[Emergency nurses and workplace violence: a cross-sectional study in Campania, South Italy]. / Gli infermieri di pronto soccorso e la violenza sul luogo di lavoro: un'indagine trasversale nel contesto campano.

AIM: To determine the characteristics of workplace violence towards emergency nurses in Campania, South Italy. INTRODUCTION: In Italy, workplace violence is a severe and widespread problem. A national survey describes that, working in South Italy significantly increases the probability of being exposed. However, available data in Campania workplace violence towards nurse emergency department (ED) is lacking. METHOD: We used a cross-sectional design, in two emergency department. Between April and May 2019, we distributed a questionnaire (QIN16VIPs). Three types of violence have been investigated: verbal/physical violence, verbal violence and physical violence. The data were analyzed using procedures of descriptive statistics. RESULTS: A total of 83 questionnaires (response rate 92.3%), 48.2% of emergency nurses experienced verbal violence, 21.7% both verbal and physical violence and only 28.9% denied having experienced either. Nurses feeling at risk in emergency setting were more exposed to workplace violence (p=0.001). Anxiety (p=0.023) and anger (p=0.001) were perceived feeling with significant repercussions on the degree of evidence working in ED (p=0.043) and on trust in management (p=0.001). CONCLUSIONS: Workplace violence turns out to be a serious and widespread problem that generates negative feelings in the attacked subject that affect the personal and work dimension. The promotion of simple and anonymous reporting systems would help nurses to be more aware of the importance of reporting the event, which is still in deficit today, thus preventing a true and proper estimate of the phenomenon. Future research should be focused for preventive measures could be drawn up to reduce the problem.

Appearance of HbeAg in an occult persistent hepatitis B virus infection.

Occult hepatitis B virus infection (OBI) is characterized by the presence of ongoing viral replication with very low levels of viremia (<200 IU/ml), and negativity for HBsAg, while the so-called 'false' OBI with higher levels of HBV-DNA that are negative for HBsAg are usually due to the occurrence of mutations of the HBsAg sequence that may alter the recognition by some immunoassays. We describe here a case of occult HBV infection that combines both aspects. A male patient with severe systemic diseases, positive for anti-HBc and anti-HBs and negative for all other HBV markers, including HBsAg, since at least 4 years, showed a positivity for HBeAg at a follow-up control in November 2008; HBV-DNA testing by real-time PCR evidenced very low levels of viremia (<40 IU/ml), direct sequencing of the surface antigen-coding and Pol/RT coding regions allowed the identification of genotype D, serotype adw2, one immune escape mutation (G145R) and no drug resistance mutations. The positivity for HBeAg could be attributed to a superinfection in a naturally immune subject or to reactivation of a latent infection; the mutated virus had a reduced fitness and was therefore able to replicate only at low levels, resulting in a mild form of occult HBV infection.