Dental unit water content and antibiotic resistance of Pseudomonas aeruginosa and Pseudomonas species: a case study.

Background: Many studies consider the contamination of dental unit waterlines (DUWLs), but few of them have studied the possible presence of antibiotic resistant Pseudomonas aeruginosa in the DUWLs. Aims: Investigation of the presence of P. aeruginosa and Pseudomonas spp. strains in DUWLs and evaluation of their resistance to six antibiotics (ceftazidime, netilmicin, piperacillin/tazobactam, meropenem, levofloxacin, colistin sulfate) at a public dental clinic in Milan, Italy. Results: Dental units were contaminated by P. aeruginosa with loads of 2-1,000 CFU/L and were mainly located on the mezzanine floor, with a range of 46-54%, while Pseudomonas spp. were primarily found on the first and second floors, ranging from 50 to 91%. P. aeruginosa was antibiotic resistant in 30% of the strains tested, andPseudomonas spp. in 31.8% . Cold water from controls was also contaminated by these microorganisms. Conclusion: Monitoring antibiotic resistance in the water and adopting disinfection procedures on DUs are suggested within the Water Safety Plan.

Nurse Case Manager Lifestyle Medicine (NCMLM) in the Type Two Diabetes patient concerning post COVID-19 Pandemic management: Integrated-Scoping literature review.

Background: The American Case Manager Association defines Case Management, in Lifestyle Medicine perspective, a collaborative practice between all the actors involved in the care process. The goal of this review was to evaluate the Nurse Case Manager role in Type 2 Diabetes patients, analyzing the quali/quan-titative data related to Nurse Case Management programs in Lifestyle Medicine view. Study design and Methods: Three independent operators were involved in two distinct phases, applying the Prisma method, specifics PICOS and research strategies from PubMed and Cinahl. The first part integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus, while the second part evaluated the Nurse Case Manager interventions in Lifestyle Medicine view. Results: The first part includes 13 studies and the second 6. The glycemic control was improved in the Nurse Case Manager groups in Lifestyle Medicine perspective. Good results were appreciated in secondary outcomes: lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to Lifestyle Medicine programs are encouraging. Conclusions: It emerged unequivocally that, taking care and supporting the diabetic subject, leads to significant benefits in the general health and to reduction of possible complications. After the Covid-19 Pandemic, the Nurse Case Manager Lifestyle Medicine could represent a valid alternative of health management for the improvement of care in Type 2 Diabetic patients.

Burnout syndrome: a preliminary study of a population of nurses in italian prisons.

INTRODUCTION: Burnout is a set of psychological manifestations ("emotional exhaustion", "depersonalization" and reduced "personal accomplishment") that principally affects healthcare professionals. OBJECTIVES: Analysis of the level of burnout among twelve nurses who work in two Italian prisons. MATERIAL AND METHODS: The Maslach Burnout Inventory was administered. In order to explore possible correlations between the three dimensions of the Maslach Burnout Inventory and such variables as age, years of service in general and years of service in prisons, multiple regression based on the ordinary least squares method (OLS model) was performed. RESULTS: The response rate was 100%, of whom 66.6% female and 33.4% male. The average age is 38.1 years. Over half of the sample had worked from 0 to 10 years in prisons (58.4%), and only one respondent had done so between 21 and 30 years (8.3%). The data indicate that the highest levels of burnout concerned the dimension of "depersonalization" (66.7%) and "personal accomplishment" (41.6%). Emotional exhaustion of nurses in carrying out their work diminished with the increase of the independent variable of "personal accomplishment" (p-value 0.0361); it increased with the increase of the age variable (p-value 0.0117). Personal accomplishment decreased with the increase of the independent variables of emotional exhaustion (p-value 0.0361) and years of service in prisons (p-value 0.0238). For depersonalization, no statistically significant coefficients were observed. Model 1 of multiple regression showed a significant statistical association between the emotional exhaustion (dependent variable) and personal achievement (p-value 0.0361), and increase in age (p-value 0.0117). Model 2 showed significant statistical association between personal achievement (dependent variable) and emotional exhaustion (p=value 0.0361) and years of service nursing in prisons (p-value 0.0238). Model 3 showed no statistical association between depersonalization (dependent variable) and the other variables. CONCLUSIONS: While twelve nurses formed this small sample, the study nonetheless indicated how the variables examined can influence the levels of burnout. Given that thorough inquiries into the levels of burnout among nurses who work in Italian prisons, specifically in the Marche Region, have yet to be conducted, this pilot study can serve as a point of reference for future research to improve evidence-based medicine.

Campaign manufacturing of highly active or sensitizing drugs: a comparison between the GMPs of various Regulatory Agencies.

BACKGROUND: Cross-contamination and mix-ups are among the problems which could have a negative impact on the quality of the finished product during the production of highly active or sensitizing drugs with campaign manufacturing. Standardised, validated procedures ensure quality standards are maintained during production. In spite of this, the operating conditions and applicability of methods adopted by the various regulatory agencies manifest significant differences which could consequently compromise the safety of the finished product. This work has analysed and compared the GMP of various Regulatory Agencies to examine issues connected to campaign manufacturing highly active or sensitizing drugs. METHODS: The GMP of the following Regulatory Agencies have been studied: EMA, CFDA, COFEPRIS, FDA, Health Canada, ANVISA, CDSCO, PIC/S and WHO. The study was carried out for the purpose of understanding which agencies consent to the use of campaign manufacturing for the following categories of medicinal products: hormones, immunosuppressants, cytotoxic agents, highly active pharmaceutical ingredients (APIs), biological preparations, steroids, sensitizing pharmaceutical materials, antibiotics, cephalosporins, penicillins, carbapenems and beta-lactam derivatives. RESULTS: The GMP of Health Canada, EMA, PIC/S and FDA show a number of similarities, starting with the fact that they allow campaign manufacturing for similar categories of pharmaceutical products after an appropriate risk evaluation has been performed. CFDA, WHO, ANVISA authorise campaign manufacturing in "exceptional circumstances", though they do not always define what they mean by this. COFEPRIS authorises campaign manufacturing for certain classes of drugs, while there is no mention of campaign manufacturing in the CDSCO regulations. CONCLUSIONS: Quite a few significant differences have been found in the various regulations concerning the use of campaign manufacturing and the classes of drugs that can be produced with this method. In the light of this, it is obvious that efforts to harmonise legislation internationally have not yet been successful: currently, states can adopt different quality standards. The pharmaceutical industry could use this situation to its advantage by delocalising production on the basis of existing standards. The need to harmonise GMPs is a priority which must be achieved as soon as possible.

Healthcare acquired infections: malpractice and litigation issues.

BACKGROUND: Healthcare acquired infections (HAIs) represent a significant burden for hospitalized patients in terms of mortality, morbidity, length of stay and costs. Also cause medical liability and medical malpractice litigation. METHODS: Specific keywords combinations were analitically searched in PubMed and Scopus databases. Publications concerning medical liability, medical malpractice and litigation issues were reviewed. RESULTS: The authors outlined the healthcare workers and healthcare settings mandatory duties in consideration of the Italian law. In case of infections occurred in hospital environment the patients must demonstrate the guilty nature of the physicians and healthcare settings, the existence of a harm and causal connection. Physicians and healthcare facilities defence is mainly based on demonstration that protocols and aseptic measures were adopted scrupulously applying the up to date scientific knowledge. CONCLUSIONS: HAI are a complex issue which need a multitask strategy and a surveillance system to control the phenomenon and help physicians and healthcare facilities to reduce malpractice litigation.

The pharmacist's role in health information, vaccination and health promotion.

On the subject of vaccination, owing to complex issues connected to vaccine refusal and vaccine hesitancy, the pharmacist is seen as a professional figure in the health sector who is qualified to improve social accountability with the aim of increasing the consent. In order to provide accurate information, Law no. 119/2007 has confirmed the central role of the pharmacist in the promotion of prophylactic vaccination, explicitly stating under art. 2 that the Ministry will be able to count on the collaboration of pharmacists as well as general practitioners and paediatricians. Pharmacists are pinpointed as new professional figures who could assist the national health service in its vaccine awareness and administration campaigns. Art. 5 comma 1 of Law no.119/2017 states that to meet vaccine goals, each Region will be able to allow vaccines to be booked through the Italian booking system (CUP) and administered free-of-charge in authorized pharmacies.

Fighting obesity in children from European World Health Organization member states. Epidemiological data, medical-social aspects, and prevention programs.

Childhood obesity is one of the most serious public health chal-lenges of this century. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. In the WHO European Region one child out of 3, is overweight or obese. Over 60% of children who are overweight before puberty will be overweight in early adulthood. Children and adolescents, aged 5-19 have shown rising obesity rates in almost all nations, including where the situation was far from alarming 40 years ago. Several nations have seen the prevalence almost double: Israel has gone from 5.8% in 1975 to 11.9% in 2016, Andorra from 6.2% to 12.8%, and Malta from 7.4% to 13.4%. Analyzing overweight and obesity, we can see that they follow similar trends and patterns. In 1975 the majority of European countries had a prevalence less than 10% and obesity less than 5%, while no European country had overweight prevalence higher than 30% and obe-sity higher than 10%. In 2016 the trend reversed, showing a worrying increase in the number of European countries with a high prevalence of overweight (over 30%) and obesity (over 10%) (Fig. 1)(29). Starting from the analysis of epidemiological data on obesity in the WHO European Region, the paper analyzes the adopted prevention programs in order to assess their effectiveness and figure out the best strategies to reduce the prevalence of overweight and obesity. The WHO European Childhood Obesity Surveillance Initiative reported that children tend to overeat and not to do enough physical exercise. Different preventive programs have identified different areas of action and corresponding measures: consumption of healthy foods, physical exercise, care before conception and during pregnancy, early childhood, school age children, weight management, monitoring and evaluation. Primary prevention is essential to reduce obesity incidence: it is easier to act on the adoption of healthy eating habits than intervene with diets on children who already have weight issues. Working on pre-vention programs represents an investment for the future of children's health. By simply acting on prevention, particularly on body weight reduction, it could be possible to tackle the spreading of correlated di-seases. Therefore, prevention programs ought to be prioritized priority at a national and international level.

Immunization in Vietnam.

Since the Expanded Program on Immunization was proposed by the World Health Organization in 1981, it has been promptly adopted by Vietnam as one of the country's national priority programs. In 1986, Vietnam achieved some remarkable goals, including polio-free status and the elimination of neonatal tetanus. At the same time, however, barriers and difficulties have also emerged. This article aims to provide an overview of both achievements and barriers to the implementation of the program and proposes some solutions.

Training to improve resilience and coping to monitor PTSD in rescue workers.

BACKGROUND: Few studies focus on the role training has on rescue workers who are active as volunteers or actual workers in emergency situations such as an earthquake. In October 2016, a strong earthquake hit Central Italy and in particular the province of Macerata in the Marche region. Lots of rescuers were called to deal with the emergency. The aim of this study was, therefore, to examine their preparation, studying resilience and coping strategies, as these qualities can protect against complications brought on by traumatic situations (post traumatic stress disorder). STUDY DESIGN: An observational study on 70 rescue workers who active in the area affected by the disaster within the province of Macerata was carried out. MATERIALS AND METHODS: The questionnaire proposed by the Coping Inventory for Stressful situations (CISS) was used, while individual resilience levels were measured with the Resilience Scale. Both methods were employed in two separate interviews conducted before and after their intervention in the disaster area. To verify a possible difference between the resilience and coping values before and after the activity of rescue effort, the paired Student t test was applied. RESULTS: The sample showed medium to high levels of coping (91.6%) and resilience (89.6%) were present in both interviews and not significant statistical differences was observed for the resilience (among females t = 1.63, p-value = 0.179, and among males (t = -0.76; p-value = 0.487). In contrast, CISS scores before and after the rescue effort showed significant statistical differences both among females (t = 4.81; p-value = 0.009) and males (t = 10.06; p-value = 0.001).Some areas relative to coping mechanisms, such as social avoidance and distraction are preferred by women, while men prefer avoidance and task-oriented activity. Results for resilience show a slight difference for perseverance in men. CONCLUSIONS: The ability to use mechanisms of self-preservation like coping and resilience helps rescue workers to better respond in emergency situations. Surely one of the most appropriate ways to reach this result is provided by their preparation.

Obesity in the European region: social aspects, epidemiology and preventive strategies.

Obesity related to metabolic syndrome is gaining an increasing importance as the main risk factor for diseases and disability in the European region. We herein review the increasing trend of obesity and overweight in males and females from Europe, preventive programs addressed to children, youngsters, adult population and subjects with particular diseases which can profit from healthy nutrition. The main feature is that some European countries have implemented programs on World Health Organization (WHO) proposals, while some others have focused attention only on some aspects. Based on the reported obesity increase over the last twenty years, prevention programs seem to have been ineffective. Most likely, the effects will be observed later on. In this concern, it will be fundamental to continue and finance the countries of the European region, where those programs have been extensively applied, to obtain even better results in terms of obesity prevention.

Lifestyles and discomfort in a sample of young Romanian students.

INTRODUCTION: The 40.3% of the Romanian youth population is at risk of poverty or social exclusion, and, in addition, the abuse of substances increases. It was interesting to evaluate the attitudes shared by pupils as well as their knowledge of these substances with a view to analyzing causes and types of risky behaviour in young people. METHODS: This is an observational study on the harassment influence in the lifestyle of a sample of Craiova high-school students The Fagerström Test was applied to evaluate the degree of nicotine dependence, and the data processed to assess the Odds Ratio. RESULTS: The sample was composed by 1,980 students with an average age of 17, of which 1,727 correctly responded to the questionnaire. The 37.4% of students admit to smoke, and the 67% to drink alcohol. The Fagerström test showed that the 68.2% of respondents are not highly addicted to smoke while the 31.8% was associated with a middle-to-high addiction level. A worrying weekly consumption of beer has been registered in the students. Regarding psychological distress caused by harassment a high Odds Ratio was recorded between the smokers and the drug users. CONCLUSIONS: More than half of students did not know about the health consequences of smoking, and the same result was recorded about the consumption of alcohol. A special attention should be done to the understanding of harassment problem in the young people. In fact, almost all the respondents declared to have suffered abuse and admits to use drug and cigarettes.

Energy drink consumption: a survey in high school students and associated psychological effects.

INTRODUCTION: Energy drinks represent an emerging health problem among young people. Energy drinks generally refer to a class of beverages containing sugars and various combinations of bioactive ingredients such as caffeine, taurine etc. Also the mix of energy drinks with alcohol is fairly frequent among young people and could be associated with dangerous effects. METHODS: In 2016-2017, a cross-sectional study was conducted in 1581 students attending eight high school in the Marche Region. Data were collected via an anonymous self-administered questionnaire. RESULTS: The 27.7% of students use energy drinks and the majority, corresponding with the 93.0%, are aware of the main ingredients contained in energy drinks. The main activities for which young people use these drinks are: sport, leisure, pleasure, study. Young people who admit to using alcohol mixed with energy drinks more than 4 times a month are an alarming fact. CONCLUSIONS: This research confirms that energy drinks are used more by young males and especially by those who practice sports. Furthermore, the use these beverages to increase the concentration in the study and to be more brilliant in free time, is confirmed.

Mental and physical effects of energy drinks consumption in an Italian young people group: a pilot study.

INTRODUCTION: The primary consumers of energy drinks were athletes, to combat fatigue, but in reality, thanks to their fast expansion and economic growth, young adults and teenagers represent the new target market. Consumption of energy drinks by both recreational and competitive athletes has increased dramatically in recent years, though they are often unaware of what is being ingested, believing to improve their physical and psychological performance. The literature shows contradictions about the capacity of energy drinks to enhance psychophysical results. In relation to probable adverse effects induced by the irregular consumption of energy drinks, which in several cases are not so clear, we decided to investigate the possible relationship between the intake of energy drinks and the presence of mental and physical stress in young people and athletes. METHODS: Two experimental sessions, separated at least by 1 week, according to a randomized cross-over design, following this protocol were conducted: in the first session a mental and physical stress was conducted without the consumption of energy drinks, the second after energy drinks consumption. BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory II) test have been used to test the mental stress, and a "cycle ergometer test" to test the physical stress. RESULTS: BAI and BDI tests results showed that before the consumption of energy drinks, subjects are considered in the range of "minimal level of anxiety", (10 and 60 percentiles) and do not report a level of depression. After the energy drinks consumption, a "mild level of anxiety" has been recorded, and the BDI showed a case with a pathological profile. The physical test recorded a small increase in the maximum heart rate was verified with the intake of an energetic beverage. CONCLUSIONS: The stimulating effect of Energy Drinks EDs on nervous system and cardiovascular system, must be checked and studied in deeper detail, because it may represent a risk for the health of young athletes.

Vaccine hesitancy, a public health problem.

The phenomenon of "vaccine hesitancy" has only been studied for a few years, and this attitude is becoming a serious threat that can frustrate the efforts of recent years that have led to the achievement of relevant scientific advances to human health. The paper analyzes the possible causes, the scope of the phenomenon and its consequences, trying to identify the most effective actions to resolve this trend.

Implications of modified food choices and food-related lifestyles following the economic crisis in the Marche Region of Italy.

BACKGROUND: The economic crisis in Italy has led to profound changes in resource management not only at the macro level but also for individual families, causing substantial changes in different habits of Italians. STUDY DESIGN: The purpose of this research was to conduct a study on changes in family eating habits potentially triggered by the economic crisis was conducted in an area of the Marche Region in central Italy. METHODS: The research was conducted in the period 2016 - 2017 by administering a specific and anonymous questionnaire. RESULTS: The interviewed people has reduced its food consumption. In particular, analyzing the results for the animal protein food group, there has been a reduction in purchase of beef, and an increase in that of pork. Overall fish consumption has decreased by 44%, with a decrease in the purchase of fresh fish, and an increase in that of canned fish products. Finally, consumers have reduced their purchases of fresh and canned legumes, fresh vegetables, and fresh fruit. CONCLUSION: The economic crisis seems to have changed the eating habits and food-related lifestyle choices of the subjects studied, especially in the urban area affected by the deeper economic depression. These changes are likely to have permanent social consequences, and deserve to be analyzed also in smaller territories in order to better understand the dynamics of individual choices and the social framework.

Knowledge and Attitudes on Food Hygiene among Food Services Staff on Board Ships.

BACKGROUND: Ships have long been sites for outbreaks of infectious diseases, particularly gastrointestinal diseases. The ship environment has the potential to facilitate the spread of such diseases, infecting susceptible cohorts of embarked passengers and crew. Gastrointestinal disorders among seafarers are fairly common and usually represent the first or second cause of requests for medical assistance aboard ships in international waters. STUDY DESIGN: The purpose of this study was to evaluate food safety and the level of knowledge among food service personnel on board merchant ships, where food handlers could be a cause of health problems for all crew members. METHODS: An anonymous self-administered questionnaire containing specific questions about food hygiene and safety knowledge was administered. RESULTS: The overall score of correct answers for the food safety aspects tested was 51.77 (SD 3.87) out of 76 points, corresponding to 68.12% of questions answered correctly. Food workers who followed a training course showed higher mean knowledge score (p < 0.05) compared to not-trained workers. The most relevant significant differences (p < 0.05) were noticeable in the personal hygiene, cross-contamination, safe storage, and knowledge of foodborne pathogens sections. CONCLUSION: Food services staff on board cargo ships should be adequately trained and should understand basic and fundamental aspects of food hygiene, related pathologies and sanitation, as they are responsible for the health and wellbeing of many seafarers.

Levels of understanding of the rules of correct medical usage among vietnamese pharmacy students: a cross-sectional study.

BACKGROUND: Comprehensive misunderstanding about medicine usage is often associated with high treatment risks which have led to unexpected and adverse effects or even death. Many researches assessing health literacy have been undertaken, but only in adults. This study was undertaken to evaluate the level of understanding in students of medical terms and its correlation with gender, grade and parental occupation. METHODS: A cross-sectional study was conducted from September to October 2017 with 594 students (28.6% of men and 71.4% of women) of Hanoi University of Pharmacy from freshman to fifth-year students chosen randomly. The knowledge of pharmacy students was assessed by a questionnaire including 25 medical terms. Descriptive statistics and Chi-square test were used with p < 0.05 as level of statistical significance. RESULTS: The level of understanding of students was high with most of medical terms reaching over 70% correct answers. A positive significant association between health literacy and education was found with higher knowledge demonstrated in upper years, while there was no difference among students with and without parents belonging to the medical field. Regarding the relation with gender, there was no significant correlation for most medical terms. CONCLUSIONS: Levels of understanding of medical terms in pharmacy students was high, presenting a significant association with education. This study should be extended in order to assess the level of health literacy in various populations, thereby indirect evaluating implementation of medical preventive programs.

Level of understanding of medical terms among italian students.

Problems related to medical treatment and health literacy are nowadays a considerable difficulty, particularly if awareness of them is low. There is still a lack of information about students understanding of medical recommendations. The aim of this work was to determine the understanding of medical terms among Italian students and to find out if there is any relation between understanding and age, gender, education or parental occupation. The research was realized via questionnaires in the Marche region of Central Italy in 2015. Students were chosen at random from grammar schools, vocational schools and the local university. 387 completed questionnaires were subsequently evaluated. The level of understanding of medical terms among students was quite poor. Most of the terms included in the study were known to only a third of respondents on average. A significant link between the comprehension of medical terms and education level or parental occupation was observed, especially in the terms that are not commonly used. Nevertheless, no relation between knowledge of medical terms and gender was found. This topic, which requires attention, should be investigated because of correct implementation of preventive medicine programs.Key words: medical terms Italian students correct use of medicine risk.

Awareness of health risks at the workplace and of risks of contracting communicable diseases including those related to food hygiene, among seafarers.

BACKGROUND: The awareness of health risks on board ships in terms of knowledge of dangers and discomfort at the workplace, and of risks of contracting communicable diseases including those related to food hygiene was assessed in a sample of workers of an Italian shipping company. Analysis was performed on crew members and on ashore personnel of the same firm to assess possible differences in risk perception. MATERIALS AND METHODS: The study was conducted by proposing an anonymous questionnaire to the crew members of 9 tankers and to the office staff of the shipping company Finaval S.p.A., which has its headquarters in Rome. RESULTS: People living ashore have a better knowledge of infectious risks than seafarers. Both ashore workers and seafarers have a reasonable awareness of blood-borne and sexually-transmitted diseases. Seafarers are more concerned about the risks of psychological problems due to isolation than are office personnel. The risk of not being adequately cared for in case of disease or injury on board is also perceived as a major problem by seafarers. Ashore personnel, eating raw fish more than their mates on board, are at a greater risk of communicable gastrointestinal diseases. CONCLUSIONS: Seafarers should be the target of specific informative campaigns about health risks, possible consequences, and how to minimize exposure to them during travel/life at sea.

Survey on HIV risk perception and sexual behaviours among seafarers.

Because the nature of their work seafarers spend long periods of time away from their families and therefore represent a group at risk for sexually transmitted diseases, including HIV infection. This paper reports the results of a survey to evaluate awareness and knowledge of the risk of HIV infection among seafarers. Risky behaviours for HIV transmission were also assessed. The survey was conducted using anonymous questionnaires on 197 workers of 9 vessels and 26 office employees of an Italian shipping company (FINAVAL S.p.A., Rome). The respondents considered HIV/AIDS as one of the diseases with a high risk of transmission. Most respondents had a good general knowledge of HIV/AIDS and on the ways of its transmission. However, there is still lack of knowledge on the basics of this disease. On the other hand, in spite of knowledge and awareness about the risks of the disease, only 56.35% of the interviewed crewmembers used protection in sexual intercourse with occasional partners. Compared to data available in literature, the percentage of self-protecting people is increasing, but the number of seafarers exposing themselves to risky behaviours is still high. As expected, condoms are used with regular partners with lower frequency compared to occasional intercourse. The results of this survey indicate that adequate prevention campaigns and major attention paid to seafarers health is useful for stimulating responsible conduct for the prevention of infectious diseases, including HIV infection. Nevertheless, it is still necessary to increase information about the risk of sexually transmitted diseases and how to reduce it.