Pediatric emergency care admissions for somatic symptom disorders during the COVID-19 pandemic.

During the COVID-19 pandemic, children and adolescents with psychiatric disorders experienced an exacerbation of their symptoms with more access to the emergency department (ED). However, little is known about the experience of somatic symptom disorders (SSDs) during the COVID-19 pandemic in children. Therefore, we aimed to compare the rates of pediatric ED admissions for SSDs before and during the COVID-19 pandemic and to understand whether the relative risk of ED admissions for SSDs changed between the two periods. We retrospectively enrolled all children between 4 and 14 years admitted for SSDs in the pediatric ED of Santobono-Pausilipon Hospital, Naples, Italy, from March 11th, 2020, to March 11th, 2021 (pandemic period), and in the same time period of the previous year (pre-pandemic period). We identified 205/95,743 (0,21%) children with SSDs presenting in ED in the pre-pandemic year and 160/40,165 (0,39%) in the pandemic year (p < 0.05). Considering the accesses for age, we observed a relative decrease of the accesses for SSDs over 12 years old (IRR 0,59; CI 0,39-0,88), while we found no differences under 12 years old (IRR 0,87; CI 0,68-1,10).   Conclusion: In this study, we found that despite the massive decrease in pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders' admissions to the pediatric ED increased, suggesting an impact of the pandemic also on pediatric psychiatric disorders. What is Known: • During the COVID -19 pandemic, children and adolescents with a psychiatric disorder experienced exacerbation of their symptoms with more accesses in Emergency Department. What is New: • We found that despite the massive decrease of the pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders admissions in healthy children to the pediatric Emergency Department increased ,suggesting an impact of the pandemic also on the pediatric psychiatric disorders.

A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery. An experiment in a rehabilitation unit in Northern Italy.

UNLABELLED: A score for identifying post-hip-fracture surgery patients at various levels (high, medium, and low) of risk for unsuccessful recovery of pre-fracture walking ability was developed. Three hundred ninety-eight HF patients were enrolled in the study. The score significantly and independently predicted failure to walk independently at discharge, failure to walk independently after 12 months, and death after 12 months. The score may be useful for clinicians and healthcare administrators to target populations for rehabilitative programs. INTRODUCTION: To develop a model predicting at the time that elderly hip-fracture (HF) patients undergo rehabilitation if they will have recovered walking independence at discharge. METHODS: Data from all patients admitted to a Department of Rehabilitation in Italy between January 2001 and June 2008 after HF surgery were used. Variables concerning cognitive, clinical, functional, and social parameters were evaluated. Predominant measures were identified through correspondence analysis, and a variable score was defined. Three risk classes (minimum, moderate, and high) were identified and univariate and multivariate logistic regressions were used to assess the model's predictivity and risk classes for the various outcomes. RESULTS: Three hundred ninety-eight HF patients were enrolled. The variables selected to construct the score were age, gender, body mass index, number of drugs being taken, the Mini Mental State Examination, the Instrumental Activity of Daily Living, and the pre-fracture Barthel index. According to univariate analysis, the score was not better than the pre-fracture Barthel's index, but, according to multivariate analysis, it was an independent predictor for all the outcomes, while the pre-fracture Barthel index predicted only outcomes at discharge. In particular, the score significantly predicted failure to walk independently at discharge, failure to walk independently after 12 months, and death after 12 months. CONCLUSIONS: A method of identifying post-HF surgery patients at various levels (high-, medium-, and low-) of risk for unsuccessful recovery of pre-fracture walking ability has been designed. The method may be useful for clinicians and healthcare administrators to target populations for rehabilitative programs.

Familial aggregation in children affected by functional gastrointestinal disorders.

BACKGROUND AND AIMS: Adults with irritable bowel syndrome may often have a first-degree relative with abdominal pain and bowel problems. The aims of this study were to evaluate the prevalence of functional gastrointestinal disorders (FGIDs) in parents and siblings of children affected by FGIDs, the psychological profile of both children and parents affected by FGIDs, and whether independent factors could influence the prevalence of FGIDs in parents of children with and without FGIDs. SUBJECTS AND METHODS: One hundred three patients affected by FGIDs according to Rome III criteria and/or their parents and siblings filled out validated questionnaires for gastrointestinal (GI) symptoms, depression, and anxiety. These patients were compared with 65 age- and sex-matched controls referred to the Primary Care Center of the Department of Paediatrics at the University of Naples "Federico II" for non-GI symptoms. RESULTS: The parents of children with FGIDs showed a significantly (P < 0.0001) higher prevalence of FGIDs compared with the parents of children without FGIDs. No significant differences between the groups were observed for marital status, parental occupation, education level, standard of living, and presence of anxiety and/or depression. An association between the children's and their parents' type of GI disorders was found in 33.9% (35/103) of patients. In particular, an association between the children's and mother's type of GI disorders was found in 25.2% (26/103) of patients. CONCLUSIONS: To our knowledge, our study is the first to demonstrate that a large number of mothers of children with FGIDs have the same FGIDs as their children.

Stratospheric Chlorine Injection by Volcanic Eruptions: HCI Scavenging and Implications for Ozone.

Because the output of volatile chlorine during a major volcanic event can greatly exceed the annual anthropogenic emissions of chlorine to the atmosphere, the fate of volcanic chlorine must be known. Although numerous observations have shown that volcanoes do not significantly contribute to the stratospheric chlorine burden, no quantitative explanation has been published. Hydrogen chloride (HCI) scavenging processes during the early phases of a volcanic eruption are discussed. A plume dynamics and thermodynamics model is used to show that HCI removal in condensed supercooled water can reduce HCI vapor concentrations by up to four orders of magnitude, preventing substantial stratospheric chlorine injection.

Reduced antarctic ozone depletions in a model with hydrocarbon injections.

Motivated by increased losses of Antarctic stratospheric ozone and by improved understanding of the mechanism, a concept is suggested for action to arrest this ozone loss: injecting the alkanes ethane or propane (E or P) into the Antarctic stratosphere. A numerical model of chemical processes was used to explore the concept. The model results suggest that annual injections of about 50,000 tons of E or P could suppress ozone loss, but there are some scenarios where smaller E or P injections could increase ozone depletion. Further, key uncertainties must be resolved, induding initial concentrations of nitrogen-oxide species in austral spring, and several poorly defined physical and chemical processes must be quantifed. There would also be major difficulties in delivering and distributing the needed alkanes.

Nuclear winter: global consequences of multple nuclear explosions.

The potential global atmospheric and climatic consequences of nuclear war are investigated using models previously developed to study the effects of volcanic eruptions. Although the results are necessarily imprecise due to wide range of possible scenaros and uncertainty in physical parameters, the most probable first-order effects are serious. Significant hemispherical attenuation of the solar radiation flux and subfreezing land temperatures may be caused by fine dust raised in high-yield nuclear surface bursts and by smoke from city and forest fires ignited by airbursts of all yields. For many simulated exchanges of several thousand megatons, in which dust and smoke are generated and encircle the earth within 1 to 2 weeks, average light levels can be reduced to a few percent of ambient and land temperatures can reach -15 degrees to -25 degrees C. The yield threshold for major optical and climatic consequences may be very low: only about 100 megatons detonated over major urban centers can create average hemispheric smoke optical depths greater than 2 for weeks and, even in summer, subfreezing land temperatures for months. In a 5000-megaton war, at northern mid-latitude sites remote from targets, radioactive fallout on time scales of days to weeks can lead to chronic mean doses of up to 50 rads from external whole-body gamma-ray exposure, with a likely equal or greater internal dose from biologically active radionuclides. Large horizontal and vertical temperature gradients caused by absorption of sunlight in smoke and dust clouds may greatly accelerate transport of particles and radioactivity from the Northern Hemisphere to the Southern Hemisphere. When combined with the prompt destruction from nuclear blast, fires, and fallout and the later enhancement of solar ultraviolet radiation due to ozone depletion, long-term exposure to cold, dark, and radioactivity could pose a serious threat to human survivors and to other species.

Climate and smoke: an appraisal of nuclear winter.

The latest understanding of nuclear winter is reviewed. Considerable progress has been made in quantifying the production and injection of soot by large-scale fires, the regional and global atmospheric dispersion of the soot, and the resulting physical, environmental, and climatic perturbations. New information has been obtained from laboratory studies, field experiments, and numerical modeling on a variety of scales (plume, mesoscale, and global). For the most likely soot injections from a full-scale nuclear exchange, three-dimensional climate simulations yield midsummer land temperature decreases that average 10 degrees to 20 degrees C in northern mid-latitudes, with local cooling as large as 35 degrees C, and subfreezing summer temperatures in some regions. Anomalous atmospheric circulations caused by solar heating of soot is found to stabilize the upper atmosphere against overturning, thus increasing the soot lifetime, and to accelerate interhemispheric transport, leading to persistent effects in the Southern Hemisphere. Serious new environmental problems associated with soot injection have been identified, including disruption of monsoon precipitation and severe depletion of the stratospheric ozone layer in the Northern Hemisphere. The basic physics of nuclear winter has been reaffirmed through several authoritative international technical assessments and numerous individual scientific investigations. Remaining areas of uncertainty and research priorities are discussed in view of the latest findings.

Tunguska meteor fall of 1908: effects on stratospheric ozone.

In 1908, when the giant Tunguska meteor disintegrated in the earth's atmosphere over Siberia, it may have generated as much as 30 million metric tons of nitric oxide (NO) in the stratosphere and mesosphere. The photochemical aftereffects of the event have been simulated using a comprehensive model of atmospheric trace composition. Calculations indicate that up to 45 percent of the ozone in the Northern Hemisphere may have been depleted by Tunguska's nitric oxide cloud early in 1909 and large ozone reductions may have persisted until 1912. Measurements of atmospheric transparentiy by the Smithsonian Astrophysical Observatory for the years 1909 to 1911 show evidence of a steady ozone recovery from unusually low levels in early 1909, implying a total ozone deficit of 30 +/- 15 percent. The coincidence in time between the observed ozone recovery and the Tunguska meteor fall indicates that the event may provide a test of current ozone depletion theories.

Environmental effects of an impact-generated dust cloud: implications for the cretaceous-tertiary extinctions.

A model of the evolution and radiative effects of a debris cloud from a hypothesized impact event at the Cretaceous-Tertiary boundary suggests that the cloud could have reduced the amount of light at the earth's surface below that required for photosynthesis for several months and, for a somewhat shorter interval, even below that needed for many animals to see. For 6 months to 1 year, the surface would cool; the oceans would cool only a few degrees Celsius at most, but the continents might cool a maximum of 40 Kelvin. Extinctions in the ocean may have been caused primarily by the temporary cessation of photosynthesis, but those on land may have been primarily induced by a combination of lowered temperatures and reduced light.

Rotavirus gastroenteritis: precursor of functional gastrointestinal disorders?

BACKGROUND AND AIMS: : Abdominal pain-related functional gastrointestinal disorders (AP-FGIDs) following bacterial acute gastroenteritis (AGE) have been demonstrated in adults and children. An adult study demonstrated AP-FGIDs resulting from an outbreak of viral AGE. Viral AGEs are common in children. Thus, the demonstration of AP-FGIDs occurring after a viral infection in children could constitute a significant finding. The aim of the study was to investigate the development of FGIDs following an episode of acute rotavirus gastroenteritis in children. This is the first pediatric multicenter study designed to assess postviral AP-FGIDs. PATIENTS AND METHODS: : It is a cohort study. Inclusion criteria of the study are children ages 4 to 18 years with history of AGE secondary to rotavirus. Sample size is 44 exposed and 44 controls (unidirectional alpha of 0.05, power of 0.80). Children consulting at 2 hospitals (Chicago, IL, and Naples, Italy) for AGE (2002-2004) who tested positive for rotavirus were randomly contacted by telephone >2 years after the episode. Each exposed child who visited the emergency department or outpatient site for acute trauma or well-child visit within 4 weeks of the index case was matched with a control of the same age and sex. Gastrointestinal symptoms and disability were evaluated with a validated pediatric questionnaire. RESULTS: : Eighty-eight patients (46 boys, mean age 5.3 years) were recruited. Contacted patients presented with AGE in 2002 (9), 2003 (11), and 2004 (24). Seven (16%) exposed patients and 3 (7%) controls reported AP-FGIDs (P = 0.31). CONCLUSIONS: : Our study suggests that rotavirus infection does not seem to place children at increased risk for AP-FGIDs at long-term follow-up. Larger, prospective studies should be conducted to evaluate whether rotavirus gastroenteritis leads to AP-FGIDs in children.

Tropospheric sulfate aerosol formation via ion-ion recombination.

We propose a source of aerosols in the lower atmosphere associated with the creation, growth, and recombination of ubiquitous cosmogenically generated ions. This particle source should be favorable in the relatively clean, stable marine boundary layer, providing a uniform, continuous fine particle generator in the presence of dimethylsulfide emissions. Through this mechanism, new sulfate aerosols can be formed at sulfuric acid vapor partial pressures well below the supersaturations required for homogeneous binary nucleation of sulfuric acid/water solutions, which is consistent with numerous observations of new particle formation under sub-saturated conditions. The evolving aerosols in turn control the acid vapor concentration and thus modulate the sizes of the precursor ions and the rate of new particle formation. A simple model representing this nonlinear coupled system predicts that the physical and chemical processes connecting ions, vapors, and aerosols effectively constrain the particle population to a relatively narrow range of values. This self-limiting behavior may explain in part the apparent stability of the marine sulfate aerosol, with mean concentrations of the order of several hundred per cubic centimeter.

Antisocial personality disorder, sexual sadism, malignant narcissism, and serial murder.

This paper examines the research on serial murder and its relationship to antisocial personality disorder and sexual sadism. The concept of malignant narcissism is also discussed. Case studies of serial killers are examined regarding the nature of sexual violation and crime scene behavior.

Hypnotherapy for traumatic grief: janetian and modern approaches integrated.

Traumatic grief occurs when psychological trauma obstructs mourning. Nosologically, it is related to pathological grief and posttraumatic stress disorder (PTSD). Therapeutic advances from both fields make it clear that the trauma per se must be accessed before mourning can proceed. The gamut of psychotherapies has been employed, but hypnosis appears to be the most specific. Pierre Janet provided a remarkably modern conceptual basis for diagnosis and treatment based on a dissociation model. His approach is combined with contemporary innovations to present a systematic and integrated account of hypnotherapy for traumatic grief.

Child serial murder-psychodynamics: closely watched shadows.

There is a malignant transformation in object relations resulting in an identification with an omnipotent and cruel object resulting in an identity transformation. If the tension, desperation, and dissociation increase, serial murder becomes spree murder. The presence of pathological narcissism and psychopathic tendencies are of diagnostic significance in understanding the murderer's personality functioning and motivation to kill. Meloy (1988) considered the degree of sadism and aggression combined with narcissistic qualities to reflect the "malignancy" of the psychopathic disturbance where gratification (of aggression) occurs in the service of narcissistic functioning--that is, cruelty toward others in the form of a triumphant victory over a rejecting object. Meloy also believes that dissociation is ubiquitious in the psychopath. The initial murder of the serial murderer may reflect a "new identity." The pathological object-relations of narcissism and the malignant narcissism are important diagnostic indicators in the personality functioning of serial killers and the occurrence of these phenomena is a significant factor in the formation of the personalities of serial killers, their inner motivations, and their pattern of commission.

Environmental implications of nanomaterials: are we studying the right thing?

A fundamental lack of data on the potential impacts of carbon based nanomaterials on natural ecosystems currently exists. The gap between what we know about environmental impacts and new products that may contain nanomaterials continues to get wider especially related to knowledge about nanocomposites. In this paper we present ideas and concerns about the current state of knowledge on nanomaterials in the environment and present a number of points about what recent work has provided us about the novel materials.

The association of coeliac disease in childhood with functional gastrointestinal disorders: a prospective study in patients fulfilling Rome III criteria.

BACKGROUND: An association between coeliac disease (CD) and functional gastrointestinal disorders (FGIDs) has at present only been demonstrated in adults. AIMS: To assess the prevalence of FGIDs at 1 year and the role of psychological aspects on the development of FGIDs in CD children. METHODS: One-hundred consecutive CD children (36M and 64F) were followed up for 1 year. Fifty-six children (25M and 31F) represented the control group. All children and/or their parents completed validated questionnaires for GI symptoms, depression, and anxiety. GI symptoms at diagnosis and after 1 year of gluten-free diet (GFD) were compared. RESULTS: Twenty-three/82 (28%) CD patients followed up prospectively, on GFD from at least 1 year, fulfilled the Rome III criteria for FGIDs compared with 5/56 (8.9%) controls (P = 0.008; χ² = 6.8; OR: 3.97; 95% CI: 1.40-11.21). Children complaining with GI symptoms alone [21/52 (40.3%)] more likely fulfilled Rome III criteria for FGIDs after 1 year of GFD than children with extra-intestinal symptoms (P = 0.045). CD children with FGDIs presented significantly higher anxiety and depression compared to CD children without FGIDs and controls (P = 0.02). CONCLUSIONS: This study demonstrates that children with CD on a GFD for a year have a much higher prevalence of functional GI symptoms than do controls. Whether the risk is due to the residua of a chronic inflammatory process, and/or due to psychological factors remains to be further tested.

Proton pump inhibitors as a risk factor for paediatric Clostridium difficile infection.

BACKGROUND: Proton pump inhibitors (PPIs) and H(2) receptor antagonists (H(2)RAs) may play an important role on the onset of Clostridium difficile-associated disease (CDAD) in adults. The impact of Clostridium difficile on children treated with gastric acid-suppressing agents remains unknown. AIM: To investigate the relationship between CDAD and exposure to acid suppressive therapy in hospitalized paediatric patients. METHODS: We reviewed the medical records of children, with a diagnosis of protracted diarrhoea and abdominal pain, whose stool was analysed for C. difficile toxins. We identified 68 patients with CDAD. For each patient, we randomly selected one control subjects with stool analysis negative for C. difficile. Comorbid illnesses, previous hospitalizations, antibiotics, corticosteroids, immunosuppressants and gastric acid suppressing exposures were recorded. RESULTS: The use of PPI was significantly higher in C. difficile positive group compared with C. difficile negative group [odds ratio (OR): = 4.5; 95% confidence interval (CI) = 1.4-14.4]. We also found a trend for the use of H(2)RAs in patients infected by C. difficile compared with C. difficile negative comparison group (OR: = 3.8; 95% CI = 0.7-18.9). CONCLUSIONS: Children exposed to PPIs therapy seem to be at higher risk for the development of Clostridium difficile-associated disease.