Bariatric Surgery and New-Onset Substance Use Disorders: A Systematic review and Meta-analysis

Increasing evidence suggests that bariatric surgery (BS) patients are at risk for substance abuse disorders (SUD). The purpose of this systematic review and meta-analysis was to determine the relationship between BS and the development of new-onset substance abuse disorder (SUDNO) in bariatric patients. On October 31, 2023, we reviewed the scientific literature following PRISMA guidelines. A total of 3242 studies were analyzed, 7 met the inclusion criteria. The pooled incidence of SUDNO was 4.28%. Patients' characteristics associated with SUDNO included preoperative mental disorders, high pre-BS BMI, and public health insurance. Surgical factors associated with new SUDNOs included severe complications in the peri- or postoperative period. The occurrence of SUDNOs is a non-negligeable complication after BS. Predisposing factors may be identified and preventive actions undertaken.

Sudden cardiac death among workers: a systematic review and meta-analysis

OBJECTIVE

Sudden cardiac death (SCD) is a rare and yet unexplained condition. The most frequent cause is myocardial infarction, while a small proportion is due to arrhythmogenic syndromes (e.g., channelopathies). This systematic review and meta-analysis aimed to provide a comprehensive overview of the prevalence and risk factors associated with SCD in workers.

MATERIAL AND METHODS

A search for eligible studies was performed utilizing three databases (PubMed, ISI Web of Knowledge, and Scopus). The inclusion criteria were fulfilled if sudden cardiac death due to channelopathy in workers was mentioned.

RESULTS

Out of the 1408 articles found across three databases, 6 articles were included in the systematic review but the meta-analysis was conducted on 3 studies The total sample included was 23,450 participants. The pooled prevalence of channelopathies in employees was 0.3% (95% CI 0.07-0.43%), of sudden cardiac death in employees was 2.8% (95% CI 0.37-5.20%), and of sudden cardiac death in employees with a diagnosis of cardiac channelopathies was 0.2% (95% CI 0.02- 0.30%).

CONCLUSIONS

SCD is a serious and potentially preventable condition that can occur among workers. By identifying and addressing work-related risk factors, providing appropriate screening and interventions, and promoting healthy lifestyle behaviors, we can work to reduce the incidence of SCD and improve the cardiovascular health and well-being of workers.

Critical care of severe bronchiolitis during shortage of ICU resources

Large seasonal outbreaks of bronchiolitis put pressure on healthcare systems and particularly on intensive care units (ICUs). ICU admission is necessary to provide respiratory support to the severest cases, otherwise bronchiolitis can result in substantial mortality. ICU resources are often insufficient and there is scant evidence to guide the ICU clinical management. Most available studies do not cover the ICU-admitted cases and do not consider the associated public health issues. We review this topic through a multidisciplinary approach from both the clinical and public health perspectives, with an analysis based on pathophysiology and cost-effectiveness. We suggest ways to optimise respiratory care, minimise ICU stay, "protect" ICU beds and, whenever possible, make them available for other critically ill children. We also provide guidance on how to prepare ICUs to work under stressful conditions due to outbreaks and to reduce the risk of nosocomial cross-contamination, particularly in ICUs caring for high-risk children.

Funding

None.

Vaccine-preventable diseases: Immune response in a large population of healthcare students

BACKGROUND

Students in medicine and other health professions are exposed to numerous occupational hazards, primarily biological hazards, during their academic careers at university. The aim of the present study was to investigate the seroprevalence characteristics of anti-HBsAg, anti-Measles, anti-Mumps, anti-Rubella and anti-Varicella IgG antibodies in healthcare students of a large teaching hospital in Rome.

METHODS

To accomplish the study's aims, antibody serology data were gathered from students of Medicine and Surgery, Dentistry, and Health Professions at the Catholic University of the Sacred Heart (Rome Campus) during their first Health Surveillance visit, that took place from 2013 to 2023.

RESULTS

Our study sample included 2523 students, 44.4 % were protected against Hepatitis B, 87.3 % against measles, 85.5 % against mumps, 94.6 % rubella and 95.2 % against varicella. Differences in antibody coverage between age groups were statistically significant (p < 0.001), except for mumps. It found a lower probability of having seronegative anti-HBVs with an older date since the presumed primary vaccination.

CONCLUSION

In our sample, seropositivity rate against vaccine-preventable diseases, especially for Hepatitis B, was often inadequate to prevent possible biological risks connected with the activities carried out on the ward.

Assessing the Great Resignation phenomenon: voluntary resignation of young Italian workers during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has determined a radical change in workplace dynamics, with a reported increase in voluntary resignation from employment at a global level, especially among the young-est workers. The aim of this study is to investigate the social, demographic, and cultural characteristics of young people aged between 25 and 45 years who voluntarily resigned from their previous jobs during the COVID-19 pandemic.

Methods

This is a cross-sectional observational study; an ad hoc questionnaire was designed and admin-istered via an online link. Descriptive analyses were performed to describe the sample, and the Pearson analysis was performed to investigate statistically significant correlations; p values ≤ 0.05 were considered statistically significant.

Results

A total of 72 valid responses were gathered. Mean age was 32.6 years; 43.1% participants were males, 54.2% were married, and 80.6% had no children; most participants (68.1%) had a college level education. The most reported cause of job resignation was work dissatisfaction (38.9%), followed by inadequate remuneration (27.8%). The most reported perspective for people who had resigned or were planning on resigning, was a better salary (27.8%), followed by the pursuit of a higher work-life balance (25.0%). The perception that having resigned was the right choice was significantly correlated with the timeframe of resignation (p<0.01), with having suffered from COVID-19 (p<0.05), and with a close relative having suffered from COVID-19 (p<0.01).

Conclusion

This study highlighted that voluntarily resigning was significantly correlated to having suffered from COVID-19, or a close relative having suffered from it; 84.9% of participants who had resigned thought that it had been the right choice. The COVID-19 pandemic could have changed workplace perception, making employees feel more at risk; the indirect impact of the pandemic should be further investigated, and prevention strategies should be implemented to ensure the safety and wellbeing of employees.

Mental health and adherence to Mediterranean diet among university students: an Italian cross-sectional study

OBJECTIVE

This study is aimed to explore severe mental illness (SMI), mental well-being (MWB), and Mediterranean Diet adherence (MedDiet) among university students.

PARTICIPANTS

University students in Northern Italy (sample size = 502).

METHODS

Cross-sectional survey was conducted in 2019. The questionnaires included Warwick-Edinburgh Mental Well-Being Scale for MWB, K6 for SMI, Mediterranean Diet Adherence Screener for MedDiet. Multivariable regressions were mainly performed (p < .05 as significant).

RESULTS

MWB was high in 3.93% of the participants and low in 23.97%. SMI was probable in 21.87%. MedDiet adherence was high in 2.19% and low in 35.06%. Mainly, poor/very poor perceived health, Economics/Legal/Strategic Sciences courses, and not being on time with exams showed associations with both lower MWB and probable SMI. Gender and some lifestyle, dietary, and university factors predicted MedDiet. MWB and MedDiet were positively associated.

CONCLUSIONS

This study found high levels of mental issues and low MedDiet. Modifiable factors at university level should be investigated to design preventive interventions.

Public health leadership in the COVID-19 era: how does it fit? A scoping review

The COVID-19 pandemic has put a lot of pressure on all the world's health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.

Occupational exposure to work-related stress, a proposal of a pilot study to detect psychological distress in collar-workers

Introduction

Work-related psychosocial risks have been identified as significant occupational health and safety risks; the occupational physicians must assess and monitor the health status of workers in order to verify that work is not a source of harm to exposed operators. The aim of the study was to investigate the outcomes related to anxiety and depression traits in workers exposed to stress-related work.

Methods

A questionnaire was administered to a large population of Italian public administration workers; the Centre for Epidemiologic Studies - Depression Scale questionnaire was used to measure depression, the Self rating Anxiety Scale was used to measure anxiety, the UK Management Standards Indicator tool questionnaire was used to assess work adjustment. A descriptive analysis, a multivariate analysis, as well as logistic regression models were used to assess the health outcomes related to stress.

Results

A total of 292 workers participated in the study; 100% of participants had a Centre for Epidemiologic Studies - Depression Scale score over the cut-off; 41.78% had a Self rating Anxiety Scale score over the cut-off; the results support a correlation between the Centre for Epidemiologic Studies - Depression Scale results and the UK Management Standards Indicator tool results; and a correlation between Self-rating Anxiety Scale results and the UK Management Standards Indicator tool results.

Conclusions

The Demand, Management, Support and Relationship results were associated with mental health outcomes, and it could be a useful tool in occupational medicine, to identify workers at risk for negative mental health outcomes, becoming an essential tool in workers' health assessment and for prevention of mental health disorders.

Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses

OBJECTIVES

The aim of this umbrella review of systematic reviews and meta-analyses was to address workplace violence (WPV) against healthcare workers (HCWs). Several systematic reviews exist in the literature, but the diversity of settings, population considered, and type of violence investigated make it difficult to gain insight and use the vast amount of available data to implement policies to tackle WPV. With this in mind, we conducted an umbrella review of systematic reviews and meta-analyses on WPV against HCWs to examine the global prevalence of the phenomena and its features.

STUDY DESIGN AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and ISI Web of Science were searched for relevant systematic reviews and meta-analyses published in English up to November 2022. Data on authors, year, country, violence type, prevalence (pooled and not), setting, population, and specific considerations were extracted.

RESULTS

A total of 32 systematic reviews were included, 19 of which performed a meta-analysis, investigating overall, physical, and non-physical violence. Even considering the variability of the data, the COVID-19 pandemic has exacerbated the scale of the problem. From our review, we found that overall violence prevalence among HCWs was reported to be as high as 78.9%, and nurses working in psychiatric wards were the professionals most impacted.

CONCLUSION

In conclusion, this umbrella review revealed a high prevalence of WPV among HCWs, which varies between countries, population subgroups, and detection methods. Strengthening recognition of the problem could lead to appropriate local and international strategies to address it.

Long-term outcome of COVID-19 patients treated with helmet noninvasive ventilation vs. high-flow nasal oxygen: a randomized trial

BACKGROUND

Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure.

METHODS

In this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6 months after the enrollment.

RESULTS

Among 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47-77] of predicted vs. 80% [71-88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53-70] vs. 80 [70-83], p = 0.01).

CONCLUSIONS

In patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6 months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients. Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020.

Coping with burnout and the impact of the COVID-19 pandemic on workers' mental health: A systematic review

Introduction

The COVID-19 pandemic had a negative impact on the psychological wellbeing of workers worldwide. Certain coping styles may increase burnout risk. To investigate the relationship between burnout and coping styles, a systematic review was performed.

Methods

Following the PRISMA statements, three databases were screened up until October 2022, including research articles written in English language and investigating the relationship between burnout and coping strategies in workers. The quality of articles was assessed by the Newcastle-Ottawa Scale.

Results

The initial search resulted in 3,413 records, 15 of which were included in this review. Most studies were performed on healthcare workers (n = 13, 86.6%) and included a majority of female workers (n = 13, 86.7%). The most used burnout assessment questionnaire was the Maslach Burnout Inventory (n = 8, 53.3%), and the most used coping assessment tool was the Brief-COPE (n = 6, 40.0%). Task-related coping was a protective factor for burnout in all four studies investigating its correlation with burnout dimensions. Two of the four studies investigating emotion-oriented coping found that it was protective while the other two found that it was predictive of burnout. All five studies investigating avoidance-oriented coping and burnout dimensions found that this coping style was predictive of burnout.

Discussion

Task-oriented and adaptive coping were protective for burnout, avoidance-oriented, and maladaptive coping were predictive factors of burnout. Mixed results were highlighted concerning emotion-oriented coping, suggesting that different outcomes of this coping style may depend on gender, with women relying more on it than men. In conclusion, further research is needed to investigate the effect of coping styles in individuals, and how these correlates with their unique characteristics. Training workers about appropriate coping styles to adopt may be essential to enact prevention strategies to reduce burnout incidence in workers.

HPV Vaccination Adherence in Working-Age Men: A Systematic Review and Meta-Analysis

BACKGROUND

Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection in the world. HPV vaccination adherence rates in men are generally lower than in women. The aim of this systematic review and meta-analysis was to assess adherence to HPV vaccination in young working-age males (18-30 years old).

METHODS

A systematic review was performed using three databases: PubMed, Scopus, and Web of Science, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

After duplicate removal, the initial search resulted in 478 eligible papers. With the exclusion of 425 papers after screening the abstracts, full texts of 53 articles were reviewed. Subsequently, 45 were excluded. Among the eight studies included, four (50%) examined the vaccination adherence in young adults through data registered in nationwide insurance or private companies' databases, three (37.5%) in young adults in different settings through data collected from surveys and questionnaires, and one (12.5%) an HPV vaccination campaign in a family medicine residency practice.

CONCLUSION

Adherence to HPV vaccination in men of working age (18-30 years) does not appear to be adequate (pooled prevalence 11%). In order to achieve a higher level of compliance, it is important to place an emphasis on vaccination campaigns in schools as well as in the workplace, after consultation with and approval from local, regional, and federal public health agencies.

Pandemic Preparedness among Big Energy Companies: Call to Research and Action

The COVID-19 pandemic, as a global phenomenon, has affected all the working realities, worldwide, with the same issues. The aim of the present work is to assess the experiences of management and their preparedness during the pandemic among big companies, in particular, in the energy sector. Based on an overview of scientific evidence and grey literature, we found that big companies followed evidence-based decision-making practices and offered preparedness and information plans. Specifically, these plans contained recommendations and best practices to be followed to avoid the risk of infection in the workplaces, as well as in the field of epidemiological surveillance and vaccination. Nevertheless, many research efforts are required, and it is important that a large number of big companies and corporations address these challenges worldwide, adopting a new sustainable approach that includes both the productivity and health of the workers. A Call to Action was then issued in order to achieve evidence-based leadership to address current and future public health emergency scenarios.

TElewoRk-RelAted Stress (TERRA), Psychological and Physical Strain of Working From Home During the COVID-19 Pandemic: A Systematic Review

BACKGROUND

Many workers shifted to working from home due to the COVID-19 pandemic. This review aims to investigate if this sudden change caused an increase in TElewoRk-RelAted stress (TERRA) which is defined as physical and mental stress caused by telework.

METHODS

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed of three scientific databases (PubMed, ISI Web of Knowledge, and Scopus), which also included a quality assessment. Articles measuring stress, psychological or physical, in remote workers, published from December 2019 through August 2021 were included in the review. Results were extracted by reporting: authors, country, study design, type of workers, sample, questionnaires and measurements, and outcomes. Data were synthesized quantitatively for country, type of workers, and outcomes.

RESULTS

Out of the 518 articles found in the three databases, 19 articles were included in the systematic review (10,012 participants overall), and 78.9% of these highlighted an increase in TERRA levels in remote workers. Among 85.7% of the studies considering gender as a variable, TERRA levels were higher in female workers. Twelve (63.2%) of the studies investigated psychological well-being, two (10.5%) focused on the physical well-being of remote workers, three (15.8%) investigated both, and two studies had other outcomes (10.5%).

CONCLUSIONS

Considering the redefinition of workplaces dictated by the COVID-19 pandemic, this review highlights the emerging issue of remote work and the use of technology in working from home, emphasizing a rapidly growing occupational health problem. Remote workers need to be provided with emotional and technical support to prevent TERRA in remote workers.

Alcohol Consumption in the Workplace: A Comparison between European Union Countries' Policies

BACKGROUND

Alcohol use is an ever-growing phenomenon in the population, consumption data indicate that 5-20% of the European working population have serious problems related to alcohol. The use of alcohol constitutes a risk to the health and safety of workers as well as to the safety of the general population. The present work aims to address the problem of alcohol intake in occupational settings by comparatively analyzing alcohol consumption behavior within the 27 countries of the European Union.

METHODS

The purpose of this research is to analyze the differences between the 27 countries of the European Union in the application of measures to assess and manage the risk of alcohol intake in occupational settings.

RESULTS

An examination of the legislation and guidelines of the different countries reveals profound differences in the management of the problem of alcohol in the workplace. The discrepancy is very wide that it ranges from the complete absence of legislative restrictions on a national level in some countries to highly restrictive measures with severe sanctions in others.

CONCLUSIONS

It would be appropriate-also for the purpose of ease of movement of workers within the European Community-to find shared management models useful for protecting the health and safety of workers and the general population.

Psychological and Mental Sequelae in Elite Athletes with Previous SARS-CoV-2 Infection: A Systematic Review

During the COVID-19 pandemic, many athletes from several sporting disciplines were infected with the SARS-CoV-2. The aim of this systematic review is to summarize the current scientific evidence on the psychological sequelae and mental health of elite athletes who have been infected by the virus. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement; three databases were searched: PubMed, ISI Web of Knowledge, and Scopus. The initial search resulted in 2420 studies; after duplicate removal and screening by title and abstract, 41 articles were screened by full-text. A total of four eligible articles were included in the review. All included articles measured depression and anxiety in athletes who had suffered from COVID-19, while in three papers levels of stress were measured. Overall, the only two questionnaires used in more than one study were the DASS-21 and the APSQ. In our systematic review, we highlighted that mental and psychological health in elite athletes has the same importance as physical health. This statement suggests that these examinations should be introduced and performed during the competitive sports' medical examinations conducted at the start of the sporting season, which currently consists only of the examination of physical parameters. Due to lack of studies on the topic, the results of our review show that mental health in athletes with a history of SARS-CoV-2 infection is an issue that requires more investigation, considering the evidence of clinical consequences. The importance of post-infection psychological sequelae is significant in assessing possible repercussions on the athletes' sporting performance.

Employee Participation in Workplace Vaccination Campaigns: A Systematic Review and Meta-Analysis

To reduce vaccine-preventable diseases in workers, workplace vaccination campaigns can be implemented on-site. The aim of this systematic review was to evaluate adherence to workplace vaccination campaigns. Three databases, PubMed, ISI Web of Science, and Scopus, were screened systematically for articles in English or Italian addressing participation in an on-site vaccination program by employees. The following data was extracted: authors, year, country, type of vaccine, type of workplace, sample size, vaccination rate. Data on the prevalence of flu vaccination were calculated and pooled using a random-effects model. Thirteen articles were included in the review, ten in the meta-analysis. Most studies were conducted in the USA (30.7%) and most vaccination campaigns were against influenza (69.2%), with a pooled estimate of 42% (95% CI: 0.25-0.60%); participation rate was highly variable, ranging from 88.9% for an influenza vaccination campaign to 5.7% for a Lyme disease vaccination campaign. Offering free on-site vaccination can be a successful tool to ensure adherence to vaccination campaigns and administration of all required doses according to the vaccine administration scheme. The occupational physician can play a key role in implementing workplace campaigns for employee mandatory vaccinations.

COVID-19 sequelae among competitive athletes: a systematic review

Background

During the COVID-19 pandemic, several professional athletes from different sports were infected by SARS-CoV-2. The aim of this systematic review was to evaluate the currently available scientific evidence regarding the cardiological, pulmonary, psychological, and combined sequelae, in professional athletes.

Methods

The present systematic review was performed following the PRISMA statements, thereby searching on 3 databases: PubMed, ISI Web of Science, Scopus. Primary studies published between January 2020 and March 2022, investigating symptomatic and instrumental sequelae in competitive athletes after COVID-19 infection, were included.

Results

A total of 1,957 articles were screened, finally 18 were included (6 cohort studies, 2 case-control studies and 10 cross-sectional studies). Studies’ sample size ranged from a minimum of 12 to 1908 athletes playing different sports. In addition, the studies examined the following type of sequelae: 12 cardiological, 2 psychological, 1 pulmonary and 3 combined. Regarding the cardiological field, the prevalence of anomalies in instrumental examinations ranged 0-27.89% for first level tests (echocardiography, electrocardiogram, troponin), and 0-6.21% for second level tests (cardiac magnetic resonance). The prevalence of myocarditis and pericarditis in the athletes ranged from 0 to 3.33%, whereby the prevalence of myocarditis was in the range 0-2.32% and that of pericarditis in the range 0-2.22%.

Conclusions

The results show that post SARS-CoV-2 infection cardiac sequelae have a quite low prevalence among competitive athletes included in our review, but it would be important to set up a gradual and continuous testing approach to preserve sports performance. Public health framework, such as vaccination campaign, is important both at European and international level in order to address potential consequences of infectious diseases among competitive athletes.

Key messages

• It is important to monitor all COVID-19 sequelae in European competitive athletes playing different sports.

• Considering anti-COVID-19 vaccination in competitive athletes as an important preventive measure, to limit the circulation of the virus and the physical consequences that may occur.

Leadership in public health crisis: a review to summarize lessons learned from COVID-19 pandemic

Background

During the COVID-19 pandemic, several public health challenges were faced, requiring worldwide leaders able to direct, guide, and establish appropriate strategies. The aim of this review was to summarize evidence on public health leadership during the COVID-19 era.

Methods

The systematic literature review was conducted according to the PRISMA 2020 checklist. A search of relevant articles was performed in the PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published between 2020 and 2022, that outlined one or more characteristics of effective public health leadership during the COVID-19 pandemic We excluded all articles that did not explicitly address the COVID-19 pandemic or had a different setting.

Results

A total of 2499 records were screened, and 45 articles were included. We identified 93 characteristics, clustered in six groups, that were reported as fundamental to be an effective leader in public health crises worldwide. Emotional intelligence and human traits (reported by 46.67% of the articles) were considered essential to build trust in the population and ensure cooperation with working groups. Communication skills (47%) are considered necessary to enable people to understand and accept measures. A supportive, multidisciplinary team and accountability mechanisms (33,33%) were highlighted as central elements, especially in the international field, to ensure reliability and consistency in action. Management skills (35,56%), adaptability (44,44%), and evidence-based approach (33,33%) were reported as key capabilities to ensure a prompt and rapid response to the challenges created by the pandemic.

Conclusions

The identification of the attributes of an effective public health leader conducted in this study is useful in choosing the key personalities who must lead public health today and in the training of tomorrow's European and worldwide leaders to be ready to face future threats.

Key messages

• Effective public health leaders in crisis are empathetic and trustworthy people, who have developed management and communication skills, and are able to make timely and evidence-based decisions.

• In order to create leaders capable of facing future threats, more emphasis in the training of public health workforce on soft skills and management competencies should be recommended.

Searching for an alliance with journalism: a survey to investigate health literacy in Italy

OBJECTIVES

This study (GLASS) aimed to explore low health literacy (HL) prevalence among journalists and general population and factors associated with low HL.

METHODS

GLASS was an Italian online cross-sectional study. Questionnaires included instruments for different HL dimensions: single item literacy screener (SILS), medical term recognition test (METER), medical data interpretation test (MDIT). For each instrument, multiple regressions were performed.

RESULTS

Participants were 665. A total of 24.6%, 85.0%, and 58.9% journalists and 19.5%, 77.8%, and 62.6% general population reported low HL (SILS, METER, MDIT, respectively). Regressions showed that journalists who had never written about health and journalists who had personally written about health without being health journalists had a higher likelihood of low HL compared with health journalists.

CONCLUSION

Since journalists are key players in public health, our findings are relevant; especially considering the context of the current pandemic. It would be advisable to bolster a stronger collaboration between professionals in the media world and the scientific community.

Post-Acute COVID-19 Sequelae in a Working Population at One Year Follow-Up: A Wide Range of Impacts from an Italian Sample

Long COVID-19 is a term used to describe the symptomatic sequelae that develop after suffering from COVID-19. Very few studies have investigated the impact of COVID-19 sequelae on employment status. The aim of this research was to characterise sequelae of COVID-19 in a population of workers who tested positive for COVID-19, with a follow-up within one year of the acute illness, and to analyse the possible association between this and changes in the workers' occupational status. In this retrospective cohort study, a questionnaire was administered to 155 workers; descriptive, univariate (chi-square tests), and multivariate (logistic regression model) analyses were carried out. The mean age was 46.48 years (SD ± 7.302); 76 participants were males (49.7%), and 33 participants reported being current smokers (21.3%). Overall, 19.0% of patients reported not feeling fully recovered at follow-up, and 13.7% reported a change in their job status after COVID-19. A change in occupational status was associated with being a smoker (OR 4.106, CI [1.406-11.990], p = 0.010); hospital stay was associated with age > 46 years in a statistically significant way (p = 0.025) and with not feeling fully recovered at follow-up (p = 0.003). A persistent worsening in anxiety was more common in women (p = 0.028). This study identifies smoking as a risk factor for workers not able to resume their job; furthermore, occupational physicians should monitor mental health more closely after COVID-19, particularly in female workers.

Nitrous oxide occupational exposure in conscious sedation procedures in endoscopic ambulatories: a pilot retrospective observational study in an Italian hospital

SUMMARY

Introduction. Nitrous oxide (N2O) is widely used to induce sedation also outside of operating rooms; there is a chance of workplace exposures for the operators engaged in the outpatient use of nitrous oxide. The aim of this research is to assess nitrous oxide exposure in gastroenterology outpatient settings. Methods. We performed an observational study marked by N2O environmental testing in a gastroenterology outpatient care; environmental research was supported by biological monitoring with urinary N2O analysis in exposed operators. The research was conducted both without and using a collective security device (NIKI mask). Results. The study was rolled out in 10 sessions of day shift procedures, totaling 4105 samples. The average N2O concentration in the environment was 27.58 (SD 1.76) and 449.59 (SD 35.29), respectively with and without NIKI Mask; the distribution of gases in the environment under investigation was not homogeneous (Anovatest P=0.001). Biological testing revealed a substantial rise in urinary concentration of 8.97 (p=0.001) between the start and the end of the shift, and the use of the NIKI-mask was effective (p=.003). Discussion. The exposure levels reported exceed the limits of 50 ppm (Italy operating rooms threshold value) as well as the value of 25 ppm (NIOSH threshold-value), indicating a significant issue in the outpatient use of N2O. Technical measures are needed to contain the occupational risk from N2O exposure outside of operating rooms; for the exposure results detected in this research, it is also evident that workers exposed to N2O must be subject to adequate health surveillance accounting for this occupational risk.

Sex and gender differences in migraines: a narrative review

Introduction

Gender medicine is a new medical approach aimed at the study of the differences between women and men in terms of prevention, diagnosis, and the outcome of all diseases. Migraines are among these. They represent the most common neurological illness; they are most prevalent in adults between 20 and 50 years of age and are three to four times more frequent in woman than in men. Affecting people in working age, migraines are a problem that strongly impacts the psychophysical health and productivity of workers, regardless of the specific job task they have.

Methods

A narrative review was performed, searching for the most relevant articles describing gender differences in people suffering from migraines, and particularly in workers.

Results

Migraine global prevalence is 20.7% in women and 9.7% in men whereas prevalence in Italy is 32.9% for women and only 13.0% for men. This difference is partly explained by hormonal differences, as well as by differences in brain structure, genetic polymorphisms and neuronal pathways. Sex differences may also play a role in the progression from episodic to chronic migraine. In workers, migraines are mostly associated with strenuous physical work in men, whilst migraines triggered by night shifts, lack of sleep, or irregular sleep patterns are more common in women.

Conclusions

To this day, the reasons of sex/gender disparity for migraine are still obscure. However, migraines, chronic migraine in particular, have a negative impact on the lives of all individuals affected by this disease, but particularly in women in which family cares and working activity are often superimposed. Migraine prevention strategies should be planned in workers through the occupational health physician.

Returning to work and the impact of post COVID-19 condition: A systematic review

BACKGROUND: The COVID-19 pandemic is still ongoing, with rapidly increasing cases all over the world, and the emerging issue of post COVID-19 (or Long COVID-19) condition is impacting the occupational world. OBJECTIVE: The aim of this systematic review was to evaluate the impact of lasting COVID-19 symptoms or disability on the working population upon their return to employment. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements we performed a systematic review in December 2021, screening three databases (PubMed, ISI Web of Knowledge, Scopus), for articles investigating return to work in patients that were previously hospitalized due to COVID-19. A hand-searched was then performed through the references of the included systematic review. A quality assessment was performed on the included studies. RESULTS: Out of the 263 articles found through the initial search, 11 studies were included in this systematic review. The selected studies were divided based on follow-up time, in two months follow-up, follow-up between two and six months, and six months follow-up. All the studies highlighted an important impact of post COVID-19 condition in returning to work after being hospitalized, with differences based on follow-up time, home Country and mean/median age of the sample considered. CONCLUSIONS: This review highlighted post COVID-19 condition as a rising problem in occupational medicine, with consequences on workers’ quality of life and productivity. The role of occupational physicians could be essential in applying limitations to work duties or hours and facilitating the return to employment in workers with a post COVID-19 condition.

Buffering the Effects of Burnout on Healthcare Professionals' Health-The Mediating Role of Compassionate Relationships at Work in the COVID Era

Managing the COVID-19 pandemic posed several challenges for healthcare professionals, which likely heightened their risk of burnout (Amanullah and Ramesh Shankar, 2020) and, consequently, their general physical and mental health. Although it may not be possible to address and eliminate the causes of burnout, current research informs healthcare organizations about protective strategies to reduce its detrimental consequences. The promotion of compassionate interactions among healthcare professionals may play such a role. Compassion within healthcare organizations positively affects individual performance and well-being. Building on these considerations and within the framework of the Conservation of Resources theory, this study explores the relationships among burnout dimensions, received compassion at work, and general health in 711 Italian healthcare professionals (68.5% female), aged between 21 and 73 years (Mage = 36.4, SD = 11.2). Analyses were conducted to investigate the association between burnout and general well-being (H1) and between burnout symptoms and perceived compassion at work (H2); and the mediational role of compassion in the relationship between burnout symptoms and general well-being. H1 and H2 were confirmed (r < 0.01 for both), and a SEM model showed the mediating role of compassion at work in the association between burnout symptoms and general well-being (RMSEA < 0.08, SRMR < 0.08, CFI and TLI > 0.90). Theoretical and practical implications of the findings are discussed in the paper.

A Cohort Study on Influenza Vaccine and All-Cause Mortality in Older Adults: Methodological Concerns and Public Health Implications

Introduction

In 2020, the restrictions adopted to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to an unprecedented reduction in influenza-related burden. As such, the reduced chance to characterize the circulating virus strains might have increased the risk of vaccine mismatch for the forthcoming winter seasons. The role of an effective influenza vaccination campaign might therefore assume even more value, especially for frail and multimorbid older individuals. Methodological concerns on confounding by indication are always debated in vaccine effectiveness studies and it might be instrumental to give a pragmatic message on an individual’s responsibility to receive the influenza vaccine. We therefore investigated the role of specific confounders to explain the association between influenza vaccine and mortality among older adults.

Methods

Using a primary care database, we formed a cohort of patients aged 65 years or older who were actively registered with their general practitioner (GP) at the beginning of each of nine influenza seasons through to the 2018/2019 season. The study index date was the related seasons’ starting date. Exposure to the influenza vaccine was operationally defined in the 2 months preceding the index date up to 2 weeks before the exit date. Cox regression models were estimated to calculate hazard ratios (HRs) and their 95% confidence intervals (CI) of death between vaccinated and unvaccinated patients in a time-dependent fashion. The potential confounders sequentially entered the model based on their increasing effect size observed in univariate analyses.

Results

Over the 10 years under study, the influenza vaccine showed a significant protective effect in terms of mortality, reaching 13% reduction (HR 0.87, 95% CI 0.80–0.95) in the 2018/2019 influenza season. When we estimated the multivariate model by sequentially adding the potential confounders, there was an inversion of HR (below the unit) that was significantly explained by the covariates coding for a prior history of lower respiratory tract infections and the presence of the pneumococcal vaccine.

Conclusion

In the current pandemic scenario, we cannot divert attention to proper use of face masks, social distancing, and hand hygiene, which are important measures to prevent influenza and other respiratory viral infections. Nonetheless, their effectiveness might be negligible without acceptable coverage for influenza vaccine, especially in older patients with a history of lower respiratory tract infections, which appears to be the main source of confounding by indication.

How the reduction of working hours could influence health outcomes: a systematic review of published studies

OBJECTIVES

The health effects of work-time arrangements have been largely studied for long working hours, whereas a lack of knowledge remains regarding the potential health impact of reduced work-time interventions. Therefore, we conducted this review in order to assess the relationships between work-time reduction and health outcomes.

DESIGN

Systematic review of published studies. Medline, PsycINFO, Embase and Web of Science databases were searched from January 2000 up to November 2019.

OUTCOMES

The primary outcome was the impact of reduced working time with retained salary on health effects, interventional and observational studies providing a quantitative analysis of any health-related outcome were included. Studies with qualitative research methods were excluded.

RESULTS

A total of 3876 published articles were identified and 7 studies were selected for the final analysis, all with a longitudinal interventional design. The sample size ranged from 63 participants to 580 workers, mostly from healthcare settings. Two studies assessed a work-time reduction to 6 hours per day; two studies evaluated a weekly work-time reduction of 25%; two studies evaluated simultaneously a reduced weekly work-time reduction proportionally to the amount of time worked and a 2.5 hours of physical activity programme per week instead of work time; one study assessed a reduced weekly work-time reduction from 39 to 30 hours per week. A positive relationship between reduced working hours and working life quality, sleep and stress was observed. It is unclear whether work time reduction determined an improvement in general health outcomes, such as self-perceived health and well-being.

CONCLUSIONS

These findings suggest that the reduction of working hours with retained salary could be an effective workplace intervention for the improvement of employees' well-being, especially regarding stress and sleep. Further studies in different contexts are needed to better evaluate the impact of work-time reduction on other health outcomes.

Adverse skin reactions to personal protective equipment ( PPE ) during COVID ‐19 pandemic in Italian health care workers

To avoid exposure to SARS‐COV‐2, healthcare professionals must use personal protective equipment (PPE). Their use has been related to a series of adverse effects; the most frequent adverse events were headache, dyspnoea, and pressure injuries. Skin adverse effects are very common, including contact dermatitis, itching, erythema, and acneiform eruptions. The objective of this study is to evaluate the skin problems caused by personal protection equipment (PPE) in health care workers (HCWs) and to individuate eventual risk factors. From May to June 2020 a retrospective observational multi‐centric study conducted by an online survey sent by email, involving 10 hospital centers, was performed. We considered as independent variables gender and age, occupational group and sector, time of utilization, type and material of PPE. We tested 3 types of PPE: gloves, bonnet, and mask for different time of utilization (<1, 1–3, 3–6, >6 h). We performed a multiple logistic regression model to correlate them with skin adverse events occurrence. Among all the 1184 participants, 292 workers reported a dermatological pathology: 45 (15.41%) had psoriasis, 54 (18.49%) eczema, 38 (13.01%) acne, 48 (16.44%) seborrheic dermatitis, and 107 (36.64%) other. In our sample previous inflammatory dermatological conditions, female sex, prolonged use of PPE were significant risk factors for developing skin related adverse events considering all the PPE considered. The use of PPE is still mandatory in the hospital setting and skin adverse reactions still represent a global problem. Although data from Europe are limited, our study highlighted the importance of the problem of PPE skin reactions in a large sample of Italian healthcare professionals.

A new tool to evaluate burnout: the Italian version of the BAT for Italian healthcare workers

BACKGROUND

Healthcare workers (HCWs) represents one of the highest-risk population to develop burnout symptoms. Recently, a new tool has been designed to measure several dimensions that capture an exhaustive expression of burnout symptoms by six dimensions (i.e., exhaustion; mental distance; cognitive impairment; emotional impairment; psychological distress; psychosomatic complaints).

METHODS

The current study aims to adapt the Burnout Assessment Tool (BAT) to an Italian Healthcare workers' sample confirming the original second-order factorial structure. Furthermore, we expected to find good indexes of reliability and validity tests. Participants were 697 Italian Health Care Workers (Female = 68.44%; mean age = 36.47; SD = 11.20). Data were collected by self-report questionnaires submitted by the snowball method.

RESULTS

Findings show a good fit of the BAT's structure, confirming the hypothesized second-order factorial model. Furthermore, good reliability has been established with the study's measures.

CONCLUSIONS

The BAT for HCWs is eligible as a new tool to evaluate burnout in the at-risk HCWs as a multi-facet constellation of symptoms.

The Dermatological Effects and Occupational Impacts of Personal Protective Equipment on a Large Sample of Healthcare Workers During the COVID-19 Pandemic

Introduction

Working during the Sars-CoV-2 pandemic healthcare workers (HCWs) had to wear Personal Protective Equipment (PPEs) for extended periods of time, leading to an increase in dermatological reactions. The study evaluates the prevalence of adverse skin reactions to PPEs among Italian healthcare workers during the COVID-19 pandemic, and aims to determine whether prolonged PPEs usage poses a significant occupational health risk, by measuring the loss of work days and the eligibility of workers that requested health surveillance due to dermatological PPEs reactions.

Materials and Methods

An online ad hoc questionnaire was administered to a sample of Italian HCWs. Questions verted on sociodemographic characteristics, PPEs usage, and occupational well-being. Descriptive analyses and logistic regressions were performed to explore possible associations between variables.

Results

Two types of PPEs, Gloves and Masks, were tested. The sample included 1,223 interviewed HCWs, 1,184 gave their consent for participation. A total of 90 medical surveillance visits were requested due to PPEs related dermatological issues: in 30 cases were recognized limitations in working duties and in one case the worker was deemed not fit to keep working. Furthermore, 25 workers had a loss of occupational days due to dermatological issues. A statistically significant correlation was observed with being a nurse or midwife (OR = 1.91, IC = 1.38–2.63, p < 0.001), and being female (OR = 2.04, IC = 1.49–2.78, p < 0.001), which acted as risk factors.

Discussion

The enhanced protection measures put in place during the COVID-19 pandemic, highlight the importance of occupational dermatology. This study could contribute to assess the issue, aiming to develop better prevention strategies in the workplace in order to improve well-being of HCWs and reduce the impact of dermatological adverse reactions to PPEs.

Public Health Regulations and Policies Dealing with Preparedness and Emergency Management: The Experience of the COVID-19 Pandemic in Italy

Worldwide, the management of health emergencies requires a high degree of preparedness and resilience on the part of governments and health systems. Indeed, disasters are becoming increasingly common, with significant health, social, and economic impacts. Living in a globalized world also means that emergencies that occur in one country often have an international, in some cases global, spread: the COVID-19 pandemic is a cogent example. The key elements in emergency management are central governance, coordination, investment of resources before the emergency occurs, and preparedness to deal with it at all levels. However, several factors might condition the response to the emergency, highlighting, as for Italy, strengths and weaknesses. In this context, policies and regulation of actions to be implemented at international and national level must be up-to-date, clear, transparent and, above all, feasible and implementable. Likewise, the allocation of resources to develop adequate preparedness plans is critical. Due to COVID-19 pandemic, the European Commission proposed the temporary recovery instrument NextGenerationEU, as well as a targeted reinforcement of the European Union’s long-term budget for the period 2021–2027. The pandemic highlighted that it is necessary to interrupt the continuous defunding of the health sector, allocating funds especially in prevention, training and information activities: indeed, a greater and more aware public attention on health risks and on the impacts of emergencies can help to promote virtuous changes, sharing contents and information that act as a guide for the population.

Mental health and discrimination among migrants from Africa: An Italian cross-sectional study

This study aimed to assess depression, anxiety, posttraumatic stress disorder (PTSD) and discrimination in African migrants and investigate determinants. A cross-sectional study was conducted in Italy (July 2019-February 2020). Inclusion criteria: being a citizen of an African country or having parents who are citizens of an African country. Questionnaires included tests for depression, anxiety, PTSD, discrimination. Multivariable regressions were performed. Participants were 293. The prevalence of depression, anxiety, and PTSD was: 12.1%, 12.1%, and 24.4%. Only 7.2% declared not to be discriminated. Among significantly associated factors, waiting for/being in possession of temporary permits and discrimination were associated with all mental outcomes. Being (or having parents from) Sub-Saharan Africa increased the likelihood of discrimination. A relevant prevalence of mental illnesses was reported. Particularly, Sub-Saharan Africans potentially offer a unique point of view. Migrants' mental health should be a priority for national and international programs of health monitoring.

Is the pandemic leading to a crisis of trust? Insights from an Italian nationwide study

OBJECTIVES

Along with mistrust toward politics and journalism, the pandemic is amplifying mistrust in healthcare. To explore trust in key professionals among the Italian population, we focused on perceived change in trust during the pandemic.

STUDY DESIGN

Nationwide online cross-sectional survey (called COCOS).

METHODS

COCOS was conducted in Italy in two periods: the end of the first lockdown (T1: April-May 2020) and the end of 2020 (T2: November-December 2020). Descriptive analyses and multivariable logistic regressions were performed (sample size = 2673).

RESULTS

Trust in healthcare workers (HCWs) was reduced in 1.5% of participants (T1) and 2.8% (T2). Trust in scientists/researchers was reduced in 5.8% (T1) and 7.6% (T2). Trust in politicians was reduced in 37.6% (T1) and 52.3% (T2). Trust in journalists was reduced in 41.7% (T1) and 48.3% (T2). Considering multivariable models, participants of the second period, participants who were HCWs, participants with anxiety symptoms, and those experiencing economic struggle due to the pandemic had a higher likelihood of having a reduced trust. The period had the strongest association with reduced trust.

CONCLUSIONS

We argue that a central role might be played by the pandemic fatigue. We suggest leading figures should be more aware of the relationship between communication and trust. The pandemic is a real-world experiment in reshaping mediated communication and, although social media play an important role, other approaches might be successful. As a notable part of the population is trusting politicians and media less and less, Italian key professionals should implement initiatives to reinvigorate public support.

Are 2020’s medical students still suffering from gender stereotypes? An Italian study

Background

Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students.

Methods

During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness.

Results

Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p &lt; 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p &lt; 0.05) and those who have received good example from tutors (coefB 0.14, p &lt; 0.05) were more gender-sensitive. Older age (coefB 0.04, p &lt; 0.05), a better knowledge on gender medicine (coefB 0.12, p &lt; 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p &lt; 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p &lt; 0.05), male sex (coefB 0.12, p &lt; 0.05) and older age (coefB 0.03, p &lt; 0.05) were associated with more stereotypes towards doctors.

Conclusions

Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered.

Key messages

Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.

Mental health and access of care during Covid-19 pandemics: an italian cross-sectional study

Background

COVID-19 emergency forced nations to introduce containment measures to reduce the spread of the virus. This study assessed the possible effects of the pandemic on mental health and care access.

Methods

A cross-sectional study was conducted in Italy in two observation periods in 2020: April-May (first lockdown) and November-December (no lockdown). Categorical variables were compared with χ2 tests. Mental health outcomes (PHQ-2 ≥ 3; or GAD-2 ≥ 3) and outcomes related to care access were considered. Multivariable logistic regression models were performed.

Results

Participants were 2673 (66.8% female; mean age=44 years, SD = 15). Depressive symptoms were found in 24.7% of participants, while 24.2% showed an anxious symptomatology. A total of 12.5% said they voluntarily gave up scheduled medical service, 6.4% avoided acute treatments, and 5% changed therapy themselves. Comparing the two periods, there were no significant differences in the outcomes under study. Students were at higher risk of depressive symptoms (OR = 2.23; 95% CI 1.42-3.52; p = 0.001). Women and those who increased the time on internet presented an increased risk of developing depressive and anxious symptomatology. The scheduled medical service was mainly postponed by those who said they were afraid to go out of necessity (OR = 2.49; 95% CI 1.87-3.32; p &lt; 0.001) or to cause themselves an injury (OR = 1.78; 95% CI 1.32-2.40; p &lt; 0.001). Foreigners (OR = 4.24; 95% CI 1.70-10.55; p &lt; 0.002) are more likely to avoid acute treatment. Workers and those with anxious disorders appear to be more inclined to self-medicate (OR = 2.05; 95% CI 1.29-3.26; p = 0.003).

Conclusions

Compared to the pre-pandemic period, higher levels of anxiety and depression were observed. No differences in mental health and care access were shown between the two observation periods. Being afraid to go out of necessity and avoidance of physical activity for fear of injury is related to reduced access to care, but not to self-medication.

Key messages

The 24.7 % of the sample reported depressive symptoms, and 24.2 % anxious symptoms. Similar increases were observed in both periods: April-May (first lockdown) and November-December (no lockdown). During the pandemic, delayed access to planned and acute care, avoidance of physical activity for fear of injury, and self-medication pose a major public health challenge in the coming period.

Pre-exposure prophylaxis' knowledge, attitudes, practices amongst italian men who have sex with men

Background

Pre-exposure prophylaxis (PrEP) is suitable for human immunodeficiency virus (HIV)high-infection-risk people, foremost amongst males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use.

Methods

An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour, knowledge on HIV and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify possible associations with PrEP knowledge.

Results

A total of 196 MSM completed the survey. Overall data showed very good HIV and safe sexual behaviour knowledge (94.4% of correct answers). Nevertheless, our sample rarely used PrEP because of existing barriers: high therapy price (26.9%)and fear of side effects (23.8%). Only 10.3% of partecipants were informed on HIV and PReP by institutional channels, even less (7.5%) from specialized physicians and general practitioners. The most significant association with PrEP knowledge was having regular HIV-tests (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29);

Conclusions

PreP's Knowledge was well established, but PrEP use was not widespread. It is necessary to improve communication on PrEP and to lower existing barriers in order to grant access to PrEP access.

Key messages

Barriers to access PrEP have to be lowered. Healthcare personnel has to be involved in PrEP's benefits communication.

The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review

The primary aim was to evaluate the burnout prevalence among healthcare workers (HCWs) in intensive care units (ICUs) and emergency departments (EDs) during the COVID-19 pandemic. The secondary aim was to identify factors associated with burnout in this population. A systematic review was conducted following PRISMA guidelines by searching PubMed, Embase, PsychINFO, and Scopus from 1 January to 24 November 2020. Studies with information about burnout prevalence/level during the pandemic regarding ICU/ED HCWs were eligible. A total of 927 records were identified. The selection resulted in 11 studies. Most studies were conducted in April/May 2020. Samples ranged from 15 to 12,596 participants. The prevalence of overall burnout ranged from 49.3% to 58%. Nurses seemed to be at higher risk. Both socio-demographic and work-related features were associated with burnout. Many pandemic-related variables were associated with burnout, e.g., shortage in resources, worry regarding COVID-19, and stigma. This review highlighted a substantial burnout prevalence among ICU/ED HCWs. However, this population has presented a high burnout prevalence for a long time, and there is not sufficient evidence to understand if such prevalence is currently increased. It also outlined modifiable factors and the need to improve emergency preparedness both from an individual and structural level.

Clinical Relevance of Tubular Breast Carcinoma: Large Retrospective Study and Meta-Analysis

Background: Tubular carcinoma (TC) is a low proliferative grade 1 (G1) breast cancer (BC). Despite its favorable outcome and allegedly lower aggressiveness, patients are treated like other luminal G1 BC, with radiotherapy (RT) and hormonal therapy (HT). We performed: (1) a retrospective study comparing a TC cohort and a control series of luminal G1 BC and (2) a systematic review and meta-analysis focused on TC outcome.

Materials and Methods: We selected a series of 572 G1 luminal BC patients [111 TC, 350 not otherwise specified (NOS), and 111 special-type (ST) BC] with follow-up and clinico-pathological data, who underwent local excision followed by RT at Città della Salute e della Scienza Hospital, Turin. Moreover, 22 and 13 studies were included in qualitative and quantitative meta-analysis, respectively.

Results: TCs were generally smaller (≤10 mm) (P < 0.001), with lower lymph node involvement (P < 0.001). TCs showed no local and/or distant recurrences, while 16 NOS and 2 ST relapsed (P = 0.036). Kaplan–Meier curves confirmed more favorable TC outcome (DFI: log-rank test P = 0.03). Meta-analysis data, including the results of our study, showed that the pooled DFI rate was 96.4 and 91.8% at 5 and 10 years, respectively. Meta-regression analyses did not show a significant influence of RT nor HT on the DFI at 10 years.

Conclusions: Compared to the other G1 BCs, TCs have an excellent outcome. The meta-analysis shows that TC recurrences are infrequent, and HT and RT have limited influence on prognosis. Hence, accurate diagnosis of TC subtype is critical to ensuring a tailored treatment approach.

Knowledge, Attitudes and Practices Regarding Pre-Exposure Prophylaxis (PrEP) in a Sample of Italian Men Who Have SEX with MEN (MSM)

BACKGROUND

Pre-exposure prophylaxis (PrEP) is suitable for high human immunodeficiency virus (HIV)-infection risk people, foremost among whom are males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. No previous study has assessed this issue; Methods: An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour and habits, HIV/acquired immune deficiency syndrome (AIDS) knowledge and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify factors associated with PrEP knowledge; Results: A total of 196 MSM participated in this survey. Overall data showed that 87.2% of participants knew what PrEP is, but only 7.5% have ever used it. The main reason for not using PrEP was the cost of the therapy (26.9%). The principal source of PrEP information was the Internet (68.4%). Being regularly tested for HIV was significantly associated with PrEP knowledge (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29); Conclusions: Knowledge regarding PrEP was well established, but PrEP use was not equally widespread. It is necessary to improve research on PrEP usage in order to PrEP access to be granted.

Beyond COVID-19: a cross-sectional study in Italy exploring the covid collateral impacts on healthcare services

With COVID-19, populations are facing unmet health needs due to fear of contagion, lockdown measures and overload of Healthcare services (HCS). The COCOS study aimed to investigate reduced healthcare access among Italian citizens, additionally looking for specific subgroups that will primarily need health services in the next future. A cross-sectional online survey was performed during the Italian lockdown between April and May 2020. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed as Odd Ratios and Adjusted Odd Ratios (ORs and AdjORs). Totally, 1,515 questionnaires were collected. Median age was 42 years (IQR 23), 65.6% were females. Around 21.8% declared to suffer from chronic diseases. About 32.4% faced a delay of a scheduled Medical Service (MS) by provider decision, 13.2% refused to access scheduled MS for the fear of contagion, and 6.5% avoided HCS even if having an acute onset issue. Alarmingly, 1.5% avoided Emergency Department when in need and 5.0% took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR [95% CI]: 2.16 [1.16-4.02]). This study demonstrated that indirect effects of COVID-19 are significant. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. Immediate efforts are needed to reduce the backlog that HCSs incurred in.

Prevalence of gastro-oesophageal reflux symptoms: An Italian cross-sectional survey focusing on knowledge and attitudes towards lifestyle and nutrition

INTRODUCTION

The gastro-oesophageal reflux disease (GERD) is a public health issue for its prevalence and association with low life quality and substantial costs. Since most of Italian data refer to over a decade ago, the aim was to provide an updated estimate of GERD symptoms prevalence. Knowledge about appropriate nutrition and behaviours in presence of GERD was assessed. Predictors for symptoms presence and knowledge were explored.

METHODS

This study was an online cross-sectional survey that investigated socio-demographics, knowledge about nutrition/behaviours in case of GERD (Knowledge Score KS: percentage of right answers), nutrition/lifestyle attitudes. The questionnaire included the GerdQ to assess symptoms (presence if score ≥8). Adults resident in Italy were enrolled between June and August 2019 through convenience sampling on the major social networks (sample size = 559). Descriptive analyses were run. Multivariable regressions were performed to explore predictors of symptoms presence and KS.

RESULTS

The 27.7% had GERD symptoms. Among them, 33.8% never received GERD information by their general practitioner (GP). Body mass index (P = .036), secondary education (P = .040) were associated with higher symptoms risk. Weekly exercise was associated with lower risk (P < .001). Median KS was 92% (IQR = 12). Sleeping on the left side, chocolate, citrus fruit, mint reported the lowest right answers percentages. None/basic education was negatively associated with KS (P < .001), being female (P = .004) and in a relationship (P = .012) positively.

CONCLUSIONS

A high prevalence was reported, consistently with the worldwide increasing trend. Despite overall knowledge was high, specific gaps were found. GPs should improve communication and awareness campaigns targeted to less known aspects must be planned.

Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis

BACKGROUND

To evaluate the prevalence of work-related musculoskeletal disorders (WRMSDs) in perioperative nurses and to explore their association with personal characteristics.

METHODS

Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library and Joanna Briggs Institute Database were systematically searched. A meta-analysis calculating event rates, and relative 95% Confidence Intervals (CI) was performed for each musculoskeletal body region. The contribution of perioperative nurses' sex, age, and BMI was assessed through a meta-regression.

RESULTS

Twenty-two studies, considering 3590 perioperative nurses, were included in the systematic review. The highest prevalence of WRMSDs was found for the lower-back (62%; 95% CI 0.54-0.70), followed by knee (47%; 95% CI 0.36-0.59), shoulder (44%; 95% CI 0.37-0.51), waist (42%; 95% CI 0.31-0.53), neck (39%; 95% CI 0.29-0.51), ankle-feet (35%; 95% CI 0.22-0.51), upper-back (34%; 95% CI 0.25-0.44), hand-wrist (29%; 95% CI 0.20-0.40), and elbow (18%; 95% CI 0.12-0.26). Meta-regression showed that sex, age, and BMI were not significant predictors of low-back disorders (p = 0.69; R² = 0).

CONCLUSIONS

WRMSDs represent a high prevalence issue among perioperative nurses. Perioperative nurses, in general, are steadily exposed to both physical and temporal risk factors. Further studies should be addressed to identify specific interventions aimed at reducing the burden of WRMSDs including ergonomic education and physical rehabilitation. Our data could be used in future studies as a reference to assess the risk of WRMSDs in other health-care professionals' population.

Wrong administration route of medications in the domestic setting: a review of an underestimated public health topic

Introduction: Since medication errors related to incorrect administration routes are less common than other errors, they are rarely considered when assessing patient mistakes. The present review was performed to search for papers assessing incorrect route medication errors made by adult patients with the aim of providing an overview of this phenomenon.Areas covered: PubMed, Scopus, and EMBASE were searched up to October 2019 using free text and MeSH terms, returning 7609 results. Papers were considered eligible if they considered incorrect administration route errors by adult patients in domestic settings. Eleven papers were included, primarily from National Poison Centers (NPCs) or similar institutions from USA or Europe (observation period: 1985-2014). The data showed how an incorrect route of self-administration is a concern for patient safety and should be considered when evaluating medication errors. Moreover, one of the main observations that the results highlighted was the difficulty of obtaining clear and precise data regarding self-administration.Expert opinion: NPC reports are a reliable but not exhaustive tool due to high underreporting; reports should provide additional information or insights into these issues. Additionally, improvements in drug packaging and labeling, proper plain language instruction and patient education could reduce the frequency of such errors.

Healthcare Workers' (HCWs) attitudes towards mandatory influenza vaccination: A systematic review and meta-analysis

Influenza is a disease responsible for thousands of deaths every year. Although healthcare workers (HCWs) represent a way of contagion for patients, vaccination coverage among them is low. Mandatory vaccination has been proposed, but controversies remain. This systematic review and meta-analysis aimed to assess the acceptance of mandatory vaccination by HCWs, and to investigate associated characteristics. MEDLINE, Scopus, Embase, PsycInfo, CINAHL and Web of Science were used to search for studies assessing the topic. PRISMA statements were followed. Of the 13,457 univocal records found, 52 studies were included in the systematic review and 40 in the meta-analysis. The pooled proportion of HCWs accepting the policy was of 61% (95% CI: 53%- 68%) but with great heterogeneity between continents (from 54% in Europe to 69% in Asia) and in different professionals (from 40% in nurses to 80% in students). Vaccinated HCWs agreed more frequently with mandatory vaccination than non-vaccinated ones. More studies that consider mandatory vaccination acceptance as the main outcome are needed, but the results of this study confirm that in some settings the majority of HCWs favour mandatory vaccination. This, combined with effects that a flu epidemic could have if overlapped to pandemics with similar symptoms, requires renewed considerations on mandatory vaccination.

Empowering seizure management skills: Knowledge, attitudes, and experiences of school staff trained in administering rescue drugs in Northern Italy

PURPOSE

The administration of rescue medication at school concerns students for which it may be essential, on doctor's prescription, to take therapy during school hours. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death.

METHODS

Every year, the Local Health Unit "TO3" in Northern Italy, provides training for school staff to administrate rescue medication at school. From December 2019 to February 2020, the same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases completed it before the course.

RESULTS

About 60% of the sample (N = 123) had been trained in seizure management at least once in their lifetime. Median knowledge score in subjects with no seizures training was 7 (Q25/Q75: 5/8), while it was 9 (Q25/Q75: 6/10) in subjects with seizures training (p < 0.001). The self-reported level of confidence in their skills to administer rescue medication was high in 10.2% of subjects not trained for seizures and in 62.9% of those trained (p < 0.001).

CONCLUSION

Results suggest that medical training for school staff increases knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude toward seizures, no longer considering them a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a better place for all students.

Which is the best communication strategy, based on anti-tobacco ads, to impress teenagers? A multicenter cross-sectional study

BACKGROUND

Well-planned mass-media campaigns can increase health literacy and raise awareness about the consequences of tobacco use. This study aims to evaluate the emotions and opinions of adolescents about several anti-tobacco spots delivered by the mass media over the world.

STUDY DESIGN

Cross-sectional study.

METHODS

The study was conducted in Italy in 2016-2017 among students aged 13-17 years. Students expressed their emotions and opinions about seven anti-tobacco spots from all over the world on different topics and styles.

RESULTS

499 students attended. The video "Sponge" was found to be the most impressive (30.2%) and what they would have chosen if they had been responsible for campaign launched by the Minister of Health (40.5%). The "Icons" spot ranged second, with 19.2% and 17.4%, respectively.

CONCLUSIONS

In summary, this study showed that the communication strategies most effective, according to the students interviewed, are those that give clear messages with a scientific profile or that discover the false stereotypes, as in the video "Icons". However, further research is needed to investigate the effectiveness of TV campaigns against smoking, in terms of habits and knowledge in young people.