Scanning the solutions for the sustainable supply of forest ecosystem services in Europe.

Forests are key components of European multifunctional landscapes and supply numerous forest ecosystem services (FES) fundamental to human well-being. The sustainable provision of FES has the potential to provide responses to major societal challenges, such as climate change, biodiversity loss, or rural development. To identify suitable strategies for the future sustenance of FES, we performed a solution scanning exercise with a group of transdisciplinary forest and FES experts from different European regions. We identified and prioritized fifteen major challenges hindering the balanced provision of multiple FES and identified a series of potential solutions to tackle each of them. The most prominent challenges referred to the increased frequency and impacts of extreme weather events and the normative mindset regarding forest management. The respective solutions pointed to the promotion of forest resilience via climate-smart forestry and mainstreaming FES-oriented management through a threefold strategy focusing on education, awareness raising, and networking. In a subsequent survey, most solutions were assessed as highly effective, transferable, monitorable, and with potential for being economically efficient. The implementation of the solutions could have synergistic effects when applying the notion of leverage points. Seven emerging pathways towards the sustainable supply of FES have been identified. These pathways build on each other and are organized based on their potential for transformation: (1) shifting forest management paradigms towards pluralistic ecosystem valuation; (2) using integrated landscape approaches; (3) increasing forest resilience; (4) coordinating actions between forest-related actors; (5) increasing participation in forest planning and management; (6) continuous, open, and transparent knowledge integration; and (7) using incentive-based instruments to support regulating and cultural FES. These pathways can contribute to the implementation of the new EU Forestry Strategy to support the balanced supply of multiple FES. Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-022-01111-4.

Metabolic syndrome and diabetes mellitus in childhood cancer survivors.

BACKGROUND: The survival of children with cancer has grown considerably in recent years resulting in a marked increase of endocrine complications. increasingly recognized problems are metabolic syndrome and diabetes mellitus. DATA SOURCES: We critically analysed the most recent literature about the prevalence and molecular mechanisms of metabolic dysregulation and long-term cardio-metabolic risk in this population. RESULTS: Hypothalamic irradiation determines growth hormone deficiency and hypogonadism; moreover it is able to disrupt the appetite regulating centre leading to hyperphagia and progressive obesity. These conditions determine an insulin resistant state, contributing to the development of metabolic syndrome and diabetes mellitus. Irradiation and/or chemotherapy may lead to an insulin secretory defect through a direct damage of pancreatic beta cells. CONCLUSION: Metabolic syndrome and diabetes mellitus represent increasingly recognized long-term complications of childhood cancer treatment. The different impact of insulin resistance and secretory defects on the onset and progression of metabolic syndrome and diabetes mellitus remains unclear.

The familiarity of idiopathic scoliosis: statistical analysis and clinical considerations.

PURPOSE: The etiology of idiopathic scoliosis (IS) has been the subject of extensive research, and the current opinion is in favor of a multifactorial pathogenesis with an important genetic component. The aim of this study is to investigate the pattern of inheritance over generations of IS and its possible risk factors. METHODS: A total of 70 patients affected by IS was selected and studied up to the third generation for an overall cohort of 2,055 subjects. The genealogy was investigated and correlated for scoliosis. RESULTS: The outcomes showed that 73 % of the patients had an age between 12 and 15 years. The 60 % of the mothers had an age between 20 and 29 years and 57 % of the patients were "first born". The 5.8 % of the brothers and the 12.7 % of the sisters were affected by scoliosis. From the analysis of the total sample, it is clear that in 53 % of the families, there is at least another scoliotic besides the patient. CONCLUSION: The statistical analysis revealed three different types of transmission: autosomic dominant, autosomic recessive and multifactorial. When this last mode of inheritance is involved, female sex and firstborn resulted as risk factors of IS.

Humanitarian mission improves health conditions of schoolchildren in Ethiopia. the case of Adwa.

OBJECTIVE: The objective of this study is to compare health conditions of schoolchildren receiving aids from the mission Kidane Mehret Integrated Project (KMIP) in the city of Adwa, Ethiopia, with the ones of the general population. METHODS: From September, 2008, to November, 2008, 400 children were randomly selected in the school inside KMIP and in the one of Adi Abetu. In phase 1, a questionnaire was distributed to children's families. In phase 2, children underwent physical examination. RESULTS: Girls from KMIP started weaning on average at 7.3+/-3.9 vs 8.3+/-4.7 months of the control group (p>0.05); boys from KMIP started weaning on average at 6.7+/-4.1 vs 8.7+/-5.1 months of the control group (p<0.01). Centiles for height for age, weight for age and BMI for age were significantly higher in girls attending KMIP compared to the control group. CONCLUSIONS: Merged data suggests the significant impact of KMIP on the schoolchildren of Adwa. Moreover, women and youngest children, usually the most discriminates, were the band of the society that benefited most from the aids coming from the mission.

[5 days Cefaclor vs. 10 days amoxicillin/clavulanate in the treatment of childhood streptococcal pharyngitis. Data from a randomized clinical trial]. / Efficacia di Cefaclor 5 giorni vs. amoxicillina-acido clavulanico 10 giorni, nella terapia della faringotonsillite streptococcia del bambino. Risultati di uno studio clinico randomizzato.

AIM: The duration of therapy represents a fundamental aspect in the compliance to the therapy of child pathologies, such as pharyngotonsillitis, treated with oral therapy. Although penicillin and amoxicillin are the first choice antibiotics in the case of a child suffering from pharyngotonsillitis with the proven presence of Group A ß-hemolytic Streptococcus (GAS), the number of orally administered doses and 10 days of therapy, considerably lower the compliance. METHODS: An open phase IV randomized multicenter clinical trial was conducted in parallel groups, involving 49 family pediatrician (FP), distributed over the entire national territory, enrolling 435 children suffering from GAS-FT. 210 children received Cefaclor, 50 mg/kg/day, administered twice daily for five days, whilst 213 children received amoxicillin/clavulanate 40 mg/kg/day administered twice daily for 10 days. RESULTS: The results showed percentages of eradication of 88.4% for the Cefaclor group and 94.3% for the amoxicillin/clavulanate group, and a positive clinical judgement of 92.3% for the Cefaclor group and 96.6% for the amoxicillin/clavulanate group. The two arms of the study did not have any significant statistical differences, neither for the eradication, nor for the clinical judgement nor for the reduction of the Milano Score between the beginning and the end of treatment, with a P=0.042 for amoxicillin/clavulanate for eradication. CONCLUSION: This study confirms that the administration of Cefaclor for five days during GAS-FT has the same efficacy as a 10-day therapy with amoxicillin/clavulanate, with a clearly different compliance.

Bismuth oxychloride nanoflakes: interplay between composition-structure and optical properties.

Strongly (001) oriented BiOCl nanoflakes have been prepared at room temperature by the controlled hydrolysis of bismuth chloride in the presence of acetylacetone. The nanoflakes thermally treated in air up to 600 °C have been studied by X-Ray Photoelectron Spectroscopy (XPS), X-Ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). Composition, structure and morphology of the nanoflakes have been correlated to their electronic absorption and luminescence properties. Irrespective of the thermal treatments, the samples are characterized by transmittance higher than 98% in the near-infrared region. In the mildly annealed specimen (≤ 200 °C), the absorption bands in the ultraviolet can be effectively exploited for the selective excitation of the blue (394 nm) and green (520 nm) photoluminescence, the latter being visible only for λ(exc) > 310 nm. Conversely, at higher temperature only the blue emission is observed which, on the basis of the observed trend, can be assigned to emitting centres located in the oxide sheet of the Bi-O-Cl stacks.

Report on the working activity of an Italian family pediatrician: a three-year analysis 2004-2006.

AIM: Italian family pediatrician (FP) represents a unique example of global medical assistance for children throughout the world. Their role, however, is not fully known because appropriate feedback has not developed to evaluate the impact of FP's care on childhood disease morbidity. METHODS: This study contains a report of the daily activity of a FP, during the years 2004, 2005 and 2006 to create a picture of the current situation in the Italian medical health system that deals with children. Results have demonstrated that the mean number of yearly visits is 3 293±351, the mean routine health-checks is 952±60 and the mean number of yearly access is 4 245±391. The mean number of daily visits is 4.5±0.3 for routine health-checks and 15.5±1.5 for the visits, making a total of 20 daily visits. Children suffering from chronic diseases, included in the FP list, is on average of 60 yearly, representing 1.8% of the total children. These children received an average of 6.6±1.0 yearly visits statistically significant (P=0.08) in respect to the yearly visits carried out. While children aged 0-2 years received 70% of total routine health-checks, children aged between 3 and 6 years received 38% of total visits. RESULTS: Respiratory tract diseases appeared as the more frequent disease, representing over 60% of total diagnosis. CONCLUSION: FP's work is mainly dedicated to prevention with the important support of routine health-checks while the rest of his work concerns acute illnesses. Nowadays it is becoming more important to assist children suffering from chronic diseases because they represent the future of child assistance.

[Clinical pattern of pediatric acute gastroenteritis in the community]. / Aspetti clinici della gastroenterite acuta del bambino nel territorio.

Acute gastroenteritis (AGE) is a typical illness seen in outpatient children, usually treated by Family Pediatricians (FP). To analyze the characteristics of community AGE, we have collected all the case histories of children observed in a FP office, analyzing computerized clinical file (FIMED Infantia), taken from the period 2003-2007. We enrolled 1140 children with AGE were gathered, for an average of 228 cases/year; 578 (51%) males and 562 (49%) females; the month with highest number of cases is October (120 cases, 10.5%), followed by September and April (105 cases in both, 9.2%). The month with the lowest incidence is February (75 cases, 6.6%) followed by August (81 cases, 7.1%); children's mean age is 4.6 +/- 3.4 years with a wide range (10 days divided by 16 years). As regards the clinical pattern, 314 children (27.5%) presented high fever, 395 (34.6%) vomiting and 24 cases (2.1%) bloody diarrhea; mean daily stools is 3.9 +/- 1.1; only 4 children suffered from severe dehydration. 255 children (22.4%) received antibiotic prescription, mainly cotrimoxazole (51%), followed by cephalosporins (39%) and macrolides (10%); 893 children (78.3%) were prescribed probiotics. Oral rehydrating solution was always offered to all children, followed by normal diet and only 4 children (0.4%) need the administration of a lactose free formula. Mean duration of diarrhea was 3.4 +/- 1.7 days, only 10 children (0.9%) suffered from chronic diarrhea and only 2 children (0.2%) were hospitalized due to severe dehydration. In conclusion, the child that refers to the FP office, is often a child with minor symptoms, for whom admission is not required; he/she presents a regular course and slight complications.

[Epidemiology and clinical pictures of pharyngitis: report on the activity of a family paediatrician]. / Epidemiologia e clinica della faringotonsillite: report dell'attività ambulatoriale di un pediatra di famiglia.

OBJECTIVES: Pharyngitis (PM) is the most common child disease, that Family Paediatricians (FP) have to deal with. The aim of this study is to analyze epidemiology of PM comparing the validity of clinical scores and Rapid Antigen Detection Test (RADT) to diagnose Group A Streptococci PM. An evaluation of antibiotic prescription was performed too on the basis of the two groups. METHODS: A three-years epidemiological investigation was performed on a group of children observed in a FP office. Children was divided into two groups on the basis of the RADT (RADT+ and RADT-) and for each group statistical and epidemiological analysis was performed. RESULTS: A total of 1.445 children was gathered, 1.128 of them (78%) had RADT- and 317 (22%) RADT+. Data analysis shows significant statistical differences between data of children with RADT+, comparing to those of RADT-, regarding Milano Score and other clinical criteria, with the only exception of McIsaac Score. CONCLUSIONS: PM remains the most important children disease in an FP office. The use of RADT allows a rapids and correct etiological diagnosis and to contain to less than 50% antibiotic prescription. RADT is the diagnostic test to use in the PM practice, being easy and quick to perform, compared with clinical criteria and scores.

[Prevention of antibiotic-associated diarrhea with Lactobacillus sporogens and fructo-oligosaccharides in children. A multicentric double-blind vs placebo study]. / Prevenzione della diarrea associata ad antibiotici con Lactobacillus sporogenes e frutto-oligosaccaridi. Studio pediatrico multicentrico in doppio cieco vs placebo.

AIM: The aim of this paper is to determine the efficacy of a fructo-oligosaccharides (FOS)-Lactobacillus sporogenes preparation in the prevention of diarrhea due to antibiotics in childhood. METHODS: A multicentre, randomised, double-blind versus placebo study was carried out. A total of 120 children, with active infections requiring antibiotics, were enrolled in the study and treated for 10 days either in the experimental group (F) or in the placebo one (P). The results of the study were recorded from the patients' diary and from follow-up clinical examinations. RESULTS: Out of 98 evaluable patients, 71% in group F had no diarrhea versus 38% in group P. The duration of diarrhea in F and P groups was 0.7 vs 1.6 days (p=0.002), respectively. CONCLUSION: Prophylaxis with Lactobacillus sporogens, associated to FOS, significantly reduced the number of days and duration of events in children with antibiotic-induced diarrhea.

The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases.

OBJECTIVE: The demographic, clinical, and epidemiological features of subclinical/silent celiac disease in Italy were analyzed in a multicenter study carried out with the participation of 42 centers, in the years between 1990 and 1994. METHODS: One thousand twenty-six subclinical/silent patients (644 children and 382 adults, 702 women and 324 men) were considered eligible for the study. RESULTS: The prevalence of the subclinical/silent form increased significantly during the study both in adults (p < 0.001) and in children (p < 0.005), but its prevalence was always lower (p < 0.001) in children than in adults. This increase appears more likely due to a greater diagnostic awareness and to a better use of screening than to a higher number of subclinical/silent cases. Whereas in 1990 a significantly higher proportion (p < 0.001) of subclinical/silent celiac patients was diagnosed in Northern Italy rather than in Southern-Insular Italy, both in adults (46.7% vs 17.2%) and in children (22.0% vs 9.0%), in 1994 such a difference was no longer conspicuous. Both in children and in adults, iron-deficiency anemia appeared to be the most frequent extraintestinal symptom, followed by short stature in children and cutaneous lesions of dermatitis herpetiformis in adults. In 25.9% of the cases another disease was present, with a significantly higher frequency (p < 0.05) in adults (30.1%) than in children (20.7%). Diabetes and atopy appeared to be the most frequently associated conditions both in children and in adults. CONCLUSIONS: This study has provided an analysis of the largest series of subclinical/silent celiac disease reported to date. In Italy, this form is most frequently recognized in adults, and prospective studies will clarify whether the lower frequency observed in children is a real or apparent phenomenon.

Celiac disease and Turner syndrome.

BACKGROUND: Short stature is one of the features of Turner syndrome and a form of presentation of monosymptomatic celiac disease. METHODS: The recognition of celiac disease in two antiendomysium antibody-positive Turner syndrome girls who did not respond to growth hormone treatment led us to perform as a screening for celiac disease IgA and IgG antigliadin antibodies and antiendomysium antibodies determination in other 35 Turner syndrome patients. Intestinal biopsy was proposed to the antiendomysium antibodies-positive girls; in the former, subtotal villous atrophy was found; in the latter, one parent's consent for intestinal biopsy was not obtained. RESULTS: The prevalence of celiac disease in Turner syndrome patients observed in the present study (8.1 if we consider 3 villous atrophy, 10.8 if we consider 4 antiendomysium antibody-positive) is quite high and seems to indicate that the association of these two disorders could not be coincidental. As to the clinical picture, celiac disease appeared atypical in one case, typical in another one and as a silent form in the third case. Of the 3 cases with villous atrophy on gluten-free diet growth hormone therapy was not effective in two girls, who were older than 16 years, while in the younger patient, detected by the screening, a significant increment of height velocity and height Standard Deviation Score for Chronological Age according to Turner references was observed. CONCLUSIONS: This study suggests that celiac disease can be associated with Turner syndrome and even responsible for a failure of growth hormone therapy. Therefore we propose to perform in Turner syndrome patients antiendomysium antibody determination as a screening followed by intestinal biopsy in positive cases. This would be advisable at least before starting growth hormone treatment.

Prevalence and clinical features of selective immunoglobulin A deficiency in coeliac disease: an Italian multicentre study. Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP) and "Club del Tenue" Working Groups on Coeliac Disease.

BACKGROUND: Selective immunoglobulin A (IgA) deficiency (SIgAD) is associated with coeliac disease (CD). AIM: To make a retrospective study of the association of SIgAD with CD in Italy. METHODS: Hospital medical records of 2098 patients consecutively diagnosed as having CD were reviewed. RESULTS: Of 2098 patients with CD, 54 (2.6%) had SIgAD, representing a 10-16-fold increase over that in the population in general. This increase was not influenced by age or geographical factors. Patients with SIgAD had a higher incidence of silent forms (7/54, 13%), recurrent infections (16/54, 29.6%), and atopic diseases (7/54, 13%) than those without. The association with autoimmune and malignant diseases and the outcome after eating a gluten free diet were similar in patients with or without SIgAD. In all patients with SIgAD, antibodies for IgA gliadin and endomysium were absent, but serum levels of IgG anti-gliadin antibodies were high in almost all of them (51/54). CONCLUSIONS: Serum IgA should be measured in order to be able to interpret negative results for IgA anti-gliadin antibodies and anti-endomysial antibodies in patients being screened for CD. Since some patients with CD and SIgAD may be negative for IgG anti-gliadin antibodies, an intestinal biopsy should be performed in all suspected cases.

Celiac disease and selective immunoglobulin A deficiency.

Selective IgA deficiency was observed in 12 of 688 (1.7%) patients with celiac disease who were clinically undistinguishable from patients with celiac disease with normal IgA levels. This high prevalence of IgA deficiency in patients with celiac disease makes serum IgA assay advisable when screening for celiac disease is performed by measurement of antigliadin antibodies or anti-IgA endomysium antibodies. Similarly, subjects with IgA deficiency should be considered at risk of celiac disease.

Autism and celiac disease: failure to validate the hypothesis that a link might exist.

Autism is a heterogeneous condition and the possible pathogenic role of several different factors has been postulated. Association between celiac disease and neurological manifestations such as drug resistant epilepsy and cerebral calcifications is well known. Some authors in the past also reported the existence of a linkage with autism. On the basis of these observations, we have evaluated 120 patients with celiac disease diagnosed at the Pediatric Clinic of the University of Catania, Italy, in order to identify behavioral problems and autistic features: there were 20 controls for this part of the study. At the same time, AGA and AEMAb were assayed in 11 patients with infantile autism and 11 age- and sex-matched controls. No celiac case was detected among the group of autistic patients and, although two of them had slightly increased levels of AGA IgG and AEMAb, subsequent antibodies determinations and jejunal biopsies gave normal results. Moreover none of the celiac patients had a positive DSM-III-R test for infantile autism.

Antibody pattern in childhood celiac disease.

BACKGROUND: We carried out a study of the antibody pattern in 50 celiac children [34 females (F) and 16 males (M); F/M, 2.1], ages 7 months-15 years, compared with that in 25 control subjects (13 females and 12 males) of the same age. METHODS: IgA and IgG antigliadin antibodies (AGA) were determined with an enzyme-linked immunosorbent assay technique. IgA anti-R1-reticulin antibodies (ARA) and IgA antiendomysium antibodies (EmA) were determined with the fluorescein isothiocyanate-conjugate-labeled anti-human immunoglobulin technique. To compare sensitivity and specificity, EmA were identified using monkey esophagus and human umbilical cord as substrates. RESULTS: While AGA (IgA and IgG) showed a high sensitivity but a low specificity, ARA showed a high specificity but a low sensitivity. Data on EmA showed a high sensitivity and specificity with both tissue sections, with monkey esophagus being more sensitive (96%) and umbilical cord more specific (100%). CONCLUSIONS: Our results confirm the importance of celiac disease-related antibodies in identifying celiac children. Moreover, the easy availability of human umbilical cord indicates that it would be proper to use this tissue as substrate, instead of monkey esophagus, for EmA search in the future.

Serum levels of osteocalcin and type I procollagen in children with celiac disease.

BACKGROUND: Bone metabolism may be disturbed in children with celiac disease. METHODS: Two markers of bone turnover were used: the level of osteocalcin (BGP) and the level of carboxylterminal peptide of type I procollagen (PICP). BGP and PICP were measured by radioimmunoassays in 18 untreated children with celiac disease (mean age: 22.9 +/- 15.6 months) and in 15 control subjects (mean age 28.5 +/- 21 months). All the patients were rechecked after 1 month and again after 3 months from beginning of a gluten-free diet (GFD). RESULTS: Compared with controls at diagnosis our patients had significantly lower serum levels of BGP and PICP (p = 0.003 and p = 0.018 by Student's t test, respectively). These levels increased markedly during the 1st 3 months of GFD. CONCLUSIONS: The alteration in calcium phosphate homeostasis caused by celiac disease directly affects the synthesis of both components of the connective matrix of bone. Measurements of BGP and PICP provide a reliable and rapidly obtainable index of normalization of the processes of bone growth which can be achieved with a GFD.