Impact of the Organizational Model Adopted during the COVID-19 Pandemic on the Perceived Safety of Intensive Care Unit Staff.

BACKGROUND: The SARS-CoV-2 pandemic had a devastating health, social, and economic effect on the population. Organizational, technical and structural operations aimed at protecting staff, outpatients and inpatients were implemented in an Italian hospital with a COVID-19 dedicated intensive care unit. The impact of the organizational model adopted on the perceived safety among staff was evaluated. METHODS: Descriptive, structured and voluntary, anonymous, non-funded, self-administered cross-sectional surveys on the impact of the organizational model adopted during COVID-19 on the perceived safety among staff. RESULTS: Response rate to the survey was 67.4% (153 completed surveys). A total of 91 (59%) of respondents had more than three years of ICU experience, while 16 (10%) were employed for less than one year. Group stratification according to profession: 74 nurses (48%); 12 medical-doctors (7%); 11 physiotherapists (7%); 35 nurses-aides (22%); 5 radiology-technicians (3%); 3 housekeeping (1%); 13 other (8%). The organizational model implemented at ISMETT made them feel safe during their workday. A total of 113 (84%) agreed or strongly agreed with the sense of security resulting from the implemented measures. A vast majority of respondents perceived COVID-19 as a dangerous and deadly disease (94%) not only for themselves but even more as vectors towards their families (79%). A total of 55% of staff took isolation measures and moved away from their home by changing personal habits. The organizational model was perceived overall as appropriate (91%) to guarantee their health. CONCLUSION: The vast majority of respondents perceived the overall model applied during an unexpected, emergency situation as appropriate.

Assessing Vaccine Hesitancy among Healthcare Workers: A Cross-Sectional Study at an Italian Paediatric Hospital and the Development of a Healthcare Worker's Vaccination Compliance Index.

Healthcare workers (HCWs) in paediatric hospitals are an important source of advice on vaccinations, but vaccine hesitancy can affect even these professionals. The aim of this study is to assess this phenomenon, measuring it by means of a scoring system. A survey was conducted in five departments of an Italian paediatric university hospital of national interest. Vaccination against influenza was considered a behavioral indicator of vaccination uptake. Using the collected data, the healthcare worker's vaccination compliance index (HVCI) was computed. The results demonstrate statistically significant differences between departments and professional profiles. Nearly 80% of the sample was not immunized against seasonal influenza. According to the HVCI scores, the most hesitant departments are the intensive care unit, emergency room, and oncohematology department, while the most hesitant professional profiles are nurses and auxiliary staff. The score of the unvaccinated is significantly lower than that of the vaccinated, and the same difference was found between those who self-perceive to be skilled versus unskilled. The HVCI score was statistically verified as a predictive parameter to assess vaccination against seasonal influenza. By means of strategic training policies, both HVCI and perceived skills could be improved, suggesting that hospital management should draw a complex intervention program to fight against hesitancy.

Hospitalizations for pneumonia, invasive diseases and otitis in Tuscany (Italy), 2002-2014: Which was the impact of universal pneumococcal pediatric vaccination?

Streptococcus pneumoniae is the main causative organism of acute media otitis in children and meningitis and bacterial pneumonia in the community. Since 2008 in Tuscany, central Italy, the pneumococcal conjugate vaccine (7-valent vaccine, switched to 13-valent vaccine in 2010) was actively offered free of charge to all newborns. Aim of the study is to evaluate the impact of pneumococcal pediatric vaccination in the Tuscan population on hospitalizations potentially caused by S. pneumoniae, during pre-vaccination (PVP, 2002-2007) and vaccination period (VP, 2009-2014). We analyzed hospital discharge records (HDRs) of all hospitals in Tuscany from 2002 to 2014. Hospitalizations potentially due to pneumococcal diseases were 347, 221. The general hospitalization rate was 716/100,000 inhabitants during PVP and 753/100,000 in VP, with a decrease of 29.1% in the age-group 0-9 y ("target" of the vaccination program) and an increase of 75.7% in subjects >64 y of age. During VP, admission days and hospitalization costs increased (6.2% and 24.2%, respectively), especially in patients >64 y (12.9% and 33.8%, respectively); in children <10 y decreased by 21.2% and 12.8%, respectively. The pneumococcal pediatric vaccination resulted in the decrease of hospitalizations in younger but the expected indirect effect in the elderly was not reported, justifying the Tuscan recommendation to extend the vaccination to subjects > 64 y.

The right to food, food donation and microbiological problems of food safety: an experience in the territory of Florence.

AIM: The aim of this study is to understand whether the freezing without a rapid blast chiller represents a storage method for food at the end of shelf life that guarantees microbiological food safety, so to be considered an effective tool for the appropriate management of food in charitable organizations. METHODS: The study has been performed on 90 food samples, among those that a charitable foodservice trust receives by the large-scale distribution. The products have been frozen using a domestic refrigerator. The indicators used were: total aerobic microbial count, Escherichia coli, Salmonella spp, Staphylococcus aureus, Campylobacter spp, sulphite reducing clostridia. RESULTS: The results show that the preservation of the chosen fresh products at the end of shelf life in refrigerators, frozen without the use of chillers, is a potential management strategy to avoid the loss of edible food, while maintaining the safety standards.

Human papillomavirus prevalence in paired urine and cervical samples in women invited for cervical cancer screening.

With the introduction of Human papillomavirus (HPV) vaccination in young girls in 2007, it is important to monitor HPV infections and epidemiological changes in this target population. The present study has evaluated the detection of human papillomavirus DNA in paired cervical and urine samples to understand if HPV testing in urine could be used as non-invasive method to monitor HPV status in young women. The study enrolled 216 twenty five-year-old women, resident in Florence and invited for the first time to the cervical cancer Screening Program within a project evaluating the impact of HPV vaccination. HPV genotyping was performed on 216 paired urine and cervical samples. The overall concordance between cervix and urine samples, investigated by HPV genotyping (INNO-LiPA HPV Genotyping Extra), was: 85.6% (184/215), 84.6% (182/215), 80% (172/215) when the same HPV, at least the same HR HPV and all HR HPV, respectively, were detected. HPV type specific concordance in paired urine and cervical samples was observed in 85.8% (175/204) of women with normal cytology and in seven out of nine women with abnormal cytology. Urine seems to be a suitable and reliable biological material for HPV DNA detection as evidenced by the high concordance with HPV detected in cervical samples. These results suggest that urine could be a good noninvasive tool to monitor HPV infection in vaccinated women.

[Avoidable mortality in Tuscany Region (Central Italy) from 1987 to 2008]. / La mortalità evitabile in Toscana dal 1987 al 2008.

OBJECTIVE: to evaluate the impact of avoidable mortality (AM) on the changes in life expectancy at birth (LE) in Tuscany Region (Central Italy) in two periods (1987-1989 and 2006-2008). SETTING AND PARTICIPANTS: a list of AM causes previously published was used. The AM were divided into two groups: AM by Health Policy Interventions (HPI), AM by Health System Interventions (HSI). MAIN OUTCOME MEASURES: years of potential life lost (PYLLs), rates of PYLL standardized on the European population (TSPYLLs), and LE were examined. RESULTS: in 2006-2008, LE increased with a gain of 5.2 in men and 3.8 in women in comparison to 1987-1989 LE (respectively 79 and 84,9 years). If AM did not have occurred, LE would have further increased of 2 years in men and 1.5 in women. AM recorded a 39% decrease: from 25.3% of overall mortality in men in 1987-1989 to 16.1% in 2006-2008; in women from 14.3% to 8.4%. Injury/poisoning and lung cancer are the most frequent IPP. The only increasing AM is lung cancer in women. Disentangling LE increases by group of causes, 25% of the increases in 2006- 2008, compared to 1987-1989, was attributable to HSI reduction, and 4% in women and 16% in men to HPI reduction. CONCLUSIONS: AM recorded a 39% decrease from 1987-1989 to 2006-2008 in Tuscany. In 2006-2008, about one third of LE increase in women and 2/5 in men was attributable to AM decrease, while 2/3 in women and 3/5 in men to increased survival in eldest people.

[Mortality in immigrants in Tuscany]. / La mortalità nella popolazione straniera in Toscana.

OBJECTIVE: Aim of the paper is to examine the characteristics and the trend of mortality in immigrants in Tuscany in the last decade, and to compare it with that observed in Italians resident in the same region. DESIGN: it is a descriptive study using the data 1997- 2008 of the Regional Mortality Registry of Tuscany. SETTING AND PARTICIPANTS: Immigrants have been defined those who are resident in Tuscany with non Italian citizenship.They have been classified in immigrants from countries at high migration rates (PFPM) and immigrants from developed countries (PSA). MAIN OUTCOME MEASURES: Proportional mortality for the period 1997-2008 and trends of standardized (standard: European population) mortality truncated rates (20-64 years) per 100 000 in the period 2002-2008 by citizenship (PFPM, PSA and Italians), gender, age-class and causes of death. RESULTS: In the period 1997-2008, in Tuscany, 4 755 deaths have been registered in immigrants: 3 055 residents (1 782 from PFPM and 1 273 from PSA) and 1 700 not residents. Trends for all and the main causes of death show an increasing gap in mortality between immigrants from PFPM and Italians, with higher rates for Italians.On the contrary infant mortality is higher in children from PFPM and the gap is increasing in the last years. Also the mortality for accidents (1° and 3° cause of death respectively in male and female PFPM) and the mortality for infectious diseases are higher in PFPM immigrants. CONCLUSION: Mortality study on immigrants in Tuscany highlighted specific health problems of this population deriving from living conditions in the home country as well in the host country. It will be necessary to continue to monitor the mortality trend and characteristics of this population because it represents a good indirect tool to evaluate his socioeconomic integration (considering also his use of our health system), and because this population is still expected to raise in the next decades.