Journal articles on the topic 'Reggio Emilia. Studium generale'

Vengono fatte alcune considerazioni sul rapporto tra medicina generale e psicoterapia, sottolineando anche la importanza della formazione dei medici di base tramite il metodo dei gruppi Balint. Questo scritto č una sintesi dell'intervento tenuto al convegno "Psichiatria e medicina di base" (Reggio Emilia, 25 gennaio 1991) Qui č preceduto da una dettagliata nota introduttiva dell'Autore in cui viene ripercorsa la storia del rinnovamento nell'assistenza sociosanitaria, e dell'attenzione allora prestata dalle amministrazioni pubbliche verso la formazione dei medici di base, a Reggio Emilia negli anni 1970-80. Questo rinnovamento, che investiva anche altri settori (welfare, igiene ambientale, psichiatria, medicina del lavoro, ospedali, scuola, ecc.), piů tardi subě un arresto, le cui cause vengono qui brevemente discusse.

L'autore descrive le origini dei Centri di Igiene Mentale (CIM) di Reggio Emilia, e piů in generale la nascita della psichiatria territoriale, attraverso il racconto delle sue esperienze personali agli inizi degli anni 1970. Voluta dall'Amministrazione Provinciale, la realizzazione dei CIM fu affidata alla fine degli anni 1960 allo psichiatra e noto intellettuale Giovanni Jervis (1933-2009), che inizialmente aveva lavorato con l'antropologo Ernesto De Martino e che proveniva dall'esperienza pionieristica di Gorizia condotta con Franco Basaglia. Viene descritta la situazione sociale e politica di Reggio Emilia in quel periodo, e raccontato come un gruppo di studenti di provincia si formň una coscienza civile attraverso l'esperienza di lotta antimanicomiale, in un periodo in cui si realizzň un'alleanza tra la classe politica della cittŕ e un gruppo di tecnici decisi a umanizzare e modernizzare l'assistenza psichiatrica.

Kindergarten teachers' attitudes toward immigrant children and children of immigrant families is the subject of research conducted between 2009 and 2010. The study compares teachers in the public schools of Avignon, France, with state school teachers of Reggio Emilia, Italy. The analysis conducted mainly considered relations between two variables. However, the research tools used (participant observation, Likert type-scale questionnaire and semi-structured interviews) also allowed for the triangulation of data. The intent of this article is to elaborate on the methodological contribution to the research using multivariate analysis. This analysis provides both three-dimensional representations of the teachers' attitudes as well as individualized representations of relevant relations between variables. The statistic test of the null hypotheses, the "chi-square test" is used. The analysis points out attitude and behaviour differences between Reggio Emilia teachers and Avignon teachers. Differences are mostly observed in the synchronic dimension data analysis. Nevertheless, if the point of observation is changed and data are studied in the diachronic dimension, that general view demonstrates how a current historical period influences educational choices within a particular educational system and consequently influences teachers' attitudes.

IntroductionSeveral studies had shown the effectiveness of combined interventions in the treatment of young patients with a first episode of psychosis (FEP). More controversial are the evidence about the stability of the therapeutic outcomes in individuals ultra-high risk (UHR).AimsTo describe the regional project for the treatment of early psychosis implemented in the Reggio Emilia Mental Health Department (ReMHD) and also to report preliminary data from a 2-year follow-up.MethodsIn addition with the treatment as usual (TAU), treatment implemented within the regional project for early psychosis (PREP) in the ReMHD comprises the following:– pharmacotherapy according to international guidelines;– a phase-specific individualized Cognitive-Behavioural therapy;– a psycho-educational intervention addressed to family members;– a case management recovery-oriented.Action strategies are preceded by the administration of Reggio Emilia at Risk mental States Battery Checklist as a comprehensive assessment useful to define the severity and the quality of symptoms, the degree of functioning, the subjectivity of suffering, and the perceived quality of life.ResultsThe assessment carried out after 24 months of continuous treatment showed significant improvements in both the psychotic symptoms (positive, negative and general psychopathology PANSS subscales) that the daily functioning (SOFAS).ConclusionsAlthough our sample is still relatively small (n = 50) to draw definitive conclusions, it is emerging the good prognosis for UHR individuals and patients with FEP submitted on PREP treatment implemented in the ReMHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

2048 Background: The impact on the general population of temozolomide concurrent with and adjuvant to radiotherapy (RT/TMZ) was assessed in the context of the Registry of the Project of the Emilia-Romagna Region in Neuro-Oncology (PERNO), the first Italian prospective observational population-based study in the field of neuro-oncology. Methods: Patients (pts) meeting the following inclusion criteria were evaluated: age ≥18 years; PS 0-3; histologically confirmed GBM, no previous or concomitant non-glial tumoral disease, residence in the Emilia Romagna region. The data were collected prospectively. Results: Study accrual, started on January 1 2009, was closed, as planned, on December 31 2010. Two hundred sixty-eight pts (F=111, M=157; median age, 63.5 [range 29-34] years) were studied. mOS was 10.7 months (95%CI: 9.2 – 12.3). MGMT status, assessed in 186 (89%) of 210 pts who had at least radiotherapy was evaluable in 174 pts (83%), being methylated in 76 (43.7%), and unmethylated in 98 (56.3%) pts. mOS for pts with MGMT methylated status was 18.5 months (95%CI: 14.4-22.6), and 12.4 months for those with MGMT unmethylated status (95%CI: 10.5 - 14.3, p<0.0001). 140 pts <70 years were treated with RT/TMZ; mOS in this group was 16.4 months (95% CI: 14.5 – 18.4). mOS was 20 months in the 59 pts (42%) harboring MGMT methylation (95% CI: 12.8 - 27.2), and 13.5 months in the 73 pts (52%) without MGMT methylation (95% CI: 10.8 – 16.2, p<0.0001). At multivariate analysis, a significant prognostic role was found for performance status (p=0.001), extent of surgery (p=0.009), age (p=0.004), postsurgical treatment (p=0.03), and MGMT status (methylated vs unmethylated, p=0.01). Conclusions: The data from the present large prospective population study are in line with those reported in the EORTC/NCIC randomized trial, confirming that this successful approach has been widely incorporated in daily practice.

(1) Background: A large body of literature is available on the environmental, social, and economic sustainability of alternative food systems, but not much of it is devoted to the dynamics underlying their design and implementation, more specifically the processes that make an alternative food system successful or not in terms of its sustainability aims. This gap seems to be particularly critical in studies concerning alternative food systems in urban and peri-urban agriculture (UPA). This paper explores how the design and implementation of multifunctional farming activity in a peri-urban area surrounding the city of Reggio Emilia in the Emilia-Romagna region of Italy impact the achievement of its sustainability aims. (2) Methods: The environmental, social, and economic components of this project are explored in light of the sociology of market agencements. This method brings up the motivations of the human entities involved in the project, the role played by nonhuman entities, and the technical devices used for the fulfillment of the project’s aims. (3) Results: The alternative food system under study lacked a robust design phase and a shared definition of the project aims among all the stakeholders involved. This ended in a substantial mismatch between project aims and consumer expectations. (4) Conclusions: When a comprehensive design stage is neglected, the threefold aim concerning sustainability might not be achievable. In particular, the design of alternative food systems must take into account the social environment where it is intended to be put in place, especially in UPA, where consumers often live in suburban neighborhoods wherein the sense of community is not strong, thus preventing them from getting involved in a community-based project. In such cases, hybridization can play a role in the sustainability of alternative food networks, provided that some trade-offs occur among the different components of sustainability—some components of sustainability will be fully achieved, while others will not.

IntroductionHalf of all patients with cancer experience cachexia, with the prevalence rising above 80% in the last weeks of life. Cancer cachexia (CC) is a complex relational experience that involves the patient–family dyad. There are no studies on the association between the psychoeducational component and the rehabilitative component of dyads for supporting more functional relationships in the management of CC.The primary objective of this study is to evaluate the feasibility of a psychoeducational intervention combined with a rehabilitative intervention on dyads.The secondary objective is to improve the quality of life (QoL) and acceptability of the intervention.Methods and analysisThis mixed-methods study with a nonpharmacological interventional prospective includes 30 consecutive cancer patients with cachexia and refractory cachexia and their caregivers, assisted by the Specialised Palliative Care Team. The recruitment will last 1 year. The intervention involves two components: (1) psychoeducational intervention: 3 weekly face-to-face consultations between dyads and trained nurses to help the dyads cope with involuntary weight loss and strengthening dyadic coping resources and (2) rehabilitation intervention: 3 biweekly educational sessions between dyads and trained physiotherapists focused on self-management, goal-setting, physical activity with three home exercise sessions per week.The primary endpoint will be in adherence to the intervention, indicated by a level of completion greater than or equal to 50% in both components. The secondary endpoints will be QoL (Functional Assessment of Anorexia-Cachexia Therapy), caregiver burden (Zarit Burden), physical performance (Hand-Grip strength and 30 seconds sit-to-stand test), and the acceptability of the intervention (ad hoc semi-structured interviews with the dyads and the healthcare professionals).Ethics and disseminationThe study was approved by the Ethics Committee Area Vasta Emilia Nord, Azienda USL-IRCSS Reggio Emilia, Italy, number: 73/2019/SPER/IRCCSRE. The authors will provide the dissemination of the results through publication in international scientific journals.Trial registration numberNCT04153019.

Acute cerebrovascular events are not randomly distributed over time but show specific temporal patterns of occurrence. However, most studies focused stroke and little is known about transient ischemic attack. This study aimed to explore the existence of a temporal pattern of transient ischemic attack and the possible influence by the most common risk factors. The analysis included all hospital admissions with the ICD9-CM code for TIA, recorded in the database of the Emilia Romagna region of Italy (1998-2006; n = 43642, mean age 76.8 ± 11.5 years, 45.5% males). Transient ischemic attack was most frequent in autumn and winter and less common in spring and summer (P < 0.0001), with the highest number of cases in October and the lowest in February, and also most frequent on Monday (P < 0.0001). This study shows a seasonal and weekly pattern in occurrence of transient ischemic attack, independent of sex and the presence of the most common risk factors.

The present research which originates from the author’s PhD dissertation awarded at the School of Politics of the University of Newcastle upon Tyne in 2019, explores the comparative evolution of rural development policies and Local Action Groups (LAGs) in the United Kingdom (Argyll and the Islands LAG—Scotland and Coast, Wolds, Wetlands and Waterways LAG—England) and in Italy (Delta 2000 LAG—Emilia-Romagna Region and Capo Santa Maria di Leuca LAG—Puglia Region) in a multi-level governance framework. LAGs and in particular their public–private local partnerships have become common practice in the governance of rural areas. This governance operates within the European Union LEADER approach as a tool designed to generate the development of rural areas at local level. In order to establish the implications of the LAG practices, the following main objectives for this research have been established: (1) to explore the utility of EU strategies for rural development; (2) to explain how LAGs structure, institutional arrangements and working are positioned in the layers of MLG framework; (3) to carry out a comparative evaluation of the LAGs working in the different nations and their subnational contexts. Some significant findings from the case studies are summarized in relation to these themes: the key characteristics and the outcomes associated with the LAG working mechanisms and what do we draw about the emergence, operation and performance of local partnerships. The core argument of the research is that the partnership approach has given the rural development actors a governance platform to help increase beneficial interactions and economic activity in each of these LAGs, but it is the bottom-up leadership of key local actors, seizing opportunities provided by the EU funding, which have been the most important factors for the LAG successes.

Introduction: Patients’ awareness of clinical research and their involvement in clinical trials is of great importance, but it is difficult to estimate the extent of knowledge on the research being undertaken. Methods: We evaluated the level of knowledge about clinical research using a self-reporting survey distributed to 967 adult patients with cancer attending the Departments of Medical Oncology and Onco-Haematology Units of IRST IRCCS and 4 hospitals in the region of Emilia-Romagna, Italy. The questionnaire was composed of 10 specific items on research knowledge. Patients responding correctly to at least 8 of the 10 items were considered to have a good understanding of clinical research. Results: The questionnaire was completed by 769 patients (response rate 79.5%). Only 19% of patients were found to have a good understanding of clinical research. Patients with higher education and those who had previous clinical trial experience showed a significantly better understanding. Fifty-three percent of patients said that they would be willing to participate in a trial studying a new drug and 75% expressed an interest in taking part in informative meetings/events about clinical studies. Conclusions: Our results show that patients’ understanding of clinical research is limited and highlight an interest in learning more.

Regional economies are shaped by their economic histories and existing endowments. This paper explores the question: how do a region’s economic history and institutional endowments affect its success and trajectory in an emerging industry? Our case, electric vehicle development and production, is an industry which combines more traditional skilled manufacturing with knowledge-driven innovation activities. We present deep qualitative case studies of two regions, focusing on one firm in each. The case of Tesla in the San Francisco Bay Area examines an electric vehicle firm in a region with a strong tech innovation system, while the case of Maserati in Emilia-Romagna, Italy, examines a firm that builds on a regional history of automotive manufacturing. Across cases, we compare regional skill endowments, institutional coordination, and place-based policymaking. We conclude that, as an emerging industry under a new economic paradigm, electric vehicle manufacturing by Tesla and Maserati represents two different conceptions of the industry and consequently two different location strategies. Yet these two strategies remain rooted in regional contexts, owing both their success to successful exploitations of these, and their struggles to their failure to compensate for regional gaps. This presents a clear opportunity for place-based industrial strategy to evolve and intervene.

Background: The federalization of the Italian National Health Service (NHS) gave administrative, financial, and managerial independence to regions. They are in reciprocal competition according to the “quasi-market” model. A network of independent providers replaced the state monopoly. The NHS, based on the Beveridge model in which citizens are free to choose their place of treatment, was consolidated. The aim of our research was to analyze the fulfillment of need for hospital services on site and patients’ migration to hospitals of other regions. Material and Methods: We analyzed data from 2013 to 2017 of Hospital Discharge Cards (HDCs) provided by the Ministry of Health. The subjects of the analysis (catchment areas) were the hospital networks of every Italian region. The study of flows was developed through Internal Demand Satisfaction, Attraction, Escape, Attraction, Absorption, and Escape Production indexes. Graphic representations were produced using Gandy’s Nomogram and Qgis software. Results: In the studied period, the mean number of mobility admission was 678.659 ± 3.388, with an increase of 0.90%; in particular, the trend for ordinary regime increased 1.17%. Regions of central/northern Italy have attracted more than 60% of the escapes of the southern ones. Gandy’s Nomogram showed that only nine regions had optimal public hospital planning (Lombardy, Autonomous Province of Bolzano, Veneto, Friuli V.G., Emilia-Romagna, Tuscany, Umbria, Latium and Molise). Conclusion: The central/northern regions appear more able to meet the care needs of their citizens and to attract patients than the southern ones.

Background Mortality data have clearly highlighted the province of Ferrara as an area with a particular distribution of tumors strictly related with environmental factors. Methods The project of a tumor registry has been planned for a better description of cancer incidence and for a deeper insight into etiologic factors, considering the typical features of the province from geographic and occupational points of view. Results This study presents the registration results of the first 2 years, in order to verify the quality level of data recruitment and to confirm that observed in previous studies. The population covered by the registry was 151,968 males and 165,835 females, with high representation of the elderly. In this period 2,087 tumors in men and 1,778 in women were observed. Lung cancer reaches one of the highest levels in Italy, according to that observed in Lombardy and Veneto regions and the northern Adriatic coast. Incidence and mortality are, however, significantly higher than in other Emilia-Romagna areas, as pointed out by the registries of Parma, Modena and Forlì. Colon cancer also presents high frequencies in comparison with neighboring areas, whereas non-Hodgkin lymphomas reach the highest level in Italy. Gastric tumors, although well represented in males and females, show lower levels than the high-risk neighboring Romagna region. In women, a low incidence of cervix uteri tumors and high levels of breast cancer have also been observed. Conclusions The distribution of such neoplasms and the differences observed among neighboring areas deserve further analytical studies, with the aim of a better reading of cancer onset and diffusion. The quality of data obtained (about 70% of histocytologic confirmations, and 5% of “final” death-certificate-only cases), appears to reach satisfying levels, considering the starting phase of the registry.

Background: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. Aim: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. Design: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. Setting/participants: The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015. Results: Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI): 0.04–0.06), emergency department visits (OR = 0.23, 95% CI: 0.21–0.25), intensive care unit stays (OR = 0.29, 95% CI: 0.26–0.32), major operating room procedures (OR = 0.22, 95% CI: 0.21–0.24), and lower in-hospital death (OR = 0.11, 95% CI: 0.10–0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI: 1.21–1.33) ( p < 0.01 for all comparisons). Conclusion: Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.

Aims and background Given the industrialization in Italy over this past century much migration has occurred within the country especially from southern to northern regions. Following repeated drainings of the pre-existing marsh area (Pontina plain) during the 1930s the Latina province received an unusual north-south immigration from the regions of Veneto, Friuli and Emilia Romagna. This consisted principally of manual workers, farmers and their families. Four new towns developed after a few years (Littoria, later renamed Latina, Sabaudia, Pontinia and Aprilia), and the whole province quickly reached a population of 60,000. The availability of a population-based Cancer Registry in the Latina province allowed us to assess the cancer risk in this migrant population. Methods Standardized Incidence Ratios (SIRs) according to cancer site and sex were computed for residents over the age of 55 years, born in northern Italy. Population data, by sex, age and region of birth were based on the 1981 census. The age-sex-site specific incidence rates for the 1983-1987 period for the entire population of the Latina province over 55 years of age were used as standard. Results A significant excess of cancer risk for subjects of both sexes born in northern Italy was found. In addition, a statistically significant higher risk was observed for the cancers of the lung, skin (non-melanomas) and prostate in males, and of the mouth-pharynx, lung and skin (non-melanomas) in females. Conclusions SIRs for all sites confirm the findings from other studies on migrants in Italy and strongly support the hypothesis that the place of birth has an important influence on the frequency of cancer. Some possible etiological factors are suggested for cancer sites with higher frequencies in northern-born subjects.

Abstract. The damage triggered by different flood events costs the Italian economy millions of euros each year. This cost is likely to increase in the future due to climate variability and economic development. In order to avoid or reduce such significant financial losses, risk management requires tools which can provide a reliable estimate of potential flood impacts across the country. Flood loss functions are an internationally accepted method for estimating physical flood damage in urban areas. In this study, we derived a new flood loss function for Italian residential structures (FLF-IT), on the basis of empirical damage data collected from a recent flood event in the region of Emilia-Romagna. The function was developed based on a new Australian approach (FLFA), which represents the confidence limits that exist around the parameterized functional depth–damage relationship. After model calibration, the performance of the model was validated for the prediction of loss ratios and absolute damage values. It was also contrasted with an uncalibrated relative model with frequent usage in Europe. In this regard, a three-fold cross-validation procedure was carried out over the empirical sample to measure the range of uncertainty from the actual damage data. The predictive capability has also been studied for some sub-classes of water depth. The validation procedure shows that the newly derived function performs well (no bias and only 10 % mean absolute error), especially when the water depth is high. Results of these validation tests illustrate the importance of model calibration. The advantages of the FLF-IT model over other Italian models include calibration with empirical data, consideration of the epistemic uncertainty of data, and the ability to change parameters based on building practices across Italy.

Abstract Epidemiological, diagnostic, prognostic and therapeutical data were retrospectively obtained by the Italian Registry in over 2000 Essential Thrombocythemia (ET) patients who mainly were diagnosed according to the PVSG criteria and were treated with potentially leukemogenic drugs. The Registro Italiano Trombocitemie (RIT), that is a GIMEMA project, has been activated in order to registry italian ET patients, to improve the diagnosis appropriateness (WHO criteria), to promote the acquisition of biological data, to evaluate the compliance to the therapeutical guidelines of the Italian Society of Hematology (SIE), to monitor in particular the ET patients receiving Interferons alpha and Anagrelide, to evaluate cases of pregnancy, pediatric age and familiarity, to define the prognostic value of the biological factors as JAK2 mutation, clonality, etc, to create a network for activation of new clinical and biological studies. The RIT, co-ordinated by the Hematology Unit of Reggio Emilia, is a web based registry that beside a public area comprehends a database of italian ET patients. The data, with respect of the privacy rules, are object of validation and analysis by various RIT expert subcommittees. Eighty hematological Institutions adhered to the RIT and 801 patients have been registered since June 2005. The ET diagnosis was done according to the PVSG (90%) and WHO (10%) criteria. The patients, 492 females and 309 males, had age <40 yr (19%), 40–60 yr (32%), 60–70 yr (19%), >70 yr (30%), and the median age was 59 years. At diagnosis the platelet count was >1000 ×109/L in 29% of cases (mean 932). Few patients had prior thrombosis (4%; major 2%) and prior hemorrhage (2.6%). Patients at high risk of thrombosis were 55% on considering age >60 yr and/or previous thrombosis and/or PLT count >1500 ×109/L, and 65% on considering the PLT count cut-off of 1000 ×109/L. The patients shown general thrombotic risk factors (70%), disease related symptoms (40%) and splenomegaly (25%). By applying the WHO diagnostic criteria, the picture of true ET was found in 27% of cases. Sixty pregnancies have been reported. Aspirin was administered in 72% of patients and cytoreduction was performed in 62% of them, with use of Hydroxyurea (65%), Anagrelide (10%), Interferons alpha (10%), Pipobroman (4%), Busulfan (2%). A separate analysis for patients treated with Anagrelide and Iterferons alpha is in progress. To improve the diagnostic approach, the RIT has promoted the bone marrow biopsy revision (WHO criteria) and the acquisition of the new biological parameters.

Background:Behçet disease (BD) is a systemic and potentially severe disease. Its incidence varies widely worldwide. In Spain, published BD’s epidemiological studies are scarce.Objectives:In a well-defined Northern Spanish population-based cohort, the aim of this study was a) to estimate epidemiological variations, b) clinical domains and c) to compare our results with other regions.Methods:Study of unselected all consecutive patients diagnosed with definitive or possible BD by expert rheumatologists between 1980 and 2020 in our health region. Two classification criteria were applied: a) International Study Group (ISG) for BD [1], and b) International Criteria for BD (ICBD) [2]. In addition, a literature review of Medline publications was carried out.Results:In this study, from a total of 120 patients diagnosed with BD by expert opinion (58 women/62 men), 96 met ICBD and 59 ISG criteria. Mean age of the cohort at diagnosis was 37.6±13.8 years similar to other countries, as well as sex distribution.Prevalence was higher than in most European populations regardless the diagnostic criteria applied: expert opinion (20.6), ICBD (16.5) or ISG (10.1) (TABLE 1). Incidence was lower (expert opinion: 0.022, ICBD: 0.018, ISG: 0.011). Clinical domains’ frequency was in line with other regions except vascular and gastrointestinal involvement, which were lower.TABLE 1.Diagnostic criteria and study periodn cases / population sizeMean age at onset and sex (%female)Prevalence (over 100000) / incidenceOral / genital ulcers (%)Skin lessions/ pathergy test (%)Ocular involve ment (%)Joint involve ment (%)Neurobehcet/ Vascular/ Gastrointestinalinvolvement (%)Sánchez. L et al. Southern Europe (Cantabria, Spain)Expert opinion, ISG, ICBD / 1980- 2020120 (expert opinion) / 96 (ICBD) / 59 (ISG) / 58164137.6 ±13.8/ 48.320.6 (expert opinion), 16.5 (ICBD), 10.1 (ISG) / 0.022 (expert opinion), 0.018 (ICBD), 0.011 (ISG)94.2 / 59.263.3 / 25. 241.66510.8 / 11.6 / 6.6Calamia, K. T. et al. North America (Minnesota, USA)ISG / 1960-200513 / NR31 / 305.2 / 0.38100 / 6285 / NR624623 / 23 / NRAltenburg, A. et al. Northern Europe (Berlin, Germany)ISG and ABD classification tree / 1961-2005590 / 339134426 / 584.9 / 1 (estimated)98.5 / 63.762.5 / 33.758.15310.9 / 22.7 / 11.6Mohammad, A. et al. Northern Europe (Skane County, Sweden)ISG / 1997-201040 / 80931730.5 / 334.9 / 0.2100 / 8088 / NR53400 / 20 / NRMahr, A. et al. Southern Europe (SeineSaint-Denis County, France)ISG / 200379 / 109441227.6 / 437.1 / NR100 / 8090 / 20515910 / NR / 10Salvarani, C. et al. SouthernEurope (Reggio Emilia, Italy)ISG, 1988-200518 / 48696133 / 503.7 / 0.24100 / 78100 / NR565011 / 6 / NRAzizlerli, G. et al. Middle East (Istambul, Turkey)ISG / prevalence study101 / 23986NR / 48.542 / NR100 / 70.2Not globally reported / 69.327.7Not globally reportedNR / Not globally reported / NRDavatchi, F. et al. Middle East (Iran nationwide)Expert opinion / 1975-20187641 / NR25.6 / 44.280 / NR97.5 / 64.462.2 / 50.455.638.13.9 / 8.9 / 6.8Krause, I. et al. Middle East (Galilee, Israel)ISG / 15 years (not specific years have been reported)112 / 73700030.6 / 4715.2 / NRNR / 6841 / 44.4587011.6 / Not globally reported / NRNishiyama, M. et al. Asia (Japan nationwide)1987 JCBD / 19913316 / NR35.7 / 50.6NR / NR98.2 / 73.287.1 / 43.869.156.911 / 8.9 / 15.5JCBD: Japanese diagnostic Criteria of Behçet’s Disease; n: number of cases; NR: Not ReportedConclusion:BD’s prevalence in Northern Spain is higher than in most European populations. These differences likely reflect a combination of true geographic variation, methodological artifacts as well as the easy access to Public Health System and its efficiency. In contrast, clinical phenotypes are similar to other regions.References:[1]Lancet. 1990; 335:1078-80[2]J Eur Acad Dermatol Venereol. 2014; 28:338-47Disclosure of Interests:Lara Sanchez-Bilbao: None declared, Guillermo Suárez-Amorín: None declared, Carmen Álvarez-Reguera: None declared, Alba Herrero-Morant: None declared, David Martínez-López: None declared, José Luis Martín-Varillas: None declared, M. Cristina Mata Arnaiz: None declared, Rosalía Demetrio-Pablo: None declared, Miguel A González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Celgene and MSD., Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD., Grant/research support from: AbbVie, MSD and Roche.

Background:Few studies have been investigating ultrasonographic (US) changes at peripheral entheses and joints in patients with anterior acute uveitis (AAU)1and none has been comparing non granulomatous uveitis (AANGU) with granulomatous uveitis (AAGU).Objectives:To investigate prevalence of US entheses and joints abnormalities in a consecutive series of AAU patients and to compare US findings in AANGU HLA-B27 positive and HLA-B27 negative, with AAGU patients.Methods:121 consecutive patients diagnosed with AAU [91 AANGU (40 B27-, 61 B27+) and 20 AAGU, M/F 32/29, mean age 45.4± 12.8 y, mean disease duration 44± 84 m] from the Immunology Eye Unit (AUSL-IRCCS Reggio Emilia, Italy) entered the study. Patients with Fuchs uveitis were enrolled as controls (AAGU group). A complete rheumatological examination, including 68/66 peripheral joint count, entheses and bone spine mobility evaluation, was conducted. Using an Esaote MyLabClass, 18-6MHz linear multifrequency transducer both in B-mode and PD-mode, 6 entheses were evaluated bilaterally for the presence of any elementary lesion, structural damage and active enthesitis, according to OMERACT definitions2. The following sites were studied: lateral epicondyle of humerus, distal quadriceps insertion into the patella, proximal and distal patellar tendon insertions, calcaneal insertion of Achilles tendon and plantar fascia. Knee and ankle joints, were evaluated for synovial hypertrophy, effusion and PD signal. Extensor and flexor tendons of the foot and ankle were also examined for tendon sheath effusion, synovial hypertrophy and PD signal.Results:Abnormal US findings, consisting in the presence of at least one entheseal abnormality, were detected in 110/121 patients (90.2%), the mean number of abnormal entheses per patient was 6.71±5.46. At the enthesis level, structural damage was significantly higher in AANGU, as compared with AAGU (30.9% vs 21.7%, p<0.001) and in AANGU B27+ as compared with B27- (27% vs 36%, p < 0.001). The presence of PD signal at enthesis was significantly increased in AANGU vs AAGU (7.1% vs 0.4%, p < 0.001) but also among AANGU B27+ vs AANGU B27- pts (5.9% vs 9%, p = 0.040). Analysis based on patient-level data showed a significantly higher percentage of patient in AANGU group having at least one enthesis exhibiting PD signal, when compared with AAGU (31% vs 5%, p = 0.023) (Table 1). The prevalence of US joint and tendon sheath alterations was negligible in the entire AAU population (<1%) without any difference between groups.Table 1.US findings at the patient levelTotaln = 121AAGUn = 20AANGUn = 101AANGU B27–n = 40AANGU B27+n = 61AANGU vs AANGUAAGU vs AANGU B27-AAGU vs AANGU B27 +AANGU B27- vs AANGU B27+Entesophyte, n. (%)109 (90,1%)16 (80%)93 (92,1%)39 (97,5%)54 (88,5%)0,1110,0380,4510,142Entheseal erosion, n. (%)12 (9,9%)012 (11,9%)5 (12,5%)7 (11,5%)0,2130,1590,1841Hypoechogenicity, n. (%)5 (5,1%)05 (5%)3 (7,5%)2 (3,3%)0,5890,54410,382Thickened enthesis, n. (%)118 (97,5%)19 (95%)96 (98%)37 (97,4%)59 (97,3%)0,44010,4401Doppler signal at enthesis, n. (%)32 (26,4%)1 (5%)31 (30,7%)13 (32,5%)18 (29,5%)0,0240,0230,0320,750Active enthesitis, n. (%)10 (8,3%)010 (9,9%)5 (12,5%)5 (8,2%)0,2110,1590,3260,512Structural damage, n. (%)109 (90,1%)16 (80%)93 (92,1%)39 (97,5%)54 (88,5%)0,1110,0380,4510,142Results are presented as number and percentage of patients having at least 1 entheseal abnormality, with significanceConclusion:US entheseal structural damage is frequent in AAU patients, whereas US active enthesitis has a low prevalence. At the patient level, the presence of PD signal at enthesis seems to be associated with AANGU, without apparent influence of HLA-B27 positivity.References:[1]Muñoz-Fernández S, et al. Arthritis Rheum. 2009;60(7):1985-1990.[2]Balint P V, et al. Ann Rheum Dis. 2018;77(12):1730-1735.Disclosure of Interests:None declared

Background:Previous studies evaluated clinical relapses and long-term remission mainly in patients with biopsy-proven GCA and/or patients satisfying the ACR 1990 criteria for GCA classification. Also, radiological involvement was unfrequently used to define relapses and monitor disease activity in patients with LV-GCAObjectives:To evaluate characteristics and predictors of relapses and long-term remission in an Italian cohort of patients with large-vessel (LV) giant cell arteritis (GCA).Methods:We evaluated 87 consecutive patients with LV-GCA followed up at the Rheumatology Unit of Reggio Emilia Hospital (Italy) for at least 2 years. Patients with relapses and long-term remission were compared to those without. A comparison group of 34 patients with biopsy proven GCA without LV vasculitis (LVV) at diagnosis was considered for comparison.Results:37 patients (42.5%) experienced one or more relapses. Nineteen (37.2%) of the 51 relapses were experienced during the first year after diagnosis. The majority of relapses occurred with doses of prednisone (PDN) ≤ 10 mg/day (74.5%). Polymyalgia rheumatica (PMR) (41.2%) and worsening at imaging of LVV (39.2%) were the most frequently observed relapsing manifestations. The total cumulative prednisone dose was significantly higher (p = 0.0001) and the total duration of PDN treatment longer (p = 0.0001) in relapsing patients compared to those without relapses. Relapsing patients had at diagnosis more frequently fever ≥ 38°C (p = 0.03) and visual manifestations (p = 0.03), and less frequently long-term remission (p = 0.003). In the multivariate model fever ≥ 38 °C (HR 3.22, 95%CI:1.43-7.27),duration of PDN treatment (HR 1.01, 95%CI: 1.00-1.02) and total cumulative PDN dose (HR 1.20, 95%CI: 1.09-1.33) were significantly associated with an increased risk of relapses, while aortic arch involvement at imaging at diagnosis (HR 0.22, 95%CI: 0.09-0.55) and long-term remission (HR 0.30, 95%CI: 0.12-0.75) with a reduced risk. 37 patients (42.5%) experienced long-term remission. PMR and disease relapses were less frequently observed (p = 0.003 for both), and the total cumulative prednisone dose was lower (p = 0.005) in patients with long-term remission compared to those without. In the multivariate model the presence of relapses (HR 0.33, 95%CI: 0.14-0.78) and the total cumulative PDN dose (HR 0.89, 95%CI: 0.83-0.96) were significantly negatively associated with long-term remission.Conclusion:In our cohort of patients with LV GCA we identified predictors of a relapsing course and long-term remission, which were observed in around half of the patients.Disclosure of Interests:luigi boiardi: None declared, Francesco Muratore: None declared, Giovanna Restuccia: None declared, Alberto Cavazza: None declared, Maria Grazia Catanoso: None declared, Pierluigi Macchioni: None declared, Lucia Spaggiari: None declared, Luca Cimino: None declared, Raffaella Aldigeri: None declared, Nicolò Pipitone: None declared, Antonio Fontana: None declared, Massimiliano Csaali: None declared, Stefania Croci: None declared, Nicolò Girolimetto: None declared, Carlo Salvarani Grant/research support from: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis, Consultant of: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis

Merchant, Hugo, Antonio Zainos, Adrián Hernández, Emilio Salinas, and Ranulfo Romo. Functional properties of primate putamen neurons during the categorization of tactile stimuli. J. Neurophysiol. 77: 1132–1154, 1997. We used psychometric techniques and neurophysiological recordings to study the role of the putamen in somesthetic perception. Four monkeys were trained to categorize the speed of moving tactile stimuli. Animals performed a task in which one of two target switches had to be pressed with the right hand to indicate whether the speed of probe movement across the glabrous skin of the left, restrained hand was low or high. During the task we recorded the activity of neurons in the putamen contralateral (right) and ipsilateral (left) to the stimulated hand. We found different types of neuronal responses, all present in the right and left putamen. Some neurons responded during the stimulus period, others responded during the hand-arm movement used to indicate categorization, and others responded during both of these periods. The responses of many neurons did not vary either with the speed of the stimuli or in relation to the categorization process. In contrast, neurons of a particular type responded differentially: their activity reflected whether the stimulus speed was low or high. These differential responses occurred during the stimulus and hand-arm motion periods. A number of the nondifferential and differential neurons were studied when the same stimuli used in the categorization task were delivered passively. Few neurons with nondifferential discharges, and none of the differential neurons, responded in this condition. In a visually cued control task we studied the possibility that the differential responses were associated with the intention to press or with the trajectory of the hand to one of the target switches. In this condition, a light turned on instructed the animal which target switch to press for a reward. Very few neurons in both hemispheres maintained the differential responses observed during the categorization task. Those neurons that discharged selectively for low or high speeds were analyzed quantitatively to produce a measure comparable with the psychometric function. The thresholds of the resulting neurometric curves for the neuronal populations were very similar to the psychometric thresholds. The activity of a large fraction of these neurons could be used to accurately predict whether the stimulus speed was low or high. The results indicate that the putamen, both contralateral and ipsilateral to the stimulated hand, contains neurons that discharge in response to the somesthetic stimuli during the categorization task. Those neurons that respond irrespective of the stimulus speed appear to be involved in the general sensorimotor behavior of the animal during the execution of the task. The results suggest that the putamen may play a role in bimanual tasks. The recording of neurons in the right and left putamen whose activities correlate with the speed categories suggests that this region of the basal ganglia, in addition to its role in motor functions, is also involved in the animal's decision process.

Background:Considerable epidemiological variations in prevalence of Behçet’s disease (BD) have been reported. These disparities may either reflect geographical differences, methodological artifacts, changes over time or random fluctuations. In Spain, published BD’s epidemiological studies are scarce.Objectives:To study epidemiological and clinical domains of BD in a well-defined population of Northern Spain, as well as, to compare results with other regions.Methods:We included all consecutive 111 patients, diagnosed of definitive or possible BD by expert rheumatologists between 1980 and 2019. Two Classification criteria were applied: a) International Study Group (ISG) for BD(Lancet. 1990; 335:1078-80), and b) International Criteria for BD (ICBD)(J Eur Acad Dermatol Venereol. 2014; 28:338-47). In addition, a literature review of Medline publications was carried out.Results:In our study, prevalence was higher than in most European populations regardless of the diagnostic criteria applied. Incidence was low (expert opinion: 0.021, ICBD: 0.016, ISG: 0.012). Mean age at onset (36.8±13.2) and gender distribution (55.9% females) were similar to other countries. Pathergy test was performed in 9% of patients giving low results (25.2%). Clinical domains’ frequency was in line with other regions except vascular and gastrointestinal involvement, which were lower. (TABLE)Conclusion:BD’s prevalence in Northern Spain is higher than in most European populations. These differences likely reflect a combination of true geographic variation, methodological artifacts as well as the easy access to Public Health System and its efficiency. In contrast, clinical phenotypes are similar to other regions.TABLEDiagnostic criteria and study periodn cases / population sizeMean age at onset and sex (%females)Prevalence (over 100000) / incidenceOral / genital ulcers (%)Skin lessions/ pathergy test (%)Ocular involvement (%)Joint involvement (%)Neurobehcet/ Vascular/ Gastrointestinal involvement (%)Herrero, A et al. Southern Europe (Cantabria, Spain)Expert opinion, ISG, ICBD / 1980-2019111 (expert opinion) / 86 (ICBD) / 65 (ISG) / 58107836.8±13.2/ 55.919.1 (expert opinion), 14.8 (ICBD), 11.2 (ISG) / 0.021 (expert opinion), 0.016 (ICBD), 0.012 (ISG)99 / 53.168.4 / 25. 235.168.518 / 10 / 4.5Calamia, K. T. et al. North America (Minnesota, USA)ISG / 1960-200513 / NR31 / 305.2 / 0.38100 / 6285 / NR624623 / 23 / NRAltenburg, A. et al. Northern Europe (Berlin, Germany)ISG and ABD classification tree / 1961-2005590 / 339134426 / 584.9 / 1 (estimated)98.5 / 63.762.5 / 33.758.15310.9 / 22.7 / 11.6Mohammad, A. et al. Northern Europe (Skane County, Sweden)ISG / 1997-201040 / 80931730.5 / 334.9 / 0.2100 / 8088 / NR53400 / 20 / NRMahr, A. et al. Southern Europe (Seine-Saint-Denis County, France)ISG / 200379 / 109441227.6 / 437.1 / NR100 / 8090 / 20515910 / NR / 10Salvarani, C. et al. Southern Europe (Reggio Emilia, Italy)ISG, 1988-200518 / 48696133 / 503.7 / 0.24100 / 78100 / NR565011 / 6 / NRAzizlerli, G. et al. Middle East (Istambul, Turkey)ISG / prevalence study101 / 23986NR / 48.542 / NR100 / 70.2Not globally reported / 69.327.7Not globally reportedNR / Not globally reported / NRDavatchi, F. et al. Middle East (Iran nationwide)Expert opinion / 1975-20187641 / NR25.6 / 44.280 / NR97.5 / 64.462.2 / 50.455.638.13.9 / 8.9 / 6.8Krause, I. et al. Middle East (Galilee, Israel)ISG / 15 years (not specific years have been reported)112 / 73700030.6 / 4715.2 / NRNR / 6841 / 44.4587011.6 / Not globally reported / NRNishiyama, M. et al. Asia (Japan nationwide)1987 JCBD / 19913316 / NR35.7 / 50.6NR / NR98.2 / 73.287.1 / 43.869.156.911 / 8.9 / 15.5Disclosure of Interests:Alba Herrero Morant: None declared, Guillermo Suárez Amorín: None declared, Lara Sanchez Bilbao: None declared, Carmen Álvarez Reguera: None declared, David Martínez-López: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Patricia Setien Preciados: None declared, M. Cristina Mata Arnaiz: None declared, Rosalía Demetrio-Pablo: None declared, Miguel Ángel Gordo Vega: None declared, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

Background:contrast-enhanced ultrasonography (CEUS) has been proposed as a tool to assess myositis, but data in the literature are still scarce (Radiologe 2018;58:579).Objectives:to evaluate CEUS as a tool to assess myositis patients and its accuracy in differentiating myositis from common mimickers.Methods:16 patients with myositis (4 polymyositis, 6 dermatomyositis, 2 immune-mediated necrotizing myopathy, 1 inclusion body myositis, 2 overlaps Sjøgren’s syndrome - myositis and 1 Enterovirus-reactive myositis) and 4 controls (2 peripheral neuropathy, 1 limb girdle muscle dystrophy, and 1 metabolic myopathy) underwent after rest CEUS (Esaote MyLab, linear probe 13-5 MHz, Sonovue®) at a room temperature of 20° of the vastus lateralis and medialis muscles. CEUS was performed by 2 ultrasonographists with an expertise in muscle US blinded to the clinical data of the patients. CEUS muscle signal was expressed on a 0-4 scale as described in J Rheumatol 2001; 28:1271 per each muscle group and the global score was divided by four. Creatine kinase (CK), manual muscle test (MTT) and MRI of the thigh muscles were performed within maximum one month from the CEUS. MMT was expressed using the 0-5 Medical Research Council scale; intermediate points were converted into decimals as detailed in Kendall FP et al, Muscle Testing & Function: Testing and Function with Posture and Pain. 5th ed., Lippincott Williams & Wilkins, 2005. MRI of the thigh muscles was considered positive if it showed muscle edema. Myositis was defined active if CK was raised above the reference range and/or MMT showed progressive worsening. Results were expressed as median (range). Between-group comparison was performed with Mann-Whitney test. Statistical analysis was performed with SPSS version 20. The study was approved by the Ethics Committee and all patients provided their written consent.Results:Median (range) age was 38 (69) years in the myositis and 41 (45) years in the control group (p=0.89). Disease duration in the myositis group was 60 (334) months. CEUS muscle score was 0.5 (3) in the myositis group and 2 (3) in the control group (p=0.99). In the myositis group, CEUS score did not differ between treated and untreated patients (p=0.84). CK values were 361 (6442) in the myositis group and 363 (799) in the control group (p=0.68). MMT was significantly lower in the myositis group [4.33 (2)] than in the control group [4.94 (0)] (p=0.038). CEUS was 77% (47-05 95% confidence interval) sensitive and 67% (9-99% 95% confidence interval) specific for a diagnosis of myositis. CEUS was positive in 10/13 patients and negative in 3/13 with active myositis, while was negative in 2/3 patients and positive in 1/3 with inactive myositis. Statistically, CEUS did not discriminate between active and inactive myositis (Fisher’s exact test p= 0.21). All controls had a positive CEUS. No association was found between MRI edema and a positive CEUS (intraclass correlation coefficient p=0.5). No correlation was found between CEUS score, on the one hand, and CK levels or MMT, on the other (Spearman’s rho p>0.05).Conclusion:CEUS has moderate sensitivity for a diagnosis of myositis, but does not discriminate between myositis and some of its common mimickers. Larger studies are required to better evaluate the role of CEUS in patients with myositis.Disclosure of Interests:Nicolo Pipitone Consultant of: Received royalties from Uptodate.comInvestigator for the gevokizumab in myositis Servier study (2014), the sirukumab in GCA GSK study (2016), PI for the ToReMy AIFA funded (2017) study and for the FOREUM funded (2018) GCA study, Speakers bureau: Guest speaker at UCB-sponsored meetings: (Immunology Summits, Prague, 2012, 2013 & 2014, MACRO Meet the expert at the ACademy of RheumatOlogy, Bologna 13 - 14 April 2012, GRAPPA Workshop, Milan 29 January 2016 and Rome 30 November 2017), Fininvest (Catania 2016), Aim Group (Reggio Emilia 2018), I&C (Cologna, 2018), Alfa-Wassermann sponsored meeting (Rhewind, Bologna, February 2016 and 2019), Pierluigi Macchioni: None declared, Gianluigi Bajocchi: None declared, Carlo Salvarani Grant/research support from: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis, Consultant of: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis

In recent years, STEAM (Science, Technology, Engineering, Art, and Mathematics) has received wide attention. STEAM complements early childhood learning needs in honing 2nd century skills. This study aims to introduce a loose section in early childhood learning to pre-service teachers and then to explore their perceptions of how to use loose parts in supporting STEAM. The study design uses qualitative phenomenological methods. FGDs (Focus Group Discussions) are used as data collection instruments. The findings point to two main themes that emerged from the discussion: a loose section that supports freedom of creation and problem solving. Freedom clearly supports science, mathematics and arts education while problem solving significantly supports engineering and technology education. Keywords: Early Childhood Educators, Loose-part, STEAM References: Allen, A. (2016). Don’t Fear STEM: You Already Teach It! Exchange, (231), 56–59. Ansberry, B. K., & Morgan, E. (2019). Seven Myths of STEM. 56(6), 64–67. Bagiati, A., & Evangelou, D. (2015). Engineering curriculum in the preschool classroom: the teacher’s experience. European Early Childhood Education Research Journal, 23(1), 112–128. https://doi.org/10.1080/1350293X.2014.991099 Becker, K., & Park, K. (2011). Effects of integrative approaches among science , technology , engineering , and mathematics ( STEM ) subjects on students ’ learning : A preliminary meta-analysis. 12(5), 23–38. Berk, L. E. (2009). Child Development (8th ed.). Boston: Pearson Education. Can, B., Yildiz-Demirtas, V., & Altun, E. (2017). The Effect of Project-based Science Education Programme on Scientific Process Skills and Conception of Kindergargen Students. 16(3), 395–413. Casey, T., Robertson, J., Abel, J., Cairns, M., Caldwell, L., Campbell, K., … Robertson, T. (2016). Loose Parts Play. Edinburgh. Cheung, R. H. P. (2017). 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More and more frequently, patients admitted to surgical wards present characteristics similar to those admitted to medical units. They are fragile patients, often elderly, with significant comorbidity. In recent years, to address these emerging clinical issues in a surgical setting, different organizational models involving specialists of different backgrounds were studied, and in particular involving internists and geriatricians. To widen our current knowledge, in 2011 the Federation of Associations of Hospital Doctors on Internal Medicine of Emilia-Romagna, northern Italy (FADOI-ER), proposed a questionnaire to the public healthcare internal medicine departments of the Emilia Romagna region to collect information as to in what way and to what extent internists are involved in the management of surgical patients. In this article, we analyze the results of the questionnaire and make some organizational considerations and proposals. The questionnaire was very simple, consisting of 14 items. The survey was conducted from 1-28 February 2011. Replies were received from 20 internal medicine departments of a total of 75 in the Emilia Romagna region. The FADOI-ER survey has some limitations, the first of which is that only just under 25% of internal medicine departments in the Emilia Romagna region took part. However, the results are still interesting and seem to suggest that internists, because of their particular cultural background and training, could be the preferred partners for comanagement within the context of inpatient surgical procedures. The results of the FADOI-ER questionnaire are also consistent with the data reported in literature and daily clinical experience that highlight the need for a more multi-specialist approach to patient management with medical internists. Further studies will help provide answers as to the best way to conduct this multidisciplinary approach that could represent one of the future challenges for healthcare.

Abstract Background Lead is a heavy metal naturally occurring in the environment and also released by some anthropogenic activities. Food is one the major sources of human exposure for non-occupationally exposed individuals. In this study, we aimed at characterizing lead (Pb) content in foods consumed in Northern Italy population, in order to estimate its dietary intake. Methods We measured lead content in 908 food and beverage samples bought at small shops and supermarkets of the Northern Italy provinces of Modena and Reggio Emilia, through inductively coupled plasma mass spectrometry. We used a validated semi-quantitative food frequency questionnaire to assess the dietary habits of a representative sample of 719 individuals (319 males and 400 females) aged 18-87 years residing in Northern Italy (Emilia Romagna). We estimated weekly dietary intakes of Pb, and we compared them with safety standards set by the European Food Safety Authority (EFSA). Results In this population, vegetables and vegetables products were the main contributors to Pb intake. The highest levels of Pb were in edible offal, and then in crustaceans, dry fruits, chocolate free sweet confectionery, and coffee and tea as beverages. In general, Pb levels in our samples were comparable and did not exceed the average contamination levels reported by EFSA in various European countries. We found a comparable average Pb intake in both sexes. Average weekly intake of Pb was below EFSA recommended provisional tolerable weekly intake. Conclusions Our study provides an updated assessment of lead exposure through diet in a Northern Italian community. Although environmental lead contamination and exposure have markedly decreased in the last decades, recent evidence pointed out that a safety threshold value cannot yet be established for prevention of adverse effects due to lead exposure, since even low levels of lead intake may still increase the risk of chronic renal disease and hypertension. Key messages Food is one the major lead sources of human exposure for non-occupationally exposed individuals. Lead levels in Northern Italian population studied are comparable and do not exceed the average contamination levels reported by European Food Safety Authority in various European countries.

Abstract Background and Aims Many studies are available that reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative therapy for chronic kidney disease (CKD) have received lower attention, therefore little is known about how COVID-19 may affect this population. The aim of this study was to analyse the COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program, living in a small area of Northern Italy. Method The study population included CKD patients from the Emilia-Romagna Prevention of Progressive Renal Insufficiency (PIRP) project, followed up in the 4 nephrology units (Ravenna, Forlì, Cesena and Rimini) of AUSL Romagna (Italy) and alive at 1.01.2020. All patients were in conservative therapy and none of them had initiated dialysis or received kidney transplantation. The hospital discharge database was used to identify patients hospitalized with COVID-19 up to 31.07.2020, and the mortality database was used to assess mortality among patients with COVID-19 at the same date. Multivariable logistic regression was used to identify predictors of COVID-19 disease, and Kaplan-Meier survival analysis to identify predictors of COVID-19 mortality. Excess mortality of 2020 compared to mortality in 2015-19 in the PIRP cohort was also estimated. Results COVID-19 incidence among CKD patients was 4.09% (193/4716 patients), while in the general population it was 0.46% (5,195/1,125,574). COVID-19 was more likely in CKD patients with older age (Odds Ratio=1.038), cardiovascular comorbidities (OR=2.217), COPD (OR=1.559) and less likely in patients living in the province of Ravenna (OR=0.468), that was hit later by the first wave of pandemic compared to the other areas of AUSL Romagna. Baseline eGFR was lower in CKD patients with COVID-19 (31.7 vs. 35.8 ml/min/1.73 m2), but this difference did not reach statistical significance (p=0.066). As of 31.07.2020, the crude mortality rate among CKD patients with COVID-19 was 44.6% (86/193), compared to 4.7% (215/4523) in CKD patients without COVID-19 and to 14.5% (4289/29670) in the general population with COVID-19 of the Emilia-Romagna region. Factors associated with mortality of CKD patients with COVID-19 were older age (p=0.034) and the period of COVID-19 onset (p=0.003). The highest crude mortality rate (71.4%) was found in CKD patients for whom COVID-19 onset occurred between 8 and 21 March. The excess mortality of January-July 2020 with respect to the average mortality of January-July 2015-19 in the PIRP cohort was +17.7%, corresponding to 77 excess deaths. March-April was the period with the highest excess mortality (+69.8%), while in January-February a 15.9% lower mortality was observed with respect to the corresponding months of the five previous years. Conclusion In our study, including a cohort of regularly followed up CKD patients, the risk of COVID-19 disease and of COVID-19 related mortality was comparable, or even somewhat higher, to that observed in patients on dialysis and those who received kidney transplantation. The incidence of COVID-19 in CKD patients was higher in the areas of AUSL Romagna earlier affected by the pandemic wave, whereas mortality rates were similar across all areas. CKD patients represent a population very vulnerable to COVID-19 disease, and their protection should be highly prioritized in the models of care and prevention measures.