, the lung amphibole fibre burden exceeded 1,000,000 fibres per g/dry tissue, The highest values were detected in the mesothelioma cases, in which the mean fibre concentrations differed statistically (t=2.29, p=0.045) from the mean calculated for the other asbestos-related diseases; in 9 subjects only amphibole fibres were detected. There was a good correlation between total asbestos fibre concentration and cumulative exposure index (r=0.91, p<0.0001). CONCLUSION: This study, which was numerically the biggest ever performed in Italy for this category of workers, confirms a wide range of total asbestos fibre burden in heavily occupationally exposed workers and showed that of the asbestos-related diseases, the highest lung concentrations of asbestos fibres were reached in cases of mesothelioma. It was also observed that almost the entire lung burden consists of only amphibole fibres, all exceeding 1 million per gramme of dry tissue. This study tested a synthetic cumulative occupational exposure index, which appears to be well correlated to the level of exposure established by biological analysis.

The psychotic spectrum: validity and reliability of the Structured Clinical Interview for the Psychotic Spectrum.

This study evaluates the validity and the reliability of a new instrument developed to assess the psychotic spectrum: the Structured Clinical Interview for the Psychotic Spectrum (SCI-PSY). The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising the clinical and subsyndromal psychotic manifestations. The items of the interview include, in addition to a subset of the DSM-IV criteria for psychotic syndromes, a number of features derived from clinical experience and from a review of the phenomenological descriptions of psychoses. Study participants were enrolled at 11 Italian Departments of Psychiatry located at 9 sites and included 77 consecutive patients with schizophrenia or schizoaffective disorder, 66 with borderline personality disorder, 59 with psychotic mood disorders, 98 with non-psychotic mood disorders and 57 with panic disorder. A comparison group of 102 unselected controls was enrolled at the same sites. The SCI-PSY significantly discriminated subjects with any psychiatric diagnosis from controls and subjects with from those without psychotic disorders. The hypothesized structure of the instrument was confirmed empirically.

Suicide mortality is decreasing among cancer patients in Central Italy.

The objective of this study was to discover whether suicide mortality among patients diagnosed with cancer during the period 1985-1999 had decreased with calendar time in comparison to the rate in the general population. 90?197 cancer patients resident in Tuscany, Central Italy and incident during the period 1985-1999 were followed up for life status to 31 December 2000. The mortality codes for suicide were considered (E950-E959). Time trends for suicide rates were assessed by using Kernel smoothing estimators, standardised mortality ratios and Poisson analysis of the observed/expected ratios. The standardised mortality ratios were 324, 224, and 185 for cancer patients diagnosed during the periods 1985-1989, 1990-1994, and 1995-1999, respectively. Tests for linear trends were borderline significant (P=0.053). Suicide mortality among cancer patients in central Italy had decreased with calendar time relative to the suicide trend in the general population. Improved treatment options and better communication of diagnosis are possible explanations of this finding.

Diagnosis of flour-induced occupational asthma in a cross-sectional study.

The diagnosis of occupational asthma is usually performed in epidemiology using a combination of symptoms and bronchial hyperresponsiveness, while in a clinical setting the 'gold standard' for the diagnosis of occupational asthma is the specific bronchial challenge test in the laboratory The aim of this study was to detect new cases of flour-induced occupational asthma (OA) in a group of workers exposed to grain and/or flour dust, by means of a step-by-step approach, as used in a clinical setting. In an epidemiological study, III millers and 186 bakers were examined by means of questionnaire, pulmonary function tests and skin-prick tests (SPT) to common allergens and to wheat flour dust extracts. From the whole sample, 82 subjects who showed asthma-like symptoms in the questionnaire and/or low forced expiratory volume in 1 sec (FEV1) were selected. Selected subjects underwent methacholine challenge test, and hyperreactive subjects underwent specific bronchial challenge with flour dust in the laboratory. Sixty-two of the selected subjects performed the methacholine challenge test, and 22 (33 8%) were hyperreactive (PD20 FEV1 <1 mg of methacholine). Fifteen of 22 hyperreactive subjects underwent specific bronchial challenge test (s BCT) with flour dust; a positive response was elicited in six subjects. These subjects can be diagnosed as having flour-induced occupational asthma. Atopy and skin sensitivity to flour was partially related to the response to flour bronchial challenge. Bronchial hyperreactivity can be observed in a small percentage of subjects with asthma-like symptoms and/or low FEV1, and a positive response to s BCTwas observed in a subgroup of hyperreactive subjects.Therefore, using these selection criteria, a diagnosis of flour-induced OA, as commonly performed in a clinical setting, can be performed in few previously undiagnosed subjects.This approach could be relevant for an early diagnosis ofoccupational asthma.

Dyspnoea is associated with pulmonary function impairment in exposed workers.

This study aimed to evaluate the prevalence of dysponea and its predictors in studies on several working male groups in British Columbia (BC), Canada (cedar sawmill, grain elevator, pulpmill, and aluminum smelter workers), and Tuscany (T), Italy, (shoe and furniture makers, millers, bakers, and pharmaceutical workers). We performed cross-sectional health studies (interviews and pulmonary function tests) for 2498 BC and 1474 T workers exposed to air contaminants, and 1110 BC and 243 T controls. Similar questionnaires and the same definitions were used in BC and in T. Pulmonary function tests were also performed. The participation rates were >92% in BC workers and 82% in T workers. The overall prevalence of moderate dyspnoea was not different in exposed BC and T workers in comparison with controls. Slight dyspnoea was significantly more frequent in BC workers, but not in T workers, with respect to controls. After adjusting for age, body mass index (BMI), smoking, current asthma, and chronic bronchitis, forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were found to be significantly associated with slight and moderate dyspnoea in BC workers, and slight dyspnoea in T workers. Isolated dyspnoea is associated with reduction in FEV1 and FVC in working populations, after adjusting for potentially confounding variables.

Orientation of collagen fibers at the boundary between two successive osteonic lamellae and its mechanical interpretation.

By applying an original technique, an investigation has been carried out to determine the orientation of collagen fibrils at the boundary between two successive lamellae in alternate osteons. Evidence is reported that the predominant fiber direction does not change abruptly from one lamella to the next; there is an intermediate system of criss-crossed fibers whose main orientation makes an angle of nearly 45 degrees with the direction of the fibers in the two adjacent lamellae. Taking a composite orthogonally reinforced laminate as a model, a mechanical interpretation of this intermediate system of collagen fibers is given.

The torsional properties of single selected osteons.

The aim of the present investigation is to determine the mechanical behavior of single selected osteons loaded by torsion along their axis. Two osteon types were chosen: (a) fully calcified 'longitudinal' osteons, whose fibers (and, consequently, crystallites) have a marked longitudinal spiral course in successive lamellae, (b) fully calcified 'alternate' osteons, whose fibers (and, consequently, crystallites) have a marked longitudinal spiral course in one lamella, and an apparently transverse or circular course in the next. The osteon samples, which were cylindrically shaped, and whose extremities fitted into two rectangular lugs, were prepared on a microturning lathe. The principle of the specially manufactured torsional device was that of a pendulum set oscillating around a very sharp wedge so as to reduce friction to negligible levels. The results indicate that longitudinal osteons are those most resistant to torsional loading. The low resistance to torsional loading of the lamellae whose fibers apparently have an almost transversal course is discussed with reference to recent views on the microstructure of this type of lamella.

The bending properties of single osteons.

The bending properties of two fully calcified osteon types (longitudinal and alternate) have been investigated in 62 cylindrical samples by applying the technique of three-point bending loading. The bending of each sample was recorded using a microwave micrometer based on the cavity and pulse technique. It has been shown that alternate osteons are better able to withstand bending stress than longitudinal ones. This result offers a definitive explanation for the high concentration of transverse lamellae in pathologically bowed bone shaft.

The tensile properties of single osteonic lamellae: technical problems and preliminary results.

An investigation on the tensile properties of osteonic lamellae whose fiber bundles have an almost transversal spiral course has been carried out, using samples obtained from alternately structured osteons by applying a procedure described in detail by Ascenzi et al. (1973). A very sensitive microwave extensometer based on cavity and pulse technique was employed in order to record the tensile curve from each lamellar sample. The inhomogeneity in thickness within, and between, single lamellae has ruled out any form of comparison between the curves recorded for ultimate tensile strength and modulus of elasticity. This result is in agreement with the morphological finding that there is usually a wide, continuous range of variation in thickness even along the length of single osteonic lamellae.

Mechanical hysteresis loops from single osteons: technical devices and preliminary results.

The purpose of this paper is to describe an original apparatus for recording hysteresis loops from single osteons and a special microgrinding lathe for preparing osteonic samples for testing. The results obtained by testing isolated osteons, and composite bone samples ground to the same size as an osteon sample justify one to draw the following main conclusions: at an equal degree of calcification, longitudinal osteons show larger hysteresis loops under compression and alternate osteons show larger hysteresis loops under tension; there seems to be little chance of acquiring detailed information on the mechanical effects of osteon calcification recording hysteresis loops; collagen orientation in lamellae is the main factor determining the kind of hysteresis loops displayed by a composite bone sample.

Pinching in longitudinal and alternate osteons during cyclic loading.

Pinching is a degrading phenomenon which occurs during cyclic loading of certain materials. A change in the slope of the deflection curve reveals pinching lesions, either flexural cracks or bond degradation, cause pinching. This paper investigates pinching for 20 longitudinal and 18 alternate fully calcified osteonic samples of cylindrical shape and 500 micron length. Each sample was axially loaded beyond the proportional limit using an electromechanical device acting as a transducer of the variations in length of the sample into changes in the resonance frequency of a microwave micrometer. A cubic polynomial served as a mathematical model to investigate the stress-strain diagrams at the first and last cycles through the study of strain limits, stiffness and pinching behaviours, and energy absorption. The hysteretic behaviour of the two types of osteons differs and is far from ideal. The presence of pinching may derive from the existence of longitudinal fibrils, in particular the yielding of the incompletely calcified ones. In longitudinal osteons consisting mainly of longitudinal collagen fibrils, the deformation under compression is not protected by lamellae consisting of transverse fibrils, therefore the lesions inducing pinching are magnified. In contrast, in alternate osteons, where the fibrils having a longitudinal orientation are reduced and protected by lamellae containing transversely oriented fibrils, the lesions-inducing pinching are lessened.

[2 cases of tularemia observed at Monte Amiata]. / Descrizione di due casi di tularemia osservati sul Monte Amiata.

Two cases of tularemia caused by direct contact with an infected hare are described. Recent epidemiological discoveries about the disease are reported with reference to other known foci in Tuscany and the measures taken to control and isolate the infected areas.

[Kaposi's sarcoma: on its frequent association with lymphoreticular neoplasms and diabetes mellitus]. / Sarcoma di Kaposi: sulla frequente associazione con neoplasie linforeticolari e diabete mellito.

Kaposi's sarcoma (K.S.) is associated relatively frequently with diabetes mellitus and with a second often lymphoreticular neoplasia. On the basis of the three cases reported, which presented an association of diabetes mellitus, chronic lymphatic leukaemia, Hodgkin's lymphoma and K.S., the relationship between neoplastic diseases, immunological and lymphoproliferative disorders and virus infections is considered.

[The Tuscany longitudinal study: mortality among selected causes in inner city of Florence and Leghorn]. / Studio Longitudinale Toscano: un'analisi per quartiere per le città di Firenze e Livorno.

The analysis of mortality in urban settings for the Cities of Florence (1991-95) and Leghorn (1987-95), based on data from the Tuscany Longitudinal Study, is reported in the present paper. The data came from a census-based cohort study, all residents at the census day 1981 (Leghorn) or 1991 (Florence) being enrolled and followed-up by automated procedures of record-linkage. The cause of death certificate had been eventually collected by the Regional Mortality Register. For each city, internally standardized mortality ratios (SMR) had been calculated by sub-urban areas (city sectors or wards). The analysis was restricted to age groups > 15 years to have interpretable results on socio-economic variables derived from census questionnaires. Bayesian estimates (Besag, York e Mollié) of mortality relative risks had been calculated to overcome extra-variability of SMRs. In the city of Florence two wards showed about 10% excess risk for overall mortality. In the city of Leghorn one sector was at higher risk while one showed a significant lower mortality. For both cities such risk gradients were still present after adjustment for deprivation index at individual level.

[Socioeconomic inequalities in health in the Tuscany Longitudinal Study (SLTO): persistence and changes over time in overall mortality and selected causes (lung cancer, liver cirrhosis, AIDS and overdose)]. / Condizione socio-economica e disuguaglianze nella mortalità nello Studio Longitudinale Toscano (SLTo): persistenza ed evoluzione nel tempo (mortalità generale, tumore del polmone, cirrosi epatica), ed aspetti emergenti (AIDS e overdose).

We evaluate the persistence of social inequalities in overall mortality or mortality by causes (lung cancer, liver cirrhosis; AIDS and overdose) in the Tuscany Longitudinal Study (SLTo), a record linkage-study on the census population identified at the 1981 and 1991 censuses in Leghorn (1981: 175,741 subjects; 1991: 167,512 subjects), and 1991 in Florence (403,294 subjects), Central Italy. The census data allow an evaluation of socio-economic status of each subject, using variables such as education or occupation, or constructing indexes inclusive of deprivation indexes. Follow-up is from the census up to 1995 and for specific causes of death from 1987 (Leghorn) or 1991 (Florence). Estimates of risk are computed comparing rates of mortality among socio-economic groups, by means of poisson regression models, or by means of Standardized Mortality Ratios using the indirect method. The causes of deaths have been selected mainly because explained by known and strong determinants. As far as overall mortality, the results suggest the persistence of gradients by social class, more often negative among males. Mortality from lung cancer has a strong negative social class gradient among males, and a divergent gradient among women in the two towns, which is interpreted as the effect of a different prevalence of smoking by period, social class and sex. High RRs among lower socio-economic groups have been detected for liver cirrhosis mortality. Excess mortality of AIDS and overdose, an expression of the recent drug crisis, concentrates on the lower social strata and in young adults. Whereas mortality from AIDS has been detected among both sexes, deaths from overdose are occurring among males only. Being AIDS and overdose recent diseases, they stress the persistence of social inequalities over time.

[Air pollution and daily mortality among Milan residents, 1980-89. Preliminary results]. / Inquinamento atmosferico e mortalità giornaliera nei residenti a Milano, 1980-89. Risultati preliminari.

Short term effects of air pollutant levels on daily mortality were studied, using time series approach, in Milan from the year 1980 to 1989. The Poisson regression with autocorrelated residuals was applied. This paper reports preliminary results of the analyses on the association between total daily number of deaths and the 24h mean concentrations, on the same day, for two air pollutants: sulphur dioxide and total suspended particulate. A positive and curvilinear relation (with a logarithmic shape) has been found between total daily mortality and concentration levels for each pollutant. This result confirm a steeper increase in mortality at low concentrations, lower than the international standards in use at the moment.

Juxtarenal aortic aneurysms: preliminary experience with fenestrated E-vita abdominal stent-graft.

Endovascular aneurysm repair (EVAR) offers a minimally invasive treatment to patients with improved short-term and similar mid-term results compared to conventional, open repair. Approximately 20% of patients have an aneurysm neck morphology inadequate for a standard stent-graft and requires an endograft to cross vital aortic side branches to achieve a seal. This work describes the promising single center preliminary results in the management of juxtarenal aortic aneurysm using E-vita stent-graft.

Predictors of response among patients with panic disorder treated with medications in a naturalistic follow-up: the role of adult separation anxiety.

BACKGROUND: Efficacy of treatments for panic disorder is well established, but not all patients respond. Adult separation anxiety has been found to predict poorer response to CBT, but its effect on response to medication has not been previously explored. STUDY AIM: The aim of this study is to investigate if panic-agoraphobic spectrum factors, including 'separation anxiety' factor predict treatment outcome in patients with panic disorder. STUDY SAMPLE: Participants who met criteria for PD (n=57) completed baseline assessment and 12 months follow-up. Patients were administered the Panic Agoraphobic Spectrum Self-Report (PAS-SR, Lifetime and Last-Month Versions), and the Panic Disorder Severity Scale (PDSS). We examined patients who met the following criteria at baseline: 1) PDSS total score>7; 2) no current Axis I comorbidity with major depression; 3) no lifetime or current bipolar disorder. All patients were treated with evidence-based psychopharmacological treatment for panic disorder during the 12-month observation period. RESULTS: Twenty eight patients (48.1%) achieved remission during the follow-up period. In a logistic regression model, controlling for baseline severity, gender and age, only the last-month PAS-SR 'separation anxiety' factor was associated with a lower likelihood of remission. CONCLUSIONS: Signs and symptoms of separation anxiety in adulthood, as assessed with the PAS-SR Last Month version, are predictors of poor treatment outcome in patients with PD. We submit that the assessment of panic-agoraphobic spectrum features, including adult separation anxiety, should become routine of clinical assessment of patients with PD. It is likely that a better psychopathological characterization of patients may inform treatment selection, and result in better treatment outcome.