Patient safety subcultures among nursing home staff in Italy: a cross-sectional study

Nursing home (NH) residents are vulnerable subjects and highly susceptible to adverse events. Knowledge of patient safety culture (PSC) is essential for an organization to ensure patient safety. However, research on PSC in NHs, and its variability among staff, is still scarce. This study aimed to explore whether and how PSC differed among NH staff (Managers, Nurses, Direct Care Staff, Support Staff, Administrative Staff and Other Providers) in the Autonomous Province of Trento, Italy. This study employed a cross-sectional design and collected data from 1145 NH providers using the Nursing Home Survey on Patient Safety Culture (NHSPSC). Data were analyzed using linear mixed models, with each of the 12 NHSPSC domains as a response variable. The majority of the respondents (61.6%) were Direct Care Staff members. ‘Feedback and Communication about Incidents’ and ‘Overall Perceptions of Resident Safety’ were the domains with the highest proportions of positive answers (PPAs). For most staff categories, ‘Staffing’ was the domain with the lowest PPA. Support Staff showed significantly lower scores in the majority of domains (8/12). Shorter job tenure, fewer weekly working hours, working mostly during the day and working in highly specialized areas were associated with higher scores in several domains. Interventions to improve PSC must consider the differences between professional groups. Further research is needed to explore the relationship between job-related features and perceptions of patient safety among NH workers

Postural control in childhood: investigating the neurodevelopmental gradient hypothesis

Neurodevelopmental disorders (NDDs) have been suggested to lie on a gradient continuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This case-control study aimed to assess postural stability against such hypothesis in 104 children/adolescents aged 5-17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurodevelopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis

Latitude variation in the prevalence of asthma and allergic rhinitis in Italy: results from the GEIRD study

BACKGROUND: Earlier studies have pointed out a great variability in the prevalence of asthma and asthma-like symptoms in different geo-climatic areas. AIM: To test the association between latitude and prevalence of asthma and allergic rhinitis in Italian young adults. METHODS: In the frame of Gene-Environment Interaction in Respiratory Diseases study, a postal screening questionnaire on respiratory health and exposure to environmental factors was administered to 18,357 randomly selected subjects aged 20-44 years in 7 centres: 3 in Northern (Torino, Pavia, Verona), 2 in Central (Ancona, Perugia) and 2 in Southern Italy (Salerno, Sassari). RESULTS: 10,494 (57.2%) subjects responded to the questionnaire. The prevalence of self-reported doctor-diagnosed asthma and allergic rhinitis in the lifespan was 10.2% and 26.9%, respectively, and was significantly different across the centres (p<0.05). After adjusting for sex, age, potential risk factors for respiratory diseases and design confounders, the prevalence of asthma (OR: 1.07 per 1°latitude decrease, p<0.001), asthma-like symptoms (wheezing, chest tightness, asthma attacks: OR ranging from 1.04 to 1.06, p<0.05) and allergic rhinitis (OR: 1.03, p=0.04) showed a significant north-to-south trend. Similarly, a 1°C increment in temperature was significantly associated with asthma (OR: 1.10, p<0.001) and asthma-like symptoms (OR from 1.07 to 1.10, p<0.05), but not with allergic rhinitis (OR=1.02, p=0.190). CONCLUSION: The prevalence of asthma and allergic rhinitis increased moving southwards in Italy, suggesting that prolonged exposure to different geo-climatic conditions may affect the onset of asthma and allergic respiratory diseases

Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010

The prevalence of asthma increased worldwide until the 1990s, but since then there has been no clear temporal pattern. The present study aimed to assess time trends in the prevalence of current asthma, asthma-like symptoms and allergic rhinitis in Italian adults from 1990 to 2010. The same screening questionnaire was administered by mail or phone to random samples of the general population (age 20–44 yrs) in Italy, in the frame of three multicentre studies: the European Community Respiratory Health Survey (ECRHS) (1991–1993; n56,031); the Italian Study on Asthma in Young Adults (ISAYA) (1998–2000; n518,873); and the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007–2010; n510,494). Time trends in prevalence were estimated using Poisson regression models in the centres that repeated the survey at different points in time. From 1991 to 2010, the median prevalence of current asthma, wheezing and allergic rhinitis increased from 4.1% to 6.6%, from 10.1% to 13.9% and from 16.8% to 25.8%, respectively. The prevalence of current asthma was stable during the 1990s and increased (relative risk 1.38, 95% CI 1.19–1.59) from 1998–2000 to 2007–2010, mainly in subjects who did not report allergic rhinitis. The prevalence of allergic rhinitis has increased continuously since 1991. The asthma epidemic is not over in Italy. During the past 20 yrs, asthma prevalence has increased by 38%, in parallel with a similar increase in asthma-like symptoms and allergic rhiniti

Stability and expression levels of HLA-C on the cell membrane modulate HIV-1 infectivity

HLA-C expression is associated with a differential ability to control HIV-1 infection. Higher HLA-C levels may lead to a better control of HIV-1 infection through both a higher efficiency of antigen presentation to cytotoxic T lymphocytes (CTLs), as well as the triggering of activating Killer Immunoglobulin like receptors (KIR) on NK-cells, whereas lower levels may provide a poor HIV-1 control and a rapid progression toward AIDS.We characterized the relative amount of HLA-C heterotrimers (heavy chain/\u3b22m/peptide) and HLA-C free heavy chains on PBMC from healthy blood donors harboring both alleles with stable or unstable binding to \u3b22m/peptide. We analyzed the stability of HLA-C heterotrimers of different allotypes and the infectivity of HIV-1 virions produced by PBMC with various allotypes.We observed significant differences in HLA-C heterotrimers stability and in expression levels. We found that R5 HIV-1 virions produced by PBMC harboring unstable HLA-C alleles were more infectious than those produced by PBMC carrying the stable variants.We propose that HIV-1 infectivity might depend both on the amounts of HLA-C molecules and on their stability as trimeric complex. According to this model, individuals with low expressed HLA-C alleles and unstable binding to \u3b22m/peptide might have a worse control of HIV-1 infection and an intrinsically higher capacity to support viral replication.IMPORTANCE Following HIV-1 infection, some people advance rapidly toward AIDS while others have a slow disease progression. HLA-C, a molecule involved in immunity, is a key determinant of HIV-1 control.Here we reveal how HLA-C variants contribute to modulate viral infectivity. HLA-C is present on the cell surface in two different conformations: the immunologically active conformation is part of a complex that includes \u3b22-microglobulin/peptide; the other conformation is not bound to \u3b22-microglobulin/peptide and can associate with HIV-1, increasing its infectivity. Individuals with HLA-C variants with a predominance of immunologically active conformations would display a stronger immunity against HIV-1, a reduced viral infectivity and an effective control of HIV-1 infection, while subjects with HLA-C variants that easily dissociate from \u3b22-microglobulin/peptide would have a reduced immunological response to HIV-1 and produce more infectious virions.This study provides new information that could be useful to design novel vaccine strategies and therapeutic approaches against HIV-1

Evolution of Asthma Severity in a Cohort of Young Adults: Is There Any Gender Difference?

INTRODUCTION:Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics METHODS:Subjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998-2002, as part of the European Community Respiratory Health Survey (ECRHS). All participants to follow-up with current asthma at baseline were eligible for the analysis. To assess change over the follow-up, asthma severity at the two surveys was defined using standardized data on respiratory symptoms, lung function and medication according to the Global Initiative for Asthma (GINA) Guidelines. Another quantitative score (Ronchetti) further considering hospitalizations was also analysed. RESULTS:The study included 685 subjects with asthma followed-up over a mean period of 8.65 yr (min 4.3-max 11.7). At baseline, asthma severity according to GINA was distributed as intermittent: 40.7%, 31.7% as mild persistent, 14% as moderate persistent, and 13.5% as severe persistent. Using the Ronchetti score derived classification, the distribution of asthma severity was 58% mild, (intermittent and mild persistent), 25.8% moderate, and 15.4% severe. Whatever the classification, there was no significant difference in the severity distribution between men and women. There was also no gender difference in the severity distribution among incident cases which developed asthma between the two surveys. Men with moderate-to-severe asthma at baseline were more likely than women to have moderate-to-severe asthma at follow-up. Using GINA, 69.2% of men vs. 53.1% of women (p = 0.09) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. Using Ronchetti score, 53.3% of men vs. 36.2% of women (p = 0.03) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. CONCLUSIONS:There was no gender difference in asthma severity at the two surveys. However, our findings suggest that asthma severity might be less stable in women than in men

Mettiamo caso che... (i manicomi fossero rimasti).

La riforma italiana del 1978 ha trasformato radicalmente il sistema assistenziale psichiatrico bloccando i ricoveri nei manicomi e sviluppando servizi alternativi nella comunità e negli ospedali. L’articolo ipotizza alternative possibili nell’andamento e nell’uso del sistema psichiatrico pubblico qualora la riforma non avesse avuto luogo. Vengono inoltre effettuate delle comparazioni con altri paesi europei, per individuare somiglianze e differenze nei profili di cambiamento dei rispettivi sistemi psichiatrici. Infine, si utilizzano i dati correnti sul numero di pazienti al loro primo ricovero nei servizi psichiatrici italiani odierni, per stimare la numerosità della popolazione che avrebbe altrimenti sperimentato l’istituzionalizzazione in manicomio nei trenta e più anni trascorsi dalla riforma.The 1978 Italian psychiatric reform law brought about fundamental changes in the system of care by blocking admissions to mental hospitals and developing alternative community and general-hospital services. The paper discusses the possibly different course and use of the public psychiatric system had the reform not been implemented. Comparisons with other European countries are also presented to identify similarities and differences in the patterns of change of their psychiatric systems. Finally, available data on current first-ever psychiatric admissions in Italy are used to estimate the number of people who would have experienced institutionalization in an asylum in the 30+ years since the reform