Requirements for cabin crew medical examinations and assessments

The aim of the current study is to review current regulations relatively to medical requirements necessary to achieve suitability to fly of the cabin crew. There are three classes of flight crew medical standards and licensing. A first class medical certificate is required for all pilots who perform professional flights or skydiving instructors. A second class medical certificate is required only for persons who do not perform professional flights, skydiving activities or any other professional activity related to aircraft piloting (cabin crew, holders of Light Aircraft Pilot’s Licence - LAPL, remote pilot operators). Finally, a third class medical certificate is required for workers engaged in air traffic control

The need to improve implementation and use of lifestyle surveillance systems for planning prevention activities: an analysis of the Italian Regions

Objectives: To describe the level of use of lifestyle surveillance systems in Italy and to identify predictors of their use by the Italian Regions for planning and monitoring purposes. Study design: Data were extracted from the 19 Regional Prevention Plans (RPPs) and the health promotion and prevention projects included in them developed by the Italian Regions within the National Prevention Plan 2010-2013. Methods: The 19 RPPs and the 702 projects were appraised using a tool specifically developed for the purpose. Multiple logistic regression was performed to identify predictors of use of surveillance systems in the 359 projects that could use them. Results: The analysis of regional epidemiological contexts does not always rely upon surveillance system data and there were too few projects aimed at the maintenance and the development of these systems. Moreover, fewer than half of projects that could have used surveillance systems for planning and evaluation procedures actually did so, despite the potential value of these data. There was a statistically significant association between Regional Health Care Expenditure (RHCE) and the use of surveillance system data for planning and/or evaluation of the projects (OR 7.81, 95% CI 2.86-21.29). Conclusions: Use of surveillance systems for regional prevention planning in Italy is not optimal due to late implementation, presence of different data collecting systems and RGDP inequalities. There is a pressing need for full implementation of surveillance systems to allow better definition of the priorities and objectives of public health interventions

European survey on knowledge and attitudes of public health professionals on public health genomics: pilot study

Background: During the past decade a debate has arisen on the possible utility of genomic science for public health purposes. Within this context, a survey is being conducted to assess attitudes of European public health (PH) professionals belonging to European Public Health Association (EUPHA) network regarding their role in the implementation of public health genomics (PHG), and their knowledge and attitudes regarding genetic testing and the delivery of genetic services. Methods: A pilot on-line survey was conducted on professionals from Sapienza University of Rome and the Vrije University of Amsterdam. The survey tool is composed of 5 sections: Personal details, Professional activity, Knowledge on genetic testing and delivery of genetic services, Attitudes on genetic testing and delivery of genetic services, Attitudes on the role of PH professionals in PHG. Results: 34 people responded to the questionnaire, mostly medical doctors (61.8%). No respondents correctly identified all evidence-based applications of genetic testing. More than one third of respondents agreed that it would be more important to invest resources in the social and environmental causes of ill health than in genetic testing. Nearly 70% thought that PHG needs to be grounded on evidence of effectiveness, a lower rate agreed ii should be grounded on cost-effectiveness. The rate of agreement with the proposed roles of PH professionals in PHG was very high. Conclusion: This pilot study showed a positive attitude but the need to improve knowledge of PH professionals on PHG. It provided useful input for the implementation of the survey to all members of the EUPHA network

How much do needlestick injuries cost? a systematic review of the economic evaluations of needlestick and sharps injuries among healthcare personnel

objective. To provide an overview of the economic aspects of needlestick and sharps injury (NSI) management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate the impact of safety-engineered devices on health care methods. A systematic review of economic analyses related to NSIs was performed in accordance with the PRISMA statement and by searching PubMed and Scopus databases (January 1997–February 2015). Mean costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int$). results. A total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11 studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means for aggregate (direct + indirect) costs was Int$747 (range, Int$199–Int$1,691). The medians of the means for disaggregated costs were Int$425 (range, Int$48–Int$1,516) for direct costs (9 studies) and Int$322 (range, Int$152–Int$413) for indirect costs (6 studies). When compared with data-driven studies, modeling studies had higher disaggregated and aggregated costs, but data-driven studies showed greater variability. Indirect costs were consistent between studies, mostly referring to lost productivity, while direct costs varied widely within and between studies according to source infectivity, HCP susceptibility, and post-exposure diagnostic and prophylactic protocols. Costs of treating infections were not included, and intangible costs could equal those associated with NSI medical evaluations. conclusions. NSIs generate significant direct, indirect, potential, and intangible costs, possibly increasing over time. Economic efforts directed at preventing occupational exposures and infections, including provision of safety-engineered devices, may be offset by the savings from a lower incidence of NSIs

Identification of delivery models for the provision of predictive genetic testing in Europe: protocol for a multicentre qualitative study and a systematic review of the literature

Introduction: The appropriate application of genomic technologies in healthcare is surrounded by many concerns. In particular, there is a lack of evidence on what constitutes an optimal genetic service delivery model, which depends on the type of genetic test and healthcare context considered. The present project aims to identify, classify, and evaluate delivery models for the provision of predictive genetic testing in Europe and in selected Anglophone extra-European countries (the USA, Canada, Australia, and New Zealand). It also sets out to survey the European public health community’s readiness to incorporate public health genomics into their practice. Materials and equipment: The project consists of (i) a systematic review of published literature and selected country websites, (ii) structured interviews with health experts on the genetic service delivery models in their respective countries, and (iii) a survey of European Public Health Association (EUPHA) members’ knowledge and attitudes toward genomics applications in clinical practice. The inclusion criteria for the systematic review are that articles be published in the period 2000–2015; be in English or Italian; and be from European countries or from Canada, the USA, Australia, or New Zealand. Additional policy documents will be retrieved from represented countries’ government-affiliated websites. The results of the research will be disseminated through the EUPHA network, the Italian Network for Genomics in Public Health (GENISAP), and seminars and workshops. Expected impact of the study on public health: The transfer of genomic technologies from research to clinical application is influenced not only by several factors inherent to research goals and delivery of healthcare but also by external and commercial interests that may cause the premature introduction of genetic tests in the public and private sectors. Furthermore, current genetic services are delivered without a standardized set of process and outcome measures, which makes the evaluation of healthcare services difficult. The present study will identify and classify delivery models and, subsequently, establish which are appropriate for the provision of predictive genetic testing in Europe by comparing sets of process and outcome measures. In this way, the study will provide a basis for future recommendations to decision makers involved in the financing, delivery, and consumption of genetic services

Identification of delivery models for the provision of genetic testing, policies governing the use of genomic applications and evaluation of genetic services: a multicentre study

The provision of genetic services, along with research in the fields of genomics and genetics, has evolved in recent years to meet the increasing demand of consumers interested in prediction of genomic diseases and various inherited traits (e.g. ability in sports, nutrigenomics, ancestry, etc.). Consumer demand and commercial interests have paved the way for the premature introduction, in the public and private healthcare sectors, of genetic tests with insufficient data on analytical and clinical validity, as well as clinical utility. There is also lack or insufficient evidence of cost-effectiveness of several genetic applications already introduced in clinical and public health practice. These concerns contribute to the lack of evidence on what constitutes an optimal genetic service delivery model, defined as the broad context within the Public Health Genomics framework in which genetic services are offered to individuals and families with or at risk of genetic disorders. The aim of this dissertation is to identify existing genetic service delivery models, policies governing the use of genomic applications, and measures to evaluate genetic testing and related services in Europe and extra-European (Anglophone) countries (Canada, USA, Australia, or New Zealand). Two methodological approaches have been employed, a systematic review of the literature and a cross-sectional study addressing healthcare professionals with good knowledge and/or experience on the provision of BRCA1/2, Lynch syndrome, familial hypercholesterolemia, and inherited thrombophilia genetic testing, policies on genetic applications and evaluation of genetic services. The identification and evaluation of existing genetic service delivery models are important steps towards the enhancement and standardization of genetic service provision. Current models of genetic services require the integration of genetics in all medical specialties, collaboration among different healthcare professionals, and redistribution of professional roles. Prior to implementation in clinical and public health practice, genetic tests should be evaluated based on available efficacy and cost-effectiveness data and offered to the citizens as right to benefit from innovative healthcare. The proper implementation of genomics application in mainstream medicine can be achieved through professional education, training, adequate funding, public policies, and public awareness of the field of genomic medicine

Identificazione di modelli organizzativi di offerta di test genetici predittivi: proposta di un protocollo di studio multicentrico europeo

La genomica in sanità pubblica è un ambito multidisciplinare che ha stabilito basi scientifiche per una corretta implementazione dei progressi della genomica nella pratica clinica e di sanità pubblica. Tuttavia, tale implementazione è ancora nelle fasi iniziali con numerosi quesiti non ancora risolti. La rapida diffusione dei test genetici e la loro commercializzazione hanno un impatto sul sistema sanitario e sollevano preoccupazioni per quanto riguarda la corretta fornitura di servizi di genetica medica. La preoccupazione principale è l'introduzione precoce di test genetici predittivi, sia nel settore pubblico che nel privato, di cui la validità analitica e clinica, nonché l'utilità delle strategie diagnostiche e di screening non sono ben documentate. Una grande varietà di test genetici sono attualmente offerti direttamente ai consumatori (Direct-To-Consumer, DTC) da parte di imprese private presenti soprattutto negli Stati Uniti, ma anche in Europa. La maggior parte delle aziende opera via internet e senza il coinvolgimento di un professionista sanitario. Pertanto, è necessario un programma di ricerca globale per trasferire le scoperte del genoma umano nella pratica clinica, massimizzando i benefici per la salute e minimizzando i danni alle popolazioni: aspetti di cui si occupa la ricerca traslazionale. I modelli organizzativi di offerta di test genetici predittivi sono nella fase T3 della ricerca traslazionale che studia i modelli per l’implementazione delle linee guida evidence-based nella pratica clinica, attraverso ricerche sulle modalità di trasferimento, disseminazione e diffusione delle nuove tecnologie. Obiettivi. Gli obiettivi del progetto sono: 1) descrivere e classificare i modelli organizzativi di offerta di test genetici predittivi esistenti in Europa e nei paesi extra-europei (USA, Canada, Australia, Nuova Zelanda) mediante una revisione sistematica della letteratura; 2) valutare i modelli organizzativi di offerta di test genetici predittivi tramite interviste a testimoni privilegiati e la raccolta degli indicatori di processo e di esito dai modelli organizzativi identificati in letteratura; 3) valutare le competenze dei professionisti di sanità pubblica provenienti da 26 paesi europei membri dell’European Public Health Association (EUPHA), tramite survey sull’uso appropriato delle tecniche genetiche in ambito preventivo. Risultati attesi. Lo studio fornirà un contributo alla descrizione e alla valutazione dei modelli più idonei per la fornitura di test genetici predittivi, rendendo possibile l’individuazione di modelli organizzativi internazionali e delle best practices da adattare alla realtà italiana. Inoltre, lo studio sarà utile per rilevare il fabbisogno formativo e le esigenze informative dei professionisti di sanità pubblica nell’ambito della medicina predittiva

Procedura per la comunicazione di eventi avversi al paziente e alla famiglia.

La comunicazione trasparente ed onesta degli eventi avversi e delle loro conseguenze realizza un principio etico ed deontologico che permette di rafforzare la relazione di fiducia tra operatori sanitari e pazienti ed i loro familiari, e favorisce l'apprendimento dall'errore e il miglioramento della pratica clinica. Saper comunicare e' una componente indispensabile di una sanita' che pone la persona al centro dei propri interessi

Knowledge, attitudes and behaviours on doping and supplements in young football players in Italy

Highlights • This study investigates knowledge, attitudes and behaviours of young amateur players about doping (growth hormone, anabolic steroids) and the use of nutritional supplements (amino acids, creatine) in sport. • Amateur football players, residing in three Italian regions (Campania, Lazio, Sardegna), were randomly selected from the list of qualified schools of the FIGC (Italian Football Federation) and interviewed. • We found that up to 6.5% of males consider personal use of substances to enhance sport performance and, a gap in knowledge about their side-effects, especially for anabolic steroids. • The present study provides additional information regarding the importance of the intention to use doping agents among young amateur players. • The coach, the team manager and the general practitioner should be a referential figure for young athletes