Sick leave request following anti-COVID-19 vaccine administration is low among healthcare workers: results from a retrospective cross-sectional monocentric study.

OBJECTIVE: Anti-COVID-19 vaccines were mainly associated with non-serious adverse events (AEs), whose prevalence was reported to be up to 70% in healthcare workers (HCWs). This may lead to sick leave requests, but this impact has never been quantified. This study aimed to investigate the absence from work among HCWs following anti-COVID-19 vaccination. Its association with age and previous COVID-19 infection was also assessed. PATIENTS AND METHODS: This is a retrospective observational cross-sectional study on administrative data about sick leave requests after anti-COVID-19 vaccination. All the HCWs employed at the Niguarda Hospital (Milan, Italy) who received the vaccine from December 27, 2020 to February 28, 2021 were included. RESULTS: In total, 4,088 HCWs received the first dose of the vaccine and 4,043 completed the vaccination cycle. After the first injection, 1.6% of HCWs requested sick leave, while after the second injection, the number of requests significantly increased (+6.1%, p<0.001). A significant increase in sick leave was detected for those who have had SARS-CoV-2 infection after the first injection (+2.3%, p<0.001). After the second dose, a significant increase in sick leave was observed in the 20-30-year-old group compared to >30 years (+3.6%, p=0.017), if HCWs without a history of SARS-CoV-2 infection were considered. CONCLUSIONS: The requests for sick leave among HCWs following the anti-COVID-19 vaccine were limited and higher after the second injection. This may help the management of the human resources when the large-scale administration of the anti-COVID-19 vaccines will involve other categories of workers.

Chronic, acute and acute-on-chronic pain prevalence in a tertiary care hospital setting.

OBJECTIVE: The aim of the study was to develop appropriate pain therapy and prevention plans; pain needs to be understood in terms of prevalence and associated predictor factors in hospital and primary care. The purpose of our research was to assess the prevalence of chronic, acute, and acute-on-chronic pain, and ascertain the effects of several factors on the likelihood of pain in an Italian Tertiary Care Hospital. PATIENTS AND METHODS: This is a prevalence study in which the primary outcome was the prevalence rate of chronic pain inpatients. Fisher's exact tests and binomial logistic regression were performed for the prevalence measures, and to ascertain the effects of Hospital Unit, sex, age, surgery and preexisting chronic pain on the likelihood of pain during the hospitalization, respectively. RESULTS: Chronic pain was reported in one-fifth of inpatients [21.7% (95% CI: 0.1764, 0.2625)], with a high prevalence of pain-related interference on sleep and emotional status. Nearly 70% of chronic pain patients accused acute-on-chronic pain [15.3% (95% CI: 0.1178, 0.1934)]. High pain prevalence rates were assessed at the time of the interview (37.3%; 95% CI: 0.3234, 0.4239) and in the last 24 hours of hospitalization (53.3%; 95% CI: 0.4814, 0.5850). A 2.7 and 2.6 higher odds to suffer from pain during the hospitalization were associated with surgery, and preexisting chronic, respectively. CONCLUSIONS: This study raises awareness of the necessity to refine pain assessment and management in hospital and outpatient services. The promotion and enhancement of hospital-territory integration are essential for improving pain prescribing practices and increasing patient safety.

Host factors and history of SARS-CoV-2 infection impact the reactogenicity of BNT162b2 mRNA vaccine: results from a cross-sectional survey on 7,014 workers in healthcare.

OBJECTIVE: This study aimed to improve the post-marketing surveillance on mRNA anti-SARS-CoV-2 vaccines, characterizing the adverse events (AEs) after the first dose of mRNA BNT162b vaccine. The associations between the AEs and individuals' characteristics were explored. PATIENTS AND METHODS: All adult healthcare workers at Niguarda Hospital (Milan, Italy) who were referred for the first dose of vaccine were offered to participate in a cross-sectional survey during the second-dose administration, between 18 January and 7 February 2021. All participants completed a questionnaire about age, gender, weight, height, medical history, concurrent therapies, employment status, previous diagnosis/testing for SARS-CoV-2 infection, and a list of 24 AEs (solicited AEs). The development of at least one solicited AEs was the main outcome. AEs were stratified by the presence of injection-site symptoms, systemic symptoms or both, and the differences between strata were assessed as a secondary outcome. Biometric data and reports of a previous diagnosis of SARS-CoV-2 infection were also explored, as predictors of the main outcome. RESULTS: 7,014 healthcare workers were included. An incidence of 3 per 10.000 persons for serious AEs following the first administration of the mRNA BNT162b vaccine was found. An association between the development of non-serious AEs with young age, female gender, low body mass index, and previous history of SARS-CoV-2 was described. CONCLUSIONS: This real-life study supported data on the safety profile of the BNT162b2 mRNA vaccine. Our findings on the associations between the development of non-serious AEs with some individual characteristics may help physicians and patients make educated and informed medical decisions towards anti-COVID-19 vaccination.

Difference between apnea-hypopnea index (AHI) and oxygen desaturation index (ODI): proportional increase associated with degree of obesity.

PURPOSE: Obesity is one of the main predisposing factors for obstructive sleep apnea (OSA) hypopnea syndrome. It has been described that body mass index (BMI) influences the accuracy of oxygen desaturation index (ODI) for the diagnosis of OSA by polysomnography (PSG). We analyzed the relationship between traditional indicators: apnea-hypopnea index (AHI) and ODI in a population at high risk for OSA, by respiratory polygraphy (RP) and PSG. METHODS: This is a retrospective study of 1898 patients with suspicion of OSA, from which 1053 underwent RP and 582 underwent PSG with OSA. We compared results considering gender, age, and degree of obesity. RESULTS: This study included 1333 records of patients with OSA-more than 80 % of whom were overweight or obese. We observed that AHI and ODI increased progressively with obesity grade and said increase was associated with BMI only in men. The evaluation of the agreement between AHI and ODI found a difference between normal weight and obese patients, regardless of gender. CONCLUSIONS: Study findings contribute to understand the role of oximetry in the diagnosis of OSA in obese patients. Our results were observed using full PSG and a simplified home method. The correlation between these indicators could improve our clinical interpretation of OSA severity among obese patients when abbreviated tests are used.

Spatial organization of osteoblast fibronectin matrix on titanium surfaces: effects of roughness, chemical heterogeneity and surface energy.

We investigated the early events of bone matrix formation, and specifically the role of fibronectin (FN) in the initial osteoblast interaction and the subsequent organization of a provisional FN matrix on different rough titanium (Ti) surfaces. Fluorescein isothiocyanate-labelled FN was preadsorbed on these surfaces and studied for its three-dimensional (3-D) organization by confocal microscopy, while its amount was quantified after NaOH extraction. An irregular pattern of adsorption with a higher amount of protein on topographic peaks than on valleys was observed and attributed to the physicochemical heterogeneity of the rough Ti surfaces. MG63 osteoblast-like cells were further cultured on FN-preadsorbed Ti surfaces and an improved initial cellular interaction was observed with increasing roughness. 3-D reconstruction of the immunofluorescence images after 4 days of incubation revealed that osteoblasts deposit FN fibrils in a specific facet-like pattern that is organized within the secreted total matrix overlying the top of the samples. The thickness of this FN layer increased when the roughness of the underlying topography was increased, but not by more than half of the total maximum peak-to-valley distance, as demonstrated with images showing simultaneous reconstruction of fluorescence and topography after 7 days of cell culture.

Emergency system prospective performance evaluation for cardiac arrest in Lombardia, an Italian region.

BACKGROUND: The aim of this research is to evaluate quality of out-of-hospital medical services in our country, using performance indicators and a new computerised database. METHODS: (a) EXPERIMENTAL DESIGN: Data were collected prospectively in three emergency dispatch centres for 90 days. Follow-up was evaluated at 1 day and 1 month after the event. This paper presents data on the cardiac arrest cohort only. (b) SETTING: Three emergency dispatch centres in Lombardia. (c) PATIENTS: One hundred and seventy-eight patients in non-traumatic cardiac arrest were enrolled. (d) INTERVENTIONS: None. The study was observational only. RESULTS: Mean interval between phone call and arrival on scene was 8.5+/-3.5 min. BLS manoeuvres were carried out from bystanders only in 15% of the cohort; this was associated with significant mortality reduction (85.7 versus 95.8%, chi(2) P<0.05). One hundred and thirty-three patients (75%) received assistance from BLS crews while only 45 patients (25%) were assisted by ALS medical personel, with a significant mortality reduction (ALS deaths 86.7%, BLS deaths 97%). Total 24 h survival was 9% and survival at 1 month declined to 6.17%. CONCLUSIONS: Quality monitoring produces objective information on interventions and outcomes. Only with this information, is it possible to implement improvement programmes that are planned according to the data presented.

Detection of posterior urethral valves with voiding cystourethrosonography with echo contrast.

PURPOSE: Cystosonography with echo contrast is an imaging modality developed to avoid x-ray exposure during detection of vesicoureteral reflux. The main role of cystosonography has been limited to screening for reflux in the female and for followup of both sexes. In males the radiographic voiding cystourethrogram is still considered the gold standard for urethral evaluation. We determined whether cystosonography during the voiding phase (voiding cystourethrosonography) can adequately visualize the male urethra and differentiate the normal from the obstructed urethra. MATERIALS AND METHODS: 100 males underwent cystosonography with echo contrast to detect vesicoureteral reflux. During the voiding phase the urethra was studied with ultrasound. The transperineal sagittal approach was chosen because the bladder neck and proximal part of the urethra were better visualized with the probe maintained coaxial to these structures. In every case in which ultrasound urethral imaging was considered abnormal a radiographic voiding cystourethrogram was performed for comparison, and the urethra was directly observed with cystourethroscopy. All patients with normal urethral imaging have been followed for 12 to 54 months (mean 32). RESULTS: Voiding cystourethrosonography visualized the voiding phase in all patients studied with the transperineal ultrasound approach. Of the 100 boys 8 were correctly diagnosed with posterior urethral valves. None of those with normal ultrasound imaging showed clinical signs suggestive of urethral obstruction and remained asymptomatic. CONCLUSIONS: The male posterior urethra can be effectively visualized with voiding cystourethrosonography, which can differentiate normal from the pathological obstructive urethral findings. This new approach can be recommended as the primary imaging modality to detect vesicoureteral reflux for both sexes, limiting the role of conventional fluoroscopic voiding cystourethrogram only to confirmation of a pathological finding in the male patient with a suspected obstructed urethra.

[Quality and efficiency of the Health Service in the Italian Region of Lombardy]. / Efficienza e qualità nel servizio sanitario Lombardo.

The Regional Law No. 31 of 1997 has revised the Lombardy Health Service as a whole, separating "providers", credited Public and Private Health Institutions, from "purchasers", Local Health Agencies. To this purpose, the improvement of the quality of assistance has been enhanced through an accreditation process aimed at implementing second level regional requirements considered as being necessary for carrying out effective treatment and meeting patient needs. Training, implementation and evaluation of quality service within Health Institutions have been carried out with the assistance of the Regional Observatory on the Quality of Health Service, which helped to identify initial intervention areas, define process indicators, activities and outcomes and verify patient satisfaction, all this to improve performance, reduce risks and control costs. To fully develop the Institutions in the accreditation process, the complex and difficult aspect of health care quality has been more extensively and deeply dealt with by adopting an "Excellence accreditation" model in cooperation with the Joint Commission International Accreditation and by experimenting with Professional accreditation supported by Scientific Societies to further contribute to the development of technical skills and knowledge. The Quality Project carried out so far is based on the integration of various projects, which will be the object of practical interventions by the General Health Direction. All the information and results gathered from this project will be very helpful in finding solutions that will enable all Health Institutions in Lombardy to reach an adequate level of quality.

A familial syndrome due to Arg648Stop mutation in the X-linked renal chloride channel gene.

We describe a familial syndrome in two brothers who were investigated after the casual discovery of tubular proteinuria in their 1st month of life. During a follow-up of 20 and 11 years, respectively, the two children grew well and were asymptomatic, but developed the same biochemical abnormalities, i.e., tubular proteinuria and hyperphosphaturia, progressive decrease in serum phosphorus below the normal values for age, and an increase in serum 1,25-dihydroxyvitamin D levels over normal values. Moreover, hyperabsorptive hypercalciuria and systemic osteopenia developed and progressively worsened. In both children, at a different age, medullary nephrocalcinosis appeared. The oldest boy suffered a progressive decrease in urinary concentration ability and in glomerular filtration rate. Oral phosphate supplementation led to reversal of all biochemical abnormalities, with the exception of decreased phosphate tubular reabsorption and tubular proteinuria. With long-term phosphate supplementation, a normal bone mass was reached, while progression of nephrocalcinosis was arrested and impairment of renal function was slowed down. In a family study (siblings and parents), the only detectable abnormality was microglobinuria in the mother, thus suggesting a X-linked inheritance of this disorder. In the two probands a mutation within the renal chloride channel gene (CLCN5) was discovered.