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Background: Cytomegalovirus (CMV) infection is the most common and serious congenital infection, with universal screening in pregnancy, standardized therapy, and a vaccine still lacking. Study design: In the 1990s, we noted that intravenous ganciclovir did not cure some children with severe sequelae due to congenital cytomegalovirus (CMV) infection. Therefore, we performed an open randomized trial using intravenous foscarnet as an alternative to intravenous ganciclovir in 24 infants (12 in each therapy group), all with severe neurological manifestations due to congenital CMV infection. Nine and five infants, belonging to the foscarnet or ganciclovir group, respectively, had abnormal hearing. One infant in each group also had chorioretinitis. Concomitantly, 12 CMV-infected infants with similar manifestations, who did not receive any therapy, were used as controls. The results of short-term (2 years) and long-term (7–29 years, mean 22.2) follow-up are reported herein. Short-term results: Neurological outcomes were normal in five of the twelve children who were treated with foscarnet, compared to nine of the twelve children given ganciclovir. None of the untreated children were healthy. There was a statistically significant difference (p = 0.023) between the treated and untreated children. Hearing was normal in four of the twelve children treated with foscarnet, seven of the twelve children treated with ganciclovir, and two untreated children. Long-term-results: Two children in both therapy groups died before the age of 17 years, and six untreated children died between 7 and 26 years of age. Neurological outcomes were normal in three of the ten children treated with foscarnet, in two of the ten treated with ganciclovir, and in none of the untreated children. Hearing was normal in two children treated with foscarnet, in six children treated with ganciclovir, and in one untreated child. Conclusions: Intravenous ganciclovir and foscarnet were found to be safe at long-term follow-up and appeared to be capable of mitigating the neurological and auditory consequences of congenital CMV disease at the short-term follow-up. However, there was progressive worsening of the symptomatology in all three groups, with a statistically significant increase in the number of deaths (p = 0.035) among 4 of the 24 children in the therapy groups and 6 of the 12 untreated children.

ObjectivesHigher levels of individual health literacy have been associated with better health outcomes, greater medication adherence and improved self-management of chronic conditions. Hence, higher health literacy levels are expected to be indirectly associated with lower healthcare costs. The aim of this review is to identify and synthesise available studies on the relationship between individual health literacy and healthcare costs.DesignSystematic review with qualitative evidence synthesis.Data sourcesMEDLINE, Scopus, Web of Science Core Collection and CINAHL were searched up to 7 March 2025.Eligibility criteriaWe considered only studies that investigated and quantified the relationship between individual health literacy and healthcare costs sustained by individuals, insurance companies or health providers.Data extraction and synthesisArticle screening and data extraction were performed by two authors independently. We critically appraised the identified study by using the AXIS checklist and evaluated the methodology adopted for cost analysis. Finally, we performed a qualitative synthesis of the study results.ResultsOf a total of 5801 articles identified, 23 studies met the inclusion criteria. Almost half of the studies were conducted in the USA and about one-third in European countries. The included studies showed fair average quality and great heterogeneity in health literacy measures and cost analyses. The analyses considered general medical, treatment-related, inpatient, outpatient and emergency costs, out-of-pocket expenses and financial hardship. Fifteen studies reported statistically significant results, estimating the association between health literacy and costs or evaluating the difference in costs incurred by different health literacy subgroups. All study results supported the hypothesised negative association between health literacy levels and healthcare costs.ConclusionIndividual health literacy was found to be negatively associated with a range of healthcare costs, although the supporting evidence was not always robust. Interventions aimed at containing healthcare expenditure should consider this association, while further research is needed to define its nature.PROSPERO registration numberThe review has been registered in the PROSPERO International prospective register of systematic reviews (registration code CRD42023435502).

Cytomegalovirus (CMV) is the most common cause of congenital infections in developed countries because is capable of infecting the fetus after both primary and recurrent maternal infection, and because the virus may be spread for years through infected children. Moreover, CMV is the most serious congenital infection associated with severe neurological and sensorineural sequelae, which can occur at birth or develop later on. Hygienic measures can prevent CMV transmission, which mainly involve contact with children under 3 years of age and attending a nursery or daycare. In animal and human pregnancies, many observational and controlled studies have shown that CMV-specific hyperimmune globulin (HIG) is safe and can significantly decrease maternal–fetal transmission of CMV infection and, mostly, the occurrence of CMV disease. Recently, valaciclovir at the dosage of 8 g/day was also reported to be capable of decreasing the rates of congenital infection and disease. However, comparing the results of our two recent case series, the infants born to women treated with HIG showed significantly lower rates of CMV DNA positivity in urine (9.7% vs. 75.0%; p < 0.0001) and abnormalities after follow-up (0.0% vs. 41.7%; p < 0.0001). The implementation of CMV screening would enable primary prevention via hygiene counseling, improve the understanding and awareness of congenital CMV infection, and increase the knowledge of the potential efficacy of preventive or therapeutic HIG or antiviral administration.

Study designMeta-analysisObjectivesDenervation and androgen deficiency, peculiar to individuals with chronic spinal cord injury (SCI), could hinder, to some extent, both prostate growth and activity. To comprehensively assess the relationship between SCI and prostate volume, we carried out a meta-analysis of the available case-control studies.MethodsA thorough search of MEDLINE, Scopus and Web of Science was carried out to identify studies comparing prostate volume in men with and without SCI. Quality of the studies was assessed using the Newcastle–Ottawa Scale (NOS). Mean differences (MDs) in prostate volume were combined using a random effect model. Funnel plot was used to assess publication bias.ResultsFour studies met the inclusion criteria and provided information on 278 men with SCI and 1385 able-bodied controls. The overall difference in prostate volume between the two groups reached the statistical significance (pooled MD: −14.85 ml, 95% CI: −27.10 to −2.61, p = 0.02). In a subgroup analysis including only the studies with the highest NOS score, the pooled MD remained significant (pooled MD: −18.56, 95% CI: −33.14 to −3.99, p = 0.01). The shape of funnel plot did not allow to rule out a possible publication bias.ConclusionsThis meta-analysis suggests that in men with SCI, prostate volume tends to be smaller than in age-matched able-bodied men. Longitudinal studies of men with long-lasting SCI in advanced age are warranted to clarify whether this condition is associated with a lower risk of age-related prostate proliferative diseases.

Background Inorganic lead exposure is a relevant occupational health issue in many industry sectors. European regulations set specific limits for time-weighted chemical airborne exposure and for biological exposure. While blood lead monitoring is the current standard, saliva sampling offers a less invasive alternative for biomonitoring. This study evaluates the potential of salivary lead assessment as an alternative biological matrix for occupational exposure monitoring. Methods An observational study was conducted at a lead-acid battery production facility in Central Italy from July to December 2024. Ninety-two male workers participated: 46 occupationally exposed and 46 non-exposed workers. Salivary lead levels were measured using ICP-MS in all participants. Blood lead levels and personal airborne lead assessments were performed in the exposed group. Socio-demographic data were collected through self-administered questionnaires. Results Mean salivary lead levels were significantly higher in exposed workers (23.3 ± 41.4 ng/swab) compared to non-exposed workers (0.3 ± 0.6 ng/swab, p  < 0.001). A moderate positive correlation was found between environmental and salivary lead levels (ρ = 0.5587, p  = 0.0003). No significant correlations were observed between blood and salivary lead levels or between environmental and blood lead levels. Occupational exposure and alcohol consumption were significant predictors of salivary lead levels. Conclusions Saliva appears to be a promising alternative matrix for recent lead exposure monitoring, showing better correlation with environmental exposure than blood lead levels. Further research is needed to establish reference values and standardize salivary lead biomonitoring protocols.

Background The COVID-19 pandemic has ravaged many countries worldwide since December 2019. The high infection rates, and the need for health care assistance for individuals with comorbidities, strained the national health care systems around the world. Outbreak peaks increased the burden on hospitals that where perceived as high-risk places by people, who often decided to cancel or defer hospital visits. Thus, Italian Local Health Authorities had to develop new organizational models to meet the increased health care needs of the population. The aim of this study is to assess the impact of strengthened community health services on the hospital burden. Methods We analysed the number of Emergency Department access at the Hospital De Lellis covered by the Local Health Authority in Rieti, from March 2020 to November 2021. We then assessed the effects of community health services: the Special District Continuing Care Units (SDCUs) and the the COVID hub, on the COVID-19-related ED access, admission and mortality rates. A Chi-squared test for trend and three multivariable logistic regression models were used to investigate the trends and the possible predictors of COVID ED access, COVID hospital admissions, and deaths. Results Being male (OR = 1.41, CI95% 1.05–1.90; p  = 0.022) and older age (OR = 1.03, CI95% 1.02–1.04; p  < 0.0001) increase the likelihood of hospitalisation for Sars-CoV-2. The implementation of the nursing and medical SDCUs contributed to reducing COVID-19-related deaths (OR = 0.09, CI95% 0.03–0.29; p  < 0.0001). The simultaneous implementation of the COVID hub and of the nursing SDCUs had a synergistic effect in reducing the likelihood of hospitalisation (OR = 0.24, CI95% 0.09–0.65; p  = 0.005). The subsequent implementation of the medical SDCUS has further contributed to lowering the admission rates. These protective effects persisted also after potential cofounders, such as age, sex, clinical condition on admission, and the immunisation status, were adjusted. Conclusions These measures have helped in the management of patients in a complex context such as that of a pandemic by reducing the hospital load and playing an important role in the management of the pandemic. Further studies could assess the transferability of this model in a non-pandemic context.

Firefighters are potentially exposed to multiple harmful substances, and their activities are classified as carcinogenic to humans. This case study assessed early genotoxic damage (fpg-comet and BMCyt assays) and epigenetic alterations (seven circulating miRNAs) in 35 firefighters compared to 45 non-exposed workers. Occupational exposure to fire smoke was self-reported via questionnaire. Firefighters showed higher median genotoxic DNA damage with respect to the non-exposed group (%DNA tail Buff 19.4 vs. 16.8; %DNA tail Enz 22.2 vs. 19.3; Tail moment 5.5 vs. 4.5; % of apoptotic cells 1.13 vs. 0.97). miRNAs related to air pollution, oxidative stress, tumor suppression, and immune responses, like mir-16, mir-15a, mir-29a, mir-125b, and mir-142, showed significant downregulation (p < 0.001) in the exposed group. Mean percentages of early apoptosis biomarkers and composite DNA damage indices among FF also differed significantly from the other participants (‰Condensed chromatin 0.46 vs. 0.06; ‰Tot anomalies 5.15 vs. 3.82). Multiple correlations emerged, particularly between miRNAs and comet assay parameters, and between comet assay and BMCyt indicators. The implemented integrated approach provides information about the existence of a relationship between genotoxic and epigenetic effects in firefighters, also influenced by time since exposure. Future studies with bigger sample sizes are required.

Unhealthy behaviors may contribute to the development and the progression of chronic diseases with negative consequences on patients’ quality of life. The present study aimed to investigate the relationship between unhealthy behaviors (physical inactivity, tobacco consumption, and alcohol consumption) and health-related quality of life, measured with the SF-36 questionnaire, in women with endometriosis. To achieve this, data from a previous cross-sectional web survey among Italian adult women were analyzed. A total of 1045 responses were included in the analysis. Among the SF-36 subscales, the lowest score was recorded in the energy/fatigue domain: mean = 35.536 (Standard Deviation = 18.452). Smoking and physically inactive women had lower scores than non-smoking and physically active women, respectively, in each SF-36 domain. Women who drank more than one unit of alcohol a day, on average, reported lower scores than women with an alcohol intake <1 unit a day, for the following SF-36 domains: role limitations due to physical health, role limitations due to emotional problems, and emotional well-being. The multivariable analysis evidenced that employment, physical inactivity, and tobacco consumption were significant predictors for each SF-36 domain (p < 0.05). Physical inactivity and tobacco consumption had negative effects on the SF-36 subscales. Our results showed the need to monitor unhealthy behaviors to improve the overall well-being of women with endometriosis. Tailored strategies addressing smoking cessation, promoting physical activity, and moderating alcohol intake may aid in enhancing health-related quality of life in this vulnerable population.

Background and Objectives: The objective of the study was to evaluate the epidemiology of slope-related accidents in a high-volume trauma center during the winter season. In addition, this study aims to analyze patient-related, equipment-related, and environment-related characteristics. Materials and Methods: A questionnaire containing 22 items was distributed to all adult patients admitted to the emergency department of the Brixen Hospital (Italy) during the 2023/24 winter season because of a ski/snowboard-related injury. Results: The final database included 579 questionnaires from 579 patients who ultimately entered the study: 285 were females and 294 were males. The analysis of risk factors for fractures revealed that patients with fractures were generally older (50.7 ± 16.0 years) compared to those without fractures (45.4 ± 17.2 years, p = 0.0021). Thirty-six percent of injuries were considered as joint sprain/ligament strain: patients in this group were younger (45.5 ± 16.2 years) compared to all patients (48.3 ± 17.3 years, p = 0.0151). Conclusions: In conclusion, this study identified significant risk factors associated with skiing and snowboarding injuries. Fractures were more common among older and more experienced skiers, particularly those who described themselves as experts. Ligamentous distortions were more common among younger and less experienced skiers. Fatigue is generally underestimated, and the general physical preparation is often lacking for sports like skiing and snowboarding. Additionally, the absence of significant correlations between weather conditions, snow quality, equipment type, and the difficulty of the slope with injury risk suggests that individual factors such as age and skill level are more critical determinants of injury risk than environmental or equipment-related factors.

Occupational accidents are a serious public health issue. In this retrospective observational study, we examined all injuries involving healthcare workers of the Abruzzo Local Health Authority No. 1 (Italy) during the three years 2019–2021. Data were collected by tracing the injury reports filed by the emergency service during the workers’ admission and analyzing the cause, type, distribution by sex, and geographical district to which they belonged, taking into account the period before and during the COVID-19 pandemic outbreak. Most injuries (45.7%) were reported in the Marsica area; the most common cause was commuting accidents (10.7%). Assaults were more common among men (8.6%), while commuting accidents were more common among women (11.8%). In 36% of cases, the upper limbs were affected. The most common type of injury was contusions (22.2%). When the frequency of reports was compared between the pre-pandemic and pandemic periods, there was an increase in injuries in healthcare assistants (p = 0.052), while the percentage of injuries in administrative (p = 0.056) and other categories decreased (p = 0.002). This analysis allows us to identify points of interest relating to the Marsica area, to specific types of accidents, such as aggression and commuting accidents, and to specific duties.