Advances in selenium supplementation: From selenium-enriched yeast to potential selenium-enriched insects, and selenium nanoparticles.

Selenium (Se) is an essential micronutrient that plays an important role in animal and human development and physiological homoeostasis. This review surveys the role of Se in the environment, plants and animal bodies, and discusses data on Se biofortification with different sources of supplementation, from inorganic to organic forms, with special focus on Se-enriched yeast (Se-yeast). Although Se-yeast remains one of the main sources of organic Se, other emerging and innovative sources are reviewed, such as Se-enriched insects and Se-nanoparticles and their potential use in animal nutrition. Se-enriched insects are discussed as an option for supplying Se in organic form to livestock diets. Se-nanoparticles are also discussed, as they represent a more biocompatible and less toxic source of inorganic Se for animal organisms, compared to selenite and selenate. We also provide up to date information on the legal framework in the EU, USA, and Canada of Se that is contained in feed additives. From the scientific evidence available in the literature, it can be concluded that among the inorganic forms, sodium selenite is still one of the main options, whereas Se-yeast remains the primary organic form. However, other potential sources such as Se-enriched insects and Se-nanoparticles are being investigated as they could potentially combine a high bioavailability and reduced Se emissions in the environment.

Healthcare workers and health care-associated infections: knowledge, attitudes, and behavior in emergency departments in Italy.

BACKGROUND: This survey assessed knowledge, attitudes, and compliance regarding standard precautions about health care-associated infections (HAIs) and the associated determinants among healthcare workers (HCWs) in emergency departments in Italy. METHODS: An anonymous questionnaire, self-administered by all HCWs in eight randomly selected non-academic acute general public hospitals, comprised questions on demographic and occupational characteristics; knowledge about the risks of acquiring and/or transmitting HAIs from/to a patient and standard precautions; attitudes toward guidelines and risk perceived of acquiring a HAI; practice of standard precautions; and sources of information. RESULTS: HCWs who know the risk of acquiring Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) from a patient were in practice from less years, worked fewer hours per week, knew that a HCW can transmit HCV and HIV to a patient, knew that HCV and HIV infections can be serious, and have received information from educational courses and scientific journals. Those who know that gloves, mask, protective eyewear, and hands hygiene after removing gloves are control measures were nurses, provided care to fewer patients, knew that HCWs' hands are vehicle for transmission of nosocomial pathogens, did not know that a HCW can transmit HCV and HIV to a patient, and have received information from educational courses and scientific journals. Being a nurse, knowing that HCWs' hands are vehicle for transmission of nosocomial pathogens, obtaining information from educational courses and scientific journals, and needing information were associated with a higher perceived risk of acquiring a HAI. HCWs who often or always used gloves and performed hands hygiene measures after removing gloves were nurses, provided care to fewer patients, and knew that hands hygiene after removing gloves was a control measure. CONCLUSIONS: HCWs have high knowledge, positive attitudes, but low compliance concerning standard precautions. Nurses had higher knowledge, perceived risk, and appropriate HAIs' control measures than physicians and HCWs answered correctly and used appropriately control measures if have received information from educational courses and scientific journals.

Characteristics of patients returning to emergency departments in Naples, Italy.

BACKGROUND: Crowding in hospital Emergency Departments (EDs) is a problem in several countries. We evaluated the number and characteristics of patients who make repeated visits to the EDs in Naples, Italy. METHODS: All patients (> or = 16 years) who presented to the EDs of three randomly selected non-academic acute care public hospitals, within randomly selected week periods, were studied. The two outcomes of interest were the re-utilization, within 72 hours, of the ED and the number of visits in the previous year. RESULTS: Of the 1430 sampled patients, 51.9% self-reported multiple visits in the previous year and 10.9% and 1.6% used the ED for 3 and > or =4 times, respectively. The number of visits in the previous year was significantly higher in those who live closer to hospital, with a more severe burden of overall comorbidity, and who were on pharmacological treatment. Overall, 72-hours return visits were found in 215 patients (15.8%). Patients were more likely to re-use within 72 hours the ED if younger, were not on pharmacological treatment, attended the ED more times in the previous year, were referred by a physician, arrived at the ED by car driven by other person, had problems of longer duration prior to arrival at the ED, had a surgical ED discharge diagnosis, and were admitted to the hospital. CONCLUSION: The data may assist policymakers in the development and implementation of protocols to track changes in the re-utilization of the ED for the high financial impact and for the benefit of the patients.

Knowledge, attitudes, and preventive practices about colorectal cancer among adults in an area of Southern Italy.

BACKGROUND: Colorectal cancer (CRC) is the second most commonly diagnosed cancer for both sexes in developed countries. This study assessed the knowledge, attitudes, and preventive practices regarding CRC of adults in Italy. METHODS: A random sample of 1165 adults received a self-administered questionnaire on socio-demographic characteristics; knowledge regarding definition, risk factors, and screening; attitudes regarding perceived risk of contracting CRC and utility of screening tests; health-related behaviors and health care use; source of information. RESULTS: Only 18.5% knew the two main modifiable risk factors (low physical activity, high caloric intake from fat) and this knowledge was significantly associated with higher educational level, performing physical activity, modification of dietary habits and physical activity for fear of contracting CRC, and lower risk perception of contracting CRC. Half of respondents identified fecal occult blood testing (FOBT) as main test for CRC prevention and were more knowledgeable those unmarried, more educated, who knew the main risk factors of CRC, and have received advice by physician of performing FOBT. Personal opinion that screening is useful for CRC prevention was high with a mean score of 8.3 and it was predicted by respondents' lower education, beliefs that CRC can be prevented, higher personal perceived risk of contracting CRC, and information received by physician about CRC. An appropriate behavior of performing FOBT if eligible or not performing if not eligible was significantly higher in female, younger, more educated, in those who have been recommended by physician for undergo or not undergo FOBT, and who have not personal history of precancerous lesions and familial history of precancerous lesions or CRC. CONCLUSION: Linkages between health care and educational systems are needed to improve the levels of knowledge and to raise CRC screening adherence.

Appropriate tetanus prophylaxis practices in patients attending Emergency Departments in Italy.

OBJECTIVE: This study evaluated the physician compliance with tetanus prophylaxis and immunization practices for patients with wounds attending Emergency Departments (EDs) of four randomly selected non-academic acute care public hospitals in Italy. METHODS: All presenting patients (> or = 16 years) within randomly selected week periods were studied. Physician and nurse, who were not involved in care, interviewed each patient regarding: socio-demographics, wound characteristics, and tetanus immunization history; they also collected, through direct observation, data of the physician practices for tetanus prophylaxis and immunization. RESULTS: A total of 29.8% patients had a wound tetanus-prone and this was more frequently observed in those lower educated, who arrive at the ED with medical referral during daytime and in the weekday, whose injury occurred outdoor, who had not completed the primary vaccination series or has received a booster dose < or =10 years before, and for a wound in abdomen, pelvis, and lower extremity. Overall, 54% of the physicians recorded for each patient information about the characteristics of the wound and the tetanus immunization history and this was more frequently for those patients traumatized outdoor, injured less than 1h before, when the wound was non-tetanus-prone, and less frequently when the wound site was head and neck. Only 1.5% of the physicians correctly adhere to guidelines on tetanus prophylaxis and immunization in wound management and this more frequently adopted for younger patients' and when the physician recorded information about tetanus immunization history. CONCLUSION: Health policies and programs should be aimed at improving the quality of health care.

A survey of knowledge, attitudes and practices towards avian influenza in an adult population of Italy.

BACKGROUND: Several public health strategic interventions are required for effective prevention and control of avian influenza (AI) and it is necessary to create a communication plan to keep families adequately informed on how to avoid or reduce exposure. This investigation determined the knowledge, attitudes, and behaviors relating to AI among an adult population in Italy. METHODS: From December 2005 to February 2006 a random sample of 1020 adults received a questionnaire about socio-demographic characteristics, knowledge of transmission and prevention about AI, attitudes towards AI, behaviors regarding use of preventive measures and food-handling practices, and sources of information about AI. RESULTS: A response rate of 67% was achieved. Those in higher socioeconomic classes were more likely to identify the modes of transmission and the animals' vehicles for AI. Those older, who knew the modes of transmission and the animals' vehicles for AI, and who still need information, were more likely to know that washing hands soap before and after touching raw poultry meat and using gloves is recommended to avoid spreading of AI through food. The risk of being infected was significantly higher in those from lower socioeconomic classes, if they did not know the definition of AI, if they knew that AI could be transmitted by eating and touching raw eggs and poultry foods, and if they did not need information. Compliance with the hygienic practices during handling of raw poultry meat was more likely in those who perceived to be at higher risk, who knew the hygienic practices, who knew the modes of transmission and the animals' vehicles for AI, and who received information from health professionals and scientific journals. CONCLUSION: Respondents demonstrate no detailed understanding of AI, a greater perceived risk, and a lower compliance with precautions behaviors and health educational strategies are strongly needed.

Patients' knowledge, attitudes, and behavior toward hospital-associated infections in Italy.

BACKGROUND: Hospital-associated infections are associated with morbidity, extended hospital stay, mortality, and attributable costs to the health care sector. METHODS: A survey of 450 patients admitted to hospitals in Italy determined knowledge, attitudes, and behaviors regarding hospital-associated infections. A face-to-face interview sought information about: patient's sociodemographic characteristics; hospital admissions and examinations; knowledge, understanding, attitudes, and experience of health care-associated infections; and sources for information. RESULTS: Patients who were higher educated, unmarried, first-time admitted, and who have received information about hospital-associated infections were more likely to know definition, risk groups, and risk factors of such infections. Respondents' levels of perceived risk of contracting a hospital-associated infection were significantly higher in those who were married, unemployed, in medical wards, who overestimated the incidence rate, and who believed that health care professionals cannot infect patients. Patients willing to stop a health care worker who is not using gloves and mask were females, higher educated, those who believed that health care professionals can infect patients, who overestimated the incidence rate, who have never been exposed to such infections, who have never had received information, and who do not need information about hospital-associated infections. CONCLUSIONS: Actions aimed at improving knowledge are crucial to the development and implementation of effective public health preventive strategies.