The impact of COVID-19 on the European short-term rental market.

The diffusion of COVID-19 and related containment measures practically halted tourism flows, which in many countries generate a significant share of GDP. By leveraging Airbnb data covering the main touristic destinations in Europe, we investigate the impact of the pandemic on the market for short-term rentals up to early 2021. We find that the epidemic reduced dramatically both the supply of apartments available for rents and customers' demand, with travellers cancelling many reservations and reducing new bookings even many months in advance. Accommodations relying relatively more on foreign tourism were the hardest hit and reacted by cutting prices. By exploiting the different timing of the epidemic spread across Europe and the timelines and intensity of the measures adopted to contain it, we show that government mandated restrictions had a stronger impact than the spread of the infection itself. All in all, our results point to a persistent and heterogeneous impact of COVID-19 on the accommodation industry.

Oligo metastatic renal cell carcinoma: stereotactic body radiation therapy, if, when and how?

BACKGROUND AND PURPOSE: Renal cell carcinoma (RCC) has traditionally been considered radioresistant with a limited role for conventional fractionation as a local approach. Nevertheless, since the appearance of stereotactic body radiation therapy (SBRT), radiotherapy (RT) has been increasingly employed in the management of metastatic RCC (mRCC). The aim of this study was to evaluate the role of SBRT for synchronous and metachronous oligo metastatic RCC patients in terms of local control, delay of systemic treatment, overall survival and toxicity. PATIENTS AND METHODS: A Monocentric single institution retrospective data collection was performed. Inclusion criteria were: (1) oligo-recurrent or oligo-progressive disease (less than 5 metastases) in mRCC patients after radical/partial nephrectomy or during systemic therapy, (2) metastasectomy or other metastasis-directed, rather than SBRT not feasible, (3) any contraindication to receive systemic therapy (such as comorbidities), (4) all the histologies were included, (5) available signed informed consent form for treatment. Tumor response and toxicity were evaluated using the response evaluation criteria in solid tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. Progression-free survival in-field and out-field (in-field and out-field PFS) and overall survival (OS) were calculated via the Kaplan-Meier method. The drug treatment-free interval was calculated from the start of SBRT to the beginning of any systemic therapy. RESULTS: From 2010 to December 2018, 61 patients with extracranial and intracranial metastatic RCC underwent SBRT on 83 lesions. Intracranial and extracranial lesions were included. Forty-five (74%) patients were treated for a solitary metastatic lesion. Median RT dose was 25 Gy (range 10-52) in 5-10 fractions. With a median follow-up of 2.3 years (range 0-7.15), 1-year in-field PFS was 70%, 2-year in-field PFS was 55%. One year out-field PFS was 39% and 1-year OS was 78%. Concomitant systemic therapy was employed for only 11 (18%) patients, for the others 50 (82%) the drug treatment-free rate was 70% and 50% at 1 and 2 years, respectively. No > G1 acute and late toxicities were reported. CONCLUSION: The pattern of failure was pre-dominantly out-of-field, even if the population was negatively selected and the used RT dose could be considered palliative. Therefore, SBRT appears to be a well-tolerated, feasible and safe approach in oligo metastatic RCC patients with an excellent in-field PFS. SBRT might play a role in the management of selected RCC patients allowing for a delay systemic therapy begin (one out of two patients were free from new systemic therapy at 2 years after SBRT). Further research on SBRT dose escalation is warranted.

Protective role of the Mediterranean diet on several cardiovascular risk factors: evidence from Sicily, southern Italy.

BACKGROUND AND AIMS: Epidemiological studies conducted in European countries demonstrated that the adoption of a Mediterranean diet protect against clustered risk factors but those evaluating such benefits specifically in southern Italy are scarce. Thus, the aim of this study was to assess the association between the adherence to the Mediterranean diet and cardiovascular risk factors obesity, diabetes, and hypertension. METHODS AND RESULTS: A cross-sectional population-based survey including 3090 subjects was conducted in Sicily, southern Italy. Food intake was evaluated through a validated food frequency questionnaire and adherence to the dietary pattern was assessed using the MedDietScore. Linear and logistic regression models were performed to estimate odds ratios (ORs) and respective confidence intervals (CIs). After adjusting for confounding factors such as age and gender, participants in the highest tertile of the MedDietScore were less likely to be obese (OR 0.35, 95% CI: 0.24-0.51), hypertensive (OR 0.73, 95% CI: 0.55-0.97), and diabetic (OR 0.43, 95% CI: 0.24-0.77). Linear inverse relation between the MedDietScore and BMI (r(2) = 0.34, P < 0.001), waist circumference (r(2) = 0.17, P < 0.001), and waist-to-hip ratio (r(2) = 0.06, P < 0.001) was found. CONCLUSION: Despite the prevalence rates of nutrition-related diseases are high in Sicily, greater adherence to the Mediterranean dietary pattern is still associated with a better health status.

Recipient-donor age matching in liver transplantation: a single-center experience.

OBJECTIVE: The aim of this study was to investigate whether donor age was a predictor of outcomes in liver transplantation, representing an independent risk factor as well as its impact related to recipient age-matching. METHODS: We analyzed prospectively collected data from 221 adult liver transplantations performed from January 2006 to September 2009. RESULTS: Compared with recipients who received grafts from donors <60 years old, transplantation from older donors was associated with significantly higher rates of graft rejection (9.5% vs 3.5%; P = .05) and worse graft survival (P = .021). When comparing recipient and graft survivals according to age matching, we observed significantly worse values for age-mismatched (P values .029 and .037, respectively) versus age-matched patients. After adjusting for covariates in a multivariate model, age mismatch was an independent risk factor for patient death (hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.1-4.17; P = .027) and graft loss (HR 3.86, 95% CI 1.02-15.47; P = .046). CONCLUSIONS: The results of this study suggest to that optimized donor allocation takes into account both donor and recipient ages maximize survival of liver-transplanted patients.

Predictive value of the Charlson comorbidity index in kidney transplantation.

BACKGROUND: Nonimmunologic factors have been recently implicated in worse outcomes after kidney transplantation, producing a need to predict the operative risk among kidney recipients. We assessed the predictive value of the Charlson comorbidity index (CCI) among kidney transplant recipients. METHODS: A retrospective study of 223 first deceased-donor kidney transplantations performed from 2000 to 2007 evaluated the role of comorbidities. RESULTS: About 50% of recipients displayed >1 comorbid condition before transplantation; the most frequently reported was diabetes mellitus. Increasing CCI scores significantly affected graft and patient survivals. Crude analysis showed a significant association between CCI >1 and risk of death (hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.06-14.06; P = .04). After adjustment for several covariates, high CCI values remained significantly predictive of posttransplantation outcomes with a HR for death of (12.53; 95% CI, 1.9-82.68; P = .009). CONCLUSIONS: Our predictive model showed a strong association of CCI and patient survival even after adjustment for several clinical covariates. CCI may be used to evaluate patients referred for kidney transplantation who display a significant burden of comorbid conditions that increase the risk of premature death or graft loss.

The role of obesity in kidney transplantation outcome.

BACKGROUND: The number of obese kidney transplant candidates has been growing. However, there are conflicting results regarding to the effect of obesity on kidney transplantation outcome. The aim of this study was to investigate the association between the body mass index (BMI) and graft survival by using continuous versus categoric BMI values as an independent risk factor in renal transplantation. METHODS: We retrospectively reviewed 376 kidney transplant recipients to evaluate graft and patient survivals between normal-weight, overweight, and obese patients at the time of transplantation, considering BMI as a categoric variable. RESULTS: Obese patients were more likely to be male and older than normal-weight recipients (P = .021; P = .002; respectively). Graft loss was significantly higher among obese compared with nonobese recipients. Obese patients displayed significantly lower survival compared with nonobese subjects at 1 year (76.9% vs 35.3%; P = .024) and 3 years (46.2% vs 11.8%; P = .035). CONCLUSIONS: Obesity may represent an independent risk factor for graft loss and patient death. Careful patient selection with pretransplantation weight reduction is mandatory to reduce the rate of early posttransplantation complications and to improve long-term outcomes.

Correlational study between psychic symptoms and quality of life among hemodialysis patients older than 55 years of age.

BACKGROUND: The loss of renal function and urination with dialysis can produce a strong emotional crisis in a patient. This study explored the correlation between psychic symptoms and quality of life among hemodialysis patients who were older than 55 years of age in relation to demographic characteristics of age, time on dialysis, and education. PATIENTS AND METHODS: Twenty patients undergoing hemodialysis were included in the study. The psychic symptoms were studied using the Symptom Checklist-90. Revised (SCL-90 R) and the quality of life was studied using the Complete Form Health Survey (SF 36). RESULTS: The high correlation between psychological sizes investigated through the SCL-90 R test and those for the SF-36 test confirmed the close relationship between physical disorders and mental suffering, and reduced vitality, and lack of socialization. CONCLUSION: The psychiatrist and psychologist may help hemodialysis patients to improve their quality of life by providing new coping strategies for each of the family, occupational, and social network.

Delayed graft function and long-term outcome in kidney transplantation.

BACKGROUND: There are still many controversies about the impact of delayed graft function (DGF) on kidney transplantation outcome. The aims of this study were to define factors associated with DGF and to ascertain the relative impact of DGF on kidney transplantation outcome, both in the early postoperative period and in long-term follow-up. PATIENTS AND METHODS: Four hundred kidney transplant recipients were reviewed to assess the clinical impact of DGF on long-term outcome. RESULTS: The overall prevalence of DGF was 24.3%. DGF was significantly associated with increasing recipient and donor age, duration of dialysis, and cold ischemia time. Patients with DGF displayed a significantly worse graft (P = .005) and patient (P < .001) survival compared with recipients with immediate function. CONCLUSION: DGF is a frequent complication of renal transplantation and may be associated with a reduced graft and even patient survival. Strategies to prevent graft injury and, more specifically, DGF may be an important clue to provide a better long-term outcome in kidney transplantation.

The Charlson comorbidity index as a predictor of outcomes in liver transplantation: single-center experience.

Several comorbidity indices, such as the Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score, have been used to optimize available organ resources and adjust priorities in diagnosis and allocation of grafts for patients who are candidates for liver transplantation. There have also been various attempts to create instruments to accurately predict outcomes after liver transplantation, but none has proved to be truly applicable, with the exception of the Charlson comorbidity index (CCI). We retrospectively reviewed data of 221 liver recipients, including living-related liver transplantation and multiple organ transplantation performed between January 2006 and September 2009. Survival analysis revealed a significant association of the CCI with decreased posttransplantation patient survival (P = .003). Furthermore, Kaplan-Meier plots and log-rank test showed a significant association between graft survival and the score (P = .039). Our data suggest that the CCI is a simple tool for the evaluation of comorbidity and that increased preoperative patient comorbidity increases the risk of graft loss and patient death after liver transplantation. The CCI should be considered an important tool for improving patient care because of its potential applications for patient management.

Probiotics in the gastrointestinal diseases of the elderly.

Changes of the gut microflora in elderly appear to involve a reduction in numbers of healthy bacteria (lactobacilli and bifidobacteria) and an increase in numbers of potentially pathogenic species. These changes are generally described as gastrointestinal disorders and infections. This review analyses benefits of probiotics in old people, with particular interesting for the latest researches relevant to elderly people, e.g. trials examining enteric infections, antibiotic-associated diarrhea and Clostridium difficile associated diarrhea, functional bowel problems (constipation and irritable bowel syndrome), inflammatory bowel diseases, stimulation of the immune system and prevention of cancer. A growing number of researches indicates that some probiotic strains may help to maintain the health in old people, suggesting both health and cost-saving benefits in offering fermented dairy products. These benefits include: establishment of balanced intestinal microflora; improving colonization resistance and or prevention of diarrhea; reduction of fecal enzymes; reduction of serum cholesterol; reduction of potential mutagenes; reduction of lactose intolerance; synthesis of vitamins; predigestion of proteins.

Pattern of antibiotic use in the community: νon-adherence and self-prescription rates in an Italian urban population.

The aim of the present study was to assess the pattern of antibiotic use in a community setting of an urban area of Italy and identify factors that affect adherence to their use. By using a questionnaire-based survey, we collected 1,269 interviews and performed analysis on those patients who had their last course of antibiotic within the past 12 months (956 subjects). Among the subjects reporting that they had not followed their last antibiotic course as prescribed, 14.7% stopped therapy early, 5.4% modified the dosage, and 5% changed the prescribed antibiotic. Approximately 23% of the subjects declared that they self-prescribed antibiotics. After adjusting for all covariates, major predictors for the self-prescription of antibiotics were younger age, female gender and higher socioeconomic and educational status. Conversely, both low educational and socioeconomic status were associated with a higher risk of non-adherence to physician indications. The findings of this study assessed the widespread pattern of poor antibiotic-taking behavior and provides important implications for understanding the targets of future educational campaigns to control the use and misuse of antibiotics.

Primary headaches in children: clinical findings on the association with other conditions.

The aim of the present study is to report on the frequency of some comorbidities in primary headaches in childhood. Two hundred and eighty children (175 males and 105 females; ratio 1.7:1), aged 4 to 14 years, affected by primary headaches were consecutively enrolled in this study. In direct interviews, parents and children gave information about the association of their headaches with different conditions including asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight, affections some time associated in the literature to headache as comorbidities . In addition, anxiety and depression, attention deficit/hyperactivity disorder, tics, learning disabilities and obsessive-compulsive disorders, using psycho-diagnostic scales were evaluated. Two hundred and eighty children matched for age, sex, race and socio-economic status, were used as controls. No significant association of primary headaches was found with asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight. Overall behavioral disorders were more common in children who experienced headache than in controls. A significant association of primary headache was found with anxiety and depression (p value < 0.001), but not with the other psychiatric disorders. Primary headaches in children are not associated with most of the psychiatric and systemic conditions herein investigated. On the contrary, there was a significant association with anxiety and depression, as frequently reported in adults.

[Adherence to antihypertensive and lipid-lowering medications: a problem of public health, not yet resolved]. / Aderenza alla terapia con farmaci antipertensivi e ipolipemizzanti: un problema di sanità pubblica ancora irrisolto.

Assessment of compliance in patients with relevant comorbidity condition, above all those at high cardiovascular risk, is especially relevant because their clinical condition can be considerably mitigated by treatment with concomitant antihypertensive (AH) and lipid-lowering (LL) medications. The aim of the study was to evaluate patterns and predictors of adherence and persistence with concomitant AH and LL therapy. This retrospective cohort study included 363 enrolled from database of 3 physicians who initiated treatment with AH and LL therapy between January 2007 and January 2010. Adherence was measured as the proportion of days covered in 3-month intervals and patients were considered adherent if they had filled prescriptions for at least 80% of the period. Persistence was measured as absence of discontinuation define as > 30 days between a filled prescription and the subsequent claim. A multivariate analysis with a Cox regression model was performed to evaluate potential predictors of adherence and persistence. Finally, patients outcome was evaluated to assess potential association with adherence and persistence with AH and LL therapy. The mean percentage of patients adherent with both AH and LL medications was 39%, declining from 47% to 31%. The mean percentage of persistence was 43%. After adjustment for variables of interest, major predictors of adherence and persistence were the number of concomitant prescriptions, age of patients, gender time between start of AH and LL therapy, and gravity of coronary disease. Finally, adherent and persistent patients had significant lower blood pressure compared to other subjects. Adherence and persistence with concomitant AH and LL therapy was poor and declined over time. Interventions to improve these attitudes and to contain costs affecting a limited health budget are needed.

[Project financing in public hospital trusts]. / Il project financing nel settore ospedaliero.

The growing debate in recent years over how to finance public works through private capital has progressively highlighted the role of project finance (PF) and publicprivate partnerships (PPP) in general. More and more European countries are turning to PF to finance their public infrastructure development. The UK, which pioneered the adoption of project finance in this field, has been followed by Italy, Spain, France, Portugal and Germany and more recently by Greece, Czech Republic and Poland. Beginning in the late 1990's, Italy has steadily amplified its use of PF and PPPs in key sectors such as healthcare as an alternative way of funding the modernisation of its health facilities and hospitals. The trend reveal an average annual growth of 10.9% since 2002 with peaks of varying intensity over the five year period. Project finance and PPPs represent an effective response to the country's infrastructure gap and support the competitiveness of local systems and the quality of public services. None of this will transpire, however without energetic new planning efforts and adequate policy at the centre.

Role of socioeconomic conditions on outcome in kidney transplant recipients.

INTRODUCTION: While deaths with a functioning graft have occurred more frequently in recent years, other nonimmunologic factors may have an important role in late allograft loss. These variables include socioeconomic and cultural status as risk factors for posttransplantation noncompliance with therapy. We examined the effect of socioeconomic and cultural status on graft and patient survival in a population of kidney transplant recipients. PATIENTS AND METHODS: This retrospective study included 223 kidney transplantations performed between September 2000 and December 2006. RESULTS: A significant improvement in graft and recipient survival was observed with increased educational achievement level. Subjects with a high school diploma or college degree demonstrated significantly better outcome. Recipients who had attended intermediate or technical schools were also significantly more likely to have a better outcome than the lowest educational group. Using the lowest socioeconomic class as a reference, a proportional hazard model demonstrated statistically significant benefit for better outcome in patients with skilled occupations. CONCLUSIONS: Results of the present study showed a significant difference in kidney transplantation outcome between different socioeconomic and educational classes. These results could help physicians to educate patients with end-stage renal disease to better understand long-term recovery after transplantation.

[Evolution of hospital concept in Italy]. / Evoluzione del concetto di ospedale in Italia.

Hospital building trade was born before the origin of Healthcare System and followed the complex development of healthcare during all the past years to present day. At the beginning of 700's, when infective pathology was predominant and hygienic conditions was parameter of quality, pavilions structure took place. These hospitals required wide land to be built on, with a high surface area to volume ratio and a horizontal development. There were about 1200-1500 sleeping accommodations in large rooms (ward) where patients were split up. The typical pavilions structure were used until half 900's when it was replaced with a new concept of building trade, the mono-polibloc. They were buildings with vertical development that minimized horizontal distances and operating costs. Every floor has confinement and service rooms and represent a single and autonomous operating unit. Nowadays hospitals building trade point to use the flat-tower model that enhance the distinction between confinement area (with a vertical development-monobloc) and diagnosis, care and services area (with a horizontal development-flat). The challenge we willface in the future is to convert healthcare buildings to other uses like trading centres and services areas, to improve structures' flexibility, to better include them in the context of the urban and natural setting.

[Drug misuse in the community: factors which influence patients to self-prescribe antibiotics]. / L'abuso di farmaci nella comunità: fattori che influenzano i pazienti ad autoprescrivere gli antibiotici.

This study aimed at deepening our knowledge about patients' non-compliance with antibiotic treatment, at determining which patients in our community use antibiotics without consulting a physician and at examining patient characteristics associated with such antibiotic misuse. The study focused on the correlation between self-prescribing antibiotic and socioeconomic and cultural status. Data were obtained by using a questionnaire-based survey and we computed univariate and multivariate analysis using chi-square test and logistic regression model. Of 663 respondents, 18.7% admitted using non-prescribed antibiotics. Multivariate analysis identified four variables associated with self-prescribing antibiotic: age [p= 0.009; for patients aged 25-44 and over 65 OR: 1.87 (95% C.I.: 0.66-5.32) and OR: 0.55 (95% C.I.: 0.17-1.80) respectively], gender [p=0.027; for women OR: 1.67 (95% C.I.: 1.06-2.64)], socioeconomic (p=0.022) and cultural status (p=0.037) where classes associated with high risk are the most elevated [for highest socioeconomic class OR: 3.99 (95% C.I.: 1.47-10.85) and for highest cultural class OR: 1.37 (95% C.I.: 0.65-2.86)]. Our study demonstrates that high socioeconomic and cultural status is associated with self-administering antibiotics. These results can be used to design appropriate interventions and target future educational campaigns to control and correct use of antibiotics.

Clinical and endoscopic presentation of primary gastric lymphoma: a multicentre study.

BACKGROUND: Although the stomach is the most frequent site of intestinal lymphomas, few data are available on both clinical endoscopic presentation of gastric lymphoma and possible differences between low-grade and high-grade lymphomas. METHODS: Clinical, histological and endoscopic records of consecutive patients with primary low-grade or high-grade lymphoma diagnosed were retrieved. Symptoms were categorized as 'alarm' or 'not alarm'. The endoscopic findings were classified as 'normal' or 'abnormal'. RESULTS: Overall, 144 patients with primary gastric lymphoma were detected, including 74 low-grade and 70 high-grade lymphoma. Alarm symptoms, particularly persistent vomiting and weight loss, were more frequently present in patients with high-grade lymphoma than in those with low-grade lymphoma (54% vs. 28%; P = 0.002). Low-grade lymphomas presented as 'normal' appearing mucosa (20% vs. 0%; P = 0.0004) or petechial haemorrhage in the fundus (9% vs. 0%; P = 0.02) more frequently than high-grade lymphomas, being also more often confined to the antrum (47% vs. 27%, P = 0.03) and associated with Helicobacter pylori infection (88% vs. 52%, P < 0.0001). On the contrary, high-grade lymphomas presented more commonly as ulcerative type (70% vs. 52%; P = 0.03), being also more frequently diagnosed in stage >I when compared with low-grade lymphomas (70% vs. 21%, P < 0.0001). CONCLUSIONS: The overall prevalence of alarm symptoms is quite low and may be absent in more than 70% of patients with low-grade lymphoma.

Normal human lung fibroblasts differently modulate interleukin-10 and interleukin-12 production by monocytes: implications for an altered immune response in pulmonary chronic inflammation.

The ability of lung fibroblasts to modulate the immune response has been evaluated by analyzing the synthesis and release of interleukin (IL)-10 and IL-12 by lipopolysaccharide (LPS)-stimulated peripheral blood monocytes exposed to pulmonary fibroblast conditioned medium (FCM). IL-10 and IL-12 contents and gene expression were markedly modified by treatment with FCM as measured by ELISA (+97.5 +/- 12.8% and -68 +/- 7.3% for IL-10 and IL-12, respectively), immunocytochemistry, and reverse transcriptase-polymerase chain reaction (RT-PCR). These effects appeared to be mediated by prostaglandin E(2) (PGE(2)) as the modified release of both cytokines was reduced by treatment with indomethacin and mimicked by addition of exogenous PGE(2.) As a result of the enhanced production of IL-10, exposure of LPS/interferon (IFN)-gamma-activated monocytes to FCM was also able to reduce the expression of the class II major histocompatibility complex (MHC) molecule, human leukocyte-associated antigen-DR (HLA-DR) (-51.8 +/- 8.7%) and of the costimulatory molecule, CD40 (-53.9 +/- 11.7%). The expression of both molecules was completely restored when monocytes were pretreated with a neutralizing anti-IL-10 monoclonal antibody. The FCM obtained from fibrotic lung fibroblasts was instead less efficacious in potentiating LPS-stimulated IL-10 release and, consequently, in reducing HLA-DR and CD40 expression, suggesting that an impairment of the immune regulation operated by fibroblasts may be involved in the maintenance of chronic pulmonary inflammation.

Role of endogenous nitric oxide in asthma.

Endogenous nitric oxide (NO) is an ubiquitous signaling molecule with important regulatory functions such as regulation of blood pressure, neurotransmission, and host and immune defense. In the respiratory tract, NO is formed and released by various sources including endothelial and epithelial cells, nerves, airway smooth muscle, and inflammatory cells. Recent evidence suggests that endogenous NO is the neurotransmitter of the nonadrenergic noncholinergic inhibitory (iNANC) system, the only bronchorelaxant neural pathway of human airways. A number of studies also suggest that in some species epithelium-derived NO accounts for the functional bronchoprotective role of the so-called epithelium-derived relaxing factor. In human airways, endogenous NO counteracts the bronchoconstriction induced by pharmacologic stimuli such as bradykinin, histamine, and methacholine. On the basis of these and other observations, it is suggested that a reduced synthesis and/or activity of endogenous NO may contribute to the pathogenesis of airway hyperresponsiveness that characterizes asthma and other respiratory disorders. This short paper summarizes the activities of endogenous NO in the airways of experimental animals and man, and discusses the evidence supporting the view that NO confers bronchoprotection.