Ambiente e salute a Gela: stato delle conoscenze e prospettive di studio

The high environmental risk area of Gela, Niscemi and Butera includes the Gela Reclamation Site of National Interest (Gela RSNI). If compared to the other sites of national interest, the Gela RSNI is a case in which many important data on environmental matrices and health outcome are available. However these data do not cover all matrices nor the entire risk area, but are mainly limited to the industrial site. These data are also underutilised, almost never integrated, and a clear example of the lacking of coordination and connection between environment and health data collection and management. In Gela there is an important industrial site whose activities have caused over the years a progressive contamination of several environmental matrices, and extremely high levels of chemical toxic, persistent and bio-accumulative pollutants have been found. In this same area, several epidemiological population health studies have been carried out showing a presence of health outcomes higher than in neighbouring areas and in regional data. Most environmental and health data cannot be compared since their respective survey and monitoring systems are planned upon specific regulations having different goals. A local system to assess the relation between environmental pollution and population health is therefore urgently needed to provide risk managers with ad-hoc tools to improve environmental protection and prevent further risks for Gela\u27s population. In this framework, a multidisciplinary working group has been established to study present pollution-exposure-effect data, transform them into a knowledge system, and complete present knowledge on the cycle of pollutants, from migration in the environment to health impact. Workshops were organised in October 2007 and March 2008 in Rome, and in June 2008 in Gela.L\u27area ad alto rischio di crisi ambientale di Gela, Niscemi e Butera include il Sito di Interesse Nazionale per la bonifica di Gela, SIN. A confronto con gli altri, il SIN di Gela ? caratterizzato da ampia disponibilit? di dati di buona qualit? su diverse matrici ambientali e numerosi esiti sanitari. Tuttavia questi dati non coprono tutte le matrici e gli esiti, e sono spesso lacunosi nelle aree esterne al SIN ma interne all\u27area ad alto rischio, che include gli abitati. Inoltre, questi dati sono spesso sottoutilizzati, risulta carente il collegamento tra i due settori ambiente e salute ed un coordinamento organico. Nell\u27area di Gela ? presente un importante polo industriale la cui attivit? ha comportato nel corso degli anni una progressiva contaminazione di diverse matrici ambientali, nelle quali sono stati rilevati livelli estremamente elevati di inquinanti chimici con caratteristiche di tossicit?, persistenza e bioaccumulo. Nella stessa area sono stati effettuati diversi studi epidemiologici sullo stato di salute della popolazione che hanno evidenziato la presenza di patologie in eccesso rispetto alle aree limitrofe e alla regione. La maggior parte dei dati ambientali e sanitari non sono correlabili perch? i sistemi di rilevamento e monitoraggio sono stati pianificati sulla base di normative specifiche con obiettivi differenti. Risulta quindi urgente costruire un sistema locale in grado di valutare l\u27associazione tra l\u27inquinamento ambientale e lo stato di salute della popolazione per poter offrire strumenti mirati ai gestori del rischio per migliorare la protezione ambientale e prevenire ulteriori rischi per la popolazione gelese. In tale contesto, al fine di studiare e sistematizzare le conoscenze attuali sulla concatenazione inquinamento-esposizione-effetto e con l\u27obiettivo di integrare le conoscenze sul ciclo degli inquinanti, dalla migrazione nell\u27ambiente agli effetti sulla salute, ? stato istituto un gruppo di lavoro multidisciplinare per l\u27area di Gela. I seminari si sono svolti a ottobre 2007 e marzo 2008 a Roma e a giugno 2008 a Gela

Patient safety competencies in undergraduate nursing students: a rapid evidence assessment

Aims To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students. Background Patient safety in nursing education is of key importance for health professional environments, settings, and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety. Design Rapid Evidence Assessment. Data Sources MEDLINE, CINAHL, SCOPUS, and ERIC were searched, yielding 500 citations published between 1 January 2004 - 30 September 2014. Review Methods Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies. Results Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students’ overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication, and facilitates adequate supervision and feedback. Conclusion Few studies describe the nursing students’ patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students’ patient safety competencies

A case report of thyroid carcinoma confined to ovary and concurrently occult in the thyroid. Is conservative treatment always advised?

Introduction: Struma ovarii is an ovarian teratoma, represented in more than 50% by thyroid tissue. Five percent of struma ovarii cases have been proven to be malignant and, as in the thyroid gland, papillary thyroid carcinoma is the most common histotype arising in struma ovarii. Because of the unusual occurrence of this tumor, its management and follow-up after pelvic surgery is still controversial. Usually, total thyroidectomy followed by radioiodine treatment is the choice treatment in metastatic malignant struma ovarii, while these procedures are still controversial in non-metastatic thyroid cancer arising in struma ovarii. Case Presentation: We report a female with follicular variant of papillary thyroid carcinoma arising in struma ovarii. After pelvic surgery, thyroid morphofunctional examinations were performed and a single nodular lesion in the left lobe was discovered. The patient underwent total thyroidectomy and histological examination showed a papillary carcinoma. Radioiodine-ablation of residual thyroid tissue was performed and levothyroxine mildly-suppressive treatment was started. Conclusions: A more aggressive treatment should not be denied for malignant struma ovarii without any evidence, even when apparently confined into the ovary. However, in selected cases, aggressive treatment may be advisable to decrease the risk of recurrence and to allow an accurate follow-up

L'impatto delle patologie gastrointestinali sul trattamento tiroxinico

Negli ultimi anni l’approccio alla terapia tiroxinica è mutato da una condizione di empirismo posologico a una fine calibrazione che consente di prevederne un dosaggio individualizzato. Il mancato raggiungimento del target terapeutico in corso di terapia con levotiroxina può derivare non solo da un inadeguato rapporto medico-paziente o dall’interazione con altri farmaci, ma anche e soprattutto dalla presenza di patologie gastrointestinali concomitanti, frequentemente occulte. La terapia tiroxinica diviene così, oltre che strumento terapeutico, un possibile strumento diagnostico

HST unveils a compact mildly relativistic Broad Line Region in the candidate true type 2 NGC 3147

NGC 3147 has been considered the best case of a true type 2 AGN: an unobscured AGN, based on the unabsorbed compact X-ray continuum, which lacks a broad line region (BLR). However, the very low luminosity of NGC 3147 implies a compact BLR, which produces very broad lines, hard to detect against the dominant background host galaxy. Narrow (0.1"x0.1") slit HST spectroscopy allowed us to exclude most of the host galaxy light, and revealed an H$\alpha$ line with an extremely broad base (FWZI$\sim27\,000$ km s$^{-1}$). The line profile shows a steep cutoff blue wing and an extended red wing, which match the signature of a mildly relativistic thin accretion disk line profile. It is indeed well fit with a nearly face on thin disk, at $i\sim23^\circ$, with an inner radius at $77\pm15$ r$_g$, which matches the prediction of $62^{+18}_{-14}$ r$_g$ from the $R_{\rm BLR} \sim L^{1/2}$ relation. This result questions the very existence of true type 2 AGN. Moreover, the detection of a thin disk, which extends below 100 r$_g$ in an $L/L_{\rm Edd}\sim10^{-4}$ system, contradicts the current view of the accretion flow configuration at extremely low accretion rates.Comment: 6 pages, 3 figures, accepted for publication in MNRAS Letter

The Point of View of Undergraduate Health Students on Interprofessional Collaboration: A Thematic Analysis

Interprofessional education (IPE) is essential to prepare future professionals for interprofessional collaboration (IPC). Learning together is essential for students because it is a way to understand the roles of other colleagues, improve their skills, knowledge, competencies, and attitudes to collaborate with the interprofessional teams. To explore how undergraduate students who attend IPE courses define IPC, a qualitative study using semistructured interviews followed by a thematic analysis was performed. Four main themes were identifed: IPC as a resource, requirements for IPC, emotions linked to IPC, and tutor\u2019s role to facilitate students\u2019 perception of IPC. Students considered IPE important to build IPC, where clinical placement tutors play a key role. The most important findings of the present study include the students\u2019 considerations about the importance of IPE when building their IPC definition and the key role played by the tutor during the placement in building IPC in clinical practic

Role of Thyroglobulin, Neck Ultrasound, Thyroglobulin Antibodies Trend and Diagnostic Whole Body Scan in the Management of Differentiated Thyroid Cancer Patients with Persistent Thyroglobulin Antibodies

Background: During the follow-up of differentiated thyroid cancer patients, the presence of thyroglobulin antibodies makes thyroglobulin measurements unreliable. For this reason, thyroglobulin antibodies measurement and the evaluation of their titer trend are also recommended. Objective: We aimed to identify the best method among stimulated thyroglobulin, thyroglobulin antibodies titer trend, neck ultrasound and diagnostic whole body scan for detecting the presence of disease in a group of differentiated thyroid cancer patients with thyroglobulin antibodies. Patients and methods: We retrospectively reviewed the data of 212 consecutive differentiated thyroid cancer patients with thyroglobulin antibodies referred to us between 2005 and 2007 for performing a diagnostic whole body scan. All patients were evaluated during the first two years after the initial treatment. Results: Diagnostic whole body scan sensitivity and specificity in detecting persistent diseases were 70% and 72%, respectively. Diagnostic whole body scan alone had the best positive and negative predictive values (93% and 32%, respectively). A low sensitivity and specificity (56% and 10%, respectively) for increasing or stable thyroglobulin antibodies titer trends were also identified. A good compromise between sensitivity and specificity was obtained when diagnostic whole body scan, stimulated thyroglobulin and neck ultrasound were combined without considering thyroglobulin antibodies trend evaluations (82% and 45%, respectively). Conclusions: Diagnostic whole body scan plays an important role in detecting persistent disease in differentiated thyroid cancer patients with thyroglobulin antibodies, both alone and in association with other methods. However, its low negative predictive value suggests that when a suspicious persistent disease is present, the use of other imaging methods, such as computed tomography scan or FDG-positron emission computed tomography, is recommended. Finally, from this study, it appears that the thyroglobulin antibodies titer trend does not add any useful information about the disease status in the first two years after initial treatment

Adolescents' Appraisal of Homophobic Epithets: The Role of Individual and Situational Factors

Homophobic epithets have become commonly-used insults among adolescents. However, evidence suggests that there are differences in how these homophobic epithets are evaluated based on beliefs held by the observer, and by the context in which they are used. In order to examine this, Italian high school students were asked to rate the offensiveness of homophic epithets, as well as to consider how they or others would react to homophobic epithets across various situations. Homophobic beliefs and beliefs about the social acceptability of homophobic epithets were also examined. It was found that greater perceived social acceptability of homophobic epithets was related to dismissive reactions to their use, whereas homophobic beliefs were predictive of negative emotional reactions, but in varying ways depending on the specific context. The results indicate that homophobic epithets may not always be perceived as homophobic by adolescents, and that attempts to alter the social acceptability of these insults may be an effective manner of reducing their use

Health Impact Assessment Practice and Potential for Integration within Environmental Impact and Strategic Environmental Assessments in Italy

Avoiding or minimizing potential environmental impact is the driving idea behind protecting a population\u27s health via Environmental Impact Assessments (EIAs) and Strategic Environmental Assessments (SEAs). However, both are often carried out without any systematic approach. This paper describes the findings of a review of HIA, EIA and SEA experiences carried out by the authors, who act as institutional competent subjects at the national and regional levels in Italy. The analysis of how health is tackled in EIA and SEA procedures could support the definition of a protocol for the integration of HIA with EIA and SEA. Although EIA and SEA approaches include the aim of protecting health, significant technical and methodological gaps are present when assessing health systematically, and their basic principles regarding assessment are unsatisfactory for promoting and addressing healthcare concepts stated by the WHO. HIA is still poorly integrated into the decision-making process, screening and monitoring phases are only occasionally implemented, and operational details are not well-defined. The collaborative approach of institutions involved in environment and health is a core element in a systematic advancement toward supporting effective decisions and effective protection of the environment and health. At the Italian national level, the definition of guidelines and tools for HIA, also in relation with EIA and SEA, is of great interest

The contribution of nursing doctoral schools to the development of evidence 10 years after their establishment in Italy: An exploratory descriptive survey of former and current doctoral students’ publications

AimTo analyse through an exploratory descriptive survey how former and current doctoral students’ publications have contributed to the development of evidence between the establishment of the doctoral schools of nursing between 2006 - 2015.Design An exploratory descriptive survey.Methods We analysed the papers published in peer-reviewed journals by the four Italian PhD Schools of Nursing between 2006 - 2015. Additional missing information was retrieved from Web of Science.Results We identified 478 scientific papers. The papers increased from 12 in 2006 to 110 in 2015. Most are published in 29 journals, of which 15 have an impact factor ranging between 0.236-3.755. These results show the increasingly significant contribution of nursing doctoral programs to the production of evidence, which can be used to improve the quality of nursing and inform health policies. Nursing doctoral schools deserve a greater recognition, especially by Italian funding agencies and political institutions