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Migrants may constitute a risk group and should have specific targets for health policy. To identify their health needs, it is important to investigate their epidemiological profile and their access to health services. The aim of this study was to identify the pattern of hospital and neurological services use among immigrants living in Brescia (Italy). The analysis took into account the records of 45,645 immigrants admitted to the ER (Emergency Room) as well as the discharge data of 6419 patients hospitalized in the Department of Neurology of the Azienda Ospedaliera Spedali Civili di Brescia, over a 3.5 years period. To take confounding factors into account, immigrant patients admitted to the department of Neurology were compared to a selection of Italian patients matched by age and sex. The main objectives were to explore causes of admission of the immigrant population-along with socio-demographic characteristics-to the Emergency Room and to the Neurology Units. Immigrants showed a similar pattern of hospital use to the Italian patients, although with a higher frequency of infective diseases and traumatic injuries. They also showed a higher mean Diagnosis-Related Group (DRG) weight than the Italians. Average length of hospitalization was longer in immigrant population. However, the use of neurological services by migrants is less than their demographic share. Poorer economic and social conditions, as well as a worse labor market experienced by immigrants may expose them to risk factors for injuries and infective diseases. Reducing the language and bureaucratic barriers, as well as enhancing cross-cultural skills of physicians, might be crucial in decreasing the length and the cost of hospitalization.

We report the case of a patient who presented with respiratory failure, recurrent ventricular fibrillation, ventricular arrhythmias, and hypotension after an intentional ingestion of aconite flowers. Significant ingestion of this plant can produce life-threatening cardio- and neurotoxicity that may require evacuation from the wilderness to a medical facility capable of advanced treatment and intensive care monitoring.

Rationale This study aims to determine a relationship between short-term exposure to Particulate Matter and Fine Particulate Matter (PM10 and PM2.54) and the Emergency Department (ED) visit's trend for COPD Exacerbation. Visits' outcomes were also evaluated. The analysis has been conducted in Brescia, a city recognized for being one of the most important European industrial realities and one with the most complex environmental issues. Methods For this study, a dedicated database with data exclusively focused on COPD Exacerbation-related ED admissions has been created. Starting from January 1 st , 2014, to January 2016, 431 ED admission records for COPD Exacerbation have been collected. Data for the Particulate Matter daily mean concentrations were collected from the Environmental Protection Regional Agency (ARPA) and added to the database. Finally, a timeseries analysis with distributed day-lag has been conducted, and the results have been expressed in terms of Relative Risk (RR) and Relative Risk Increase (ER) for COPD Exacerbation-related ED visits and/or hospitalizations, over a 10µg/m3 increase in PM10 or PM2.5 concentration. Results A significant association for both PM10 and PM2.5 with the risk of ED visits and/or hospitalization for COPD Exacerbation. In lag0-1, increases of 10µg/m3 in PM10 concentration corresponded to a RR(IC95%) for ED visit of 1.06, while, for PM2.5, corresponded to 1.08 (p<0.05). At lag0-5, the RR(IC95%) corresponded to 1.06 and 1.09 for PM10 and PM2.5 respectively (p<0.05). Considering the hospitalizations, similar results have been found, with a RR of 1.07 and 1.10 in lag0-1; 1.07 and 1.11 in lag0-5. Conclusions Our findings increase the knowledge regarding the shortterm effects of exposure to Particulate Matter on the respiratory system. This study could also provide reliable data to monitor ED visits and outcomes over time.

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To assess the correlation between progressive PM levels and Asthma Exacerbation events, we investigated the role of short-term PM exposure in the increase of Emergency Department (ED) admissions in Brescia. METHODS:We conducted an analysis of clinical records of ED admissions for Asthma Exacerbation, starting from January 2014 to December 2017. Daily PM levels were collected from the Environmental Protection Regional Agency (ARPA). We performed a time-series analysis using a Poisson regression model with single and multiple day-lag. Results were expressed as Relative Risk (RR) and Excess of Relative Risk (ER) of Asthma Exacerbation-related ED admissions, over a 10mg/m3 increase in PM10 and PM2.5 concentration. RESULTS:We included 543 admissions. The time-series study revealed an increase of the RR (CI95%) for Asthma Exacerbationrelated ED admissions of 1.24 with an ER of 24.15% for PM2.5 at lag0-1 (p<0.05). We also documented a RR (CI95%) of 1.12 with an ER of 12.53% at lag0-5 (p#0.05). We then studied the population living exclusively in the city, obtaining a RR (CI95%) for PM10 and PM2.5 respectively of 1.21 and 1.34 with ERs of 20.82% and 33.75% at lag01 (p<0.05). Lastly we evaluated the increase of hospitalizations after ED admission. For this event we documented a RR (CI95%) of 1.31 with an ER of 30.67% for PM2.5 at Lag01 (p<0.05).CONCLUSIONS: Short-term PM exposure acts a critical role in inducing Asthma exacerbation events, especially PM2.5. CLINICAL IMPLICATIONS: Rising pollution plays a crucial role in developing several respiratory diseases. Particulate Matter (PM)-induced Asthma Exacerbation is one of the most life-threating events.