DETERMINANTS OF METHADONE TREATMENT ASSIGNMENT AMONG HEROIN ADDICT ON FIRST ADMISSION TO PUBLIC TREATMENT CENTRES IN ITALY.

Aims: To identify factors associated with entering any methadone treatment at first admission at an NHS treatment centre in Italy and to investigate determinants of receiving detoxification or maintenance methadone treatments. Methods: Data were analysed from 565 heroin addicts who entered for the first time one of 90 NHS treatment centres in 12 Italian regions between September 1998 and March 2001. Subjects were interviewed at admission by the centre's staff and followed-up for 18 months. Details on treatments provided were recorded using a standardised form. Random effects logistic regression analysis was applied. Results: Factors positively associated with any methadone treatment assignment were: being younger than 25 years and using heroin more than twice a day, having been recently incarcerated, and living with a partner. Independent predictors of admission to methadone maintenance were injecting heroin, having sex without a condom in the previous six months, being HIV positive and having been enrolled at a NHS TC where a psychiatrist was present. Using heroin once a day or more and using cocaine were factors associated with enrolment into detoxification treatment. A significant heterogeneity between centres was observed. Conclusions: Results from this study give an insight into different patient profiles who are enrolled in methadone treatments. The observed heterogeneity between centres indicates the need to develop and implement common guidelines for the access of heroin addicts to substitution treatment. © 2005 Elsevier Ireland Ltd. All rights reserved

Wastewater workers and hepatitis A virus infection.

The main occupational hazard of wastewater workers (WWs) is the direct exposure to the variety of infectious agents present in sewage material, with hepatitis A virus (HAV) being the most frequent one. Most epidemiological studies have shown a higher risk of hepatitis A among WWs, although some studies have produced conflicting evidence. To evaluate the hypothesis of increased risk of HAV infection in WWs. The prevalence of antibodies toHAV in 869WWswas compared to 311 other subjects and analysed to detect the main potentially confounding variables. Univariate analysis demonstrated that occupational exposure to sewage was not significantly associated with the prevalence of anti-HAV(1). The anti-HAV(1) prevalence was strongly associated with age and shellfish consumption (P,0.05) when the subcategories of workers were examined separately (WWs and control group) and jointly. In the logistic regression model, a significant association between anti-HAV(1) prevalence and duration of employment (P,0.05) was found. The interaction term(age3duration of employment) was significant (P,0.001) when included in the logistic model. This study shows that working in a wastewater treatment plant does not seem to be related to a greater prevalence of antibodies to hepatitis A. Moreover, the relative risk of HAV infection among WWs seems to be correlated with low anti-HAV(1) prevalence in the general population

Polycyclic aromatic hydrocarbons loads into the Mediterranean Sea: Estimate of Sarno River inputs

The polycyclic aromatic hydrocarbons (PAHs) pollution in the Sarno River and its environmental impact on the Gulf of Naples (Tyrrhenian Sea, Central Mediterranean Sea) were estimated. The 16 PAHs identified by the USEPA as priority pollutants and perylene were determined in the water dissolved phase (DP), suspended particulate matter (SPM) and sediments. Total PAHs concentrations ranged from 23.1 to 2670.4 ng L(-1) in water (sum of DP and SPM) and from 5.3 to 678.6 ng g(-1) in sediment samples. Source analysis revealed that PAHs mainly came from combustion process. Contaminant discharges of PAHs into the sea were calculated in about 8530 gd(-1) showing that this river should account as one of the main contribution sources of PAHs to the Tyrrhenian Sea

Health Technology Assessment: An Essential Approach to Guide Clinical Governance Choices on Risk Management

A large part of academic literature, business literature as well as practices in real life are resting on the assumption that uncertainty and risk does not exist. We all know that this is not true, yet, a whole variety of methods, tools and practices are not attuned to the fact that the future is uncertain and that risks are all around us. However, despite risk management entering the agenda some decades ago, it has introduced risks on its own as illustrated by the financial crisis. Here is a book that goes beyond risk management as it is today and tries to discuss what needs to be improved further. The book also offers some cases

The consumption of genetically modified foods in Italian high school students

Genetically modified organisms (GMOs) can be defined as organisms in which the DNA has been altered in a way that does not occur naturally. Such methods are used to create GM plants – which are then used to grow (GM) food crops. GM foods have the potential to solve many of the world’s hunger and malnutrition problems, and to help protect and preserve the environment by increasing yield and reducing reliance upon chemical pesticides and herbicides. Nevertheless, the consumption of GM foods provokes doubts and hesitations among consumers, especially in Italy. This paper has two aims, the first is to investigate genetically modified (GM) foods consumption in Italian high school students through a large sample size survey on 2122 students randomly selected in 39 schools of a metropolitan area (Naples, South-Italy). The second, by examining the behavioural process that drives individual’s perceptions of GM food taking advantage of an empirical choice methodology that corrects for endogeneity in decision making relationships, namely structural equation model (SEM). The results show that a very large percentage of students never or rarely eat GM food and a lot of them do not suggest the consumption of GM food. The proposed SEM is a full formative measurement model and shows that GM foods consumption in Italian students depends on the knowledge of GMO and on the impact of the GMO on the men’s health and on the environment. Therefore, in order to orient population it could be realized a standardized evaluation systems relative to human health and environment consequences produced by GM organisms and GM foods

Machine Learning and Lean Six Sigma to Assess How COVID-19 Has Changed the Patient Management of the Complex Operative Unit of Neurology and Stroke Unit: A Single Center Study

Background: In health, it is important to promote the effectiveness, efficiency and adequacy of the services provided; these concepts become even more important in the era of the COVID-19 pandemic, where efforts to manage the disease have absorbed all hospital resources. The COVID-19 emergency led to a profound restructuring-in a very short time-of the Italian hospital system. Some factors that impose higher costs on hospitals are inappropriate hospitalization and length of stay (LOS). The length of stay (LOS) is a very useful parameter for the management of services within the hospital and is an index evaluated for the management of costs. Methods: This study analyzed how COVID-19 changed the activity of the Complex Operative Unit (COU) of the Neurology and Stroke Unit of the San Giovanni di Dio e Ruggi d'Aragona University Hospital of Salerno (Italy). The methodology used in this study was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC roadmap, characterized by five operational phases. To add even more value to the processing, a single clinical case, represented by stroke patients, was investigated to verify the specific impact of the pandemic. Results: The results obtained show a reduction in LOS for stroke patients and an increase in the value of the diagnosis related group relative weight. Conclusions: This work has shown how, thanks to the implementation of protocols for the management of the COU of the Neurology and Stroke Unit, the work of doctors has improved, and this is evident from the values of the parameters taken into consideration

Studi e ricerche di sanità pubblica e delle professioni sanitarie

[English]:This book belongs to a new collection promoted by the School of Medicine at Federico II University of Naples. The publication wants to encourage communication between those who are engaged in Research, Prevention, and the application of Medicine in various medical specialties. Spreading the culture of prevention is of primary importance in planning health policies. Research topics will be: Health education and promotion, Infectious diseases, Sports medicine, Cancer prevention, Health prevention, Psychiatry and pathological addiction, Health and environment, Animal health, Public health , Food Safety, Vaccinations.[Italiano]:La pubblicazione del volume Studi e ricerche di Sanità Pubblica e delle professioni sanitarie vuole incoraggiare la comunicazione tra coloro che sono impegnati nella ricerca in generale e nello studio dei vari aspetti della prevenzione applicati alle diverse specialità mediche. Diffondere la cultura della prevenzione è di fondamentale importanza nella pianificazione e nella programmazione delle politiche sanitarie. Saranno argomenti di ricerca: Acque destinate al consumo umano, Acque di balneazione, Educazione e promozione della salute, Malattie infettive, Medicina dello sport, Prevenzione dei tumori, Prevenzione in sanità pubblica, Psichiatria e dipendenze patologiche, Salute ambiente, Sanità animale, Sanità pubblica, Sicurezza alimentare, Vaccinazioni

Respiratory function in power plant workers exposed to nitrogen dioxide.

BACKGROUND: Power plant workers are potentially exposed to nitrogen dioxide (NO2) and may therefore be at higher risk of pulmonary diseases than the general population. AIMS: To assess the association of NO2 exposure with spirometric abnormalities in power plant workers. METHODS: Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and forced expiratory ratio (FER = FEV1/FVC) were correlated with demographic characteristics, smoking history and environmental exposure to NO2 in power plant workers exposed to environmental NO2 at work and in a control group of administrative employees. Twenty-four hour environmental NO2 concentrations were measured at each workplace. RESULTS: The concentrations of environmental NO2 ranged from 1.21 to 7.82mg m(-3) with a mean value of 3.91 + 1.51mg m(-3). The results showed that FEV1 and FVC were significantly lower in 347 power plant workers than in the 349 controls (P < 0.001). The FER was significantly correlated with age, environmental NO2 concentration, smoking and height. CONCLUSIONS: Occupational exposure to NO2 emissions in power plants is significantly associated with lung function abnormalities as assessed by spirometry. Spirometric measurements in power plant workers exposed to NO2 emissions may be an effective means of detecting early signs of impaired respiratory health in this group of workers

Polychlorinated biphenyls and organochlorine pesticides in Tiber River and Estuary: Occurrence, distribution and ecological risk

The polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) pollution in the Tiber River and its environmental impact on the Tyrrhenian Sea (Central Mediterranean Sea) were estimated. 32 PCBs and 17 OCPs (aldrin, α-BHC, β-BHC, δ-BHC, lindane, p,p'-DDD, p,p'-DDE, p,p'-DDT, dieldrin, endosulfan I, endosulfan II, endosulfan sulfate, endrin, endrin aldehyde, heptachlor, heptachlor epoxide, methoxychlor) were determined in the water dissolved phase (DP), suspended particulate matter (SPM) and sediment samples. Total concentrations of PCBs ranged from 0.54 to 74.75ngL-1 in water (sum of DP and SPM) and from 3.73 to 79.30ngg-1 dry weigh in sediment samples; while the concentrations of total OCPs collected in water (sum of DP and SPM) ranged from 0.07 to 7.04ngL-1 and from 0.66 to 10.02ngg-1 dry weigh in sediment samples. Contaminant discharges into the sea were calculated in about 227.08kgyear-1 for PCBs and 24.91kgyear-1 for OCPs, showing that this river should account as one of the main contribution sources of PCBs and OCPs to the Tyrrhenian Sea. The ∑TEQPCB from the sediment samples ranged from 0.0006 to 0.37ngg-1 with an average level of 0.13ngg-1. Based on Sediments Quality Guidelines, biological adverse effects on aquatic ecosystem were rare to occasional for PCB and OCP levels in Tiber water syste

Assessment of the efficacy of Umonium38 on multidrug-resistant nosocomial pathogens.

INTRODUCTION: We investigated the efficacy of a biocide Umonium38 on multidrug-resistant strains by comparison with a chloride derivative (Decs). METHODS: In vitro susceptibility tests were performed by agar diffusion disk and results were interpreted according to Clinical and Laboratory Standards Institute (CLSI). In vitro antibacterial efficacy of Umonium38 and Decs over selected strains was evaluated according to European Standards protocol with or without organic substance. RESULTS: In vitro tests with Umoniumnr at 2.5% concentration demonstrated an overall drop in microbial and yeast charges after 5 min. contact without organic substance. The same results were obtained in presence of organic substance. In vitro tests with chloride derivative at 5% without organic substance also resulted in overall drop in bacterial and mycotic charges. Conversely, in presence of organic substance, the hypochlorite reduced the initial 10 UFC/ml to 10 UFC/ml for all bacterial strains with a decrease of 4 log except for Enterococcus faecalis and Candida albicans whose reduction was 2 and 1 log units respectively. DISCUSSION: The organic substance in water requires large use of oxidising disinfectants (chloride, ozone) implying in the need for higher-than-standard concentrations. The disinfecting effect of chloride is only visible when the "requirement" of organic substance has been met. By contrast, Umonium38 behaves like a powerful biocide even in presence of organic substance, as it is not "consumed" by possible organic residues. CONCLUSIONS: Umonium38 resulted beneficial and effective. It is to be stressed, however, that all these experiments were in vitro tests and still requires validation from a correct use of clinical practice