Volunteering in an emergency project in response to the COVID-19 pandemic crisis: the experience of Italian midwives.

OBJECTIVES: During the first wave of the COVID-19 pandemic, the Region of Lombardy in Italy and its Regional Emergency Service (Azienda Regionale Emergenza Urgenza [AREU]) created a dedicated 24/7 free phone service to help the Lombard population. After an invitation from their professional order, local midwives collaborated on the AREU project as volunteers to address the needs of women from antenatal to postnatal periods. The aim of this article was to explore the experiences of midwives who volunteered in the AREU project. STUDY DESIGN: This was a qualitative study using an interpretative phenomenological approach (IPA). METHODS: The experiences of midwives volunteering in AREU (N = 59) were explored using audio diaries. Written diaries were also offered as an alternative. Data collection took place between March and April 2020. Midwives were provided with semistructured guidance that indicated the main areas of interest of the study. The diaries were thematically analysed following a temporal criterion; a final conceptual framework was created from emerging themes and subthemes. RESULTS: The following five themes were identified: (1) choosing to join the volunteer project, (2) the day-to-day difficulties, (3) strategies to cope with the unexpected, (4) professional relationships and (5) reflecting on the personal experience. CONCLUSIONS: This is the first study to investigate the experiences of Italian midwives who volunteered in a public health project during a pandemic/epidemic. According to participants, taking part in the volunteer activities was informed by and impacted on both their professional and personal lives. Overall, the experiences of midwives who volunteered in AREU were positive and of humanitarian value. Providing midwifery services within a multidisciplinary team for the benefit of public health represented both a challenge and personal/professional enrichment.

Antonio Scarpa (1752-1832): His Contribution to the History of Surgery.

BACKGROUND: Antonio Scarpa (1752-1832) is generally remembered for his discoveries in the field of anatomy, but he also provided some important contributions to the history of surgery. METHODS: We analyzed main treatises written by Scarpa, highlighting how he contributed to the development of modern surgery. RESULTS: Scarpa made great innovations in three branches of surgery: abdominal surgery (hernia), orthopedics (clubfoot) and vascular surgery (aneurism). Furthermore, he contributed to the birth of modern ophthalmology.

The birth of experimental physiology.

The year 2023 marks the 300th anniversary of the death of Antonio Maria Valsalva (1666-1723). Valsalva was a leading physician across the 17th and 18th centuries, specifically for his focus on experimental physiology, the science dealing with the normal functioning of bodily organs as a basis for a better understanding of diseases, symptoms, and care. He used a top-down systematic approach typical of the Enlightenment, rather than a heuristic one ("trial-and-error"), which became feasible after the long-lasting ban on dissecting human corpses was lifted. Valsalva's main interest was exploring the complex structure of the human ear, to which he dedicated a specific treatise, De Aure Humana. He understood the issues inherent in the imbalance in pressure between the outer and inner ear and found ways to exploit it to get rid of purulent fluid by deliberately raising the inside pressure with his maneuver. Time was however not yet ripe to see the broader importance that the Valsalva maneuver would achieve, not just in otorhinolaryngology, but also in cardiology and other fields of medicine. Although Valsalva's name is usually associated with his maneuver, his contributions to the history of medicine were broader: he discovered several anatomical parts (i.e., the sinuses of Valsalva), built the basis for the development of pathological anatomy, introduced advances in surgery, and promoted compassionate care of patients affected by mental diseases.NEW & NOTEWORTHY Antonio Maria Valsalva (1666-1723) was a pioneer in experimental physiology between the 17th and 18th centuries. The Valsalva maneuver is still a popular academic topic and has broad applications not only in physiology research, but also in the diagnosis and therapy of various diseases. The celebration of 300 years from his death could be a timely occasion to commemorate the scientific works of this illustrious scientist.

Sleep disorders and night-shift work in nursing students: a cross-sectional study.

BACKGROUND: University students are known to have higher sleep disorders prevalence than the general population. Among them, nursing students are even more susceptible to sleep disorders. This study evaluates sleep disorders' risk factors among nursing students and their potential association with symptoms and assesses whether night shifts affect sleep quality by increasing the prevalence of sleep disorders. METHODS: A total of 202 nursing students were included; a self-administered questionnaire was used to collect data on sociodemographic and academic characteristics (i.e., gender, age, height, weight, and year of nursing program) and risk factors for sleep disorders (e.g., smoking, lack of physical activity, and coffee intake late in the evening). The survey included the General Health Questionnaire to assess perceived stress, the Sleep and Daytime Habits Questionnaire, and the Epworth Sleepiness Scale to assess sleep disorders symptoms. RESULTS: A high level of perceived stress is associated with sleep disorders symptoms and with poor sleep quality. Daytime symptoms are also associated with smoking. Students who drink coffee late in the evening report fewer nighttime symptoms. Night shifts and their increasing number are not associated with sleep disorders symptoms. The perception of an unsatisfying academic performance is associated with daytime symptoms and poor sleep quality. CONCLUSIONS: Although night shifts seem to not affect sleep quality among nursing students, sleep disorders represent a critical issue in this population since sleep disorders symptoms may result in errors, accidents, or low academic performance.

Animal magnetism in Italy during the nineteenth century: the conflicting relationship with the Catholic Church.

This article explores the relationship between the Catholic Church and animal magnetism. At the beginning of the nineteenth century, the Catholic Church had first tried to stem the rise of animal magnetism in a vague manner, but after a few decades, it eventually put a genuine veto in place. This measure was founded upon the dangers to morality and faith arising from the progressive polarization of the original doctrine in forms related to esotericism. Among the causes of the condemnation by the Congregation of the Holy Office, the primary ones were the naturalist interpretation of the miracles described in the Gospels and in the New Testament, and the possibility of falling under the control of a demonic spirit.

Prolonged exposure to welding fumes as a novel cause of systemic iron overload.

BACKGROUND & AIMS: Inhalation of welding fume may cause pulmonary disease known as welder's lung. At our centre we came across a number of welders with systemic iron overload and prolonged occupational history and we aimed at characterizing this novel clinical form of iron overload. METHODS: After exclusion of other known causes of iron overload, 20 welders were fully evaluated for working history, hepatic, metabolic and iron status. MRI iron assessment was performed in 19 patients and liver biopsy in 12. We included 40 HFE-HH patients and 24 healthy controls for comparison. RESULTS: 75% of patients showed lung HRCT alterations; 90% had s-FERR > 1000 ng/mL and 60% had TSAT > 45%. Liver iron overload was mild in 8 and moderate-severe in 12. The median iron removed was 7.8 g. Welders showed significantly lower TSAT and higher SIS and SIS/TIS ratio than HFE-HH patients. Serum hepcidin was significantly higher in welders than in HFE-HH patients and healthy controls. At liver biopsy, 50% showed liver fibrosis that was mild in four, and moderate-severe in two. Liver staging correlated with liver iron overload. CONCLUSIONS: Welders with prolonged fume exposure can develop severe liver iron overload. The mechanism of liver iron accumulation is quite different to that of HFE-HH suggesting that reticuloendothelial cells may be the initial site of deposition. We recommend routine measurement of serum iron indices in welders to provide adequate diagnosis and therapy, and the inclusion of prolonged welding fume exposure in the list of acquired causes of hyperferritinemia and iron overload.

Giovanni Maria Lancisi (1654-1720) and the modern cardiovascular physiology.

Giovanni Maria Lancisi (1654-1720) was one of the most important Italian physicians of the modern age. Orphaned of his mother, he spent his early years in the city of Orvieto; when he was 12, his father brought him back to Rome and enrolled him to study medicine at the Sapienza University in Rome. His dedication to study and work soon led him to increasingly important positions. Within a few years, the fame of Lancisi became such that he was appointed the personal physician of three popes. In De Subitaneis Mortibus (1707), he described the pathophysiology of heart diseases, identifying the cause of sudden deaths in structural anomalies of the heart, lungs, and brain. He also wrote about cerebral localizations and first discussed the physiological mechanisms of urine formation and excretion. In 1717, Lancisi described the pathogenesis of malaria and the close correlation between its onset and the swampy waters of the Tiber River, proposing the draining of marshes to eradicate malaria. In the posthumous De Motu Cordis et Aneurysmatibus (1728) he described for the first time heart dilatation and aneurysms of the great vessels, providing a fundamental contribution to the history of cardiovascular physiology. Proof of his interest in medical education is the establishment of an academy and the donation of a library to the hospital, bridging the gap between theory and practice in medical training. Over the centuries, Lancisi's memory has faded, but his work is still relevant for anyone practicing the medical profession.

IrO_{2} Surface Complexions Identified through Machine Learning and Surface Investigations.

A Gaussian approximation potential was trained using density-functional theory data to enable a global geometry optimization of low-index rutile IrO_{2} facets through simulated annealing. Ab initio thermodynamics identifies (101) and (111) (1×1) terminations competitive with (110) in reducing environments. Experiments on single crystals find that (101) facets dominate and exhibit the theoretically predicted (1×1) periodicity and x-ray photoelectron spectroscopy core-level shifts. The obtained structures are analogous to the complexions discussed in the context of ceramic battery materials.

"The Cabinet of Dr. Caligari": The Scientific Debate on Hypnosis and Its Legal Implications between the 19th and the 20th Century.

Movies could provide unexpected information on the state of medical knowledge in different historical periods. The first centenary of the German silent horror movie Das Cabinet des Dr. Caligari (The Cabinet of Dr. Caligari) by Robert Wiene (1873-1938) could be a timely occasion to reflect on the scientific debate of hypnosis and its legal implications between the 19th and the 20th century. In particular, this article describes the positions of the School of Salpêtrière (Charcot) and the School of Nancy (Bernheim) on the possibility of crimes committed by subjects under hypnosis and the influence of these theories on medical community and public opinion of Germany in the interwar period.

The representation of a goiter by Renaissance painter Moretto da Brescia.

Alessandro Bonvicino (c. 1498-1554), commonly known as Il Moretto da Brescia, was an Italian Renaissance painter. In his "The Adoration of Shepherds" (1539-1540), a shepherd shows a bi-lobar goiter. The painter was active in a geographical area, where inhabitants often suffered from endemic goiter due to dietary iodine deficiency and could have influenced Moretto.

The first steps of industrial hygiene and occupational toxicology at the Clinica del Lavoro di Milano under the guidance of Luigi Devoto.

INTRODUCTION: The Clinica del Lavoro, the first clinic for occupational diseases of the world, was inaugurated in Milan on 20 March 1910; its first director was Luigi Devoto, who was in charge until 1935. The purpose of this work is to review the activities of industrial hygiene and toxicology carried out at the Clinica del Lavoro under the guidance of Devoto. METHODS: Documents published by the Istituti Clinici di Perfezionamento, a group of clinics of which the Clinica del Lavoro was part, record the birth and organization of this structure and the presence of a laboratory of chemistry; documents by Devoto and other authors were also retrieved to extrapolate specific information on activities of industrial hygiene and toxicology. RESULTS: The Clinica del Lavoro, at the time of its inauguration, included four laboratories: of chemistry, clinical physics, histopathology and bacteriology. The chemistry lab was located on the first floor and was composed of 6 well-lit rooms, modernly equipped with work benches that could accommodate 12 people. In Devoto's view, the chemistry laboratory, supported by that of clinical physics, had to assess the toxicological properties of chemicals commonly found in the workplace and to reveal the mechanisms of induction of damage to humans. In the first 30 years of activity, the Clinica del Lavoro investigated various diseases deriving from exposure to chemical agents, including saturnism, or lead intoxication, mercurialism, phosphorism, benzolism, sulfocarbonism, dust diseases. Several assays were developed and applied to measure toxicants in different biological and environmental mean as evidenced by scientific publications starting from 1920. CONCLUSION: In Devoto's view, industrial hygiene and toxicology were essential tools for the research and prevention of occupational diseases since the first years of activity of the Clinica del Lavoro.

The birth of modern industrial hygiene and occupational toxicology. A historical reconstruction through the analysis of the contributions of three protagonists.

BACKGROUND: The Clinica del Lavoro of Milan provided several contributions to industrial hygiene and occupational toxicology during the twentieth century. OBJECTIVES: Describe the first years of the laboratory of industrial hygiene of Milan through three figures who played a leading role: Enrico Carlo Vigliani, Nicola Zurlo and Gianmario Cavagna. METHODS: Scientific literature of the period 1948-1970 was investigated, also interviewing first-hand witnesses of that period. RESULTS: Enrico Vigliani was the first European scholar to understand the importance of a laboratory of industrial hygiene within his institution. Thanks to the support of private (Montecatini) and public (INAIL) institutions he succeeded in creating a laboratory in 1948. Nicola Zurlo, who directed this structure in the first thirty years, conducted innovative studies on chronic mercury intoxication, lead intoxication and silicosis, designing and creating instruments for capturing and analyzing atmospheric dust and protection devices. He conducted analysis of the health effects of organophosphorus insecticides and started to study the air pollution. Zurlo also provided an epistemological and methodological content to the discipline. Gianmario Cavagna, one of the first Italian toxicologists, contributed to the discovery of the origin of fevers caused by the inhalation of metal fumes and to the studies on the pathogenesis of byssinosis, hypothesizing a role of bacterial endotoxins in the genesis of this disease. CONCLUSIONS: The contributions provided by these three protagonists to industrial hygiene and occupational toxicology were relevant and made in those years the Clinica del Lavoro of Milan as a landmark, not only in Italy but also abroad.

Benzene and leukemia: from scientific evidence to regulations. A historical example.

BACKGROUND: Benzene is a highly flammable, highly volatile liquid aromatic hydrocarbon. It has been used in many industrial processes as a solvent or a starting material. At the beginning of the twentieth century, it was very widely used in the workplace, especially in printing and in the shoe manufacturing and rubber industries. Although benzene was first recognized to cause aplastic anemia, its association with leukemia has been investigated only since the 1930s. In 1963, Italy was one of the first countries in the world to adopt a law to ban benzene as a solvent in work activities. OBJECTIVES: This study analyzed the contribution of the Clinica del Lavoro in Milan, Italy, to studies of the relationship between exposure to benzene and leukemia. METHODS: Scientific literature and historical sources on benzene and leukemia in the twentieth century were reviewed, and interviews with a first-hand witness of that period were conducted. RESULTS: By 1928, several scholars had reported anecdotal cases of leukemia among workers exposed to benzene. Enrico Vigliani was the first to collect all of these cases and to try to conduct statistical analysis on these data, in order to support the association between benzene and leukemia. In the 1960s, Vigliani and Alessandra Forni showed that benzene could cause chromosome aberrations in the bone marrow that could produce leukemic clones. CONCLUSIONS: As a result of these studies and the subsequent regulations which banned benzene, exposure conditions changed in the workplace in the last few decades. The resulting low concentrations have prompted researchers to investigate new exposure biomarkers and to study any related health problems.

Occupational medicine and occupational psychology: a rendezvous in Milan after World War II.

BACKGROUND: In the 1950s, occupational medicine and occupational psychology found a common field of action in the Clinica del Lavoro in Milan. OBJECTIVES This study aims to analyze and document how this encounter took place and, in particular, the contribution of the Clinica del Lavoro to the development of occupational psychology in Italy. METHODS: Historical sources of that period were investigated. RESULTS: Before the 1950s, experimental psychology was only taught at the Catholic University of the Sacred Heart in Milan. The first professor of clinical psychology in the School of Medicine at the State University of Milan, was Marcello Cesa-Bianchi (1926-2018). He collaborated with the graphic, textile and pharmaceutical industries for the personnel training and management, and carried out important research in occupational psychology on behalf of the European Coal and Steel Community. The Chair of Clinical Psychology was initially located in the Clinica del Lavoro and the activity of the team of Cesa-Bianchi was oriented towards the elaboration of professional profiles and job analysis. In those years Cesa-Bianchi also conducted pioneering research in the field of psycho-gerontology. CONCLUSIONS: The historical experience that integrated psychology and occupational medicine in the scientific context of Milan contains a series of values, useful to today's reflection and practice. Our work also undelines the importance of preserving historical documents: only a better knowledge of history can guarantee a better destiny.

Risk behaviors among Italian healthcare students: a cross-sectional study for health promotion of future healthcare workers.

BACKGROUND: Risk behaviors are frequent among young adults and they are particularly relevant when considering healthcare students. OBJECTIVES: The study is aimed to examine the prevalence of smoking, binge drinking, physical inactivity, and excessive bodyweight in a population of healthcare students attending an Italian university. METHODS: Healthcare students filled an anonymous multiple-choice questionnaire on the occasion of the occupational health visit that preceded their hospital internship. The questionnaire covered socio-demographic characteristics (including student's working status and cohabitation) and risk behaviors. We evaluated the prevalence of risk behaviors and their association with socio-demographic characteristics. RESULTS: The sample consisted of 494 students (65% women): 23.2% were smokers, 7.9% had excessive bodyweight, 35% did not practice any physical activity and 50% reported binge drinking at least once in the last 12 months. We found associations of male sex (30.5%) and being nursing students (29.9%) with smoking habit. The frequency of binge drinking was higher in men (38.4%), working students (53.9%), and among those who lived without family (50%). Physical inactivity was associated with female sex (44.2%) and living without family (57.1%). Finally, the co-presence of 2 risk behaviors or more was higher in men (36.8%), in nursing students (39.6%) and in working students (44.7%). CONCLUSIONS: Our findings regarding the prevalence of risk behaviors and their potential association with socio-demographic factors may be a clue to the definition of targeted strategies aimed at reducing of risk behaviors among healthcare students.

Treatment of hip fracture of Pope Innocent XII by Marcello Malpighi with bed rest.

Marcello Malpighi (1628-1694), who is referred to as the father of microscopical anatomy, histology, physiology and embryology was an Italian biologist and physician, well known for his discoveries on microscopical anatomy of kidney, circulating and lymphatic systems. As well as being a brilliant anatomist, Malpighi was also a valued physician so far as to became the personal physician of Pope Innocent XII (1615-1700). On 23 August 1691, one month after his election, the Pope fell to the ground hitting his left hip. Malpighi, as his personal physician, was immediately called and diagnosed a hip fracture. At that time fractures were generally treated by surgeons, barbers and sawbones, while physicians were mainly concerned with internal diseases. Despite that, Marcello Malpighi cured Pope Innocent XII's hip fracture by applying some modern traumatologic concepts. This article analyses how Malpighi treated this hip fracture, comparing it with the current approach.

"Nabucco" by Giuseppe Verdi: A Case of Delirium in an Italian Romantic Opera.

Italian operas can provide relevant information on the medical knowledge during the Romantic Age, especially in the field of neuroscience. One of the most renowned operas, "Nabucco" by Giuseppe Verdi (1813-1901) may provide us with some information on the state of knowledge on neuropsychiatric diseases in the first part of the nineteenth century. The main character of this opera, the Assyrian king Nabucco suffers from delirium. Psychic signs and symptoms attributed to Nabucco in Verdi's opera could have been influenced by a better knowledge of neuropsychiatric diseases in the nineteenth century. Furthermore, the representation of Nabucco's mental illness in the opera could also have been influenced by direct experiences of Verdi himself, who seems to have suffered from recurrent depressive episodes in that period, and for the rest of his life.