Search Results (580)

The construction sector generates over one-third of all waste in Europe, yet the reuse of building components remains marginal compared to recycling, and circular strategies are rarely aligned on the territorial scale at which materials, stakeholders and infrastructure operate. This paper investigates the regulatory, institutional, infrastructural and operational conditions under which reuse to become a systemic practice. A desk-based comparative analysis of six European contexts (Belgium, the Netherlands, Switzerland, Germany, France, Denmark) was conducted on 282 documents, using a framework of seven dimensions grouped into three macro-families drawn from the literature on territorial circular ecosystems. The findings show that these conditions form a dependency chain of five ordered links: legal recognition of the non-waste status; a standardized pre-demolition audit; preparation and storage physical hubs, in parallel with research infrastructures, absorbing technical uncertainty; a guarantee system covering performance, liability and insurability; and a demand-side activation. The guarantee link is a constraint and a key element in demand activation. Regulation is necessary but not sufficient, since binding instruments target recycling or auditing while reuse remains voluntary in all six contexts. The chain yields a typology of ecosystem configurations and a replicable diagnostic instrument, whose transferability is assessed on the Italian case. Full article

Background/Objectives: Children with medical complexity (CMC) often suffer from chronic or evolving conditions that require increasingly complex treatment regimens over time, resulting in increased therapeutic and care burdens, costs, and the risk of adverse effects and medication errors. The study aimed to describe the variation in healthcare needs, medication regimens and medication burden over time and to describe the relationship between the number of drugs and healthcare needs. Methods: In this cohort study, conducted at the Pediatric Palliative Care Center of Padua, Italy, two repeated assessments were performed, respectively, in October 2021 (t₀) and in February 2023 (t₁). A total of 169 patients aged ≤23 years receiving at least one prescribed medication were enrolled. Longitudinal analyses were performed in the 147 patients with complete assessments at both time points. Data were collected from medical records and caregiver interviews. Drug costs were collected from the Italian Medicines Agency. Changes between baseline and follow-up were assessed using paired statistical tests (Wilcoxon signed-rank test for continuous variables and McNemar test for categorical variables). The associations between the number of drugs and the ACCAPED scale (Accertamento dei Bisogni Clinico Assistenziali Complessi in Cure Palliative Pediatriche) were assessed using linear regression models. Results: The study analyzed treatment regimens of 147 patients with a median age of 12.1 years at t₀ and 14.1 at t₁. The prevalence of patients with medication burden (42% vs. 50%, p = 0.022), do-not-resuscitate order (20% vs. 27%, p = 0.027) and an ACCAPED score > 50 (57% vs. 66%, p = 0.012) significantly increased on the second assessment. Also, the number of total daily administrations (5 [3–12] vs. 6 [3–14], p = 0.019) and the number of medications (4 [2–7] vs. 5 [3–8], p = 0.013) significantly increased. However, polypharmacy and the median daily cost per patient did not significantly increase between t₀ and t₁. The association between the number of drugs and the ACCAPED score showed that each additional prescribed drug is associated with an average increase of 3.2 points in the ACCAPED score (95% CI: 2.6, 3.9; p < 0.001). Conclusions: Over time, the degree of complexity in our population increased significantly, as evidenced by the increased healthcare needs, treatment regimens and burden on families. The number of prescribed drugs showed a strong and statistically significant relationship with patient care complexity. Treatment regimen characteristics were strongly associated with patient care complexity. Future studies should evaluate whether these pharmacological variables may have a role in supporting clinical assessment. Full article

Background: Endometriosis is a chronic condition affecting a substantial proportion of women of reproductive age and leading to impaired quality of life. Despite its potential occupational implications, evidence on how occupational physicians (OPs) manage workers affected by endometriosis remains scarce. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding endometriosis among Italian OPs. Methods: A cross-sectional web-based survey was conducted between 1 and 18 April 2026 by recruiting a convenience sample of 155 occupational physicians. The questionnaire was specifically designed and investigated knowledge status, risk perception, perceived barriers to workplace management, and previous experience of participating professionals. Results: Most respondents considered themselves adequately informed about endometriosis (78.1%) and reported previous professional experience with affected workers (81.3%). Knowledge gaps were identified, particularly regarding disease prevalence (26.5% correct responses), familial predisposition (34.8%), and diagnostic pathways (31.6%). Overall, 65.8% of participants reported having previously issued conditioned fitness-for-work appraisals, most frequently recommending increased work breaks, avoidance of night shifts, or limitations on shift work. In multivariable analysis, male gender (adjusted odds ratio [aOR] 5.69, 95% confidence interval [95% CI] 1.84–17.58), participation in continuing medical education activities (aOR 85.72, 95% CI 6.60–1114.21), information obtained from colleagues (aOR 4.67, 95% CI 1.23–17.77), and employment in healthcare settings (aOR 5.91, 95% CI 1.92–18.16) were independently associated with having previously issued restricted fitness-for-work judgments, whereas relying exclusively on undergraduate medical education was negatively associated with this outcome (aOR 0.07, 95% CI 0.01–0.39). Conclusions: Among the sampled Italian OPs, endometriosis was recognized as a clinically relevant condition frequently encountered in daily practice. Continuous professional education, interdisciplinary exchange, and practical experience were more strongly associated with occupational decision-making than undergraduate training alone. These findings support the development of targeted educational interventions and shared occupational recommendations aimed at improving workplace management and promoting the inclusion and retention of women affected by endometriosis in the workforce. Full article

This article examines the changing role of Italian among Cameroonian-origin families who experienced onward migration after a prolonged period of residence in Italy. Drawing on qualitative data collected between June 2024 and August 2025 through socio-biographical questionnaires and semi-structured interviews with 15 families, the study investigates how Italian is maintained, reduced, or refunctionalised after relocation to Belgium, Canada, France, Germany, Switzerland, or the United States or return to Cameroon. The findings show that Italian played a central role during the period of residence in Italy, functioning as a language of education, employment, institutional participation, and social integration. After onward migration, however, these functions are largely assumed by the dominant language of the new country, especially among children whose schooling and peer relationships develop in French, English, or German. Nevertheless, Italian rarely disappears completely. It persists in more specialised domains, including couple interaction, transnational networks, professional niches, private communication, lexical routines, naming practices, and emotional attachment to the family’s life in Italy. The article argues that Italian should not be understood only through the binary opposition between language maintenance and language shift. Rather, onward migration produces a functional reconfiguration of Italian, whereby a former language of integration becomes a biographical, relational, and symbolic resource within multilingual family repertoires. Full article

The collection of honey and propolis is crucial for the nutrition and health of honey bee colonies. In this study, Apis mellifera with high productivity for both honey and propolis (MJ) was developed through long-term selective breeding using Apis mellifera caucasica and Apis mellifera carnica as breeding materials, resulting in substantial improvements in both honey yield and propolis production. To elucidate the genetic basis and molecular mechanisms underlying efficient foraging behavior for nectar and resins in honey bees, whole-genome resequencing was performed on MJ, the C-lineage, and the O-lineage of Apis mellifera. In addition, transcriptome sequencing was conducted using MJ and Apis mellifera ligustrica, which exhibited the highest honey and propolis production traits. MJ had a composite genetic background dominated by O-lineage ancestry. Compared with C-lineage honey bees, MJ exhibited 234 candidate genes under selection, mainly related to chitin and amino sugar metabolism. Transcriptome analysis identified 504 and 2676 differentially expressed genes between MJ and Italian honey bees in the nectar-forager and resin-forager comparisons, respectively, involving chemosensory gene families. Genes upregulated in MJ nectar and resin foragers were mainly associated with redox regulation and energy metabolism, respectively. Integrated analyses identified 7 candidate genes associated with nectar foraging and 41 candidate genes associated with resin foraging; these genes were involved in chemosensory responsiveness, flight-related structural traits, energy metabolism, and redox regulation in MJ. These findings provide genetic and transcriptomic resources for further studies on the division of labor in foraging and molecular breeding in honey bees. Full article

Background/Objectives: Psychosocial, neuropsychological, social, and academic difficulties may persist after pediatric cancer treatment. We described parent/caregiver-reported functioning and support needs and explored their associations with clinical, family-related, socio-economic, premorbid, and place-based characteristics in an Italian survivorship setting. Methods: This single-center cross-sectional exploratory study included 93 of 130 families approached between November 2022 and January 2023 (response rate, 71.5%). One parent or caregiver completed a purpose-built questionnaire for each survivor. The cohort included 38 survivors with central nervous system (CNS) tumors and 55 with non-CNS tumors. Outcomes were evaluated relative to retrospectively reported pre-diagnosis functioning. Exact confidence intervals, effect estimates, multivariable Firth logistic regression, and Benjamini–Hochberg false discovery rate correction were used. Results: Worsening internalizing difficulties were reported for 48/90 survivors (53.3%), neuropsychological difficulties for 42/90 (46.7%), academic worsening for 30/85 (35.3%), and social integration difficulties for 27/90 (30.0%). CNS survivors more frequently had social integration difficulties than non-CNS survivors (47.4% versus 17.3%; odds ratio, 4.22; 95% confidence interval, 1.50–12.73; q = 0.015) and underwent cognitive assessment after cancer (50.0% versus 17.0%; odds ratio, 4.80; 95% confidence interval, 1.71–14.44; q = 0.013). Municipality size and geographic area showed no nominal associations with parent-reported outcomes. No candidate-variable association in the exploratory screen remained significant after false discovery rate correction. Conclusions: Parent-reported difficulties and support needs were common, with differences by CNS versus non-CNS tumor site. Family-related, premorbid, and place-based patterns are hypothesis-generating and require prospective evaluation using validated multi-informant measures. Full article

Employment is a key social determinant of health, yet autistic individuals face high levels of unemployment, with consequences for well-being and social inclusion. This exploratory study examined stakeholder perceptions regarding the inclusion of autistic individuals in public administration employment within the Italian context, considering its potential role in advancing health equity through stable and regulated work environments. A cross-sectional online survey was conducted to explore perceptions of current inclusion measures, the importance of specific inclusion domains, and the usefulness of potential support tools. Participants (n = 62) included autistic adults, family members, and professionals with expertise in autism. Quantitative data were analyzed using non-parametric tests, while qualitative responses were examined through reflexive thematic analysis. Quantitative findings showed that educators express more positive views on existing measures and greater support for new interventions compared to family members; autistic participants report intermediate perspectives. Qualitative analysis identified five areas: recognition of autistic perspectives, need for interventions, support figures, work personalization, and staff training. Although the study does not evaluate intervention effectiveness, the findings highlight stakeholder priorities and perceived needs related to employment inclusion. While exploratory and based on a limited sample, the results may inform future research and the development of more inclusive public employment practices. Full article

Background: The gut microbiota is an emerging factor in athletic performance. Methodological limitations persist in longitudinal microbiome studies, particularly regarding the compositional nature of microbiota data and the lack of standardized performance metrics in team sports. The present study applies a Compositional Data Analysis (CoDA) framework with ANOVA-Simultaneous Component Analysis (ASCA) to investigate longitudinal gut microbiota dynamics in elite volleyball athletes and introduces a novel Technical Performance Level (TPL) metric for objective performance quantification. Methods: Seven elite male volleyball athletes from the Italian SuperLega Championship were monitored across four sampling timepoints (T0, T1, T2, T3) during the Regular Season, Rest Period, and Tournament Period. Fecal samples underwent 16S rRNA metabarcoding. CLR-transformed data were analyzed at the Phylum, Family, and Genus level using ASCA with Season, Player, and their interaction. Statistical significance was assessed using the Freedman-Lane permutation test (10,000 iterations). Within-subject associations between TPL and CLR-transformed microbial features were assessed by repeated-measures correlation. Results: Season and Player effects were statistically significant at all taxonomic levels (p ≤ 0.0004), whereas the Season × Player interaction was significant at the Family and Genus levels (p ≤ 0.002) but not at the Phylum level (p = 0.108). The Player effect represented the largest source of variance at the Family (51.31%) and Genus (50.75%) levels. At the Phylum level, the Season × Player interaction accounted for the largest share of variance (36.23%), although it did not reach significance. Within-subject correlation analyses revealed no statistically significant association between microbial features and TPL at any taxonomic level, and none remained significant after correction for multiple comparisons. Conclusions: The application of a compositional data analysis framework modifies the interpretation of gut microbiota dynamics in elite volleyball athletes compared to standard approaches. Individual athlete identity accounted for most of the compositional variance in the microbiota, whereas exploratory within-subject analyses did not reveal statistically significant associations between taxa and TPL. Given the small cohort, any observed trends should be interpreted as exploratory and hypothesis-generating until confirmed in adequately powered cohorts. Longitudinal monitoring of gut microbiota could support individualized surveillance of gut health in elite sport. Full article

We present the first vascular flora of Sirente-Velino Regional Park, a protected area located in central Apennine (Abruzzo, Central Italy), covering 550 km². The floristic inventory was compiled based on extensive field surveys conducted from 1990 to 2025. Thanks to specific funding secured for the final three years (2023–2025), field trips became systematic, aimed at covering the entire territory of the park, including its diverse habitats across different seasons. Furthermore, an analysis of the relevant literature was performed, alongside a comprehensive review of herbarium specimens housed at APP, FI, NAP, and RO. The park’s flora comprises 2066 taxa (1370 species and 696 subspecies, including 11 hybrids), belonging to 117 families and 671 genera, with 122 classified as alien. Notably, 169 taxa are endemic to Italy. Our study reports 234 taxa for the first time within the park, while 52 remained unconfirmed in recent times and 22 are of doubtful occurrence. Five taxa are newly recorded for the Abruzzo region: Alchemilla alpinula, A. obtusa, A. vulgaris, Hyacinthoides non-scripta, and Salsola tragus. Additionally, the revision of APP herbarium specimens led to the exclusion of Euphorbia tommasiniana from the regional flora, reassigning the material to the alien E. saratoi. The species richness of the native flora exceeds expectations by 50.8%, a finding likely driven by the area’s significant geographical, geological, and microclimatic diversity, which results in high environmental heterogeneity. Conversely, alien taxa are 5.6% lower than expected, probably due to the high ecological integrity of the park, a predominantly mountainous territory with low population density and minimal anthropogenic disturbance. Representing 20.6% of the entire Italian flora, the Sirente-Velino Regional Park stands out as one of Europe’s protected areas with the greatest diversity of vascular plants. Full article

Background: Genetic testing is increasingly part of the diagnostic pathway of congenital hearing loss (CHL), clarifying etiology and supporting clinical management. However, its psychosocial impact, especially differences between syndromic and non-syndromic conditions, remains underexplored. Objectives: This study evaluated the differential psychological impact of genetic diagnosis in syndromic versus non-syndromic pediatric patients, its relationship with clinical and rehabilitative variables, and the role of post-diagnostic psychological assessment. Methods: A cross-sectional post-diagnosis survey was conducted in families of children with genetically confirmed syndromic (Usher syndrome, n = 21) and non-syndromic (GJB2-related, n = 21) CHL; a total of 37 families responded. Parental empowerment was assessed using an Italian translated version of the Genetic Counseling Outcome Scale (GCOS-24). In an exploratory analysis, GCOS-24 items were grouped into three author-derived domains (understanding/awareness, emotional experience, and informational support) based on semantic content, not validated psychometrically. Results: No significant differences in GCOS-24 scores emerged between groups, nor in relation to clinical variables like hearing loss severity, auditory outcomes, or rehabilitative interventions. Genetic diagnosis occurred later in the syndromic group. Qualitative observations suggested parental empowerment varied with timing of diagnosis, clarity of information, and therapeutic alliance quality. Conclusions: Overall, these results highlight the importance of integrating psychological support and structured communication into clinical pathways to support families and patients in understanding and adapting to the diagnosis over time. Further longitudinal studies are needed to clarify the evolving psychosocial impact of genetic diagnosis in CHL. Full article

Sweet chestnut (Castanea sativa Mill.) coppice forests are important Mediterranean resources, but the genetic structure of local coppice stands remains insufficiently characterized, limiting their use as reference systems for wood provenance studies. This study integrated population genetic analysis, optimization of wood-derived DNA recovery, and reference-based assignment to evaluate Lazio coppice stands and test the declared origin of timber samples. Four Lazio populations were genotyped at 12 SSR loci, screened for Hardy–Weinberg disequilibrium, null alleles, and kin structure, and compared with eight European/Mediterranean populations using five shared loci. DNA extraction from dried wood was optimized through a CTAB-PEG workflow, and 40 timber samples from four sawmills, including two declared from Lazio (MCt and RPt), one from Calabria (CALt) and one from France (FRAt), were assigned using supervised DAPC, STRUCTURE with population information and GDA_NT Bayesian assignment and exclusion testing. Lazio stands retained high SSR diversity but showed heterozygote deficiency and fine-scale family structure; therefore, a conservative post-COLONY dataset was used for downstream analyses. Differentiation was weak among Lazio stands, but they showed a coherent Central Italian affinity within the available European/Mediterranean reference set. The optimized protocol yielded reproducible SSR profiles from all timber samples, with an 80.0% successful wood extraction rate. Within the available reference panel, assignment analyses indicated compatibility of MCt and RPt with a Lazio origin, whereas CALt and FRAt were incompatible with the Lazio references and should be interpreted as extra-regional or insufficiently represented by the current baseline. SSRs provide a practical first-line tool for regional chestnut timber screening, although broader reference panels and complementary high-resolution markers are needed to strengthen fine-scale provenance inference. Full article

Background/Objectives: Elder abuse remains a significantly underreported public health issue. The study examines how elder abuse is detected through a passive, suspicion-based case-finding pathway in an Italian university hospital emergency department (ED) and what the findings imply for improving systematic screening. Methods: This retrospective study analyzed elder abuse cases accessed at Careggi University Hospital ED (Florence, Italy) from 2017 to 2022. Eligible patients were aged ≥65 years and had suspected or confirmed elder abuse identified through Rosa Code protocol activation, abuse-related ICD-10 codes, and forensic consultation records. Two investigators independently reviewed eligible charts using predefined inclusion criteria and a standardized data-extraction form. Missing or unclear documentation was quantified descriptively, and no imputation was performed. Results: Sixty-seven elder abuse cases were identified during the six-year period, corresponding to a reported detection rate of 0.8% among the records screened for this study (mean: 11.2 cases/year). All eligible cases were captured through Rosa Code activation; ICD-10 and forensic-record searches did not identify additional cases. The majority of victims were women (76.1%), with a mean age of 75.5 years, and 76.1% had documented comorbidities. Physical abuse was the most common form (61.2%), predominantly perpetrated by family members (93.8%) within the victim’s home (64.2%). Head and neck injuries were most frequent (43.3%). A notable 50% decline in reported cases occurred during the COVID-19 pandemic. Despite law enforcement notification in 78% of cases, 65.7% of patients were discharged home. Conclusions: The study’s detection rate (<1%) falls critically short of international benchmarks (3–5%), underscoring urgent need for systematic screening using validated tools and staff training and multidisciplinary safeguarding pathways in Italian emergency departments. Full article

Background: Mutations in the FBXO7 gene (PARK15) cause an autosomal recessive, early-onset neurodegenerative disorder typically presenting as Parkinsonian-Pyramidal Syndrome (PPS). Despite its recognition, the high phenotypic variability often delays diagnosis. Here, we report a novel Italian family and synthesize data from all published cases to date, offering an updated clinical and molecular overview of the disease. Methods: We performed clinical and molecular characterization of a newly identified family. Furthermore, we conducted a systematic literature review (from 2008 to 2026) to aggregate clinical, genetic, and geographic data of all reported PARK15 cases. Results: Two siblings presented with a complex phenotype including early-onset parkinsonism, cognitive decline, psychiatric symptoms, and aphasia-type speech disorders. Genetic analyses identified two novel likely pathogenic variants: a missense substitution in the UBL domain (p.Ile74Met) and a frameshift indel (p.Val233GlufsTer8). The literature review (incorporating clinical data from Europe, Asia, and South America) confirms a high prevalence of postural instability (87.5%), bradykinesia (83.3%), and pyramidal signs (~60%). We observed a distinct distribution of variants: missense mutations cluster in the N-terminal UBL and F-box domains, while truncating variants are more common in the C-terminal region. Discussion: Our findings expand the FBXO7 mutational landscape and underscore the “atypical” clinical markers, such as pyramidal signs and cognitive decline, that distinguish PARK15 from other recessive forms of parkinsonism like PARK2 and PARK6. The dual role of FBXO7 in mitochondrial quality control and proteasomal assembly suggests a broad disruption of cellular homeostasis. These observations refine genotype–phenotype correlations and may guide variant interpretation in routine diagnostic settings. Full article

Heart failure (HF)—a highly prevalent condition among older adults—is characterized by recurrent exacerbations and progressive symptom burden, significantly affecting functional autonomy and quality of life. Palliative care may alleviate symptoms and improve quality of life for patients and their families, promoting personalized care aligned with individual preferences. Although international guidelines recommend the early integration of palliative care into standard HF management, its implementation in real-world practice remains limited. Improving awareness and competencies in identifying end-of-life needs and in advance care planning may facilitate earlier integration of palliative care into HF clinical pathways. This paper presents a case of advanced HF in which palliative care was introduced only during the final hospitalization, highlighting the importance of the earlier integration of palliative care throughout the disease trajectory. This paper results from a collaboration between young members of the Italian Society of Palliative Care and the Italian Society of Gerontology and Geriatrics. The case serves as a practical training model for healthcare professionals in applying a palliative care approach to advanced HF. It illustrates key strategies and tools employed across different stages of care, including patient identification, multidimensional assessment, shared decision-making, advance care planning, symptom management, medication review, and palliative sedation. Full article

Objective: Based on the Person-Centered Approach, this study targeted parents of very preterm (VPT) infants in Neonatal Intensive Care Units (NICUs) from Italy and Portugal. The primary aim was to classify parents by identifying latent classes of perceived risks (NICU stressors) and resources (sources of social support). Potential specificities in class membership according to Country of Belonging and sociodemographic factors were also investigated. Methods: Overall, 303 parents (92 Italian; 211 Portuguese) completed a survey including sociodemographic factors, Parental-Stressor-Scale-NICU, and Multidimensional-Scale-of-Perceived-Social-Support. Data were analyzed by multigroup latent class analysis and multinomial logistic regression. Results: Three statistically valid and cross-country classes were identified and labelled as Class 1, Adjusted/Beneficial-and-Supported-System, Class 2, Stressed-and-Supported-System, and Class 3, Parental-Role-Alteration-with-Family-Supported-System. Portuguese parents were mainly grouped in Classes 1 and 2, while Italian parents were in Class 3. Men were less likely to belong to Classes 2 and 3, while older parents having another child were more likely to belong to Class 3. Conclusions: The experience of parents of VPT infants in NICUs is inherently challenging, yet identifying specific risk profiles featured by the unique nuances of stressors and sources of support while accounting for further factors (Country of Belonging, Gender, Age, Having another child) can foster the customization of interventions aimed at providing parents with the necessary resources for adjusting to this extremely demanding experience. Full article