Resting energy expenditure in women with polycystic ovary syndrome.

STUDY QUESTION: Is resting energy expenditure (REE) altered in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER: Women with PCOS have a reduction in REE, when corrected for fat-free mass, independent of PCOS clinical phenotypes and BMI categories. WHAT IS KNOWN ALREADY: Obesity is an important issue in women with PCOS, in terms of frequency and pathophysiological implications. It has been hypothesized that obesity may be favoured by alterations in REE, but the studies have been limited and conflicting. STUDY DESIGN, SIZE, DURATION: This case-control study was a comparison of 266 women with PCOS and 51 healthy controls, recruited in the Verona 3P study from 2010 to 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with PCOS diagnosed by the Rotterdam criteria, with normal thyroid function and no interfering medications, were referred to the outpatient clinic of a tertiary care centre of endocrinology and metabolism for a measurement of REE. Healthy controls were recruited in the same period and submitted to the same procedure. In all subjects, REE was measured by indirect calorimetry and serum androgens were measured by LC-MS/MS. In women with PCOS, insulin sensitivity was assessed using the hyperinsulinemic-euglycemic clamp. MAIN RESULTS AND THE ROLE OF CHANCE: REE was similar in women with PCOS and controls. However, REE corrected for fat-free mass (REE/FFM) was significantly lower in women with PCOS than in controls (31.8 ± 4.0 vs 35.4 ± 3.9 kcal/kgFFM·day, P < 0.001). REE/FFM did not differ between normal-weight, overweight, or obese women with PCOS, and each of these subgroups showed lower REE/FFM values than controls. Reduced REE/FFM values were found in each phenotype of the syndrome. In multiple regression analysis, REE/FFM was independently associated with age and PCOS status, but not with fat mass. In PCOS women, REE/FFM was independently and directly associated with ovarian follicle number. LIMITATIONS, REASONS FOR CAUTION: Limitations of the study are the cross-sectional design, which limits the causal inference of the results, and the unavailability of precise information about lifestyle factors, which may be potential confounders. Further prospective studies are needed to establish the importance of this phenomenon in contributing to the weight excess of PCOS. WIDER IMPLICATIONS OF THE FINDINGS: A reduction of REE could potentially favour weight gain in women with PCOS and possibly contribute to the altered metabolic profile typical of this condition, even counteracting the therapeutic strategies aimed to reduce excess body fat in these women. Nevertheless, the presence of this abnormality in both obese/overweight and normal-weight patients suggests that other factors must play a role in this phenomenon. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by academic grants to PM from the University of Verona (FUR 2010-2022). All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Assessing safety culture in NICU: psychometric properties of the Italian version of Safety Attitude Questionnaire and result implications.

RATIONALE, AIMS AND OBJECTIVE: Neonatal intensive care units (NICUs) are a high-risk setting. The Safety Attitude Questionnaire (SAQ) is a widely used tool to measure safety culture. The aims of the study are to verify the psychometric properties of the Italian version of SAQ, to evaluate safety culture in the NICUs and to identify improvement interventions. METHOD: A cross-sectional study was conducted in 6 level III NICUs. The SAQ was translated into Italian and adapted to the context, a confirmatory factor analysis (CFA) was performed to validate the questionnaire. RESULTS: 193 questionnaires were collected. The mean response rate was 59.7% (range 44.5%-95.7%). The answers were analysed according to six factors: f1 - teamwork climate, f2 - safety climate, f3 - job satisfaction, f4 - stress recognition, f5 - perception of management, f6 - working conditions. The CFA indexes were adequate (McDonald's omega indexes varied from 0.74 to 0.94, the SRMR index was equal to 0.79 and the RMSEA index was 0.070, 95% CI = 0.063-0.078). The mean composite score was 57.6 (SD 17.9), ranging between 42.3 and 69.7 on a standardized 100-point scale. We highlighted significant differences among units and professions (P < 0.05). CONCLUSIONS: The Italian version of the SAQ proved to be an effective tool to evaluate and compare the safety culture in the NICUs. The obtained scores significantly varied both within and among the NICUs. The organizational and structural characteristics of the involved hospitals probably affect the safety culture perception by the staff.

Measurement of a urinary marker (8-hydroxydeoxy-guanosine, 8-OHdG) of DNA oxidative stress in epidemiological surveys: a pilot study.

BACKGROUND: 8-Hydroxydeoxyguanosine (8-OHdG) is a commonly used marker of DNA oxidative stress in epidemiological studies. The aim of this study was to establish whether the urinary concentration of 8-OHdG varies during the first part of the day, when clinical tests are usually performed, and whether it can therefore be measured without bias in spot urine samples. MATERIAL AND METHODS: Spot urine samples were collected using a convenience sample. A linear mixed-effects model for repeated measurements was used to analyze 8-OHdG levels. RESULTS: A significant increasing trend in time in the 8-OHdG concentration was found among smokers, but not in the case of nonsmokers. CONCLUSIONS: In epidemiological studies on oxidative stress, all participants should collect their early morning urine specimens - before their first cigarette if they are smokers - to gather information on individual background oxidation levels.

A questionnaire to evaluate the knowledge and attitudes of health care providers on pain.

The aims of this study were to survey the knowledge and attitudes of Italian health care professionals toward pain and develop a valid instrument to assess pain knowledge of physicians and nurses. A 21-item questionnaire on a Likert scale was given to 4,961 health professionals in 20 hospitals in Italy who volunteered to participate in the study. The results were analyzed psychometrically in three phases: the Principal Component Analysis phase identified two components, of which only the one that had 10 items about pain knowledge and attitudes (PAK) was studied; the Homogeneity Analysis revealed its acceptable internal reliability (Cronbach's alpha=0.72) and confirmed the Likert equidistance of the item options response; and the Confirmatory Factor Analysis proved that it had a very good construct validity. A standardized score was calculated on the PAK questionnaire using the final 10 selected items, considering 100% as the best level of knowledge of pain management and 0% as the worst. The standardized mean score on the whole sample was equal to 52.6% (95% Confidence Interval: 52.3%-53.0%). There was a statistically significant difference (P<0.001) in percentage score between physicians (56.5%) and nurses (51.3%). Knowledge was best among physicians in Anesthesiology and Emergency; this was followed by doctors in Medicine and then surgeons. The knowledge of nurses was almost constant. This scale fills a void by providing a validated instrument for testing the general knowledge about pain treatment of hospital staff. It is brief and can easily be administered to a considerable number of people.

Clustering of cardiovascular risk factors associated with the insulin resistance syndrome: assessment by principal component analysis in young hyperandrogenic women.

OBJECTIVE: Hyperinsulinemia is often associated with several metabolic abnormalities and increased blood pressure, which are risk factors for cardiovascular disease. It has been hypothesized that insulin resistance may underlie all these features. However, recent data suggest that some links between insulin resistance and these alterations may be indirect. The aim of our study was to further investigate this issue in a sample of young hyperandrogenic women, who often show insulin resistance and other metabolic abnormalities typical of the insulin resistance syndrome. RESEARCH DESIGN AND METHODS: We tested the hypothesis of a single factor underlying these features by principal component analysis, which should recognize one component if a single mechanism explains this association. The analysis was carried out in a sample of 255 young nondiabetic hyperandrogenic women. Variables selected for this analysis included the basic features of the insulin resistance syndrome and some endocrine parameters related to hyperandrogenism. RESULTS: Principal component analysis identified four separate factors, explaining 64.5% of the total variance in the data: the first included fasting and postchallenge insulin levels, BMI, triglycerides, HDL cholesterol, and uric acid; the second, BMI, blood pressure, and serum free testosterone; the third, fasting plasma glucose, postchallenge glucose and insulin levels, serum triglycerides, and free testosterone; and the fourth, postchallenge plasma insulin, serum free testosterone, and gonadotropin-releasing hormone agonist-stimulated 17-hydroxyprogesterone. CONCLUSIONS: These results support the hypothesis of multiple determinants in the clustering of abnormalities in the so-called insulin resistance syndrome.