Abstract
STUDY QUESTION
Could epidermal growth factor-like domain 7 (EGFL7) be a factor involved in the preparation of the endometrium for implantation and could its dysregulation be implicated in ...poor reproductive outcomes?
SUMMARY ANSWER
EGFL7 is highly expressed in the endothelium and glandular epithelium throughout the menstrual cycle; it is upregulated by stromal cells in secretory phase and appears strongly reduced in endometrial biopsies and isolated stromal cells of women with unexplained recurrent pregnancy loss (uRPL) and recurrent implantation failure (RIF).
WHAT IS KNOWN ALREADY
The secreted factor EGFL7, originally identified as a gene primarily expressed in endothelial cells, is also expressed by the mouse blastocyst and by mouse and human trophoblast cells. It regulates trophoblast migration and invasion by activating NOTCH1 signaling. NOTCH1 has been demonstrated to play a fundamental role in endometrial receptivity and its dysregulation may be involved in selected pregnancy complications characterized by altered endometrial receptivity, such as uRPL.
STUDY DESIGN, SIZE, DURATION
This is an exploratory study for which 84 endometrial biopsies were collected from normally fertile women, as well as from women with uRPL and RIF.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Samples were collected from women in both the proliferative and secretory phases of the menstrual cycle and stratified into three sub-groups according to the patient clinical history: 20 fertile women (8 in proliferative and 12 in secretory phase), 41 women with uRPL (6 in proliferative and 35 in secretory phase), and 27 women with RIF (8 in proliferative and 19 in secretory phase). Immunohistochemistry, real-time PCR, and western blot analyses were performed to study the expression of EGFL7 and NOTCH1, as well as the NOTCH target genes.
MAIN RESULTS AND THE ROLE OF CHANCE
Analysis of spatial and temporal distribution of EGFL7 in endometrial biopsies from fertile women revealed higher levels of EGFL7 in samples from the secretory phase compared to proliferative phase. The expected expression of EGFL7 in endothelial cells was shown as well as the novel, not previously reported, expression in endometrial glands and stromal cells. EGFL7 was significantly reduced in the endometrium of women with uRPL and RIF in the secretory phases and this was associated with a downregulation of the NOTCH1 signaling pathway. Human recombinant EGFL7 was able to activate the NOTCH1 signaling pathway in endometrial stromal cells (EndSCs) obtained from fertile women but not in cells from uRPL or RIF patients. EndSCs from fertile women and decidualized in vitro for three days showed an upregulation of EGFL7 expression, whereas cells obtained from women with uRPL and RIF and decidualized in vitro did not.
LIMITATIONS, REASONS FOR CAUTION
This study was conducted with a relatively small number of patient samples. Although results are highly reproducible and consistent, additional observations from multicentric cohorts would strengthen the relevance of the data. Moreover, this is an in vitro study, which might only partially represent the in vivo conditions.
WIDER IMPLICATIONS OF THE FINDINGS
Our results demonstrate for the first time that EGFL7 is new player involved in decidualization and provide new insights into the pathophysiology of selected implantation defects and early pregnancy complications. Our studies have revealed that alterations in EGFL7 expression and the consequent dysregulation of NOTCH signaling are potential underlying causes of RIF and uRPL. Our results might have therapeutic relevance, as the EGFL7/NOTCH pathway may represent a potential target for medical intervention.
STUDY FUNDING/COMPETING INTEREST(S)
This study has been supported by the Grant for Fertility Innovation 2017 (Merck KGaA). There are no competing interests to disclose.
TRIAL REGISTRATION NUMBER
Not applicable.
The SARS-CoV-2 pandemic has affected also the school environment. Prolonged closures and the weakness of available data prevent a definitive answer to the question of school transmission. We report ...our experience of responding to COVID-19 cases in the school setting, presenting a case study of the management of an outbreak in a large school.
The LHA/ASL Roma 1 has organized the School Units with a structure firmly rooted in the territory. At the local level, the District Unit mainly manages the relationship with schools, while the Hygiene and Public Health Service of the Prevention Department holds a coordinating and facilitating role. The HPHS carries out contact tracing activities facilitated by the schools, through the figure of the COVID-19 Contact Person, who is specifically trained to manage the preliminary stages of the reports.
Following several reports of COVID-19 suspect cases from two schools and, after a complex phase of contact tracing, it was possible to identify the major transmission chains. Furthermore, we performed a population-based screening on the entire school. Beyond the known transmission chains, for which quarantine was already in place, only five additional cases emerged, all asymptomatic, out of 1,231 swabs tested with RT-PCR.
Our experience confirms that an active interaction between the school and the School Unit made it possible to quickly control a potentially dangerous outbreak. The large-scale screening test demonstrated the substantial absence of collateral transmission chains. Effective contact tracing allowed to set forth a successful response. Our model of intervention can be used to support public health protocols regarding school outbreaks.
This study tries to evaluate, through a multidisciplinary approach, the relationship between urban structure, isolation and distribution of social determinants of health, in the so-called ..."formerly-Bastogi, a compound, with more than 1,500 inhabitants, located in north-western Rome, Italy.
The architectural-urban analysis, conducted through site visits and evaluations of urban situation, showed how strongly the compound is isolated from the neighbourhoods, and structurally degraded. The socio-demographic analysis, based on the National Census data, showed significant differences in the distribution of the social determinants of health between "formerly-Bastogi" and the surrounding areas.
The area under study appears to be isolated from the surrounding urban space, both because of social and architectural factors. This situation could have some association with inhabitants' health.
If our preliminary investigation was useful for a diagnosis of the situation, a more complete - qualitative and quantitative - investigation of the context will be needed to plan appropriate multidisciplinary health-promoting interventions.
Summary
The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that aims to provide hip analgesia with preservation of motor function, although evidence is currently ...lacking. In this single‐centre, observer‐masked, randomised controlled trial, patients undergoing total hip arthroplasty received pericapsular nerve group block or no block (control group). Primary outcome measure was maximum pain scores (0–10 numeric rating scale) measured in the first 48 h after surgery. Secondary outcomes included postoperative opioid consumption; patient mobilisation assessments; and length of hospital stay. Sixty patients were randomly allocated equally between groups. The maximum pain score of patients receiving the pericapsular nerve group block was significantly lower than in the control group at all time‐points, with a median (IQR range) of 2.5 (2.0–3.7 0–7) vs. 5.5 (5.0–7.0 2–8) at 12 h; 3 (2.0–4.0 0–7) vs. 6 (5.0–6.0 2–8) at 24 h; and 2.0 (2.0–4.0 0–5) vs. 3.0 (2.0–4.7 0–6) at 48 h; all p < 0.001. Moreover, the pericapsular nerve group showed a significant reduction in opioid consumption, better range of hip motion and shorter time to ambulation. Although no significant difference in hospital length of stay was detected, our results suggest improved postoperative functional recovery following total hip arthroplasty in patients who received pericapsular nerve group block.
Have you ever wondered, what does a clinical research nurse (CRNs) do from day-to-day or week-to-week? This article will attempt to answer those questions by including what defines research, clinical ...research and a CRN. Topics will also include the roles in which CRNs are responsible for or can complete, the challenges they face and their importance in clinical trials. In additional, advantages of being a CRN will be reviewed and how this can powerfully change your view on the career and then stories from CRNs at two major academic research institutes will be reported and how lives are changed because of research nurses. If you read this article and determine that this path may be what you want to pursue or learn more about, the writer has included a section about training and certification which can be reviewed and explored. Also included is knowledge which is helpful to learn when exploring this topic.
Abstract
Background
Several indicators at individual and area level have been used to stratify the population. The aim of this work was to investigate the association between real estate prices, ...education and health status in Rome.
Methods
We used the administrative cohort of residents in Rome at the 2011 census. We followed subjects aged 18+ from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The census includes several individual information, comprising sex, age, education, and residential urbanistic zone. From mortality register we collected date and cause of death. Real estate prices (€/m2) were available for each urbanistic zone. We classified the population in five categories according to the quintile of the distribution (1=highest prices, 5=lowest prices). We used adjusted Cox regression models to estimate the hazard ratios (HRs) and 95%CIs.
Results
We selected 2,053,668 subjects, not living in institutions at the time of the census survey. Women were 54% of the population; the mean age was 52 years (sd 18), 22.5% had a high education (university degree) and 37% a low education (≤ junior high school). During the follow-up, 126,548 subjects died. As expected educational level was strongly associated with all-cause mortality (39% higher risk of low vs. high educated). The mortality risk increased with decreasing real estate prices, taking account of age and sex. Compared to subjects living in highest prices areas, those living in level 2 areas had a HR = 1.08 (95%CI: 1.06-1.10), those in level 3 had a HR = 1.14 (95%CI: 1.12-1.16), those in level 4 a HR = 1.16 (95%CI 1.14-1.18), and finally those living in the cheapest areas a HR = 1.22 (95%CI: 1.20-1.25). When we considered both education and real estate prizes, the HRs marginally decreased.
Conclusions
There is an independent association of both individual education and socioeconomic characteristics of the area of residence and all-cause mortality.
Key messages
There are strong socioeconomic inequalities in Rome. A simple indicator such as real estate prices can be used to tackle inequalities.
Previous studies have showed that people living in Bastogi - a segregated and deprived peripheral area of Rome- have difficulties in accessing and relating to health services. Our aim was to analyze ...the health perception, health-related behaviors, and the interaction between healthcare professionals and the census population living in Bastogi, compared to the population living in the area of the same local health unit, ASL Roma 1 (hereafter ASL). The PASSI survey (from the Italian Surveillance System) was administered by phone and through door-to-door interviews to a sample of 210 residents of Bastogi. Data were analyzed and compared to the ones of the ASL collected in 2017-2018. Descriptive and univariate analysis were performed with STATA 13. P-values ≤ 0.05 were considered statistically significant. The socio-economic indicators, acknowledged determinants of health inequalities, showed a worse condition for the inhabitants of Bastogi. There was a significantly higher proportion of foreign and unemployed residents in Bastogi, with a lower educational level compared to the ASL. 58.1 % of the Bastogi group claimed their health to be good/very good (ASL: 71.6%; p = 0.000). 56.2% of the respondents from Bastogi were current smokers (ASL: 25.8%; p = 0.000). Risk factors for and prevalence of chronic diseases were significantly higher in Bastogi. The proportion of respondents who stated they had not had any recent contact with health professionals was significantly higher, and mammogram screening uptake was lower (75.3%; ASL: 90.4%; p = 0.001). Despite their lower help-seeking behavior, our study pointed out that the respondents from Bastogi who had had a contact with a health professional reported a higher perceived interest about their health than in the ASL. Further studies are needed to investigate whether this attention is attributable to the higher prevalence of chronic diseases or to the health professional's awareness of vulnerability of a hard-to-reach group.
Key messages
The population from Bastogi is marginalized and hard-to-reach: we found a worse overall self- reported health condition, a worse help-seeking behavior and a lack of reliance on health professionals.
The PASSI survey administration has led to a greater involvement of the competent health institution, which resulted in the introduction of a community nurse and a Single Access Point.
Abstract
Introduction
Health and safety of foreign workers employed in agriculture and zootechny present several critical areas. The multidisciplinary project ’Livingstone’, funded by INAIL and ...carried out by several Italian universities, aims to address some of these critical issues. One of the project research line focuses on health professionals and has the objective to investigate their perception of the risks to which foreign workers are exposed and their training needs.
Methods
A 33 items questionnaire is being self-administered to social and health professionals of three Italian regions (Lazio, Lombardia and Campania) where agriculture is developed; the administration phase will last 13 months (2018, April - 2019, May). The questionnaire has been built starting from a literature review; a pilot study have been conducted in a pilot sample in Rome in March 2018. The questionnaire is composed by five sections: general, social and professional information; characteristics of the respondents’ foreign patients/users; knowledge about health problems of foreign patients and about possible obstacles in use of health services, with a specific focus on foreign patients working in agriculture and zootechny sector; perception about health and safety risks of these workers; training background and needs, included desired training contents and modalities.
Results
The research is ongoing. 238 answered questionnaires have been collected yet. 65 of the respondents are General Practitioners; the rest are other health and social professionals. The complete results will be shown during the congress.
Conclusions
This study will contribute to widen the knowledge about health professionals’ perceptions about problems and needs of foreign workers employed in agriculture and zootechny sector.
Specific training addressed to social and health professionals will be developed from the observation of their current knowledge and from their reported needs.
Key messages
This study will contribute to widen knowledge about health professionals’ perceptions about problems and needs of foreign workers employed in agriculture and zootechny sector.
Specific training addressed to social and health professionals will be developed from the observation of their current knowledge and from their reported needs.
Abstract
Background
The Italian law provides for international protection and universal health-care coverage for asylum seekers (AS). Indeed, they are entitled to be regularly registered at the ...National Healthcare Service. Before submitting the application for refugee status, medical assistance to migrants is up to local administration. Our aim was to describe and compare policies and protocols regulating AS healthcare from their arrival to their application for refugee status, at national and regional level. Moreover, we investigated the daily healthcare practice addressing potential gaps between policies and practice.
Methods
The research team is a subgroup of the Inequality working group of the Italian hygiene society and it is composed of public health residents. The research involved also local health workers and other professionals belonging to regional groups of Italian migrant medicine society (SIMM). We collected national, regional and local policies and protocols and we compared them using a specific framework. Furthermore, we achieved a mapping of daily practice implementation at local health organization (LHO) level using a checklist.
Results
The most relevant findings were that regional policies themselves vary notably from each other and, as regard practices, LHO implement differently the same regional legislation. Furthermore, we found some critical issues: the delayed inclusion in primary care assistance and lack of continuity of care and of a computerized system of recording information.
Conclusions
The lack of uniformity concerning policies and practices of AS healthcare might also result in unawareness and uncertainty about how to access to healthcare services by migrants. An enhanced cooperation between groups dealing with migrants’ issues may lead to avoid variability at the implementation. Finally, a computerized system for data collection might facilitate the continuity of care and the assessment of the real health needs of the AS population.
Key messages
It is a priority challenge for health systems to strengthen the interventions aimed at overcoming the linguistic, economic, cultural and administrative barriers to the health services access.
It is crucial to improve the recording information system to detect the real health needs of AS, their change and the inequalities in access and to improve collaboration between groups and university.
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