Assessment of an organizational model during the first wave of COVID -19 in the South-Eastern Tuscany Health Unit: intensifying community services as prescribed by Ministerial Decree 77 of 2022.

Introduction: At the end of 2019 a new virus, called SARS-CoV-2, emerged in Wuhan, China. The aim of the present study was to assess the impact of the first wave of the COVID-19 pandemic on the health system of the Tuscany Region and the response implemented by the South-Eastern Local Health Unit, also in view of the new reform of territorial healthcare established by Ministerial Decree No. 77 of 2022. Methods: Data were taken from the "OpenToscana" database beginning when the first case was recorded in Italy (18 February 2020) until July 2020. We analyzed infections and deaths in each Local Heal.th Unit in the Tuscany Region and calculated the fatality rate (number of deaths/cases x 100) following COVID-19 infection. We subsequently compared the fatality rates among the Local Health Units by means of the Kruskal Wallis test. Results: During the first wave, the South-Eastern Local Health Unit had fewer infections (a total of 1,532 by July) and fewer deaths (total: 107 by July) than the other Local Health Units. In the South-Eastern Local Health Unit, the fatality rate in July was 6.98%. The comparison of the fatality rates among the various LHUs and the whole Region showed statistically significant differences (p<0.001). Conclusions: The organizational models promptly implemented by the South-Eastern Local Health Unit for good territorial care and the management of COVID-19-positive patients limited the spread of infection, and consequently the deaths, thus reducing the fatality rate in the first wave of the pandemic.

Factors influencing the first thousand days of life. The importance of Nurturing Care.

Background: WHO, Unicef, the World Bank and the Maternal and Child Health Partnership wrote the document "Nurturing care for early child development: a global framework action". This paper highlights the benefits of early intervention and thus the need to invest more in health during this period. The aim of our study is to assess how much social support received by pregnant mothers can influence maternity outcomes. Materials and Methods: The retrospective observational study was conducted on a sample of mothers enrolled via social networks, who were administered a questionnaire from 1 July to 1 September 2021. The questionnaire consisted of 37 questions, 6 of which were used to calculate the "Maternity Social Support Scale". The ODDs Ratio was calculated. Results: Our sample consisted of 3447 women. 59.01% were between 26 and 35 years of age. The mean Maternity Social Support Scale (MSSS) score was calculated to be 23.9 points. A low MSSS score correlated with a higher probability of stopping breastfeeding before 6 months of age (OR: 1.2; CI:1.1-1.4) and of having a caesarean section (OR: 1.2; CI: 1.1-1.4) and to a lower probability of having a spontaneous labour (OR: 0.9; CI: 0.7-0.9) and a spontaneous delivery (OR: 0.8; CI: 0.7-0.9). In contrast, a high MSSS score had a lower likelihood of ceasing breastfeeding before 6 months (OR: 0.8; CI: 0.7-0.9) and caesarean section(OR: 0.8; CI: 0.7-0.9) and higher likelihood of spontaneous onset labour (OR: 1.2; CI: 1.1-1.3) and spontaneous delivery (OR: 1.2; CI: 1.1-1.4). Conclusions: Pregnancy, childbirth and maternity outcomes are strongly influenced and conditioned by the social context in which they occur and the support the woman may receive. The presence or lack of this support may affect the health of newborns.

Surveillance of Influenza and Other Airborne Transmission Viruses during the 2021/2022 Season in Hospitalized Subjects in Tuscany, Italy.

Winter in the northern hemisphere is characterized by the circulation of influenza viruses, which cause seasonal epidemics, generally from October to April. Each influenza season has its own pattern, which differs from one year to the next in terms of the first influenza case notification, the period of highest incidence, and the predominant influenza virus subtypes. After the total absence of influenza viruses in the 2020/2021 season, cases of influenza were again recorded in the 2021/2022 season, although they remained below the seasonal average. Moreover, the co-circulation of the influenza virus and the SARS-CoV-2 pandemic virus was also reported. In the context of the DRIVE study, oropharyngeal swabs were collected from 129 Tuscan adults hospitalized for severe acute respiratory infection (SARI) and analyzed by means of real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 and 21 different airborne pathogens, including influenza viruses. In total, 55 subjects tested positive for COVID-19, 9 tested positive for influenza, and 3 tested positive for both SARS-CoV-2 and the A/H3N2 influenza virus. The co-circulation of different viruses in the population requires strengthened surveillance that is no longer restricted to the winter months. Indeed, constant, year-long monitoring of the trends of these viruses is needed, especially in at-risk groups and elderly people.

Epidemiological and virological surveillance of Severe Acute Respiratory Infections in the 2019/2020 season in Siena, Tuscany, Italy.

BACKGROUND: Influenza is a major public health issue. Indeed, in Italy there were 7.6 million symptomatic cases of influenza in the 2019/2020 influenza season (from October 2019 to April 2020). The aim of this study is to analyse the circulation of influenza A and B viruses in hospitalized adult and elderly patients with Severe Acute Respiratory Infections (SARI) at Le Scotte University Hospital in Siena. METHODS: Oropharyngeal swabs were taken from SARI patients, who also completed a questionnaire recording their underlying diseases and vaccination status. Total RNA was extracted from each respiratory swab by means of the QIAamp Viral RNA Mini kit, and RT-PCR was carried out. All statistical analyses were performed by means of GraphPad Prism 6 software and STATA. RESULTS: In this study we collected 68 swabs. The average age of subjects was 79.4 years (C.I.: 76.6-82.3) and 52.9% were female. The subjects had fever (89.7%), fatigue (77%), headache (47%), cough (75%), sore throat (70.5%), and breathlessness (63.2%). We found that 20% of the 68 subjects were positive (13% for A H3N2 and 7% for A H1N1). Of the 68 subjects, 25% had received a seasonal influenza vaccine (91.6% trivalent and 8.4% quadrivalent). CONCLUSIONS: Our study is important in order to determine the timing and spread of influenza viruses and track changes in circulating influenza viruses, so as to inform seasonal influenza vaccine composition. Seasonal vaccination is considered the most effective way to prevent influenza and its complications.

Opposites in Reasoning Processes: Do We Use Them More Than We Think, but Less Than We Could?

Our aim in this paper is to contribute toward acknowledging the general role of opposites as an organizing principle in the human mind. We support this claim in relation to human reasoning by collecting evidence from various studies which shows that "thinking in opposites" is not only involved in formal logical thinking, but can also be applied in both deductive and inductive reasoning, as well as in problem solving. We also describe the results of a series of studies which, although they have been developed within a number of different theoretical frameworks based on various methodologies, all demonstrate that giving hints or training reasoners to think in terms of opposites improves their performance in tasks in which spontaneous thinking may lead to classic biases and impasses. Since we all possess an intuitive idea of what opposites are, prompting people to "think in opposites" is something which is undoubtedly within everyone's reach and in the final section, we discuss the potential of this strategy and suggest possible future research directions of systematic testing the benefits that might arise from the use of this technique in contexts beyond those tested thus far. Ascertaining the conditions in which reasoners might benefit will also help in terms of clarifying the underlying mechanisms from the point of view, for instance, of analytical, conscious processing vs. automatic, unconscious processing.

Prevalence and significance of T-wave inversion in children practicing sport: A prospective, 4-year follow-up study.

BACKGROUND: T-wave inversion (TWI) is rare in athlete's heart but is a common manifestation in cardiomyopathies. Although TWI has been extensively investigated in adult athletes, the ability of this ECG pattern to distinguish between a physiological variant and a developing heart muscle disease in children is controversial. The aim of this longitudinal study was to establish the prevalence, changes and clinical significance of TWI in a large cohort of pre-adolescent athletes. METHODS: 2227 children (mean age 12.3 ±â€¯2.0 years) undergoing sports preparticipation screening were included. Children with TWI underwent yearly follow-up until the positivisation of TWI for a maximum follow-up of 4 years. RESULTS: Among 2227 children, 358 (16%) had TWI. Children with TWI were younger (11.4 ±â€¯2.1 vs. 12.5 ±â€¯2.0 years, p < 0.0001) and had a lower BSA than children without TWI (p < 0.0001). 97% of children showed anterior TWI while only 3% had infero-lateral TWI. Anterior TWI became positive in 94% of children during the 4-year follow-up (p < 0.0001 vs. baseline) and the remaining 6% did not show abnormal clinical findings. Conversely, in the group of 9 children with infero-lateral TWI, only 1 showed normalisation during follow-up (p = 0.81) and 1 was found to have a cardiomyopathy. CONCLUSIONS: Anterior TWI is common in children and generally becomes positive by the age of 14 years. Conversely, infero-lateral TWI is rare, persistent and may be associated with structural heart disease. Therefore, infero-lateral TWI should not be interpreted as physiologically related to age, development or training and children with infero-lateral TWI should remain under strict clinical surveillance.

Can Contraries Prompt Intuition in Insight Problem Solving?

This paper aims to test whether the use of contraries can facilitate spatial problem solving. Specifically, we examined whether a training session which included explicit guidance on thinking in contraries would improve problem solving abilities. In our study, the participants in the experimental condition were exposed to a brief training session before being presented with seven visuo-spatial problems to solve. During training it was suggested that it would help them to find the solution to the problems if they systematically transformed the spatial features of each problem into their contraries. Their performance was compared to that of a control group (who had no training). Two participation conditions were considered: small groups and individuals. Higher success rates were found in the groups exposed to training as compared to the individuals (in both the training and no training conditions), even though the time required to find a solution was longer. In general, participants made more attempts (i.e., drawings) when participating in groups than individually. The number of drawings done while the participants were trying to solve the problems did not increase after training. In order to explore if the quality (if not the number) of drawings was modified, we sampled one problem out of the seven we had used in the experiment (the "pigs in a pen" problem) and examined the drawings in detail. Differences between the training and no training conditions emerged in terms of properties focused on and transformed in the drawings. Based on these results, in the final discussion possible explanations are suggested as to why training had positive effects specifically in the group condition.