The Workplace Health Promotion (WHP) programme in an Italian University Hospital.

INTRODUCTION: Description of the lifestyles of employees of the Siena University Hospital (Azienda Ospedaliera Universitaria Senese: AOUS), as assessed through a Workplace Health Promotion (WHP) project in the two-year period 2017-18; assessment of possible short-term effects of integrated health promotion interventions in the workplace, within the framework of the Tuscany WHP network, as applied in the AOUS and involving about 1,000 workers. METHODS: A cross-sectional study and a pre-post evaluation of data collected by means of anonymous questionnaires in two phases: before the beginning of the programme and after 12 months. RESULTS: Twelve months after the start of the programme regarding diet (consumption of fruit and vegetables) and physical activity, the positive effects that emerged were not statistically significant. No differences were observed between gender or professional categories. The employees' perception of the programme was satisfactory. CONCLUSIONS: Albeit within the methodological limits of the assessment, the results showed that the diffusion of some major risk factors for chronic diseases had not decreased after 12 months' exposure to the programme. However, monitoring of these risk factors needs to be continued over a longer period, in order to detect the appearance of the expected changes in the long term. Moreover, it is essential to continue monitoring by sex and professional category, in order to pick out any differences and, if possible, take remedial actions. Further studies, in collaboration with the pertinent physicians, are desirable, since integrating data collected during health surveillance with a limited set of indicators of general risk factors may help to promptly identify possible health needs among employees.

Microarchitectural study of the augmented bone following ridge preservation with a porcine xenograft and a collagen membrane: preliminary report of a prospective clinical, histological, and micro-computed tomography analysis.

Socket preservation using a combination of porcine xenograft and collagen membrane maintains the vertical and horizontal dimensions of the ridge. The aim of this study was to evaluate the microarchitecture of the grafted area by histological analysis and micro-computed tomography. Patients in the test group (group 1; nine patients) underwent socket preservation, while the sockets in the control group (group 2; eight patients) were allowed to heal without preservation. After a 6-month healing period, bone core biopsy samples were obtained and implants were placed in the augmented sites in the test group (12 biopsy samples) and the non-augmented sockets of the control group (12 biopsy samples). Analysis of the biopsy samples obtained from group 1 revealed that particles of the graft were surrounded by newly formed bone in eight cases and by granulation tissue in four cases. Micromorphometric data showed statistically significant differences in several parameters between the microarchitecture of the native bone and the newly formed bone within the augmented sites, which suggests that the xenograft particles interfere with the bony healing of the alveoli.

Hospital-based expert model for health technology procurement planning in hospitals.

Although in the last years technology innovation in healthcare brought big improvements in care level and patient quality of life, hospital complexity and management cost became higher. For this reason, necessity of planning for medical equipment procurement within hospitals is getting more and more important in order to sustainable provide appropriate technology for both routine activity and innovative procedures. In order to support hospital decision makers for technology procurement planning, an expert model was designed as reported in the following paper. It combines the most widely used approaches for technology evaluation by taking into consideration Health Technology Assessment (HTA) and Medical Equipment Replacement Model (MERM). The designing phases include a first definition of prioritization algorithms, then the weighting process through experts' interviews and a final step for the model validation that included both statistical testing and comparison with real decisions. In conclusion, the designed model was able to provide a semi-automated tool that through the use of multidisciplinary information is able to prioritize different requests of technology acquisition in hospitals. Validation outcomes improved the model accuracy and created different "user profiles" according to the specific needs of decision makers.

A queueing theory based model for business continuity in hospitals.

Clinical activities can be seen as results of precise and defined events' succession where every single phase is characterized by a waiting time which includes working duration and possible delay. Technology makes part of this process. For a proper business continuity management, planning the minimum number of devices according to the working load only is not enough. A risk analysis on the whole process should be carried out in order to define which interventions and extra purchase have to be made. Markov models and reliability engineering approaches can be used for evaluating the possible interventions and to protect the whole system from technology failures. The following paper reports a case study on the application of the proposed integrated model, including risk analysis approach and queuing theory model, for defining the proper number of device which are essential to guarantee medical activity and comply the business continuity management requirements in hospitals.

A methodology aimed to guarantee technology continuity in health structures.

In healthcare the importance of clinical continuity is essential for both patients life and health organization activity. Since technology continuity is having more and more importance for the service continuity, a correct management of medical devices must be guided by criteria that ensure its safe, appropriate and economical use through a well planned purchase, appropriate preventive and corrective maintenance Indeed, the aim of health technology managers is to optimize the integration of external interventions assistance and internal technical service to guarantee an efficient and cost-effective maintenance system. This paper proposes an innovative carefully thought methodology which is aimed to provide technological and procedural actions which offer support to decision makers in technology management regarding the implementation of continuity in medical services and response to technology failures and emergency events.

Medical software management: a failure analysis approach for maintenance and safety plan.

Medical software management represents one of the biggest future challenge in healthcare. Technology level is actually waiting for appropriate normative and regulatory support by including maintenance, assistance and safety. This paper aims to highlight the critical aspects in medical software management and specifically to provide a methodology in order to support decision makers responsible for medical software assistance in health structures. The results show how medical software effectiveness depends on technical, organizational and clinical aspects.

Treatment of human granulocytic ehrlichiosis during pregnancy and risk of perinatal transmission.

A pregnant woman from Nantucket Island, MA was diagnosed with human granulocytic ehrlichiosis at 34 weeks gestation. We describe the diagnostic and therapeutic dilemmas involved and discuss the risks of perinatal transmission.

[Effect of the quality of restorations and of dental prosthesis on the alveolar bone loss in patients with chronic destructive periodontitis]. / A konzerváló és protetikai munkák minóségének hatása krónikus destruktív parodontitisben szenvedó betegek alveoláris csontnívójára.

In recent years many risk factors have been implicated in the etiology of destructive periodontitis. The quality of the previous dental works might play a decisive role in the development of periodontal attachment loss. The main objective of the present clinical study was to evaluate the aggravating role of the subgingival restorations with questionable quality and the interproximal untreated carious lesions in the progression of periodontal attachment loss in a randomly selected group of patients with destructive periodontitis. The panoramic radiographs of 170 randomly selected patients suffering with destructive periodontitis were analyzed and the quality of the approxima restorations, the presence or absence of interproximal untreated carious lesions and the interdental bone loss were recorded. The level of interproximal bone around the teeth with restorations or with approxima carious lesions were compared with the sound contralateral counterparts and with the overall average alveolar bone level. Some more than 50% of 2175 approxima restorations were faulty. 280 untreated carious lesions were present in 170 subjects. The interproximal bone loss was always greater around teeth with untreated carious lesions or with faulty restoration. The differences between the control teeth and the carious teeth were statistically significant (P < 0.01) excepting the maxillary front and mandibular premolar region. The differences between the teeth with faulty restorations and the controls were statistically significant (P < 0.01) in the mandible and in the maxillary molar region. Although there were significant differences between teeth with untreated carious lesions or with faulty restoration and the controls in many regions of the dental arch, the differences clinically were not always necessarily significant, showing only less than 0.5 mm differences in bone levels, In conclusion the faulty restorations and untreated carious lesions do not seem to be decisive aggravating risk factors leading to bone loss in patients with chronic destructive periodontitis.

[The value of beta-tricalcium-phosphate (CERASORB) in pre-prosthetic surgery]. / A beta-tricalcium-foszfát (CERASORB) jelentósége a preprotetikai sebészetben.

Short- and medium-term experience with a pure-phase beta-tricalcium phosphate bone-substitute material (Cerasorb) is reported on the basis of clinical, radiological (panorama, 2-3D CT records) and histological examination on 52 patients. The treatment modes on these patients included the filling of cysts, sinus grafting, augmentation and the filling of parodontal lesions. Disturbance of wound healing was not observed in any of the cases, and both the radiological and the histological examinations revealed that transformation of the implanted beta-tricalcium phosphate into bone could be detected as early as in the second month. During the 10-month follow-up period, this transformation was continuous, but was not complete; completion is to be expected only after 12 months. It is important that load-bearing tissue had already developed after 4-6 months. Studies to date suggest that autologous bone is not necessary for either sinus grafting or the filling of large cysts: Cerasorb alone is suitable for this purpose.

[Laboratory and clinical investigation of multifunctional dentifrices. Clinical study of a new triclosan-containing toothpaste]. / Multifunkcionális fogkrémek laboratóriumi és klinikai vizsgálata. Egy új Triclosan-tartalmú fogkrém klinikai kipróbálása.

The purpose of this work was to assess the in vitro antibacterial effectiveness of three dentifrices containing antimicrobial agents and to test the in vivo anti plaque and anti gingivitis effect of a toothpaste containing triclosan (CAOLA). The in vitro tests showed a marked antibacterial effect of both triclosan and chlorhexidine containing dentifrices. The randomized clinical trial presented good evidences that the triclosan had some but statistically non significant plaque and gingivitis reduction in patients even without previous mechanical cleaning. Nevertheless the triclosan dentifrice was effective in reducing the plaque and gingivitis scores in combination with initial mechanical debridement and oral hygienic instructions.

[A 3-year experience with guided tissue regeneration procedures]. / Az irányított szövetregenerációs technikákkal nyert három éves klinikai tapasztalatok.

The Guided Tissue Regeneration (GTR) procedures are promoting a clinically and radiologically as well as histologically verifiably periodontal attachment gain. The objective of the study was to evaluate the clinical efficacy of these GTR techniques. In the past four years different barrier membranes (Gore-tex, Resolut and Guidor) were used around 318 teeth of 196 patients. 169 periodontal defects of 140 patients were followed up at least for two years. 54 patient had chronic adult type periodontitis, 67 suffered with rapidly progressing periodontitis and 15 had different severe mucogingival lesions. 111 vertical bony defects, 43 Class II-III furcation lesions and 15 mucogingival lesions were surgically corrected. The average preoperative probing depth (PD) and the clinical attachment loss (CAL) of the vertical bony defects were 5.3 +/- 1.7 mm and 6.2 +/- 1.9 mm respectively. The PD of the deepest Class III furcation lesion was 11 mm. The average gingival recession of the mucogingival lesions was 4.5 +/- 1.1 mm. The GTR technique provided the best results in the Class II-III furcation lesions, where an average 2.4 +/- 0.9 clinical attachment gain was observed one year postoperatively. The GTR techniques provided an average 1.8 +/- 1.2 mm attachment gain in the vertical bony crater cases. In both groups of cases a marked gingival recession followed the healing and the periodontal regeneration. In this way the average reduction in the probing depth exceeded the average attachment gain by more that 1.5 mm. 1 year after the operation the average radiologic bone fill was about 0.9-1.2 mm. The resorbable barrier membranes resulted in clinically significant root coverage and an average 3.5 +/- 1.7 mm gain in the width of keratinized gingiva. The success or failure of our cases were mainly determined by the patient's compliance, the level of the postoperative professional and individual oral hygiene and the number of periodontal recalls. These findings are also underlining the importance of the high standard of oral hygiene in the postoperative periodontal regeneration.

Circulating immune complex studies on patients with oral lichen planus.

To investigate the role of systemic factors such as age, diabetes, and hypertension in the formation of subepithelial immune deposits in oral lichen planus (OLP) we performed circulating immune complex CIC determinations by polyethylene glycol precipitation in sera of patients with OLP, diabetes mellitus, and hypertension and in sera of healthy control subjects. We examined patients with leukoplakia as a control group with oral keratosis but no OLP. Forty percent of the OLP patients were suffering from diabetes, hypertension, or both. The occurrence of CIC positivity was higher in the OLP group with diabetes than in the group with OLP only. However, we could not find CIC positivity in our control patients with diabetes. The almost equal distribution of hypertension among, patients with OLP who tested positive for CIC and those who tested negative does not seem to support the hypothesis that this factor causes the CIC positivity in OLP. The same applies to other assumed factors such as age, medication, dental foci, or metal framework. In summary, we support the idea that CIC positivity may be the consequence of lichen itself, but diabetes and hypertension contribute to the development of erosive OLP lesions.