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

HCV-1b intra-subtype variability: Impact on genetic barrier to protease inhibitors

Due to error-prone RNA polymerase and the lack of proofreading mechanisms, to the spread worldwide and probable long-term presence in human population, HCV showed a high degree of inter- and intra-subtype genetic variability. Protease inhibitors (PIs), a new class of drugs, have been designed specifically on the HCV genotype 1 NS3 protease three-dimensional structure. The viral genetic barrier limits the efficacy of PIs, and fourteen loci in the HCV NS3 gene are involved in resistance to PIs. A sensitive method (15UI/ml) for study the HCV genetic profile of 125 strains from patients naïve to PIs, was developed through the use of new degenerate primers for subtype 1b. We observed the presence of naturally resistance-associated variants in 14% of the HCV strains (V36L, F43S, T54S, I153V, R155Q, D168A/G). T54S was the most common mutation (4%) detected. We investigated, through minimal score (m.s.) calculating, how the HCV intra-subtype 1b variability modifies the genetic barrier to PIs. For >60% of strains a single transition (m.s. of 1) was required for selection of low to medium resistance mutations, while more than one transition/transversion (m.s. ⩾2.5) or one transition plus one transversion (m.s. ⩾3.5) was necessary for most of the high level PI-resistant-associated mutations, except for A156V, for which a single transition was sufficient (m.s. of 1). However, the presence at locus 36 of the amino acid polymorphism S36 in one case and the wild type V36 in 6 isolates, encoded by unusual GTA or GTG codons, might determined a higher probability of V36L/M mutations because of the reduction of the genetic barrier. Instead, the presence of the CGA and CGT codons in the 155(th) position increases the genetic barrier for R155M or R155Q/M. The large intra-subtype variability, suggests that a routine baseline resistance test must be used before PIs-treatment

Knowledge, attitudes, behaviour and training needs of ICU nurses on medication errors in the use of IV drugs: a pilot study

Background. Prior studies have shown that lack of knowledge and training, incorrect behaviours and attitudes put Intensive care unit (ICU) patients at risk. The aim of this study was to assess knowledge, attitudes and professional behaviour of Italian nurses towards preparation and administration of intravenous medications in ICUs. Reliability and validity of the questionnaire were assessed as well. Methods. A survey was conducted on a sample of Italian nurses in 2015 through a self-administered questionnaire. Reliability was tested and content validity was evaluated using Cronbach’s alpha. Multiple logistic regression models were built to identify predictors of knowledge, attitudes and behaviours. Results. In total, 123 nurses completed the questionnaire. For the variable ‘adequate knowledge’ nurses were divided in those who had correctly answered 7 of 8 questions on knowledge and everyone else, while for ‘attitudes and professional behaviour’ responders were grouped into those who showed a positive attitude and appropriate behaviour and everyone else. Results of the multiple logistic regression analyses show some association, although not statistically significant, between correct behaviour, positive attitudes and the years of work experience. It is interesting to note that appropriate knowledge weighs negatively on correct behaviour (OR 0.06, 95% CI 0.04-0.42). Moreover, graduate nurses have more appropriate knowledge than those who are not. A high level of interest for specific training was reported by almost all responders. Cronbach’s alpha for all three sections together resulted in a value of 0.49. Conclusions.This pilot study demonstrated the need to amend the questionnaire, especially the knowledge and behaviour sections, in which the Cronbach’s alpha was less than 0.7. Targeted educational programs are needed to improve the expertise of nurses to reduce medication errors during preparation and administration of IV medications in the ICU

Which BRCA genetic testing programs are ready for implementation in health care? A systematic review of economic evaluations

Purpose: There is considerable evidence regarding the efficacy and effectiveness of BRCA genetic testing programs, but whether they represent good use of financial resources is not clear. Therefore, we aimed to identify the main health-care programs for BRCA testing and to evaluate their cost-effectiveness. Methods: We performed a systematic review of full economic evaluations of health-care programs involving BRCA testing. Results: Nine economic evaluations were included, and four main categories of BRCA testing programs were identified: (i) populationbased genetic screening of individuals without cancer, either comprehensive or targeted based on ancestry; (ii) family history (FH)-based genetic screening, i.e., testing individuals without cancer but with FH suggestive of BRCA mutation; (iii) familial mutation (FM)- based genetic screening, i.e., testing individuals without cancer but with known familial BRCA mutation; and (iv) cancer-based genetic screening, i.e., testing individuals with BRCA-related cancers. Conclusions: Currently BRCA1/2 population-based screening represents good value for the money among Ashkenazi Jews only. FHbased screening is potentially very cost-effective, although further studies that include costs of identifying high-risk women are needed. There is no evidence of cost-effectiveness for BRCA screening of all newly diagnosed cases of breast/ovarian cancers followed by cascade testing of relatives, but programs that include tools for identifying affected women at higher risk for inherited forms are promising. Cost-effectiveness is highly sensitive to the cost of BRCA1/2 testing

Greenhouse gas from moving bed based integrated fixed film activated sludge membrane bioreactors

The present paper reports the results of a nitrous oxide production investigation in a moving bed based integrated fixed film activated sludge (IFAS) membrane bioreactor (MBR) pilot plant designed in accordance with the UCT layout for biological phosphorous removal. Samples of gas and liquid were collected in order to measure the gaseous, as well as the dissolved concentration of N2O. Furthermore, the gas flow rate from each reactor was measured and the gas flux was estimated. The results confirmed that the anoxic reactor represents the main source of nitrous oxide production. A significant production of N2O was, however, also found in the anaerobic reactor, thus indicating a probable occurrence of the DPAOs activity

Risk factors and outcome among a large patient cohort with community-acquired acute hepatitis C in Italy

BACKGROUND: The epidemiology of acute hepatitis C has changed during the past decade in Western countries. Acute HCV infection has a high rate of chronicity, but it is unclear when patients with acute infection should be treated. METHODS: To evaluate current sources of hepatitis C virus (HCV) transmission in Italy and to assess the rate of and factors associated with chronic infection, we enrolled 214 consecutive patients with newly acquired hepatitis C during 1999-2004. The patients were from 12 health care centers throughout the country, and they were followed up for a mean (+/- SD) period of 14+/-15.8 months. Biochemical liver tests were performed, and HCV RNA levels were monitored. RESULTS: A total of 146 patients (68%) had symptomatic disease. The most common risk factors for acquiring hepatitis C that were reported were intravenous drug use and medical procedures. The proportion of subjects with spontaneous resolution of infection was 36%. The average timespan from disease onset to HCV RNA clearance was 71 days (range, 27-173 days). In fact, 58 (80%) of 73 patients with self-limiting hepatitis experienced HCV RNA clearance within 3 months of disease onset. Multiple logistic regression analyses showed that none of the variables considered (including asymptomatic disease) were associated with increased risk of developing chronic hepatitis C. CONCLUSIONS: These findings underscore the importance of medical procedures as risk factors in the current spread of HCV infection in Italy. Because nearly all patients with acute, self-limiting hepatitis C - both symptomatic and asymptomatic - have spontaneous viral clearance within 3 months of disease onset, it seems reasonable to start treatment after this time period ends to avoid costly and useless treatment

Phylogenetic Analysis of isolates from new cases of HBV infection in Southern Italy.

The level of endemicity of hepatitis B virus (HBV) infections in Italy is low and genotype D infections predominant. New HBV strains may however be introduced as a result of movements of people from regions of high endemicity. The aim of the present study was to determine whether strains from new cases of acute hepatitis B detected in southern Italy were due to endemic or new HBV strains. We studied 34 isolates from patients with acute hepatitis B infection, and 35 from chronic hepatitis B patients. A phylogenetic analysis of preS/S region was done by comparing the sequences from the acute and chronic cases with references sequences. The study showed that 44% of strain from acute hepatitis B patients were of genotype A, 53% of genotype D, and 3% of genotype E. The molecular analysis of isolates from acute hepatitis B patients from Sicily showed a change in the local epidemiology of this infection, with an increase in HBV/A infections and a clustering effect for HBV D2, possibly correlated to immigration. The introduction of new genotypes , could have an effect on HBV-correlated diseases due to the different association between genotype, liver disease and response to antiviral therapy