Annali dell'Istituto superiore di sanita最新文献

Objectives: To estimate Suicidal Ideation (SI) prevalence among Italian medical students and explore associated factors.

Methods: Multicentre cross-sectional study (2018). Students were enrolled through convenience sampling (sample size=2513). Questionnaires included socio-demographic items and Beck Depression Inventory-II, which has an item on SI. A multivariable regression was performed (p-value<0.05 significant).

Results: SI prevalence was 13.7%. Among students with and without depression SI prevalence was 36.0% and 4.3%. Being female, being in a relationship, good/excellent family cohesion, perceived good economic status were significantly associated with lower SI. Increasing age, bisexual/asexual orientation, psychiatric family history, negative judgment on medical school choice, competitive/hostile climate and unsatisfying friendships among classmates, being worried about not measuring up to the profession significantly increased SI.

Conclusion: There was a high SI prevalence among Italian medical students, consistently with worldwide data. Demographic, relational, and motivational factors seem to influence SI. Determinants should be further investigated to plan university-level interventions.

Minimal or measurable residual disease (MRD) is a term that refers to the submicroscopic tumor disease persisting after therapy. Sensitive immunophenotypic and molecular techniques are used to detect the small amount of residual tumor cells, conferring a detection capacity clearly more sensitive of common cytomorphologic techniques. MRD evaluation now represents an important tool in the study of solid tumors and of hematological malignancies. Concerning hematological malignancies, MRD evaluation was particularly developed in the study of multiple myeloma and acute myeloid leukemia, representing in these diseases a precious biomarker to quantify response to treatment, to evaluate the chemosensitivity/chemoresistance of the disease and to have a prognostic prediction on disease outcome. The finding that MRD evaluation may have a prognostic value, predicting the risk of relapse, stimulated interest in the introduction of MRD in clinical trials, either as a clinical endpoint or as a tool to guide treatment decisions. However, the clinical use of MRD requires a standardization of the techniques used for its detection, the use of multiple techniques and the development of a consistent accuracy and reproducibility. Finally, prospective clinical trials are required to assess the real clinical benefit potentially deriving from the introduction of MRD evaluation into clinical studies.

Introduction and aim: Biologic treatment - particularly with the anti-TNF molecules - is frequently used in clinical practice to treat the severe form for both chronic rheumatic diseases and inflammatory bowel diseases. The immunosuppression induced by biologic therapies increases the risk of infections, including tuberculosis, as well as hepatitis B virus (HBV) reactivation may occur in inactive carriers or occult HBV infection (OBI) subjects during biologic therapy. This study aimed to update data on HBV prevalence and reactivation in patients receiving biologic therapy for either chronic rheumatic diseases or IBD, and to describe their management in clinical practice.

Materials and methods: This study was performed in 6 Italian centers (3 Rheumatology Units and 3 Gastroenterology Units). Clinical, biochemical and virological data, as well as follow up information, were recorded and analyzed.

Results: 984 patients were considered, including 817 with rheumatic disease and 167 with IBD. A total of 43 showed HBV infection (38 OBI and 5 carriers) accounting for a prevalence of 4%. Among OBI patients, 1 (2.6%) case of HBV reactivation occurred in a male patient with Crohn disease. Among the 5 HBV carriers, two patients (1 with spondyloarthritis and 1 with rheumatoid arthritis) did not received HBV antiviral therapy, and both experienced flare of hepatitis at 47 and 49 months following biologic therapy starting.

Discussion: Data of our study highlight that guidelines on management of HBV patients treated with biologic therapies should be still implemented in clinical practice when considering that, although infrequent, HBV reactivation could be potentially life-threatening.

Introduction: Taranto Province (Puglia Region, Southern Italy) is of particular Public Health relevance due to the presence of industrial sources of dioxins and PCBs. The aim of this study was to analyze the spatio-temporal distribution of these pollutants in milk and cheese produced from 2013 to 2018.

Materials and methods: Raw milk and dairy products were sampled in the farms located within 20 km from the industrial area.

Results: 1005 milk samples were collected. Median (IQR) concentrations were: dioxins 0.21 (0.21) pg WHO-TEQ/g fat; dioxins+DL-PCBs 0.83 (0.71) pg WHO-TEQ/g fat; NDL-PCBs 1.92 (1.56) ng/g fat. Overall, only 6 (0.6%) samples were found to be non-compliant for at least one pollutants group. Temporal analysis showed a decreasing trend in dioxins and PCBs concentrations over the observed years and higher values in the first trimester. Spatial analysis showed higher levels of PCBs in areas closest to the industrial pole. 70 dairy products samples were collected. Median pollutants concentrations were far below the EU limits and no exceedances were observed.

Conclusions: The extremely low number of exceedances appeared as an encouraging result and supported the validity of the Public Health measures adopted by the Department of Prevention of Taranto.

The progressive ageing of a population leads to an increase in the number of people suffering from cognitive deterioration. This requires particular attention in terms of the necessity to assess these people's cognitive functions and their capacity to make decisions. The present systematic review analyses the clinical and ethical aspects of any assessment of capacity, with a specific focus on the capacity of the individual to give informed consent for medical treatment and also with regard to their testamentary capacity. The results indicate that the concepts of capacity, competence and decision-making need to be better clarified, ad-hoc devised tools are required and a multidisciplinary, clinical and legal approach to assessments of capacity needs to be adopted. This is crucial to guarantee that the two ethical principles of capacity assessment are adhered to: respect for an individual's autonomy and the protection of fragile individuals.

Background: On 6 March 2020, a big fire in a village forced the firefighters to draw water simultaneously from many sources, including the Adige river. From 9 March, an increasing number of inhabitants reported gastrointestinal symptoms. We describe the outbreak and the challenges linked to the concurrent COVID-19 spread.

Methods: Residents with enteric symptoms and their relatives were interviewed and samples from some of the patients and public water pipelines were tested for enteric pathogens with microbiological and molecular methods.

Results: By 20 March, 182 people reported symptoms and 131 met the case definition. Norovirus GI/GII and other pathogens were found in human and water samples.

Conclusions: Contamination of the public water network with sewage-contaminated river water through the firefighters pressurized water tank was the suspected source of the outbreak. The investigation was partly hampered due to the SARS-CoV-2 emergency. Control measures included avoiding tap water, alternative water supplies and chlorination of public water.

Clostridioides (previously Clostridium) difficile infection (CDI) is a common cause of antibiotic-associated diarrhea, whose symptoms range from mild diarrhea to life-threatening pseudomembranous colitis. CDI is characterized by significant recurrence rate following initial resolution and recurrent C. difficile infection (rCDI) represents an onerous burden for the healthcare systems. Conventional antibiotic-based approaches are generally used for the treatment of rCDI but the effective therapy remains elusive. Recently, the faecal microbiota transplantation (FMT) has emerged as an alternative therapeutic strategy against rCDI, with high treatment success rate. In 2018, the Italian National FMT Program was launched, with the aim to provide high quality standards in FMT application to adults with rCDI not responding to antibiotic therapy. Here, we sketch out the key characteristics and the progress of the Italian National FMT Program during the COVID-19 pandemic.

Italy has been one of the countries with the greatest burden of HCV in Western Europe and with the highest number of HCV liver-related deaths. In order to achieve HCV elimination by 2030 Italy, like many other countries, will need to succeed in tackling the undiagnosed individuals with active HCV infection. To this aim beginning in 2021, a nationwide action has been implemented, consisting of the performance of screening tests among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The realization of the proactive screening during the first two years will define the tracks for the whole optimized screening strategy, including also the screening of 1948-1968 birth cohorts, reported to be the best cost-effective strategy in achieving the HCV elimination targets by 2030 in Italy. Each Italian region needs to define the present and future steps to reach HCV elimination goal by 2030 guaranteeing the equity of care.

Aims: To examine mortality risk and causes of death in a cohort of a population of patients treated for gambling disorders in northern Italy from 1992 to 2019.

Methods: Cohort study.

Results: Half of the patients were diagnosed with psychiatric disorders, substance use disorder or alcohol dependence. The excess mortality compared to the general population (SMR) was 1.16 (0.85-1.58), more elevated among females aged 40 to 59 and males aged 20 to 29. Females had higher SMRs for all cancers and suicide; males for malignant neoplasm of liver, of lung, of prostate, and of bladder.

Conclusions: Despite patients increasing, subjects who most turn to the services are the most serious ones, in older age, with comorbid mental disorders and with a compromised health status. This is reflected in the high risk of death for all cancers.