Mini-Z validation for burnout and stress evaluation: an observational study.

BACKGROUND: The Mini-Z is a questionnaire created to evaluate the levels of burnout in healthcare workers. It consists of 10 items rated using a 5-point Likert scale and one open question. It explores three outcomes (burnout, stress and satisfaction) and seven drivers of burnout (work control, work chaos, teamwork, values alignment with leadership, documentation time pressure, EMR use at home, and EMR proficiency). The aim of this study is to validate the Italian version of the Mini-Z, comparing it with the other most used scales. MATERIALS AND METHODS: We recruited a sample of 120 healthcare professionals and administered all three questionnaires to each of them, after which we compared the answers and the scores of the results. A cross-sectional study among healthcare workers was conducted from May to July 2022. An online questionnaire was sent, by e-mail, to 120 healthcare workers (60.8% male, 39.2% female), aged between 18 and 60 years old (26.8% between 25 and 38 years old). They were invited to answer to an anonymous survey, consisting of three assessment instruments: Copenhagen Burnout Inventory (CBI), Maslach Burnout Inventory (MBI) and Mini-Z Inventory 2.0. The Mini-Z 2.0 is a new and easier tool to assess burnout syndrome, actually validated only in English. It was translated into Italian by reverse translation. Cronbach's Alpha coefficient, a statistical index, was used to assess its reliability. The last phase of the study compared the Mini-Z, the CBI and the MBI, by means of Pearson's coefficient, to highlight the Mini-Z's ability to be used for Burnout assessment. RESULTS: The analysis of the results showed that 18.3% of the interviewed healthcare professionals scored equal (2.5%) or higher (15.8%) than 40. The average percentage value was 33.35%, with a standard deviation of 6.3%. This emphasises, therefore, that this portion of employees is more or less satisfied with their working environment. The remaining portion of employees, on the other hand, 81.7%, scored below 40, emphasising an unpleasant and unjoyful working environment. DISCUSSION AND CONCLUSIONS: Burnout is very common among employees and especially among healthcare workers and a routine assessment seems to be necessary to be able to prevent the syndrome. The Italian version of the Mini-Z includes ten items, is more user-friendly and aims to assess not only Burnout subscales, as in the previous tests, but also well-being factors and has applied a rigorous approach, including forward translation, back translation and cognitive debriefing.

Higher rates of fully preserved posterior cruciate ligament in total knee arthroplasty using a double tibial cut: a prospective randomized controlled trial.

PURPOSE: In cruciate retaining total knee arthroplasty, posterior cruciate ligament damage may occur during tibial cutting. A prospective randomized study was conducted to investigate whether a novel tibial cutting technique was more effective than the currently used techniques. MATERIALS AND METHODS: Patients undergoing cruciate retaining total knee arthroplasty were recruited in a prospective, randomized, controlled trial. In 25 patients (group 1) the tibial cut was performed using a double tibial cut technique; in 25 (group 2) and 25 (group 3) patients, the bone island and en bloc resection techniques were performed, respectively. Posterior cruciate ligament integrity and femoral rollback were assessed at the end of surgery. The Oxford Knee Score, WOMAC score and range of motion were assessed postoperatively. RESULTS: Posterior cruciate ligament was completely preserved in 92% of patients in group 1 and in 64% in group 2 and 3, respectively (p = 0.03). The Oxford Knee Score and WOMAC scores did not differ between groups (p = 0.4). The mean knee flexion was 126.4°, 121.5° and 123.9° in groups 1, 2 and 3, respectively (p = 0.04). The femoral rollback at 120° flexion was 80.7%, 72.2% and 75.4% in groups 1, 2 and 3, respectively (p = 0.01). CONCLUSIONS: The double cut technique preserves the posterior cruciate ligament at significantly higher rates than the bone island or en bloc resection techniques. Better posterior cruciate ligament preservation may improve the femoral rollback and knee flexion. LEVEL OF EVIDENCE: Prospective randomized controlled trial, Level I.

Design of a magnetic resonance imaging-based screening program for early diagnosis of prostate cancer: preliminary results of a randomized controlled trial-Prostate Cancer Secondary Screening in Sapienza (PROSA).

OBJECTIVES: The main objective is to propose an MRI-based screening protocol, investigating the role of MRI without the injection of contrast media (bi-parametric MRI, bpMRI) as a secondary prevention test for prostate cancer (PCa) early diagnosis, comparing MRI with the prostate specific antigen (PSA) test. For this reason, preliminary results of Prostate Cancer Secondary Screening in Sapienza (PROSA) are presented, to investigate the efficiency of an MRI-based screening protocol. PROSA is a prospective, randomized, single-center study. To date, 351 men have been enrolled and blindly randomized into two different arms: (A) Men underwent a bpMRI regardless of their PSA values (175); (B) Men followed as per clinical practice: those with increased PSA (61) were referred to bpMRI, while those with normal PSA (112) were not. Men who screened positive on MRI were directed to MR-directed targeted biopsy. On arm A, 4 clinically significant PCa have been detected, while none was found on arm B (p = 0.046). To evaluate the efficiency of the screening protocol, we calculated the experimental event rate (EER, 3.6%), control event rate (CER, 1.2%.), absolute risk reduction (ARR, 2.5%), and number needed to treat (NNT, 40.3). PROSA represents an interesting experience in the field of imaging-based PCa screening. The preliminary data from this trial highlight the promising role of non-contrast MRI as a screening tool for early detection of PCa. Further data will finally validate the most appropriate screening program. CLINICAL RELEVANCE STATEMENT: PROSA depicts an interesting experience in the field of research focused on imaging-based prostate cancer screening. Its preliminary data highlight the promising role of non-contrast MRI as a screening tool for early detection of PCa. KEY POINTS: • Promotion of an MRI-based screening protocol, investigating the role of non-contrast MRI as a secondary prevention test for prostate cancer early diagnosis, comparing MRI with PSA test. • Prostate Cancer Secondary Screening in Sapienza (PROSA) represents an interesting experience in the field of research focused on imaging-based prostate cancer screening; its preliminary results indicate that it is possible to use non-contrast MRI as a screening tool for early detection of PCa. • This new approach to PCa screening could facilitate the early diagnosis of clinically significant prostate cancer while reducing the number of unnecessary prostate biopsies and the detection of clinically insignificant prostate cancer.

Workplace Bullying in Italy: A Systematic Review and Meta-Analysis.

BACKGROUND: Within any work environment, employees may be affected by "workplace bullying", a form of violent and repeated social behavior towards subordinates and colleagues. This review aimed to investigate the prevalence of bullied workers in Italy, the causes of the phenomenon, and the consequences at physical, psychological, and organizational levels. METHODS: We included observational studies and systematic reviews examining the prevalence of bullied workers and the causes and consequences in Italian workplaces. Data extraction and analysis were performed on all included studies. The research strategy included three electronic databases (PubMed, Scopus, and Web of Science). A comprehensive search was done to retrieve articles based on a PRISMA-compliant protocol registered in PROSPERO: CRD 42023394635. RESULTS: One hundred eighty-four articles were retrieved, and once duplicates and irrelevant articles were removed, 42 useful articles were reviewed. The mean pooled prevalence, calculated based on workers complaining of mistreatment, was 6.7% (SD: 4,09) and increased significantly to 17.0% (SD: 12.88) when considering only healthcare workplaces. Causes include how impaired mental health and high workload reinforce the possibility of being bullied in the workplace, resulting in a worsening of the worker's quality of life (physical and psychological) and the work organization with increased absenteeism and job changes. CONCLUSIONS: Workplace bullying is a very present phenomenon within workplaces in Italy. In light of this, it is necessary to put prevention plans in place and find solutions to maintain optimal organizational well-being in the work environment.

The Association between Levels of Physical Activity and Lifestyle, Life Expectancy, and Quality of Life in Patients with Alzheimer's Disease.

BACKGROUND: Engaging in physical activity could help improve the quality of life in patients with Alzheimer's disease. The objective of this study was to determine the association between the levels of physical activity and lifestyle, life expectancy, and quality of life in patients with Alzheimer's disease in Iran and Italy. METHODS: A total of 165 participants from Iran and Italy were enrolled in this cross-sectional study. In Iran, 85 patients participated in the study. In Italy, we enrolled 80 patients at the Sapienza University teaching hospital, Policlinico Umberto 1 in Rome. The inclusion criteria in this study include patients over 60 years old, non-smokers, and non-users of antidepressants and hypnotics. RESULTS: The results of Tukey's post hoc test of the study conducted in Iran showed that the lifestyle of patients with moderate (p = 0.001) and low (p = 0.009) physical activity levels was significantly better than inactive patients. Life expectancy in patients with moderate physical activity levels was significantly higher than inactive patients (p = 0.011). The quality of life was significantly better in patients with moderate (p = 0.001) and low (p = 0.002) physical activity levels than inactive patients. On the other hand, the findings of Tukey's post hoc test of the study in Italy showed that the quality of life in patients with low (p = 0.001) and moderate physical activity levels (p = 0.01) was significantly higher than inactive patients. CONCLUSIONS: A low to moderate level of physical activity could be associated with an improved lifestyle, life expectancy, and quality of life in patients with Alzheimer's disease compared to inactivity.

Analysis of the Economic Burden of COVID-19 on the Workers of a Teaching Hospital in the Centre of Italy: Changes in Productivity Loss and Healthcare Costs Pre and Post Vaccination Campaign.

Introduction: Following the concerning levels of spread and severity of the infection, on 11 March 2020, the World Health Organisation declared the COVID-19 outbreak a pandemic. In response to the pandemic, governments adopted several mitigation strategies. The pandemic posed a great threat to the Italian healthcare workforce (HW), with Italy being one of the hardest-hit countries. The aim of this study is to estimate the economic burden of COVID-19 on the workforce of a teaching hospital in Central Italy. Two periods are compared: 1 March 2020-9 February 2021 vs. 10 February 2021-31 March 2022. Methods: This study is conducted from a societal perspective. The database (n = 3298) of COVID-19-confirmed cases among the HW was obtained from the occupational health office of the hospital. The first entry on the database refers to 1 March 2020. Cost data were used to assess the economic burden of COVID-19 on the hospital workforce. They include two main groups: hourly salaries and medical expenses. The cost of productivity loss, hospital admission, at-home treatments, and contact tracing and screening tests were computed for the first and second periods of the analysis. Results: The total economic burden during the first period is estimated to be around EUR 3.8 million and in the second period EUR 4 million. However, the average cost per person is smaller in the second period (EUR 1561.78) compared to the first one (EUR 5906). In both periods, the cost of productivity loss is the largest component of the economic burden (55% and 57%). The cost of hospital admission decreased by more than 60% in the second period. Conclusion: Outcomes of the analysis suggest that the economic burden of COVID-19 on the HW is higher in the first period of analysis compared to the second period. The main reason could be identified in the shift from more severe and critical confirmed cases to more asymptomatic, mild, and moderate cases. The causes of this shift are not easily detectable. Vaccination, variants of the virus, and an individual's determinants of health could all be causes of the decrease in the economic burden of COVID-19 on the HW. COVID-19 can generate a high economic burden on healthcare workers and, more generally, on HWs. However, a comprehensive estimate of the economic burden of the pandemic needs to integrate the mental health repercussions and the long-term COVID-19 that will become evident in the coming years.

Nursing Sensitive Outcomes evaluation in the Emergency Department: An Umbrella Review / Evaluación de resultados sensibles de Enfermería en el Servicio de urgencias. Revisión de alcance / Avaliação de resultados de enfermagem sensíveis no pronto-socorro. Revisão do escopo

Objective. The aim of this review was to identify reported nursing-sensitive outcomes in the Emergency Department to date. Methods. An Umbrella review was conducted. Four databases, CINAHL, Pubmed, Web of Science and Scopus, were searched from inception until October 2022. MeSH terms were: "nursing", "sensitivity and specificity", "emergency service, hospital", "nursing care". Two reviewers independently screened studies against the inclusion criteria for eligibility, extracted data and assessed study quality with the SIGN tool. Results of the included studies were summarized and described in themes for narrative analysis. The study was enrolled in the PROSPERO registry (CRD42022376941) and PRISMA guidelines were followed. Results. The search strategy yielded 2289 records. After duplicate removal, title, abstract and full-text eligibility screening, nine systematicInvest Educ Enferm. 2023; 41(3): e03Nursing Sensitive Outcomes evaluation in the Emergency Department:An Umbrella Reviewreviews were included in the review. A total of 35 nursing-sensitive outcomes were reported. The most described outcomes were waiting times, patient satisfaction and time to treatment. The less measured were mortality, left without being seen and physical function. Synthesizing nursing-sensitive outcomes in themes for reporting, the most measured outcomes were within the safety domain (n=20), followed by the clinical (n=9), perceptual (n=5) and the least explored functional domain (n=1). Conclusion. Nursing sensitive outcomes research in emergency nursing practice is a conceptual challenge still in its early stage. Several nursing-sensitive outcomes were identified in this review that can evaluate the contribution of emergency department nursing care to patient outcomes. Further research is required to explore patient outcomes sensitive to emergency nursing care.

Objetivo. Identificar los resultados sensibles de enfermería reportados en los Servicios de Urgencias. Métodos. Se realizó una revisión general. Se hicieron búsquedas en cuatro bases de datos, CINAHL, Pubmed, Web of Science y Scopus, desde su inicio hasta octubre de 2022. Los términos MeSH empleados fueron: "nursing", "sensitivity and specificity", "emergency service, hospital", "nursing care". Dos revisores examinaron de forma independiente los estudios en función de los criterios de inclusión para determinar su elegibilidad, extrajeron los datos y evaluaron la calidad de los estudios con la herramienta SIGN. Los resultados de los estudios incluidos se resumieron y describieron en temas para el análisis narrativo. El estudio se inscribió en el registro PROSPERO (CRD42022376941) y se siguieron las directrices PRISMA. Resultados. La estrategia de búsqueda produjo 2289 registros. Tras la eliminación de duplicados y el cribado de elegibilidad de título, resumen y texto completo, se incluyeron en la revisión nueve revisiones sistemáticas. Se informó de un total de 35 resultados sensibles a la enfermería. Los resultados más descritos fueron los: tiempos de espera, la satisfacción del paciente y el tiempo hasta el tratamiento. Los menos medidos fueron la mortalidad, el tiempo sin ser evaluado y la función física. Sintetizando los resultados sensibles a la enfermería en temas para la notificación, los resultados más medidos estaban dentro del dominio de la seguridad (n=20), seguidos por el clínico (n=9), el perceptivo (n=5) y el dominio funcional menos explorado (n=1). Conclusión. En esta revisión se identificaron varios resultados sensibles a la enfermería que pueden evaluar la contribución de los cuidados de enfermería en los servicios de urgencias a los resultados de los pacientes. La investigación de resultados sensibles a la enfermería en la práctica de la enfermería de urgencias es un reto conceptual que aún se encuentra en su fase inicial.

Objetivo. Identificar resultados de enfermagem sensíveis notificados em Serviços de Emergência. Métodos. Foi realizada uma revisão geral. Foram pesquisadas quatro bases de dados: CINAHL, Pubmed, Web of Science e Scopus, desde a sua criação até outubro de 2022. Os termos MeSH utilizados foram: "enfermagem", "sensibilidade e especificidade", "serviço de emergência, hospital", "cuidados de enfermagem". Dois revisores selecionaram independentemente os estudos em relação aos critérios de inclusão para determinar a elegibilidade, extraíram os dados e avaliaram a qualidade do estudo com a ferramenta SIGN. Os resultados dos estudos incluídos foram resumidos e descritos em temas para análise narrativa. O estudo foi registrado no registro PROSPERO (CRD42022376941) e as diretrizes PRISMA foram seguidas. Resultados. A estratégia de busca produziu 2.289 registros. Após remoção das duplicatas e triagem do título, resumo e texto completo para elegibilidade, nove revisões sistemáticas foram incluídas neste estudo. Foram relatados 35 resultados de enfermagem sensíveis, sendo os mais descritos: tempo de espera, satisfação do paciente e tempo para tratamento. Os menos frequentes foram: mortalidade, tempo sem avaliação e função física. Sintetizando os resultados sensíveis à enfermagem por meio de tópicos de relato, os mais mensurados foram dentro do domínio segurança (n=20), seguido do domínio clínico (n=9), do perceptual (n=5) e do funcional. menos explorados (n=1). Conclusão. Esta revisão identificou vários resultados sensíveis à enfermagem que podem avaliar a contribuição dos cuidados de enfermagem nos serviços de urgências para os resultados dos pacientes. A investigação de resultados sensíveis na prática de enfermagem em emergências é um desafio conceitual que ainda está em fase inicial.

The Effectiveness of Paracetamol to Reduce the Post-Vaccination SARS-CoV-2 Adverse Effects in an Italian Vaccination Center.

The arrival of specific vaccines was crucial for the eradication of COVID-19. Despite the security of the vaccination, the administration of COVID-19 mRNA vaccines often causes systemic side effects for a short time after the injection, such as headache, fatigue, fever, muscle pain and nausea. These side effects can limit the adherence to COVID-19 vaccines administration, especially in healthcare workers. This study aims to analyze the impact of the prophylactic use of paracetamol to reduce the post-vaccination Comirnaty/Pfizer adverse effects. The study took place at the San Giovanni Battista Hospital in Rome and included all hospital employees who received two doses of Pfizer-BioNTech. The vaccination health personnel recommended the preventive intake of 1 g of paracetamol before the inoculation of the vaccine and then every 6 h in the first 24 h. Information was collected through forms and subsequent telephone recall. A total of 403 volunteers were involved in the study, with 391 of them receiving two doses and twelve individuals only one dose of the vaccine. The main results demonstrated that the prophylactic therapy influenced the lower onset of asthenia in the first and second doses. However, there were no significant differences between the two groups in terms of fever, headache and localized pain. Paracetamol had a good impact on the side effect of COVID-19 vaccination, reducing asthenia in both doses and mitigating the total of symptoms during the second vaccination.

Occupational Medicine and Prevention of Chronic and Infectious Diseases.

Occupational medicine is a clinical discipline that draws attention to the health of workers and their ability to work [...].

B3 lesions of the breast and cancer risk. A single-centre experience.

BACKGROUND: Breast lesions of uncertain malignant potential, also known as B3 lesions, represent a heterogeneous group of tumors with variable malignancy risk. Surgical excision should be considered depending on clinical, radiological and histological features, family history and following informed consent. The aim of the present paper is to evaluate the positive predictive value (PPV) of diagnosis of malignancy in surgically excised B3 lesions in order to identify possible predictive upgrade criteria. We mainly focused on disclosing the concordance rate between tissue biopsy and final surgical pathology and correlation between radiology and pathology. METHODS: Between January 2018 and December 2021, 83 patients undergoing ultrasound guided tru-cut needle biopsy or VABB with a B3 diagnosis and surgical excision following multidisciplinary discussion were retrospectively reviewed in our Breast Unit. RESULTS: Out of a total of 83 cases with a B3 diagnosis before surgery, atypical ductal hyperplasia accounted for 29/83 cases(34.93%) and the most part of patients presented nodular lesions (n = 34/83, 40.96%). Among the 15 cases of malignancy detected after surgery, micro calcifications were registered in 53.3% of patients on mammography (n = 8/15). CONCLUSION: We assessed the correlation between radiological and pathological criteria in order to guide risk stratification and ensure adequate patient management. Correspondence between histological diagnosis, imaging and type of diagnostic biopsy were evaluated. No statistically significant predictors were identified for the parameters assessed in our study. KEY WORDS: B3 Breast Lesions, Lesions of Uncertains Malignant Potential, Mammografic Distortion, Screen Detected Breast Lesion.

Comment on Clayton-Chubb et al. Understanding NAFLD: From Case Identification to Interventions, Outcomes, and Future Perspectives. Nutrients 2023, 15, 687.

This letter is to comment on the article by Clayton-Chubb et al. on the pathogenesis of non-alcoholic fatty liver disease and its outcomes, and the description of current, emerging and future directions to treat this condition [...].

Chest CT features of COVID-19 in vaccinated versus unvaccinated patients: use of CT severity score and outcome analysis.

OBJECTIVES: To evaluate the impact of vaccination on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and moreover on coronavirus disease 2019 (COVID-19) pneumonia, by assessing the extent of lung disease using the CT severity score (CTSS). METHODS: Between September 2021 and February 2022, SARS-CoV-2 positive patients who underwent chest CT were retrospectively enrolled. Anamnestic and clinical data, including vaccination status, were obtained. All CT scans were evaluated by two readers using the CTSS, based on a 25-point scale. Univariate and multivariate logistic regression analyses were performed to evaluate the associations between CTSS and clinical or demographic variables. An outcome analysis was used to differentiate clinical outcome between vaccinated and unvaccinated patients. RESULTS: Of the 1040 patients (537 males, 503 females; median age 58 years), 678 (65.2%) were vaccinated and 362 (34.8%) unvaccinated. Vaccinated patients showed significantly lower CTSS compared to unvaccinated patients (p < 0.001), also when patients without lung involvement (CTSS = 0) were excluded (p < 0.001). Older age, male gender and lower number of doses administered were associated with higher CTSS, however, in the multivariate analysis, vaccination status resulted to be the variable with the strongest association with CTSS. Clinical outcomes were significantly worse in unvaccinated patients, including higher number of ICU admissions and higher mortality rates. CONCLUSIONS: Lung involvement during COVID-19 was significantly less severe in vaccinated patients compared with unvaccinated patients, who also showed worse clinical outcomes. Vaccination status was the strongest variable associated to the severity of COVID-related, more than age, gender, and number of doses administered.

Evaluation of the Factors Associated with Reinfections towards SARS-CoV-2 Using a Case Control Design.

OBJECTIVE: The risk of reinfection with SARS-CoV-2 has been rapidly increased with the circulation of concerns about variants. So, the aim of our study was to evaluate the factors that increase the risk of this reinfection in healthcare workers compared to those who have never been positive and those who have had only one positivity. METHODS: A case-control study was carried out at the Teaching Hospital Policlinico Umberto I in Rome, Sapienza University of Rome, in the period between 6 March 2020 and 3 June 2022. Cases are healthcare workers who have developed a reinfection with the SARS-CoV-2 virus, while controls were either healthcare workers who tested positive once or those who have never tested positive for SARS-CoV-2. RESULTS: 134 cases and 267 controls were recruited. Female gender is associated with a higher odds of developing reinfection (OR: 2.42; 95% CI: 1.38-4.25). Moreover, moderate or high alcohol consumption is associated with higher odds of reinfection (OR: 1.49; 95% CI: 1.19-1.87). Diabetes is also associated with higher odds of reinfection (OR: 3.45; 95% CI: 1.41-8.46). Finally, subjects with increased red blood cell counts have higher odds of reinfection (OR: 1.69; 95% CI: 1.21-2.25). CONCLUSION: From the prevention point of view, these findings indicate that particular attention should be paid to subjects with diabetes mellitus, women and alcoholic drinkers. These results could also suggest that contact tracing represents a fundamental approach model against the SARS-CoV-2 pandemic, together with the health information of participants.

Synergistic Effect between SARS-CoV-2 Wave and COVID-19 Vaccination on the Occurrence of Mild Symptoms in Healthcare Workers.

BACKGROUND: Since the beginning of the pandemic, five variants of epidemiological interest have been identified, each of them with its pattern of symptomology and disease severity. The aim of this study is to analyze the role of vaccination status in modulating the pattern of symptomatology associated with COVID-19 infection during four waves. METHODS: Data from the surveillance activity of healthcare workers were used to carry out descriptive analysis, association analyses and multivariable analysis. A synergism analysis between vaccination status and symptomatology during the waves was performed. RESULTS: Females were found at a higher risk of developing symptoms. Four SARS-CoV-2 waves were identified. Pharyngitis and rhinitis were more frequent during the fourth wave and among vaccinated subjects while cough, fever, flu syndrome, headache, anosmia, ageusia, arthralgia/arthritis and myalgia were more frequent during the first three waves and among unvaccinated subjects. A correlation was found between vaccination and the different waves in terms of developing pharyngitis and rhinitis. CONCLUSION: Vaccination status and viruses' mutations had a synergic effect in the mitigation of the symptomatology caused by SARS-CoV-2 in healthcare workers.

Assessment of the Impact of Low-dose Ionizing Radiation Exposure on Health Care Workers: A Study of Methods Used from a Scoping Review.

ABSTRACT: Healthcare workers may be exposed to ionizing radiation. Ionizing radiations are an important occupational risk factor for the potential damage they can cause to workers' health. Actually, the attention is focused on diseases caused by damage to radiosensitive organs. The aim of our study is to evaluate the methods used for the assessment of the impact of exposure to low-dose ionizing radiation in a population of healthcare workers (HCWs). The electronic database PubMed was searched by title, abstract, and medical subheadings (MeSH) terms. The extracted data were arranged into tables by dividing bibliographic reference, exposure, and statistical analysis information. The quality assessment was performed with the use of the Newcastle-Ottawa Quality Assessment Scale. The search strategy involved retrieving 15 studies (eight cohorts and seven cross-sectional studies). The univariate tests have been performed in 14 studies (93.3%), and Chi-square and T-test were the most commonly used. Multivariate tests have been performed in 11 studies (73.3%), and the most commonly performed were Logistic and Poisson Regressions. The most rated organ was the thyroid gland (six studies). The annual cumulative effective dose was the most used method to assess the dose rate (seven studies). Due to the characteristics of pathologies involved, a retrospective cohort study with an adequate control group and use of the annual cumulative effective dose to account for exposure could be useful features to obtain the best possible evidence. All the elements were found rarely in studies considered. The need is highlighted for more in-depth studies to investigate this topic.

The effects of bullying on healthcare workers: an umbrella review of systematic reviews and meta-analyses.

OBJECTIVE: This umbrella review will provide a broad overview of the prevalence of vertical and horizontal bullying, the departments and the workers most affected by these attacks. METHODS: We included systematic reviews and meta-analyses examining the effects of bullying on healthcare workers. Data extraction and analysis was performed on all included studies. The research strategy was undertaken in May 2021 and included three electronic databases (PubMed, Scopus and Web of Science): a total of 435 articles were retrieved from the Abstract and, once duplicates and irrelevant articles were removed, a total of 19 useful articles were reviewed. A comprehensive search was done to retrieve articles based on a PRISMA compliant protocol registered in PROSPERO: CRD 42021268082. RESULTS AND DISCUSSION: The general prevalence goes from 2 to 100%; for the individual healthcare workers, the highest prevalence is among nurses, 9-100%, followed by doctors 11.50-78.10%. Due to the heterogeneity of the studies, the other healthcare workers such as midwives, radiology technicians, administrative, employees were grouped and their prevalence goes from 3.30 to 100%. The results show that female nurses are significantly more likely to be abused than their male colleagues (women 3.60-100%; men 2.00-64.40%). The workplace in many studies was relevant for bullying: in particular, the most affected departments were emergency departments (2-100%) followed by intensive care units (17-84.80%). CONCLUSIONS: Bullying is extremely present among health workers and must be adequately countered. It will be necessary to carry out further studies to deepen the knowledge on this matter.

The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis.

BACKGROUND: For many years, occupational physicians have debated whether there is a link between working the night shift and depression and other co-occurring mental health issues, with an emphasis on work-related, biological, individual, and environmental factors. We performed this systematic review and meta-analysis to estimate the overall association between sleep deprivation and depression among nurses working night shifts. METHODS: A systematic search was carried out across the electronic databases PubMed, Scopus, and Web of Science from inception to 30 September 2022, for studies that reported a relationship between estimated night shift work and depression in nurses. The outcomes were measured using the odds ratio (OR) and matching 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation technique was used to evaluate the quality of the evidence, and the Newcastle-Ottawa Scale was utilized to assess the methodological quality of each of the included studies. We determined the overall relationship between working nights and the onset of depression. RESULTS: A total of 20 studies were included in the systematic review. Furthermore, 8 studies were included in the meta-analysis due to their common use of the OR as an effect measure. The 8 studies gave an overall estimate indicating a statistically significant association between night shift work and depression among nurses (OR = 1.49 95% CI: 1.26, 1.76). The prediction interval for the overall estimate was (0.995, 2.231). This implies that the true OR in a future study would most likely fall within this range, with a 95% certainty. CONCLUSIONS: The outcome of this systematic review and meta-analysis showed a significant association between night shift work, the circadian and sleep disruption it causes, and the risk of depression in nurses. This demonstrates that nurses who work night shifts are at risk of developing depression.

Potential Protective Role of Pregnancy and Breastfeeding in Delaying Onset Symptoms Related to Multiple Sclerosis.

The impact of pregnancy and breastfeeding on the development and outcomes of Multiple sclerosis (MS) has been debated for decades. Since several factors can influence the evolution of the disease, the protective role of multiparity and breastfeeding remains uncertain, as well the role of hormone replacement therapy in the perimenopausal period. We report two cases of relatively late-onset MS in two parous women, who developed their first neurological symptoms after six and nine pregnancies, respectively. Both women breastfed each of their children for 3 to 12 months. One of them underwent surgical menopause and received hormone replacement therapy for 7 years before MS onset. We performed a systematic literature review to highlight the characteristics shared by women who develop the disease in similar conditions, after unique hormonal imbalances, and to collect promising evidence on this controversial issue. Several studies suggest that the beneficial effects of pregnancy and breastfeeding on MS onset and disability accumulation may only be realized when several pregnancies occur. However, these data on pregnancy and breastfeeding and their long-term benefits on MS outcomes suffer from the possibility of reverse causality, as women with milder impairment might choose to become pregnant more readily than those with a higher level of disability. Thus, the hypothesis that multiparity might have a protective role on MS outcomes needs to be tested in larger prospective cohort studies of neo-diagnosed women, evaluating both clinical and radiological features at presentation.

Subclinical vascular damage in Schistosoma spp. endemic regions.

Background: Cardiovascular abnormalities have been described in patients with schistosomiasis. Their true prevalence and clinical features in endemic settings are unknown. Patients and methods: The study aimed to assess the prevalence of subclinical cardiovascular damage in a population endemic to schistosomiasis. A cross-sectional study was conducted using colour-ultrasound assessment of abdominal and carotid arteries among adults aged >18 years living in Kome Island, Tanzania. Carotid intimal medial thickness, carotid plaque, mean abdominal aortic diameter, and presence of aneurysms were assessed. Anamnestic data on previous Schistosoma infection was collected; the actual prevalence of Schistosoma mansoni and Schistosoma haematobium was also assessed through stool and urine investigations. Results: A total of 264 participants (166 female, 98 male) were enrolled (mean age of 50±15.5 years). The history of previous schistosomiasis was 27.3%, and actual positivity for Schistosoma mansoni was 5.9%. The Latero-lateral Abdominal Aortic Diameter was significantly increased among participants with a previous history of schistosomiasis (16.7±2.8 mm vs. 17.6±3 mm; p=0.02), with an aOR of 1.15 [CI 1.04-1.28]; p=0.007]. Conclusions: The significant difference in the Latero-lateral Abdominal Aortic Diameter in participants with previous Schistosomiasis history schistosomiasis, suggests the need for further investigations on aortic damage in endemic populations, independently from the positive laboratory investigations.

Knowledge, Attitude, and Behavior toward COVID-19 Vaccination in Young Italians.

Purpose: The knowledge, attitudes, and behavior of young Italians towards the COVID-19 vaccination were analyzed in order to provide information useful to elaborate the strategies that can be implemented to obtain the best possible vaccination coverage in this population. Methods: A cross-sectional study was conducted on 5313 young people aged between 11 and 30 years. Data were collected through an online survey during the period from 1 to 10 March 2021. The answers to the questionnaire were analyzed using SPSS statistical software. Intention to vaccinate was studied by univariate analysis using Pearson's chi-square test to assess differences between groups for categorical variables, and by multivariate analysis applying the binary logistic regression model, and the Hosmer−Lemeshow test was performed to assess goodness of fit. Results: Television (32.1%), internet/search engine (25.9%), and social networks (10.4%) were the main sources of information for young Italians. The survey analysis showed that 74.5% (3956) of the respondents were willing to be vaccinated against COVID-19 versus 25.5% (1357) who were against it. Demographic data, in particular, age, gender, experience with influenza vaccine, and level of knowledge about the disease, were significant determinants (p < 0.001) for the choice to vaccinate against COVID-19. Discussion: These results suggest that in order to implement the vaccination campaign, correct information is needed to improve awareness of the vaccine and COVID-19, while also taking into account the target group, which differs not only in age but also in the sources of information used compared to the adult population.