Search Results (171)

Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study was to evaluate the impact of LUS, performed by a non-expert operator, in determining diagnosis and prognosis of patients with dyspnea. Methods: A total of 60 patients presenting with dyspnea at the ED were prospectively enrolled and underwent LUS examination by a medical student, after brief training, within 3 h of triage. LUS findings were classified into four patterns: N.1, absence of notable ultrasound findings, attributable to COPD/ASMA exacerbation; N.2, bilateral interstitial syndrome, suggestive of acute heart failure; N.3, subpleural changes/parenchymal consolidations, suggestive of pneumoniae; and N.4, isolate polygonal triangular consolidation, attributable to infarction in the context of pulmonary thromboembolism. Results: The diagnostic hypothesis formulated after LUS was compared with the final diagnosis after further investigations in the ED, showing agreement in 90% of cases. The mean LUS score value was higher in patterns N.2 (18.4 ± 8.5) and N.3 (17 ± 6.6), compared to patterns N.1 and N.4 (9.8± 6.7 and 11.5 ± 2.1). Given the high prevalence of pattern N.2, the diagnostic accuracy of LUS in this context was further evaluated, showing a sensitivity of 82% and specificity of 100%. In terms of the prognostic value of LUS, hospitalized patients had a higher LUS score compared to those discharged (17.3 ± 8.1 vs. 8.5 ± 6.8, p value 0.004). A similar trend was obtained in the subgroup of patients requiring non-invasive ventilation (NIV), who present a higher LUS score (21.1 ± 6.6 vs. 13.1 ± 8.1, p value 0.002). When considering a combined outcome (death and NIV), patients with worse outcomes more often had a LUS score > 15 (p value < 0.001). Conclusions: In conclusion, this study confirms that LUS is a very useful tool in the ED, assisting the clinical evaluation for diagnosis, treatment decision, and determination of the appropriate care setting for patients with acute dyspnea. Its short learning curve allows even non-expert staff to use it effectively. Full article

In the last decades, there has been huge interest in Per- and Polyfluoroalkyl Substances (PFAS) worldwide because of the toxic effects on humans. In 2013, a large-scale contamination of PFASs in the Veneto region was caused by a fluorochemical plant in Vicenza. About 130,000 inhabitants were exposed to PFAS in their drinking water. To date, relatively few studies have investigated the associations between blood serum PFAS concentrations and oxidative stress in semen. This study compared the antioxidant activity, lipoperoxide levels and protection or induction of oxidative DNA damage by sperm nuclear basic proteins (SNBP) in subjects living in Veneto exposed to PFAS (VNT) with those living in a non-PFAS contaminated area (VSL). Although the semen parameters were within the WHO range, the VNT semen samples showed higher levels of lipoperoxides and lower antioxidant activity compared to the VSL samples. These differences were statistically significant. We also examined DNA damage following SNBP addition under pro-oxidative conditions, finding a significantly different distribution of DNA damage types between the two groups, where 0 means no damage and 1 to 3 means increasing damage with 3 indicating maximum damage. SNBP of VNT subjects showed a reduced ability to protect DNA from oxidative damage. In the VSL group, damage 0 was found in 56% of subjects, 35% of the VNT group show damage 1, 36% damage 2 and 18% damage 3, while only 11% of VNT subjects show damage 0. Additionally, VNT with 0-grade DNA oxidative damage also exhibited reduced antioxidant activity and higher levels of lipoperoxides, in contrast to VSL. The results of this study indicate that exposure to PFAS produces oxidative stress in the semen of VNT subjects, who were also found to have blood serum perfluorooctanoic acid (PFOA) levels above the threshold. This suggests the possibility of infertility issues and emphasises the necessity for additional research into the long-term consequences of oxidative stress on male fertility and the health of offspring. Full article

Background/Objectives: Inequalities in access to nursing professionals represent a significant challenge to achieving equity in healthcare systems. In decentralized countries like Italy, disparities in the distribution of nurses persist despite a universal national health system. This study investigates the extent and determinants of regional inequality in the distribution of the nursing workforce in Italy. Methods: A retrospective ecological analysis was conducted using administrative data from official national sources (ISTAT, Ministry of Health) concerning the number of nurses and population per region, along with Human Development Index (HDI) data from 2021. Descriptive statistics, the Gini coefficient, Lorenz curve, and Pearson correlation were used to assess inequality and identify influencing factors. Results: The national Gini coefficient was 0.136, indicating a moderate degree of inequality in the distribution of nurses across Italian regions. A strong positive correlation was observed between HDI and nurse-to-population ratio (r = 0.76, p < 0.001), suggesting that more developed regions have higher nursing density. Conclusions: Despite a universal healthcare system, Italy shows persistent regional disparities in nurse distribution. These findings emphasize the need for targeted policies and coordinated planning to reduce inequalities and ensure equitable access to nursing care across all regions. Full article

Background: Looking for anomalies and vascular control gains a central role in colon cancer surgery. Complete mesocolic excision (CME) presents technical challenges, primarily due to the considerable variability in the arterial configuration of the right colon. The importance of understanding colonic vascular anatomy has become more prominent with the adoption of this surgical technique. The aim of this study is to systematically review the vascular anatomical variations in the superior mesenteric artery (SMA) in the setting of extended lymphadenectomy for CME in right colon cancer and to show its impact in clinical practice. Methods: A systematic review of the literature on Medline (PubMed), Web of Science (WOS), and Scopus was performed according to PRISMA guidelines. The following criteria were set for inclusion: (1) studies reporting minimally invasive (robotic, laparoscopic, and hybrid techniques) or open CME/D3 lymphadenectomy; (2) studies reporting patients with right-sided colon cancer; (3) studies reporting the description or illustration of SMA variations. The methodological quality of all included studies was evaluated using the Newcastle–Ottawa Scale (NOS). Results: After the literature search, 800 studies were recorded, 31 studies underwent full-text reviews, and 9 studies met the inclusion criteria. All studies reported vascular variations in SMA, and the total number of patients was 813. No intraoperative complications were reported. In 6.4% of patients, post-operative bleeding occurred. Conclusions: Vascular anatomical variations are not a rare entity. In experienced centers, vascular anomalies are not associated with an increase in complications, both in traditional open and minimally invasive surgery (MIS). However, in MIS, full access to central vessels and intraoperative vascular control, moderate retraction, safety maneuvers, and accurate vascular dissection are mandatory. Full article

Ground-source heat pumps (GSHPs), despite their high efficiencies, are still not as cost-effective as air-source heat pumps, especially in urban environments, due to the necessity of drilling/excavation. Integrating GSHPs into existing geo-structures, such as underground tunnels, can play a vital role in reducing the overall costs of GSHP systems and promoting their use in cities. Tunnels can be realized through artificial ground freezing (AGF) by using probes for circulating the freezing fluid, which are left in the ground once the tunnel is completed. The novelty of the present work lies in the proposal of a sustainable reuse of AGF probes as ground heat exchangers (GHEs). The idea of converting AGF probes is both sustainable and cost-effective for GSHPs, as it can reduce installation costs by eliminating the drilling/excavation process. A test was performed for the first time in the Piazza Municipio metro station in Naples, Southern Italy, where several AGF probes, initially used for the construction of two tunnels, have then been converted into GHEs. The probes have been connected to a testing device called the energy box. The experiments included testing the heat transfer in the recovered AGF probes through cooling and heating operations. This work presents a numerical simulation of a test that has been validated against experimental results. Full article

Background/Objectives: Understanding how work environments affect nurses’ turnover intentions is crucial for improving retention and organizational stability. Research on factors influencing nursing turnover intentions in Italy is limited despite its significant impact on healthcare sustainability today. Aim: This study aims to identify the individual, interpersonal, and job-related factors influencing quit intentions among nurses, examining the mediating role of job satisfaction. Methods: Guided by the Job Demands–Resources (JD-R) theory and Social Exchange Theory (SET), this cross-sectional study applied structural equation modelling (SEM) to analyse theoretical relationships. Researchers collected data between August 2022 and December 2023 via an online survey sent to nurses in different settings across Italy. This study tested a hypothesised mediation model using SEM analysis, demonstrating good fit indices. Results: A total of 1745 nurses responded. The findings reveal that high job demands—physical, mental, and emotional workloads—were significantly associated with increased dissatisfaction and quit intentions. Conversely, job resources, including decision-making autonomy, inspiring leadership, and positive leader–member exchanges, were linked to greater job satisfaction and retention. Contrary to expectations, work satisfaction did not mediate the relationship between job demands/resources and turnover intentions. This could be explained by the strong direct effect of job satisfaction on turnover intentions. Additionally, younger nurses were more likely to report higher turnover intentions. Conclusions: Identifying potential quitters at an early stage is essential for the sustainability of healthcare organizations. Understanding the factors contributing to nurse turnover is crucial for developing effective retention strategies. This study emphasizes the need for healthcare organizations to prioritize supportive work environments to enhance nurse job resources, well-being, and retention. Full article

Background: Healthy cognitive functioning is a primary component of well-being, independence, and successful aging. Cognitive deficits can arise from various conditions, such as brain injury, mental illness, and neurological disorders. Rehabilitation is a highly specialized service limited to patients who have access to institutional settings. In response to this unmet need, telehealth solutions are ideal for triggering the migration of care from clinics to patients’ homes. Objectives: The aim of EARLY-COGN^3 will be threefold: (1) to test the efficacy of a digital health at-home intervention (tele@cognitive protocol) as compared to an unstructured cognitive at-home rehabilitation in a cohort of patients with Chronic Neurological Diseases (CNDs); (2) to investigate its effects on the biomolecular and neurophysiological marker hypothesizing that people with CNDs enrolled in this telerehabilitation program will develop changes in biological markers and cortical and subcortical patterns of connectivity; (3) to analyze potential cognitive, neurobiological, and neurophysiological predictors of response to the tele@cognitive treatment. Method: In this single-blind, randomized, and controlled pilot study, we will assess the short- and long-term efficacy of cognitive telerehabilitation protocol (tele@cognitive) as compared to an unstructured cognitive at-home rehabilitation (Active Control Group—ACG) in a cohort of 60 people with Mild Cognitive Impairment (MCI), Subjective Cognitive Complaints (SCCs), or Parkinson’s Disease (PD). All participants will undergo a clinical, functional, neurocognitive, and quality of life assessment at the baseline (T0), post-treatment (5 weeks, T1), and at the 3-month (T2) follow-up. Neurophysiological markers and biomolecular data will be collected at T0 and T1. Conclusions: EARLY-COGN^3 project could lead to a complete paradigm shift from the traditional therapeutic approach, forcing a reassessment on how CNDs could take advantage of a digital solution. (clinicaltrials.gov database, ID: NCT06657274) Full article

The term incel is a neologism combining “involuntary” and “celibate”, describing men who experience involuntary absence from sexual and romantic relationships. Incels frequently espouse conspiratorial and misogynistic ideologies, often engaging in verbal aggression. The present study aimed at qualitatively exploring the emotional experiences and beliefs articulated within an online incel community, contributing to the formation of its collective identity. A thread (453 comments) sampled from an Italian “incel” forum was analyzed by two independent raters, using thematic analysis. Four themes emerged: (a) “non-persons (i.e., women) are not like us” revealed perceived gender inequality and misogynistic beliefs, (b) “without experiences in adolescence you are ruined” reflected the belief that early romantic and sexual experiences are crucial for later relationship satisfaction, (c) “I have no life” captured expressions of profound distress and life dissatisfaction, and (d) “only ours is true suffering” highlighted a sense of unique victimhood. Incel group identity was shaped by gender role stress, primarily stemming from the perceived failure to meet socially constructed expectations of hegemonic masculinity. Suffering emerged as the dominant emotional experience, seemingly exacerbated by feelings of hopelessness regarding romantic and sexual prospects. The perceived subordinate status of men and male suffering were exploited to rationalize and perpetuate misogyny. The observed incels’ openness in discussing experiences of suffering and trauma may present an opportunity for the development of preventive interventions aimed at increasing help-seeking behavior in this population. Full article

Background/Objectives: The nursing profession is expected to undergo substantial transformations in the coming years due to rapidly evolving sociocultural, environmental, and technological changes. Defining and assessing nursing competencies are essential to ensuring high-quality care and fostering professional development. This systematic review aims to explore the future nursing competencies required and the sociocultural factors influencing their evolution. Methods: A comprehensive systematic search was conducted in several indexed databases PubMed, CINAHL, Scopus, and Web of Science databases using keywords such as “nursing competencies”, “future”, “healthcare systems”, and “demographic change”. Studies published within the last five years were included, and a rigorous quality assessment was performed. Results: The findings suggest that key sociocultural and technological factors—including environmental sustainability, technological advancements, innovation, globalization, urbanization, policy uncertainty, and demographic shifts—will significantly shape the development of nursing competencies. It is projected that nearly 70% of the nursing workforce will operate in highly unpredictable environments. The review highlights the need to develop interpersonal, higher-order cognitive, and system-level competencies, alongside complementary skills in personal and customer services, decision making, technology utilization, creativity, and scientific methodologies. Conclusions: Addressing the future challenges in nursing requires a holistic and strategic approach, including a cultural shift within the profession supported by targeted policies and sustained investment in education and continuous professional development. Training systems should prioritize the development of core competencies and promote lifelong learning to ensure adaptability in an evolving healthcare landscape. Full article

Background/Objectives: Caregivers engage in essential tasks that support patients’ well-being and survival, including administering medications, promoting healthy lifestyle choices, and monitoring and managing symptoms. To date, no valid and reliable instrument is available to assess Caregiver Contribution (CC) to self-care in chronic conditions in middle-income countries such as Albania. Aim: To evaluate the measurement properties (structural and construct validity, internal consistency reliability, stability, and measurement error) of the instrument CC to Self-Care of the Chronic Illness Inventory (CC-SC-CII) in Albanian caregivers caring for elderly people affected by multiple chronic conditions. Methods: A cross-sectional study. We enrolled caregivers of patients with multiple chronic conditions, from August 2020 to April 2021, if they were (a) 18 years of age or older and (b) were identified by the patient as the main unpaid caregiver. Results: Confirmatory factor analysis confirmed the two-factor structure of the CC to Self-Care Maintenance and Management scales and the one-factor structure of the CC to Self-Care Monitoring scale. Reliability estimates were adequate for all (coefficients ranging between 0.827 and 0.961). The construct’s validity was supported. The measurement error was adequate. Conclusions: The Albanian version of the CC to Self-Care of the Chronic Illness Inventory features sound measurement properties and is a valid and reliable instrument for assessing caregiver contribution to patient self-care behaviors in the Albanian population. Full article

Background/Objectives: The uneven distribution of nurses in Albania is a major problem that compromises equitable access to health services. Rural and less developed regions suffer from a chronic shortage of nursing staff, while urban areas attract health professionals. This study aims to quantify the inequalities in the distribution of nurses in Albania, analyzing the nurse-to-population ratio and its impact on the quality of healthcare. The main objective of this study is to examine the distribution of the nursing workforce in Albania and assess regional disparities, using the Gini coefficient and the Human Development Index (HDI) to measure and compare inequalities between regions. Methods: This descriptive–analytical study was conducted in 2024. The data were collected from official sources, including the Albanian Ministry of Health and the World Health Organization (WHO). The Gini coefficient and the Lorenz curve were used to analyze the distribution of nurses in relation to the population and HDI of the different regions. The analysis included data on the number of nurses, population, and regional socioeconomic conditions. Results: The average nurse-to-population ratio in Albania is 28 nurses per 10,000 inhabitants, with significant variations between regions. Tirana has the highest ratio (60 nurses per 10,000 inhabitants), while Kukës and Dibër have the lowest values (10 per 10,000 inhabitants). The calculated Gini coefficient is 0.0228, indicating a very low level of inequality in the distribution of the nursing workforce. Conclusions: Inequalities in the distribution of nurses in Albania require targeted policy interventions. Policies are needed that incentivize health workers to work in less developed regions, through economic incentives, infrastructure improvements, and lifelong learning programs. These interventions are essential to reduce disparities and ensure equitable access to health services across the country. Full article

Background/Objectives: Mental representation of spatial information relies on egocentric (body-based) and allocentric (environment-based) frames of reference. Research showed that spatial memory deteriorates as Alzheimer’s disease (AD) progresses and that allocentric spatial memory is among the earliest impaired areas. Most studies have been conducted in static situations despite the dynamic nature of real-world spatial processing. Thus, this raises the question: Does temporal order affect spatial memory? The present study, by adopting a dynamic spatial memory task, explored how the temporal order of item presentation influences egocentric and allocentric spatial judgments in individuals with early-stage Alzheimer’s disease (eAD) and healthy elderly individuals (normal controls—NC). Method: Participants were required to memorize dyads of simple 3D geometrical objects presented one at a time on a desk along with a bar. Afterwards, they had to choose what stimulus appeared either closest to them (egocentric judgment) or closest to the bar (allocentric judgment). Results: Results revealed that the temporal order significantly affected spatial judgments in eAD patients but not in NC participants. While eAD patients remain anchored to the item presented first, which is more accurate regardless of the frame used, NC are equally accurate with the item that appears first or second. This is presumably because eAD patients struggle to flexibly shift attention and update spatial representations in dynamic situations, which leads to reliance on initial information and difficulties with information presented later. Conclusions: This highlights the importance of further understanding the cognitive strategies employed by AD patients. Full article

Background: Sprengel’s Deformity (SD) is a rare condition of the shoulder girdle, appearing as the principal congenital anomaly of the shoulder in paediatric patients. The aim of this study is to document the combined experience of two paediatric orthopaedic departments in managing SD using the modified Green Procedure, with a specific emphasis on the clinical and functional outcomes reported by patients; Methods: from June 2010 to February 2023, 42 shoulders in 40 paediatric patients were surgically treated for SD at two paediatric orthopaedic departments. All patients were treated using the modified Green Procedure with or without clavicle osteotomy. To better evaluate the deformity, the Cavendish’s classification for aesthetic appearance and the Rigault’s classification for radiological aspect were used, while movements of abduction and flexion were quantified to assess shoulder mobility. Several dedicated questionnaires such as QuickDASH, the Shoulder Pain Index and the Shoulder Disability Index (SPADI) and finally the UCLA Shoulder Scale were submitted to assess the quality of life of the subjects and the ability to practice certain activities, including work and sports. Complications were evaluated according to the modified Clavien–Dindo–Sink classification; Results: The mean follow-up was 5 years (range, 1.0–13.6). Clavicular osteotomy, performed in 15 patients, improved post-operative abduction by a mean of 25° (95% CI: 11–39°; p = 0.001). Three patients had complications (7.1%), with two requiring re-operation. At follow-up, 67.5% of patients had a qDASH score < 7, highlighting excellent functional outcomes. Shoulder function showed moderate correlation with pre- and post-operative flexion. The SPADI and UCLASS scores indicated significant improvement, with 70.0% reporting high satisfaction. Factors like sex, associated anomalies, and surgical technique did not impact patient-reported outcomes or satisfaction; Conclusions: The modified Green’s technique has proven to be a safe procedure with a low rate of complications and satisfactory clinical and functional patient-reported outcomes. Full article

Background: Fibrous dysplasia (FD) is a rare condition in which normal spongy and cortical bone is replaced by non-neoplastic fibrous tissue, leading to weakened bone matrix and increased risk of pathological fractures and deformities. Treating these deformities poses a significant challenge for surgeons. While various cases of surgical stabilization and limb lengthening using intramedullary nails have been reported, there is limited evidence on the use of Motorized Intramedullary Limb-Lengthening Nails (MILLNs) in FD patients. This case report presents the clinical history of a patient with FD who underwent multiple surgical interventions to address severe lower limb length discrepancy (LLD) and angular deformity caused by multiple fractures. Case presentation: A sixteen-year-old Caucasian girl with polyostotic FD developed a severe post-traumatic LLD of 10 cm on the right side, associated with coxa vara, valgus knee, and patellar instability. The deformity of the proximal femur was addressed with a valgus and derotational femoral osteotomy. However, this procedure exacerbated the knee’s valgus deformity and only partially corrected the LLD, leading to the decision to proceed with femoral lengthening. A retrograde magnetic intramedullary nail (PRECICE, NuVasive) was utilized for this purpose. Approximately three months postoperatively, radiographs revealed the loosening of the proximal anchoring screw, while the nail had reached maximum distraction. We then proposed reactivating the previously implanted nail. Nine months after the final surgery, standing long-leg radiographs showed a residual shortening of 1 cm, with excellent healing at the fracture sites and the nail and screws remaining securely in place. The patient was monitored regularly, with the latest follow-up occurring four years and five months after the conclusion of the last lengthening procedure. Conclusions: This case report describes the reactivation of a MILLN in a patient with polyostotic fibrous dysplasia. While nail reactivation has been previously described in the literature, to our knowledge, it has not been reported for treating complications arising from FD. In cases of mechanical complications, this approach can equalize leg length discrepancies and correct deformities, avoiding additional invasive surgeries and reducing healthcare costs. As this is an off-label treatment, preoperative consent from both the patient and the parents is required. Full article

Background: Transformational leadership fosters trusting relationships; new visions; and personal, professional, and cultural growth. Effective leaders support their team’s motivational growth and organizational goals. This study aims to underscore the importance of transformational leadership and its various dimensions, focusing on its impact on job satisfaction and personal mastery among nursing leaders in healthcare organizations. Method: A cross-sectional design with convenience sampling was used. The evaluation tools included the Multifactor Leadership Questionnaire (MLQ-6S), the Satisfaction of Employees in Health Care (SEHC) questionnaire, and the Personal Mastery Scale (PMS). Results: The findings indicate that job satisfaction is influenced by transformational leadership, emphasizing the importance of tailored leadership development strategies within healthcare organizations. The laissez-faire leadership style was the only one showing no correlation with nurses’ job satisfaction. Other leadership styles showed significant positive or negative correlations with the analyzed variables. Conclusions: Transformational leaders are essential for fostering trust and enhancing job satisfaction in healthcare settings. Positive leadership styles contribute to higher levels of job satisfaction and personal mastery among nursing leaders. Conversely, laissez-faire and autocratic leadership styles can negatively impact performance and staff satisfaction. These findings highlight the critical role of leaders in creating positive work environments and supporting employee development and well-being in healthcare. Full article