Study of the excess mortality associated with the SARS-CoV-2 pandemic in the Local Health Authorities and Districts of the Autonomous Region of Sardinia - quinquennium 2017-2021.

Background: Based on the indications of the Italian National Recovery and Resilience Plan and the Ministerial Decree n°77/2022, detecting specific populations' social-welfare needs is essential to reorganize the national and regional health service. The present analysis studies the impact of pandemic and pre-pandemic conditions in terms of mortality on Sardinian health service organizational subunits to indirectly investigate the need for specific social and health interventions. Design: Retrospective observational mortality study on the Sardinian resident population, surveyed by the Italian National Institute of Statistics (Istat) from 2017 to 2021. Methods: The database was built by crossing demographic data from the Istat divided into 21 five-year age groups (0-4 to 100+). Mortality and excess mortality were calculated with a focus on local health authorities and districts. The analysis were made considering three age groups (0-64, ≥ 65, 0-100+) and comparing the individual years 2020 and 2021 with the pre-pandemic triennium 2017-2019. To better understand the phenomenon of excess mortality, the old age index was calculated for the Local Health Authority and District for each year of the quinquennium considered. Results: Standardized mortality ratios increased in the biennium of the SARS-CoV-2 pandemic compared to the baseline 2017-2019. A global increaseof the Standardized mortality ratios in all districts (2021) was measured, including those with Standardized mortality ratios already increasing in 2020. Notably, the Standardized mortality ratios (2020 and 2021) were often increased by the 0-64 age group. The regional excess mortality (0-100+) confirmed an increase in mortality compared to the baseline, with a slight decrease from 2020 to 2021. Conclusions: Sardinia presents peculiar demographic and geographical characteristics. Monitoring mortality rates and excess mortality confirms to be crucial to constantly re-modulating health interventions and planning of the supply of services, including the equitable allocation of resources based on actual health needs. Sardinia should embrace the concept of "age-friendly community" and create communities designed to promote active aging and social participation.

Plan optimization for mediastinal radiotherapy: Estimation of coronary arteries motion with ECG-gated cardiac imaging and creation of compensatory expansion margins.

BACKGROUND AND PURPOSE: Inadvertent heart and coronary arteries (CA) irradiation may increase the risk of coronary artery disease (CAD) in patients receiving thoracic irradiation. To date, the entity of cardiac-related CA displacement and the possible margins to be used for planning organs at risk volume (PRV) have been poorly described. Aim of this study was to quantify CA displacement and to estimate PRV through the use of ECG-gated computed tomography (CT) scans. MATERIAL AND METHODS: Eight patients received an ECG-gated intravenous contrast enhanced CT for non-cancer related reasons. Nine data sets were reconstructed over the entire R-R cycle with a dedicated retrospective algorithm and the following structures were delineated: Left main trunk (LM), left anterior descending (LAD), left circumflex (CX) and right coronary artery (RCA). CA displacements across the different cardiac phases were evaluated in left-right (X), cranio-caudal (Y) and anteroposterior (Z) directions using the McKenzie-van Herk formula (1.3 * Σ + 0.5 * σ). RESULTS: The following CA displacements were found in X, Y and Z coordinates: 3.6, 2.7 and 2.7 mm for LMT, respectively; 2.6, 5.0 and 6.8 mm for LAD, respectively; 3.5, 4.5 and 3.7 mm for CX, respectively; 3.6, 4.6 and 6.9 mm for RCA, respectively. Based on the mean displacements, we created a PRV of 3 mm for LM, 4 mm for CX and 5 mm for LAD and RCA. CONCLUSION: CA showed relevant displacements over the heart cycle, suggesting the need for a specific PRV margin to accurately estimate the dose received by these structures and optimize the planning process.

[Implementation of an operating room safety chart in Turin (Italy)]. / Adozione di una cartella di sala per la sicurezza in sala operatoria.

To ensure the safety of surgical procedures, a local health authority in Turin (Piedmont Region, Italy) adopted an operating room chart as a standard procedure that contextualizes the Ministerial surgical checklist and fills the surgical safety requirements of the regional health authority. Three characteristics make the adopted operating room chart especially useful and innovative: (i) it is completed by surgical nurses; (ii) it is completed during the surgical procedure itself; (iii) the greater number and type of checks required in addition to those specified in the ministerial checklist.

Sailing for rehabilitation of patients with severe mental disorders: results of a cross over randomized controlled trial.

This study set out to evaluate the effectiveness of a sailing and learning-to-sail rehabilitation protocol in a sample of patients diagnosed with severe mental disorders. The study was a randomized, crossover, waiting-list controlled trial, following recruitment in the Departments of Mental Health of South Sardinia. Participants were outpatients diagnosed with severe mental disorders, recruited through announcements to the directors of the Departments of Mental Health of South Sardinia. Out of the 40 patients enrolled in the study, those exposed to rehabilitation with sailing during a series of guided and supervised sea expeditions near the beach of Cagliari (Sardinia), where the aim to explore the marine environment while sailing was emphasized, showed a statistically significant improvement of their clinical status (measured by BPRS) and, as well, of their general functioning (measured by HoNOS Scale) against the control group. The improvement was maintained at follow-up for some months only: after 12 months, the patients returned to their baseline values on the measures of psychopathology and showed a worsening trend of their quality of life. Sailing can represent a substitute of important experiences that the patients with severe mental disorders miss because of their illness.

Alexithymia affects pre-hospital delay of patients with acute myocardial infarction: meta-analysis of existing studies.

BACKGROUND: The time between the onset of symptoms and reperfusion is a critical determinant of the clinical course of patients with acute myocardial infarction (AMI). Any delay in seeking help will affect patient's outcome. Alexithymia can influence the information processing but also the skills to detect the signal of an ongoing AMI. METHOD: Systematic review and meta-analysis of studies investigating the role of alexithymia in pre-hospital delay after AMI. Pubmed/Medline and PsychINFO/Ovid search from 1990 until 2012. RESULTS: Out of 29 studies investigating the role of psychological factors in pre-hospital delay after AMI, 3 studies specifically assessed alexithymia, involving 258 patients. All studies used the Toronto Alexithymia Scale to group patients into clusters by time to presentation after AMI. Meta-analysis of data showed that the patients with higher emotional awareness (i.e., low alexithymia) had shorter time to presentation after AMI. CONCLUSIONS: Preliminary evidence indicates that alexithymia may have a role in seeking help delay after AMI. Further studies are necessary to better appreciate how alexithymia influence help-seeking in patients with an evolving AMI and in what extent their ineffective behavior can be changed.