Ecological correlation between diabetes hospitalizations and fine particulate matter in Italian provinces

Background: Exposure to particulate matter has been associated with increased risk of cardiovascular and respiratory diseases. We evaluated the ecological correlation between standardized hospital discharges with diabetes in Italian provinces and fine particulate matter (PM2.5) adjusting for common risk factors, socioeconomic factors and differences in hospitalization appropriateness. Methods: We used cross sectional data aggregated at the province level and available from official institutional databases for years 2008–2010. Covariates included prevalence of adult overweight, obese, smokers, physically inactive, education and income (as average gross domestic product per person, GDP). We reduced the number of covariates to a smaller number of factors for the subsequent statistical model by extracting meaningful components using principal component analysis (PCA). Log-linear multiple regression analysis was used to model diabetes hospital discharges with PCA components and PM2.5 levels and hospitalization appropriateness for men and women. Results: The first PCA components for both men and women were characterized by larger loadings of risk factors (obesity, overweight, physical inactivity, cigarette smoking) and lower socioeconomic factors (educational level and mean GDP). Diabetes hospitalization increases with the first PCA component and decreases with the index of hospitalization appropriateness. In fully adjusted models, diabetes hospitalizations increase with increasing annual PM2.5 concentrations, with a rise of 3.5 % (1.3 %–5.6 %) for men and of 4.0 % (1.5 %-6.4 %) for women per unit of PM2.5 increase. Conclusions: We found a significant ecological relationship between sex and age standardised hospital discharge with diabetes as principle diagnosis and mean annual PM2.5 concentrations in Italian provinces, once that covariates have been accounted for. The relationship was robust to different means of estimating PM2.5 exposure. A large portion of the variance of diabetes hospitalizations was linked to differences of hospital care appropriateness between Italian regions and this variable should routinely be included in ecological analyses of hospitalizations

Familial hypercholesterolemia: a systematic review of guidelines on genetic testing and patient management

BACKGROUND: Familial hypercholesterolemia (FH) is an autosomal-dominant hereditary disorder of lipid metabolism that causes lifelong exposure to increased LDL levels resulting in premature coronary heart disease and, if untreated, death. Recent studies have shown its prevalence to be higher than previously considered, which has important implications for the mortality and morbidity of associated cardiovascular disease (CVD). Several clinical tools are used worldwide to help physicians diagnose FH, but nevertheless most patients remain undetected. This systematic review of guidelines aims to assess the role of genetic testing in the screening, diagnosis, and management of patients affected by heterozygous or homozygous FH and to identify related health-care pathways. METHODS: We performed a systematic review of the literature; inclusion criteria were English or Italian guidelines focusing on genetic testing. The guidelines were included and evaluated for their content and development process using the Appraisal of Guidelines for Research and Evaluation II instrument. RESULTS: Ten guidelines were considered eligible, and all were judged to be of good quality, with slight differences among them. The most common indications for performing genetic tests were high levels of cholesterol, or physical findings consistent with lipid disorder, in the subject or in the family history. Subsequent screening of family members was indicated when a mutation had been identified in the index patient. Regarding patient management, the various guidelines agreed that intensive treatment with lipid-lowering medications should begin as quickly as possible and that lifestyle modifications should be an integral part of the therapy. CONCLUSION: Since the early detection of affected patients is beneficial for effective prevention of CVD, genetic testing is particularly useful for identifying family members via cascade screening and for distinguishing between heterozygous and homozygous individuals, the latter of which require more extreme therapeutic intervention

Socioeconomic deprivation status and air pollution by PM10 and NO2: an assessment at municipal level of 11 years in Italy

The aim of this observational study was to assess the relationship between environmental risk factors and some aspects of social economic status (SES) of the population in different Italian municipalities. Nitrogen dioxide (NO2) and particulate matter (PM10) annual means were extracted from ISPRA-BRACE (environmental information system of 483 Italian municipalities, 6% of the total amount of administrative units) from 2002 to 2012. As an indicator of sociodemographic and SES data, we collected the following: resident population, foreign nationality, low level of education, unemployment, nonhome ownership, single-parent family, and overcrowding. Low educational level, unemployment, and lack of home ownership were indirectly associated with the higher mean values of NO2 at the statistically significant level (). Major resident population and rental housing percentage determined higher levels of PM10. Northern regions showed similar results compared to the national level, with the exception of foreign residency that showed direct correlation with the increase of PM10. The central regions showed a direct relationship between NO2 and PM10 levels and higher educational levels and between NO2 levels and percentage of single-parent family. In the southern areas, higher NO2 levels were correlated with a higher rental housing percentage, as well as higher PM10 levels with a higher percentage of unemployment and lower housing density. The study shows high heterogeneity in the findings but confirms the relationship between high educational level and employment with the increased concentration of pollutants. The higher rental housing percentage may increase the pollutants’ levels too. The housing density does not seem to be in relationship with NO2 and PM10 at the national level. The analysis stratified by geographical areas showed that the direction of the correlations was different over time as the analysis was at a national level. The study represents an example of how data from national information systems can provide a preliminary evaluation and be a comparative tool for policy-makers to assess environmental risk factors and social inequalities

The use of yoga to manage stress and burnout in healthcare workers: a systematic review

The purpose of this systematic review is to analyze and summarize the current knowledge regarding the use of yoga to manage and prevent stress and burnout in healthcare workers. In February 2017, a literature search was conducted using the databases Medline (PubMed) and Scopus. Studies that addressed this topic were included. Eleven articles met the inclusion criteria. Seven studies were clinical trials that analyzed yoga interventions and evaluated effectiveness by gauging stress levels, sleep quality and quality of life. A study on Chinese nurses showed statistical improvement in stress levels following a six-month yoga program (χ2 = 16.449; p < 0.001). A population of medical students showed improvement in self-regulation values after an 11-week yoga program (from 3.49 to 3.58; p = 0.04) and in self-compassion values (from 2.88 to 3.25; p = 0.04). Four of the included articles were observational studies: They described the factors that cause stress in the work environment and highlighted that healthcare workers believe it is possible to benefit from improved physical, emotional and mental health related to yoga activity. According to the literature, yoga appears to be effective in the management of stress in healthcare workers, but it is necessary to implement methodologically relevant studies to attribute significance to such evidence

All-Optical Method to Assess Stromal Concentration of Riboflavin in Conventional and Accelerated UV-A Irradiation of the Human Cornea.

PURPOSE. We investigated the concentration of riboflavin in human donor corneas during corneal cross-linking using two-photon optical microscopy and spectrophotometry. METHODS. Eight corneal tissues were de-epithelialized and soaked with 20% dextran-enriched 0.1% riboflavin solution for 30 minutes. After stromal soaking, three tissues were irradiated using a 3 mW/cm(2) UV-A device for 30 minutes and three tissues irradiated using a 10 mW/cm2 device for 9 minutes. Two additional tissues were used as positive controls. A Ti:sapphire laser at 810 nm was used to perform two-photon emission fluorescence (TPEF) and second harmonic generation axial scanning measurements in all specimens before and after stromal soaking and after UV-A irradiation. In addition, spectrophotometry was used to collect the absorbance spectra of each tissue at the same time intervals. Analysis of the absorbance spectra and TPEF signals provided measures of the concentration depth profile of riboflavin in corneal stroma. RESULTS. After stromal soaking, the average peak concentration of riboflavin (0.020% +-0.001%) was found between a stromal depth of 100 and 250 lm; the concentration of riboflavin was almost constant up to 320 6 53 lm depth, then decreased toward the endothelium, though riboflavin was still enriched in the posterior stroma (0.016%% 6 0.001%). After conventional and accelerated UV-A irradiation, the concentration of riboflavin decreased uniformly 87% 6 2% and 67% 6 3% (P < 0.001), respectively. CONCLUSIONS. The combined use of two-photon optical microscopy and spectrophotometry provides relevant information for investigating the concentration of riboflavin in corneal stroma. The method can assist with the assessment of novel riboflavin formulations and different UV-A irradiation protocols

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

Policy and planning of prevention in Italy: results from an appraisal of prevention plans developed by Regions for the period 2010-2012

Health policies on disease prevention differ widely between countries. Studies suggest that different countries have much to learn from each other and that significant health gains could be achieved if all countries followed best practice. This paper describes the policy development and planning process relating to prevention activities in Italy, through a critical appraisal of Regional Prevention Plans (RPPs) drafted for the period 2010-2012. The analysis was performed using a specific evaluation tool developed by a Scientific Committee appointed by the Italian Ministry of Health. We appraised nineteen RPPs, comprising a total of 702 projects, most of them in the areas of universal prevention (62.9%) and prevention in high risk groups (27.0%). Italian Regions established prevention activities using an innovative combination of population and high-risk individuals approaches. However, some issues, such as the need to reduce health inequalities, were poorly addressed. The technical drafting of RPPs required some improvement; e.g. the evidence of the effectiveness and cost-effectiveness of the health interventions proposed was seldom reported. There were significant geographical differences across the Regions in the appraisal of RPPs. Our research suggests that continuous assessment of the planning process of prevention may become a very useful tool for monitoring, and ultimately strengthening, public health capacity in the field of prevention. Further research is needed to analyze determinants of regional variation

ER access by foreign citizens between 1999 and 2014 in five large hospital of Rome, Italy

...Lack of information about the health services and the status of illegal immigrant can make difficult for foreign population to access primary care, leading to misuse of emergency rooms (ER). This study investigated the accesses between January 1999 and December 2014 to the ERs of five large hospital of Rome, Italy

Reliability and use of Copenhagen Burnout Inventory in italian sample of university professors

Academics often have to face with burnout syndrome at work. This cross-sectional study evaluates the reliability of the Italian version of the Copenhagen Burnout Inventory (CBI) in a sample of Academics of Sapienza University of Faculty of Medicine and Pharmacy, through an online questionnaire composed of the CBI, SF12 Health Survey, and Positivity Scale. Univariate, bivariate, multivariate analyses, and Cronbach α coefficients of CBI were performed. Ninety-five participants completed the questionnaire (response rate 85%). Cronbach’s α of the three domains were high (0.892, 0.868, and 0.836). Women, younger and part time professors reported higher score in personal (p = 0.025; 0.060) and work burnout. In multivariate analysis decreasing age (β = −0.263; p = 0.001); being a professor in environmental technicians (β = −0.120; p = 0.098); and low mental (β = −0.263; p = 0.020), physical (β = −0.319; p ≤ 0.001) and positivity scores (β = −0.237; p = 0.031) predict significantly higher personal burnout. Low physical (β = −0.346; p &lt; 0.001) and mental (β = − 0.249; p = 0.013) positivity (β = −0.345; p = 0.001) scores; fewer years of work (β = −0.269; p ≤ 0.001); and being a medical or nursing professor (β = 0.169; p = 0.016) predicts high work burnout. Low MCS predicts a high level of student burnout. Results suggest that the Italian version of the CBI is a reliable instrument. Further research should focus on the prevalence of burnout in academics