Studio trasversale sulle variabili di stress lavoro-correlato nei medici in formazione specialistica del maggiore Policlinico Universitario della Sicilia

Introduzione: Il rischio stress lavoro-correlato è uno degli obiettivi della valutazione e prevenzione dei rischi occupazionali negli operatori sanitari (O.S.). I medici in formazione specialistica (MIFS) rappresentano una tipologia di OS sovrapponibile ai dirigenti medici in termini di esposizione lavorativa e quindi di insorgenza di sindromi da stress lavoro-correlato. Obiettivi: Obiettivo dello studio è valutare un set di fattori di rischio stress lavoro-correlato nei MIFS del principale Policlinico Universitario della Sicilia, sottoposti a sorveglianza sanitaria. Materiali e Metodi: Studio trasversale condotto mediante questionario anonimo ed autosomministrato. Risultati: Il 45% dei MIFS di area clinica ed il 37% di area chirurgica usufruiscono del giorno di riposo compensativo a fronte del 92% dell’area dei servizi (p<0,001). Il sistema di rendicontazione delle presenze/monte orario è presente nell’80% delle scuole dell’area dei servizi, nel 60% di quelle di area medica e nel 50% di quelle di area chirurgica (p<0,001). I MIFS delle scuole dell’area chirurgica dichiarano di usufruire delle pause lavorative (41%) con frequenza minore rispetto ai MIFS dell’area medica (60%) e dell’area dei servizi (74%) (p<0,001). I MIFS sia di area medica (47%) che di area chirurgica (47%) risultano essere più esposti a stress lavoro-correlato (p<0,001) rispetto ai MIFS dell’area dei servizi (29%). Conclusioni: Il lavoro documenta un maggiore rischio di stress lavoro-correlato nei MIFS di area chirurgica rispetto alle altre aree professionali indagate. Appare necessario strutturare degli specifici programmi formativi finalizzati alla gestione dell’esposizione al rischio di stress lavoro-correlato per i MIFS, incentrandoli sia sulla persona che sull’ambiente di lavoro.Background: Among health care workers (HCWs), assessment and prevention of work-related stress in the workplace is one of the main goal. Post-graduate medical residents (MRs) are a group of HCWs comparable to medical doctors in terms of occupational exposure and of work-related stress syndromes occurrence. Objectives: To assess the risk of the exposition to work-related stress among MRs attending the major University Hospital of Sicily. Methods: Cross-sectional survey through an anonymous and self-administered questionnaire. Results: 45% of clinical MRs and 37% of surgical MRs have access to compensatory rest days against 92% of MRs of the services area (p <0.001). A work attendance detection system for MRs is available in 80% of the postgraduate medical schools of the services area, in 60% of the clinical postgraduate schools and in 50% of the surgical postgraduate schools (p <0.001). MRs of postgraduate surgical schools declare to have access to work breaks (41%) with less frequency compared to clinical (60%) and services MRs (74%) (p <0.001). Both clinical (47%) and surgical MRs (47%) result to be more exposed to work-related stress than MRs of the services area (27%) (p <0.001). Conclusions: The survey documents an exposure excess of work-related stress for all the considered variables in MRs of surgical area. It is strongly suggested to provide for specific training programs aimed to manage the MRs risk exposure to work-related stress, focusing both on the workers and the work environment

Erratum to nodal management and upstaging of disease. Initial results from the Italian VATS Lobectomy Registry

[This corrects the article DOI: 10.21037/jtd.2017.06.12.]

Cannabidiol Reduces Aβ-Induced Neuroinflammation and Promotes Hippocampal Neurogenesis through PPARγ Involvement

Peroxisome proliferator-activated receptor-γ (PPARγ) has been reported to be involved in the etiology of pathological features of Alzheimer's disease (AD). Cannabidiol (CBD), a Cannabis derivative devoid of psychomimetic effects, has attracted much attention because of its promising neuroprotective properties in rat AD models, even though the mechanism responsible for such actions remains unknown. This study was aimed at exploring whether CBD effects could be subordinate to its activity at PPARγ, which has been recently indicated as its putative binding site. CBD actions on β-amyloid-induced neurotoxicity in rat AD models, either in presence or absence of PPAR antagonists were investigated. Results showed that the blockade of PPARγ was able to significantly blunt CBD effects on reactive gliosis and subsequently on neuronal damage. Moreover, due to its interaction at PPARγ, CBD was observed to stimulate hippocampal neurogenesis. All these findings report the inescapable role of this receptor in mediating CBD actions, here reported

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Work-related stress variables among post-graduate medical residents (MESH) at the major teaching hospital of Sicily (Italy): A cross-sectional survey

Background: Among health care workers (HCWs), work-related stress is one of the main topics in risk assessment and prevention at the workplace. Post-graduate medical residents (MRs) are a group of HCWs comparable to medical doctors in terms of occupational exposure and occurrence of work-related stress syndromes. Objectives: Risk assessment of work-related stress among MRs attending the major University Hospital of Sicily. Methods: A cross-sectional survey via an anonymous and self-administered questionnaire. Results: 45% of clinical MRs and 37% of surgical MRs had access to compensatory rest days against 92% of MRs of the services area (p&lt;0.001). A work attendance recording system for MRs was available in 80% of the postgraduate medical schools of the services area, in 60% of the clinical postgraduate schools and in 50% of the surgical postgraduate schools (p&lt;0.001). MRs of the postgraduate surgical schools reported having access to work breaks (41%) with less frequency compared to clinical (60%) and services MRs (74%) (p&lt;0.001). Both clinical (47%) and surgical MRs (47%) were more exposed to work-related stress than MRs of the services area (27%) (p&lt;0.001). Conclusions: The survey demonstrated excess exposure to work-related stress for all the considered variables in MRs of the surgical area, compared with MRs of clinical and services areas. It is strongly recommended to provide specific training programmes aimed at managing the MRs' risk of exposure to work-related stress, focusing both on the workers and the work environment

Bladder cancer: Innovative approaches beyond the diagnosis

Bladder carcinoma (BC) is the most common urinary malignant tumor. In the light of the unsuccessful current therapies and their side effects, new pharmacological strategies are needed. In addition to the well known therapeutic possibilities described in the first section, we focused our attention on very recent and innovative tools to approach this target (new drug candidates from epigenetic modulators to endothelin receptor inhibitors, improved technological formulations, active principles from plants, and dietary components). Then, in the last paragraph, we analyzed the etiology of recurrent BC, with particular attention to cellular microenvironment. In fact, the incidence of recurrence is up to 90%, and 25% of tumours show progression towards invasiveness

High Variability of Fabry Disease Manifestations in an Extended Italian Family

Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of the lysosomal hydrolase \u3b1-galactosidase A (\u3b1-GAL). The impairment of \u3b1-GAL results in the accumulation of undegraded glycosphingolipids in lysosomes and subsequent cell and microvascular dysfunctions. This study reports the clinical, biochemical, and molecular characterization of 15 members of the same family. Eight members showed the exonic mutation M51I in the GLA gene, a disease-causing mutation associated with the atypical phenotype. The clinical history of this family highlights a wide phenotypic variability, in terms of involved organs and severity. The phenotypic variability of two male patients is not related to differences in \u3b1-GAL enzymatic activity: though both have no enzymatic activity, the youngest shows severe symptoms, while the eldest is asymptomatic. It is noticeable that for two female patients with the M51I mutation the initial clinical diagnosis was different from FD. One of them was diagnosed with Familial Mediterranean Fever, the other with Multiple Sclerosis. Overall, this study confirms that the extreme variability of the clinical manifestations of FD is not entirely attributable to different mutations in the GLA gene and emphasizes the need to consider other factors or mechanisms involved in the pathogenesis of Fabry Disease

Pleurodesis with Thulium Cyber Laser versus talc poudrage: a comparative experimental study

none12noSclerosing fluids to achieve pleurodesis could be hardly replaced for bed-side procedures, but other devices may be successfully applied during thoracoscopy. Thulium Cyber Laser was experimented for this purpose and compared to talc poudrage. Twenty pigs underwent operative videothoracoscopy (VATS). Ten models were subjected to double-port VATS and parietal pleura photoevaporation using Thulium Cyber Laser™ (TCL) 150 W 2010 nm on the posterior third of three ribs; the pleural surface was homogeneously treated inside the target perimeter. The remaining ten pigs underwent uniportal thoracoscopy; talc poudrage was performed using the current clinical practice dosage (1 g/18 kg) with accurate talc powder spread over the whole pleural surface. All models were followed up for 60 days. Pleurodesis firmness was graded on a three-tier scale (none-moderate-firm) and site-matching topographical expectancy was evaluated. TCL produced pleurodesis in all models: 7/10 were firm and 3/10 moderate. Talc poudrage pleurodesis was firm in 4/10 and moderate in 6/10. Pleural adhesions were found exclusively in the treated area after laser treatment, while talc created a wide spectrum of effects, most commonly anarchic jagged adhesions obliterating less than 50 % of the pleural cavity (7/10), mostly declivous. The pathologist found more aggressive inflammation (sometimes severe) in the talc group. Expected localized pleurodesis was always registered in laser group (10/10), while talc poudrage was found poorly effective if consistent pleurodesis is expected in an apico-dorsal position (2/10). Laser pleurodesis appears more homogeneous, qualitatively not inferior, and topographically more predictable than talc pleurodesis. Parietal photoevaporation seems effective and the localized pleurodesis is reproducible.mixedDroghetti, Andrea; Vannucci, Jacopo; Bufalari, Antonello; Bellezza, Guido; De Monte, Valentina; Marulli, Giuseppe; Bottoli, Maria Caterina; Giovanardi, Michele; Daddi, Niccolo'; De Angelis, Verena; Moriconi, Franco; Puma, FrancescoDroghetti, Andrea; Vannucci, Jacopo; Bufalari, Antonello; Bellezza, Guido; De Monte, Valentina; Marulli, Giuseppe; Bottoli, Maria Caterina; Giovanardi, Michele; Daddi, Niccolo'; De Angelis, Verena; Moriconi, Franco; Puma, Francesc