Azienda ULSS numero 20 Verona

Emergency and critical care services inevitably expose their staff to potential work stressors and traumatic events, which can cause emotional, behavioral, and physical reactions. The literature presents a wide range of evidence-based knowledge on the effectiveness of interventions to promote mental health after traumatic events. However, little is known about the effectiveness of prevention programs. In this study, we sought to improve the empirical understanding of the potential of a combination of psycho-educational-defusing training for trauma prevention. We employed a mixed methods approach using statistical modeling and content/focus group analysis to describe the sample of investigation and the effectiveness of the prevention training. A retrospective quantitative chart measured and evaluated the psychological state of physicians, nurses, and registered nurses (N = 222). A retrospective qualitative chart examined staff accounts of traumas and their coping strategies via autobiographies (n = 26). Prospective focus groups examined participants of the psycho-educational defusing intervention administered (n = 61). Findings revealed different forms of experiencing grief and trauma. Prospective analysis of the training effectiveness revealed favorable perceptions by participants. Results support the formal implementation of continuous prevention, building relational support, and coping strategies as keys to recovery and preventing traumas.

Background In highly treatment-experienced people with HIV (PWH) mutations interact within a complex system. To date, network-based approach has not been used to study HIV mutations. This study aims to identify communities of mutations archived in proviral DNA in PWH with 4-class drug resistance (PWH-4DR) under virological suppression. Methods HIV-1 DNA next-generation sequencing (Illumina MiSeq) was performed with a 5% cutoff; we included major mutations (based on Stanford HIV Drug Resistance Database) detected in suppressed individuals from the PRESTIGIO Registry. A correlation network was constructed by calculating Spearman coefficients between each pair of mutations (nodes). Weighted edges represent significant correlations (adjusted Benjamini-Hochberg p<0.001) with thresholds set at the 5th and 95th percentiles for negative and positive values, respectively. The analysis was repeated including other mutations (accessory and polymorphisms non-resistance related) detected in ≥10% of study population. Results Overall 91 PWH-4DR, maintaining HIV-RNA<50 cps/mL for a median of 3.2 (IQR=1.7–5.0) years, included: at sampling 70 (77%) males, median (IQR) age 54 (50–59) years, on ART for 23 (21–25) years, on the current ART regimen for 2.6 (1.5–3.6) years and CD4+ 655 (484–890) cells/mm3. Out of 1226 mutations detected, 71 majors [25 for protease inhibitors (PI), 13 for nucleoside reverse transcriptase inhibitors (NRTI), 18 for non-nucleoside reverse transcriptase inhibitors (NNRTI), 15 for integrase strand transfer inhibitors (INSTI)] were selected for the above criteria. Network analysis revealed 3 connected components that are biologically relevant (figure 1). The largest one (Figure 1, A-component) is characterized by 2 distinct communities, connected by a negative correlation among thymidine analog mutations (TAMs), indicating mutually exclusive mutation patterns; type 2 TAMs are associated with a cluster of PI major mutations, while type 1 are linked to L90M for PIs and Y188L for NNRTIs. The B-component in figure 1 is characterized by a pattern of INSTI major mutations, where Q148K is the connector node between 3 groups, composed of NNRTI and major mutations from other drug classes. The second analysis including all mutations (71 majors, 125 minors, 6 stop codons) confirms the structure of these components (figure 2: A-, B-, C-component), suggesting that not only major mutations may play a role in generating the network. Regarding potentially defective reservoir in proviral DNA, the C-component in figure 2 presents a cluster of stop codons associated with APOBEC-related context drug resistance mutations. • Download figure • Open in new tab • Download powerpoint Abstract OC-18 Figure 1 Correlation network of major mutations according to 4-class drug-resistant HIV • Download figure • Open in new tab • Download powerpoint Abstract OC-18 Figure 2 Correlation network of major and other mutations Conclusions In PWH-4DR network analysis allows the identification of distinct clusters of major mutations across different drug classes; it also highlights the direction and strength of the association between them. This innovative approach may outline the complex system of relations between proviral DNA mutations.

Introduction Porcine circovirus 2 (PCV-2) is a key pathogen for the swine industry at a global level. Nine genotypes, differing in epidemiology and potentially virulence, emerged over time, with PCV-2a, -2b, and -2d being the most widespread and clinically relevant. Conversely, the distribution of minor genotypes appears geographically and temporally restricted, suggesting lower virulence and different epidemiological drivers. In 2022, PCV-2e, the most genetically and phenotypically divergent genotype, was identified in multiple rural farms in North-eastern Italy. Since rural pigs often have access to outdoor environment, the introduction from wild boars was investigated. Methods Through a molecular and spatial approach, this study investigated the epidemiology and genetic diversity of PCV-2 in 122 wild boars across different provinces of North-eastern Italy. Results Molecular analysis revealed a high PCV-2 frequency (81.1%, 99/122), and classified the majority of strains as PCV-2d (96.3%, 78/81), with sporadic occurrences of PCV-2a (1.2%, 1/81) and PCV-2b (2.5%, 2/81) genotypes. A viral flow directed primarily from domestic pigs to wild boars was estimated by phylogenetic and phylodynamic analyses. Discussion These findings attested that the genotype replacement so far described only in the Italian domestic swine sector occurred also in wild boars. and suggested that the current heterogeneity of PCV-2d strains in Italian wild boars likely depends more on different introduction events from the domestic population rather than the presence of independent evolutionary pressures. While this might suggest PCV-2 circulation in wild boars having a marginal impact in the industrial sector, the sharing of PCV-2d strains across distinct wild populations, in absence of a consistent geographical pattern, suggests a complex interplay between domestic and wild pig populations, emphasizing the importance of improved biosecurity measures to mitigate the risk of pathogen transmission.

Delayed anaphylaxis after ingestion of red meat because of galactose-alpha-1,3-galactose (alpha-gal) syndrome has increased in recent years. The mechanism involves an immunoglobulin E reaction to alpha-gal, a molecule found in mammalian meat, dairy products, medications and excipients containing mammalian-derived components, and tick salivary glycans. Sensitization occurs due to the bite of a lone star tick and the transmission of alpha-gal molecules into person's bloodstream. We describe a case of alpha-gal syndrome with severe food, drug, and perioperative allergy in which anaphylaxis with hypovolemic shock occurred immediately after an emergency surgical procedure, when a gelatin-containing drug was injected. This case study confirms that the clinical manifestations of alpha-gal syndrome could be different depending on the route of administration, with immediate reactions if an alpha-gal-containing drug is injected and delayed type allergic manifestations occurring several hours after oral intake. The purpose of this report is to highlight the importance of risk communication in case of exposure to medical products and surgical procedures of patients with alpha-gal syndrome and to encourage drug manufacturers to indicate clearly the origin of excipients in product literature.

Objectives Circulating tumor DNA (ctDNA) is emerging as a potential prognostic biomarker in multiple tumor types. However, despite the many studies available on small series of patients with ovarian cancer, a recent systematic review and meta-analysis is lacking. The objective of this study was to determine the association of ctDNA with progression-free-survival and overall survival in patients with epithelial ovarian cancer. Methods An electronic search was conducted using PubMed (MEDLINE), Embase, CENTRAL (Cochrane Library), and CINAHL-Complete from January 2000 to September 15, 2023. To be included in the analysis the studies had to meet the following pre-specified inclusion criteria: (1) evaluable ctDNA; (2) progression-free-survival and overall survival reported as hazard ratio (HR); and (3) the patient population had epithelial ovarian cancer at the time of ctDNA detection. We evaluated the association of ctDNA with progression-free survival and overall survival. Secondary outcomes focused on sub-group analysis of genomic alterations and international Federation of Gynecology and Obstetrics (FIGO) stage. Results A total of 26 studies reporting on 1696 patients with epithelial ovarian cancer were included. The overall concordance rate between plasma-based and tissue-based analyses was approximately 62%. We found that a high level of ctDNA in epithelial ovarian cancer was associated with worse progression-free survival (HR 5.31, 95% CI 2.14 to 13.17, p<0.001) and overall survival (HR 2.98, 95% CI 1.86 to 4.76, p<0.0001). The sub-group analysis showed a greater than threefold increase in the risk of relapse in patients with positive HOXA9 meth-ctDNA (HR 3.84, 95% CI 1.57 to 9.41, p=0.003). Conclusions ctDNA was significantly associated with worse progression-free survival and overall survival in patients with epithelial ovarian cancer. Further prospective studies are needed. PROSPERO registration number CRD42023469390.

Purpose: this systematic review with meta-analysis aimed to assess the effectiveness of electrophysical agents in improving pain, function, disability, range of motion, quality of life, perceived stiffness, and time to recovery in subjects with frozen shoulder (FS). Methods: A thorough search of MEDLINE, cochrane library, PeDro, and EMBASE yielded 1143 articles, of which 23 randomized controlled trials were included. Risk of bias (RoB) was assessed through cochrane Risk of Bias 2 tool. The certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development, and evaluation (GRADe). Results: the analysis included a total of 1073 subjects. None of the studies were judged as low RoB. Potentially clinically significant differences were observed in pain at 6 weeks and 5 months after extracorporeal shockwave therapy (ESWT), and in disability up to 3 months with laser therapy, albeit with uncertain results due to the high RoB and to the study heterogeneity. Ultrasound (US) therapy did not yield significant differences in any outcomes. the certainty of evidence was very low. Conclusions: Based on the high heterogeneity and low quality and certainty of evidence, ESWT, laser, and US cannot be recommended for FS treatment. Caution should be exercised in interpreting the findings.

Background Worldwide uptake of telepsychiatry accelerated during the COVID-19 pandemic. Objective To conduct an evaluation of the opinions, preferences and attitudes to telepsychiatry from service users, carers and clinicians in order to understand how telepsychiatry can be best used in the peri/post-COVID-19 era. Methods This mixed-methods, multicentre, international study of telepsychiatry was set in two sites in England and two in Italy. Survey questionnaires and focus group topic guides were co-produced for each participant group (service users, carers and clinicians). Findings In the UK, 906 service users, 117 carers and 483 clinicians, and in Italy, 164 service users, 56 carers and 72 clinicians completed the surveys. In all, 17 service users/carers and 14 clinicians participated in focus groups. Overall, telepsychiatry was seen as convenient in follow-ups with a specific purpose such as medication reviews; however, it was perceived as less effective for establishing a therapeutic relationship or for assessing acutely disturbed mental states. In contrast to clinicians, most service users and carers indicated that telepsychiatry had not improved during the COVID-19 pandemic. Most service users and carers reported that the choice of appointment modality was most often determined by the service or clinician. Conclusion and relevance There were circumstances in which telepsychiatry was seen as more suitable than others and clear differences in clinician, carer and service user perspectives on telepsychiatry. Clinical implications All stakeholders should be actively engaged in determining a hybrid model of care according to clinical features and service user and carer preferences. Clinicians should be engaged in training programmes on telepsychiatry.

Introduction Porcine circovirus 3 (PCV-3) was firstly reported in 2017. Although evidence of its pathogenic role has been provided, its clinical relevance seems lower than Porcine circovirus 2 (PCV-2), as well as its evolutionary rate. Different studies have reported a high PCV-3 prevalence in wild boars, sometimes higher than the one observed in commercial pigs. Nevertheless, to date, few studies have objectively investigated the relationships between these populations when inhabiting the same area. Moreover, the role of small-scale, backyard pig production in PCV-3 epidemiology is still obscure. Methods The present study investigated PCV-3 occurrence in 216 samples collected from the same area of Northern Italy from commercial and rural pigs, and wild boars. PCV-3 presence was tested by qPCR and complete genome or ORF2 sequences were obtained when possible and analysed using a combination of statistical, phylogenetic and phylodynamic approaches. Results A higher infection risk in wild boars and rural pigs compared to the commercial ones was demonstrated. The phylodynamic analysis confirmed a larger viral population size in wild and rural populations and estimated a preferential viral flow from these populations to commercial pigs. A significant flow from wild to rural animals was also proven. The analysis of the Italian sequences and the comparison with a broader international reference dataset highlighted the circulation of a highly divergent clade in Italian rural pigs and wild boars only. Discussion Overall, the present study results demonstrate the role of non-commercial pig populations in PCV-3 maintenance, epidemiology and evolution, which could represent a threat to intensive farming.

Introduction: Bias in dissemination and reporting of clinical research findings has an impact on the pooled summary utilised to produce clinical-therapeutic guidelines and recommendations. This analysis aims to evaluate the dissemination and reporting biases of interventional and observational studies conducted in the setting of the Local health authority of Verona (Aulss). The possible correlation between both biases and profit versus no-profit sponsors was also evaluated. Methods: Verona's Aulss studies completed in the period 01.01.2014-31.01.2021 were extracted from the Clinical study register of the Veneto Region and any form of results' dissemination was identified and compared with the original protocol. Identified studies were stratified by profit or no-profit sponsor and results compared using the Chi-Square test. Results: 67 studies (29 profit; 38 non-profit) were included in this analysis. 58.2% of the studies (n=39/67) reports at least one type of findings' dissemination, for 22.4% data-analysis or publication is in progress, while 19.4% has not been published. Regarding the evaluation on reporting bias, 36 of the 39 published studies were considered (n=19 profit; n=17 non-profit): 64% (23/36) showed inconsistencies between the results reported in the manuscript and the protocol. The number of non-compliant profit studies (n=15/19; 79%) was statistically higher than the compliant ones [n=8/17; 47%; (p=0.049; χ2=3.845)]. Discussion: This study highlights that findings' dissemination occurs for the majority of the studies evaluated and that the odds of selective reporting are higher for industry funded studies than for publicly funded studies, affecting the quality of the research.

Aim: Our aim was to evaluate the impact of the COVID-19 pandemic on breastfeeding at discharge in a Baby Friendly hospital in 2020. Methods: This study retrospectively compared healthy neonates born in 2019 with those born in 2020 at the Baby Friendly San Bonifacio Hospital in Verona, Italy. We also compared those born to mothers who tested negative and positive for the virus that causes COVID-19. Breastfeeding support practices, nationality and type of birth were evaluated. The outcomes were type of breastfeeding at discharge and the presence of breastfeeding difficulties. Results: We analysed 2,171 healthy neonates, which was 83.5% of those born in the hospital in 2019 and 2020, and 20 were born to mothers with the virus. Exclusive breastfeeding rates were 4.6% lower in 2020 than 2019 and breastfeeding difficulties rose by 10.1%. Mixed feeding, at the mother's request, and formula feeding due to medical indications, increased by 5.9% and 18.1%, respectively. Most of the Baby Friendly hospital practices were implemented, but prenatal and intrapartum support decreased. Conclusion: Exclusive breastfeeding fell during the COVID-19 pandemic in 2020 and breastfeeding difficulties rose. These may have been due to the effect of maternal and healthcare factors during the pandemic.

The use of social media has increased considerably in recent years. However, these tools are not always used consciously, and the stress that can result from their inappropriate use is often underestimated. Children, who tend to be heavy users of social media, are exposed to risks associated with their intensive use. Data on the consequences of social media on children’s health are extensive; however, few studies have examined the association between their use and functional gastrointestinal disorders (FGIDs). Our research showed that social media use is associated with adverse health outcomes such as stress, poor sleep quality, and gastrointestinal disorders in children and adolescents. FGIDs should be considered a group of biopsychosocial disorders involving gut dysfunction and psychological health. Stress may exacerbate the symptoms of these disorders and is associated with psychological comorbidities. Recent findings demonstrated a high prevalence of social media use and the incidence of psychological disorders, such as anxiety and depression, and decreased well-being in children with FGIDs. This review underlines that social media use is an emerging aspect of the psychosocial lives of children and adolescents; thus, it may be involved in FGID onset. Further studies in this field are needed to elucidate the link between social media and gastrointestinal health. Clinicians and politicians can play an important role in promoting the regulated and responsible use of digital platforms to protect the psychological health and preserve the well-being of children and adolescents.

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Background Factitious Disorder is a condition included among psychiatric disorders, where symptoms are intentionally produced to seek medical attention. Its epidemiology, treatment, and outcome are largely unknown. Objective To increase knowledge of the condition, we discuss a pediatric case where the patient feigned neuropsychiatric symptoms. Methods A 15-year-old female adolescent presented with neuropsychiatric symptoms suggestive of rare conditions such as Delusional Misidentification Syndrome [i.e., Capgras and Fregoli syndromes] and Developmental Prosopagnosia as well as epileptic seizures. Results When a Delusional Misidentification Syndrome was suspected, she was treated with Risperidone. Due to suboptimal response, Alprazolam and Sertraline were added and then Risperidone was cross-titrated to Haloperidol. The condition severity led to her admission to an inpatient Child and Adolescent Neuropsychiatry Unit. MRI scan and electroencephalographic recording were normal. The self- and parent-reported psychological assessment indicated several psychiatric symptoms. Instead, the clinician-administered Minnesota Multiphasic Personality Inventory-Adolescent and Structured Inventory of Malingered Symptomatology suggested a fake-bad profile and neuropsychiatric symptom simulation. Along with evidence of incongruent symptoms between the patient’s interviews, such investigations led to the diagnosis of Factitious Disorder. Psychopharmacological treatment was discontinued, and psychological support was offered to the patient and her parents. Conclusion Increasing knowledge about Factitious Disorder is needed.

Many studies have investigated the impact of gender on mental health, but only a few have addressed gender differences in mental health risk and prevention. We conducted a narrative review to assess the current state of knowledge on gender-specific mental health preventive interventions, along with an analysis of gender-based risk factors and available screening strategies. Out of 1598 articles screened using a comprehensive electronic search of the PubMed, Web-of-Science, Scopus, and Cochrane databases, 53 were included for review. Among risk factors for mental health problems, there are individual, familiar, social, and healthcare factors. Individual factors include childhood adversities, which show gender differences in distribution rates. However, current childhood abuse prevention programs are not gender-specific. Familiar factors for mental health problems include maternity issues and intimate partner violence, and for both, some gender-specific preventive interventions are available. Social risk factors for mental health problems are related to education, employment, discrimination, and relationships. They all display gender differences, but these differences are rarely taken into account in mental health prevention programs. Lastly, despite gender differences in mental health service use being widely known, mental health services appear to be slow in developing strategies that guarantee equal access to care for all individuals.

Introduction: Management by the palliative care network (RLCP) has been identified as one of the major determinants of clinical appropriateness and reduction of hospital admissions in cancer patient's end of life. The patient's transition process from hospital cancer care to palliative home care is particularly frail from both a clinical and organizational point of view, requiring a multidimensional assessment (VMD) and the draft of an individual care plan (PAI). The aim of this study was to assess the impact of appropriate home-based palliative care in reducing hospitalizations, and also to identify critical issues in the patient's transition to home palliative care. Methods: Retrospective cohort study enrolling all 375 patients listed by the Local Health Authority No.8, Veneto Region (North-East Italy), as dying of cancer in 2017 and living at home during the last six months before death. Results: Of the cohort considered, 40% patients had been taken into care by a palliative home-care team. These patients were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life than patients who were not taken into palliative network's care. Reporting of the oncologist to the Primary Care Doctor (MAP) for activation of home palliative care services takes place on average 120 days prior to death. 18.8% of these reports are not acknowledged and do not result in the MAP request for palliative home care. The time interval between the reporting of the need by the oncologist and the execution of the VMD is on average 36.8 days. The absence of the palliative care specialist during the VMD is associated with lower likelihood of being taken into care by palliative care teams (52.4% vs 97.3%) and a delay in their activation (56.3 vs 3.81 days), compared to cases in which the palliative care provider was present. Discussion and conclusions: Our findings indicate that the access to a palliative care network enables more terminally ill consenting cancer patients to spend their last days at home with relatives, reducing end-of-life hospital utilization and in-hospital deaths. There's evidence of critical issues in coordination and integration of professionals operating within the palliative network, precluding or delaying access to appropriate palliative care. These results could be useful to palliative care providers in order to review their networks and make them accessible, effective, compliant with current legislation and sustainable over time.

Aims We assessed the outcome of hospitalized coronavirus disease 2019 (COVID-19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID-19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF-COVICAV). The primary endpoint was in-hospital mortality. Of 1974 patients hospitalized with COVID-19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in-hospital mortality was 25% (n = 323/1282 deaths). In-hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non-HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in-hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in-hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001). Conclusions Hospitalized COVID-19 patients with HF are at increased risk for in-hospital death. In-hospital worsening of HF or acute HF de novo are common and associated with a further increase in in-hospital mortality.

AURORA aims to study the processes of relapse in metastatic breast cancer (MBC) by performing multi-omics profiling on paired primary tumors and early-course metastases. Among 381 patients (primary tumor and metastasis pairs: 252 targeted gene sequencing, 152 RNA sequencing, 67 single nucleotide polymorphism arrays), we found a driver role for GATA1 and MEN1 somatic mutations. Metastases were enriched in ESR1, PTEN, CDH1, PIK3CA, and RB1 mutations; MDM4 and MYC amplifications; and ARID1A deletions. An increase in clonality was observed in driver genes such as ERBB2 and RB1. Intrinsic subtype switching occurred in 36% of cases. Luminal A/B to HER2-enriched switching was associated with TP53 and/or PIK3CA mutations. Metastases had lower immune score and increased immune-permissive cells. High tumor mutational burden correlated to shorter time to relapse in HR+/HER2− cancers. ESCAT tier I/II alterations were detected in 51% of patients and matched therapy was used in 7%. Integration of multi-omics analyses in clinical practice could affect treatment strategies in MBC. Significance The AURORA program, through the genomic and transcriptomic analyses of matched primary and metastatic samples from 381 patients with breast cancer, coupled with prospectively collected clinical data, identified genomic alterations enriched in metastases and prognostic biomarkers. ESCAT tier I/II alterations were detected in more than half of the patients. This article is highlighted in the In This Issue feature, p. 2659