Background: Alpha-synuclein is a constituent of Lewy bodies and mutations of its gene cause familial Parkinson’s disease (PD). A previous study showed that a variant of the alpha-synuclein gene (SNCA), namely the 263 bp allele of Rep1 was associated with faster motor progression in PD. On the contrary, a recent report failed to detect a detrimental effect of Rep1 263 on both motor and cognitive outcomes in PD. Aim of this study was to evaluate the influence of the Rep1 variants on disease progression in PD patients. Methods: We recruited and genotyped for SNCA Rep1 426 PD patients with age at onset ≥40 years and disease duration ≥4 years. We then analyzed frequency and time of occurrence of wearing-off, dyskinesia, freezing of gait, visual hallucinations, and dementia using a multivariate Cox’s proportional hazards regression model. Results: SNCA Rep1 263 carriers showed significantly increased risk of both dementia (HR = 3.03) and visual hallucinations (HR = 2.69) compared to 263 non-carriers. Risk of motor complications did not differ in the two groups. Conclusion: SNCA Rep1 263 allele is associated with a worse cognitive outcome in PD.

Objectives The emergency department (ED) is one of the most critical areas in any hospital. Recently, many countries have seen a rise in the number of ED visits, with an increase in length of stay and a detrimental effect on quality of care. Being able to forecast future demands would be a valuable support for hospitals to prevent high demand, particularly in a system with limited resources where use of ED services for non-urgent visits is an important issue. Design Time-series cohort study. Setting We collected all ED visits between January 2014 and December 2019 in the five larger hospitals in Milan. To predict daily volumes, we used a regression model with autoregressive integrated moving average errors. Predictors included were day of the week and year-round seasonality, meteorological and environmental variables, information on influenza epidemics and festivities. Accuracy of prediction was evaluated with the mean absolute percentage error (MAPE). Primary outcome measures Daily all-cause EDs visits. Results In the study period, we observed 2 223 479 visits. ED visits were most likely to occur on weekends for children and on Mondays for adults and seniors. Results confirmed the role of meteorological and environmental variables and the presence of day of the week and year-round seasonality effects. We found high correlation between observed and predicted values with a MAPE globally smaller than 8.1%. Conclusions Results were used to establish an ED warning system based on past observations and indicators of high demand. This is important in any health system that regularly faces scarcity of resources, and it is crucial in a system where use of ED services for non-urgent visits is still high.

Background: Non-natural mortality in children and adolescents is a global public health problem that varies widely from country to country. Data on child and adolescent maltreatment are not readily available, and mortality due to violent causes is also underestimated. Methods: Injury-related mortality rates (overall and by specific causes) from 2000 to 2018 in selected European countries were analysed to observe mortality patterns in children and adolescents using data from the Eurostat database. Age-standardized mortality rates per 100,000 person-years were calculated for each country. Joinpoint regression analysis with a significance level of 0.05 and 95% confidence intervals was performed for mortality trends. Results: Children and adolescent mortality from non-natural causes decreased significantly in Europe from 10.48 around 2005 to 5.91 around 2015. The Eastern countries (Romania, Bulgaria, Poland, Slovakia, Czech Republic) had higher rates; while Spain, Denmark, Italy, and the United Kingdom had the lowest. Rates for European Country declined by 5.10% per year over the entire period. Larger downward trends were observed in Ireland, Spain and Portugal; smaller downward trends were observed for Eastern countries (Bulgaria, Czech Republic, Poland, Slovakia) and Finland. Among specific causes of death, the largest decreases were observed for accidental causes (-5.9%) and traffic accidents (-6.8%). Conclusions: Mortality among children and adolescents due to non-natural causes has decreased significantly over the past two decades. Accidental events and transport accidents recorded the greatest decline in mortality rates, although there are still some European countries where the number of deaths among children and adolescents from non-natural causes is high. Social, cultural, and health-related reasons may explain the observed differences between countries.

Objectives This paper aims to provide an estimate of the prevalence rate of autism spectrum disorder (ASD) in 8-year-olds in 2017 based on administrative databases and to investigate the change in healthcare service use during the healthcare transition age of 18. Design This research is based on a longitudinal retrospective cohort study. Setting The data is drawn from the Italian Administrative Healthcare Database (2010–2017). Participants We identified 5607 ASD patients; 331 ASD patients from 2012 to 2015 in the calendar year of their 18th birthday were selected and their health service utilisation during a 5-year period—ranging from 2 years preceding and succeeding their 18th year—were investigated. Interventions None. Primary and secondary outcome measures Prevalence, incidence and proportion of ASD patients receiving specific healthcare services were included in the outcome measures. Results Prevalence of ASD at age 8 was 5.4/1000. Global access to health and social services was lower both before and after age 18 (46.5% at 16; 68.0% at 18; 54.1% at 20). The percentage of patients receiving a neuropsychiatric consultation decreased after age 18 (30.8% at 18; 5.4% at 20). Community mental health services (CMHS) utilisation rate increased above 18 years of age. Regarding psychiatric visits, for both outpatient and CMHS, an increase was observed from 17.8% at age 18 to 25.4% at age 20. The utilisation of rehabilitation services decreased with age, dropping from 17.8% at age 16 to 1.8% at age 20. Psychiatric outpatient services remained stable across ages at about 14%. Conclusion Our findings suggest that ASD patients changed clinical reference services with age from neuropsychiatric and rehabilitative services towards psychiatric and community-based services as they transitioned from paediatric to adult healthcare services.

Extreme heat is a major weather-related cause of death and is expected to intensify in European cities. We quantified Milan-specific temperature–mortality relationships, defined impact-based heat thresholds around the minimum mortality temperature (MMT) and identified vulnerable subgroups using individual-level risk factors. We conducted a time-stratified case-crossover study including 2230 natural deaths among Milan residents aged ≥75 years occurring between 15 July and 15 September 2022. The MMT (29 °C) was used as the reference temperature [odds ratio (OR) = 1], and mortality risks were evaluated across high-impact (1.20 < OR ≤ 1.50, ≥35 °C) maximum temperature (Tmax) days. Compared with MMT days, mortality was higher on high-impact days (OR 1.44), with somewhat larger estimates among adults aged ≥85 years (OR 1.63) and men (OR 1.50). Disability (OR 1.51) and socioeconomic deprivation (OR 1.89) were also associated with higher vulnerability, with relatively higher estimates observed in women aged ≥85 years and in men with comorbidities or living alone. Overall, the findings suggest that extreme heat may have had a greater impact on the oldest old and on socially or clinically vulnerable groups, highlighting the possible relevance of targeted heat–health interventions and neighborhood-focused prevention strategies.

Climate change is increasing the frequency and intensity of heatwaves, with substantial health impacts and higher mortality among vulnerable groups including older adults and individuals with chronic diseases. Risk stratification tools may support public health systems in identifying high-risk individuals and implementing targeted preventive interventions. This population-based study included Milan residents aged ≥75 years during the summers of 2022–2023 and aimed to test an algorithm for stratifying heat-related health risk. By combining individuals’ classification as ill, treated, and deprived, four heat-related risk levels were defined. The algorithm was developed on the 2022 cohort and validated on the 2023 cohort. A logistic regression model with cross-validation was used, and performance was assessed using AUC, calibration, and Brier score. A total of 192,063 (2022) and 181,509 (2023) residents aged ≥75 years were included. Approximately 56% were classified as high or very high risk, with slightly higher proportions in 2023. Mortality increased with risk level and multimorbidity. The model showed good overall accuracy, fair discrimination, and good calibration in the development cohort. Higher mortality was associated with male, older age (≥85 years), and higher risk strata, while living alone showed inconsistent associations. This prognostic algorithm may contribute to the stratification of heat-related mortality risk among older adults and could support targeted prevention and timely responses to heatwave.