Two-meshes approach in posterior component separation with transversus abdominis release: the IMPACT study (Italian Multicentric Posterior-separation Abdominal Complex hernia Transversus-release).

BACKGROUND: Surgical management of large ventral hernias (VH) has remained a challenge. Various techniques like anterior component separation and posterior component separation (PCS) with transversus abdominis release (TAR) have been employed. Despite the initial success, the long-term efficacy of TAR is not yet comprehensively studied. Authors aimed to investigate the early-, medium-, and long-term outcomes and health-related quality of life (QoL) in patients treated with PCS and TAR. METHODS: This multicenter retrospective study analyzed data of 308 patients who underwent open PCS with TAR for primary or recurrent complex abdominal hernias between 2015 and 2020. The primary endpoint was the rate of hernia recurrence (HR) and mesh bulging (MB) at 3, 6, 12, 24, and 36 months. Secondary outcomes included surgical site events and QoL, assessed using EuraHS-QoL score. RESULTS: The average follow-up was 38.3 ± 12.7 months. The overall HR rate was 3.5% and the MB rate was 4.7%. Most of the recurrences were detected by clinical and ultrasound examination. QoL metrics showed improvement post-surgery. CONCLUSIONS: This study supports the long-term efficacy of PCS with TAR in the treatment of large and complex VH, with a low recurrence rate and an improvement in QoL. Further research is needed for a more in-depth understanding of these outcomes and the factors affecting them.

Role of nutritional therapy on dietary habits and glycemic control in insulin-treated kidney transplant patients with diabetes.

AIMS: To evaluate the effect of nutritional therapy on glycemic compensation and key cardio-renal risk markers in patients with diabetes and kidney transplant, on insulin treatment by Multiple Daily Injection (MDI) or Continuous Subcutaneous Insulin Infusion (CSII). METHODS: 34 patients with diabetes on insulin treatment and kidney transplant recipients were enrolled;12 participated in the structured nutritional program (intervention group), 22 patients (control group) did not receive nutritional protocol. Both groups were then divided into subgroups according to the method of insulin administration (MDI and CSII). RESULTS: Statistically significant reduction in fasting blood glucose values, glycosylated hemoglobin (HbA1c) and glycosuria were observed in both groups at the end of the study. The intervention group, significantly reduced total cholesterolemia and the glycemic index, together with reduced dietary intake of lipids, cholesterol, soluble carbohydrates and increased consumption of carbohydrates and fiber. These improvements were even more pronounced in patients treated with CSII. CONCLUSIONS: A proper nutritional approach optimize glycometabolic outcomes and contribute significantly to the reduction of the major cardiovascular risk factors in renal transplant patients.

Comparing the influence of gender stereotypes on well-being in Italy and Turkey during the COVID-19 lockdown.

OBJECTIVE: The hypothesis that gender stereotypes influence human behaviour and relational well-being is widely accepted in the literature. However, a comparison based on scientific assumptions is necessary to deeply understand the mechanisms activated by stereotypes in conditions of stress. The global health emergency from COVID-19 offers the opportunity to compare countries with different socio-cultural conditions, whose population has been subjected to the same stressful event during the lockdown phase. SUBJECTS AND METHODS: The same questionnaire was disseminated in both Italy and Turkey during their respective lockdown phases. 140,000 interviews were collected in Italy and 10,000 in Turkey, a number big enough to obtain useful information for a comparative analysis in relation to behaviours, attitudes and well-being, also using the recursive regression models. RESULTS: The results, based on scientific data, show that gender stereotypes are much more rooted in Turkey than in Italy, where the emancipation process of the population is more advanced, producing profound social changes and decreasing differences between men and women in terms of behaviour and reactions to difficult situations, such as the present one. CONCLUSIONS: Stereotypes, which are hostile to any opposite evidence, affect individual behaviours and attitudes to the point that, within a specific context, they play a protective role against the uncertainty during a period of health emergency, inducing people to seek shelter in pre-established and widespread behavioural models. According to the data analysis, this has happened in Turkey more than in Italy. The results show that within a culture still strongly pervaded by these social conditioning, especially at the presence of low levels of education, the adherence to gender roles constitutes a "protective factor" of the individual well-being against external stress factors.

Adaptive behavioural coping strategies as reaction to COVID-19 social distancing in Italy.

OBJECTIVE: Social distancing, as experienced by the Italian population during the COVID-19 outbreak, generated the long-term activation of stress-response in individuals. This has been a crucial opportunity to study the coping strategies that people put in place to adapt their lives and habits to such a unique condition. For this reason, we have investigated both emotion-focused and problem-oriented coping strategies among the Italian population by relating them to other structural factors, such as social, economic and cultural conditions. MATERIALS AND METHODS: More than 140,000 online interviews were collected in Italy from March 22 to April 2, 2020. This large dataset was used to carry out multivariate statistical data analysis with the aim of creating behavioral profiles, starting from coping parameters and other information. This technique has produced an association, showing a good level of statistical significance, between coping strategies and reactions to social distancing, due to the health emergency, during the data collection phase. RESULTS: Two coping indicators - problem-oriented and focused on positive emotions coping strategies - were selected as objective variables in a "decision tree" modelling. The results have shown a link between individual factors (i.e., atmosphere at home) and educational and social factors (i.e., compliance with restrictions during the health emergency). CONCLUSIONS: The reduction of social interaction had quite a significant impact on people's behavior; furthermore, coping strategies have played a crucial role in facing this stressor. For both the selected coping indicators, the best predictor was the atmosphere perceived at home. Moreover, the respondents' previous experiences have played a relevant role in the acceptance of new rules imposed by the government. This information can be useful in planning future social policies, both at national and international level, during such peculiar times.

A nation-wide survey on emotional and psychological impacts of COVID-19 social distancing.

OBJECTIVE: Social distancing is crucial in order to flatten the curve of COVID-19 virus spreading. Isolation, scarcity of resources and the lack of social contacts may have produced a negative impact on people's emotions and psychological well-being. This study aims to explore the reasons and the ways through which social distancing generates negative emotions in individuals who experienced the lockdown. To a larger extent, the objective is to check the existence of relations between negative emotions and the satisfaction of basic needs. MATERIALS AND METHODS: In Italy 140,656 online interviews were collected from March 22 to April 2, 2020. Data analysis was carried out using mono and bivariate statistical analysis, K-means clustering and the Principal Components Analysis (PCA). The parameters for the identification of six clusters were: the intensity of the respondent's basic emotions and the layers of Maslow's hierarchy of needs. RESULTS: The majority of people involved in an emergency situation, implying a collapse of social contacts, experience some kind of emotional reactions. In our study, we found a correlation between basic emotions and Maslow's hierarchy of needs. In times of crisis, the most basic needs are the physiological ones. Fear, anger and sadness are predominant in all population groups; anger and disgust mainly appear when people are exposed to the risk of not being able to meet subsistence needs, thus perceiving a lack of economic security. CONCLUSIONS: The well-known Maslow's theory of human needs seems to fit well with the outbreak of negative emotions in the context of COVID-19. This study demonstrates the existence of links between negative emotions and primary needs that mainly refer to the first three levels of Maslow's pyramid. As a result of COVID-19 worldwide pandemic, many people have been sucked into the bottom layers of the pyramid. This change in individual basic needs has triggered a relevant transformation in individual emotional status and a shift towards negative emotions.

The geography of adult mortality: results from the fuzzy clumping method.

"This study analyses provincial differences in adult mortality (separately for men and women, aged 30-64 years) in Italy between 1984 [and] 1987.... By applying the fuzzy clumping method to mortality rates by cause...groups of provinces can be identified where mortality profiles (irrespective of the intensity) are not only similar for all or only for some of the mortality causes considered, but also specify the grade of similarity common to the provinces in the same group. This method, whereby any single province can belong to several groups, provides an image of the geography of mortality where homogeneous groups are not separated by fixed boundaries but may actually have provinces in common." (SUMMARY IN ITA)