Livelli di presenteismo fra gli infermieri italiani. Uno studio multicentrico

BACKGROUND: Presenteeism represents the need to "get to work although we feel sick"; thus, affecting the quality of work, leading to errors or omissions, reducing productivity and increasing costs. Nurses are among the job categories with the highest degree of Presenteeism, which may negatively affect work quality. Aims and objectives: To assess the prevalence of Presenteeism among Italian nurses. METHODS: A cross-sectional, multicentric study was carried out from January to December 2015 in a sample of Italian nurses. A total of 652 nurses completed the questionnaire. The mean Stanford Presenteeism Scale (SPS-6) total score was 21.6 (±4.0). Nurses showed high Presenteeism levels when considering the “Avoiding distractions” and “Completing work” sections of the Scale. RESULTS: Male nurses showed a lower degree of Presenteeism than women, which also tended to be less severe with increasing age (both p<0.05). The presence of ≥1 self-reported health problem was associated with an increase in the score (p<0.05). CONCLUSIONS: In line with previous studies performed outside Italy, Presenteeism appear to be a widespread condition also among Italian nurses, requiring appropriate treatment and recognition by healthcare providers. The results of this survey might be used as a minimum, most likely underestimated basis for targeted public health policies.INTRODUZIONE: Il presenteismo rappresenta la necessità di "mettersi al lavoro anche se ci si sente male"; influenzando così la qualità del lavoro, portando a errori o omissioni, riducendo la produttività e aumentando i costi. Gli infermieri sono annoverati tra i professionisti con il più alto grado di presenteismo, con potenziali effetti negativi sulla qualità del lavoro. OBIETTIVI: Accertare la prevalenza del Presenteismo tra gli infermieri italiani. METODI: E’ stato condotto uno studio trasversale, multicentrico da gennaio a dicembre 2015 su un campione di infermieri italiani. 652 infermieri hanno completato il questionario. Il punteggio totale medio alla Stanford Presenteeism Scale (SPS-6) era 21.6 (± 4.0). Gli infermieri hanno mostrato elevati livelli di Presenteismo nelle sezioni: "Evitare distrazioni" e "Completare il lavoro" della Scala. RISULTATI: Gli infermieri maschi hanno mostrato livell inferiori di Presenteismo rispetto alle donne, che tendevano anche ad essere minori con l'aumentare dell'età (entrambi p <0,05). La presenza di ≥1 problema di salute auto-riferito è stata associata ad un aumento del punteggio (p <0,05). CONCLUSIONI: In linea con studi precedenti effettuati nel contesto internazionale, il Presenteismo sembra essere una condizione diffusa anche tra gli infermieri italiani, che dovrebbe essere adeguatamente riconosciuta da parte dei manager sanitari. I risultati di questa indagine potrebbero essere utilizzati come spunto di riflessione, per implementare mirate strategie di politica sanitaria

Presenteeism levels among Italian nurses. A multicentric survey [Livelli di presenteismo fra gli infermieri italiani. Uno studio multicentrico]

INTRODUZIONE: Il presenteismo rappresenta la necessità di "mettersi al lavoro anche se ci si sente male"; influenzando così la qualità del lavoro, portando a errori o omissioni, riducendo la produttività e aumentando i costi. Gli infermieri sono annoverati tra i professionisti con il più alto grado di presenteismo, con potenziali effetti negativi sulla qualità del lavoro. OBIETTIVI: Accertare la prevalenza del Presenteismo tra gli infermieri italiani. METODI: E’ stato condotto uno studio trasversale, multicentrico da gennaio a dicembre 2015 su un campione di infermieri italiani. 652 infermieri hanno completato il questionario. Il punteggio totale medio alla Stanford Presenteeism Scale (SPS-6) era 21.6 (± 4.0). Gli infermieri hanno mostrato elevati livelli di Presenteismo nelle sezioni: "Evitare distrazioni" e "Completare il lavoro" della Scala. RISULTATI: Gli infermieri maschi hanno mostrato livell inferiori di Presenteismo rispetto alle donne, che tendevano anche ad essere minori con l'aumentare dell'età. La presenza di ≥1 problema di salute auto-riferito è stata associata ad un aumento del punteggio. CONCLUSIONI: In linea con studi precedenti effettuati nel contesto internazionale, il Presenteismo sembra essere una condizione diffusa anche tra gli infermieri italiani, che dovrebbe essere adeguatamente riconosciuta da parte dei manager sanitari. I risultati di questa indagine potrebbero essere utilizzati come spunto di riflessione, per implementare mirate strategie di politica sanitaria.BACKGROUND: Presenteeism represents the need to "get to work although we feel sick"; thus, affecting the quality of work, leading to errors or omissions, reducing productivity and increasing costs. Nurses are among the job categories with the highest degree of Presenteeism, which may negatively affect work quality. AIMS AND OBJECTIVES: To assess the prevalence of Presenteeism among Italian nurses. METHODS: A cross-sectional, multicentric study was carried out from January to December 2015 in a sample of Italian nurses. A total of 652 nurses completed the questionnaire. The mean Stanford Presenteeism Scale (SPS-6) total score was 21.6 (±4.0). Nurses showed high Presenteeism levels when considering the "Avoiding distractions" and "Completing work" sections of the Scale. RESULTS: Male nurses showed a lower degree of Presenteeism than women, which also tended to be less severe with increasing age. The presence of ≥1 self-reported health problem was associated with an increase in the score. CONCLUSIONS: In line with previous studies performed outside Italy, Presenteeism appear to be a widespread condition also among Italian nurses, requiring appropriate treatment and recognition by healthcare providers. The results of this survey might be used as a minimum, most likely underestimated basis for targeted public health policies

Nursing Education: challenges and perspectives in a COVID-19 age

The COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses’ daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients’ body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students’ learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students’ education and faculty’s activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing (2020). Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses (Dewart et al. 2020). Challenges connected to clinical learning environments Nursing curricula at the European level need to spend at least half of the overall education into clinical practice (European Directive 2013/55/EU). The COVID-19 outbreak affected the possibility to fulfil the criteria and it should be necessary to delay the graduation of undergraduate nursing students to achieve the formal standards for nursing education. Furthermore, it is not clear the impact of this situation in achieving and in maintaining the nursing students’ clinical competences. Competence development and maintenance both require a constant exposure to clinical practice, especially in the last year students, which need soon to face the professional role. Competence is considered as a setting- and time- specific concept where knowledge, skills and behaviours merge together. However, even in professional practice, there are no clear standards to certify competence maintenance over time (Casey et al., 2017). The effect of the break from clinical learning imposed by the outbreak is far to be measured, but we could reasonably suppose that students’ competences are not still stable over time in undergraduate education and they could be affected by a mastery loss. On the other side, the first year students need clinical practice to adjust into the nursing role and, often, to be aware of their choice in nursing, in order to possibly change their educational career. At the beginning of nursing education students experience uncertainty and the behavioural answer to these feeling depend on their motivation and their coping strategies with the academic and the nursing practice’s demands (Ha & Pepin, 2018). When the direct relationship with the academic and the clinical environment is lost or switched to a virtual one, students lose an opportunity to cope and to test their expectations with the choice they made. The first clinical internship experience represents, in a sense, an imprinting moment for the professional future. Due to COVID-19 pandemic, many students not only have lost meaningful chances of clinical learning, but they will also not be able to recover them, with important implications to their competencies acquisition and professional identity, that can be built only in the real clinical settings. Perspectives to push forward nursing education The COVID-19 outbreak also highlighted the relevance of nurses in facing the pandemic: nurses have been in the frontline in critical care, in supporting the community health, in preventing the contagion spread in the population. In this vein, the current pandemic represents an opportunity to drawing attention to the community-based nursing care, where nurses play a pivotal role in maintaining public health and to effectively manage further potential health emergencies. These all are relevant insights of the nursing role and they state the need to re-think nursing curricula and the education in facing infective diseases and in managing public health. Moreover, nurses demonstrated their readiness in facing public health issues on many levels, on broader levels than hospital care. This could have an impact on society’s perception of nurses and nursing and it could motivate the new generations to start a nursing career. The next year will tell us if this will be true or not, but for sure, now, nursing education has a chance to innovate both the study plan and the way to plan differently clinical learning. The study plans should implement more public health contents by educating students also in contact tracing activities and the inter-professional collaboration with public health assistants. Nurses could play a pivotal role in educating people at home in managing health at home, especially with chronically ill patients. Furthermore, nurses have a broader view on the community healthcare services to taking care of people at home when disability, chronic diseases, or social issues occur. COVID-19 outbreak deeply changed our healthcare systems’ view and so should change our nursing education view, in a way to highlight more the nursing role outside the hospital in integrating different views of care and healthcare professional collaboration. Nursing curricula should also focus more on patients’ empowerment and self-care. Healthcare communication has been crucial in promoting healthy and safe behaviours in the population during the outbreak. The roots of nursing are embedded into the proximity to patients’ needs and in finding the right way to improve people’s healthy behaviours. This pandemic brought us to disclose more these roots. The clinical nursing environments should also be re-though in order to enhance the healthcare settings’ integration and the transition of care. Nursing students should be more prepared to deepen patients’ biography, to conduct an in-depth interview useful to understand their habits, the contacts they had, in order to take in charge also the family members, especially when a contagion risk is a concrete possibility. The hospital-oriented education could had weakened a comprehensive view of patient’s history. This pandemic shifted also the focus on how hospital care is deeply linked with public health issues and on how public health issues affect nursing care. If holistic care was a statement and a value of nursing care and nursing education, now holistic care is an imperative need to deliver effective nursing care. Nursing education has to be set for at least 50% in clinical practice, but until now no further details have been stated about the distribution of this 50% in different clinical areas. Clinical competences should be coherent with the population needs and the priorities of the society; nursing education has the duty to provide nurses educated to face the worldwide priorities. It should be clear now that nursing education need to be specific to the area of nursing being practiced in the community and hospital environments. Clinical learning needs to consider how these times differently shaped the society’s needs. Further strategies should be also implemented to improve digitalization into clinical learning. In virtual education there are many factors, which contribute to effective and active learning and which should be considered in the implementation of the virtual learning environment. In detail it is important to consider technological barriers, student expectations and the students’ engagement in simulated environments. Moreover, the planning of virtual clinical educational programs should include effective student-to-teacher and student-to-student communication strategies and the design of specific activities to ensure students’ support (Jowsey et al. 2020). The idea to implement virtual clinical education is not new: both technical and relational skills can be exercised virtually and this was acknowledged as a useful way to test and to educate clinical competences in a safe and non-threatening environment. Although these technological resources are known and available, during the COVID-19 pandemic, heterogeneity has emerged within the nursing faculties. Not all academic institutions have effectively implemented technology to support students’ learning, perhaps because of the sudden and unexpected changes in the education system, which have imposed the use of technological resources not always recognized as regulatory requirements within the faculties. Indeed, the rapid transition from face to face education to virtual education has highlighted several problems related to virtual learning. Following the pandemic, many universities were able to offer education in an emergency distance learning programs but not a structured online education based on “well-considered, durable learning plans” (Morin, 2020). However, COVID-19 is an ongoing crisis but it could be the catalyst that drives nursing education towards innovations and a flexible but effective use of online learning. In spite of the potential of a well-planned online education, we should also consider the risk of inequality issues affecting students’ capability to achieve their learning outcomes; especially when they live in disadvantaged social contexts, with any access to Internet or Wi-Fi or obsolete computer. To encourage a more inclusive distance education some strategies should be implemented, as: to create small classes; to promote new teaching methods as inter-professional education; to create a structured mentoring program in supporting the relationship with students; to provide immediate and constructive feedback; to re-learn how to manage time, while supporting participative learning. On the other hand, distance learning might curb the burden of tuition fees, which could make higher education inaccessible for many individuals. In this vein, virtual teaching could allow more flexibility and a wider access to education (Murphy, 2020). For these reasons, it is possible that the future of undergraduate nursing education will strongly consider distance learning, and it will improve a blended approach to teaching clinical competences. This could represent an opportunity, as long as more efforts are made to improve transparency, accountability, service orientation and inclusion to education but also associated with some fears in respect to surveillance and control, privacy issues, power relations, and inequalities (Murphy, 2020). Conclusions The COVID-19 outbreak deeply affected nursing education, anyway together with the challenges, many new perspectives have been disclosed to reform nursing curricula or to implement new strategies in clinical learning. Those challenges and perspectives should push nursing education forward to innovate and they could shape new approaches to implement contents and competences in tune with the evolution of the societal needs. The new generations of graduate nurses will face a new normality. As the way of thinking nursing care changed, nursing education and clinical learning are the first drivers to shape this new normality in nursing. This historical period shapes a new educational environment deeply embedded in strong roots, and ready to face new perspectives to developing nursing care. The COVID-19 outbreak deeply changed our lives on different levels. Social restrictions and distancing shaped in a different way our view of social relationships and behaviours. Like many aspects of daily life, also education has undergone radical changes. Nursing care was strongly affected by the outbreak, not only due to the risks in everyday practice, the heavy workload or the impact on nurses’ daily lives outside the healthcare settings, but also because nursing is caring profession and it embeds in its roots the close relationship with the patient, the touch, the patients’ body proximity as a way to communicate and to deliver an effective nursing care. All these issues, when brought in nursing education are also a learning opportunity for students and a way to develop their professional identity and to focusing on the nursing role. The COVID-19 outbreak heavily hit the clinical learning environments, as they are healthcare settings. The situation affected students’ learning opportunities, since clinical placements were suspended, Universities closed and in-person courses moved into online teaching. While lessons and courses rapidly switched into online teaching, in order to safeguard students’ education and faculty’s activity, it was not possible to manage the pre-clinical activities, such as simulations and labs, in order to support technical and relational competences. Most of all, it was not possible to arrange the clinical placements due to the uncertainty of the healthcare settings and the social and organizational restrictions to limiting unnecessary accesses to the services, as recommended by the American Association of Colleges of Nursing (2020). Recently, many authors have explored the issues related to the future of nursing education. In detail, an emerging issue is how it will be possible to educating nurses in a society facing isolation and social distance measures, but at the same time, in a society that needs more and more prepared clinical nurses (Dewart et al. 2020). Challenges connected to clinical learning environments Nursing curricula at the European level need to spend at least half of the overall education into clinical practice (European Directive 2013/55/EU). The COVID-19 outbreak affected the possibility to fulfil the criteria and it should be necessary to delay the graduation of undergraduate nursing students to achieve the formal standards for nursing education. Furthermore, it is not clear the impact of this situation in achieving and in maintaining the nursing students’ clinical competences. Competence development and maintenance both require a constant exposure to clinical practice, especially in the last year students, which need soon to face the professional role. Competence is considered as a setting- and time- specific concept where knowledge, skills and behaviours merge together. However, even in professional practice, there are no clear standards to certify competence maintenance over time (Casey et al., 2017). The effect of the break from clinical learning imposed by the outbreak is far to be measured, but we could reasonably suppose that students’ competences are not still stable over time in undergraduate education and they could be affected by a mastery loss. On the other side, the first year students need clinical practice to adjust into the nursing role and, often, to be aware of their choice in nursing, in order to possibly change their educational career. At the beginning of nursing education students experience uncertainty and the behavioural answer to these feeling depend on their motivation and their coping strategies with the academic and the nursing practice’s demands (Ha & Pepin, 2018). When the direct relationship with the academic and the clinical environment is lost or switched to a virtual one, students lose an opportunity to cope and to test their expectations with the choice they made. The first clinical internship experience represents, in a sense, an imprinting moment for the professional future. Due to COVID-19 pandemic, many students not only have lost meaningful chances of clinical learning, but they will also not be able to recover them, with important implications to their competencies acquisition and professional identity, that can be built only in the real clinical settings. Perspectives to push forward nursing education The COVID-19 outbreak also highlighted the relevance of nurses in facing the pandemic: nurses have been in the frontline in critical care, in supporting the community health, in preventing the contagion spread in the population. In this vein, the current pandemic represents an opportunity to drawing attention to the community-based nursing care, where nurses play a pivotal role in maintaining public health and to effectively manage further potential health emergencies. These all are relevant insights of the nursing role and they state the need to re-think nursing curricula and the education in facing infective diseases and in managing public health. Moreover, nurses demonstrated their readiness in facing public health issues on many levels, on broader levels than hospital care. This could have an impact on society’s perception of nurses and nursing and it could motivate the new generations to start a nursing career. The next year will tell us if this will be true or not, but for sure, now, nursing education has a chance to innovate both the study plan and the way to plan differently clinical learning. The study plans should implement more public health contents by educating students also in contact tracing activities and the inter-professional collaboration with public health assistants. Nurses could play a pivotal role in educating people at home in managing health at home, especially with chronically ill patients. Furthermore, nurses have a broader view on the community healthcare services to taking care of people at home when disability, chronic diseases, or social issues occur. COVID-19 outbreak deeply changed our healthcare systems’ view and so should change our nursing education view, in a way to highlight more the nursing role outside the hospital in integrating different views of care and healthcare professional collaboration. Nursing curricula should also focus more on patients’ empowerment and self-care. Healthcare communication has been crucial in promoting healthy and safe behaviours in the population during the outbreak. The roots of nursing are embedded into the proximity to patients’ needs and in finding the right way to improve people’s healthy behaviours. This pandemic brought us to disclose more these roots. The clinical nursing environments should also be re-though in order to enhance the healthcare settings’ integration and the transition of care. Nursing students should be more prepared to deepen patients’ biography, to conduct an in-depth interview useful to understand their habits, the contacts they had, in order to take in charge also the family members, especially when a contagion risk is a concrete possibility. The hospital-oriented education could had weakened a comprehensive view of patient’s history. This pandemic shifted also the focus on how hospital care is deeply linked with public health issues and on how public health issues affect nursing care. If holistic care was a statement and a value of nursing care and nursing education, now holistic care is an imperative need to deliver effective nursing care. Nursing education has to be set for at least 50% in clinical practice, but until now no further details have been stated about the distribution of this 50% in different clinical areas. Clinical competences should be coherent with the population needs and the priorities of the society; nursing education has the duty to provide nurses educated to face the worldwide priorities. It should be clear now that nursing education need to be specific to the area of nursing being practiced in the community and hospital environments. Clinical learning needs to consider how these times differently shaped the society’s needs. Further strategies should be also implemented to improve digitalization into clinical learning. In virtual education there are many factors, which contribute to effective and active learning and which should be considered in the implementation of the virtual learning environment. In detail it is important to consider technological barriers, student expectations and the students’ engagement in simulated environments. Moreover, the planning of virtual clinical educational programs should include effective student-to-teacher and student-to-student communication strategies and the design of specific activities to ensure students’ support (Jowsey et al. 2020). The idea to implement virtual clinical education is not new: both technical and relational skills can be exercised virtually and this was acknowledged as a useful way to test and to educate clinical competences in a safe and non-threatening environment. Although these technological resources are known and available, during the COVID-19 pandemic, heterogeneity has emerged within the nursing faculties. Not all academic institutions have effectively implemented technology to support students’ learning, perhaps because of the sudden and unexpected changes in the education system, which have imposed the use of technological resources not always recognized as regulatory requirements within the faculties. Indeed, the rapid transition from face to face education to virtual education has highlighted several problems related to virtual learning. Fo

Relationship between peripheral insertion site and catheter-related phlebitis in adult hospitalized patients: a systematic review - Relazione tra sito anatomico di inserimento del catetere venoso periferico e flebite catetere correlata nei pazienti adulti ospedalizzati: una revisione sistematica

AIM. To explore the relationship between the anatomical site of peripheral venous catheteriza- tion and risk of catheter-related phlebitis.BACKGROUND. Peripheral venous catheterization is frequently associated with phlebitis. Recent guidelines, recommend the use of an upper-extremity site for catheter insertion but no univocal consensus exists on the anatomical site with lower risk of phlebitis.DESIGN. Systematic review.METHODS: We searched Medline (PubMed) and CINAHL (EBSCOhost) databases until the end of January 2017. We also reviewed the reference lists of retrieved articles and gray literature was excluded. Searches were limited to articles published in English with no restriction imposed to date of publication. The primary outcome was the incidence of phlebitis associated with anato- mical site of peripheral catheterization. We included randomized controlled trials and observa- tional studies on adult patients who required a peripheral catheter for the administration of medi- cation, intermittent or continuous fluid infusion.RESULTS. Antecubital fossa veins are associated with lower phlebitis rates, while hands veins are the most risky sites to develop phlebitis. There is no consensus regarding vein in forearm.CONCLUSION. Choosing the right anatomical site to insert a peripheral venous catheter is impor- tant to decrease phlebitis rate. Further studies should compare indwelling time in different anato- mical sites with phlebitis rate. A more standardized approach in defining and assessing phlebitis among studies is recommended.KEY WORDS: systematic review, phlebitis, peripheral venous catheterization, anatomical sites.RIASSUNTOOBIETTIVO. Esplorare la relazione tra il sito anatomico di inserimento del catetere venoso peri- ferico e il rischio di flebite correlata.INTRODUZIONE. Il cateterismo venoso periferico è spesso associato a flebiti. Linee Guida recenti raccomandano l'utilizzo delle vene degli arti superiori per l'inserimento del catetere ma non esiste univoco consenso circa il sito anatomico correlato al minor rischio di sviluppare flebite.METODI. Abbiamo effettuato una revisione sistematica della letteratura consultando i database Medline (PubMed) e CINAHL (EBSCOhost) fino al termine del mese di Gennaio 2017. Inoltre, abbiamo revisionato le citazioni bibliografiche degli articoli reperiti e la letteratura grigia è stata esclusa. Sono stati ricercati articoli pubblicati in lingua inglese, senza limiti posti per la data di pubblicazione. Abbiamo incluso: gli studi che riportavano dati sui tassi di flebite associati al sito anatomico di cateterismo periferico; gli studi clinici randomizzati controllati e gli studi osserva- zioni condotti su pazienti adulti che necessitavano dell'inserimento di un catetere venoso perife- rico per la somministrazione intermittente o continua di liquidi e farmaci.RISULTATI. L'inserimento del catetere venoso periferico nelle vene della fossa antecubitale è asso- ciato ad un minor tasso di flebiti, mentre le vene della mano sono il sito a maggior rischio di sviluppare flebite. Non esiste consenso circa le vene dell'avambraccio.CONCLUSIONI. La scelta del sito anatomico corretto per l'inserimento di un catetere venoso peri- ferico è importante per diminuire i tassi di flebite. Ulteriori studi dovrebbero comparare i tassi di flebite associati al tempo di permanenza dei cateteri venosi periferici inseriti in differenti siti anatomici. Si raccomanda, inoltre, un approccio maggiormente standardizzato nella definizione e valutazione del grado di flebite all'interno dei diversi studi.PAROLE CHIAVE: revisione sistematica, flebiti, cateterismo venoso periferico, siti anatomici

Isotopic characterization of groundwater for drinking use in multilayer aquifers of the Milano and Monza provinces

Groundwater, drinking water, isotopes, EU directives, hydrogeolog

Multi-isotopic regional-scale screening on drinking groundwater in Lombardy Region (Italy)

Groundwater represents the main and safest source of water that supply, for drinking purposes, numerous urban and rural communities all over the world. A deep knowledge of aquifer systems in terms of quality, vulnerability and renewability is fundamental to preserve groundwater resources. Thanks to the contribution of different members of Water Alliance in synergy with Sapienza University, during November 2019 a multi-isotopic analysis at regional scale on groundwater tapped for drinking purposes in a wide area of Lombardy Region, has been carried out. The study aimed to improve knowledge about recharge mechanisms, groundwater relative age and impact of human activities on groundwater quality Each Water Alliance supplier selected wells and springs for a total of 121 samples, catching different aquifer groups and distributed from North to South. Groundwater stable isotope analyses were performed on all the monitoring points, instead tritium, nitrogen isotopes (15N and 18O in nitrates), sulphate isotopes (34S and18O) and 13C isotope in Dissolved Inorganic Carbon (DIC), were analysed in selected monitoring wells basing on previous data and major ions concentrations results. Therefore, results confirmed the key role of multi-isotopic approach in defining aquifer recharge processes, relative groundwater age and origin of pollutants, offering a useful tool to point out local issues which can be deeply investigated by each water supplier

Barriers and facilitators to vaccination for COVID-19, pertussis, and influenza during pregnancy: Protocol for an umbrella review

Pregnant women are particularly vulnerable to infection. Furthermore, infection from pertussis, influenza and COVID-19 increases the likelihood of adverse consequences to the mother and developing baby such as stillbirth, ICU admission, and pre-term caesarean birth. Increased rates of transmission and risk of adverse consequences from infection justifies the provision of national maternal vaccination programmes. Additionally, maternal vaccination helps protect the infant until they are able to receive their own vaccinations; a time when they are most at risk of mortality from influenza and pertussis. Vaccination during pregnancy has been repeatedly demonstrated as safe and effective in reducing harm, although rates of uptake remain low compared to the general population. The current protocol describes the methodology for an umbrella review aiming to explore the barriers and facilitators of vaccination during pregnancy for pertussis, influenza, and COVID-19. Systematic reviews that investigate the barriers and facilitators of at least one of either pertussis, influenza, or COVID-19 will be included in this review. Multiple databases will be searched, and included reviews assessed for quality (using the Joanna Briggs Institute (JBI) quality assessment for systematic reviews) and degree of overlap of included primary studies. Included reviews will be analysed according to the WHO SAGE model of determinants of vaccine hesitancy and separated by whether these explore influenza and pertussis, or COVID-19. The outcomes of this review will help inform the development of interventions to increase uptake of vaccination during pregnancy, and on whether interventions need to be tailored depending on the infectious disease. The key findings will identify the specific barriers and facilitators of vaccination hesitancy by considering contextual influences (e.g. sociodemographic variables), individual/social group influences (e.g. trust in the institutions), and vaccine-specific issues (e.g. safety and recommendations)

Cardiometabolic risk estimation using exposome data and machine learning

Background: The human exposome encompasses all exposures that individuals encounter throughout their lifetime. It is now widely acknowledged that health outcomes are influenced not only by genetic factors but also by the interactions between these factors and various exposures. Consequently, the exposome has emerged as a significant contributor to the overall risk of developing major diseases, such as cardiovascular disease (CVD) and diabetes. Therefore, personalized early risk assessment based on exposome attributes might be a promising tool for identifying high-risk individuals and improving disease prevention. Objective: Develop and evaluate a novel and fair machine learning (ML) model for CVD and type 2 diabetes (T2D) risk prediction based on a set of readily available exposome factors. We evaluated our model using internal and external validation groups from a multi-center cohort. To be considered fair, the model was required to demonstrate consistent performance across different sub-groups of the cohort. Methods: From the UK Biobank, we identified 5,348 and 1,534 participants who within 13 years from the baseline visit were diagnosed with CVD and T2D, respectively. An equal number of participants who did not develop these pathologies were randomly selected as the control group. 109 readily available exposure variables from six different categories (physical measures, environmental, lifestyle, mental health events, sociodemographics, and early-life factors) from the participant's baseline visit were considered. We adopted the XGBoost ensemble model to predict individuals at risk of developing the diseases. The model's performance was compared to that of an integrative ML model which is based on a set of biological, clinical, physical, and sociodemographic variables, and, additionally for CVD, to the Framingham risk score. Moreover, we assessed the proposed model for potential bias related to sex, ethnicity, and age. Lastly, we interpreted the model's results using SHAP, a state-of-the-art explainability method. Results: The proposed ML model presents a comparable performance to the integrative ML model despite using solely exposome information, achieving a ROC-AUC of 0.78±0.01 and 0.77±0.01 for CVD and T2D, respectively. Additionally, for CVD risk prediction, the exposome-based model presents an improved performance over the traditional Framingham risk score. No bias in terms of key sensitive variables was identified. Conclusions: We identified exposome factors that play an important role in identifying patients at risk of CVD and T2D, such as naps during the day, age completed full-time education, past tobacco smoking, frequency of tiredness/unenthusiasm, and current work status. Overall, this work demonstrates the potential of exposome-based machine learning as a fair CVD and T2D risk assessment tool.</p

Developing mentorship in clinical practice: Psychometrics properties of the Mentors' Competence Instrument

Clinical placements are an important part of nursing education to developing nursing students' competencies. In enhancing clinical learning, to focus on mentors' competences is pivotal as they are the main role models and experts in guiding. This study is validated the Italian version of the Mentors' Competence Instrument. A sampling frame of 648 mentors was involved. The final sample included 291 mentors (response rate 45%). Confirmatory Factor Analysis was performed. Fit indices were also calculated to evaluate validity. The scale demonstrated optimal fit indexes and its validity was confirmed by psychometrical testing. In detail, Root Mean Square Error of Approximation is 0.058, Standardized Root Mean Residual is 0.046, Comparative Fit Index is 0.893 and Tucker-Lewis Index 0.886. Cronbach's alpha ranges from 0.77 to 0.95 among factors. This is the first validation of the scale performed in a different country from the original study. The performed psychometric testing showed that the scale is valid and reliable, as well as consistent with the theoretical structure reported for a different national context. This scale can be beneficial for comparing mentors' competencies across different clinical learning environments and could be used to build a broader model of mentors' competencies

Effectiveness of a family nurse‐led programme on accuracy of blood pressure self‐measurement: A randomised controlled trial

Aims and objectives: To evaluate the effectiveness of a Family Nurse Practitioner (FNP)-led programme on the degree of adherence of current recommendations on home blood pressure self-measurement (HBPM) as compared to routine care and management. Background: HBPM plays an important role for monitoring hypertensive patients; however, patients’ adherence to current guidelines is unsatisfactory. A nurse-led training programme in the community setting could be an effective strategy to achieve high level of patients’ adherence to recommendations. Design: A multicentre randomised controlled trial was carried out from September 2016 to September 2017.MethodsIn total, 170 patients were randomly allocated into the intervention group (n = 83) and the usual care (n = 87). All participants received usual care (written and verbal information on HBPM recommendations); subjects in the intervention group also received 1-hour training session on how to correctly self-measure BP. Clinical trial registration was done (ClinicalTrials.gov.: NCT04681703). The CONSORT checklist for randomised controlled trials was used in this study. Results: At baseline, the level of adherence to the recommendation was similar in the two groups (p 5 min before performing the measurement (all p < .05). Conclusions: The FNP-led programme is effective in improving patients’ adherence to guidelines on the correct technique to self-measure BP at home. Relevance to clinical practice: This programme may be added to the existing interventions in the community setting or considered into specifically nurse-led hypertension management models