Human biomonitoring in the area around the petrochemical site in Gela, Sicily-Italy

Close to the town of Gela (Sicily, Italy) a petrochemical site is operating since 1962. A power station, chemical plants and an oil refiney plant incleded. In 1990 a large area around the site was declared " at high risk of environmental cirsis" in 2000 a subarea was designated " Reclamation Site of National Inerest" Extremely high concentrations of hazardous chemicals have been measured in soil, surface and groundwater, in marine water and sediments. Mortality, hospital discharges and birth defects were reported higher than neighbouring areas and other references

Effects on Clinical Outcomes of a 5-Year Surgical Safety Checklist Implementation Experience: A Large-scale Population-Based Difference-in-Differences Study

The adoption of a surgical checklist is strongly recommended worldwide as an effective practice to improve patient safety; however, several studies have reported mixed results and a number of issues are still unresolved. The main objective of this study was to explore the impact of the first 5-year period of a surgical checklist-based intervention in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public hospitals between 2006 and 2014. The adherence to the checklist was measured between 2011 and 2013 through a computerized database. The effects of the intervention were explored through multivariable logistic regression and difference-in-differences (DID) approaches, based on current administrative data sources. In-hospital and 30-days mortality, 30-days readmissions and length-of-stay (LOS) \u2a7e8 days were the observed outcomes. Adherence to the checklist showed marked variations across hospitals (0%-93.3%). A pre/post analysis detected statistically significant differences between surgical interventions performed in hospitals with higher adherence to the checklist (\u2a7e75% of the surgeries) and those performed in other hospitals, as for the 30-days readmissions rate (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98) and LOS \u2a7e 8 days rate (OR: 0.88; 95% CI: 0.87-0.89). These findings were confirmed after risk adjustment and DID analysis. No association was observed with mortality outcomes. On the whole, our study attained mixed results. Although a protective effect of the surgical checklist use could not be proved over the first 5 years of this regional implementation experience, our research offers some methodological insights for practical use in the evaluation process of large-scale implementation projects

A family nurse-led intervention for reducing health services’ utilization in individuals with chronic diseases : The ADVICE pilot study

Objectives Intensive health services’ utilization is common in older individuals affected by chronic diseases. This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services’ use (readmissions and/or emergency service access) among older people affected by chronic conditions. Methods This is a non-randomized before-after pilot study. A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months. Standard home care was provided during the first four months’ period (months 1–4), followed by the educational intervention until the end of the study (months 5–8). The intervention, based on the teach-back method, consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment, potential complications, medication adherence, and health behaviours. Rates of health services’ use were collected immediately before (T0), and after the interventions (T1). Differences in utilization rates were examined by the McNemar’s test. Potential factors associated with the risk of health services’ use were explored with a Cox proportional hazard regression model. Results The sample (n = 78) was predominantly female (n = 50, 64.1%), and had a mean age of 76.2 (SD = 4.8) years. Diabetes mellitus was the most frequent disease (n = 27, 34.6%). McNemar’s test indicated a significant reduction in health services’ use at T1 (McNemar χ2 = 28.03, P < 0.001). Cox regressions indicated that time and patient education, as well as their interaction, were the only variables positively associated with the probability of health services’ use. Conclusion A teach-back intervention led by a family nurse practitioner has the potential to reduce health services’ use in older patients with chronic diseases

A study protocol for the evaluation of occupational mutagenic/carcinogenic risks in subjects exposed to antineoplastic drugs: a multicentric project

<p>Abstract</p> <p>Background</p> <p>Some industrial hygiene studies have assessed occupational exposure to antineoplastic drugs; other epidemiological investigations have detected various toxicological effects in exposure groups labeled with the job title. In no research has the same population been studied both environmentally and epidemiologically. The protocol of the epidemiological study presented here uses an integrated environmental and biological monitoring approach. The aim is to assess in hospital nurses preparing and/or administering therapy to cancer patients the current level of occupational exposure to antineoplastic drugs, DNA and chromosome damage as cancer predictive effects, and the association between the two.</p> <p>Methods/Design</p> <p>About 80 healthy non-smoking female nurses, who job it is to prepare or handle antineoplastic drugs, and a reference group of about 80 healthy non-smoking female nurses not occupationally exposed to chemicals will be examined simultaneously in a cross-sectional study. All the workers will be recruited from five hospitals in northern and central Italy after their informed consent has been obtained.</p> <p>Evaluation of surface contamination and dermal exposure to antineoplastic drugs will be assessed by determining cyclophosphamide on selected surfaces (wipes) and on the exposed nurses' clothes (pads). The concentration of unmetabolized cyclophosphamide as a biomarker of internal dose will be measured in end-shift urine samples from exposed nurses.</p> <p>Biomarkers of effect and susceptibility will be assessed in exposed and unexposed nurses: urinary concentration of 8-hydroxy-2-deoxyguanosine; DNA damage detected using the single-cell microgel electrophoresis (comet) assay in peripheral white blood cells; micronuclei and chromosome aberrations in peripheral blood lymphocytes. Genetic polymorphisms for enzymes involved in metabolic detoxification (i.e. glutathione <it>S</it>-transferases) will also be analysed.</p> <p>Using standardized questionnaires, occupational exposure will be determined in exposed nurses only, whereas potential confounders (medicine consumption, lifestyle habits, diet and other non-occupational exposures) will be assessed in both groups of hospital workers.</p> <p>Statistical analysis will be performed to ascertain the association between occupational exposure to antineoplastic drugs and biomarkers of DNA and chromosome damage, after taking into account the effects of individual genetic susceptibility, and the presence of confounding exposures.</p> <p>Discussion</p> <p>The findings of the study will be useful in updating prevention procedures for handling antineoplastic drugs.</p

A regional audit system for stillbirth: A way to better understand the phenomenon

Background: Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. Methods: For each stillbirth ( 65 22 weeks of gestation, 65 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. Results: Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62-7.03) and intrapartum cases (OR 6.64, CI95% 2.61-17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06-3.36) and were more frequent before term (OR 1.86, CI95% 1.11-3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61-17.02). Conclusions: Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures

In guerra contro il virus invasore: un’analisi critica delle metafore sul COVID-19 nel discorso politico istituzionale

Il contributo analizza le metafore ricorrenti nella comunicazione politica istituzionale nel periodo dell'emergenza sanitaria da COVID-19. La ricerca, che si col- loca nell’ambito dell’analisi critica del discorso, si basa sulle comunicazioni ufficiali (ad es. comunicati stampa, appelli alla nazione, ecc.) relative al COVID-19, rilasciate nel periodo marzo-settembre 2020 da Boris Johnson, Giuseppe Conte e Pedro Sánchez, allora, rispettivamente, i primi ministri del Regno Unito, dell’Italia e della Spagna