Knowledge of public health informatics among Italian medical residents: design and preliminary validation of a questionnaire

Background: public health requires strong information skills and competencies, as it is information-intensive and information-driven. Public health informatics has been defined as the “systematic application of information, computer science, and technology to public health practice, research, and learning”. New information and communication technologies offer unprecedented opportunities, such as linking smart-phones and mobiles devices to web based tools for data collection, enabling and enhancing participatory epidemiology. However, being an emerging discipline, despite its potential and importance, public health informatics is often neglected and overlooked, being rarely offered as course. The present study was designed as a pilot study, with the aim of designing and validating a questionnaire on the knowledge of public health informatics among medical residents in public health in Italy.  Methods and Results: thirty-two Italian residents in public health volunteered to take part into the study. Mean age of the sample was 31.44±2.23 years, most responders were males (68.8%), from northern Italy (53.1%), at the third year of residency (34.4%) and currently doing practical training at the clinical management staff/hospital directorate (34.4%). Other places of training were the Prevention Department (21.9%), the Institute of Hygiene (18.8%), the local health units and the territory (12.5%), the occupational health service (6.3%) and the Regional Health Agency (3.1%). Cronbach’s alpha coefficient yielded a value of 0.909, demonstrating excellent psychometric properties of the instrument.  Conclusion: in conclusion, the developed questionnaire seems to be an appropriate and useful tool to detect gaps concerning knowledge, education and practices of public health informatics among residents in public health.&nbsp

Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9– 2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Twelve Variants Polygenic Score for Low-Density Lipoprotein Cholesterol Distribution in a Large Cohort of Patients With Clinically Diagnosed Familial Hypercholesterolemia With or Without Causative Mutations

: Background A significant proportion of individuals clinically diagnosed with familial hypercholesterolemia (FH), but without any disease-causing mutation, are likely to have polygenic hypercholesterolemia. We evaluated the distribution of a polygenic risk score, consisting of 12 low-density lipoprotein cholesterol (LDL-C)-raising variants (polygenic LDL-C risk score), in subjects with a clinical diagnosis of FH. Methods and Results Within the Lipid Transport Disorders Italian Genetic Network (LIPIGEN) study, 875 patients who were FH-mutation positive (women, 54.75%; mean age, 42.47±15.00 years) and 644 patients who were FH-mutation negative (women, 54.21%; mean age, 49.73±13.54 years) were evaluated. Patients who were FH-mutation negative had lower mean levels of pretreatment LDL-C than patients who were FH-mutation positive (217.14±55.49 versus 270.52±68.59 mg/dL, P<0.0001). The mean value (±SD) of the polygenic LDL-C risk score was 1.00 (±0.18) in patients who were FH-mutation negative and 0.94 (±0.20) in patients who were FH-mutation positive (P<0.0001). In the receiver operating characteristic analysis, the area under the curve for recognizing subjects characterized by polygenic hypercholesterolemia was 0.59 (95% CI, 0.56-0.62), with sensitivity and specificity being 78% and 36%, respectively, at 0.905 as a cutoff value. Higher mean polygenic LDL-C risk score levels were observed among patients who were FH-mutation negative having pretreatment LDL-C levels in the range of 150 to 350 mg/dL (150-249 mg/dL: 1.01 versus 0.91, P<0.0001; 250-349 mg/dL: 1.02 versus 0.95, P=0.0001). A positive correlation between polygenic LDL-C risk score and pretreatment LDL-C levels was observed among patients with FH independently of the presence of causative mutations. Conclusions This analysis confirms the role of polymorphisms in modulating LDL-C levels, even in patients with genetically confirmed FH. More data are needed to support the use of the polygenic score in routine clinical practice

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Recensioni

Recensioni: Ajello, Epifanio. Recensione di “Orazio Longo. Instant shooting”, P. 707 ; Boffa, Marika. Recensione di “Valeria Giannantonio. Le autobiografie della Grande guerra: la scrittura del ricordo e della lontananza”, P. 709 ; Castagnino, Angelo. Recensione di “Attilio Scuderi. Il libertino in fuga. Machiavelli e la genealogia di un modello culturale.”, P. 718 ; Ceschin, Arianna. Recensione di “A tavola con le Muse. Immagini del cibo nella letteratura italiana della modernità, a cura di laria Crotti, Beniamino Mirisola”, P. 721 ; Cudazzo, Annalucia. Recensione a “Girolamo Comi. Poesie. Spirito d’armonia. Canto per Eva. Fra lacrime e preghiere, a cura di Antonio Lucio Giannone e Simone Giorgino”, P. 724 ; D’Ambrosio, Antonio. Recensione di “Silvia Cavalli. Progetto «menabò» (1959-1967)”, P. 728 ; D’Elia, Antonio. Recensione di “Michele Bianco. Lev Shomeà (I Re 3,9). «Un cuore ascoltante». Da Dante a Luzi. Epifania del divino, ierofania e amor di Patria”, P. 731 ; Favaro, Angelo. Recensione di “Epifanio Ajello. Carabbattole. Il racconto delle cose nella letteratura italiana”, P. 767 ; Fusco, Antonio. Recensione di “Paolo Rumiz. Il filo infinito”, P. 771 ; Onorii, Simona. Recensione di “Fabrizio Miliucci. Nella scatola nera. Giorgio Caproni critico e giornalista”, P. 773 ; Onorii, Simona. Recensione di “Luigi Pirandello. Umorismo, a cura di Giuseppe Langella e Davide Savio”, P. 775 ; Turra, Giovanni. Recensione di “Paolo Leoncini. Emilio Cecchi, L’etica del visivo e lo Stato liberale. Con appendice di testi giornalistici rari. L’etica e la sua funzione antropologica”, P. 778 ; Viola, Alessandro. Recensione di “Alberto Carli. L’occhio e la voce. Pier Paolo Pasolini e Italo Calvino fra letteratura e antropologia”, P. 781 ; Galvano, Rosalba. Recensione di “Carlo Bugnone. Piccoli crolli”, P. 784