Adolescent pregnancy is a global issue. Early childbearing is strongly linked to poverty and negative health outcomes, including increased neonatal death risk. This study explores spatial patterns of adolescent pregnancies and neonatal deaths and their association with socioeconomic characteristics.

This population-based study used spatial analysis techniques to investigate the geographical distribution of adolescent pregnancies, socioeconomic characteristics and neonatal mortality rate (NMR).

The 645 municipalities of State of Sao Paulo, Brazil.

All live births to mothers residing in the State of Sao Paulo, Brazil, between 2004 and 2020.

The socioeconomic indicators used were: municipal human development index and per capita income (PCI). Spatial patterns were assessed for spatial autocorrelation (Moran’s I, LISA), and smoothed using local Bayesian estimation. Spearman’s correlation was used to ascertain the relationship between the percentage of live births to adolescent mothers and socioeconomic indexes. This calculation was also undertaken between different maternal age groups of NMR.

The study analysed over 10 million live births, with 14.3% attributed to adolescent mothers. Spatial analysis revealed significant clustering of adolescent pregnancies, strongly associated with lower socioeconomic indicators. NMR also exhibited spatial clustering, particularly after smoothing. Statistically significant differences were observed in PCI medians between high–high and low–low clusters for adolescent births. High and low incidence areas of NMR, both in all maternal ages and stratified by adolescent and non-adolescent mothers, demonstrated considerable overlap.

The results indicated the existence of clustering areas of adolescent pregnancy and neonatal deaths and suggested that the prevalence of births to adolescent mothers is not distributed equally and is higher in lower socioeconomic developed areas.

Only symptomatic treatments are available for patients with Parkinson’s disease (PD), the second most common chronic neurodegenerative disease worldwide, and it is therefore imperative to identify disease-modifying interventions that can alter the course of the disease. Epidemiological studies in PD patients suggest that a Mediterranean diet is associated with better motor and non-motor symptoms, slower progression and reduced mortality. Few interventional studies, however, investigated the relationship between diet and PD severity and progression. This study aims to determine whether a Mediterranean nutritional intervention can benefit motor and non-motor symptoms experienced by PD patients. As a secondary aim, the effects of a modified Mediterranean diet on the immune system, metabolomics and microbiome will also be assessed.

This is an interventional, non-pharmacological, superiority, randomised, controlled, single-centre, masked study with two parallel groups to evaluate the efficacy and safety of a modified Mediterranean diet on motor and non-motor patient-reported symptoms. PD patients meeting inclusion criteria will be enrolled (44 participants, aged between 40 years and 85 years), block-randomised and split into two parallel arms to either maintain their usual diet (control) or follow a modified Mediterranean diet for 6 months (intervention).

Patient-reported symptomatology is the primary outcome, measured through the Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS) I+II score. Secondary outcomes include the immunophenotype of circulating cells of the adaptive immune system, the nasal and faecal microbiome composition, faecal and urinary metabolites and the measurement of inflammatory and metabolic markers. Disease severity (MDS-UPDRS III), non-motor symptomatology (Non-Motor Symptoms Scale), participant’s well-being (36-Item Short Form Health Survey), gastrointestinal symptomatology (Gastrointestinal Symptom Rating Scale and the Patient Assessment of Constipation Quality of Life) and intensity of dopaminergic replacement therapy (levodopa equivalents) will also be assessed. Evaluations will be conducted before the start and at the end of the intervention.

The Ethical Committee ‘Comitato Etico Territoriale Lombardia 5’ first approved this study on 17 September 2024 Prot. Nr. 420/24. Findings will be disseminated via peer-reviewed research papers and conference presentations.

NCT06705517.

Emergency departments (EDs) suffer from crowding due to patients with low urgency whose treatment is often inappropriate in many cases. Crowding in the ED may indicate inefficiencies in the primary care infrastructure. According to the literature, it is associated with individual and system-related factors, such as younger age, convenience of visiting the ED and a negative perception of care outside the hospital. However, patients’ motives driving decision-making for non-urgent visits to the ED in this post-pandemic period require further exploration. Therefore, this study aims to describe the proportion of potentially avoidable, non-urgent ED visits and to explore the associations between socio-demographic and clinical characteristics, patients’ motives, and potentially avoidable, non-urgent visits to the ED.

This multicentre cross-sectional study will be conducted in the ED of seven public hospitals in the South Tyrolean Health Service in the northern Italian Province of Bolzano-Bozen. A consecutive sample of 1000 adult patients (≥18 years) with clinical conditions that are triaged as ‘non-urgent’ (ie, Manchester Triage System priority level ‘blue’ or ‘green’) and consent to participate in the study will be included. Data will be collected in each ED over two full working weeks (24 hours, weekdays and weekends) between 1 September 2024 and 30 November 2024. For each patient, triage nurses and medical doctors will fill out a data collection sheet, including the triage code, diagnosis at discharge and avoidability of the ED visit. Patients will be surveyed using a structured questionnaire with standardised instruments (eg, the Patient Activation Measure and Mental Health Inventory) and self-developed items (eg, motives for ED visits and previous use of community care services). Data analysis will involve descriptive and inferential analyses (ie, ² tests) to determine group differences. Multivariate multilevel modelling will be applied to explore the associations between individual, system and cultural factors and potentially avoidable, non-urgent visits.

Ethical approval for this study was obtained from the Medical Ethics Committee of the South Tyrolean Health Service (Nr. 41-2024). The results will be published in relevant scientific journals and communicated to the public and relevant institutions through dissemination activities, including press releases and stakeholder meetings. The findings will inform recommendations aimed at refining health policies and optimising access to primary and emergency care services.

ISRCTN registry (ISRCTN17355506).

Migraine is a primary headache showing a multifactorial component that includes altered pain processing, psychological/emotional problems, neurocognitive and executive function deficits, all with a possible genetic association. The aim of the current study will be to evaluate the association between sensitisation, psychological/emotional, neurocognitive and genetic profile on conditioned pain modulation (CPM) in women with migraine from a multidisciplinary perspective.

A cross-sectional observational case–control study including 90 women with chronic migraine, 90 women with episodic migraine and 90 women without migraine (as controls) will be conducted. Clinical variables (disability, pain), processing (sensitisation-associated, neuropathic-like symptoms), psychological/emotional (anxiety, depression, sleep quality, catastrophising), neurocognitive (attention), executive functions (memory, mental inhibition, speed processing) and genetics (Val158Met polymorphism rs4680 gene) will be assessed in all subjects by healthcare professionals. Subsequently, CPM will be evaluated with the cold-pressor test paradigm by assessing changes obtained in mechanical and thermal stimuli. The association of each group of variables on CPM will be analysed with multivariate analyses (OMNIBUS analysis of variance). A network model will also be created to identify those variables showing the greatest key measure of centrality with the rest of the severity indicators (strength, intermediation and closeness) to establish the potentially therapeutic targets in patients with migraine from a multidisciplinary point of view.

The protocol of the current study has been approved by the Ethics Committee of all involved institutions (Hospital Universitario Fundación Alcorcón 24–117, Universidad Rey Juan Carlos 010220240912024). All procedures will be conducted following the Declaration of Helsinki. Participants will be informed of the aims and procedures of the study and will receive the informed written consent which should be signed before their inclusion. Study results will be disseminated through peer-reviewed publications and presentations at scientific meetings.

To measure the perceived autonomy level in managing lower respiratory tract infections (LRTIs) among paediatric residents and to compare perceived autonomy with the assessments by tutors who directly supervise and evaluate residents

A survey on managing LRTIs was distributed among all Italian paediatric residents and tutors via Google Forms between January 1 and 31, 2024.

Participants, residents and tutors were classified according to their training year and clinical setting: primary care paediatrics (PCP), emergency department (ED) and hospital ward (HW).

Perceived autonomy of paediatric residents in managing LRTI in different settings; overall perceived autonomy and interest in employment.

A total of 391 questionnaires were returned, with 273 completed by residents and 118 by tutors. Among residents, 3% in their first year felt fully capable of managing LRTIs without supervision in both ED and HW settings. This percentage remained below 25% until the third year and increased to 72% in ED and 83% in HW by the fifth year. In PCP settings, autonomy ranged from 15% in the first year to 96% in the final year. No differences were found between residents’ self-evaluations and tutors’ assessments. Confidence in skills showed no regional differences across Italy.

Most residents did not feel ready to manage winter respiratory infections in children without supervision, especially in the ED compared with the HW; however, self-confidence was higher in the PCP setting. Tutors shared similar perceptions. The location did not affect the response pattern. These findings caution against employing residents to work autonomously, particularly in emergency settings.