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Summary:Purpose: The incidence of malformations among infants of mothers with epilepsy treated with antiepileptic drugs (AEDs) during pregnancy is higher than that found in the general population. The aim of this study was to contribute to providing a definition of the rate of congenital anomalies in the offspring of mothers with epilepsy and to detect possible risk factors.Methods: Since 1977, 517 pregnancies were followed up at the San Paolo Hospital in Milan by a team of epileptologists and obstetricians. The patients received monthly obstetric and neurologic examinations, and the blood levels of AEDs were tested monthly. During pregnancy the patients underwent ultrasound investigations to evaluate fetal morphology and development. At the time of delivery, the infants were submitted to a standardized examination by a pediatrician, and a more detailed clinical examination was performed on day 5. Malformations were classified as (a) genetic and chromosomic, (b) severe and mild malformations, and (c) deformities.Results: The overall rate of malformations was 9.7%: of these, 5.3% were structurally severe, 2.2% were mild, 0.4% were chroniosomic-genetic, and 1.8% were deformities. No malformation was detected in the 25 untreated patients.Conclusions: The risks of teratogenicity have been regarded as multifactorial, involving such factors as genetic predisposition, although most prospective studies show that AED-related factors are the primary risk factors for an increased incidence of congenital malformations. Key Words: Epilepsy-Pregnancy-Malformations-Antiepileptic drugs.Exposure to antiepileptic drugs (AEDs) during pregnancy is associated with an increased risk of congenital anomalies in the offspring. In order to better define the rate of congenital malformations in the offspring of women with epilepsy treated with different AEDs, in 1977 we started a prospective study within the framework of the Milan Collaborative Study on Epilepsy and Pregnancy.In a previous study (l), we reported the data on 305 patients prospectively studied during pregnancy from 1977 to 1989. The study was continued, and we now report the data regarding the overall number of pregnancies prospectively studied from December 1996 to 1977.The main objective of this study was to evaluate the relative degree of safety of individual AEDs; secondary objectives were to establish the pattern of major malfor- PATIENTS AND METHODSFrom 1977, 628 pregnancies were followed up at the San Paolo Hospital in Milan by a team of epileptologists and obstetricians. Patients with incomplete follow-up data due to change of residence or with partly missing records were excluded from the analysis.Women were referred to us either by the Epilepsy Center of the San Paolo Hospital or by other Epilepsy Centers in the Lombardy region. Qur population is made up of women from different sociocultural backgrounds, mainly from the Milan metropolitan and suburban areas, although women from other Italian regions were also included in the study.All women were entered in the stu...

The impact that the COVID-19 pandemic had on the lives of many is indisputable. Among the possible strategies to cope with the feeling of insecurity that comes with this, religion can play a significant role. Using firsthand data from the ResPOnsE COVID-19 rolling cross-section survey, this article shows that Italian people who reported a COVID-19 contagion in their family reported also higher religiosity both in terms of attendance at religious services (via web, radio and tv) and prayer during the pandemic. The result holds primarily for those who received religious socialization during their childhood, and this reinforces the role of family transmission as a way to shape religious beliefs and behaviours and to provide individuals with religious coping strategies. These findings suggest that under dramatic circumstances a short-term religious revival is possible, even in contexts where the process of secularization is ongoing.

PurposeThis article contributes to a better theoretical and empiric understanding of mixed results in the literature investigating the relationship between institutional confidence and adherence to recommended measures during a pandemic.Design/methodology/approachThe article relies on structural equation models (SEMs) based on data from ResPOnsE COVID-19, a rolling cross-section (RCS) survey carried out in Italy from April to June 2020.FindingsThe authors’ findings show the existence of multiple pathways of confidence at the national and local level. Confidence in the institutions is positively associated with support for the performance of the Prime Minister and that of the regional institutions in the North West, which in turn, raises the likelihood of following the restrictive measures. However, in the same regions, a good appraisal of the regional system's performance also had a direct positive effect on the perception of being safe from the virus, decreasing adherence to the restrictive measures. Finally, the direct effect of confidence in the institutions on compliance is negative.Social implicationsThe result enlightens the crucial role both of national and local institutions in promoting or inhibiting adherence to restrictive measures during a pandemic and suggests that “one size fits all” measures for increasing overall institutional confidence might not be sufficient to reach the desired goal of achieving compliance in pandemic times.Originality/valueThe authors theorize and test three cognitive mechanisms – (1) the “cascade of confidence”; (2) the “paradox of support” and (3) the “paradox of confidence” – to account for both the positive and negative links between measures of political support and public acceptability of COVID-19 containment measures.

We evaluated, retrospectively, the outcome of 56 patients (39 male, 17 female; mean age, 34 years; age range, 14-65 years) who received azathioprine for either steroid-resistant (group A, n = 10) or steroid-dependent (group B, n = 46) ulcerative colitis. The patients were followed for a mean of 29 +/- 17 months (median, 27 months). Twenty-four had left-sided colitis, 5 had subtotal colitis, and 27 had total colitis. The mean duration of the disease was 51 months (range, 2-192 months). At the beginning of azathioprine treatment (time 0), all patients had clinically severe disease and were taking 40 mg prednisolone per day. Azathioprine was used in addition to steroid therapy at a dosage of 2 mg/kg. The need for steroids, expressed as the median cumulative steroid dose (mg/year), and the number of clinical relapses (requiring steroid therapy) in the 2 years before azathioprine treatment, were compared with those of the 3-year follow-up with azathioprine treatment. A positive response to azathioprine was defined as (a) avoidance of colectomy, (b) a significant decrease in the median cumulative steroid dose, and (c) a significant decrease in the number of clinical relapses (expressed as number/patient/year). One patient in group A withdrew due to painful dyspepsia, and two patients in group B were lost to follow-up. Remission with complete elimination of steroids was achieved in 36 of 53 (64%), 23 of 35 (66%), and 18 of 26 (69%) patients in the first, second, and third years, respectively, of azathioprine treatment. Compared with the 2 years before azathioprine treatment, a significant decrease was observed of about 75% both in steroid consumption and in the number of clinical relapses during the 3 years of azathioprine therapy. Two of nine patients in group A and 2 of 44 patients in group B had colectomy after mean periods of 15 months and 24 months, respectively. Azathioprine is effective and safe in avoiding colectomy in patients with steroid-resistant and steroid-dependent ulcerative colitis; its use decreases both steroid requirements and clinical relapses.

Sepsis is a rapidly evolving disease with a high mortality rate. The early identification of sepsis and the implementation of early evidence-based therapies have been recognized to improve outcome and decrease sepsis-related mortality. The aim of this study was to compare the accuracy of the standard diagnostic work-up of septic patients with an integrated approach using early point of care ultrasound (POCUS) to identify the source of infection and to speed up the time to diagnosis. We enrolled a consecutive sample of adult patients admitted to the ED who met the Surviving Sepsis Campaign (SSC) criteria for sepsis. For every patient, the emergency physician was asked to identify the septic source after the initial clinical assessment and after POCUS. Patients were then addressed to the standard predefined work-up. The impression at the initial clinical assessment and POCUS-implemented diagnosis was compared with the final diagnosis of the septic source, determined by independent review of the entire medical record after discharge. Two hundred consecutive patients entered the study. A final diagnosis of the septic source was obtained in 178 out of 200 patients (89 %). POCUS-implemented diagnosis had a sensitivity of 73 % (95 % CI 66-79 %), a specificity of 95 % (95 % CI 77-99 %), and an accuracy of 75 %. Clinical impression after the initial clinical assessment (T0) had a sensitivity of 48 % (CI 95 % 41-55 %) and a specificity of 86 % (CI 95 % 66-95 %). POCUS improved the sensitivity of the initial clinical impression by 25 %. POCUS-implemented diagnoses were always obtained within 10 min. Instead the septic source was identified within 1 h in only 21.9 % and within 3 h in 52.8 % with a standard work-up. POCUS-implemented diagnosis is an effective and reliable tool for the identification of septic source, and it is superior to the initial clinical evaluation alone. It is likely that a wider use of POCUS in an emergency setting will allow a faster diagnosis of the septic source, leading to more appropriate and prompt antimicrobial therapy and source control strategies.

Religious change continues to be a controversial topic that involves both theoretical and methodological issues. As to the European context, the main dispute is between secularization and individualization theory, especially considering the ‘believing without belonging’ thesis. This article will tackle this dispute given these three choices: firstly, we assume that cohort replacement is the main driver of religious change; secondly, religious tradition has to be taken fully into account to explain religious change; thirdly, we consider religiosity as a complex phenomenon that requires a multidimensional approach. Results from a multilevel multiple responses model based on EVS (European Values Study) data show that practice is declining across cohorts in all the countries whereas trends for belief and self-definition diverge only for Eastern Orthodox countries. Depending on the interpretation, such exception seems supporting rather than undermining the ‘believing without belonging’ theory.

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