Drug driving in Italy. The results of the first roadside drug testing service utilizing on-site confirmatory analysis between 2019 and 2022.

BACKGROUND: Drug driving represents a public safety concern, and the size of this issue in Italy is not fully known. Drug testing is composed of two steps: 1) screening and 2) confirmatory analysis. The second step, and the associate medical examination to assess the state of impairment, usually are not performed right after the screening as they require specialized personnel and instrumental equipment that are not historically available at roadblocks. These pitfalls make this process both complicated and time-consuming. METHODS: A mobile laboratory was set up in 2019 by the Forensic Lab Service S.r.l. (limited liability company) to improve roadblock timing, planning, as well as to shed light on the extent of the drug driving issue in Italy. Drug screenings were performed using DrugWipe® Saliva testing. Confirmatory analysis was performed on oral fluids by liquid chromatography coupled with tandem mass spectrometry. A dedicated room of the mobile laboratory was also designed for drug driving medical assessment. RESULT: 2082 samples were collected during 88 road safety services held in different locations across Italy. In total, 9 % of the tested subjects were positive to both the screening and the confirmatory analysis. The most prevalent illicit drugs found in this study were THC (72 %), followed by cocaine (41 %). Drug drivers were mostly male (93 %) and younger than 30 years of age (58 %). CONCLUSIONS: The prevalence of drivers testing positive for illicit drugs resulted to be higher compared to the results obtained in the DRUID project and to other surveys previously performed in Italy. These data demonstrate the need for control services to improve road safety in regards to drug driving.

Suicide mortality in Italy during the first year of the COVID-19 pandemic.

BACKGROUND: Italy was severely hit by COVID-19 during 2020 and great concern about the possible increase of suicide rates in the population has arisen since early pandemic phases. Analyses limited to March-April have shown a drop in suicides in both sexes. This study aims to analyze suicide mortality in Italy during the whole 2020 making comparisons with the pre-pandemic period 2015-19, by sex, age and geographic area. METHODS: Official cause-of-death data with national coverage were used to analyze suicide mortality by sex, month, age class and geographic area in the population aged ≥10 years (54,595,179). The monthly number of suicide deaths in 2020 was compared to the average number in 2015-19. Age-specific and age-adjusted suicide rates in 2020 and in 2015-19 were compared using rate-ratios with 95 % confidence intervals. RESULTS: Compared to 2015-19 a non-significant reduction of the overall suicide rate was observed during 2020, both in males (-3 %) and females (-7 %). Suicide rates non-significantly decreased in most age groups; an increase, although not statistically significant, was found among males aged ≥75 years and females aged ≥85 years. Suicide deaths reduced mainly in Central-Southern areas and the Islands, while they slightly increased in the North especially among males. LIMITATIONS: Study limitations include accuracy of death certification and the relatively brief observation period. CONCLUSIONS: The study contributes to the analysis of early effects of the COVID-19 pandemic on suicide mortality in the whole population highlighting sex, age and territorial differences and suggesting to monitor possible increases in a longer observation period.

Food waste reduction and economic savings in times of crisis: The potential of machine learning methods to plan guest attendance in Swedish public catering during the Covid-19 pandemic.

Food waste is a significant problem within public catering establishments in any normal situation. During spring 2020 the Covid-19 pandemic placed the public catering system under greater pressure, revealing weaknesses within the system and generation of food waste due to rapidly changing consumption patterns. In times of crisis, it is especially important to conserve resources and allocate existing resources to areas where they can be of most use, but this poses significant challenges. This study evaluated the potential of a forecasting model to predict guest attendance during the start and throughout the pandemic. This was done by collecting data on guest attendance in Swedish school and preschool catering establishments before and during the pandemic, and using a machine learning approach to predict future guest attendance based on historical data. Comparison of various learning methods revealed that random forest produced more accurate forecasts than a simple artificial neural network, with conditional mean absolute prediction error of < 0.15 for the trained dataset. Economic savings were obtained by forecasting compared with a no-plan scenario, supporting selection of the random forest approach for effective forecasting of meal planning. Overall, the results obtained using forecasting models for meal planning in times of crisis confirmed their usefulness. Continuous use can improve estimates for the test period, due to the agile and flexible nature of these models. This is particularly important when guest attendance is unpredictable, so that production planning can be optimized to reduce food waste and contribute to a more sustainable and resilient food system.

Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment.

Aim and objective: Multifocal fractures of the humerus are rare. The aim of our study is to evaluate the effectiveness of surgical treatment and propose a modification to the Maresca-Pascarella classification. A flowchart for surgical treatment is provided. Materials and methods: Thirty-one patients with multifocal humeral fractures were treated and evaluated. The Maresca-Pascarella classification was used. All were treated using with either plates and screws, external fixation or intramedullary nailing. Functional outcomes were evaluated using the QuickDASH test, the University of California - Los Angeles (UCLA) shoulder score and the Mayo elbow performance score (MEPS). Results: There were 12 Type A, 17 Type B, 1 Type C and 1 of combined fractures of the proximal and distal epiphysis. Of the 31 patients, 5 were lost to the follow-up (FU), 1 died of pulmonary embolism (PE) and the remaining 25 had a mean FU of 19.8 (7-35) months. Three patients had radial nerve damage and 1 went to a non-union that required further surgical intervention. The mean QuickDASH score was 15.7, the average UCLA shoulder score was 26.3 and the mean MEPS elbow score resulted to be 83.0. Conclusion: Although multifocal fractures are severe injuries, patients are able to recover good functionality if treated judiciously. Clinical significance: We proposed a standardised surgical approach based on the fracture characteristics, site and a modified Maresca-Pascarella classification. How to cite this article: Scaglione M, Casella F, Ipponi E, et al. Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment. Strategies Trauma Limb Reconstr 2022;17(2):81-87.

Suicide mortality among the elderly population in Italy: A nationwide cohort study on gender differences in sociodemographic risk factors, method of suicide, and associated comorbidity.

OBJECTIVES: This study aimed at investigating gender differences in the relationship between sociodemographic factors and suicide mortality, as well as in the method used for suicide and the presence of comorbidities in an older population in Italy. METHODS/DESIGN: We conducted a historical cohort study based on individual record linkage across the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides among people aged 75 years or older from 2012 to 2017 were analyzed. Crude mortality rates were computed, and cause-specific mortality rate ratios were estimated using negative binomial regression models. Chi-square tests were used to evaluate significant gender differences in suicide methods and comorbidities associated with suicide. RESULTS: The study included 9,686,698 individuals (41% men, 59% women). Compared to living alone, living with children or partners reduced suicide mortality, especially among men. Having high or medium educational levels was associated with lower mortality than low educational levels among men. Foreign citizens had lower mortality among men, but not among women. Living in urban areas was associated with lower suicide rates in men and higher rates in women. Methods of suicide significantly differed by gender: leading methods were hanging, strangulation, and suffocation in men, and falling from height in women. Mental comorbidity was significantly more frequent among women, especially at ages 75-84 years. CONCLUSIONS: We believe that our findings might help to promote public health strategies taking gender differences in old age into account to improve social support and quality of life of older men and women.

Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation.

INTRODUCTION: Although Total Knee Arthroplasty (TKA) is a successful procedure, a significant number of patients are still unsatisfied, reporting instability at the mid-flexion range (Mid-Flexion Instability-MFI). To avoid this complication, many innovations, including load sensors (LS), have been introduced. The intraoperative use of LS may facilitate the balance of the knee during the entire range of motion to avoid MFI postoperatively. The objective of this study was to perform a Gait Analysis (GA) evaluation of a series of patients who underwent primary TKA using a single LS technology. METHODS: The authors matched and compared two groups of patients treated with the same posterior stabilized TKA design. In Group A, 10 knees were intraoperatively balanced with LS technology, while 10 knees (Group B) underwent standard TKA. The correct TKA alignment was preoperatively determined aiming for a mechanical alignment. Clinical evaluation was performed according to the WOMAC, Knee Society Score (KSS) and Forgotten Joint Score, while functional evaluation was performed using a state-of-the-art GA platform. RESULTS: We reported excellent clinical results in both groups without any statistical difference in patient reported outcome measurements (PROMs); from a functional standpoint, several GA space-time parameters were closer to normal in the sensor group when compared to the standard group, but a statistically significant difference was not reached. CONCLUSIONS: Gait Analysis represents a valid method to evaluate TKA kinematics. This study, with its limitations, showed that pressure sensitive technology represents a valid aid for surgeons aiming to improve the postoperative stability of TKA; however, other factors (i.e., level of intra-articular constraint and alignment) may play a major role in reproducing the normal knee biomechanics.

Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data.

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015-2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015-2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases.

The Economic Perspective of Food Poverty and (In)security: An Analytical Approach to Measuring and Estimation in Italy.

The UN Sustainable Development Goals have set clear targets on global poverty, hunger and malnutrition to be achieved by 2030, which have prompted academics and policymakers to identify useful strategies and drivers. Moreover, the COVID19 pandemic has exacerbated inequalities at national and sub-national levels thus hampering the achievement of these goals. On considering the multifaceted nature of poverty, a recent research strand focuses on food poverty and insecurity issues in terms of economic access to food and healthy diet consumption, with moderate and extreme food insecurity affecting almost 9% of the population in Europe and North America. This paper aims to analyse food poverty and insecurity at regional level in Italy. Using micro-data from the Italian Household Budget Survey carried out by ISTAT, an analytical approach was proposed to define and measure the different degree of food poverty and insecurity. Moreover, to obtain insights into whether food poverty and insecurity can afford population healthy nutrition, inequality of the distributions of food expenditure categories are estimated. The results provided us with information on other important aspects of the poverty. Indeed, in Italy individuals who are at-risk-of-food-poverty or food insecure amount to 22.3% of the entire population. Furthermore, the at-risk-of-food-poverty-rate varies at regional level from 14.6% (Umbria) to 29.6% (Abruzzo), with high levels of food consumption inequalities observed above all for vegetables, meat and fish. All these issues could help policy makers to define economic intervention policies aimed at reducing social exclusion and achieving more equitable and sustainable living conditions for the entire population.

Acute Effects of Particulate Matter on All-Cause Mortality in Urban, Rural, and Suburban Areas, Italy.

BACKGROUND: Short-term exposure to particulate matter (PM) has been related to mortality worldwide. Most evidence comes from studies conducted in major cities, while little is known on the effects of low concentrations of PM and in less urbanized areas. We aim to investigate the relationship between PM and all-cause mortality at national level in Italy. METHODS: Daily numbers of all-cause mortality were collected for all 8092 municipalities of Italy, from 2006 to 2015. A satellite-based spatiotemporal model was developed to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and mortality at province level, and then, results were pooled with a random-effects meta-analysis. Associations were estimated by combination of age and sex and degree of urbanization of the municipalities. Flexible functions were estimated to explore the shape of the associations at low PM concentrations. RESULTS: We analyzed 5,884,900 deaths (40% among subjects older than 85 years, 60% occurring outside the main urban areas). National daily mean (interquartile range) PM10 and PM2.5 concentrations were 23 (14) µg/m3 and 15 (11) µg/m3, respectively. Relative increases of mortality per 10 µg/m3 variation in lag 0-5 (average of last six days since death) PM10 and PM2.5 were 1.47% (95% Confidence Intervals (CI): 1.15%, 1.79%) and 1.96% (1.33%, 2.59%), respectively. Associations were highest among elderly and women for PM10 only, similar between rural and urbanized areas, and were present even at low concentrations, e.g., below WHO guidelines. CONCLUSIONS: Air pollution was robustly associated with peaks in daily all-cause mortality in Italy, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines (2021) for PM10 and PM2.5 are not sufficient to protect public health.

Use of a Plasma-Sprayed Titanium-Hydroxyapatite Femoral Stem in Hip Arthroplasty in Patients Older than 70 Years. Is Cementless Fixation a Reliable Option in the Elderly?

BACKGROUND: Although cementless implants are increasing in popularity, the use of cementless femoral stems for total hip arthroplasty (THA) and hip hemiarthroplasty (HH) in elderly patients remains controversial. The aim of this study was to report the outcomes of a cementless stem used in a large multicentric cohort of elderly patients receiving elective THA and HH for displaced femoral neck fracture. METHODS: A total of 293 patients (301 hips) aged 70 years or older (mean age, 78 years; range, 70-93) who received the same cementless plasma-sprayed porous titanium-hydroxyapatite stem were retrospectively evaluated after primary THA and HH to investigate stem survival, complications, and clinical and radiographic results. RESULTS: Cumulative stem survival was 98.5% (95% CI, 96.4-99.4%; 91 hips at risks) with revision due to any reason as the end-point at 10-year follow-up (mean 8.6 years, range 4-12). No stem was revised due to aseptic loosening. The mean Forgotten Joint Score was 98.7. Radiographically, the implants showed complete osseointegration, with slight stress-shieling signs in less than 10% of the hips. CONCLUSION: The use of cementless stems was proven to be a reliable and versatile option even in elderly patients for elective THA and HH for femoral neck fracture.

Guest attendance data from 34 Swedish pre-schools and primary schools.

This data article describes 34 datasets, compiled into one table, describing guest attendance at lunch meal servings in Swedish public schools and preschools. Fifteen of the schools and all 16 of the preschools covered belong to one municipality, while the remaining three schools belong to two other municipalities, all located in central Sweden. Data on number of plates was used as a proxy of the number of guests eating lunch. Number of used plates was recorded from late August 2010 to early June 2020, i.e. covering the period both before and during the initial phase of the Covid-19 pandemic, so that making possible to evaluate changes in guest attendance during the pandemic. Since these were real data, all data elements pertaining to exact canteens or staff identity have been removed. There is a scarcity of real business data for scientific and educational purposes, so these datasets can play an important role in research and education within catering management, consumption pattern analysis, machine learning, data mining and other fields.

The effect of viscosupplementation on early-stage knee osteoarthritis: Clinical evaluation and assessment of cartilage in vivo with 7 T MRI.

INTRODUCTION: Viscosupplementation is a well-known strategy for managing early stages knee Osteoarthritis. However, despite its effectiveness in reducing symptoms, it has not yet been found to have an effect on joint cartilage. The aim of this study is to evaluate the clinical efficacy of a new product with gel-like behaviour and its in vivo effects on joint cartilage. METHODS: 20 patients were treated by 2 consecutive injections of hyaluronan derivative Hymovis® at one-week interval. Clinical evaluation was performed before the treatment and at each time point during the follow-up using WOMAC and VAS. A 7 T magnet was used for cartilage evaluation at each MRI time point: T2 Relaxation Time (RT), T2∗ RT and cartilage parameters were evaluated before the first injection, after 45 days and at 6 months follow-up. Statistical analysis was obtained for each reported data. RESULTS: We report significantly reduction in symptoms with an increase in knee and global activity functions. The T2 RT for lateral tibial compartment and T2∗ RT for Patello-Femoral compartment significantly decreased. A T2 RT reduction was observed in all knee compartments except for the medial tibial one, while a T2∗ RT reduction was observed in all knee compartments. We report an increase in cartilage volume and thickness in most of patients with a reduction of cartilage defects in 9 patients, but we didn't find MRI signals clearly referable to cartilage regeneration. CONCLUSIONS: MRI results have confirmed the possibility to employ 7T magnets to evaluate early changes in cartilage structure in vivo. HA VS has provided good clinical outcomes and an improvement in the global assessment of the knee joint, but it doesn't seem to significantly modify the cartilage over the time.

A quantitative and non-invasive vibrational method to assess bone fracture healing: a clinical case study.

Orthopaedics needs a robust diagnostic tool that can help or even replace traditional radiography in bone healing assessment, thus reducing patient exposure to ionizing radiation. We used a vibrational method to assess the healing of a complex fracture treated with external fixation, exploiting a quantitative and non-invasive procedure. Callus stiffening was monitored from the time of surgery until the fixator was removed. Our approach overcomes previous limitations and involves a longer period of healing monitoring (about 9 months), very frequent tests (bi-weekly), and the analysis of a single test configuration. The healing process was monitored by analysing the percentage increments of the squared resonant frequencies (SFIs), related to the stiffness variation and the changes in the frequency response functions. The results were validated by X-rays images, and revealed that the most sensitive parameter to quantify the healing was the SFI of the first resonant frequency which increased by about 20% per month during the formation of the woven callus and up to about 50% at the end of healing completion. This study confirms the potential of the vibrational method as an alternative to radiography in fracture healing assessment.

Evolution of Pathology Patterns in Persons Who Died From COVID-19 in Italy: A National Study Based on Death Certificates.

Background: In Italy, during the first epidemic wave of 2020, the peak of coronavirus disease 2019 (COVID-19) mortality was reached at the end of March. Afterward, a progressive reduction was observed until much lower figures were reached during the summer, resulting from the contained circulation of SARS-CoV-2. This study aimed to determine if and how the pathological patterns of the individuals deceased from COVID-19 changed during the phases of epidemic waves in terms of: (i) main cause of death, (ii) comorbidities, and (iii) complications related to death. Methods: Death certificates of persons who died and tested positive for SARS-CoV-2, provided by the National Surveillance system, were coded according to ICD rev10. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Results: The percentage of COVID-19 deaths varied over time. It decreased in the downward phase of the epidemic curve (76.6 vs. 88.7%). In February-April 2020, hypertensive heart disease was mentioned as a comorbidity in 18.5% of death certificates, followed by diabetes (15.9% of cases), ischemic heart disease (13.1%), and neoplasms (12.1%). In May-September, the most frequent comorbidity was neoplasms (17.3% of cases), followed by hypertensive heart disease (14.9%), diabetes (14.8%), and dementia/Alzheimer's disease (11.9%). The most mentioned complications in both periods were pneumonia and respiratory failure with a frequency far higher than any other condition (78.4% in February-April 2020 and 63.7% in May-September 2020). Discussion: The age of patients dying from COVID-19 and their disease burden increased in the May-September 2020 period. A more serious disease burden was observed in this period, with a significantly higher frequency of chronic pathologies. Our study suggests better control of the virus' lethality in the second phase of the epidemic, when the health system was less burdened. Moreover, COVID-19 care protocols had been created in hospitals, and knowledge about the diagnosis and treatment of COVID-19 had improved, potentially leading to more accurate diagnosis and better treatment. All these factors may have improved survival in patients with COVID-19 and led to a shift in mortality to older, more vulnerable, and complex patients.

Suicide among adolescents in Italy: a nationwide cohort study of the role of family characteristics.

Suicide is a leading cause of death among adolescents and is recognized as a serious public health problem. This study aimed to investigate the relationship between family characteristics and the risk of suicide among adolescents in Italy using nationwide official data. We carried out a cohort study based on the record linkage between the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides in adolescents aged 10-19 years from 2012 to 2016 were analyzed. Hazard ratios of mortality from suicide were estimated through a multivariable Cox regression model using time-on-study as the time scale. We included 8,284,359 children and adolescents (51% males, 49% females). Over the 5-year follow-up, we registered 330 deaths from suicides (74% males), mostly occurred in the age class 15-19 years (86%). The suicide rate was 1.71 per 100,000 person-years among males and 0.65 among females. We found some familial characteristics associated with a higher risk of dying by suicide, including: living in single-parent or reconstructed families (among boys), a 40-year or more age gap between mother and child (among girls), having highly educated parents, an age difference between parents greater than 5 years. Furthermore, the study showed a lower risk for boys living in urban areas and for both boys and girls living in South Italy. Our results could help in identifying adolescents at high risk of suicide who could benefit from the planning of targeted intervention strategies.

The Role of COVID-19 in the Death of SARS-CoV-2-Positive Patients: A Study Based on Death Certificates.

Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30-59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.

Which role for synthetic ligaments in the reconstruction of patellar tendon chronic rupture after TKA? Mid-term outcomes using LARS ligament.

BACKGROUND AND AIM OF THE WORK: Patellar tendon rupture is a rare complication after Total Knee Arthroplasty (TKA) which often requires surgical treatment. Patients with chronic lesions or tendon degenerations showed good results when treated using autografts or allografts, but these techniques showed poor outcomes at long-term follow-up (FU). Moreover, allografts have high costs and limited availability, not to mention the increased risk of immune reactions and infections. Recently, the use of synthetic ligaments for patellar tendon reconstruction has taken hold with encouraging results. We report our experience in the treatment of patellar tendon ruptures after TKA using the Ligament Advanced Reinforcement System-LARS®. METHODS: Clinical evaluation was performed using the Knee Society Score and recording extensor lag. Instrumental evaluation was performed using ultrasound imaging to assess patellar tendon thickness and using conventional x-rays to assess prosthesis' mobilization signs and patella's height. RESULTS: At the final FU, 6 knees were included in our study. Patient's mean age was 66.7. Patellar tendon reconstruction occurred after a mean time of 4 months from the previous surgery. The mean FU was 44,2 months. The mean Knee Score was 63.3 and the mean Function Score was 35. In 4 knees the extensor lag was < 10° while in 2 knees it was > 20°. The mean ISI was 1.16, while the average increment in tendon thickness was 127.12%. CONCLUSIONS: In our opinion, synthetic ligaments can be successfully employed for the reconstruction of patellar tendon breakage after TKA and rTKA in selected patients, in order to quickly return them to their activity of daily living.

The role of superior capsular approach (SuperPATH) in the treatment of femoral neck fractures with hemiarthroplasty implantation: our experience and review of literature.

BACKGROUND AND AIM OF THE WORK: since 2003, a series of so called 'micro-posterior' approaches have been developed in the orthopaedic surgery to perform total hip replacement. These techniques present several theoretical advantages compared to the classic postero-lateral approach: reduction in blood loss, post-operative pain, and length of stay but also improving functional outcomes. In our hypothesis these goals could also be obtained in patients with femoral neck fractures, especially in the elderly with several comorbidities. METHODS: In our series we performed 50 consecutive cemented hemiarthroplasties through SuperPATH approach. At the latest follow-up (FU) 41 patients were included in the study. Clinical and radiological evaluation was performed before the surgery and at the latest FU using VAS score, Harris Hip Score (HHS) and conventional AP and LL X-rays. RESULTS: We didn't report any intra-operative complication (i.e. periprosthetic fractures, vasculo-nervous injuries or dislocations) or any case with a dysmetria greater than 1 cm. Mean blood transfusion units were 0.8 during surgery (0 - 4) and 1,6 after surgery (0-4). We reported a mean length of stay of 9.7 days (range 7-15) mainly due to our patients' high comorbidity rate. At the last one-year FU no cases of dislocation, infection and clinical or radiographical signs of prosthetic loosening were recorded. All our patients returned to the same activity level before femoral fracture occurred, according to HHS. CONCLUSION: The SuperPATH is a real minimally invasive approach with a low rate of intra- and post-operative complications. It is related to a reduced dislocation rate and potentially to a reduced infection rate compared to the conventional surgical approaches, allowing, furthermore, a faster functional recovery. According to our experience the advantages of this type of approach can be obtained in the trauma field too.

[Deaths from noncommunicable diseases attributable to behavioral risk factors in Italy and Italian regions, 2016]. / Decessi per patologie non trasmissibili attribuibili a stili di vita in Italia e nelle regioni italiane nel 2016.

OBJECTIVES: to estimate the number of deaths from noncommunicable chronic diseases (NCD) attributable to behavioural risk factors (tobacco smoking, unhealthy nutrition, physical inactivity, overweight, and excessive alcohol use) in 2016 for Italy and for the Italian regions. DESIGN: descriptive study. SETTING AND PARTICIPANTS: mortality data were obtained by the Italian National Institute of Statistics. Causes of deaths from NCD associated with the five RFs were selected. Italian attributable fractions were obtained by the 2016 estimates of the Global Burden of Disease Study and applied to the mortality data. Regional prevalence of risk factors was obtained by the national surveillance system PASSI for the years 2013-2016. MAIN OUTCOME MEASURES: absolute number of attributable deaths, joint attributable fraction, proportion of total deaths attributable to RFs (MAprop). RESULTS: about 191,000 out of 614,307 deaths occurred in Italy in 2016 were attributable to combined RFs (about 37% in males; 26% in women). Joint MAprop was between 33% in men (24% in women) from Val d'Aosta and 40% in men (31% in women) from Campania. In Italy, 17% and 6% of the total amount of deaths were attributable to smoking in men and women, respectively; 6% and 3% to alcohol abuse; 7% and 8% to overweight; 13% and 12% to dietary RFs, and 2% and 3% to low physical activity. The higher proportion of attributable deaths by age-group was recorded in people aged 40-59 years (43% in men; 28% in women). Regional differences in attributable deaths are confirmed by regional RF prevalence recorded by the PASSI surveillance system for the years 2013-2016. CONCLUSIONS: these are the first estimates of the number of deaths due to NCDs attributable to behavioural RFs estimated for each region and for Italy as a whole. Effective primary prevention policies should be reinforced, since these RFs are potentially modifiable.

Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14-2016/17 seasons).

OBJECTIVES: In recent years, Italy has been registering peaks in death rates, particularly among the elderly during the winter season. Influenza epidemics have been indicated as one of the potential determinants of such an excess. The objective of our study was to estimate the influenza-attributable contribution to excess mortality during the influenza seasons from 2013/14 to 2016/17 in Italy. METHODS: We used the EuroMomo and the FluMomo methods to estimate the annual trend of influenza-attributable excess death rate by age group. Population data were provided by the National Institute of Statistics, data on influenza like illness and confirmed influenza cases were provided by the National Institutes of Health. As an indicator of weekly influenza activity (IA) we adopted the Goldstein index, which is the product of the percentage of patients seen with influenza-like illness (ILI) and percentage of influenza-positive specimens, in a given week. RESULTS: We estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16 and 2016/17, respectively, using the Goldstein index. The average annual mortality excess rate per 100,000 ranged from 11.6 to 41.2 with most of the influenza-associated deaths per year registered among the elderly. However children less than 5 years old also reported a relevant influenza attributable excess death rate in the 2014/15 and 2016/17 seasons (1.05/100,000 and 1.54/100,000 respectively). CONCLUSIONS: Over 68,000 deaths were attributable to influenza epidemics in the study period. The observed excess of deaths is not completely unexpected, given the high number of fragile very old subjects living in Italy. In conclusion, the unpredictability of the influenza virus continues to present a major challenge to health professionals and policy makers. Nonetheless, vaccination remains the most effective means for reducing the burden of influenza, and efforts to increase vaccine coverage and the introduction of new vaccine strategies (such as vaccinating healthy children) should be considered to reduce the influenza attributable excess mortality experienced in Italy and in Europe in the last seasons.