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

Determinants of within-country variation in traffic accident mortality in Italy: a geographical analysis

Objective: To identify determinants of regional differences in traffic accident mortality in Italy. Data and methods: Multiple linear regression models were conducted assessing the associations between regional differences in traffic mortality, case fatality and accident rates (dependent variables) with socio-demographic factors, and variables describing road behaviour, vehicles, infrastructure and medical care (independent variables). Data were derived from the National Institute of Statistics, the National Institute of Health and the Italian Automobile Club. In addition to analyses for the whole country of Italy, separate models were conducted for Northern and southern regions. Results: In Italy large regional differences in traffic mortality rates can be observed, ranging from 5.5 to 20 per 100.000 person-years. There is a North-South gradient with higher mortality rates in the Northern part of Italy. S

An assessment of the effect of hepatitis B vaccine in decreasing the amount of hepatitis B disease in Italy

Abstract Background Hepatitis B (HBV) infection is an important cause of morbidity and mortality and it is associated to a higher risk of chronic evolution in infected children. In Italy the anti-HBV vaccination was introduced in 1991 for newborn and twelve years old children. Our study aims to evaluate time trends of HBV incidence rates in order to provide an assessment of compulsory vaccination health impact. Method Data concerning HBV incidence rates coming from Acute Viral Hepatitis Integrated Epidemiological System (SEIEVA) were collected from 1985 to 2006. SEIEVA is the Italian surveillance national system that registers acute hepatitis cases. Time trends were analysed by joinpoint regression using Joinpoint Regression Program 3.3.1 according to Kim's method. A joinpoint represents the time point when a significant trend change is detected. Time changes are expressed in terms of the Expected Annual Percent Change (EAPC) with 95% confidence interval (95% CI). Results The joinpoint analysis showed statistically significant decreasing trends in all age groups. For the age group 0–14 EAPC was -39.0 (95% CI: -59.3; -8.4), in the period up to 1987, and -12.6 (95% CI: -16.0; -9.2) thereafter. EAPCs were -17.9 (95% CI: -18.7; -17.1) and -6.7 (95% CI: -8.0; -5.4) for 15–24 and ≥25 age groups, respectively. Nevertheless no joinpoints were found for age groups 15–24 and ≥25, whereas a joinpoint at year 1987, before compulsory vaccination, was highlighted in 0–14 age group. No joinpoint was observed after 1991. Discussion Our results suggest that the introduction of compulsory vaccination could have contribute partly in decreasing HBV incidence rates. Compulsory vaccination health impact should be better investigated in future studies to evaluate the need for changes in current vaccination strategy.</p

Workplace health promotion programs in different areas of Europe

Background Aging of the workforce challenges European countries. Keeping aged workers healthy and productive, through health promotion, is a key goal of European labour policy. The aim of the present study was to collect experiences of workplace health promotion for older workers (WHPOW) conducted in 10 representative countries of Central Europe, Eastern Europe and the Mediterranean. Methods A literature review of activities of WHPOW was conducted through a comprehensive search of major scientific databases and on the website of the major European Agencies on worker health promotion. The search was restricted to papers published in English from 2000 to 2015. Companies were asked for additional documentation about WHPOW programmes in a survey conducted with SurveyMonkey. Results A total of 756 initiatives regarding WHPOW were identified. 134 of these were guidelines, regulations, or review studies. The remaining 622 activities were intervention studies performed or promoted in the workplace and targeted at older workers or at the aging of the workforce. Most of the programs were carried out in Central Europe (295, 47.4%), less in East Europe (193, 31.0%) and in Mediterranean countries (134, 21.6%). Conclusion Our study shows that there are only a limited number of WHPOW actions throughout the 10 selected European Countries. While in Central Europe widespread interest in issues of aging workforce has resulted in national policies to encourage WHPO, not all the countries of Eastern Europe are equally well equipped. Lastly, in Southern Europe health promotion activities are largely inadequate compared to needs

Knowledge, attitudes and behaviour about Sexually Transmitted Infections: a survey among Italian university female students

Aims: Improvements have been made in terms of STIs mortality, but young women still have a lack of attention to the STIs prevention. We investigated the knowledge and attitudes about STIs and their prevention among a sample of Italian university female students. Methods: We designed a questionnaire about knowledge and attitudes toward STIs, Papanicolau test (Pap test) and Human Papilloma Virus (HPV) and had it filled out by 285 young women. Chi-square test, Mann-Whitney test and a multivariable analysis were performed in order to identify associated factors. &nbsp; Results: Knowledge about STIs seems weak, oppositely to knowledge about preventive measures. In line with the results of the univariate analyses, the multivariable one confirmed a higher probability to answer rightly for women who knew the effective behaviours for preventing STIs, women who took information about STIs from Internet, books and TV and those using natural methods (OR 2.77 - 95%CI 1.47-5.23, OR 2.99 - 95%CI 1.62-5.53 and OR 2.55 - 95%CI 1.05-6.18, respectively) and a lower one for students from Cassino and those who knew is possible to recover from STIs (OR 0.38, 95%CI 0.17-0.87 and 0.42, 95%CI 0.20-0.88, respectively). Furthermore, about Pap test it also confirmed the role of a medium-high STIs level of knowledge (OR 2.11, 95%CI 1.02-4.37) and a lower probability to know about it for women from Cassino (OR 0.25, 95%CI 0.09-0.73). Conclusions: Young women are not completely aware of STIs risks and preventive measures. Informational and educational campaigns should be implemented to reach this target group and lighten the current and future burden of STIs

Are community-based nurse-led selfmanagement 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 &gt;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

Evaluation of the indicators of inflammation in the diagnosis of ovine mastitis

O objetivo do presente trabalho foi avaliar diferentes indicadores inflamatórios no diagnóstico da mamite em ovinos da raça Santa Inês. Após a realização do exame físico das mamas e a prova de fundo escuro, foram coletadas e analisadas 390 amostras de leite, sendo as metades mamárias divididas de acordo com o exame bacteriológico e a prova de fundo escuro, resultando em 290 amostras negativas em ambos os exames, 90 amostras negativas à prova de fundo escuro e positivas na cultura bacteriológica, 5 amostras positivas à prova de fundo escuro e negativas ao exame bacteriológico e 3 amostras positivas em ambos os testes. Nestas amostras foram realizadas a contagem automática de células somáticas (CCS), o California Mastitis Test (CMT), a determinação da concentração hidrogeniônica (pH) e dos teores de cloreto e lactose, e ainda a avaliação do índice de cloreto-lactose. Os maiores valores preditivos foram observados para a CCS, CMT e teor de cloreto; o pH, o teor de lactose e o índice cloreto-lactose apresentaram-se como marcadores inflamatórios menos sensíveis, onde se considerou o resultado da cultura bacteriológica como padrão ouro. O exame físico não se mostrou como método diagnóstico seguro quando utilizado isoladamente, exaltando a importância da associação de outros meios diagnósticos indiretosThe aim of this trial was to evaluate distinct indictors of inflammation in the diagnosis of mastitis in Santa Ines ewes. The physical examination and the dark bottom cup test were performed. Afterwards, the bacteriologic samples of 390 milk samples were analyzed. The samples were divided according to the bacteriological examination and the dark cup bottom test, resulting in 290 samples negative in both tests, 90 samples positive in the bacteriological examination and negative in the dark cup bottom test, 5 samples positive in the dark cup bottom test and negative in bacteriological culture, and 3 samples positive in both tests. The automatic somatic cell count (SSC), the California mastitis test (CMT), the pH, the chloride and lactose content, and the chloride-lactose number were established. Then, their predictive value as a indicator of inflammation was calculated assuming the bacteriologic examination as the gold standard test. The CCS, CMT and chloride content proved to be the best predictors, while the pH, the lactose content and chloride-lactose number were the least sensitive tests. The physical examination was revealed to be a nonsensitive diagnostic procedure when used as the only procedure to detect the disease, showing that other diagnostics tests are requiredFAPESPCNP

Workplace health promotion for older workers: A systematic literature review

Background: Aging of the workforce is a growing problem. As workers age, their physical, physiological and psychosocial capabilities change. Keeping older workers healthy and productive is a key goal of European labor policy and health promotion is a key to achieve this result. Previous studies about workplace health promotion (WHP) programs are usually focused on the entire workforce or to a specific topic. Within the framework of the EU-CHAFEA ProHealth65+ project, this paper aims to systematically review the literature on WHP interventions specifically targeted to older workers (OWs). Methods: This systematic review was conducted by making a comprehensive search of MEDLINE, ISI Web of Science, SCOPUS, The Cochrane Library, CINAHL and PsychINFO databases. Search terms included ageing (and synonyms), worker (and synonyms), intervention (and synonyms), and health (and synonyms). The search was limited to papers in English or Italian published between January, 1st 2000 and May, 31st 2015. Relevant references in the selected articles were also analyzed. Results: Of the 299 articles initially identified as relating to the topic, 18 articles met the inclusion criteria. The type, methods and outcome of interventions in the WHP programs retrieved were heterogenous, as was the definition of the age at which a worker is considered to be 'older'. Most of the available studies had been conducted on small samples for a limited period of time. Conclusion: Our review shows that, although this issue is of great importance, studies addressing WHP actions for OWs are few and generally of poor quality. Current evidence fails to show that WHP programs improve the work ability, productivity or job retention of older workers. In addition, there is limited evidence that WHP programs are effective in improving lifestyles and concur to maintain the health and well-being of older workers. There is a need for future WHP programs to be well-designed so that the effectiveness and cost-benefit of workplace interventions can be properly investigated

Cellular and microbiological profile of Santa Ines ewes in the lactation and the post-weaning period

O objetivo deste trabalho foi avaliar o perfil microbiológico e celular do leite no período lactante e de involução ativa de ovelhas da raça Santa Inês. Foram avaliadas amostras lácteas de 12 ovelhas durante estes distintos períodos. Realizou-se o exame físico da mama, sendo as amostras lácteas submetidas à contagem de células somáticas (CCS), ao California Mastitis Test (CMT), ao exame microbiológico e aos testes de sensibilidade in vitro dos patógenos encontrados. Foram observados maiores escores do exame físico, CCS, CMT durante o período de involução ativa, além de uma alta persistência da infecção durante estes períodos. O período de involução ativa não se mostrou como um momento de alta susceptilidade. Os estafilococos coagulase negativa representaram o único gênero isolado das glândulas infectadas. Uma alta sensibilidade dos agentes etiológicos envolvidos frente aos diferentes antimicrobianos in vitro foi também observadaThe aim was to evaluate and compare the microbiological and cellular profile of the milk of Santa Ines ewes during the lactation period and the active involution. Milk samples were analyzed from 12 ewes during these distinct periods. Clinical examination of the mammary gland, somatic cell count (SCC), California Mastitis Test (CMT), bacteriologic screening and sensibility of the pathogens in vitro were performed. Most alterations were observed in the active involution period. SCC and CMT were higher in this same period. Besides this, a high persistency of infection occurred. The active involution period did not show high susceptibility. Coagulase-negative staphylococci were the only isolated bacteria. A high antimicrobial sensibility of these pathogens was also encountere

Effect of freezing and preincubaton on isolation of coagulase-negative staphylococci from ewes’ milk samples

O objetivo do presente trabalho foi avaliar o efeito do congelamento e da incubação do leite de ovelhas da raça Santa Inês sobre os resultados da cultura bacteriológica. Desta forma, 45 amostras de leite ovino foram coletadas, e submetidas aos seguintes tratamentos: cultura bacteriológica (T1), e simultaneamente incubadas a 37°C por 18 horas (T2) e congeladas a -20°C por 24 horas (T3). Após esses períodos, as amostras dos T2 e T3 foram submetidas à cultura bacteriológica. O T2 possibilitou aumento no isolamento de estafilococos coagulase-negativo (ECN) comparadas ao T1, não ocorrendo o mesmo com o T3. No entanto, o T2 permitiu o desenvolvimento de bactérias normalmente presentes na microbiota dos ductos dos tetos em ovelhas sadias, como o Bacillus spp. Os resultados do presente estudo indicam que a incubação pode ser aplicada para a detecção de ECN na tentativa de reduzir resultados falso-negativos na cultura bacteriológica do leite de ovelhas da raça Santa Inês, determinando o uso mais eficiente dos recursos laboratoriais e a redução dos custos para os proprietários.Milk samples from 45 halves were collected from lactating ewes to evaluate the effect of freezing and incubation of the whole milk on the qualitative results of bacteriologic culture. Thus, these milk samples were submitted to the following treatments: standard culture technique (T1), incubation for 18h at 37°C (T2) and thawing at -20°C for 24h (T3). After these periods, the milk samples from T2 and T3 were submitted to standard culture technique. The T2 showed an increase in the proportion of coagulase-negative staphylococci (CNS) recovery compared to T1, although the same cannot be predicted by T3. Conversely, the T2 allows the growth of some bacteria present in clinically healthy teats ducts as Bacillus spp.. The results of the present study indicated that the incubation of the whole milk can be applied to detection of CNS in ewes’ milk in attempt to reduce the false-negative culture milk samples that can lead to a more efficient use of laboratory resources and reduce costs to herd owners.À Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) pelo apoio financeiro ao projeto de sanidade da glândula mamária ovina