Stewardship antibiotica neonatale: valutazione dell'esposizione antimicrobica nelle sospette early onset sepsis (EOS)

Background: Le early-onset sepsis (EOS) sono infezioni batteriche invasive definite dalla presenza di batteri nel sangue e/o nel liquor cefalorachidiano che esordiscono nelle prime 72 ore di vita e causano in epoca neonatale mortalità e morbilità importanti. Scopo: Determinare l’eccesso di trattamento antibiotico (Overtreatment index=OI) nei neonati di EG ≥34 settimane con sospetta sepsi ad esordio precoce. Metodi: Tutti i nati dal 1.01.2014 al 31.12.2018 di EG ≥34 settimane presso IRCCS Azienda Ospedaliero-Universitaria e l’Ospedale Maggiore di Bologna che hanno ricevuto terapia antibiotica endovenosa nelle prime 168 ore di vita nel sospetto di EOS. Sono stati identificati 2 gruppi: EOS provata (N=7) ed EOS sospetta (N=465). Risultati: L’incidenza di EOS è stata 0.22 su 1000 nati vivi, rispettivamente 0.12/1000 per Streptococcus agalactiae (GBS) e 0.06/1000 per Escherichia coli (E.coli). L’1.75% dei neonati ha ricevuto terapia antimicrobica empirica a largo spettro. L’OI è risultato 68. L’esposizione al trattamento antibiotico nella popolazione è stata di 85 giorni/1000 nati vivi. Tra i fattori di rischio materni, il tampone vagino-rettale (TVR) e l’urinocoltura positiva sono risultati associati al rischio di EOS provata (p=.017, p =.000). I valori di proteina C reattiva (PCR) al T0, T1 e T2 tra i due gruppi sono risultati significativi (p=.000). All’analisi multivariata è stata confermata la significatività delle variabili descritte. (TVR non noto OR=15.1, 95%CI 1.98-115.50, p =.009, urinocoltura positiva OR=30.1, 95%CI 3.6-252.1, p = .002, PCR T0 OR=1.6, 95% CI 1.29-2.07, p = .000.) Conclusioni: L’individuazione precoce di fattori di rischio e la valutazione degli indici di flogosi in neonati sintomatici può ridurre l’OI e la durata della terapia antibiotica in casi di sepsi non confermata. L’uso appropriato degli antibiotici in questa popolazione è particolarmente importante poichè riduce lo sviluppo di germi multiresistenti. Nelle Terapie Intensive Neonatali, i programmi di stewardship antimicrobica dovrebbero guidare la gestione delle sepsi.

Peer and group relationships in preschoolers: the role of social and linguistic skills

Being able to positively interact and build relationships with playmates in preschool years is crucial to achieve positive adjustment. An update review and two studies on such topics were provided. Study 1 is observational; it investigates the type of social experience in groups (N = 443) of children (N = 120) at preschool age in child-led vs. teacher-led contexts. The results revealed that in child-led contexts children were more likely to be alone, in dyads, and in small peer groups; groups were mostly characterized by same-gender playmates who engaged in joint interactions, with few social interactions with teachers. In teacher-led contexts, on the other hand, children were more likely to be involved in small, medium and large groups; groups were mostly characterized by other-gender playmates, involved in parallel interactions, with teachers playing a more active role. The purpose of Study 2 was to describe the development of socio-emotional competence, temperamental traits and linguistic skill. It examined the role of children’s reciprocated nominations (=RNs) with peers, assessed via sociometric interview, in relation to socio-emotional competence, temperamental traits and linguistic skill. Finally, the similarity-homophily tendency was investigated. Socio-emotional competence and temperamental traits were assessed via teacher ratings, linguistic skill via test administration. Eighty-four preschool children (M age = 62.53) were recruited within 4 preschool settings. Those children were quite representative of preschool population. The results revealed that children with higher RNs showed higher social competence (tendency), social orientation, positive emotionality, motor activity and linguistic skill. They exhibited lower anxiety-withdrawal. The results also showed that children prefer playmates with similar features: social competence, anger-aggression (tendency), social orientation, positive emotionality, inhibition to innovation, attention, motor activity (tendency) and linguistic skill. Implications for future research were suggested.

Sense of Community in contexts of multi culture

The theme “Belongingness” has a central role in the current debate on Community Psychology and in daily life. To try to understand the consequences of these changes, the research focuses on the concept of Sense of Community. In fact, Sense of Community has always been a central tool (Sarason, 1974; MacMillan & Chavis, 1986) to study communities (McMillan, 2011; Nowell & Boyd, 2011) and for a long time has represented positive values and something to aspire to. However, current debates indicate that Sense of Community is an outmoded concept and underline the problematic issue of “promotion of Sense of Community” in contexts of multi culture. The aim of the present research is to analyze Sense of Community in context of multi culture, as we consider that it can still be a fundamental tool to study and understand communities. In particular we are interested in understanding the role of Multiple Sense of Community (Brodsky, 2009) on Identity and Wellbeing (and its dimensions). We focused on a specific context, the Station Zone in Reggio Emilia, that is characterized by high levels of cultural diversity and different social problems (Giovannini & Vezzali, 2011). The research is developed and divided into two parts. The first part consists of an exploratory qualitative study that analyzes meanings of community among leaders of different ethnic groups living in the Station Zone. The second part consists of a “General Model” study and four parallel studies to analyze Multiple Sense of Community in different ethnic groups (Albanians, Moroccans, Chinese and Italians. The results indicate the different role of Multiple SOC in the relation between Identity and Wellbeing, in particular the relevance of Relational SOC and its different implications. Moreover, the factor “culture” represents an significant element in order to consider differences among ethnic groups.

"Ancestry, gender and language - The role of culture in economic development"

This thesis is a combination of research questions in development economics and economics of culture, with an emphasis on the role of ancestry, gender and language policies in shaping inequality of opportunities and socio-economic outcomes across different segments of a society. The first chapter shows both theoretically and empirically that heterogeneity in risk attitudes can be traced to the ethnic origins and ancestral way of living. In particular, I construct a measure of historical nomadism at the ethnicity level and link it to contemporary individual-level data on various proxies of risk attitudes. I exploit exogenous variation in biodiversity to build a novel instrument for nomadism: distance to domestication points. I find that descendants of ethnic groups that historically practiced nomadism (i) are more willing to take risks, (ii) value security less, and (iii) have riskier health behavior. The second chapter evaluates the nature of a trade-off between the advantages of female labor participation and the positive effects of female education. This work exploits a triple difference identification strategy relying on exogenous spike in cotton price and spatial variation in suitability for cotton, and split sample analyses based on the exogenous allocation of land contracts. Results show that gender differences in parental investments in patriarchal societies can be reinforced by the type of agricultural activity, while positive economic shocks may further exacerbate this bias, additionally crowding out higher possibilities to invest in female education. The third chapter brings novel evidence of the role of the language policy in building national sentiments, affecting educational and occupational choices. Here I focus on the case of Uzbekistan and estimate the effects of exposure to the Latin alphabet on informational literacy, education and career choices. I show that alphabet change affects people's informational literacy and the formation of certain educational and labour market trends.

Acculturation processes and intergroup relations of adolescents in multicultural societies: the role of family, peer, and school contexts

Acculturation processes and intergroup relations lie at the heart of developing more inclusive social attitudes. Notably, these endeavors are embedded in primary socialization contexts of adolescents, as indicated by developmental and socio-psychological theoretical models reviewed in Chapter 1. Hence, this dissertation investigated how adolescents' acculturation processes and intergroup contact are embedded in family, peer, and school contexts. Accordingly, Chapter 2 indicated the combined effects of the perceived parents' acculturation orientations and classmates' acculturation preferences on adolescents' own acculturation orientations in Italy and Turkey. Chapter 3 showed that adolescents could be classified into one of four latent growth trajectory classes (i.e., ethnic-oriented, national-oriented, dual, and marginalized identities), which could be predicted by social identification with family and classmates. Chapter 4 highlighted that adolescents' cross-ethnic friendships mediated the positive associations of parents' cross-ethnic friendships with adolescents' psychological and social adjustment beyond the positive relationships between parents' and adolescents' friendships. Multiple studies conducted in Chapter 5 confirmed that a newly developed questionnaire (i.e., ICIS-Short Version) is a reliable tool to measure positive and negative contact among ethnic minority and majority adolescents. Chapter 6 revealed that teachers' equal treatment increased positive and decreased negative contact among ethnic minority and majority adolescents. Moreover, Chapter 7 indicated that adolescents’ positive and negative contact in the school context were related over time to higher corresponding positive and negative contact in out-of-school contexts and vice versa, while their positive contact in the school context was linked over time to lower levels of negative contact in the out-of-school contexts. Eventually, Chapter 8 strived to summarize and discuss these findings in light of social inclusivity. Overall, this dissertation tapped into the paramount importance of family, peer, and school contexts to provide a unique resource for adolescents to cope with acculturative challenges that go beyond the normative developmental tasks of adolescence.

Il modello Positive Energy Districts. Approcci innovativi e strumenti operativi per la transizione verso città clima-neutrali

Ad oggi le città europee si configurano come i principali centri di cultura, innovazione e sviluppo economico. Tuttavia, ospitando circa il 75% della popolazione e consumando quasi l’80% dell’energia prodotta, a causa delle significative emissioni di gas serra esse contribuiscono in modo rilevante ai cambiamenti climatici e, allo stesso tempo, ne subiscono gli effetti più intensi. La Comunità Europea ha preso atto della necessità di intraprendere un’azione sinergica che adotti strategie di mitigazione climatica e preveda misure di adattamento per far fronte agli impatti climatici ormai inevitabili. L'orientamento dei Programmi europei di Ricerca e Innovazione sul tema delle città smart e clima-neutrali sposta l'attenzione dalla dimensione urbana verso la scala di distretto. In questa prospettiva, i Positive Energy Districts (PEDs) si configurano come distretti di nuova edificazione, ma anche come soluzioni ambiziose per la riqualificazione di quartieri esistenti che gestiscono in modo attivo il fabbisogno energetico con un bilancio nullo di emissioni e un surplus di energia prodotta da rinnovabili. La ricerca di dottorato focalizza l’indagine sul modello PEDs esplorandone il potenziale di applicabilità nel contesto urbano consolidato. Nello specifico, la tesi lavora allo sviluppo di due contributi di ricerca originali: il PED-Portfolio e il PED-Toolkit. Tali contributi propongono un approccio sistemico, attraverso il quale intraprendere un percorso di conoscenza e sperimentazione del modello PEDs in una prospettiva di riduzione del fabbisogno energetico, ma anche in un’ottica di migliore accessibilità, vivibilità e resilienza di questi distretti. Al fine di verificare l’applicabilità dei risultati della ricerca, gli strumenti sviluppati vengono testati su un’area pilota e gli esiti di tale sperimentazione sono poi messi a confronto con il quadro dello stato dell’arte e con le principali linee di ricerca internazionali sul tema PEDs, affinando gli esiti del progetto di dottorato in un processo di ricerca-sperimentazione-ricerca.

Study of genes involved in her2-positive breast cancer progression for identification of new therapeutic targets

HER2 overexpression is observed in 20-30% of invasive breast carcinomas and it is correlated with poor prognosis. Although targeted therapies have revolutionized the treatment of HER2-positive breast cancer, a high number of patients presented primary or acquired resistance to monoclonal antibodies and tyrosine kinase inhibitors. Tumor heterogenicity, epithelial to mesenchymal transition (EMT) and cancer stem cells are key factors in target therapy resistance and tumor progression. The aim of this project was to discover alternative therapeutic strategies to over-come tumor resistance by harnessing immune system and looking for new targetable molecules. The results reported introduce a virus-like particles-based vaccine against HER2 as promising therapeutic approach to treat HER2-positive tumors. The high and persistent anti-HER2 antibody titers elicited by the vaccine significantly inhibited tumor growth and metastases onset. Furthermore, the polyclonal response induced by the vaccine also inhibited human HER2-positive breast cancer cells resistant to trastuzumab in vitro, suggesting its efficacy also on trastuzumab resistant tumors. To identify new therapeutic targets to treat progressed breast cancer, we took advantage from a dynamic model of HER2 expression obtained in our laboratory, in which HER2 loss and cancer progression were associated with the acquisition of EMT and stemness features. Targeting EMT-involved molecules, such as PDGFR-β, or the induction of epithelial markers, like E-cadherin, proved to be successful strategy to impair HER2-negative tumor growth. Density alterations, which might be induced by anti-HER2 target therapies, in cell culture condition of a cell line with a labile HER2 expression, caused HER2 loss probably as consequence of more aggressive subpopulations which prevail over the others. These subpopulations showed an increased EMT and stemness profile, confirming that targeting EMT-involved molecules or antigen expressed by cancer stem cells together with anti-HER2 target therapies is a valid strategy to inhibit HER2-positive cells and simultaneously prevent selection of more aggressive clone.