Ethnic background and risk perception in construction workers: development and validation of an exploratory tool

Among occupational sectors, construction is still one of the branches with the highest reported numbers of work-related injuries and diseases, which can even lead to death and in many cases induce permanent health consequences. The vast majority of these occupational injuries and diseases are preventable; accordingly, an improvement in preventive strategies, also through a better knowledge of the main factors involved in these events, is one of the most important objectives for better occupational health and safety in the construction sector. Considering the individual factors associated with a higher risk of work-related adverse health effects in workers, an inadequate perception of occupational risks is among the most relevant issues. Risk perception can vary according to different cultural backgrounds, highly influenced by ethnicity, and it affects the relations between workers in the work environment, and the way by with they undergo the specific occupational tasks and manage risky situations frequently occurring on construction sites. Accordingly, the aim of the authors was to develop a new tool for the assessment of risk perception in construction workers with different ethnic backgrounds

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

The Individual Care Plan (ICP): proposal of a model to improve the communication between hospital and primary health care services

Background. Patients admitted to Internal Medicine wards are frequently defined complex patients for their severe symptoms, comorbidity, disabilities and socioeconomic critical conditions. Once the clinical stability is achieved, they may be discharged from hospital and to ensure continuity of care they require personalized arrangements providing medical, nursing and social supports in primary health care services. The aim of this study is to propose a model of Individual Care Plan (ICP) for complex patients. Methods. The model was developed starting from the assessment of multidimensional needs according to the International Classification of Functioning, Disability and Health (ICF) of World Health Organization (WHO), and defining for each detected need the goals, the related interventions, the professionals involved and the devices prescribed for personal use. Results. This paper presents the model in a practical manner, indicating the ICP of a complex patient. The ICP, divided into three sections (clinical, care and environmental) describes all the aspects of cure and care to be delivered in the primary health care services. Conclusions. The ICP that we proposed is a dynamic tool aimed to ensure the continuity of care and cure after hospital discharge, to facilitate the communication between hospital and primary health services and in the different settings of care in which the patient transits, to monitor the evolution of multidimensional needs over the time. Finally the ICP is useful in evaluating the costs, results and outcome of care and cure of a patient

Establishment of a Public Mental Health Database for Research Purposes in the Ferrara Province: Development and Preliminary Evaluation Study

Abstract BackgroundThe immediate use of data exported from electronic health records (EHRs) for research is often limited by the necessity to transform data elements into an actual data set. ObjectiveThis paper describes the methodology for establishing a data set that originated from an EHR registry that included clinical, health service, and sociodemographic information. MethodsThe Extract, Transform, Load process was applied to raw data collected at the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, from 1925 to February 18, 2021, to build the new, anonymized Ferrara-Psychiatry (FEPSY) database. Information collected before the first EHR was implemented (ie, in 1991) was excluded. An unsupervised cluster analysis was performed to identify patient subgroups to support the proof of concept. ResultsThe FEPSY database included 3,861,432 records on 46,222 patients. Since 1991, each year, a median of 1404 (IQR 1117.5-1757.7) patients had newly accessed care, and a median of 7300 (IQR 6109.5-9397.5) patients were actively receiving care. Among 38,022 patients with a mental disorder, 2 clusters were identified; the first predominantly included male patients who were aged 25 to 34 years at first presentation and were living with their parents, and the second predominantly included female patients who were aged 35 to 44 years and were living with their own families. ConclusionsThe process for building the FEPSY database proved to be robust and replicable with similar health care data, even when they were not originally conceived for research purposes. The FEPSY database will enable future in-depth analyses regarding the epidemiology and social determinants of mental disorders, access to mental health care, and resource utilization

Sex differences in schizophrenia-spectrum diagnoses: results from a 30-year health record registry

This study investigated sociodemographic and clinical differences between the sexes in individuals affected by schizophrenia- spectrum disorders (SSD) who accessed outpatient mental health services. Within a retrospective cohort of 45,361 outpatients receiving care in Ferrara (Italy) from 1991 to 2021, those with a SSD diagnosis were compared between the sexes for sociodemographic and clinical characteristics before and after the index date (when the ICD-9: 295.*diagnosis was first recorded) to assess early trajectory, age and type of diagnosis, and severity of illness indicated by medication use, hospitalization, and duration of psychiatric care. Predictors of discharge were also investigated. Among 2439 patients, 1191 were women (48.8%). Compared to men, women were significantly older at first visit (43.7 vs. 36.8 years) and at index date (47.8 vs. 40.6) with peak frequency at age 48 (vs. 30). The most frequent last diagnosis recorded before the index date was delusional disorder (27.7%) or personality disorder (24.3%) in men and depression (24%) and delusional disorder (30.1%) in women. After the index date, long-acting antipsychotics and clozapine were more frequently prescribed to men (46.5% vs. 36.3%; 13.2% vs. 9.4%, p < 0.05) and mood stabilizers and antidepressants to women (24.3% vs. 21.1%; 50.1% vs. 35.5%; p < 0.05). Women had fewer involuntary admissions (10.1% vs. 13.6%) and were more likely to be discharged as the time under care increased (p = 0.009). After adjusting for covariates, sex was not a significant predictor of discharge. Our study confirmed that sex differences exist in clinical and sociodemographic characteristics of outpatients with SSD and that gender considerations might influence the rapidity of diagnosis and medications prescribed. These findings highlight the need to implement a women-tailored approach in specialist care programs for psychoses

Surgery for prosthetic valve endocarditis a retrospective study of a national registry

OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design. METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study. RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P  = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P  -2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P  = 0.03), renal insufficiency (OR = 2.1; P  = 0.05), triple valve surgery (OR = 6.9; P  = 0.004) and shock (OR = 4.5; P  < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P  < 0.001), Enterococcus (OR = 2.3; P  = 0.01) and female sex (OR = 1.5; P  = 0.03) independently predicted complications, whereas ejection fraction was protective. CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors

Surgery for prosthetic valve endocarditis: a retrospective study of a national registry\u2020

We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design