Topical use of tranexamic acid in coronary artery bypass operations: A double-blind, prospective, randomized, placebo-controlled study

AbstractObjectives: We sought to investigate the effect of topical application of tranexamic acid into the pericardial cavity in reducing postoperative blood loss in coronary artery surgery. Methods: A prospective, randomized, double-blind investigation with parallel groups was performed. Forty consecutive patients undergoing primary coronary surgery were randomly assigned to group 1 (tranexamic acid group) or group 2 (placebo group). Tranexamic acid (1 g in 100 mL of saline solution) or placebo was poured into the pericardial cavity and over the mediastinal tissues before sternal closure. The drainage of mediastinal blood was measured hourly. Results: Chest tube drainage in the first 24 hours was 485 ± 166 mL in the tranexamic acid group and 641 ± 184 mL in the placebo group (P = .01). Total postoperative blood loss was 573 ± 164 mL and 739 ± 228 mL, respectively (P = .01). The use of banked donor blood products was not significantly different between the two groups. Tranexamic acid could not be detected in any of the blood samples blindly collected from 24 patients to verify whether any systemic absorption of the drug occurred. There were no deaths in either group. None of the patients required reoperation for bleeding. Conclusions: Topical application of tranexamic acid into the pericardial cavity after cardiopulmonary bypass in patients undergoing primary coronary bypass operations significantly reduces postoperative bleeding. Further studies must be carried out to clarify whether a more pronounced effect on both bleeding and blood products requirement might be seen in procedures with a higher risk of bleeding. (J Thorac Cardiovasc Surg 2000;119:575-80

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

Decreasing loneliness and social isolation among the older people: systematic search and narrative review

Introduction The aim of this study is to sum up the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among elderly persons. Methods We used a systematic approach and performed a literature search of MEDLINE, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases. After identifying 13 eligible reviews addressing interventions of our interest, we proceeded with a narrative description of the study findings. Results The initiatives largely encompassed one-to-one interventions, group activities or community engagement approaches. In particular, technology interventions were recently given much attention. Overall, the studies showed non-satisfying methodological quality and their results were often inconclusive. Conclusions Although there is a growing body of evidence referring to implementation of interventions targeting social isolation and loneliness among the elderly, future well-designed interventions are necessary in order to draw firm conclusions

health promotion for the aging workforce in poland

Objectives The aging of the workforce is an issue that calls for concrete measures to promote the health of older workers. This study reports on the results of the European "ProHealth65+" research project interventions conducted in Poland in relation to workplace health promotion for older workers (WHPOW) and the institutions involved in these programs. Material and Methods A three-stage search of peer-reviewed and grey literature on the WHPOW in Poland. Results A total of 59 WHPOW programs were retrieved in Poland in the observation period (2000–2015). Most of these aimed at improving the Qualification and Training or at the Work Climate and attitudes toward older workers. The promotion, organization, and funding of these activities were carried out mainly by supra-national and governmental bodies, enterprises and employers, and educational and trainee institutions. Conclusions Although there is great commitment to the medical surveillance of workers on the part of the Polish occupational health service, our search detected a relatively low number of the WHPOW initiatives. Greater efforts should be made to introduce strategies for addressing aging of the workforce. Int J Occup Med Environ Health 2018;31(6):753–76

Geostatistics – a tool applied to the distribution of Legionella pneumophila in a hospital water system

[b]Introduction.[/b] Legionnaires' disease is normally acquired by inhalation of legionellae from a contaminated environmental source. Water systems of large buildings, such as hospitals, are often contaminated with legionellae and therefore represent a potential risk for the hospital population. The aim of this study was to evaluate the potential contamination of [i]Legionella pneumophila[/i] (LP) in a large hospital in Italy through georeferential statistical analysis to assess the possible sources of dispersion and, consequently, the risk of exposure for both health care staff and patients. [b]Materials and Method. [/b]LP serogroups 1 and 2–14 distribution was considered in the wards housed on two consecutive floors of the hospital building. On the basis of information provided by 53 bacteriological analysis, a 'random' grid of points was chosen and spatial geostatistics or [i]FAIk Kriging[/i] was applied and compared with the results of classical statistical analysis. [b]Results[/b]. Over 50% of the examined samples were positive for [i]Legionella pneumophila[/i]. LP 1 was isolated in 69% of samples from the ground floor and in 60% of sample from the first floor; LP 2–14 in 36% of sample from the ground floor and 24% from the first. The iso-estimation maps show clearly the most contaminated pipe and the difference in the diffusion of the different [i]L. pneumophila[/i] serogroups. [b]Conclusion.[/b] Experimental work has demonstrated that geostatistical methods applied to the microbiological analysis of water matrices allows a better modeling of the phenomenon under study, a greater potential for risk management and a greater choice of methods of prevention and environmental recovery to be put in place with respect to the classical statistical analysis

Sex and gender differences in migraines: a narrative review

Introduction: Gender medicine is a new medical approach aimed at the study of the differences between women and men in terms of prevention, diagnosis, and the outcome of all diseases. Migraines are among these. They represent the most common neurological illness; they are most prevalent in adults between 20 and 50 years of age and are three to four times more frequent in woman than in men. Affecting people in working age, migraines are a problem that strongly impacts the psychophysical health and productivity of workers, regardless of the specific job task they have. Methods: A narrative review was performed, searching for the most relevant articles describing gender differences in people suffering from migraines, and particularly in workers. Results: Migraine global prevalence is 20.7% in women and 9.7% in men whereas prevalence in Italy is 32.9% for women and only 13.0% for men. This difference is partly explained by hormonal differences, as well as by differences in brain structure, genetic polymorphisms and neuronal pathways. Sex differences may also play a role in the progression from episodic to chronic migraine. In workers, migraines are mostly associated with strenuous physical work in men, whilst migraines triggered by night shifts, lack of sleep, or irregular sleep patterns are more common in women. Conclusions: To this day, the reasons of sex/gender disparity for migraine are still obscure. However, migraines, chronic migraine in particular, have a negative impact on the lives of all individuals affected by this disease, but particularly in women in which family cares and working activity are often superimposed. Migraine prevention strategies should be planned in workers through the occupational health physician

The Use of Carbohydrate-Deficient Transferrin in Occupational Setting: A Systematic Review

Background: Alcohol consumption is prohibited in some categories of workers due to its temporary and longterm effects. The purpose of this study is to review and evaluate the use of carbohydrate-deficient transferrin (CDT) as a biomarker to screen alcohol consumption in workers. Methods: A systematic review was performed, searching three databases, PubMed, Scopus and Isi Web of Knowledge, up to December 2021, screening for studies that used CDT as a biomarker in workers. A quality assessment was performed on the included studies. Results: Seven studies met the inclusion criteria, accounting for more than 3200 workers from five different countries; in the samples observed, a positive percentage of CDT was found in the single studies between 7 and 24%. The large interval could be due to the differences in populations in the included studies; furthermore, not all workers are prohibited from drinking on the job. Four out of the seven studies also included questionnaires on alcohol consumption assessment. Finally, included articles were stratified by occupational hazards and by industrial sector. Interestingly, different methods of analysis and different cut-offs were used by the different authors. Conclusions: The use of CDT as a biomarker of alcohol consumption has high specificity. However, further studies are needed to be able to strongly validate the use of CDT for screening purposes in the working population to detect alcohol abuse

Impact of COVID-19 on Uro-Oncological Patients: A Comprehensive Review of the Literature

Background: The aim of this paper is to discuss the impact of COVID-19 on patients with urological malignancies (prostate cancer, bladder and upper tract urothelial cancer, kidney cancer, penile and testicular cancer) and to review the available recommendations reported in the literature. Methods: A review was performed, through the PubMed database, regarding available recommendations reported in the literature, to identify studies examining the impact of COVID-19 on treatment and clinical outcomes (including upstaging, recurrence, and mortality) for uro-oncological patients. Results: The COVID-19 pandemic dramatically changed the urological guidelines and patients’ access to screening programs and follow-up visits. Great efforts were undertaken to guarantee treatments to high-risk patients although follow up was not always possible due to recurrent surges, and patients with lower risk cancers had to wait for therapies. Conclusions: Physically and mentally, uro-oncological patients paid a heavy price during the COVID-19 pandemic. Long term data on the “costs” of clinical decisions made during the COVID-19 pandemic are still to be revealed and analyzed