Studio trasversale sulle variabili di stress lavoro-correlato nei medici in formazione specialistica del maggiore Policlinico Universitario della Sicilia

Introduzione: Il rischio stress lavoro-correlato è uno degli obiettivi della valutazione e prevenzione dei rischi occupazionali negli operatori sanitari (O.S.). I medici in formazione specialistica (MIFS) rappresentano una tipologia di OS sovrapponibile ai dirigenti medici in termini di esposizione lavorativa e quindi di insorgenza di sindromi da stress lavoro-correlato. Obiettivi: Obiettivo dello studio è valutare un set di fattori di rischio stress lavoro-correlato nei MIFS del principale Policlinico Universitario della Sicilia, sottoposti a sorveglianza sanitaria. Materiali e Metodi: Studio trasversale condotto mediante questionario anonimo ed autosomministrato. Risultati: Il 45% dei MIFS di area clinica ed il 37% di area chirurgica usufruiscono del giorno di riposo compensativo a fronte del 92% dell’area dei servizi (p<0,001). Il sistema di rendicontazione delle presenze/monte orario è presente nell’80% delle scuole dell’area dei servizi, nel 60% di quelle di area medica e nel 50% di quelle di area chirurgica (p<0,001). I MIFS delle scuole dell’area chirurgica dichiarano di usufruire delle pause lavorative (41%) con frequenza minore rispetto ai MIFS dell’area medica (60%) e dell’area dei servizi (74%) (p<0,001). I MIFS sia di area medica (47%) che di area chirurgica (47%) risultano essere più esposti a stress lavoro-correlato (p<0,001) rispetto ai MIFS dell’area dei servizi (29%). Conclusioni: Il lavoro documenta un maggiore rischio di stress lavoro-correlato nei MIFS di area chirurgica rispetto alle altre aree professionali indagate. Appare necessario strutturare degli specifici programmi formativi finalizzati alla gestione dell’esposizione al rischio di stress lavoro-correlato per i MIFS, incentrandoli sia sulla persona che sull’ambiente di lavoro.Background: Among health care workers (HCWs), assessment and prevention of work-related stress in the workplace is one of the main goal. Post-graduate medical residents (MRs) are a group of HCWs comparable to medical doctors in terms of occupational exposure and of work-related stress syndromes occurrence. Objectives: To assess the risk of the exposition to work-related stress among MRs attending the major University Hospital of Sicily. Methods: Cross-sectional survey through an anonymous and self-administered questionnaire. Results: 45% of clinical MRs and 37% of surgical MRs have access to compensatory rest days against 92% of MRs of the services area (p <0.001). A work attendance detection system for MRs is available in 80% of the postgraduate medical schools of the services area, in 60% of the clinical postgraduate schools and in 50% of the surgical postgraduate schools (p <0.001). MRs of postgraduate surgical schools declare to have access to work breaks (41%) with less frequency compared to clinical (60%) and services MRs (74%) (p <0.001). Both clinical (47%) and surgical MRs (47%) result to be more exposed to work-related stress than MRs of the services area (27%) (p <0.001). Conclusions: The survey documents an exposure excess of work-related stress for all the considered variables in MRs of surgical area. It is strongly suggested to provide for specific training programs aimed to manage the MRs risk exposure to work-related stress, focusing both on the workers and the work environment

Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study

Background: Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19. Objective: We set-up a multicenter Italian collaboration to investigate the relationship between HCQ therapy and COVID-19 in-hospital mortality. Methods: In a retrospective observational study, 3,451 unselected patients hospitalized in 33 clinical centers in Italy, from February 19, 2020 to May 23, 2020, with laboratory-confirmed SARS-CoV-2 infection, were analyzed. The primary end-point in a time-to event analysis was in-hospital death, comparing patients who received HCQ with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores, with the addition of subgroup analyses. Results: Out of 3,451 COVID-19 patients, 76.3% received HCQ. Death rates (per 1,000 person-days) for patients receiving or not HCQ were 8.9 and 15.7, respectively. After adjustment for propensity scores, we found 30% lower risk of death in patients receiving HCQ (HR=0.70; 95%CI: 0.59 to 0.84; E-value=1.67). Secondary analyses yielded similar results. The inverse association of HCQ with inpatient mortality was particularly evident in patients having elevated C-reactive protein at entry. Conclusions: HCQ use was associated with a 30% lower risk of death in COVID-19 hospitalized patients. Within the limits of an observational study and awaiting results from randomized controlled trials, these data do not discourage the use of HCQ in inpatients with COVID-19

Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients

Is physician assessment of alcohol consumption useful in predicting risk of severe liver disease among people with HIV and HIV/HCV co-infection?

Background: Alcohol consumption is a known risk factor for liver disease in HIV-infected populations. Therefore, knowledge of alcohol consumption behaviour and risk of disease progression associated with hazardous drinking are important in the overall management of HIV disease. We aimed at assessing the usefulness of routine data collected on alcohol consumption in predicting risk of severe liver disease (SLD) among people living with HIV (PLWHIV) with or without hepatitis C infection seen for routine clinical care in Italy. Methods: We included PLWHIV from two observational cohorts in Italy (ICONA and HepaICONA). Alcohol consumption was assessed by physician interview and categorized according to the National Institute for Food and Nutrition Italian guidelines into four categories: abstainer; moderate; hazardous and unknown. SLD was defined as presence of FIB4 &gt; 3.25 or a clinical diagnosis of liver disease or liver-related death. Cox regression analysis was used to evaluate the association between level of alcohol consumption at baseline and risk of SLD. Results: Among 9542 included PLWHIV the distribution of alcohol consumption categories was: abstainers 3422 (36%), moderate drinkers 2279 (23%), hazardous drinkers 637 (7%) and unknown 3204 (34%). Compared to moderate drinkers, hazardous drinking was associated with higher risk of SLD (adjusted hazard ratio, aHR = 1.45; 95% CI: 1.03-2.03). After additionally controlling for mode of HIV transmission, HCV infection and smoking, the association was attenuated (aHR = 1.32; 95% CI: 0.94-1.85). There was no evidence that the association was stronger when restricting to the HIV/HCV co-infected population. Conclusions: Using a brief physician interview, we found evidence for an association between hazardous alcohol consumption and subsequent risk of SLD among PLWHIV, but this was not independent of HIV mode of transmission, HCV-infection and smoking. More efforts should be made to improve quality and validity of data on alcohol consumption in cohorts of HIV/HCV-infected individuals

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services