Multiparametric correlation of laboratory biomarkers to multiorgan failure outcome in hospitalized COVID-19 patients: a retrospective observational study

OBJECTIVE

COVID-19 is an extremely contagious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that will keep broadly circulating and evolving. Collected evidence revealed the clinical profile of COVID-19 patients as a potential predictor of their outcome. The aim of this study was to investigate the causal relationship between poor outcomes and laboratory parameters in hospitalized COVID-19 patients, in this sense observing how SARS-CoV-2 infection affects other organs.

PATIENTS AND METHODS

We retrospectively evaluated a cohort of 133 patients, positive for SARS-CoV-2, aged between 30 to 94 years, between January 12th and April 25th, 2021. Discharge from the hospital, transferral to the ordinary ward or nursing home, intensive care unit (ICU) admission, and in-hospital mortality were recorded, along with demographic, laboratory and clinical parameters. The whole sample was summarized by median (interquartile range) for quantitative data, and absolute and relative percentage frequencies for qualitative variables. Univariable logistic regression models were performed to assess the association between all the parameters of interest and COVID-19 adverse outcomes, single (in-hospital mortality) and composite (in-hospital mortality and ICU admission). Hence, a multivariable model was fitted to identify potential independent predictors of the composite outcome. The accuracy of the model was assessed through appropriate fitting indices, such as the C-statistic and Hosmer-Lemeshow test. Moreover, to detect multicollinearity, the variance inflation factor (VIF) was used.

RESULTS

Our study sample had a median age of 72 years old (59.0-83.0). The most common comorbidities were hypertension (63.7%), cardiovascular disease (41.9%), diabetes (33.6%), and cerebrovascular disease (21.5%); while as the most common symptoms, we observed dry cough (32.5%), dyspnoea (50.8%), and fatigue (29.8%). Totally, 18 patients died during hospitalization (13.5%), 10 required ICU admission (7.5%), 78 (58.6%) were discharged from the hospital, and 27 (20.3%) were transferred to either ordinary wards or nursing homes. We disclosed an association of older age with both composite [OR 1.06, 95% CI 1.02-1.09; p=0.003] and single outcome [OR 1.10, 95% CI 1.04-1.16; p=0.001]. A higher oxygen saturation (SpO2) was associated with a better outcome [OR 0.75, 95% CI 0.60-0.93; p=0.009 and OR 0.76, 95% CI 0.61-0.95, p=0.009]. Among laboratory parameters, higher levels of neutrophils increased the risk of a poor outcome [OR 1.05, 95% CI 1.00-1.10; p=0.043]; while higher levels of lymphocytes seem associated with a better outcome [OR 0.94, 95% CI 0.88-0.99; p=0.043]. Higher levels of creatinine were associated with a higher risk of both adverse outcomes [OR 6.20, 95% CI 2.16-17.81; p<0.001 and OR 19.90, 95% CI 5.07-78.06; p<0.001, respectively]. Higher levels of sodium (Na) were associated with a higher risk of adverse events [OR 1.15, 95% CI 1.03-1.28; p=0.014 and OR 1.14, 95% CI 1.01-1.27]. Similar findings were also observed for C-reactive protein (CRP) levels [OR 1.01, 95% CI 1.00-1.02; p=0.010 and OR 1.01, 95% CI 1.00-1.02; p=0.024]. Conversely, being positive to IgM and IgG decreases the risk of adverse outcomes [IgM: OR 0.33, 95% CI 0.14-0.77; p=0.011 and OR 0.23, 95% CI 0.08-0.66; p=0.006. IgG: OR 0.30 95% CI 0.13-0.72; p=0.007 and OR 0.22 95% CI 0.07-0.66; p=0.007]. Hence, a multivariable model was fitted to identify potential independent laboratory predictors of the composite outcome, with laboratory parameters that showed an association with composite outcome. The model can be considered accurate according to LH-Test and C-statistic [p>0.83, C-stat=0.90].

CONCLUSIONS

Our findings confirm that COVID-19 is a multiorgan disease. In fact, the analysis of laboratory parameters has revealed a strong relationship between poorer outcomes and multiple organ dysfunction, particularly established by higher levels of neutrophils, creatinine, sodium, and CRP. Alongside, cerebrovascular diseases, chronic kidney disease and older age supported this finding. Of note, higher levels of SpO2, and lymphocytes, as well as positivity to IgM and IgG were associated with a lower risk of a poor outcome.

A “Flower” to improve the lunch at school

Background

Children consume at least one main meal a day at school so ATS Val Padana (Italy) conceived a project called “Un fiore in mensa” (A flower in canteen) as an acknowledgment of the quality of the school catering service.

Objectives

The aim of the project is to assign an award - “The Flower” - after an inspection during which the entire lunch (from preparation of meal to the consumption) is examined. It is necessary to reach at least 10 points to have the 'flower ' in all 3 essential sections (the “petals”): Quality of the menu, Organization and cleaning of the kitchen and / or other locals, Collaboration of the teachers. The complete flower (with 6 petals) is reached with 60 points (in the sections: General presentation of the refectory, Collaboration between all the personnel during lunch, Children's behavior).

Results

In the 2018-19 edition of the project 79 schools were examined: 20 (25.32%) were nurseries; 34 (43.04%) were kindergartens; 25 (31.65%) were elementary school. 36 (45.47%) were private schools. 16 on 79 schools (20.25%) obtained the flower. In particular: 1 school obtained a 3-petals certificate; 6 schools obtained a four-petals certificate; 7 schools obtained a five-petals certificate; 2 schools met all the requirements and obtained the complete six petals certificate. There wasn't a statistically significant difference due to school typology (p = 0.70) or to their management (p = 0.69). There was a statistically significant difference due to the examined year (p &lt; 0.01), with better performances in 2019 compared to 2018.

Conclusions

The interest demonstrated by some schools that didn't receive the full flower to resolve some critical aspects confirmed the utility of the project.

Key messages

The project “A flower in canteen” is a way to reward the school catering service. Some schools tried to resolve some critical aspects after the inspection.

Management of Food and Feed Safety Alerts in ATS VAL PADANA (Italy)

Issue

The rapid alert system is a procedure codified in the European Community, designed to guarantee the speed of communications and consequent measures, that should be adopted if a food or feed represents a serious risk for health.

Description of the Problem

ATS Val Padana implements several measures in cases of food or feed that don't satisfy safety requirements, imported, produced, processed, or distributed by companies located in its area of competence. ATS checks the completeness and effectiveness of the actions undertaken/planned by the food/feed industry operator. The checks are focused on: - Preparation of the distribution list Activation of withdrawal/recall procedures;information provided to consumers;management of the withdrawn products;adoption of measures to prevent the placement of product on the marketAdoption of the traceability systemNotification to the authorities

Results

In November 2018-November 2019, 205 alerts were registered (11 in 2018, 191 in 2019) and specifically: - Alert notifications (risk requiring rapid action in another country): 154 Information notifications for follow-up (product present or that could be placed on the market in another Member State): 22Information notifications for attention (product present only in the Notifier country or has not been placed on the market or is no longer on the market): 29

The notifications concerned: the Department of Veterinary and Safety of Animal Origin Food(89), the Department of Hygiene and Health Prevention (89), both departments jointly (27). ATS Val Padana has managed the alerts and closed them on average within 7.59 days (DS 5.80, range 0-42). In one case the alert was closed after a month.

Lessons

The effectiveness of the Alert System depends first of the communications speed, as well as of the guarantee of rapid times to analyze sampled matrices. Our results demonstrate how ATS Val Padana operates ensuring the maximum effectiveness of the Alert System.

Key messages

The rapid alert system is a codified procedure in the European Community, designed to guarantee the speed of communications and consequent measures. The effectiveness of the Alert System depends primarily on the speed of communications.

Food Waste reduction: a proposal from ATS Val Padana (Italy)

Background

It is currently estimated that 1.3 billion tons of food are wasted in the world and that 14% of total waste comes from collective catering. Specifically, the percentages waste in school catering are highly variable, ranging from 11.9% to 27.5%. In order to deepen the phenomenon, ATS Val Padana has started a project in some middle schools in the areas of its competence.

Objectives

The project, started in 2016, was composed by 6 phases: 1) Nutritional inspection in schools to evaluate the waste; 2) Administering of a questionnaire to the students to evaluate the eating habits and opinions about the offered menu; 3) Selection of a pilot school; 4) Implementation of a new menu built on the basis of students' preferences; 5) Organization of 2-hour educational meetings for each class of the pilot school to educate students; 6) Nutritional inspection after menu modification and meetings.

Results

7 schools were examined; 1335 students involved (of which 49.3% females). The total waste was on average 36%, with higher peaks related to the side dish (66%) and fruit (39%); the first dish remains the most popular dish with a waste of 14%. The school with the highest number of students enrolled in the canteen (152) was selected for menu modification and meetings. After about 3 months it was observed: a 11% reduction of the total waste. There was a statistically significant reduction in relation to the gap for the first and the side dish. For the second dish there was a 7% increase in waste.

Conclusions

The overall reduction of waste shows that targeted actions on menus, built on the basis of student preferences, can be an effective tool to reduce the food waste.

Key messages

An important percentage of waste comes from collective catering or from school catering. Menus, built on the basis of student preferences, can be an effective tool to reduce the food waste.

The Nutritional Surveillance at school: experiences from ATS Val Padana (Italy)

Background

Correct habits acquired in childhood positively affect the future health of the adult person. Therefore the school meal isn't as a simple satisfaction of nutritional needs, but also an important moment of health promotion, which involves teachers and parents.

Objectives

In ATS Val Padana the Food Hygiene and Nutrition Unit evaluates school menu at the beginning of each year (including special diets for specific diseases that require diet therapy). During the school year, trained personnel carries out inspections in schools, according to annual planning. During the inspection are evaluated: - Presence/respect of the validated school menu Number of mealsPeople preparing and administering mealsFood preparation and storageLiking by childrenManagement of special dietsManagement of the meal as an educational moment

Results

132 inspections were performed: 70 in 2018 and 62 in 2019. 23 (17.42%) were conducted in nursery schools, 62 (46.96%) in kindergartens, 44 (33.33%) in primary schools, 3 (2.27%) in middle schools. 47 (35.60%) were privately managed; 61 (46.21%) were also equipped with a kitchen for preparing meals. 41 inspections (31.06%) showed slight criticalities; 9 (6.81%) serious problems (poor hygiene, lack of control over special diets - which required further inspections). A statistically significant difference was observed (p = 0.02) between 2018 and 2019, with a clear decrease in criticality in 2019. No difference in the results of the checks was observed in relation to the type of school, management, and to the presence or not of a kitchen (all p &gt; 0.05).

Conclusions

The effectiveness of the control system is represented by the relationship between non-conformities detected during the checks and the number of performed checks. In 2019, despite the controls have increased compared to the previous year, the incidence of non-conformities has decreased. This indicates that control activities is positive to improve the quality of the school meal.

Key messages

The school meal is a fundamental educational moment for children. Control activities have positive impact on the quality of the school meal.

Wild mushrooms poisoning: a public health challenge

Issue

Mushrooms are considered as ingredient of gourmet cuisine across the globe and mushroom poisonings can occur because of misidentification of a poisonous species as edible. Of the vast number of mushroom species, approximately 100 are toxic(**).

Description of the Problem

Mushroom poisoning is a public health problem. People should be educated about this poison as often there are no guidelines about the treatment of mushroom toxicity. Despite treatment, the prognosis can be mortal. In the Department of Hygiene and Health Prevention (ATS Val Padana, Italy) expert mycologists offer their consultation free of charge to people who pick mushrooms and register, for each consultation, quantity and toxicity of collected mushrooms.

Results

In 2018-19, 279 consultations were offered: 124(44.44%) in 2018, 155 (55.56%) in 2019. 58.42% of mushrooms were considered not dangerous for human health, without any difference among the two considered years (p = 0.167). 233.7 kg mushrooms were considered edible (mean 2.71, SD 16.44), 92.95 kg were considered dangerous and destroyed (mean 1.39, SD 6.99). The most identified species were: Agrocybe aegerita (11.47%), Armillaria Mellea (29.75%), Boletus edulis (6.45%), Macrolepiota venenata** (1.43%, N = 4), Xerocomus badius (2.51%), Lyophillum loricatum (1.79%), Agaricus Xanthodermus** (3.23%, N = 9). Intoxications occurred among people who did not refer to our mycology unit.

Conclusions

Mushroom poisoning represents a major health risk and as it's often consequence of misidentification, a free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.

Key messages

Mushroom poisoning presents a major health risk. A free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.

Piezoelectric bone surgery for impacted lower third molar extraction compared with conventional rotary instruments: a systematic review, meta-analysis, and trial sequential analysis

The aim of this study was to evaluate whether piezoelectric bone surgery (PBS) for impacted lower third molar extraction reduces the surgical time and risk of intra- and postoperative complications in comparison with conventional rotary instruments. This meta-analysis followed the PRISMA guidelines and was registered in the PROSPERO database. The PubMed, Embase, Scopus, and OpenGrey databases were screened for articles published from January 1, 1990 to December 31, 2018. Selection criteria included randomized controlled trials (RCTs) comparing PBS with conventional rotary instruments for impacted lower third molar extraction and reporting any of the clinical outcomes (intra- and postoperative complications and duration of surgery) for both groups. A risk of bias assessment was performed using the Cochrane Collaboration tool. A meta-analysis was performed, and the power of the meta-analytic findings was assessed by trial sequential analysis (TSA). Strong evidence suggests that PBS prolongs the duration of surgery and low evidence suggests that PBS reduces postoperative morbidity (pain and trismus) in comparison with rotary instruments. Data were insufficient to determine whether PBS reduces neurological complications and postoperative swelling in comparison with burs.

Microbiological surveillance of flexible bronchoscopes after a high-level disinfection with peracetic acid: preliminary results from an Italian teaching hospital

BACKGROUND

Flexible bronchoscopes are heat labile, complex and difficult to clean, and some nosocomial outbreaks related to bronchoscopy have been reported in literature. The aim of our study was to determine, through a systematic monitoring, whether bronchoscopes' cleaning and disinfection procedures have been correctly adopted by health operators.

METHODS

We conducted a 19 months-long prospective study in the Unit of Pulmonology at Careggi Teaching Hospital (Florence, Italy), analyzing endoscopes that were reprocessed through a high-level disinfection procedure. Samples collection was performed weekly by two trained operators. Results were organized in a database and then exported for descriptive and inferential statistical analysis.

RESULTS

From February 2016 to September 2017 we collected 218 samples from bronchoscopes' valves (N=109) and from their inner channels (N=109). Staphylococci were found in 34 samples (15.69% of all samples). Pseudomonas was found in 11 samples (5.04% of all samples). Pseudomonas aeruginosa wasn't found in any sample.

CONCLUSIONS

Our results came out to be better than similar studies in literature and demonstrated that a correct endoscopes' hygiene should be part of a more complex strategy of surveillance and control of healthcare-associated infections. However, a continuous monitoring of endoscopes could provide a wider view about this problem, and more reliable results.

Oral stomatitis and mTOR inhibitors: A review of current evidence in 20,915 patients

BACKGROUND

Traditional treatment of malignancies with chemotherapeutic agents is often affected by the damage inflicted on non-cancerous cells. Toxicities of the oral cavity, such as mucositis and stomatitis, are some of the most significant and unavoidable toxicities associated with anti-cancer therapies. For such reason, in the last decades, newer targeted agents have been developed aiming to decrease the rates of side effects on healthy cells. Unfortunately, targeted anti-cancer therapies also showed significant rate of toxicity on healthy tissues. mTOR inhibitors showed some adverse events, such as hyperglycemia, hyperlipidemia, hypophosphatemia, hematologic toxicities, and mucocutaneous eruption, but the most important are still stomatitis and skin rash, often reported as dose-limiting side effects.

PATIENTS AND METHODS

A search of the literature was performed by authors on the PubMed online database using the following key words: "sirolimus" OR "everolimus" OR "temsirolimus" OR "deforolimus" OR "ridaforolimus" combined with the Boolean operator AND with the terms: "stomatitis" OR "mucositis" OR "oral pain." Titles and abstracts of 382 potentially relevant studies were screened; of these, 114 studies were excluded because they did not report the inclusion criteria. In the second round, 268 studies were read full-text, but only 135 reported the inclusion criteria and were included for data extraction. Of the included studies, 95 referred to everolimus use, 16 to ridaforolimus, and 26 to temsirolimus (two studies referred to both everolimus and temsirolimus).

RESULTS

The incidence rate of stomatitis according to the agent used was 25.07% (3,959/15,787) for everolimus, 27.02% (724/2,679) for temsirolimus, and 54.76% (598/1,092) for ridaforolimus. All the three agents analyzed showed high rates of low-grade stomatitis (G1-G2), while the onset of severe stomatitis (G3-G4) was rare.

CONCLUSIONS

Analysis of the reports with patients treated with everolimus, temsirolimus, and ridaforolimus showed a clear prevalence of stomatitis grade 1 or 2. These data differ from that of patients treated with conventional chemotherapy in which mucositis is predominantly of grade 3 or 4.

Developing a new predictor of health expenditure: preliminary results from a primary healthcare setting

OBJECTIVES

Risk adjustment is a widely used tool for health expenditure prediction and control. Early approaches for estimating health expenditure were based on patient demographic variables alone, whereas more recent models incorporate patient information, such as chronic medical conditions, clinical diagnoses, and self-reported health status. Many studies have investigated the health expenditure predictive capacity of single demographic, morbidity, or health-related quality of life measures, but the best models prove to be those that include them all. The aim of this study was to develop an index that combines measures of perceived health and disease severity and to compare its efficacy in predicting health expenditure with that of the measures taken individually.

STUDY DESIGN

This is a linked cross-sectional study.

METHODS

In 2009 and 2010, the health-related quality of life questionnaire SF-36 (8 scales, two indices: Physical Component Summary [PCS] and Mental Component Summary [MCS]) was distributed to 886 patients of general practitioners in the Province of Siena, Italy. Severity of diseases was calculated for each patient using the Charlson Index (CH-I) and Cumulative Illness Rating Scale Severity Index (CIRS-SI). Siena Local Health Unit 2012 data on health expenditure were obtained for each patient. Multivariate linear regression was applied to test the performance of severity (CH-I, CIRS-SI) and perceived health (PCS and MCS) measures in predicting health expenditure. The indexes that predicted health expenditure best were then combined in a new tool, and its expenditure predictive capacity was tested.

RESULTS

The best health expenditure predictors proved to be PCS and SI (R² = 0.15 and R² = 0.17, respectively). When combined in a new index (PCS-SI), better predictive capacity of health expenditure was obtained than with the two single measures separately (R² = 0.19).

CONCLUSIONS

A multidimensional indicator proved to be a better predictor of healthcare expenditure than single health measures.

Effects of anticoagulation therapy with vitamin K antagonists on hospitalizations and emergency room accesses in Grosseto (Italy)

Introduction

A lot of drug groups are associated with preventable drug-related admissions. Coumarin derivatives, prescribed for the treatment and prevention of deep vein thrombosis or pulmonary embolism or prevention of systemic embolism or stroke in patients with prosthetic heart valves or atrial fibrillation, are often associated with bleeding. The aim of our study was to analyze how the anticoagulant therapy with VKAs could affects the hospitalizations and the visits to emergency room in the elderly population (> 65 years old).

Methods

In 2013 we conducted a cross sectional study analyzing the database of all pharmaceutical prescriptions, selecting patients living in Grosseto (Italy), which received at least two prescriptions of coumarin derivatives in 2012. We analyzed the admissions to hospital and the accesses to the emergency rooms (ERs) made by each patient, focusing especially on those related to bleeding. For each access to ER we recorded the date, time of stay, diagnosis and outcome. For each hospitalization the information we recorded were the date of admission and discharge diagnosis.

Results

3684 patients were included in our study. 261 (7.1%) patients visited the emergency room for bleeding; 37 (1%) for intracranial bleeding. The accesses made by men were higher than those made by women. The average time of stay in ER was 349 minutes. The admissions to hospital were 96 (2.6%); 42 (1.1%) were admitted to hospital with a diagnosis of major vascular event. 53 patients (20.3%), accessed to the ER more than one time. The 11.5% was admitted to the hospital more than one time.

Conclusions

Our study showed that VKAs are responsible of an increase of the accesses to ER and of the admissions to hospital. However, it would be interesting to enlarge the sample size including patients living in other provinces or in other regions, with a lower age and treated also with TSOACs, in order to evaluate the real cost-effectiveness of anticoagulant therapy.

"OKKIO alla salute 2014" results from the Tuscan sample

BACKGROUND

The prevalence of overweight and obesity among children is rapidly increasing in many countries. For this reason we decided to investigate the eating habits of 8-9 years old Tuscany children, by paying attention to the frequency of their meals per day and to their food choices, also in relation to children's Body Mass Index (BMI) classes. In addition, we considered some environmental factors that could affect children eating behaviors, such as parents' BMI.

METHODS

Data from the 2014 Tuscany nutritional surveillance system (part of the national periodical survey) and collected from children, parents and teachers, have been linked to study of children's eating habits. Logistic regression analyses were used to investigate the association between incorrect dietary habits and the potential predictors of overweight and obesity.

RESULTS

More than half of the 2,163 children (68.64% overall, 67.61% females, 69.56% males) reported to have eaten an appropriate breakfast in the morning, while 5.9% skipped breakfast and only 33.5% of children ate an appropriate mid-morning snack. Logistic regression showed that having breakfast and especially an adequate breakfast are protective factors against obesity (OR 0.57, p<0.01; OR 0.84; p=0.03 respectively).

CONCLUSION

In Tuscany Region, unhealthy dietary habits are common among children. The identified deficiencies may be a harbinger of future public health problems.

Predictive Prognostic Value of Tissue-Based MicroRNA Expression in Oral Squamous Cell Carcinoma: A Systematic Review and Meta-analysis

Oral squamous cell carcinoma (OSCC) is a common type of cancer characterized by a low survival rate, mostly due to local recurrence and metastasis. In view of the importance of predicting tumor behavior in the choice of treatment strategies for OSCC, several studies have attempted to investigate the prognostic value of tissue biomarkers, including microRNA (miRNA). The purpose of this study was to perform a systematic review and meta-analysis to evaluate the relationship between miRNA expression and survival of OSCC patients. Studies were identified by searching on MEDLINE/PubMed, SCOPUS, Web of Science, and Google Scholar. Quality assessment of studies was performed with the Newcastle-Ottawa Scale. Data were collected from cohort studies comparing disease-free survival and overall survival in patients with high miRNA expression compared to those with low expression. A total of 15 studies featuring 1,200 OSCC samples, predominantly from Asia, met the inclusion criteria and were included in the meta-analysis. Poor prognosis correlated with upregulation of 9 miRNAs (miR-21, miR-455-5p, miiR-155-5p, miR-372, miR-373, miR-29b, miR-1246, miR-196a, and miR-181) and downregulation of 7 miRNAs (miR-204, miR-101, miR-32, miR-20a, miR-16, miR-17, and miR-125b). The pooled hazard ratio values (95% confidence interval) related to different miRNA expression for overall survival and disease-free survival were 2.65 (2.07–3.39) and 1.95 (1.28–2.98), respectively. The results of this meta-analysis revealed that the expression levels of specific miRNAs can robustly predict prognosis of OSCC patients.

Midwives in England and in Italy: two realities compared

BACKGROUND

Midwives have the responsibility to provide assistance to pregnant women for non-complicated deliveries. The aim of this study was to identify the distinctive features of midwives in Italy and in England in order to provide interesting comparisons.

METHODS

From September to October 2015 we administered an online questionnaire to groups of Italian and English midwives. The questionnaire was composed by a part trying to collect the sociodemographic information and a second part to define the attitudes of care and the type of approach to birth and degree of attained professional autonomy. The questions were used to create a score for 5 macro areas: "Midwifery: who is the midwife?", "Education: how much does the midwife know?", "Responsibility: what does the midwife do?", "Ethics: how does the midwife act?", "Social acknowledgment: the midwife and the other people". Results were loaded in a database and analyzed using the using STATA.

RESULTS

183 Midwives (100 Italian and 83 English) completed the questionnaire. 92% of Italian respondents said to have a "Bachelor", 6% a "University Diploma" and only 2% a "Diploma". 80% of British midwives had a "Midwifery Degree" and 8% attended a "Midwifery Short Program", a degree course in Nursing with an additional specialization of a year and a half in Midwifery. 34% of the Italian claimed to have also a "1st level Master", 16% a "Full Degree" and the remaining 50% attended post degree training courses. Only 23% of the English sample had a "Master of Science" and the remaining 67% reported to have "other" general qualifications. 72% of Italian midwives declared to work and, in particular, in a "III level point of birth" (35%), "II level point of birth" (25%), "I level point of birth" (17%), or in "private health facilities" (4%), in "professional offices" (6%) or "counseling ambulatories" (5%). 46% of the English midwives who participated in the study worked in hospitals; 21% as employees of the NHS in territorial structures. 12% worked in birth centers and 11% had a private profession. There was a statistically significant difference between Italian and English Midwives, for all the macro areas (except for the first), with better results for English Midwives.

CONCLUSION

English Midwives tend to consider their professional role and their professional skills more acknowledged and appreciated than Italian Midwives. Actually Italians tend to be not very satisfied. However, the Midwives of both countries feel very close to women and have the same conception of themselves and of their profession.

Factors that could influence women's participation in colorectal cancer screening: an Italian study

BACKGROUND

Colorectal cancer (CRC) is the 2nd most common cancer in women worldwide. In Italy, only 50% of people invited to get the Fecal Occult Blood Test (FOBT) decided to do it. Women's participation in breast and cervical screening is, instead, very high (>70%). The aim of our study was to investigate the beliefs, the feelings and the psychological factors that could influence the participation of women in CRC screening.

METHODS

We conducted a cross sectional study, in the Hospital of Siena, Central Italy, in 2011. We administered a questionnaire to 507 women of all ages, who attended mammography or clinical breast examination. The adherence to CRC screening was analyzed only in the group of 207 older women (age >50 years). We performed descriptive, bivariate and logistic regression analysis to identify whether an association was present between participant characteristics, willingness and adherence to screening.

RESULTS

Family history of colorectal cancer (OR 4.3; p<0.007) and the General Practitioner's advice (OR: 3.4; p<0.003) were associated with a greater adherence to screening (colonoscopy). The embarrassment was another factor related to colonoscopy compliance (OR: 0.34; p<0.016).

CONCLUSION

Family history of CRC, pain or embarassment and GP's advice are the factors that correlated more strongly (positively or negatively) with adherence to colorectal cancer screening. These elements should be further analyzed to choose the best solution to improve the adherence in campaigns on colorectal cancer.

Use of a systematic risk analysis method (FMECA) to improve quality in a clinical laboratory procedure

BACKGROUND

Risk management is a set of actions to recognize or identify risks, errors and their consequences and to take the steps to counter it. The aim of our study was to apply FMECA (Failure Mode, Effects and Criticality Analysis) to the Activated Protein C resistance (APCR) test in order to detect and avoid mistakes in this process.

METHODS

We created a team and the process was divided in phases and sub phases. For each phase we calculated the probability of occurrence (O) of an error, the detectability score (D) and the severity (S). The product of these three indexes yields the RPN (Risk Priority Number). Phases with a higher RPN need corrective actions with a higher priority.

RESULTS

The calculation of RPN showed that more than 20 activities have a score higher than 150 and need important preventive actions; 8 have a score between 100 and 150. Only 23 actions obtained an acceptable score lower than 100.

CONCLUSIONS

This was one of the first experience of application of FMECA analysis to a laboratory process, and the first one which applies this technique to the identification of the factor V Leiden, and our results confirm that FMECA could be a simple, powerful and useful tool in risk management and helps to identify quickly the criticality in a laboratory process.

Italian medical students quality of life: years 2005-2015

BACKGROUND

Quality of Life (QoL) is a concept used to indicate the general wellness of persons or societies. University students report a low quality of life and a worse perception of their health status, because of a situation of greater discomfort in which they live during the course of the study, especially in faculties with an important emotional burden, such as medical schools. The aim of the study was to evaluate the perceived health status of first year medical students.

METHODS

We conducted a cross sectional study in the time span 2005-2015, administering the questionnaire Short Form 36 (SF-36) to first-year students of the School of Medicine of the University of Siena, Italy. In addition to demographic information such as gender and the age we investigated the region of residence, marital status, employment status, and smoking habits; height and weight were required to calculate the body mass index (BMI) to evaluate a possible physical discomfort connected with the perception of health status. The data from the questionnaires were organized and processed by software Stata® SE, version 12.1.

RESULTS

1,104 questionnaires were collected. Medical students reported lower SF-36 scores, compared to the Italian population of the same age. Female gender and smoking habits influence negatively the score of several scales. Body Mass Index is positively correlated with the Physical Activity, while Age is negatively correlated with Social Activities.

CONCLUSIONS

The perceived quality of life of the Italian medical students is lower when compared to the general population. This confirms that the condition of student implies additional problems, as other studies reports. It would be better to improve it, developing students' resilience. It would be interesting to extend this research to students of other years, from other faculties and other locations, to gain a broader view about the QoL of the Italian students.