[show abstract][hide abstract] ABSTRACT: Vancomycin-resistant enterococci (VRE) represent a major problem in healthcare settings worldwide. It is still unclear which is the most effective infection control and prevention (ICP) measure to reduce the spread of hospital-acquired VRE.
Cochrane databases, MEDLINE, EMBASE and CINAHL were searched until June 2012 to find studies comparing wards/hospitals where ICP measures to prevent VRE transmission were investigated. In the absence of heterogeneity, a fixed-effects model was used to estimate the pooled risk ratio (RR). Study quality was assessed according to Cochrane Effective Practice and Organisation of Care (EPOC) criteria.
The search strategy retrieved 549 studies and 9 studies (1 randomized clinical trial, 3 controlled clinical trials and 5 interrupted time series) with 30 949 participants were included. The overall study quality was low. Implementation of hand hygiene was associated with a 47% decrease in the VRE acquisition rate (pooled RR 0.53, 95% CI 0.39-0.73, I(2) 26%) while contact precautions did not significantly reduce the VRE acquisition rate (pooled RR 1.08, 95% CI 0.63-1.83, I(2) 0%). Due to the low number of studies, meta-analysis was not applied for surveillance screening, environmental cleaning and antibiotic formulary interventions. No studies were available on the effectiveness of isolation and cohorting of patients and staff.
Available evidence on the ICP measures to reduce VRE spread in adult hospitalized patients is poor. This systematic review suggests a significant role for the implementation of hand hygiene. Further studies with appropriate study design are urgently needed to define ICP measures able to reduce the acquisition of VRE among hospitalized patients.
Journal of Antimicrobial Chemotherapy 01/2014; · 5.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: Transanal local excision has been suggested as an attractive approach for patients with rectal cancer who show a major clinical response after preoperative chemoradiotherapy.
To evaluate the impact of transanal local excision on the local recurrence of rectal cancer in patients who had a major clinical response after preoperative chemoradiotherapy.
Sequential 2-stage phase II study for early efficacy.
Patients with clinical T3 or low-lying T2 rectal adenocarcinoma that showed a major clinical response after a preoperative chemoradiotherapy. Eligible patients underwent a full-thickness transanal local excision. According to their histopathology, the patients staged as ypT0-1 were observed, while the remaining patients were recommended to undergo a subsequent total mesorectal excision.
A local recurrence rate of ≤5% was set as a successful rate for stopping the trial early after the first stage.
The study group included 63 patients. Before chemoradiotherapy, patients were staged as clinical T3 (n = 42) and T2 (n = 21). After the local excision, 43 patients fulfilled the criteria to be observed with no further treatment. Nine of the remaining 20 patients for whom a subsequent total mesorectal excision was recommended refused surgery. Two of these patients who refused surgery had intraluminal local recurrence; both had a ypT2 tumor and underwent salvage surgery. The estimated cumulative 3-year overall survival, disease-free survival and local disease-free survival were 91.5% (95% CI: 75.9-97.2), 91.0% (95% CI: 77.0-96.6) and 96.9% (95% CI: 80.3-99.5), respectively.
The time of follow-up is still short and the sample size is limited.
Our data suggest that local excision is a good option for patients with a major clinical response after chemoradiotherapy. A longer period of follow-up is required to confirm these findings.
Diseases of the Colon & Rectum 12/2013; 56(12):1349-56. · 3.34 Impact Factor
[show abstract][hide abstract] ABSTRACT: Our study aimed to estimate the prevalence of pregnancy e-health seekers in a large Italian sample; to explore the factors influencing the choices of the childbearing women regarding their lifestyles after internet consultation; and finally to investigate potential differences between primiparous and multiparous women in internet use to find information about pregnancy.
A multicentre survey was carried out in seven Italian cities. Data were collected through a validated questionnaire administered in waiting rooms of outpatient departments by medical doctors. Respondents were questioned about their sociodemographic status, their use of the internet to seek pregnancy information and their consequent choices to modify their lifestyles. Data were analysed using descriptive statistics and logistic regression.
Almost all women were pregnancy e-health seekers (95%), including those who also received information from healthcare professionals. Indeed, the main reason for searching the web was the need of further knowledge on pregnancy-related topic, over and beyond other key advantages of the net such as anonymity, simplicity and rapidity. A higher likelihood of changing lifestyle after pregnancy e-health was observed among the women who searched institutional websites; declared more confidence in the information retrieved; participated into pregnancy-centred forum online; and were residents in Italy.
To reduce the likelihood for women of both finding erroneous information or misinterpreting correct ones, healthcare professionals should commit to fill the information gap and guide pregnant women in the online searches. Also, future studies are strongly needed to analyse the quality and accuracy of health information found on the web.
Journal of epidemiology and community health 09/2013; · 3.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: Introduction The aim of the present study is to review the economic burden of varicella disease and the benefit of universal varicella vaccination in different settings pending its implementation in all Italian regions. Materials and Methods Research was conducted using PubMed, Scopus and ISI databases. Score quality and data extraction were performed for all included studies. Results Twenty-three articles met the criteria: 15 cost-effectiveness, 8 cost-benefit and one cost-utility analysis. Varicella vaccination could save the society from €637,762 (infant strategy) to 53 million annually (combined infant and adolescent strategy). The median and the mean quality scores resulted in 91.8% and 85.4% respectively; 11 studies were considered of high quality and 12 of low quality. Discussion The studies are favorable to the introduction of universal varicella vaccination in Italy, being cost saving and having a positive impact on morbidity. The quality score of the studies varied greatly: recent analyses were of comparable quality to older studies.
Human vaccines & immunotherapeutics. 07/2013; 9(9).
[show abstract][hide abstract] ABSTRACT: OBJECTIVES: This study sought to assess whether intracoronary adenosine or nitroprusside following thrombus aspiration (TA) is superior to TA alone for the prevention of microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: MVO, due to its multifactorial pathogenesis, still occurs after TA in a sizeable portion of patients. METHODS: We performed a placebo-controlled, randomized, open-label, blind-examination, multicenter trial. A total of 240 STEMI patients with Thrombolysis In Myocardial Infarction (TIMI) flow grade 0/1 were randomly allocated 1:1:1 to receive adenosine (n = 80), nitroprusside (n = 80), or saline (n = 80) given distal to the occluded site after TA. The primary endpoint was the incidence of ST-segment resolution (STR) >70% on surface electrocardiogram at 90 min after PCI. Secondary endpoints were angiographic MVO incidence (TIMI flow grade ≤2 or 3 with a myocardial blush grade <2) and major adverse cardiac event (MACE) rate at 30 days as a composite of cardiac death, myocardial infarction, target lesion revascularization, and heart failure requiring hospitalization. RESULTS: STR >70% occurred in in 71% of adenosine-treated patients, in 54% of nitroprusside-treated patients, and in 51% of saline-treated patients (p = 0.009 and p = 0.75, respectively, vs. saline). Angiographic MVO occurred in 18% of adenosine-treated patients, in 24% of nitroprusside-treated patients, and in 30% of saline-treated patients (p = 0.06 and p = 0.37, respectively, vs. saline). MACE occurred in 10%, 14%, and 20% of patients, respectively (p = 0.08 and p = 0.29 vs. saline). CONCLUSIONS: In STEMI patients treated by PCI and TA, the additional intracoronary administration of adenosine, but not that of nitroprusside, results in a significant improvement of MVO, as assessed by STR.
[show abstract][hide abstract] ABSTRACT: The platform switching concept involves the reduction of the restoration abutment diameter with respect to the diameter of dental implant. Long-term follow up around these wide-platforms showed higher levels of bone preservation.
The aim of this article is to carry out a literature review of studies which deal with the influence of platform-switched implants in hard and soft oral tissues.
All papers involving "platform switching" that are indexed in MedLine and published between 2005 and 2011 were used. Clinical cases, experimental and non-experimental studies were included, as well as literature reviews.
In our search, we analized 18 clinical cases and 3 reviews. The results indicate that peri-implant bone resorption is reduced with platform switching system.
All papers written by different researchers show an improvement in peri-implant bone preservation and satisfactory aesthetic results. Further long-term studies are necessary to confirm these results.
European review for medical and pharmacological sciences 02/2013; 17(3):392-7. · 1.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: Introduction: Despite longstanding recommendations by public-health authorities vaccination coverage in health care workers worldwide are poor. The aim of this study is to conduct a systematic review of the trials conducted to increase seasonal influenza vaccination rates among health care workers. : Results: 10 articles met the pre-determined criteria. For all article the score calculation was performed. Discussion: The combination of an educational and a promotional element appared the most effective in augmenting the influenza vaccination coverage among health care workers. But some cases, the intervention did not contribute to increasing the vaccination rates among health care workers. In any case, the quality of controlled trials plays an important role in the results obtained by carrying out a specific intervention and contributed to obtaining this debatable results. Materials and Methods: Research was conducted using Scopus and PubMed database. We selected all clinical trials to perform the meta-analyses.
Human vaccines & immunotherapeutics. 01/2013; 9(2).
[show abstract][hide abstract] ABSTRACT: Objectives. To examine smoking prevalence, attitudes, knowledge and behaviours/beliefs among Health Professional School students according to the Global Health Professional Student Survey (GHPSS) approach. Methods. A cross-sectional study was carried out in Catania University Medical Schools. The GHPSS questionnaires were self-administered. Logistic regression model was performed. The level of significance was p ≤ 0.05. Results. 422 students answered to the questionnaire. Prevalence of current smokers was 38.2%. 94.3% of the total sample believe that health professionals should receive specific training to quit smoking, but only 21.3% of the sample received it during the study courses. Conclusions. Given the high prevalence of smokers among health professionals and their key role both as advisers and behavioral models, our results highlight the importance of focusing attention on smoking cessation training addressed to them.
[show abstract][hide abstract] ABSTRACT: Ehlers-Danlos syndrome hypermobility type a. k. a. joint hypermobility syndrome (JHS/EDS-HT) is a hereditary musculoskeletal disorder associating generalized joint hypermobility with chronic pain. Anecdotal reports suggest a prominent role for kinesiophobia in disease manifestations, but no study has systematically addressed this point. Objective. To investigate the impact of kinesiophobia and its relationship with pain, fatigue, and quality of life in JHS/EDS-HT. Design. Cross-sectional study. Subjects/Patients. 42 patients (40 female and 2 male) with JHS/EDS-HT diagnosis following standardized diagnostic criteria were selected. Methods. Disease features were analyzed by means of specific questionnaires and scales evaluating kinesiophobia, pain, fatigue, and quality of life. The relationships among variables were investigated using the Spearman bivariate analysis. Results. Kinesiophobia resulted predominantly in the patients' sample. The values of kinesiophobia did not correlate with intensity of pain, quality of life, and (or) the single component of fatigue. A strong correlation was discovered between kinesiophobia and general severity of fatigue. Conclusions. In JHS/EDS-HT, the onset of pain-avoiding strategies is related to the presence of pain but not to its intensity. The clear-cut correlation between kinesiophobia and severity of fatigue suggests a direct link between musculoskeletal pain and fatigue. In JHS/EDS-HT, the underlying mechanism is likely to be facilitated by primary disease characteristics, including hypotonia.
BioMed research international. 01/2013; 2013:580460.
[show abstract][hide abstract] ABSTRACT: Objectives. The aim of this study was to assess knowledge and opinions of Italian general practitioners about the effectiveness of smoking cessation interventions and physicians' attitudes in addressing tobacco-related issues. Methods. The survey was carried out through a questionnaire administered to general practitioners (GPs) attending a medical refresher course. 133 Italian GPs participated in the study with a mean age of 51.4 years (SD = 6.2). Results. The GPs had good knowledge about the predictors of smoking onset, pharmacotherapies for tobacco cessation and the clinical guidelines recommendations. Wrong answers were encountered for the prevalence of smokers in Italy, the Fagerström Test for nicotine dependence and minimal advice. Females were more subjected to higher knowledge about tobacco, and at lower risk to be a smoker/ex smoker. Furthermore, physicians ≥ 50 years old living in northern Italy had higher knowledge score. Conclusions. Physician education on tobacco counseling is associated to increased comfort and practice in advising patients who smoke. Tobacco cessation training might increase the success rate of helping patients to quit smoking.
[show abstract][hide abstract] ABSTRACT: Aims. The aims of the study were to describe the epidemiology of home injuries (HI) among Italian students' mothers and to identify the possible predictors of having HI. Methods. An anonymous questionnaire was used in several Italian schools. In order to identify predictors of having HI, a multivariate analysis was performed. Results. In our sample (3,610 women), the prevalence of HI was 18%; 6.2% of the interviewed had a severe HI. The multivariate analyses showed that increasing age, to spend more than 13 hours a day at home and to be housewife are risk factors for having HI. Conclusions. This study reports a high prevalence of HI, highlighting an urgent need for undertaking interventions to develop an adequate culture of safety and prevention.
[show abstract][hide abstract] ABSTRACT: Aim. To conduct a systematic review of this relationship using available published observational studies in the field of solid municipal waste treatment. Methods. The review of the scientific literature was based on Medline and Scopus databases up to December 2012, using the keywords HBV, waste, solid, treatment, workers, disposal, and refuse in different combinations. Results. 160 studies were found and checked. Finally, 5 observational studies were considered suitable, all cross-sectional. The pooled proportion of HBs-Ag considering all the studies was 11% (95% CI: 5-21%), and considering the high quality studies only, this proportion was 14% (95% CI: 6-24%). The pooled proportion of HBs-Ab positivity among waste workers considering all the studies was 14.2% (95% CI: 1.4-37.2%), and considering the high quality studies only, this proportion was 24% (95% CI: 18-30%). The pooled proportion of HBc-Ab positivity among waste workers considering all the studies was 24% (95% CI: 6-49%). The pooled estimation of the risk of HBV positivity (HBsAg) among exposed was OR = 2.39 (95% CI: 0.88-6.52). Conclusion. In conclusion, waste workers need to be vaccinated against HBV infection since they are at risk of acquiring this infection through the exposure to potentially infected waste.
The Scientific World Journal 01/2013; 2013:692083. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Acanthamoeba keratitis (AK) is ever more frequently reported in industrialized countries. The loss of the corneal surface integrity consequent to secondary microtrauma produced by the use of contact lens (CL) favors the penetration of the parasite into the corneal tissue.
A scientific review was performed to investigate the association of CL wear as an Acanthamoeba keratitis (AK) risk factor.
A computerized screening of 7834 Medline articles (4623 from PubMed; 3211 from Scopus) used a strict selection criteria of case-control studies involving CL wear and/or trauma.
The search yielded five case-control studies published from 1995 to 2012. All studies included showed a statistically significant positive association between AK and CL use, with a combined odds ratio (OR) of 10.21 (95%, confidence intervals [CI]; 3.57-27.64).
All studies included showed a statistically significant positive association between AK and CL use, though with differing OR values.
Though rare, AK should be held in higher consideration when ophthalmologists are faced with CL users exhibiting simplex-like lesions associated with circular stromal infiltrates and disproportionate ocular pain in respect to the objective clinical picture.
[show abstract][hide abstract] ABSTRACT: The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer's disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs.
[show abstract][hide abstract] ABSTRACT: Epidemiological studies suggest that n-3 polyunsaturated fatty acid (n-3 FA) deficiency is a risk factor for bipolar disorders (BDs). The aim of this study was to determine whether such a deficit does exist in patients with BD and to characterize the overall plasma fatty acid (FA) profile in these patients. Using gas chromatography/mass spectrometry, we measured fasting plasma levels of 15 FAs in 42 patients diagnosed with BD according to DSM-IV criteria and in 57 age- and gender-matched healthy controls. Plasma docosahexaenoic acid (DHA) levels were significantly decreased in bipolar patients (p < 0.001 versus healthy controls). Compared with controls, patients had higher plasma levels of all other FAs, including arachidonic acid (AA, p < 0.001), alpha-linolenic acid (ALA, p < 0.001), and eicosapentaenoic acid (EPA) (p < 0.001). Although in the present study we observed significant DHA deficits in the plasma of bipolar patients our findings do not support the therapeutic use of ALA and/or EPA supplementation. DHA may provide a basis for possible pharmacological intervention in psychiatric disorders at the level of second messengers linked to the phosphatidylinositol cycle. Finally, measurement of FA levels in plasma seems to be more reliable and reproducible than assays of erythrocyte FA content.
Journal of psychiatric research 11/2012; · 3.72 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Measuring the state of health is a method for quantifying the impact of an illness on the day-to-day life, health and wellbeing of a patient, providing a quantitative measure of an individual's quality of life (QoL). QoL expresses patient point of view by a subjective dimension and can express the results of medical intervention. Pulmonary rehabilitation is an essential component in the management of COPD patients, and measuring QoL has become a central focus in the study of this disease.Although nowadays several questionnaires for measuring the QoL in COPD patients are available, there are no questionnaires specifically developed for evaluating QoL in COPD patients undergoing respiratory rehabilitation.The aim of this study was to develop a novel questionnaire for the QoL quantification in COPD patients undergoing in-patient pulmonary rehabilitation program. METHODS: The questionnaire, administered to COPD patients undergoing long-term oxygen therapy into a respiratory rehabilitation ward, was developed by a simple and graphic layout to be administered to elderly patients. It included one form for admission and another for discharge. It included only tips related to the subjective components of QoL that would be relevant for patient, although likely not strictly related to the respiratory function.A descriptive analysis was performed for the socio-demographic characteristics and both the non-parametric Wilcoxon T-test and the Cronbach's alpha index were calculated for evaluating the sensitivity of the questionnaire to the effects of respiratory rehabilitation and for identifying its consistency. RESULTS: The physical and psychological condition of the 34 COPD patients improved after the rehabilitative treatment and this finding was detected by the questionnaire (overall improvement: 14.2+/-2.5%), as confirmed by the non-parametric Wilcoxon test (p<0.01). The consistency detected by the Cronbach's alpha was good for both the questionnaire at admission and at discharge (0.789+/-0.084 and 0.784+/-0.145, respectively), although some items did not adequately measure the intended outcome. CONCLUSIONS: This proposed questionnaire represents a substantial innovation compared to previous methods for evaluating the QoL, since it has been specifically designed for hospitalized COPD patients undergoing respiratory rehabilitation with serious respiratory deficiency, allowing to effectively determining the QoL in these patients.