Publications by authors named "Giuseppe La Torre"

313 Publications

Perceived work ability and work-family conflict in healthcare workers: An observational study in a teaching hospital in Italy.

J Occup Health 2021 Jan;63(1):e12271

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Objective: The aim of the study was to investigate the variables associated with work ability, work-family conflict and the relationship between these variables.

Methods: An observational prospective study was conducted and involved 436 employees of a Teaching Hospital in Rome. Data collection was performed using the following tools: the Work Ability Index (WAI) and the Work-to-family conflict and Family-to-work conflict Scale (WFC-FWC Scale). Data were analyzed through univariate analysis of variance (ANOVA) and multivariate linear regression, using the SPSS software version 25.

Results: A direct relationship of the WFC score with two variables (female gender and physicians) and an inverse relationship with other two variables (age and administrative staff) were found. There is a direct relationship between the FWC score and the variable "having sons". The WFC and FWC scores showed a direct relationship between them. The Work Ability presented an almost significant association only with the profession variable, in which administrative staff, followed by physicians, presented a higher WAI score with respect to other professional categories, such as nurses.

Conclusions: Wellbeing intervention for health workers should be directed mainly to women, older workers and those with sons. In addition, more attention should be given to nurses, who showed lower work ability scores.
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http://dx.doi.org/10.1002/1348-9585.12271DOI Listing
January 2021

Association of health status, sociodemographic factors and burnout in healthcare professionals: results from a multicentre observational study in Italy.

Public Health 2021 Jun 21;195:15-17. Epub 2021 May 21.

Universitas Mercatorum, Rome, Italy.

Objectives: The objective of this study was to measure the burden of burnout in a sample of healthcare workers (HCWs) consisting of general practitioners, professors from the Faculty of Medicine and Surgery, nurses, medical students and nursing students.

Study Design: Cross-sectional questionnaire survey.

Methods: A descriptive analysis was carried out, using averages, medians, standard deviations (SD) and ranges for quantitative variables. Univariate, bivariate and multivariate analyses were also performed.

Results: In total, 535 HCWs completed the survey. Multivariate analysis shows that increasing age (β = -0.183; P = 0.047), being a university professor (β = -0.118; P = 0.001), having a high physical score (β = -0.370; P < 0.001) and a high mental score (β = -0.574; P < 0.001) resulted in less personal burnout. Low work burnout was associated with being a student (β = -0.144; P < 0.001), a university professor (β = -0.146; P < 0.001), having a high physical score (β = -0.366; P < 0.001) and having a high mental score (β = -0.648; P < 0.001). Being female (β = -0.122; P < 0.001), a university professor (β = -0.333; P = 0.001), a student (β = -0.433; P < 0.001), having a high physical score (β = -0.26; P < 0.01) and having a high mental score (β = -0.460; P < 0.001) were predictors for reduced client burnout. However, high client burnout was seen in individuals who had a commuting time >30 min (β = 0.084; P = 0.012) predicts.

Conclusions: This study shows that burnout is an important issue among HCWs and that prevention strategies must be considered, with a particular focus on physical and mental health.
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http://dx.doi.org/10.1016/j.puhe.2021.04.004DOI Listing
June 2021

The future direction of imaging in prostate cancer: MRI with or without contrast injection.

Andrology 2021 May 16. Epub 2021 May 16.

Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy.

Background: Multiparametric MRI (mpMRI) is the "state of the art" management tool for patients with suspicion of prostate cancer (PCa). The role of non-contrast MRI is investigated to move toward a more personalized, less invasive, and highly cost-effective PCa diagnostic workup.

Objective: To perform a non-systematic review of the existing literature to highlight strength and flaws of performing non-contrast MRI, and to provide a critical overview of the international scientific production on the topic.

Materials And Methods: Online databases (Medline, PubMed, and Web of Science) were searched for original articles, systematic review and meta-analysis, and expert opinion papers.

Results: Several investigations have shown comparable diagnostic accuracy of biparametric (bpMRI) and mpMRI for the detection of PCa. The advantage of abandoning contrast-enhanced sequences improves operational logistics, lowering costs, acquisition time, and side effects. The main limitations of bpMRI are that most studies comparing non-contrast with contrast MRI come from centers with high expertise that might not be reproducible in the general community setting; besides, reduced protocols might be insufficient for estimation of the intra- and extra-prostatic extension and regional disease. The mentioned observations suggest that low-quality mpMRI for the general population might represent the main shortage to overcome.

Discussion: Non-contrast MRI future trends are likely represented by PCa screening and the application of artificial intelligence (AI) tools. PCa screening is still a controversial topic; bpMRI has become one of the most promising diagnostic applications, as it is a more sensitive test for PCa early detection, compared to serum PSA level test. Also, AI applications and radiomic have been the object of several studies investigating PCa detection using bpMRI, showing encouraging results.

Conclusion: Today, the accessibility to MRI for early detection of PCa is a priority. Results from prospective, multicenter, multireader, and paired validation studies are needed to provide evidence supporting its role in the clinical practice.
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http://dx.doi.org/10.1111/andr.13041DOI Listing
May 2021

HAPPY MAMA Project (PART 1). Assessing the Reliability of the Italian Karitane Parenting Confidence Scale (KPCS-IT) and Parental Stress Scale (PSS-IT): A Cross-Sectional Study among Mothers Who Gave Birth in the Last 12 Months.

Int J Environ Res Public Health 2021 04 12;18(8). Epub 2021 Apr 12.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.

The purposes of this study were: (1) to adapt two validated questionnaires used to evaluate maternal confidence (KPCS-IT) and maternal stress (PSS-IT) to the Italian context, in order to (2) measure the stress level and the self-efficacy in an Italian sample of mothers. The validation process has provided the construction of an online questionnaire. It was administered on a convenience mothers sample with at least a child aged 0-12 months, twice (T0 and T1) with a two day interval. Assessment of instrument stability over time was estimated by applying test-retest reliability between T0 and T1, and the Cronbach's alpha coefficient. A cross-sectional study was carried out to assess the second aim. Italian mothers with at least one child living at home aged between 0-12 months were recruited. Statistical reliability methods were applied to assess the internal validity of the two questionnaires. PSS-IT was analyzed using univariate and multivariate statistical analyses in order to study the association between KPCS-IT, demographic and maternal characteristics. Statistical significance was established as < 0.05. The Cronbach's alpha reported a good level of internal consistency of the questionnaires: PSS-IT alpha = 0.862; KPCS-IT alpha = 0.801. 32% of the mothers declared low maternal confidence and the mean value of PSS-IT was 35.4 (SD = 8). The significant inverse correlation was found between the PSS-IT and the KPCS-IT (coeff = -0.353; < 0.001): this means that a high level of perceived self-efficacy reduces the maternal stress level. The study identifies that interventions on maternal confidence can be useful to support mothers in the first months after delivery in order to prevent stress risk: the perceived self-efficacy is as a modifiable factor and the results of the study indicate that it significantly reduces the PSS-IT and EPDS scores. In future, more field trials are necessary in order to assess the realistic and feasible interventions on maternal confidence and competence to prevent maternal distress.
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http://dx.doi.org/10.3390/ijerph18084066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070573PMC
April 2021

Inclusion of Synovial Tissue-Derived Characteristics in a Nomogram for the Prediction of Treatment Response in Treatment-Naive Rheumatoid Arthritis Patients.

Arthritis Rheumatol 2021 09 9;73(9):1601-1613. Epub 2021 Aug 9.

Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy.

Objective: This study applied a synovitis score obtained during routine care from ultrasound (US)-guided biopsies of synovial tissue (ST) in patients with rheumatoid arthritis (RA) and patients with other inflammatory and noninflammatory joint diseases to identify pretreatment synovial biomarkers associated with disease characteristics, and to integrate the findings into a multiparameter nomogram for use in baseline prediction of diagnosis and treatment response in treatment-naive rheumatoid arthritis (RA) patients.

Methods: The study enrolled a total of 1,015 patients with various autoimmune diseases (545 patients with RA, 167 patients with psoriatic arthritis [PsA], 199 patients with undifferentiated peripheral inflammatory arthritis [UPIA], 18 patients with crystal-induced arthritis, 26 patients with connective tissue diseases, and 60 patients with osteoarthritis [OA] [as part of the SYNGem cohort]). All patients underwent a US-guided ST biopsy at baseline, and patients were then stratified according to disease phase. The KSS, along with disease characteristics and clinical outcomes, were incorporated into a nomogram for prediction of achievement of clinical remission in RA patients who were previously naive to treatment. In patients in whom a treat-to-target strategy was applied, remission was defined as change in the Disease Activity Score in 28 joints (DAS28) at 6 months after treatment initiation.

Results: The KSS significantly differed among RA patients, as well as PsA patients and UPIA patients, when compared to OA patients. In RA, the KSS directly correlated with the DAS28 and was related to autoantibody positivity in treatment-naive RA patients. Moreover, at baseline, treatment-naive RA patients achieving 6-month remission according to DAS28 had a lower KSS, shorter duration of symptoms (very early RA [VERA]), and lower disease activity than treatment-naive RA patients not achieving remission according to DAS28. Results of logistic regression analysis identified the following synergistic predictive factors of achievement of DAS28-based disease remission at 6 months: having a short disease duration (VERA), not having high disease activity, and having a KSS of <5 at baseline. A nomogram integrating these baseline clinical and histologic characteristics in treatment-naive RA patients yielded an up to 81.7% probability of achieving 6-month remission according to the DAS28.

Conclusion: The KSS is a reliable tool for synovitis assessment on US-guided ST biopsy, contingent on the phase of the disease and the autoimmune profile of each patient. This tool could be integrated within a therapeutic response-predictive nomogram for the prediction of treatment response in RA patients who were previously naive to treatment.
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http://dx.doi.org/10.1002/art.41726DOI Listing
September 2021

Smoking at the workplaces in Italy after the smoking ban in the Lazio Region.

Med Lav 2021 Feb 23;112(1):44-57. Epub 2021 Feb 23.

Local Health Unit Roma 5, Department of Prevention, Rome, Italy.

Background: In Italy, an anti-smoking law was issued in 2003, with the aim of reducing tobacco smoking inside public places.

Objectives: The aim of the study was to assess the observance of the smoking ban in Italy, during the period 2010-2014, in several workplaces and to evaluate the perception of workers, both smokers and non-smokers, on this issue.

Methods: This cross-sectional study analyzed data resulting from a self-administered questionnaires in 59 companies, from several working sectors (transport, healthcare and building), in the Latium Region in Italy.

Results: Out of 7200 questionnaires, 6996 were included in the analysis: 43.7% of the employees think that the smoking ban is respected in the workplace; women are more prone to think that the ban is not observed. Smokers tend to perceive the ban to be respected (AOR: 0.69; 95% CI: 0.62-0.77) while non-smokers feel more exposed to second-hand smoke (AOR: 1.57; 95% CI: 1.39-1.77). Workers in intellectual and highly specialized professions (AOR: 1.63; 95% CI: 1.25-2.13), technical professions (AOR: 1.64; 95% CI: 1.28-2.10) and craftsmen, skilled workers and farmers (AOR: 1.42; 95% CI: 1.09-1.85) tend to perceive the smoking ban not to be observed and the last two classes are the ones who feel the most exposed to second-hand smoke (AOR: 6.68; 95% CI: 0.50-0.90; AOR: 0.52; 95% CI: 0.38-0.70).

Discussion: The results of this study can be used as a starting point for the implementation of new strategies to reduce tobacco addiction, beginning from the compliance with the ban on smoking in the workplace and the promotion of a healthy lifestyle.
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http://dx.doi.org/10.23749/mdl.v112i1.8779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023054PMC
February 2021

Effectiveness of NoiBene: A Web-based programme to promote psychological well-being and prevent psychological distress in university students.

Appl Psychol Health Well Being 2021 05 17;13(2):317-340. Epub 2021 Feb 17.

Department of Psychology, Sapienza University of Rome, Rome, Italy.

Mental health problems are very common among university students. NoiBene is an evidence-based intervention for the promotion of well-being and the prevention of psychological distress among university students. NoiBene was tested in two studies. In study 1, a randomized controlled pilot trial was conducted to investigate the efficacy of NoiBene on students' well-being, emotional awareness, emotion regulation and assertiveness. The degree of satisfaction with the intervention was also investigated. Students (n = 24) were assigned to either the NoiBene programme or a control condition. In study 2, to confirm the usefulness of NoiBene, we analysed data from the current use of NoiBene (n = 178). The effectiveness of NoiBene on transdiagnostic mechanisms (perfectionism, repetitive thinking and experiential avoidance) was also investigated. In study 1, NoiBene improved self-acceptance and increased the ability to identify feelings. Students reported a good level of perceived usefulness. In study 2, the results confirmed findings from the first study and suggested that NoiBene can improve emotional awareness and decrease transdiagnostic mechanisms. NoiBene is a promising tool that can improve students' psychological well-being. More control studies are mandatory.
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http://dx.doi.org/10.1111/aphw.12251DOI Listing
May 2021

Gastrointestinal stromal tumours and other primary gastrointestinal neoplasms. A single-center experience.

Ann Ital Chir 2020 ;91:605-610

Background: In our surgical daily activity, we report the observation of rare tumour as Gastrointestinal Stromal Tumours (GIST). We report the incidence and behaviour of new cases of GIST operated in our Center during the last decade, from 2008 to 2018 and here we also describe the concomitant observation of a second gastroenteric tumor.

Method: We have examined all the case files and histological examinations of patients with CD 117-positive GISTs treated in our Institute from 2008 to 2018. We have gathered data regarding clinical symptoms at the time of diagnosis, tumour site, type of surgery performed, tumour size, histopathological data and follow up data.

Results: We have analysed 950 cases of patients who underwent surgery for gastrointestinal neoplasia in our department from 2008 to 2018. We have found 12 cases affected by GIST and in 4 cases it was also a second tumour. In two cases GIST were incidentalomas and in the others two patients a second tumour was incidentally observed in primary GIST.

Conclusion: Patients with GIST run the risk of developing a second neoplasm, nearly twice as high as the general population with a negative impact on survival; also, incidental GIST is often observed requiring a better molecular characterization for the high risk of developing second neoplasms with the aim of achieving an early diagnosis.

Key Words: Gist, Second neoplasm, Surgery.
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August 2021

Consequences of COVID19-pandemic lockdown on Italian occupational physicians' psychosocial health.

PLoS One 2021 3;16(2):e0243194. Epub 2021 Feb 3.

Postgraduate School of Hygiene and Preventive Medicine, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.

COVID-19 was declared a pandemic on March 12, 2020. Italy has been the most affected country in the world, right after China. Healthcare workers (HCWs) were among the hardest hit by this event from both a working and psychological point of view. The aim of this web-based cross-sectional study is to assess the consequences of the COVID-19 pandemic on Italian Occupational Physicians' well-being and psychological distress, in relation to demographic and occupational characteristic, lifestyle and habits during the lockdown period. We conducted a web-based cross-sectional survey questionnaire from April 1 to April 21st, 2020. To evaluate the level of psychological distress and the level of well-being, the general Health Questionnaire-12 (GHQ-12) and the WHO-5 Wellbeing Index were utilized. Since the statistical assumptions were respected, we proceeded with an analysis of variance (ANOVA) to ascertain the differences between the averages of the scores of the GHQ-12. Doctors who live in the most affected regions have a prevalence of psychological distress higher than their colleagues from the rest of Italy. ANOVA shows significant differences relating to the female gender, and to the life changes provoked by the lockdown for example not feeling sheltered at home or suffering from loneliness. This study showed a high prevalence of psychological distress in occupational physicians. To prevent the occurrence of mental disorders among Occupational Physicians, it is urgent to put in place policies of psychological support and well-being preservation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243194PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857620PMC
February 2021

Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review.

Front Med (Lausanne) 2020 12;7:594269. Epub 2021 Jan 12.

Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy.

Evidence is needed on the effectiveness of wearing face masks in the community to prevent SARS-CoV-2 transmission. Systematic review and meta-analysis to investigate the efficacy and effectiveness of face mask use in a community setting and to predict the effectiveness of wearing a mask. We searched MEDLINE, EMBASE, SCISEARCH, The Cochrane Library, and pre-prints from inception to 22 April 2020 without restriction by language. We rated the certainty of evidence according to Cochrane and GRADE approach. Our search identified 35 studies, including three randomized controlled trials (RCTs) (4,017 patients), 10 comparative studies (18,984 patients), 13 predictive models, nine laboratory experimental studies. For reducing infection rates, the estimates of cluster-RCTs were in favor of wearing face masks vs. no mask, but not at statistically significant levels (adjusted OR 0.90, 95% CI 0.78-1.05). Similar findings were reported in observational studies. Mathematical models indicated an important decrease in mortality when the population mask coverage is near-universal, regardless of mask efficacy. In the best-case scenario, when the mask efficacy is at 95%, the R0 can fall to 0.99 from an initial value of 16.90. Levels of mask filtration efficiency were heterogeneous, depending on the materials used (surgical mask: 45-97%). One laboratory study suggested a viral load reduction of 0.25 (95% CI 0.09-0.67) in favor of mask vs. no mask. The findings of this systematic review and meta-analysis support the use of face masks in a community setting. Robust randomized trials on face mask effectiveness are needed to inform evidence-based policies. CRD42020184963.
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http://dx.doi.org/10.3389/fmed.2020.594269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835129PMC
January 2021

Major reduction of NKT cells in patients with severe COVID-19 pneumonia.

Clin Immunol 2021 01 13;222:108630. Epub 2020 Nov 13.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.

Background: NK cells seem to be mainly involved in COVID-19 pneumonia. Little is known about NKT cells which represent a bridge between innate and adaptive immunity.

Methods: We characterized peripheral blood T, NK and NKT cells in 45 patients with COVID-19 pneumonia (COVID-19 subjects) and 19 healthy donors (HDs). According to the severity of the disease, we stratified COVID-19 subjects into severe and non-severe groups.

Results: Compared to HDs, COVID-19 subjects showed higher percentages of NK CD57+ and CD56dim NK cells and lower percentages of NKT and CD56bright cells. In the severe group we found a significantly lower percentage of NKT cells. In a multiple logistic regression analysis, NKT cell was independently associated with the severity of the disease.

Conclusions: The low percentage of NKT cells in peripheral blood of COVID-19 subjects and the independent association with the severity of the disease suggests a potential role of this subset.
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http://dx.doi.org/10.1016/j.clim.2020.108630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661928PMC
January 2021

Do Diet and Lifestyles Play a Role in the Pathogenesis of NMSCs?

Nutrients 2020 Nov 11;12(11). Epub 2020 Nov 11.

Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, 04019 Terracina, Italy.

Background And Aims: Literature highlights the role of risk factors like age, body mass index (BMI), tobacco smoking, alcohol intake and diet in the pathogenesis of several cancer types but little is known for non-melanoma skin cancers (NMSC). The aim of this epidemiological study was to evaluate the correlation between modifiable risk factors (BMI, metabolic panel, diet, lifestyle, medical history) and not modifiable risk factors (gender, age) and NMSC development.

Methods: From February 2018 to September 2019, 162 patients affected by NMSC were compared to a group of 167 controls. A univariate and multivariate analysis was conducted to elaborate the data collected through face-to-face interviews.

Results: While our evidence did not always reach statistical significance, NMSC study group patients exhibited high rates of analyzed risk factors (male gender aging over 55 years, high BMI, reduced physical activity) compared to the control group.

Conclusions: Our study indicates that practicing more than 30 min of physical activity daily could be a protective factor against the NMSC onset. Other risk factors were not correlated with NMSC, but more evidence is needed to establish a possible link.
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http://dx.doi.org/10.3390/nu12113459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697298PMC
November 2020

Technostress: how does it affect the productivity and life of an individual? Results of an observational study.

Public Health 2020 Dec 6;189:60-65. Epub 2020 Nov 6.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy.

Objectives: Technostress is an emergent phenomenon related to the pervasive use of technology and is associated with the increased computerisation and digitalisation seen over recent decades. This cross-sectional observational study aims to investigate the impact that stress from the use of technologies (i.e. technostress) has on the productivity and life of an individual.

Study Design: Cross-sectional study.

Methods: Data were collected using a previously proposed and validated questionnaire. The questionnaire was translated into Italian and transformed into an online format with a Google Docs form. The questionnaire was then associated with a link and QR code (also available in paper format) and disseminated manually and through the use of e-mail and social networks, such as Facebook and Twitter.

Results: The study sample included 313 individuals, 54.6% of whom were women. The mean age of the sample participants was 34.7 years. The dependent variables were technstressors (i.e. techno-overload, techno-invasion, techno-complexity, techno-insecurity and techno-uncertainty), role stressors (i.e. role overload and role conflict) and productivity. In the multivariate analysis, techno-overload was significantly associated with female gender (β = 0.128; P = 0.018) and unemployment (β = -0.303; P < 0.001); techno-invasion was significantly associated with female gender (β = 0.098; P = 0.081) and degree-level education (β = 0.149; P = 0.008); techno-complexity was significantly associated with female gender (β = 0.107; P = 0.057) and being married (β = 0.113; P = 0.046); techno-uncertainty was significantly associated with unemployment (β = 0.337; P < 0.001); role overload was significantly associated with female gender (β = 0.160; P = 0.014) and productivity was significantly associated with degree-level education (β = 0.125; P = 0.057).

Conclusions: This observational study evaluated the phenomenon of both work-related and non-work-related technostress of 313 individuals aged between 16 and 65 years. The present study investigated the impact of five techno-stressors, two role stressors and productivity. The results indicate that different techno-stressors are significantly associated with female gender, degree-level education and unemployment. Further research in this field is required to better understand and clarify the epidemiology, clinical presentation and determinants of technostress.
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http://dx.doi.org/10.1016/j.puhe.2020.09.013DOI Listing
December 2020

["Alternanza scuola lavoro": an observational study of the experience in Italy in upper secondary school in the years 2016-2018.]

G Ital Med Lav Ergon 2020 09;42(3):178-186

Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma.

Summary: Objectives. To assess the results of the national survey published by skuola.net addressed to students involved in the "Alternanza Scuola-Lavoro"(ASL) project in the years 2016-2018. Methods. An anonymous online survey was employed to gather information on students' experiences during the ASL project. Chi-squared test was performed for the univariate analysis. Results. A total of 8695 questionnaires were included in the analysis. The results of the descriptive and univariate analysis showed that a large number of students, especially those living in Northern Italy, performed more than 15 days of ASL during the year. In addition, students belonging to technical and professional institutes spent more hours compared to classical and scientific high schools ones. Employment in private companies was greater in the North than in the Center and South (54.9% vs 47.7% vs 47.7%, p minor than 0.001). In classical and scientific institutes, on the other hand, there were more students who replied that they had received a theoretical training at work (23% vs. 19.7 p minor than 0.001) or that they had carried out "outline tasks such as making photocopies, cleaning etc.". (19.6 vs 11.5, p mionr than 0.001). Another aspect investigated what kind of training they had had about safety at the workplace before starting the experience in the company: among the students resident in the South and in the Islands there was the highest number of negative responses, in fact 30.8% answered "No, by no one", compared to 15.2% in the North and 17.6% in the Center (p minor than 0.001). Conclusions. The ASL represented a concrete attempt to overcome the distinction between the world of education and the world of work within the Italian educational system. There were also some critical issues in its implementation, such as the lower involvement of classical and scientific high school students in projects consistent with their studies and their future prospects, compared to those of technical and commercial institutes. There was also a lack of homogeneity in the quality of the experiences lived between geographical macro areas, which reflects the diversity of employment opportunities present on the national territory.
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September 2020

Smoking Prevalence, Attitudes and Behavior among Dental Students in Poland and Italy.

Int J Environ Res Public Health 2020 10 13;17(20). Epub 2020 Oct 13.

Department of Oral and Maxillofacial Sciences, 'Sapienza' University of Rome, 00185 Roma, Italy.

The aim of the study was to perform preliminary research to compare the smoking prevalence, attitudes and behavior between dentistry students in two universities in Europe using the standardized Global Health Professions Student Survey (GHPSS) questionnaire. This was cross-sectional carried out among dentistry students from the Medical University in Bialystok, Poland and Sapienza University of Rome, Italy. There were 582 participants; 282 were Italians, 202 were smokers and 42% were Italians. The response rate was 79.9% of Italian students and 79.6% of Polish students. The prevalence of smoking was significantly higher among Italian students (42% vs. 28.0%). Attitudes and behaviour of smokers and non-smokers differed statistically. Polish and Italian dental students presented statistically different behavior regarding the time to smoke the first cigarette, the willingness to stop smoking and trying to stop smoking in the last year. The multiple logistic regression analysis revealed that two independent variables, exposure to second-hand smoke (SHS) both at home and in public places (OR = 3.26 and OR = 5.9, respectively), showed a significantly higher occurrence of smoking. There is a high use of tobacco among dental students, which is particularly high in Italian dental students. Students realizes the positive perception of their own tobacco counsellor role in a dental setting. Dental students should be role models to their peers and patients.
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http://dx.doi.org/10.3390/ijerph17207451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602041PMC
October 2020

Colonic J-Pouch or Straight Colorectal Reconstruction After Low Anterior Resection For Rectal Cancer: Impact on Quality of Life and Bowel Function: A Multicenter Prospective Randomized Study.

Dis Colon Rectum 2020 11;63(11):1511-1523

Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.

Background: Patient-reported outcomes associated with different bowel reconstruction techniques following anterior resection for rectal cancer are still a matter of debate.

Objective: This study aimed to assess quality of life and bowel function in patients who underwent colonic J-pouch or straight colorectal anastomosis reconstruction after low anterior resection.

Design: Bowel function and quality of life were assessed within a multicenter randomized trial. Questionnaires were administered before the surgery (baseline) and at 6, 12, and 24 months after surgery.

Settings: Patients were enrolled by 19 centers. The enrollment started in October 2009 and was stopped in February 2016. The study was registered at www.clinicaltrials.gov (Identifier: NCT01110798).

Patients: Patients who underwent low anterior resection for primary mid-low rectal cancer and who were randomly assigned in a 1:1 ratio to receive either stapled colonic J-pouch or straight colorectal anastomosis were selected.

Main Outcome Measures: The primary outcomes measured were quality of life and bowel function.

Results: Of the 379 patients who were evaluable, 312 (82.3%) completed the baseline, 259 (68.3%) the 6-month, 242 (63.9%) the 12-month, and 199 (52.5%) the 24-month assessment. Bowel functioning and quality of life did not significantly differ between arms for almost all domains. The total bowel function score, the urgency, and the stool fractionation scores significantly worsened after surgery and remained impaired over time in both arms (p < 0.0032), whereas constipation improved after surgery but recovered to baseline levels from 1 year onward (p < 0.0036). All patients showed a significant and continuous improvement in emotional functioning (p < 0.0013) and future perspective (p < 0.0001) from baseline to the end of the study.

Limitations: Limitations of the study include missing data, which increased over time; the possibility that some treatments have slightly changed since the study was conducted; and investigators not blind to treatment allocation.

Conclusion: The findings of this study do not support the routine use of colonic J-pouch reconstruction in patients with rectal cancer who undergo a low anterior resection. See Video Abstract at http://links.lww.com/DCR/B328. BOLSA J COLÓNICA O RECONSTRUCCIÓN COLORRECTAL RECTA DESPUÉS DE RESECCIÓN ANTERIOR BAJA PARA CÁNCER RECTAL: IMPACTO EN LA CALIDAD DE VIDA Y LA FUNCIÓN INTESTINAL: UN ESTUDIO ALEATORIZADO PROSPECTIVO MULTICÉNTRICO: Los resultados informados por el paciente asociados con diferentes técnicas de reconstrucción intestinal después de la resección anterior para el cáncer de recto aún son tema de debate.Evaluar la calidad de vida y la función intestinal en pacientes que se sometieron a una bolsa en J colónica o reconstrucción de anastomosis colorrectal recta después de una resección anterior baja.La función intestinal y la calidad de vida se evaluaron en un ensayo aleatorizado multicéntrico. Los cuestionarios se administraron antes de la cirugía (basal) y a los 6, 12 y 24 meses después de la cirugía.Los pacientes fueron incluidos en 19 centros. La inscripción comenzó en Octubre de 2009 y se detuvo en Febrero de 2016. El estudio se registró en www.clinicaltrials.gov (Identificador: NCT01110798).Pacientes que se sometieron a resección anterior baja por cáncer rectal primario medio-bajo y que fueron aleatorizados en una proporción de 1: 1 para recibir bolsa J colónica con grapas o anastomosis colorrectal recta.calidad de vida y función intestinal.De los 379 pacientes que fueron evaluables, 312 (82.3%) completaron la evaluación inicial, 259 (68.3%) a los 6 meses, 242 (63.9%) a los 12 meses y 199 (52.5%) a los 24 meses. . El funcionamiento intestinal y la calidad de vida no difirieron significativamente entre los dos grupos en casi todos los dominios. La puntuación total de la función intestinal, la urgencia y las puntuaciones de fraccionamiento de las heces empeoraron significativamente después de la cirugía y continuaron con el tiempo extra en ambos grupos (p <0.0032), mientras que el estreñimiento mejoró después de la cirugía pero se recuperó a los niveles basales a partir de 1 año en adelante (p <0.0036). Todos los pacientes mostraron una mejora significativa y continua en el funcionamiento emocional (p <0.0013) y la perspectiva futura (<0.0001) desde el inicio hasta el final del estudio.Datos faltantes, que aumentaron con el tiempo; la posibilidad de que algunos tratamientos hayan cambiado ligeramente desde que se realizó el estudio; investigadores no cegados a la asignación del tratamiento.Los hallazgos de este estudio no respaldan el uso rutinario de la reconstrucción de la bolsa J colónica en pacientes con cáncer rectal que se someten a una resección anterior baja. Consulte Video Resumen en http://links.lww.com/DCR/B328. (Traducción-Dr. Yesenia Rojas-Khalil).
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http://dx.doi.org/10.1097/DCR.0000000000001745DOI Listing
November 2020

Nursing Assessment of Wound-Related Pain: An Italian Learning Survey.

Adv Skin Wound Care 2020 Oct;33(10):540-548

Elena Toma, RN, CWSC, CSOC, is Independent Tissue Viability and Ostomy Care Consultant, Rome, Italy. At Sapienza University of Rome, Maria Luisa Veneziano, RN, CSWC, is Professor of Wound Care and Lecturer of Nursing; Lucia Filomeno, DNP, RN, is a nurse, Department of Public Health and Infectious Diseases; Annalisa Villa, MD, is a physician, Department of Translational and Precision Medicine; Edoardo Rosato, MD, PhD, is Professor, Department of Translational and Precision Medicine; and Giuseppe la Torre, MD, PhD, is Associate Professor, Department of Public Health and Infectious Diseases. The authors have disclosed no financial relationships related to this article. Submitted September 25, 2019; accepted in revised form January 24, 2020.

Background: Pain is an important symptom in wound management, and the choice of treatment directly affects the patient's quality of life. Pain assessment (PA) is essential for quality wound care and, in Italy, mandatory by law.

Objective: To administer a dedicated learning survey to obtain a better sense of current PA practices, ensure more training, improve procedures, and reduce malpractice.

Methods: A 16-month learning survey of nurses based on a validated questionnaire developed for this project.

Results: The survey sample comprised 512 questionnaires. Of respondents, 78% were female, 56.1% were older than 40 years, 94% were RNs, and 6% were wound care specialist nurses. Participants performed a range of dressing changes per week (1-5, 46.3%; 6-20, 34.4%; >21, 19.3%). Although 93% of respondents considered PA important, only 26% recognized it as a vital parameter, and barely one-quarter (25.4%) were aware of current legislation mandating PA. The majority (95.3%) believed that PA is not consistent with pain perceived by the patient. Further, 87.3% stated that they did not have adequate knowledge to conduct a PA, 91.4% did not consider themselves up-to-date on PA, and 81% did not document PA results. However, specific wound care training leads to significantly better PA (P < .001): 71.9% of wound care specialist nurses recognized pain as a vital parameter, and 59.4% were aware of current legislation regarding PA; further, 81.3% consistently evaluated pain, 59.4% documented PA results, and 50% communicated the outcome to the physician in charge.

Conclusions: The results illustrate the lack of sensitivity, training, and education that Italian RNs have regarding PA in wound care.
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http://dx.doi.org/10.1097/01.ASW.0000695772.37897.abDOI Listing
October 2020

Anosmia and Ageusia as Predictive Signs of COVID-19 in Healthcare Workers in Italy: A Prospective Case-Control Study.

J Clin Med 2020 Sep 4;9(9). Epub 2020 Sep 4.

Covid-19 Sapienza Collaborative group, Sapienza University of Rome, 00185 Rome, Italy.

Background: The aim of this study was to investigate the diagnostic accuracy of symptoms and signs in healthcare workers (HCW) with Sars-CoV-2.

Methods: This was a case-control study. Cases consisted of symptomatic healthcare workers who had a positive SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) test, while controls were symptomatic healthcare workers with a negative RT-PCR test. For each symptom, ROCs were plotted. Diagnostic accuracy was calculated using the sensitivity, specificity, and positive and negative predictive values. A logistic regression analysis was carried out for calculating the OR (95% CI) for each symptom associated to the SARS-CoV-2 positivity.

Results: We recruited 30 cases and 75 controls. Fever had the best sensitivity while dyspnea, anosmia, and ageusia had the highest specificity. The highest PPVs were found again for dyspnea (75%), anosmia (73.7%), and ageusia (66.7%). Lastly, the highest NPVs were related to anosmia (81.4%) and ageusia (79.3%). Anosmia (OR = 14.75; 95% CI: 4.27-50.87), ageusia (OR = 9.18; 95% CI: 2.80-30.15), and headache (OR = 3.92; 95% CI: 1.45-10.56) are significantly associated to SARS-CoV-2 positivity.

Conclusions: Anosmia and ageusia should be considered in addition to the well-established fever, cough, and dyspnea. In a resource-limited setting, this method could save time and money.
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http://dx.doi.org/10.3390/jcm9092870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564490PMC
September 2020

The influence of work context and organizational well-being on psychophysical health of healthcare providers.

Med Lav 2020 Aug 31;111(4):306-320. Epub 2020 Aug 31.

Department of Nursing Professions, Tor Vergata General Hospital, Rome, Italy.

Background: A high level of organizational well-being improves employee performance and influences the physical and mental health of healthcare providers and students.

Objective: This study investigates the relationship between the work context, organizational well-being, and the psychophysical health of healthcare providers.

Methods: A multicentre cross-sectional descriptive study was conducted on a sample of healthcare providers (physicians and nurses) and healthcare students (medical students and nursing students). A self-report questionnaire was administered between September and November 2016. -Results: Of the 300 questionnaires administered, 201 (67%) were correctly completed. Overall, both the physical and mental health of the healthcare providers and students are explained by the variables of the organizational context: organizational well-being and socio-demographic/work characteristics. In particular, the results show a dependence on gender and age. Furthermore, decision latitude had a positive effect on physical health (b=.134) while job demands had a negative effect (b=-.160) explaining 21% of the PCS of the healthcare providers and students (R2=.209). Mental health improved via the satisfaction (b=.345), and positivity (b=.222) of healthcare professionals and students of these disciplines.

Discussion: The results are significant because they directly impact the quality of care provided as well as patient safety.
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http://dx.doi.org/10.23749/mdl.v111i4.9075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809958PMC
August 2020

Flat Foot and Postural Harmony in 6-Year-Old Caucasians: What is Their Relationship?

Ann Rehabil Med 2020 Aug 28;44(4):320-326. Epub 2020 Jul 28.

Unit of Physical Medicine and Rehabilitation, Department of Medical and Oral Sciences and Biotechnologies, University G. D'Annunzio Chieti-Pescara, Chieti, Italy.

Objective: To determine whether asymptomatic flexible flat feet show specific postural assessment with respect to neutral feet in 6-year-old children.

Methods: In this cross-sectional observational study, 164 subjects were observed and divided into two groups: 57 with flexible flat feet and 107 with neutral feet. A non-quantitative inspection by podoscopy and baropodometry were performed to evaluate plantar support, and a clinical examination to assess postural setting.

Results: The prevalence of flexible flat feet was 34.8%. The differenceinthe mean centre of pressure (CoP) between the two groups was significant (p=0.028), regarding the antero-posterior direction of CoP only. There was no significant differencein the presence of postural growth disharmony between the neutral and flat-feet groups.

Conclusion: The flattening of the plantar archseems to be linked to a displacement of CoP Y, more posterior in flat feet than in neutral feet; on the other hand, postural harmony in 6-year-old children during growth is not influenced by flat feet.
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http://dx.doi.org/10.5535/arm.19091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463120PMC
August 2020

An exploratory cross-sectional study of subclinical vascular damage in patients with polymyalgia rheumatica.

Sci Rep 2020 07 9;10(1):11407. Epub 2020 Jul 9.

Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, viale del Policlinico 155, 00161, Rome, Italy.

The aim of the study was to investigate the presence of subclinical vascular damage in polymyalgia rheumatica (PMR). We enrolled PMR patients having major cardiovascular risk factors (MCVRF) and, as controls, patients with MCVRF. All underwent: color Doppler ultrasound to evaluate the common carotid intima-media thickness (IMT), the anterior-posterior abdominal aortic diameter (APAD), and the prevalence of carotid artery stenosis; the cardio-ankle vascular index (CAVI) to measure arterial stiffness together with the ankle-brachial index (ABI) to investigate the presence of lower-extremity peripheral arterial disease. Finally, we measured the serum levels of adipocytokines implicated in vascular dysfunction. As a result, 48 PMR and 56 MCVRF patients were included. An increase of IMT (1.07/0.8-1.2 vs 0.8/0.8-1.05; p = 0.0001), CAVI (8.7/7.8-9.3 vs 7.6/6.9-7.8; p < 0.0001) and APAD values (21.15/18.1-25.6 vs 18/16-22; p = 0.0013) was found in PMR patients with respect to controls. No differences were reported in the prevalence of carotid artery stenosis or ABI values between the two groups. A significant correlation between IMT and CAVI in PMR and MCVRF subjects (r = 0.845 and r = 0.556, respectively; p < 0.01) was found. Leptin levels (pg/mL; median/25th-75th percentile) were higher in PMR than in MCVRF subjects (145.1/67-398.6 vs 59.5/39.3-194.3; p = 0.04). Serum levels of adiponectin (ng/mL) were higher in PMR patients (15.9/10.65-24.1 vs 6.1/2.8-22.7; p = 0.01), while no difference in serum levels of resistin (ng/mL) was found between PMR and MCVRF subjects (0.37/0.16-0.66 vs 0.26/0.14-1.24). Our study shows an increased subclinical vascular damage in PMR patients compared to those with MCVRF, paving the way for further studies aimed at planning primary cardiovascular prevention in this population.
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http://dx.doi.org/10.1038/s41598-020-68215-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347873PMC
July 2020

[Injuries among Sapienza University students].

G Ital Med Lav Ergon 2020 03;42(1):11-15

Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma.

Summary: Background. The phenomenon of accidents during the university course is a public health problem. Students spend a lot of time at university and in structure for training. This this leads them to be exposed to biological, chemical and ergonomic risk of accidents or occupational diseases. Aim. The aim of this study is to describe accidents that occurred to students of Sapienza University in Rome during the period 2010-2015. Materials and Methods. Retrospective study conducted on a cohort of students from Sapienza University in the years 2010-2015. As a source of data was used register of accidents reported by the students. Results. During the period considered, injuries were recorded in 791 students, mainly female (71.8%). Nursing students were the most affected (92.8%), followed by medical students (5.7%) and finally students of other faculties (1.5%). Point wounds were the most frequent (n=462) representing 58.4% of the total and occur mainly at the wrist and hand (n=380); the second most frequent type of injury is contact with biological liquid (n=159) followed by contusions (n=72), the most affected site in this case are the head and the face (n=81; n=23). Contusions often also involve multiple regions (n=17). In lesser numbers there are also the distortions (n=55), and fractures (n=26) the most frequent first ankle and foot (25.5%), the second most frequent wrist and hand (34.6%) The incidence of accidents ranged from 0.079% in 2011 to 0.161% in 2012. Conclusion. There is a need to design measures for more intensive specific training on biomedical students, especially nursing students, as the most exposed category, in order to reduce the accident phenomenon. Particular attention should be paid to the safe handling of sharp objects. It would be beneficial to include in the course of teaching lessons aimed at security and greater awareness of the risk.
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March 2020

Smoking cessation interventions on health-care workers: a systematic review and meta-analysis.

PeerJ 2020 16;8:e9396. Epub 2020 Jun 16.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

Objective: The authors carried out a systematic review and a meta-analysis on smoking cessation interventions on health -care workers to clarify the state of the art interventions and to identify the best one.

Materials And Methods: This review was registered with PROSPERO: CRD42019130117. The databases PubMed, Scopus, Web of Science and CINAHL were searched until December 2018. Quality of all studies included in the systematic review was assessed according to the Newcastle-Ottawa Scale (NOS) on cohort or cross-sectional studies and to the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Meta-analysis and meta-regression analyses were also carried out for cohort studies (quasi-experimental or a before-after studies design) and clinical trials.

Results: Twenty-four studies have been included in the analysis: four before-after, 13 cross-sectional, three quasi-experimental studies and four clinical trials. Articles were heterogeneous ( for homogeneity <0.01), but they have all shown positive results since they reached the goal of smoking cessation among health-care workers, even if with different proportions. Meta-analysis was performed on 10 studies (six cohort studies and four clinical trials), showing a 21% of success rate from the application of smoking cessation interventions, either pharmacological or behavioral ones. The resulted pooled RR (Risk Ratio) was 1.21 (95% CI [1.06-1.38]), being 24% of success rate from clinical trials (pooled RR 1.244; 95% CI [1.099-1.407]) and 19% of success rate from cohort studies (pooled RR 1.192; 0.996-1.426). However, two studies have confidence intervals which include unity and one study has a wide confidence interval; as a consequence, the meta-analysis for its results depends heavily on one single study. Meta-regression analysis revealed that results were influenced by the number of participants.

Conclusion: Both policy and pharmaceutical interventions can obtain positive results in quitting smoking among health-care workers. However, as shown by our review, combination approaches can produce better results in terms of cessation percentages and smoking abstinence.
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http://dx.doi.org/10.7717/peerj.9396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304418PMC
June 2020

How Much Do Young Italians Know About COVID-19 and What Are Their Attitudes Toward SARS-CoV-2? Results of a Cross-Sectional Study.

Disaster Med Public Health Prep 2021 02 24;15(1):e15-e21. Epub 2020 Jun 24.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.

Objectives: At the end of 2019, an outbreak of novel coronavirus pneumonia, called severe acute respiratory syndrome coronavirus 1 (SARS-CoV-2), was first identified in Wuhan, Hubei Province, China. It subsequently spread throughout China and elsewhere, becoming a global health emergency. In February 2020, the World Health Organization (WHO) designated the disease coronavirus disease 2019 (COVID-19). The objective of this study was to investigate the degree of knowledge of young Italians about COVID-19 and their current attitudes toward the SARS-CoV-2 and to determine if there were prejudices emerging toward Chinese.

Methods: An online survey was conducted on February 3, 4, 5, 2020, with the collaboration of Italian website "Skuola.net". Young people had the opportunity to participate by answering an ad hoc questionnaire created to investigate knowledge and attitudes about the new coronavirus, using a link published on the homepage.

Results: A total of 5234 responses were received, of which 3262 were females and 1972 were males. Most of the participants showed generally moderate knowledge about COVID-19. Male students, middle school students, and those who do not attend school, should increase awareness of the disease; less than half of responders say that their attitudes toward the Chinese population has worsened in the last period.

Conclusions: Global awareness of this emerging infection should be increased, due to its virulence, the significant risk of mortality, and the ability of the virus to spread very quickly within the community.
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http://dx.doi.org/10.1017/dmp.2020.205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385315PMC
February 2021

ImmunizziAMO: A School-Based Field Trial to Teach New Generations the Importance of Vaccination through Games and to Fight Vaccine Hesitancy in Italy.

Vaccines (Basel) 2020 Jun 5;8(2). Epub 2020 Jun 5.

Giochiamo Collaborative Group, Sapienza University of Rome, 00185 Rome, Italy.

Background: Vaccines simulate the first contact with infectious agents and evoke the immunological response without causing the disease and its complications. High rates of immunization among the population guarantee the interruption of the transmission chain of infectious diseases. Therefore, the population should be aware of the value of vaccination and motivated. In order to implement the spread of a correct culture about these issues, schools were recognized as a privileged operational setting. The aim of this project was to transmit knowledge and convey educational messages on the importance of vaccines, through the use of games, in elementary school children, their families and teachers.

Materials And Methods: A field trial study was implemented between April and October 2019. Sample size calculations highlighted the need to recruit at least 136 students in the schools. The intervention involved 10 classes (five first grade and five s grade classes) and was structured in frontal teaching sessions and gaming sessions. Knowledge was assessed comparing the results of a questionnaire administered before and after the intervention. The questionnaires referred to the following items: dangerousness of bacteria and viruses; capability of defending from microorganisms; the role of antibodies; functioning of the vaccine in a child; type of disease for which a vaccine is efficacious; duration of a vaccine; mother- child transmission of antibodies; herd immunity.

Results: 143 children participated in all the phases of the study. The comparison between the scores at the beginning and end of the intervention showed a significant increase in the knowledge about vaccines and immunity. The mean knowledge score arose from 3.52 (SD = 1.67) to 5.97 (SD = 1.81).

Conclusions: This study suggests that the use of games in an elementary school effectively increase the knowledge related to the important topic of vaccination starting at childhood.
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http://dx.doi.org/10.3390/vaccines8020280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349980PMC
June 2020

The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness.

PLoS One 2020 3;15(6):e0234025. Epub 2020 Jun 3.

Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234025PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269249PMC
June 2020

Are There Effective Interventions to Increase Physical Activity in Children and Young People? An Umbrella Review.

Int J Environ Res Public Health 2020 05 18;17(10). Epub 2020 May 18.

Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy.

Background: Obesity and physical inactivity among children and young people are public health concerns. While numerous interventions to promote physical activity are available, little is known about the most effective ones. This study aimed to summarize the existing evidence on interventions that aim to increase physical activity.

Methods: A systematic review of reviews was conducted. Systematic reviews and meta-analyses published from January 2010 until November 2017 were identified through PubMed, Scopus and the Cochrane Library. Two reviewers independently assessed titles and abstracts, performed data extraction and quality assessment. Outcomes as level of physical activity and body mass index were collected in order to assess the efficacy of interventions.

Results: A total 30 studies examining physical activity interventions met the inclusion criteria, 15 systematic reviews and 15 meta-analyses. Most studies (N = 20) were implemented in the school setting, three were developed in preschool and childcare settings, two in the family context, five in the community setting and one miscellaneous context. Results showed that eight meta-analyses obtained a small increase in physical activity level, out of which five were conducted in the school, two in the family and one in the community setting. Most promising programs had the following characteristics: included physical activity in the school curriculum, were long-term interventions, involved teachers and had the support of families.

Conclusion: The majority of interventions to promote physical activity in children and young people were implemented in the school setting and were multicomponent. Further research is needed to investigate nonschool programs.
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http://dx.doi.org/10.3390/ijerph17103528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277151PMC
May 2020

Associations Between Social Capital and Depressive Symptoms Among College Students in 12 Countries: Results of a Cross-National Study.

Front Psychol 2020 29;11:644. Epub 2020 Apr 29.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.

Introduction: A mental health crisis has hit university campuses across the world. This study sought to determine the prevalence and social determinants of depressive symptoms among university students in twelve countries. Particular focus was placed on the association between social capital and depressive symptoms.

Methods: A cross-sectional study was conducted among students at their first year at university in Europe, Asia, the Western Pacific, and Latin and North America. Data were obtained through a self-administered questionnaire, including questions on sociodemographic characteristics, depressive symptoms, and social capital. The simplified Beck's Depression Inventory was used to measure the severity of depressive symptoms. Social capital was assessed using items drawn from the World Bank Integrated Questionnaire to Measure Social Capital. Multilevel analyses were conducted to determine the relationship between social capital and depressive symptoms, adjusting for individual covariates (e.g., perceived stress) and country-level characteristics (e.g., economic development).

Results: Among 4228 students, 48% presented clinically relevant depressive symptoms. Lower levels of cognitive (OR: 1.82, 95% CI: 1.44-2.29) and behavioral social capital (OR: 1.51, 95% CI: 1.29-1.76) were significantly associated with depressive symptoms. The likelihood of having depressive symptoms was also significantly higher among those living in regions with lower levels of social capital.

Conclusion: The study demonstrates that lower levels of individual and macro-level social capital contribute to clinically relevant depressive symptoms among university students. Increasing social capital may mitigate depressive symptoms in college students.
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http://dx.doi.org/10.3389/fpsyg.2020.00644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201069PMC
April 2020

Assessing knowledge, attitude, and practice of healthcare personnel regarding biomedical waste management: a systematic review of available tools.

Waste Manag Res 2020 Jul 8;38(7):717-725. Epub 2020 May 8.

Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.

Biomedical waste (BMW) management is an important commitment of hospitals both in terms of the possible infectious risk and from the financial point of view. Monitoring the knowledge, attitude, and practice (KAP) of healthcare professionals on this topic represents a source of information on BMW management. The aim of this study is to perform a systematic review to identify the reliable and valid tools able to assess the KAP of professionals in healthcare centers to manage BMW. Two databases (PubMed and Scopus) were searched on 10 May 2018 for cross-sectional studies with tools on BWM management, including original research studies from peer-reviewed journals, case studies, and review studies. Information on validation and reliability were collected. Methodological quality was assessed using the Newcastle-Ottawa scale for cross-sectional studies. Fifty-three articles were included, of which 19 presented a questionnaire on BMW for healthcare workers. Nine proposed a validated questionnaire: four reported Cronbach's alpha, which ranged from 0.62 to 0.86. Results further emphasize the prevalence of Asian studies facing the problem of assessing KAP about BMW management using specific tools. Overall, 14 questionnaires were designed in Asia, two in Africa, one in America, one in Australia, and one questionnaire was elaborated in Europe, in Spain. This systematic review highlighted the need of creation of validated and methodologically high-quality questionnaires. Therefore, there is the need of new cross-sectional studies to investigate these problems, improving generalization, and facilitating international comparison of research findings.
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http://dx.doi.org/10.1177/0734242X20922590DOI Listing
July 2020

Yoga and Mindfulness as a Tool for Influencing Affectivity, Anxiety, Mental Health, and Stress among Healthcare Workers: Results of a Single-Arm Clinical Trial.

J Clin Med 2020 Apr 7;9(4). Epub 2020 Apr 7.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.

Mindfulness-based interventions have emerged as unique approaches for addressing a range of clinical and subclinical difficulties such as stress, chronic pain, anxiety, or recurrent depression. Moreover, there is strong evidence about the positive effects of yoga practice on stress management and prevention of burnout among healthcare workers. The aim of this study was to conduct a single-arm clinical trial to assess the effectiveness of an intervention based on mindfulness-based stress reduction and yoga in improving healthcare workers' quality of life. Healthcare workers of two hospitals in Rome were enrolled in a 4-week yoga and mindfulness course. Four questionnaires were administered at different times (Short Form-12 (SF-12), State-Trait Anxiety Inventory (STAI) Y1 and Y2, and Positive and Negative Affect Schedule (PANAS)) to evaluate the efficacy of the intervention. Forty participants took part to the study (83.3 %). The Mental Composite Score-12, that is part of the quality of life assessment, passed from a median of 43.5 preintervention to 48.1 postintervention ( = 0.041), and the negative affect passed from a score of 16 in the preintervention to 10 in the postintervention ( < 0.001). Both the forms of the STAI questionnaires showed a decrease after the intervention. Yoga and mindfulness administered together seem to be effective to reduce stress and anxiety in healthcare workers, providing them with more consciousness and ability to manage work stressful demands.
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http://dx.doi.org/10.3390/jcm9041037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230658PMC
April 2020
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