Long-term spasticity management in post-stroke patients: issues and possible actions—A Systematic Review with an Italian expert opinion

Spasticity is a well-known motor dysfunction occurring after a stroke. A group of Italian physicians' experts in treating post-stroke spasticity (PSS) reviewed the current scientific evidence concerning the state-of-the-art clinical management of PSS management and the appropriate use of botulinum toxin, aiming to identify issues, possible actions, and effective management of the patient affected by spasticity. The participants were clinicians specifically selected to cover the range of multidisciplinary clinical and research expertise needed to diagnose and manage PSS. When evidence was not available, the panel discussed and agreed on the best way to manage and treat PSS. To address the barriers identified, the panel provides a series of consensus recommendations. This systematic review provides a focused guide in the evaluation and management of patients with PSS and its complications. The recommendations reached by this panel of experts should be used by less-experienced doctors in real life and should be used as a guide on how to best use botulinum toxin injection in treating spasticity after a stroke

Modulation of miR-146b Expression during Aging and the Impact of Physical Activity on Its Expression and Chondrogenic Progenitors

The finding of molecules associated with aging is important for the prevention of chronic degenerative diseases and for longevity strategies. MicroRNAs (miRNAs) are post-transcriptional regulators involved in many biological processes and miR-146b-5p has been shown to be involved in different degenerative diseases. However, miR-146b-5p modulation has not been evaluated in mesenchymal stem cells (MSCs) commitment or during aging. Therefore, the modulation of miR-146b-5p in the commitment and differentiation of mesenchymal cells as well as during maturation and aging in zebrafish model were analyzed. In addition, circulating miR-146b-5p was evaluated in human subjects at different age ranges. Thus, the role of physical activity in the modulation of miR-146b-5p was also investigated. To achieve these aims, RT (real-time)-PCR, Western blot, cell transfections, and three-dimensional (3D) culture techniques were applied. Our findings show that miR-146b-5p expression drives MSCs to adipogenic differentiation and increases during zebrafish maturation and aging. In addition, miR-146b-5p expression is higher in females compared to males and it is associated with the aging in humans. Interestingly, we also observed that the physical activity of walking downregulates circulating miR-146b-5p levels in human females and increases the number of chondroprogenitors. In conclusion, miR-146b-5p can be considered an age-related marker and can represent a useful marker for identifying strategies, such as physical activity, aimed at counteracting the degenerative processes of aging

Management of Microbiological Contamination of the Water Network of a Newly Built Hospital Pavilion

The good installation, as well as commissioning plan, of a water network is a crucial step in reducing the risk of waterborne diseases. The aim of this study was to monitor the microbiological quality of water from a newly built pavilion before it commenced operation. Overall, 91 water samples were tested for coliforms, Escherichia coli, enterococci, Pseudomonas aeruginosa and Legionella at three different times: T0 (without any water treatment), T1 (after treatment with hydrogen peroxide and silver ions at initial concentration of 20 mg/L and after flushing of water for 20 min/day for seven successive days) and T2 (15 days later). Coliforms were detected in 47.3% of samples at T0, 36.3% at T1 and 4.4% at T2. E. coli was isolated in 4.4% of the samples only at T1, while enterococci appeared in 12.1% of the samples at T1 and in 2.2% at T2. P. aeruginosa was isolated in 50.5% of the samples at T0, 29.7% at T1 and 1.1% at T2. Legionella pneumophila serogroup 8 was isolated in 80.2% of the samples at T0, 36.3% at T1 and 2.2% at T2. Our results confirmed the need for a water safety plan in new hospital pavilions to prevent the risk of waterborne diseases

Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic

The COVID-19 pandemic started in China in early December 2019, and quickly spread around the world. The epidemic gradually started in Italy at the end of February 2020, and by May 31, 2020, 232,664 cases and 33,340 deaths were confirmed. As a result of this pandemic, the Italian Ministerial Decree issued on March 11, 2020, enforced lockdown; therefore, many social, recreational, and cultural centers remained closed for months. In Apulia (southern Italy), all non-urgent hospital activities were suspended, and some wards were closed, with a consequent reduction in the use of the water network and the formation of stagnant water. This situation could enhance the risk of exposure of people to waterborne diseases, including legionellosis. The purpose of this study was to monitor the microbiological quality of the water network (coliforms, E. coli, Enterococci, P. aeruginosa, and Legionella) in three wards (A, B and C) of a large COVID-19 regional hospital, closed for three months due to the COVID-19 emergency. Our study revealed that all three wards' water network showed higher contamination by Legionella pneumophila sg 1 and sg 6 at T1 (after lockdown) compared to the period before the lockdown (T0). In particular, ward A at T1 showed a median value = 5600 CFU/L (range 0-91,000 CFU/L) vs T0, median value = 75 CFU/L (range 0-5000 CFU/L) (p-value = 0.014); ward B at T1 showed a median value = 200 CFU/L (range 0-4200 CFU/L) vs T0, median value = 0 CFU/L (range 0-300 CFU/L) (p-value = 0.016) and ward C at T1 showed a median value = 175 CFU/L (range 0-22,000 CFU/L) vs T0, median value = 0 CFU/L (range 0-340 CFU/L) (p-value < 0.001). In addition, a statistically significant difference was detected in ward B between the number of positive water samples at T0 vs T1 for L. pneumophila sg 1 and sg 6 (24% vs 80% p-value < 0.001) and for coliforms (0% vs 64% p-value < 0.001). Moreover, a median value of coliform load resulted 3 CFU/100 ml (range 0-14 CFU/100 ml) at T1, showing a statistically significant increase versus T0 (0 CFU/100 ml) (p-value < 0.001). Our results highlight the need to implement a water safety plan that includes staff training and a more rigorous environmental microbiological surveillance in all hospitals before occupying a closed ward for a longer than one week, according to national and international guidelines

Two years of on-site influenza vaccination strategy in an Italian university hospital: main results and lessons learned

Although the vaccination of healthcare workers (HCWs) is considered essential for preventing influenza circulation in the hospital setting, vaccination coverage (VC) in this group remains low. Among the reasons cited by HCWs is a lack of time to attend the vaccination clinic. For the 2018/2019 influenza season, active (on-site) influenza vaccination was offered directly in 44 operative units (OUs) of the Bari Policlinico hospital (50 OUs, 3,397 HCWs). At the same time, the hospital granted the HCW access to the vaccination clinic during October and December 2018. VC achieved among HCWs of Bari Policlinico during the 2018/2019 influenza season was then analyzed, and the results compared with those of the 2017/18 season. During the 2018/19 season, VC was 20.4% (n = 798) and thus higher than the 14.2% of the 2017/18 season (+6.2%). The highest VC was among physicians (33.4%), followed by other HCWs (23.8%), auxiliary staff (8.6%), and nurses (7.2%). Overall, 284 (36.5%) HCWs were vaccinated at on-site sessions. Multivariate analysis showed that vaccination uptake was associated with male gender and with work in OU where vaccination was actively offered. On the other hand, being a nurse or auxiliary staff member and working in the surgical area were deterrents. Although VC remained unsatisfactory, active on-site vaccination proved to be an important strategy to improve vaccination compliance, increasing 44% compared to the previous season. Nonetheless, mandatory vaccination directed by public health institutions may be the only way to reach a minimum level of coverage

Comparison of outcomes of multiple platforms for assisted robotic-prostatectomy: rationale and design

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Public Health, Health Management e Ricerca. Un progetto sperimentale dell'Accademia Lombarda di Sanità Pubblica per la formazione di giovani leaders.

Background. L’Accademia Lombarda di Sanità Pubblica (ALSP), Associazione no-profit fondata nel 2017, ha come obiettivo quello di promuovere il progresso in Sanità Pubblica (SP) attraverso il coinvolgimento di studiosi impegnati a vario titolo nei molteplici ambiti della SP come quello dell'igiene, dell'epidemiologia, della prevenzione, dell'ambiente, della direzione sanitarie, dell'edilizia sanitaria, del management, del diritto e dell'economia sanitaria. A tale scopo l’Accademia ha promosso, per il corrente anno 2019, l’iniziativa Academy of Young Leader in Public Health (AYLPH). È un percorso didattico-scientifico, teorico-pratico, di un anno rivolto a giovani con background formativo differente, fortemente motivati a sviluppare competenze di leadership in Public Health e già avviati a carriere professionali e di ricerca. Metodi. Il metodo didattico formativo si è basato su: incontri con riconosciuti leader nazionali e internazionali di Public Health, collaborazione a progetti di ricerca, elaborazione di programmi sperimentali su Indicatori di Qualità in Sanità e sul Piano Nazionale Esiti (PNE), scrittura di lavori scientifici in materia di Health Management e di Igiene e Sanità Pubblica. I membri AYLPH, suddivisi in cinque sottogruppi, hanno elaborato 5 revisioni sistematiche aventi oggetto “Volumi ed esiti”, “Inceneritori e Salute”, “Attività fisica e Depressione”, “Vaccinologia”, “Data mining per Risk Management”. Risultati. Una pubblicazione di rilievo internazionale, 5 revisioni sistematiche, una cerimonia conclusiva e un Team di giovani promettenti. Alla luce di questa brillante esperienza, l’Accademia Lombarda di Sanità Pubblica promuove per il prossimo 2020 percorsi formativi di giovani leaders in Sanità Pubblica con la realizzazione di campagne di comunicazione in Sanità, progetti integrati di edilizia sanitaria applicata alla riorganizzazione dell’Ospedale per Intensità di Cure, progetti “Lean” e di miglioramento della performance clinica e organizzativa, programmi di riduzione del rischio con applicazione degli standard Joint Commission International. Discussione. Nel contesto attuale di carenza di medici specialisti nelle strutture SSN, incluse le private accreditate, è fondamentale la formazione del giovane medico in formazione specialistica che, già nel corso dell’ultimo anno di specializzazione, ai sensi del comma 547 della legge n.145/2018, cosi come modificato dalla Legge n. 60/2019, è ammesso a partecipare ai concorsi pubblici per Dirigente Medico della disciplina inerente il Corso di Specializzazione e dunque ad entrare precocemente nel difficile e sempre più esigente mondo del lavoro. L’ALSP vuole formare giovani leaders in Sanità Pubblica offrendo loro competenze multidisciplinari, all’avanguardia in relazione allo sviluppo tecnologico, igienico-sanitarie, strategiche e gestionali necessarie per implementare nuovi modelli organizzativi. Mission. L’ALSP ha necessità di promuovere valori e guidare i giovani leaders al cambiamento individuale, organizzativo e politico. La AYLPH rappresenta un’occasione formativa di alto livello per giovani professionisti interessati a conoscere e attuare strategie di leadership in Sanità Pubblica