Primary care pediatricians and job satisfaction: a cross sectional study in the Lazio region.

BACKGROUND: The Order of Physicians and Dentists of the Province of Rome aims at focusing on the satisfaction of healthcare personnel as an essential factor for the quality of medical care in the health sector. The aim of this study is to assess and prioritize the factors that can be linked to a higher or lower degree of job satisfaction in Primary Care Pediatricians (PCPs). METHODS: This study is a cross sectional survey. A questionnaire was administered to all primary care pediatricians registered to the Order, exploring in particular the work activity organization, the level of satisfaction in their professional life, and the level of perceived health. A pilot activity was conducted to validate the questionnaire. Fisher exact test and ordinal logistic regression (ologit) models were used for the univariate and multivariate analysis. RESULTS: The highest level of job dissatisfaction, in both men and women, was found to be in the practice type without any form of association; among women, it reached an even higher level for those who had their own practice at a distance of 20-40 km from their home. Women, compared to men, maintained a lower level of job satisfaction also while working in Pediatric Primary Care Units (PPCUs). In PPCUs, for the same distance, females showed a more similar pattern to males. Men working in PPCUs, regardless of distance, declared a higher degree of job satisfaction. Both men and women, working as a group pediatrician or in PPCUs, did not show a significant difference in the level of job satisfaction. CONCLUSIONS: The study contributes to a deeper understanding of the factors that may influence levels of career satisfaction in female and male PCPs. Therefore, research and interventions regarding job satisfaction should foster an organizational network connection among PCPs for their job and individual well-being, from a perspective of enhancing patient care. A major effort to improve work-life balance and career satisfaction among women is important, suggesting that interventions for improving job satisfaction could benefit from a gender-specific approach.

Medical Residents' Behaviours toward Compulsory COVID-19 Vaccination in a Tertiary Hospital in Italy.

To maintain safety conditions in the provision of care and assistance, and to protect healthcare workers (HCWs) and patients, the Italian government required compulsory COVID-19 vaccination for HCWs, including medical residents (MRs). The aim of this study was to assess COVID-19 vaccination coverage in MRs in a large tertiary hospital in Italy, before and after the introduction of compulsory vaccination, according to demographic characteristics and specific residency. A database on COVID-19 vaccination status and infection of resident medical doctors was created. Descriptive statistics and logistic regressions were carried out on the data. A total of 1894 MRs were included in the study. Being vaccinated in the same hospital as the residency program was significantly related to the year of residency and being enrolled in a frontline residency. A significant association between compliance with the compulsory primary cycle vaccination and vaccination in the hospital residency was observed. Being enrolled in the second, third, and last years of residency, and in a frontline residency, were predictive of being vaccinated in the residency hospital. Almost 100% of the MRs participating in the study were vaccinated against COVID-19. Compulsory vaccination of HCWs, alongside greater and clearer information about the risks and benefits of vaccination, represents an important booster to ensure public health and to promote quality and safety of care.

Retrospective study of histopathological and prognostic characteristics of primary fallopian tube carcinomas: twenty-year experience (SOCRATE).

OBJECTIVE: Primary fallopian tube carcinoma represents a rare entity, accounting for about 0.75%-1.2% of all gynecological malignancies. The rationale of our study is to describe the prognosis of primary fallopian tube carcinoma. METHODS: We retrospectively identified patients with FIGO stage I-IV, all histology types and grading primary fallopian tube carcinoma treated in three major oncological centers between January 2000 and March 2020. Exclusion criteria were bulky tubo-ovarian carcinomas, isolated serous tubal intraepithelial carcinoma or neoadjuvant chemotherapy. RESULTS: A total of 61 patients were included. The vast majority of primary fallopian tube carcinomas were serous (96.7%) and poorly differentiated (96.7%) and arose from the fimbriated end of the tube (88.5%). Larger tumor size correlated with higher probability of correct preoperative differential diagnosis of primary fallopian tube carcinoma (p=0.003). Up to 82.4% of patients with small tumors (≤15 mm) presented with high FIGO stage (≥IIA). The most common site of metastasis was pelvic peritoneum (18.8%) and among 59% of patients who underwent lymphadenectomy smaller tumors had higher rate of nodal metastasis (42.9%≤10 mm vs 27.3%>50 mm). After 46.0 months of mean follow-up there were 27 recurrences (48.2%). The most common site of relapse was diffuse peritoneal spread (18.5%). The 5-year disease-free survival was 45.2% and 5-year overall survival was 75.5%. Of note, 42.9% of patients with stage IVB survived >36 months. CONCLUSION: Primary fallopian tube carcinoma is a biologically distinct tumor from primary epithelial ovarian carcinoma and it is mostly located in the fimbriated end of the tube. In addition, it is characterized by a high rate of retroperitoneal dissemination even at apparently an early stage and its size does not correlate with FIGO stage at presentation.

Risk of Infection and Duration of Protection after the Booster Dose of the Anti-SARS-CoV-2 Vaccine BNT162b2 among Healthcare Workers in a Large Teaching Hospital in Italy: Results of an Observational Study.

The efficacy of the first schedule of COVID-19 mRNA vaccines has decreased after the surge of the Delta variant, posing the need to administer a booster dose to enhance the neutralising immune response. This study aims at evaluating the duration of protection given by the booster dose of Pfizer-BioNTech BNT162b2 mRNA vaccine in healthcare workers (HCWs) of a large teaching hospital in Rome and to analyse the factors associated with post-booster vaccination infections. Data about vaccinations of HCWs with the BNT162b2 vaccine and nasal swabs positive for SARS-CoV-2 were extracted from the digital archives of the hospital from 27 September 2021 to 31 May 2022. In total, 5770 HCWs were observed. The cumulative risk of becoming infected by SARS-CoV-2 increased with time (2.5% at 4 weeks, 17% at 12 weeks and 40% at 24 weeks) and was significantly higher for females, younger classes of patients and for those who had developed a hybrid immunity (natural infection plus one dose, namely the primary schedule, added to the booster dose) compared to those who had completed the three doses. This study describes the duration and the determinants of the protection against infections after the booster dose of COVID-19 vaccine, highlighting the need for continuous monitoring of vaccine-induced immunogenicity.

HPV and Cytology Testing in Women Undergoing 9-Valent HPV Opportunistic Vaccination: A Single-Cohort Follow Up Study.

Background: This study evaluates the possible effect of 9-valent (9vHPV) vaccination on the results of HPV and cytological tests in a cohort of adult women. Methods: This study is a retrospective, single-cohort, monocentric study. Sexually active women aged 14-70 years, who underwent 9vHPV vaccination, were enrolled. Dose administration dates, side effects and data on Pap smears and HPV tests performed before and after the first vaccine dose were collected. Subjects were considered "unexposed" to the vaccine for all time intervals before the first dose administration, and "exposed" to the first, second and third vaccine doses in all time intervals following each specific dose. Results: A total of 512 women underwent the first 9vHPV dose administration and were enrolled in the study. Median age at vaccination was 30.5 (14-70). Log-rank tests and Cox regression analyses showed a highly statistically significant (p < 0.0001) difference in the time to negativization after the exposure to the third vaccine dose in the 207 women starting with a Pap+ smear (HR (95% C.I.), 2.66 (1.83-3.86)) and in the 198 women starting with an HPV HR+ test (HR (95% C.I.), 7.80 (4.83-12.60)). Conclusions: 9vHPV vaccination may play a role in shortening the clearance time of HPV HR+ or Pap positivity in sexually active adult women.

Evaluation of Training Load During Suspension Exercise.

ABSTRACT: Giancotti, GF, Fusco, A, Varalda, C, Capelli, G, and Cortis, C. Evaluation of training load during suspension exercise. J Strength Cond Res 35(8): 2151-2157, 2021-The aims of this study were to evaluate body inclination and ground reaction force and to predict equations to estimate the training load distribution during suspension training (ST) static back-row at different lengths of the straps. Thirty volunteers (men = 16 and women = 14; age = 23.3 ± 1.7 years; body mass = 63.9 ± 13.3 kg; height = 167.9 ± 9.2 cm; body mass index [BMI] = 22.5 ± 3.4 kg·m-2) performed 14 static back-rows at 7 different lengths of the straps in 2 different elbow positions (flexed and extended). When the length of the straps increased, ground reaction force and body inclination decreased. Moreover, in the flexed elbow position, higher ground reaction force values were recorded with respect to the extended one. Two multilevel regression models (p < 0.05) were created. In the first one, ground reaction force was used as a dependent variable, whereas body inclination angle, body mass, height, BMI, and elbow position were used as independent variables. Significant (p < 0.05) effects were found for all variables included in the model, with an intraclass correlation coefficient (ICC) of 0.31. In the second model, the body inclination angle was replaced by the length of the ST device. Significant (p < 0.05) effects were found also in the second model for all variables included, with an ICC of 0.37. The proposed models could provide different methods to quantify the training load distribution, even if the use of the straps' length could result easier and faster than body inclination angle, helping practitioners and instructors to personalize the workout to reach specific purposes and provide load progression.

Pathological features, immunoprofile and mismatch repair protein expression status in uterine endometrioid carcinoma: focus on MELF pattern of myoinvasion.

AIMS: Microcystic, elongated, and fragmented (MELF) pattern of myoinvasion has been related with increased risk of lympho-vascular space invasion (LVSI) and lymph node metastasis. We analysed a cohort of endometrioid endometrial carcinomas (EECs) to examine the relationships between the MELF pattern of invasion and the clinico-pathological and immunohistochemical features of EEC. METHODS AND RESULTS: 129 EECs were evaluated for the presence of MELF pattern and immunohistochemically tested for Mismatch repair (MMR) proteins, p16, p53 and beta-catenin. We observed 28 MELF + EECs and 101 MELF- EECs. LVSI was observed in 20 MELF + cases and in MELF- tumors. Lymph-node metastases were observed in 7 MELF + cases (2 macrometastases, 3 micrometastases and 2 ITCs). None of the MELF- cases showed micrometastases or ITCs, 18 cases had macrometastatic lymph-nodes. Statistical analysis showed that MELF + tumors carry an increased risk of developing nodal metastasis independent of tumor dimension and LVSI. Loss of MMR proteins expression was observed in 11 MELF + cases and 45 MELF- cases, respectively. Our data showed a higher frequency of immunohistochemical MLH1-PMS2 loss in MELF- pattern of invasion (32.67% of MELF- cases vs 21.43% of MELF + cases) but a higher prevalence of MSH2-MSH6 loss in MELF + pattern (7.14% in MELF + population vs 3.96% of MELF- population) CONCLUSIONS: The morphological recognition of MELF pattern is more reliable than immunohistochemical and molecular signatures of EEC in predicting the risk of nodal involvement. The observed higher prevalence of MSH2-MSH6 loss in MELF + group and MLH1-PMS2 loss in MELF- group may suggest a different molecular signature.

Strategies to Increase Flu Vaccination Coverage among Healthcare Workers: A 4 Years Study in a Large Italian Teaching Hospital.

Flu vaccination is recommended among healthcare workers (HCWs). The low vaccination coverage registered in our hospital among HCWs called for new engaging approaches to improve flu vaccination coverage. The aim of this study was to evaluate the efficacy of different strategies implemented during the last four years (2015-2019). A quasi-experimental study was conducted, involving almost 4000 HCWs each year. Starting from the 2015-2016 campaign, new evidence-based strategies were progressively implemented. At the end of each campaign, an evaluation of the vaccination coverage rate reached was performed. Moreover, during the last three campaigns, differences in coverage among job category, wards involved or not in on-site vaccination (OSV) intervention, age classes and gender were analyzed. An increasing flu vaccination coverage rate was registered, from 6% in 2015-2016 to almost 22% at the end of 2018-2019. The overall number of vaccinated HCWs increased, especially at younger ages. OSV strategy always leads to better results, and physicians always show a higher vaccination coverage than nurses and other HCWs. The implemented strategies were effective in achieving higher flu vaccination coverage among HCWs in our hospital and therefore can be considered valuable examples of good prevention practices in hospital settings.

A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups.

BACKGROUND: Recent studies have reported improvement of outcomes (progression-free survival, overall survival, and prolongation of androgen deprivation treatment-free survival) with stereotactic body radiotherapy (SBRT) in non-small cell lung cancer and prostate cancer. The aim of this retrospective, multicenter study (MITO RT-01) was to define activity and safety of SBRT in a very large, real-world data set of patients with metastatic, persistent, and recurrent ovarian cancer (MPR-OC). MATERIALS AND METHODS: The endpoints of the study were the rate of complete response (CR) to SBRT and the 24-month actuarial local control (LC) rate on "per-lesion" basis. The secondary endpoints were acute and late toxicities and the 24-month actuarial late toxicity-free survival. Objective response rate (ORR) included CR and partial response (PR). Clinical benefit (CB) included ORR and stable disease (SD). Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) and Common Terminology Criteria for Adverse Events (CTCAE) scales, according to center policy. Logistic and Cox regression were used for the uni- and multivariate analysis of factors predicting clinical CR and actuarial outcomes. RESULTS: CR, PR, and SD were observed in 291 (65.2%), 106 (23.8%), and 33 (7.4%) lesions, giving a rate of CB of 96.4%. Patient aged ≤60 years, planning target volume (PTV) ≤18 cm3 , lymph node disease, and biologically effective dose α/ß10 > 70 Gy were associated with higher chance of CR in the multivariate analysis. With a median follow-up of 22 months (range, 3-120), the 24-month actuarial LC rate was 81.9%. Achievement of CR and total dose >25 Gy were associated with better LC rate in the multivariate analysis. Mild toxicity was experienced in 54 (20.7%) patients; of 63 side effects, 48 were grade 1, and 15 were grade 2. The 24-month late toxicity-free survival rate was 95.1%. CONCLUSIONS: This study confirms the activity and safety of SBRT in patients with MPR-OC and identifies clinical and treatment parameters able to predict CR and LC rate. IMPLICATIONS FOR PRACTICE: This study aimed to define activity and safety of stereotactic body radiotherapy (SBRT) in a very large, real life data set of patients with metastatic, persistent, recurrent ovarian cancer (MPR-OC). Patient age <60 years, PTV <18 cm3 , lymph node disease, and biologically effective dose α/ß10 >70 Gy were associated with higher chance of complete response (CR). Achievement of CR and total dose >25 Gy were associated with better local control (LC) rate. Mild toxicity was experienced in 20.7% of patients. In conclusion, this study confirms the activity and safety of SBRT in MPR-OC patients and identifies clinical and treatment parameters able to predict CR and LC rate.

The impact of R1 resection for colorectal liver metastases on local recurrence and overall survival in the era of modern chemotherapy: An analysis of 1,428 resection areas.

BACKGROUND: It is still unclear whether a positive surgical margin after resection of colorectal liver metastases remains a poor prognostic factor in the era of modern perioperative chemotherapy. The aim of this study was to evaluate whether preoperative chemotherapy has an impact on reducing local recurrence after R1 resection, and the impact of local recurrence on overall survival. METHODS: Between 2000 and 2014, a total of 421 patients underwent resection for colorectal liver metastases at our unit after preoperative chemotherapy. The overall number of analyzed resection areas was 1,428. RESULTS: The local recurrence rate was 12.8%, significantly higher after R1 resection than after R0 (24.5% vs 8.7%; P < .001). These results were also confirmed in patients with response to preoperative chemotherapy (23.1% after R1 vs 11.2% after R0; P < .001). At multivariate analysis, R1 resection was the only independent risk factor for local recurrence (P < .001). At the analysis of the 1,428 resection areas, local recurrence significantly decreased according to the increase of the surgical margin width (from 19.1% in 0 mm margin to 2.4% in ≥10 mm). At multivariable logistic regression analysis for overall survival, the presence of local recurrence showed a significant negative impact on 5-year overall survival (P < .001). CONCLUSION: Surgical margin recurrence after modern preoperative chemotherapy for colorectal liver metastases was still significantly higher after R1 resection than it was after R0 resection. Local recurrence showed a negative prognostic impact on overall survival. R0 resection should be recommended whenever technically achievable, as well as in patients treated by modern preoperative chemotherapy.

Normal values of exhaled carbon monoxide in healthy subjects: comparison between two methods of assessment.

BACKGROUND: In a previous study, exhaled carbon monoxide (eCO) has been assessed in healthy non-smokers with a photo acoustic spectrometer Brüel&Kjær 1312. Unexpectedly, values were higher than those reported in literature, which were mostly obtained with electrochemical analysers. This study was aimed to compare eCO values obtained with Brüel&Kjær 1312 and PiCO + Smokerlyzer, a largely utilized electrochemical analyser. METHODS: Thirty-four healthy subjects, 15 non-smokers and 19 smokers, underwent eCO assessment with Brüel&Kjær 1312 and PiCO + Smokerlyzer during a prolonged expiration (15 seconds). Brüel&Kjær 1312 assessed CO concentration 7 and 12 seconds after the beginning of expiration and displayed the mean value. PiCO + Smokerlyzer was utilized according to the manufacturer's recommendations. In vitro, the two devices were tested with standard concentrations of CO in nitrogen (5, 9.9, 20, and 50 ppm), and the time needed by PiCO + Smokerlyzer readings to stabilize was assessed at different gas flows. RESULTS: Both Brüel&Kjær 1312 and PiCO + Smokerlyzer presented very good internal consistency. The values provided were strictly correlated, but at low test concentrations, the Brüel&Kjær 1312 readings were greater than the PiCO + Smokerlyzer, and vice versa. PiCO + Smokerlyzer overestimated the CO standard concentrations at 5 and 9.9 ppm by 20%, while Brüel&Kjær 1312 measures were correct. PiCO + Smokerlyzer readings stabilized in 12 seconds during in vitro tests and in 15 seconds during in vivo measurements, suggesting that the values displayed corresponded to the initial phase of expiration. CONCLUSIONS: Differences between Brüel&Kjær 1312 and PiCO + Smokerlyzer may be explained because Brüel&Kjær 1312 measured CO levels in the middle and at the end of expiration while PiCO + Smokerlyzer assessed them in the initial part of expiration.

[A cross-sectional study on physical activity in a sample of secondary school students in the province of Frosinone, Italy]. / Uno studio trasversale sulla pratica di attività fisica in un campione di studenti delle scuole secondarie di primo e secondo grado della provincia di Frosinone.

BACKGROUND: Physical activity is influenced by individual, socio-cultural and environmental factors. The aim of the study is to describe the practice of physical activity in 11-18 year old students and to identify its correlates in a specific area of central Italy. METHODS: Data were collected in secondary schools of the province of Frosinone (central Italy) using an opportunity sample on 856 students by means of a self administered questionnaire. RESULTS: More than 50% of students reported to practice physical activity 2-3 times a week. Most of the students practiced football or five-a-side football as main sport (25.3%), followed by gymnastic and fitness (19.8%) and swimming (18.8%). Active commuting to school was reported by less than 20% of the sample while private car was the most common mean of transport (52.8%). Differences in physical activity practice were shown according to the residential municipality. Parents' educational level and their physical activity attitudes were positively associated to children's physical activity. These associations persisted after adjusting for age, gender and residential area. CONCLUSIONS: Socio-economic position and parental behaviours are important predictors of physical activity practice in children and adolescents.

NOTCH1 mutations identify a chronic lymphocytic leukemia patient subset with worse prognosis in the setting of a rituximab-based induction and consolidation treatment.

Induction therapy with fludarabine followed by rituximab and consolidation plus maintenance with rituximab improved response duration (RD) and overall survival (OS) in our patients with chronic lymphocytic leukemia (CLL). The aim of our study was to investigate the clinical impact of NOTCH1 mutations in this setting of patients. The study included 123 progressive CLL patients homogeneously assigned to first-line induction treatment with fludarabine followed by rituximab. Fifty-nine patients either in complete remission (CR) minimal residual disease positive (MRD+) after induction (n = 39) or in partial remission (PR, n = 20) underwent consolidation/maintenance therapy with rituximab. Sixteen patients in CR MRD + or PR underwent observation only. The presence of NOTCH1 mutations was investigated by amplification refractory mutation system (ARMS) PCR and by Sanger sequencing. NOTCH1 mutations occurred in 20 out of 123 (16.3 %) cases. Consolidated patients showed longer OS than unconsolidated patients (p = 0.030). Both NOTCH1 mutated and CR MRD+ or PR NOTCH1 mutated patients showed significantly shorter OS after treatment (p = 0.00014 and p = 0.0021, respectively). Moreover, NOTCH1 wild-type consolidated cases experienced significantly longer RD and OS than NOTCH1 mutated consolidated or not consolidated cases (p = 0.00001 and p = 0.018, respectively). Finally, the independent prognostic impact of NOTCH1 mutations for OS was confirmed in multivariate analysis (p < 0.001). The presence of NOTCH1 mutations identifies a CLL subset with worse prognosis in the setting of a rituximab-based induction and consolidation treatment.

Long-term efficacy and safety of human papillomavirus vaccination.

In this paper, we review the published evidence about the long-term efficacy of the available human papillomavirus (HPV) vaccines and their safety profile. Two prophylactic HPV vaccines - bivalent (bHPV) and quadrivalent (qHPV) - are now available, and vaccination programs are being widely implemented, primarily targeting adolescent girls. Efficacy has been widely demonstrated for both vaccines. Since the risk of HPV exposure potentially persists throughout a woman's sexual life, vaccine duration of protection is critical to overall effectiveness. Interpreting the results of long-term efficacy studies for the two HPV vaccines can be puzzling, due to the heterogeneity of studies, different methods used in the assessment of immunogenicity, histopathological and virological end points, and statistical power issues. Moreover, an immunologic correlate of protection has not yet been established, and it is unknown whether higher antibody levels will really result in a longer duration of protection. Disease prevention remains the most important measure of long-term duration of vaccine efficacy. To date, the longest follow-up of an HPV vaccine has been 9.4 years for the bHPV vaccine. Long-term follow-up for qHPV vaccine goes up to 8 years. The vaccine continues to be immunogenic and well tolerated up to 9 years following vaccination. All randomized controlled clinical trials of the bHPV and the qHPV vaccines provide evidence of an excellent safety profile. The most common complaint reported is pain in the injection site, which is self-limiting and spontaneously resolved. The incidence of systemic adverse events (AEs), serious AEs, and discontinuations due to a serious AE reported in clinical studies are similar between the two vaccines and their control groups. In particular, no increased risk of autoimmune disease has been shown among HPV-vaccinated subjects in long-term observation studies. As these are crucial topics in HPV vaccination, it is important to establish systems for continued monitoring of vaccine immunogenicity, efficacy, and safety over time.

Socioeconomic differences in sport and physical activity among Italian adults.

We aimed to assess the extent of socioeconomic differences in sport and physical activity among Italian adults. A secondary data analysis of a multipurpose survey carried out by the National Institute of Statistics in 2006 in Italy was performed. We found marked differences in the practice of physical activity and sport by socioeconomic position. Subjects with a higher educational level were more likely to be physically active, practising more frequently both sport and physical activity. The Odds Ratio (OR) of regular physical activity for the highest educated compared to the lowest educated males was 1.70 (95% Confidence Interval [CI]: 1.38, 2.08), and the OR of sport participation was 2.03 (95% CI: 1.51, 2.72). Among females, the corresponding ORs were 1.32 (95% CI: 1.08, 1.63) and 2.26 (95% CI: 1.51, 3.38). Similar differences in physical activity and sport were found in relation to occupation and material conditions. Almost all sports were more frequently practised by subjects of higher socioeconomic status. Socioeconomic differences in sport and physical activity may derive from economic or cultural barriers. Policies to reduce inequalities and ensure access to sport independently of socioeconomic position are strongly needed.

Seeking Huntington disease biomarkers by multimodal, cross-sectional basal ganglia imaging.

Neurodegeneration of the striatum in Huntington disease (HD) is characterized by loss of medium-spiny neurons, huntingtin nuclear inclusions, reactive gliosis, and iron accumulation. Neuroimaging allows in vivo detection of the macro- and micro-structural changes that occur from presymptomatic stages of the disease (preHD). The aim of our study was to evaluate the reliability of multimodal imaging as an in vivo biomarker of vulnerability and development of the disease and to characterize macro- and micro-structural changes in subcortical nuclei in HD. Macrostructure (T1-weighted images), microstructure (diffusion tensor imaging), and iron content (R 2* relaxometry) of subcortical nuclei and medial temporal lobe structures were evaluated by a 3 T scanner in 17 preHD carriers, 12 early-stage patients and 29 matched controls. We observed a volume reduction and microstructural changes in the basal ganglia (caudate, putamen, and globus pallidus) and iron accumulation in the globus pallidus in both preHD and symptomatic subjects; all these features were significantly more pronounced in patients, in whom degeneration extended to the other subcortical nuclei (i.e., thalamus and accumbens). Mean diffusivity (MD) was the most powerful predictor in models explaining more than 50% of the variability in HD development in the caudate, putamen, and thalamus. These findings suggest that the measurement of MD may further enhance the well-known predictive value of striatal volume to assess disease progression as it is highly sensitive to tissue microimpairment. Multimodal imaging may detect brain changes even in preHD stages.

Looking at the smoking epidemic through the lens of population pyramids: sociodemographic patterns of smoking in Italy, 1983 to 2005.

BACKGROUND: Surveillance systems often present data by means of summary measures, like age-standardised rates. In this study, we aimed at comparing information derived from commonly used measures of smoking with that presented in modified population pyramids (PPs), using the example of the diffusion of smoking in Italy over the past two decades. METHODS: Data were derived from four National Health Interview Surveys carried out in 1983, 1990 to 1991, 1999 to 2000, and 2004 to 2005. After computing both age-specific and age-standardised rates of current, former, and never smoking, we constructed modified PPs by stratifying the male and female populations according to smoking status and educational level. RESULTS: Modified PPs showed several features of the smoking epidemic in Italy that were not apparent from conventional surveillance techniques. First, they showed that the population of smokers is aging, with most current smokers in 2005 being males aged 25 to 39 and females aged 40 to 49, whereas in 1983 most smokers belonged to the youngest age groups. Second, they showed that in 2005 most smokers were found among subjects with middle and higher education, whereas two decades earlier most smokers were (male) subjects with the lowest education. CONCLUSIONS: Modified PPs were able to show how absolute numbers of smokers were distributed by age and sex, how these numbers varied between population subgroups, and how they changed over time. PPs may help provide information on past and future trends in the absolute number of smokers and in their sociodemographic characteristics, which may be missed using only traditional surveillance methods.

[World Health Organization (WHO) Guidelines for coastal and fresh waters: Italian translation by the Society of Hygiene, Preventive Medicine and Public Health (SItI) Working Group "Movement Sciences for Health"]. / Linee Guida dell'Organizzazione Mondiale della Sanità per acque costiere ed acque dolci: traduzione a cura del Gruppo di Lavoro SItI - "Scienze Motorie per la Salute"

The Working Group "Movement Sciences for Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health has promoted the Italian translation of the WHO Guidelines for Safe Recreational Water Environments, relating to coastal and freshwater environments. In this article the authors briefly summarize the main areas covered in the guidelines, namely drowning and injury, exposure to cold, heat and sunlight, water quality, contamination of beach sand, exposure to algae and their products, aesthetic issues, exposure to chemical and physical agents, dangerous aquatic organisms, monitoring and assessment hazards and risks.

Body mass index has a curvilinear relationship with the percentage of body fat among children.

BACKGROUND: Body Mass Index (BMI), which is defined as the ratio between weight (in kg) and height (in m2), is often used in clinical practice as well as in large scale epidemiological studies to classify subjects as underweight, normal weight, overweight or obese. Although BMI does not directly measure the percentage of Body Fat (BF%), it is widely applied because it is strongly related with BF%, it is easy to measure and it is an important predictor of mortality. Among children, age and sex-specific reference values of BMI, known as percentiles, are used. However, it is not clear how strong the relationship between BMI and BF% is among children and whether the association is linear. We performed a cross-sectional study aiming at evaluating the strength and shape of the relationship between BMI and BF% among school-aged children aged 6-12 years. FINDINGS: The study was conducted on a sample of 361 football-playing male children aged 6 to 12 years in Rome, Italy. Age, weight, height and skinfold thickness were collected. BF% was estimated using 4 skinfold equations whereas BMI was converted into BMI-for-age z-score. The relationship between these variables was examined using linear regression analyses. Mean BMI was 18.2 (± 2.8), whereas BF% was influenced by the skinfold equation used, with mean values ranging from 15.6% to 23.0%. A curvilinear relationship between BMI-for-age zscore and BF % was found, with the regression line being convex. The association between BMI-for-age zscore and BF% was stronger among overweight/obese children than among normal/underweight children. This curvilinear pattern was evident in all 4 skinfold equations used. CONCLUSIONS: The association between BMI-for-age zscore and BF% is not linear among male children aged 6-12 years and it is stronger among overweight and obese subjects than among normal and underweight subjects. In this age group, BMI is a valid index of adiposity only among overweight and obese subjects.