Practice In Italy Research Articles

Prehistoric Italian foodways: Meta-analysis of stable isotope data from the Neolithic to the Iron Age

Italian Later Prehistory was characterised by profound changes that impacted everyday life in many aspects. Whether or not and how such changes were reflected in the subsistence practices of ancient populations is an ongoing question in the archaeological debate. This question has been investigated using stable carbon and nitrogen isotope analysis for several decades. Here, we present a 6000-year-long review of isotopic studies in the Italian Peninsula from the Neolithic to the Iron Age. We reconstruct chronological variations in food practices by observing δ13C and δ15N trends for 776 humans, 382 animals, and 432 C3 plants from 111 archaeological sites. During the Neolithic, when farming is first introduced, a homogenous signal characterised by terrestrial protein consumption is visible. The Copper Age, instead, shows a more varied pattern, possibly representative of a more diversified use of the landscape, characteristic of those millennia. The new cultural paradigm that invested Europe during the Bronze Age is also reflected in food practices in Italy, with the introduction of millets - signalled by high δ13C values in the Northern regions - possibly representing a pivotal shift. Not much data is available for the Iron Age, as only two sites from Northern Italy, showing a diffused consumption of C4 plants, and one site from Southern Italy, with a diet centred around C3 plants, are available for this period. The analysis of this extensive set of data suggests that the “Secondary Products Revolution” probably meant a shift in subsistence practices, with secondary sources substituting meat rather than integrating it.

Transfer Pricing End-of-Year Adjustments in Italy

This article discusses the regulations and practices in Italy regarding year-end adjustments in transfer pricing, highlighting the relevance of the OECD guidelines, the interpretations provided by the Italian tax Administration and pertinent domestic case law.

Adherence to anti-hypertensive therapy with perindopril-based single-pill versus free-pill combinations: a 10-year real-world analysis in Italy

Abstract Background/Introduction Despite the growing availability of blood pressure-lowering drugs, hypertension remains poorly controlled and a significant mortality cause worldwide. The silent course of the disease, suboptimal adherence, and complexity of therapeutic schedules are important factors in reducing the effectiveness of anti-hypertensive treatments at the population level. With the purpose of simplifying patients’ medication self-management, guidelines have strongly endorsed the use of anti-hypertensive therapy with single-pill combinations (SPCs). Perindopril (PER)-based SPCs, including both two- and three-drug combinations, have been available since 2008. Purpose We explored treatment adherence over 10 years in patients receiving PER-based regimens (SPC or free-pill combination) in Italy. Methods A retrospective real-world analysis was conducted on administrative databases covering 6.7 million Italian health-assisted residents. Among adults with hospitalization discharge diagnosis or exemption code for hypertension between 2010 and 2021, those with PER-based prescriptions were identified, considering combinations with amlodipine (AML) and/or indapamide (IND), either as SPC or free-pill or mixed (SPC+separate pill). The index-date (ID) was that of the first prescription of a PER-based regimen throughout the inclusion period. All patients with at least 12 months of available data before and after the ID were included. A cross-sectional analysis evaluated the yearly adherence for the period 2012-2021, calculating the proportion of days covered (PDC) by drug prescriptions on 1-year follow-up (PDC≥80% indicated high-adherence). Results Over 2012-2021, of 121,397 patients on a PER-based therapy, those treated with SPC ranged from 87% (during 2012) to 94.4% (during 2021), while free-pill and SPC+separate pill cohorts represented, respectively, 10.6-3.5% and 2.4-2.1% of all hypertensive patients. Over the decade, the proportion of adherent patients in SPC users was markedly higher than in free-pill and SPC+separate pill cohorts (Fig. 1). The sudden reduction of adherent patients during 2018-2019 was possibly due to a temporary shortage of PER/AML/IND as SPC in Italy from Nov-2018 to Mar-2019. Multivariate analysis showed that over 2012-2021 decade, free-pill and SPC+separate pill regimens resulted in significantly lower adherence (more than 80% reduction) than SPC formulation, while male gender and older age were predictive of better adherence (Table 1). Conclusions These findings from real clinical practice in Italy highlighted a growing attitude from clinicians to prescribe more manageable anti-hypertensive schemes based on SPC formulations, in line with current guidelines. The higher proportion of adherent patients among the users of PER-based SPCs corroborates the importance of alleviating pill burden, that is a key component in blood pressure control, and so in the reduction of hypertensive complications and cardiovascular risk.

Real-world analysis exploring the association between anti-hypertensive therapy with perindopril-based single-pill combinations (SPC) and cardiovascular outcomes and all-cause mortality in Italy

Abstract Background/Introduction A combination of blood pressure (BP)-lowering medications is recommended by guidelines as an effective strategy to obtain rapid and optimal BP control in hypertensive patients. However, the prescription of multiple BP-lowering medications increases the pill burden, potentially reducing medication adherence. Guidelines also recommend using single pill combinations(SPCs) containing ≥2 anti-hypertensive medications as a practical approach to simplify treatment schedules and possibly improve adherence. Yet, real-world evidence on the association between SPC or free combination of BP-lowering medications and hyperthensive patient outcome remains limited. Purpose We compared the association of SPC versus free-pill combination(free) on cardiovascular outcomes and all-cause mortality in hypertensive patients treated with perindopril(PER)-based therapies in real clinical practice in Italy. Methods A retrospective analysis was conducted using administrative databases covering 6.7 million health-assisted Italian residents. Among adults with hospitalization discharge diagnosis or exemption code for hypertension between 2010 and 2021, the study included patients prescribed with a combination of PER with amlodipine(AML) and/or indapamide(IND), either as SPC or free or mixed (SPC plus separate pill) combinations. Results The analysis included 24,476 hypertensive subjects receiving a PER-based therapy, 22,663 (93%) of them using SPC, 1458 (6%) free and 355 (1.4%) mixed. The last cohort was not included in the analysis due to the small sample size (N=355). The patients in the free cohort were significantly older than those in the SPC cohort (69.5±12.3 vs. 64.3±12.2 years, p<0.001), showed a higher number of pre-existing comorbidities (0.5±0.8 vs. 0.4±0.7, p<0.001), and received a larger number of different medications (pill burden: 1.2±1.7 vs. 0.7±1.3, p<0.001). To minimize selection bias, the groups were balanced with propensity score and inverse probability weighting (IPW), adjusting for baseline covariates, including comorbidity profile and pill burden. The IPW-adjusted Kaplan-Meier plots and Cox’s proportional hazard model (Table 1) revealed that, compared with SPC users, patients on free regimens had a significantly increased risk of all-cause mortality (36%, p<0.001), all cardiovascular events (45%, p<0.001), ischemic heart disease (29%, p<0.05), cerebrovascular events (84%, p<0.001), and occurrence of the composite outcome cardiovascular events/all-cause mortality (40%, p<0.001). Conclusions This real-world data from a large Italian administrative dataset suggested that PER-based anti-hypertensive therapy with SPC results in significant clinical benefits in terms of lowered risk of cardiovascular/cerebrovascular events and all-cause mortality. Reducing pill burden and simplifying therapeutic schedules is of crucial importance to maximize the potential benefits derived from the prescription of anti-hypertensive treatment.

A higher adherence to perindopril-based anti-hypertensive therapy is associated with a reduced risk of cardiovascular outcomes and all-cause mortality in real clinical practice in Italy

Abstract Background Therapeutic management of hypertension is a landmark of cardiovascular (CV) risk prevention. Combined therapies with at least 2 anti-hypertensive agents are required in many patients in whom monotherapy and lifestyle interventions failed in blood pressure control. It is well-known that poor medication adherence remains a major barrier to achieving the therapeutic targets for all CV drugs, including anti-hypertensives. Purpose We evaluated the relationship between adherence to perindopril (PER)-based therapeutic regimen prescribed as single-pill combination (SPC) or free-pill and CV outcomes and all-cause mortality in a large Italian population. Methods A retrospective analysis was performed using administrative databases corresponding to around 6.7 million health-assisted residents. Hypertensive adults were first identified through hospitalization discharge diagnosis or exemption codes for hypertension between 2010 and 2021. Patients prescribed PER-based therapies were screened for all combinations of PER with amlodipine (AML) and/or indapamide (IND) (all formulations, single-pill or free-pill). Time of the first prescription of a PER-based regimen during the inclusion period was considered the index-date. The analysis included all hypertensive subjects prescribed a PER-based therapy, having available data at least 12 months before and 24 months after the index-date, respectively. Since the analysis was focused on the possible associations between adherence level and CV outcomes and all-cause mortality, adherence was assessed during the first year of follow-up on alive patients and outcomes were assessed during the second year. Adherence was assessed using the proportion of days covered (PDC) approach on 1-year follow-up, and considering a PDC<80% as poor-to-moderate adherence, and PDC ≥80% as good adherence. The Cox’s proportional hazard model was applied to estimate Hazard Ratio (HR) adjusting for baseline covariates, including comorbidity profile and pill burden. Results The included cohort (N=24,476) was divided into sub-groups according to adherence in poor-to-moderate (N=6,781) and good adherent patients (N=17,695) with a mean age of 64.8±13.3 and 64.6±11.9 years old, respectively. The Cox’s proportional hazard model showed that good adherence was associated with a relative risk reduction of 23% in all-cause mortality (Table 1A), 21% in all CV events (Table 1B), 17% in ischemic heart disease (Table 1C), 33% in cerebrovascular events (Table 1E), and 22% in the composite outcome of CV events/all-cause mortality (Table 1G). Conclusions The present analysis provided evidence from the Italian real clinical practice that good adherence to PER-based anti-hypertensive therapy results in significantly lower cardiovascular risk and all-cause mortality. These data further emphasize the importance of promoting cost-effective measures to increase medication adherence in patients on anti-hypertensive treatment.

Insights into the Incidence, Course, and Management of Lithium-Induced Hypothyroidism in Real-World Psychiatric Practice in Italy

Insights into the Incidence, Course, and Management of Lithium-Induced Hypothyroidism in Real-World Psychiatric Practice in Italy

Parliamentary procedures and democratization in Italy during the liberal age (1861–1922)

ABSTRACT This article revolves around two focal subjects: parliamentary procedures and democratization. On the one hand it explores the use of the term ‘democratization’ in the Italian parliamentary debate during the Liberal Age (1861–1922). On the other hand, it tries to clarify how the general trend of democratization, in particular the extensions of suffrage and the birth of mass parties, affected parliamentary practices in Italy.

A wall between real estate valuation standards and professional appraisal practice: A focus on Italian market

Real estate appraisal standards provide guidelines for the preparation of reliable valuations. These standards emphasize the central role of market data collection in market-oriented valuation methodologies such as the Market Comparison Approach (MCA), which is the most commonly used. The objective of this study is to highlight the difficulties in data finding, as well as the gap between the standards and the actual appraisal practices in Italy. Thus, a detailed comparison was made between the real estate data considered necessary by the standards and those ones reasonably detectable by appraisers, showing that some important market information is not reachable due to legal, technical and economic factors. Finally, a case study is presented in which the actual appraisal of a residential property is schematically described to support what is claimed with the research question and thus the degree of uncertainty around an estimate judgment.

An Italian Delphi Consensus on the Triple inhalation Therapy in Chronic Obstructive Pulmonary Disease.

The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment. The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds. Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions. The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.

Transmitting stories of the longest revolution. Notes from Italy

ABSTRACT Building on a digitally mediated autoethnography within a contemporary Italian feminist movement, the paper analyses the transformations of feminist media practices in Italy since the start of the 20th century. If during the 1960s and 1970s Italian feminism reached its higher visibility as one of the largest in Europe, since the 1980s, it continued to operate in submerged ways through the creation of feminist bookshops, publishing companies, women’s archives and centres while engaging with practices, ideologies and texts that were circulating transnationally. Since the early 1990s Italian feminist groups started engaging with digital technologies, creating new virtual spaces of dialogue, an autonomous internet service provider, an alternative search engine, digital literacy programmes and practical laboratories. Over the past two decades, the online space became the privileged sphere for activists to challenge the hegemonic gender discourse, debate topics otherwise suppressed or misrepresented by traditional media and create a record of struggle. Expanding from a conceptualization of feminist activism as a process of transit, in this paper, I analyse how feminist media practices gradually transformed, shaped by historical and contextual specificities.

Italian Speech-Language Pathologists and Telerehabilitation for Voice Disorders: A Survey on Satisfaction, Effectiveness, Limits, and Future Prospects.

Introduction: The aim of this study was to evaluate the distribution of virtual voice therapy during the coronavirus disease 2019 (COVID-19) lockdown in Italy via the collection of opinions of speech-language pathologists (SLPs). Methods: All SLPs who regularly carried out their professional activity in public hospitals, private hospitals, or private practices in Italy were asked to fill out an online survey consisting of two sections: (1) demographic information (age, gender, work setting, seniority, working time, and regular use of virtual voice therapy) and (2) opinions regarding telerehabilitation (motivation, personal satisfaction, effectiveness, and future needs and uses). Results: A total of 299 SLPs (mean age 39.1 ± 12.4 years) completed the survey. Overall, a regular use of virtual voice therapy was declared by 31.1% (93/299) of SLPs, with the highest prevalence for SLPs working in fully private facilities (46.7%; p < 0.001). Among all respondents, 25.4% had a highly positive opinion on the possible use of virtual voice therapy, even in nonemergency situations, and 55.8% planned to maintain this rehabilitation modality in the future. Discussion: Italian SLPs, regardless of age, had a positive impact with the new telerehabilitation practices. Investments in training and updating SLPs through specific courses would help to break down the strong barriers to telepractice acceptance, such as lack of familiarity with new technologies and lack of adequate preparation. Virtual voice therapy, which had never been experienced in such a way in Italy before the COVID-19 pandemic, promises to be a valuable future addition to the current traditional rehabilitation approaches.

Prevalence of Osteosarcopenic Adiposity in Apparently Healthy Adults and Appraisal of Age, Sex, and Ethnic Differences.

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the prevalence of OSA in a large population of apparently healthy Caucasian adults (18-90 years) and to compare it with the prevalence reported in other studies and other ethnicities. This study included 9719 participants (6412 women and 3307 men), stratified into four age-group categories, and recruited from the general medical practices in Italy. OSA was defined based on body composition measurements using bioelectrical impedance BIA-ACC®, which enables assessment of total bone mass, muscle/lean, and adipose tissues. The overall prevalence of OSA was 21.9% in women and 14.0% in men, and it significantly increased in every subsequent age group for both women and men (p < 0.001). The OSA prevalence was not significantly different between men and women below 40 years; however, it was considerably higher in women over 40 years. Participants with OSA had a significantly lower BMI compared to those without OSA, indicating OSA is a separate disorder not necessarily related to physiological fluctuations of BMI. The prevalence in Asian populations was lower than in our sample, indicating ethnic specificity. The relatively high prevalence of OSA detected in this study's population across the age groups suggests the necessity for its appropriate and timely identification to prevent possible clinical outcomes, including fracture, dismobility, frailty, or chronic diseases.

Barriers against Implementation of European Society of Gastrointestinal Endoscopy Performance Measures for Colonoscopy in Clinical Practice.

Background and Objectives: The implementation and monitoring of the European Society of Gastrointestinal Endoscopy (ESGE) performance measures for colonoscopy are suboptimal in clinical practice. Electronic reporting systems may play an important role in data retrieval. We aimed to define the possibility of systematically assessing and monitoring ESGE performance measures for colonoscopy through reporting systems. Materials and Methods: We conducted a survey during a nationwide event on the quality of colonoscopy held in Rome, Italy, in March 2023 by a self-administered questionnaire. Analyses were conducted overall and by workplace setting. Results: The attendance was 93% (M/F 67/26), with equal distribution of age groups, regions and public or private practices. Only about one-third (34%) and 21.5% of participants stated that their reporting system allows them to retrieve all the ESGE performance measures, overall and as automatic retrieval, respectively. Only 66.7% and 10.7% of respondents can systematically report the cecal intubation and the adenoma detection rate, respectively. The analysis according to hospital setting revealed no significant difference for all the items. Conclusions: We found a generalized lack of systematic tracking of performance measures for colonoscopy due to underperforming reporting systems. Our results underline the need to update reporting systems to monitor the quality of endoscopy practice in Italy.

Immunosuppression in adult liver transplant recipients: a 2024 update from the Italian Liver Transplant Working Group.

Advances in surgical procedures and immunosuppressive therapies have considerably improved the outcomes of patients who have undergone liver transplantation in the past few decades. In 2020, the Italian Liver Transplant Working Group published practice-oriented algorithms for immunosuppressive therapy (IT) in adult liver transplant (LT) recipients. Due to the rapidly evolving LT field, regular updates to the recommendations are required. This review presents a consensus- and evidence-based update of the 2020 recommendations. The Italian Liver Transplant Working Group set out to address new IT issues, which were discussed based on supporting literature and the specialists' personal experiences. The panel deliberated on and graded each statement before consensus was reached. A series of consensus statements were formulated and finalized on: (i) oncologic indications for LT; (ii) management of chronic LT rejection; (iii) combined liver-kidney transplantation; (iv) immunosuppression for transplantation with an organ donated after circulatory death; (v) transplantation in the presence of frailty and sarcopenia; and (vi) ABO blood group incompatibility between donor and recipient. Algorithms were updated in the following LT groups: standard patients, critical patients, oncology patients, patients with specific etiology, and patients at high immunologic risk. A steroid-free approach was generally recommended, except for patients with autoimmune liver disease and those at high immunologic risk. The updated consensus- and evidence-based 2024 recommendations for immunosuppression regimens in adult patients with ABO-compatible LT address a range of clinical variables that should be considered to optimize the choice of the immunosuppression treatment in clinical practice in Italy.

Care Pathways in Rehabilitation for Children and Adolescents with Cerebral Palsy: Distinctiveness of the Adaptation to the Italian Context.

In 2020, a multiprofessional panel was set up in collaboration with the Italian FightTheStroke Foundation family association to produce evidence-based recommendations for the management and neuromotor rehabilitation of persons with cerebral palsy aged 2-18 years to implement in clinical practice in Italy. The recommendations of these care pathways were developed according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for Care Pathways Development and the Grading of Recommendations Assessment Development and Evaluation working group for adoption, adaptation, or de novo development of recommendations from high-quality guidelines (GRADE-ADOLOPMENT). Four strong positive recommendations were developed regarding comprehensive management, and twenty-four addressed neuromotor treatment. A holistic, individualized approach was affirmed in terms of both multidimensional patient profile and interdisciplinary management in a network with the school where children and adolescents are integrated. It was defined that all motor rehabilitation approaches must be individually tailored considering age and developmentally appropriate activities as interventions and goals, in light of the reference curves addressing prognosis for Gross Motor Function and Manual Ability Classification Systems. Intervention must be structured with adaptations of the task and/or of the context (objects and environment) based on the analysis of the child's skills to support motivation and avoid frustration.

EXTENTION OF THE SEMANTIC FIELD OF MYTHONIM “ODYSSEY” IN THE ADVERTISING DISCOURSE OF ITALY 2000-2021

The object of this article is mythonyms that move into another class of proper names - pragmatonyms or verbal trademarks. The subject of the article was chosen mythonyms from the ancient Greek poem “The Odyssey” by Homer, which are widely used in modern advertising and commercial practice in Italy to name various products: furniture, interior items, clothing, jewelry, food, technical and medical equipment. The purpose of the article is to refute the generally accepted idea that the meaning of an onym (in our case, a mythonym) is impoverished during transonymization into a verbal trademark. The article identified mythonyms from the Odyssey that most often become pragmatonyms - Odysseus, Penelope, Polyphemus. As a result of their analysis, it was demonstrated that peripheral semes of meaning that are not relevant in the mythonym are actualized in the Italian advertising discourse of 2000-2021. Thus, the semantic field of the mythonym, functioning as a trade name, expands and enriches, and not vice versa. The article highlighted the following updated components of meaning: Odysseus - masculinity and freedom, Penelope - thriftiness and beauty, Polyphemus - creative force in the service of man. In the last mythonym, the core meaning of “the destructive power of the savage” completely changed the meaning to “civilizational power of creation”, and the vector of assessment changed. In this case, advertising discourse reflects the linguistic and cultural tendency that exists in Southern Italy to master and appropriate the symbolic space of Mediterranean culture not so much through the figure of Odysseus, but through the Sicilian Polyphemus. The study used a two-stage corpus analysis method: a continuous sample of product names to identify mythonyms from the Odyssey (68 product names) and a representative sample of products with the names Odysseus, Penelope, Polyphemus.

Differential Adherence to Free and Single-Pill Combination of Rosuvastatin/Ezetimibe: Findings from a Real-World Analysis in Italy.

Adherence to cardiovascular drug treatment can significantly benefit from a reduced pill burden, but data on this matter derived from real-life settings are currently scanty. This analysis assessed the possible changes in adherence in patients treated with rosuvastatin and ezetimibe (ROS/EZE) as free multi-pill combination who switched to ROS/EZE as single-pill combination in the setting of real clinical practice in Italy. A retrospective analysis was conducted on the administrative databases for a catchment area of about sevenmillion health-assisted residents. Adults receiving ROS/EZE as a single-pill combination from January 2010 to June 2020 (followed up to 2021) were identified. The date of the first prescription of single-pill combination of ROS/EZE was considered as the index date. The analysis included the users of ROS/EZE as a free combination during the year before the index date. Baseline demographic and clinical characteristics were collected during the period of data availability prior to the index date. Adherence to therapy was evaluated as proportion of days covered (PDC), namely the percentage of days during which a patient had access to medication, in the 12-month interval preceding or following the index date (PDC < 25% non-adherence; PDC = 25-75% partial adherence; PDC > 75% adherence). A total of 1219 patients (61.1% male, aged 66.2 ± 10.4years) were included. Cardiovascular comorbidities were found in 83.3% of them, diabetes in 26.4%, and a combination of both in 16.2%. Single-pill combination of ROS/EZE was associated with a higher proportion of adherent patients compared to free-pill combination (75.2% vs 51.8%, p < 0.001). This real-world analysis suggested that switching from a regimen based on separate pills to one based on a single-pill combination resulted in improved adherence to ROS/EZE therapy.

Pediatric ultrasound practice in Italy: an exploratory survey

BackgroundThe aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide.MethodsA questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022.ResultsThere were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%).ConclusionsDespite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.

A holistic evaluation of patients with chronic Hepatitis D virus (HDV) infection enrolled in the Italian PITER-B and delta cohort

Background and AimsWe aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. MethodsThis was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. ResultsOf 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. ConclusionsCHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.

Environmental impact assessment of hemp cultivation and its seed-based food products

Introduction: Hemp is a crop cultivated in Europe since ancient times, with a variety of purposes and products. Despite being known for its positive environmental effects on ecosystems, the impacts of hemp-based food products have not been sufficiently investigated yet. This paper contributed to deepen the knowledge of the hemp industry by focusing on the potential environmental impact of the cultivation phase (under three different agronomic practices in Italy: organic outdoor and conventional outdoor, and indoor) and the production of selected hemp-based goods (seed oil and flour for food purposes and flowers for therapeutic uses).Methods: The impact was quantified utilizing the life cycle assessment within different impact categories, such as carbon footprint (CF), eutrophication (EP), acidification (AP), and water footprint (WF). For a carbon offset assessment, the carbon storage capability (i.e., the carbon fixed in crop residues left in the field) of hemp was also investigated through the guidelines provided by the Intergovernmental Panel on Climate Change (IPCC).Results and Discussion: The cultivation phase contributed to a CF that ranged from 1.2 (organic outdoor) to 374 (indoor) kg per kg of grains (conventional outdoor). These results were in line with the literature. Sensitivity scenarios based on hotspot analysis were also presented for CF mitigation for each kind of cultivation. On the other hand, the ability of hemp to sequester carbon in the soil due to crop residues left in the field (i.e., carbon storage) was evaluated (−2.7 kg CO2 (ha year)−1), showing that the CF was fully compensated (−0.27 kg CO2 (ha year)−1 for conventional outdoor and −1.07 kg CO2 (ha year)−1 for organic outdoor). Regarding hemp-based products, only dried flowers showed a negative balance (−0.99 kg CO2 per kg dry flower), while hemp oil and flour reported 31.79 kg CO2 per kg flour) when carbon storage was accounted. The results support the idea that the production chain can be sustainable and carbon-neutral only when all the different parts of the plant (flowers, seeds, fibers, leaves, and all residues) were used to manufacture durable goods according to the framework of the circular economy.