Annali dell'Istituto superiore di sanita最新文献

Introduction: Mushroom poisoning is an important cause of intoxication worldwide. The toxic mechanism remains frequently unknown and the diffusion of non-endemic species may cause the emergence of new syndromes. An example is the widespread of Chlorophyllum molybdites in Sicily.

Case series: Pavia Poison Centre was recently involved in the management of 10 intoxications caused by the ingestion of Chlorophyllum molybdites, which was not considered part of the Italian mycological species. The clinical syndrome was characterized by severe gastrointestinal symptoms. In paediatric or vulnerable patients, it may bring to hypovolemic shock that necessitate intensive support. The possibly confusion with amatoxins-containing mushrooms may complicate the management.

Conclusions: Chlorophyllum molybdites is widespread on the oriental coast of Sicily and it could be confused with "parasol mushrooms". Cooperation between emergency physicians, clinical toxicologist and mycologist, supported by improving of laboratory tests, is essential for the appropriate clinical management. Climate changes and migration flows can interfere with the diffusion of new species and the development of novel syndromes.

Background: The whole hospital system was stressed and at risk in the first phase of the pandemic. This study examined the prevalence of post-traumatic stress disorder (PTSD) in all hospital staff, medical and non-medical, within two months of the pandemic declaration. Survey concerned staff 4510 health workers of Italian Highly Specialized Research Hospitals.

Method: Subjects were asked to complete an on-line self-reported questionnaire, the PTSD Checklist 5 (PCL-5) and subjective perception of safety related to personal protective equipment (PPE).

Results: The sample included staff working in hospitals with or without COVID-19 patient admissions. Overall, 11.56% of the hospitals staff met the symptoms criteria for probable PTSD. The sample included 80.63% (3467) medical staff workers and 19.37% (833) non-medical staff workers. The 31.91% of participants worked in COVID-19 hospitals/wards. The prevalence of positive screening for PTSD symptoms in medical staff was 12.42% (426) and in non-medical staff, 8.59% (70). Among medical staff, anesthesiologists had a significant prevalence of PTSD (22.35%), followed by health care assistants/technicians (15.38%) and physicians (10.11%). Among non-medical staff, personnel involved in cleaning, catering, maintenance, security, and transportation, the symptoms of PTSD reached a rate of 12.24% and in administrative staff 8.47%. Risk factors associated with PTSD included working as an anesthesiologist, perceiving PPE as inadequate, and working in COVID-19 hospitals/wards.

Conclusions: In the present study, as in other studies, the prevalence of PTSD symptoms among hospital workers was significatively higher than the lifetime prevalence of PTSD in the general population, showing the pandemic's incredible impact.

Objective: To identify developmental symptoms reported at firsts doctor visits by parents of children later diagnosed with Autism Spectrum Disorder (ASD).

Design: Cohort study.

Setting: The study was conducted in the Department of Psychiatry Research of "Prof. Dr. Alexandru Obregia" Clinical Psychiatry Hospital from Bucharest between September 2019 and May 2021.

Patients: 105 cases: 82 boys and 23 girls, 100 children with autism, and 5 patients with Asperger's syndrome.

Intervention: ASD was diagnosed according to the DSM-5 criteria, ADOS-1 (Autism Diagnostic Observation Schedule, 1st Edition) and/or ADI-R (Autism Diagnostic Interview-Revised) tests scores; features reported by the parents for which they presented to the doctor for a diagnosis were taken into consideration.

Main outcome measures: The age at first presentation to the doctor; the most common early signs reported by the parents of children with ASD.

Results: The age at first presentation to the doctor in our group was between 9 months and 14 years. The most common early signs reported by parents were: delayed language development, deficits in understanding verbal instructions/indications, and hyperactivity and aggressivity. In the case of patients with Asperger's syndrome, the reported features were hyperactivity and aggressivity, learning difficulties, and social interaction problems. Regression and delay in language development occurred more often in boys than in girls.

Conclusions: Parents, as well as family doctors or paediatricians, should pay great attention to the children's behaviour, alongside their cognitive and language development. Early detection is essential for early intervention and our results can be used to develop training programs for parents and paediatricians for early recognition of ASD.

Aims: The main aim of this study is to estimate the impact on workers' health caused by hardwood dust exposure in selected industrial sectors in Italy.

Methods: Proportionate mortality ratios (PMR) by cancer site were calculated by linking the information on occupational exposure to carcinogens from the Italian national registry (SIREP, 1996-2018) to the national mortality archives (ISTAT, 2005-2018), assuming a Poisson distribution of the data.

Results: An elevated proportion of deaths from sino-nasal cancer was found in male exposed workers (PMR=4.25, CI 95%=1.37-13.23). Increased proportions of deaths were also found from stomach cancer in both genders (PMR=3.14, CI 95%=1.41-7.00 women; PMR=1.64, CI 95%=1.22-2.19 men).

Conclusions: Although hardwood dust is a known human carcinogen, there are still many high-risk occupational exposure settings. Epidemiological surveillance and continuous monitoring of workers is highly recommended in order to ensure compliance with regulatory obligations and limit the burden of associated mortality causes.

Besides the timely detection of different SARS-CoV-2 variants through surveillance systems, functional and modelling studies are essential to better inform public health response and preparedness. Here, the knowledge available so far on SARS-CoV-2 variants is discussed from different perspectives, in order to highlight the relevance of a multidisciplinary approach in countering the threat posed by this insidious virus.

The actual "pandemic" times, beside their burden of sorrow in terms of both victims, destruction of societal links and economic consequences, are an unprecedented occasion to give a closer look to the status of biomedical research. Beside the undoubted technological advances, the general impression is alarming: the fragmentation of science culture prevents any wise synthesis of the many aspects involved in a global phenomenon as SARS-CoV-2 epidemics. Here we try to acquire a "detached" view to some evolutionary and physiological aspects of the human-virus interaction highlighting the need to revitalize science by a strong departure from ultra-specialization toward a real integration of different fields of investigation.

Background: At the beginning of the COVID-19 pandemic, healthcare workers were faced with difficult decisions about maternity care practices. The evidence-based practices recommended by the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) were confirmed by Italian national guidance.

Aim: To describe, in a number of facilities that are part of a national Baby-Friendly network, the adherence to some steps of BFHI standards during the COVID-19 emergency.

Methods: We conducted a cross-sectional online survey, inviting all hospitals interested in the Initiative, to fill out a semi-structured questionnaire.

Results: Out of the 68 participating hospitals, 30.9% were hubs and 69.1% spokes. During May 2020, 61.8% of hospitals had COVID-19 and non-COVID-19 clinical pathways, while 38.8% were only non-COVID-19. None was dedicated exclusively to COVID-19 pathways. The BFHI was effective in guaranteeing ≥80% exclusive breastfeeding, the presence of companion of mother's choice, skin-to-skin and rooming-in. The type of accreditation was associated with the presence of a companion of the mother's choice during labour (p=0.022) and with skin-to-skin (p<0.001). According to the narratives, increased interpersonal distance made interactions with mothers difficult and the absence of a birth companion was reported as a major issue.

Discussion and conclusions: The BFHI is a highly-structured, evidence-based care model. Investing in strong collaborative care approaches contributes to hospitals' preparedness.

Introduction: Cardiovascular disease (CVD) is the first cause of death in Europe and over the world. This study analyses health-related behaviours in adults referring doctor-diagnosed CVDs.

Materials and methods: We used data from the Italian cross-sectional Behavioural Risk Factor Surveillance System PASSI gathered in 2015-2018. Complex survey design analyses included the Taylor series method for variance estimation and Poisson regression for associations between socio-demographic characteristics and CVD.

Results: Among 132,598 respondents, the prevalence of doctor-diagnosed CVD was 5%. Higher percentages are observed among: men, older individuals, socioeconomically disadvantaged people. Compared to the general population, people with CVD have greater risk and aggravating factors, and a worse health status overall. All protective behaviors and lifestyles shall be improved.

Discussion and conclusions: In Italy, adults with CVD are more likely to be exposed to aggravating modifiable risk factors: it represents a valuable information for increased preventive interventions, even more in the light of the COVID-19 pandemic scenario.

Introduction: Products containing anthraquinones (AQ) are associated with an increased risk of serious adverse events (AEs). We performed an update of the available evidence retrieved by the spontaneous reports of AE associated with herbal dietary supplement (DS) and over-the-counter medications (OTC-M) used as laxatives.

Methods: Analysis and evaluation of AE reports retrieved from the Italian Phytovigilance and Pharmacovigilance systems was performed from February 2011 to December 2020.

Results: Totally 110 AE reports, 24 related to herbal DS and 86 to OTC-M, were analyzed. Most subjects were females. Herbal products analyzed mostly contained AQ derivatives. Most AEs were gastrointestinal (41.6%), central nervous system (18.2%), and dermatological disorders (12.6%).

Conclusions: The number of AE reports recorded in the last 10 years is still relatively low. However, given the seriousness of some AEs, that does not represent a guarantee of safety. This study may contribute to enhance public awareness on the risks associated with misuse or abuse of laxatives.