Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students

Oxidative challenge in Alzheimer's disease: state of knowledge and future needs

A large body of experimental and postmortem findings indicate that Alzheimer's disease (AD) is associated with increased oxidative stress (OxS) levels in the brain. Despite the current limitations of OxS assessment in living subjects, recent data suggest that oxidative challenge might increase early both in the central nervous system and peripheral fluids. The aim of this review was to provide an overview of the existing literature linking systemic OxS to brain OxS in AD. We firmly believe that continued research aimed at overcoming the methodological and design issues affecting the body of studies in this field is mandatory for successful development of an effective antioxidant-based treatment of AD

Gene-gene interactions among coding genes of iron-homeostasis proteins and <i>APOE</i>-alleles in cognitive impairment diseases

<div><p>Cognitive impairments of different aetiology share alterations in iron and lipid homeostasis with mutual relationships. Since iron and cholesterol accumulation impact on neurodegenerative disease, the associated gene variants are appealing candidate targets for risk and disease progression assessment. In this light, we explored the role of common single nucleotide polymorphisms (SNPs) in the main iron homeostasis genes and in the main lipoprotein transporter gene (<i>APOE</i>) in a cohort of 765 patients with dementia of different origin: Alzheimer’s disease (AD) n = 276; vascular dementia (VaD), n = 255; mild cognitive impairment (MCI), n = 234; and in normal controls (n = 1086). In details, four genes of iron homeostasis (Hemochromatosis (<i>HFE</i>: C282Y, H63D), Ferroportin (<i>FPN1</i>: -8CG), Hepcidin (<i>HAMP</i>: -582AG), Transferrin (<i>TF</i>: P570S)), and the three major alleles of <i>APOE</i> (<i>APOE</i>2, <i>APOE</i>3, <i>APOE</i>4) were analyzed to explore causative interactions and synergies. In single analysis, <i>HFE</i> 282Y allele yielded a 3-fold risk reduction in the whole cohort of patients (<i>P</i><0.0001), confirmed in AD and VaD, reaching a 5-fold risk reduction in MCI (<i>P =</i> 0.0019). The other iron SNPs slightly associated with risk reduction whereas <i>APOE</i>4 allele resulted in increased risk, reaching more than 7-fold increased risk in AD homozygotes (<i>P</i> = 0.001), confirmed to a lower extent in VaD and MCI (<i>P =</i> 0.038 and <i>P =</i> 0.013 respectively) as well as in the whole group (<i>P</i><0.0001). Comparisons of Mini Mental State Examination (MMSE) among AD showed appreciable lowering in <i>APOE</i>4 carriers (<i>P =</i> 0.038), confirmed in the whole cohort of patients (<i>P =</i> 0.018). In interaction analysis, the <i>HFE</i> 282Y allele completely extinguished the <i>APOE</i>4 allele associated risk. Conversely, the coexistence in patients of a substantial number of iron SNPs accrued the <i>APOE</i>4 detrimental effect on MMSE. Overall, the analysis highlighted how a specific iron-allele burden, defined as different combinations of iron gene variants, might have different effects on cognitive impairment and might modulate the effects of established genetic risk factors such as <i>APOE</i>4. Our results suggest that established genetic risk factors might be affected by specific genetic backgrounds, making patients differently suited to manage iron accumulation adding new genetic insights in neurodegeneration. The recently recognized interconnections between iron and lipids, suggest that these pathways might share more than expected. We therefore extended to additional iron gene variants the newly proposed influencing mechanisms that <i>HFE</i> gene has on cholesterol metabolism. Our results have a strong translational potential promoting new pharmacogenetics studies on therapeutic target identification aimed at optimally tuning brain iron levels.</p></div

Association between hospitalization-related outcomes, dynapenia and body mass index: The Glisten Study

Objective: To compare the prognostic value of dynapenia, as evaluated by handgrip, and body mass index (BMI) on length of stay (LOS), days of bed rest, and other hospitalization-related outcomes in a population of older adults admitted to 12 italian acute care divisions. Methods: Data on age, weight, BMI, comorbidities, ADL, physical activity level, muscle strength, were recorded at hospital admission. LOS, days of bed rest, intrahospital falls, and discharge destination were also recorded during the hospitalization. Subjects with BMI &lt;18.5 kg/m2were classified as underweight, subjects with BMI 18.5–24.9 as normal weight, subjects with BMI ≥25 as overweight-obese. Results: A total of 634 patients, mean age 80.8 ± 6.7 years and 49.4% women, were included in the analysis. Overall dynapenic subjects (D) showed a longer period of LOS and bed rest compared with non-dynapenic (ND). When the study population was divided according to BMI categories, underweight (UW), normal weight (NW), and overweight-obese (OW-OB), no significant differences were observed in hospital LOS and days of bed rest. When analysis of covariance was used to determine the difference of LOS across handgrip/BMI groups, D/OW-OB and D/UW subjects showed significantly longer LOS (11.32 and 10.96 days, both p 0.05) compared to ND/NW subjects (7.69 days), even when controlling for age, gender, baseline ADL, cause of hospitalization and comorbidity. After controlling for the same confounding factors, D/OW-OB, D/NW and D/UW subjects showed significantly longer bed rest (4.7, 4.56, and 4.05 days, respectively, all p 0.05, but D/OW-OB p 0.01) compared to ND/NW subjects (1.59 days). Conclusion: In our study population, LOS is longer in D/UW and D/OW-OB compared to ND/NW subjects and days of bed rest are mainly influenced by dynapenia, and not by BMI class

Schematic model linking HFE, HAMP and TF to FPN1-APP complex in detoxifying action for balanced iron homeostasis.

<p>The picture highlights the main pathways and molecular mediators involved in iron homeostasis maintenance by FPN1-APP cooperation. HAMP is Hepcidin; TF is Transferrin; TF-R is Transferrin receptor; HFE is Hemochromatosis; FPN is Ferroportin; IRP and IRE are Iron Regulatory Protein and Iron Responsive Element respectively.</p

ORs evaluation in patients carrying both <i>APOE</i>4 allele and any other polymorphic allele among the iron SNPs.

<p>ORs evaluation in patients carrying both <i>APOE</i>4 allele and any other polymorphic allele among the iron SNPs.</p