Anisakiasis in italy: analysis of hospital discharge records in the years 2005-2015

Background Anisakiasis is a fish-borne zoonosis caused by the ingestion of marine food infected with Anisakis third-stage larvae, widespread marine parasitic nematodes. Gastrointestinal and/ or allergic clinical signs and symptoms are not specific. While frequently reported in countries with large raw fish consumption as Japan, the global prevalence of anisakiasis may be severely underestimated due to limitations of available diagnostic tools and to diverse clinical manifestations. Recently, infective larvae were found in the same localization with gastrointestinal tumors. The occurrence of allergic exacerbation upon secondary exposure and the possible occupational exposure, highlight the need to increase scientific evidences on anisakiasis. Methods We performed a retrospective descriptive study using analysis of Hospital Discharge Records (HDRs) from 2005 to 2015 in Italy, with particular attention to allergic manifestations. Descriptive statistics and multivariate analyses were performed using backward step-wise logistic regression models to assess spatial distribution and temporal trend as well as the variables independently associated with the allergic clinical signs and symptoms in Italian cases of anisakiasis. Results HDRs reporting the ICD-9 code for anisakiasis were retrieved (370), with a higher number of cases reported from central and southern regions, with particular regard to populations inhabiting the coastal territories. Around 40% of patients presented allergic manifestations and half of them showed serious allergic reactions. The multivariate analyses showed an independent association between allergic manifestations and features as living in southern regions and female gender, while anaphylactic episodes was independently associated only with female gender. Conclusion The present study is the first attempt to a better understanding of the epidemiological picture of anisakiasis in Italy, mining official data. A common strategy on data collection, monitoring and reporting would favor a more accurate epidemiological scenario in Italy, since the report of the diseases is not mandatory

Utilization of big data to improve management of the emergency departments. Results of a systematic review

Background. The emphasis on using big data is growing exponentially in several sectors including biomedicine, life sciences and scientific research, mainly due to advances in information technologies and data analysis techniques. Actually, medical sciences can rely on a large amount of biomedical information and Big Data can aggregate information around multiple scales, from the DNA to the ecosystems. Given these premises, we wondered if big data could be useful to analyze complex systems such as the Emergency Departments (EDs) to improve their management and eventually patient outcomes. Methods. We performed a systematic review of the literature to identify the studies that implemented the application of big data in EDs and to describe what have already been done and what are the expectations, issues and challenges in this field. Results. Globally, eight studies met our inclusion criteria concerning three main activities: the management of ED visits, the ED process and activities and, finally, the prediction of the outcome of ED patients. Although the results of the studies show good perspectives regarding the use of big data in the management of emergency departments, there are still some issues that make their use still difficult. Most of the predictive models and algorithms have been applied only in retrospective studies, not considering the challenge and the costs of a real-time use of big data. Only few studies highlight the possible usefulness of the large volume of clinical data stored into electronic health records to generate evidence in real time. Conclusion. The proper use of big data in this field still requires a better management information flow to allow real-time application

Familial hypercholesterolemia: a systematic review of guidelines on genetic testing and patient management

BACKGROUND: Familial hypercholesterolemia (FH) is an autosomal-dominant hereditary disorder of lipid metabolism that causes lifelong exposure to increased LDL levels resulting in premature coronary heart disease and, if untreated, death. Recent studies have shown its prevalence to be higher than previously considered, which has important implications for the mortality and morbidity of associated cardiovascular disease (CVD). Several clinical tools are used worldwide to help physicians diagnose FH, but nevertheless most patients remain undetected. This systematic review of guidelines aims to assess the role of genetic testing in the screening, diagnosis, and management of patients affected by heterozygous or homozygous FH and to identify related health-care pathways. METHODS: We performed a systematic review of the literature; inclusion criteria were English or Italian guidelines focusing on genetic testing. The guidelines were included and evaluated for their content and development process using the Appraisal of Guidelines for Research and Evaluation II instrument. RESULTS: Ten guidelines were considered eligible, and all were judged to be of good quality, with slight differences among them. The most common indications for performing genetic tests were high levels of cholesterol, or physical findings consistent with lipid disorder, in the subject or in the family history. Subsequent screening of family members was indicated when a mutation had been identified in the index patient. Regarding patient management, the various guidelines agreed that intensive treatment with lipid-lowering medications should begin as quickly as possible and that lifestyle modifications should be an integral part of the therapy. CONCLUSION: Since the early detection of affected patients is beneficial for effective prevention of CVD, genetic testing is particularly useful for identifying family members via cascade screening and for distinguishing between heterozygous and homozygous individuals, the latter of which require more extreme therapeutic intervention

Policy and planning of prevention in Italy: results from an appraisal of prevention plans developed by Regions for the period 2010-2012

Health policies on disease prevention differ widely between countries. Studies suggest that different countries have much to learn from each other and that significant health gains could be achieved if all countries followed best practice. This paper describes the policy development and planning process relating to prevention activities in Italy, through a critical appraisal of Regional Prevention Plans (RPPs) drafted for the period 2010-2012. The analysis was performed using a specific evaluation tool developed by a Scientific Committee appointed by the Italian Ministry of Health. We appraised nineteen RPPs, comprising a total of 702 projects, most of them in the areas of universal prevention (62.9%) and prevention in high risk groups (27.0%). Italian Regions established prevention activities using an innovative combination of population and high-risk individuals approaches. However, some issues, such as the need to reduce health inequalities, were poorly addressed. The technical drafting of RPPs required some improvement; e.g. the evidence of the effectiveness and cost-effectiveness of the health interventions proposed was seldom reported. There were significant geographical differences across the Regions in the appraisal of RPPs. Our research suggests that continuous assessment of the planning process of prevention may become a very useful tool for monitoring, and ultimately strengthening, public health capacity in the field of prevention. Further research is needed to analyze determinants of regional variation

On the development of a monitoring scheme of buffalo welfare at farm level

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Strumenti metodologici e nuove tecnologie per l’apprendimento in rete

Abstract: The article presented here focuses on innovative teaching equipment and how the latter, through technology, has revolutionized the approach to training. In particular, the themes of multisensoriality, multitasking, edutainment, paper and digital textbooks, multimedia interactive whiteboard (LIM) and online learning through the Moodle platform are explored, with the ultimate aim of branching out what positive contribution these tools have given to school and pedagogy with a view to (networked) learning. Multisensoriality and multitasking, in this sense, have now become fundamental elements in teaching instrumentation, since modern technologies allow students to be involved through the use of multiple senses simultaneously, as well as to create a more engaging learning environment in the perspective of collaborative teaching. This mode of learning has been defined edutainment, a union of education and fun, where the game becomes a tool to promote learning.All this, however, without distorting the importance of classic textbooks, which nowadays can be paper or digital. Digital textbooks, in particular, offer many benefits, such as the ability to customize content, instant access to online resources, and ease of updating. The interactive multimedia whiteboard (LIM) is also one of the latest technological innovations in educational equipment. Thanks to the LIM, teachers can create engaging lessons, incorporate with videos, images, sounds and interactive texts, representing a valid tool for online learning, since it also allows students to start to decay the lesson and to collaborate with other classmates, especially in an era in which distance learning has become a rather common and widespread topic. The article, however, also looks at the Moodle platform, an open source e-learning tool that allows teachers to create online courses and monitor student learning. Moodle allows, in other words, to create interactive activities, discussion forums and quizzes, making online learning more engaging and fun. In conclusion, this article wishes to underline the importance of choosing the teaching tools appropriate to the methodology used and to the needs of students (but also of teachers). Technology, in this sense, undoubtedly represents an opportunity to improve the learning experience of students, but it must be used strategically and consistently with the educational goal to be achieved. In pedagogy in general, technology must be a means to a specific end, namely learning, and not an end in itself. educational goal that you want to achieve. In pedagogy in general, technology must be a means to a specific end, namely learning, and not an end in itself. educational goal that you want to achieve. In pedagogy in general, technology must be a means to a specific end, namely learning, and not an end in itself.Keywords: Educational technologies. Pedagogical Educational Actions, Digital Natives.Riassunto: L'articolo qui presentato si concentra sulla strumentazione didattica innovativa e su come quest'ultima, attraverso la tecnologia, abbia rivoluzionato l'approccio alla formazione. In particolare, si esplorano le tematiche della multisensorialità, del multitasking, dell'edutainment, dei libri di testo cartacei e digitali, della lavagna interattiva multimediale (LIM) e dell'apprendimento in rete tramite la piattaforma Moodle, col fine ultimo di diramare quale apporto positivo questi strumenti hanno dato alla scuola e alla pedagogia nell'ottica dell'apprendimento (in rete). La multisensorialità e il multitasking, in questo senso, sono oramai diventati elementi fondamentali nella strumentazione didattica, poiché le moderne tecnologie permettono di coinvolgere gli studenti attraverso l'utilizzo di più sensi contemporaneamente, nonché di creare un ambiente di apprendimento più coinvolgente nella prospettiva della didattica collaborativa. Questa modalità di apprendimento è stata definita edutainment, unione di educazione e divertimento, dove il gioco diventa uno strumento per favorire l'apprendimento. Il tutto, però, senza snaturare l'importanza dei classici libri di testo, che al giorno d'oggi possono essere cartacei o digitali. I libri di testo digitali, in particolare, offrono molti vantaggi, come la possibilità di personalizzare il contenuto, l'accesso immediato alle risorseonline e la facilità di aggiornamento. La lavagna interattiva multimediale (LIM) rappresenta anch'essa una delle ultime innovazioni tecnologiche nella strumentazione didattica. Grazie alla LIM, gli insegnanti possono creare lezioni coinvolgenti, incorporare con video, immagini, suoni e testi interattivi, rappresentando un valido strumento per il learning online, poiché oltre tutto consente agli studenti di iniziare a decadere alla lezione e di collaborare con gli altri compagni di classe, soprattutto in un'epoca in cui la didattica a distanza è diventata un argomento piuttosto comune e diffuso. L'articolo, tuttavia, esamina anche la piattaforma Moodle, uno strumento di e-learning open source che consente agli insegnanti di creare corsi online e di monitorare l'apprendimento degli studenti. Moodle consente, in altri termini, di creare attività interattive, forum di discussione e quiz, rendendo l'apprendimento online più coinvolgente e divertente. In conclusione, il presente articolo desidera sottolineare l'importanza della scelta degli strumenti didattici adeguati alla metodologia utilizzata e alle esigenze degli studenti (ma anche degli insegnanti). La tecnologia, in questo senso, rappresenta senza dubbio un'opportunità per migliorare l'esperienza di apprendimento degli studenti, ma deve essere utilizzata in modo strategico e coerente con l'obiettivo educativo che si vuole raggiungere. In ambito pedagogico in generale, la tecnologia deve cioè essere un mezzo per raggiungere uno scopo preciso, ovvero l'apprendimento, e non un fine in sé stesso. obiettivo educativo che si vuole raggiungere. In ambito pedagogico in generale, la tecnologia deve cioè essere un mezzo per raggiungere uno scopo preciso, ovvero l'apprendimento, e non un fine in sé stesso. obiettivo educativo che si vuole raggiungere. In ambito pedagogico in generale, la tecnologia deve cioè essere un mezzo per raggiungere uno scopo preciso, ovvero l'apprendimento, e non un fine in sé stesso.Parole Chiave: Tecnologie didattiche. Azioni Didattiche Pedagogiche, Nativi digital

Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis

The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive

ER access by foreign citizens between 1999 and 2014 in five large hospital of Rome, Italy

...Lack of information about the health services and the status of illegal immigrant can make difficult for foreign population to access primary care, leading to misuse of emergency rooms (ER). This study investigated the accesses between January 1999 and December 2014 to the ERs of five large hospital of Rome, Italy

Knowledge, attitudes, behaviour and training needs of ICU nurses on medication errors in the use of IV drugs: a pilot study

Background. Prior studies have shown that lack of knowledge and training, incorrect behaviours and attitudes put Intensive care unit (ICU) patients at risk. The aim of this study was to assess knowledge, attitudes and professional behaviour of Italian nurses towards preparation and administration of intravenous medications in ICUs. Reliability and validity of the questionnaire were assessed as well. Methods. A survey was conducted on a sample of Italian nurses in 2015 through a self-administered questionnaire. Reliability was tested and content validity was evaluated using Cronbach’s alpha. Multiple logistic regression models were built to identify predictors of knowledge, attitudes and behaviours. Results. In total, 123 nurses completed the questionnaire. For the variable ‘adequate knowledge’ nurses were divided in those who had correctly answered 7 of 8 questions on knowledge and everyone else, while for ‘attitudes and professional behaviour’ responders were grouped into those who showed a positive attitude and appropriate behaviour and everyone else. Results of the multiple logistic regression analyses show some association, although not statistically significant, between correct behaviour, positive attitudes and the years of work experience. It is interesting to note that appropriate knowledge weighs negatively on correct behaviour (OR 0.06, 95% CI 0.04-0.42). Moreover, graduate nurses have more appropriate knowledge than those who are not. A high level of interest for specific training was reported by almost all responders. Cronbach’s alpha for all three sections together resulted in a value of 0.49. Conclusions.This pilot study demonstrated the need to amend the questionnaire, especially the knowledge and behaviour sections, in which the Cronbach’s alpha was less than 0.7. Targeted educational programs are needed to improve the expertise of nurses to reduce medication errors during preparation and administration of IV medications in the ICU