Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses.

OBJECTIVES: The aim of this umbrella review of systematic reviews and meta-analyses was to address workplace violence (WPV) against healthcare workers (HCWs). Several systematic reviews exist in the literature, but the diversity of settings, population considered, and type of violence investigated make it difficult to gain insight and use the vast amount of available data to implement policies to tackle WPV. With this in mind, we conducted an umbrella review of systematic reviews and meta-analyses on WPV against HCWs to examine the global prevalence of the phenomena and its features. STUDY DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and ISI Web of Science were searched for relevant systematic reviews and meta-analyses published in English up to November 2022. Data on authors, year, country, violence type, prevalence (pooled and not), setting, population, and specific considerations were extracted. RESULTS: A total of 32 systematic reviews were included, 19 of which performed a meta-analysis, investigating overall, physical, and non-physical violence. Even considering the variability of the data, the COVID-19 pandemic has exacerbated the scale of the problem. From our review, we found that overall violence prevalence among HCWs was reported to be as high as 78.9%, and nurses working in psychiatric wards were the professionals most impacted. CONCLUSION: In conclusion, this umbrella review revealed a high prevalence of WPV among HCWs, which varies between countries, population subgroups, and detection methods. Strengthening recognition of the problem could lead to appropriate local and international strategies to address it.

Occupational exposure to work-related stress, a proposal of a pilot study to detect psychological distress in collar-workers.

Introduction: Work-related psychosocial risks have been identified as significant occupational health and safety risks; the occupational physicians must assess and monitor the health status of workers in order to verify that work is not a source of harm to exposed operators. The aim of the study was to investigate the outcomes related to anxiety and depression traits in workers exposed to stress-related work. Methods: A questionnaire was administered to a large population of Italian public administration workers; the Centre for Epidemiologic Studies - Depression Scale questionnaire was used to measure depression, the Self rating Anxiety Scale was used to measure anxiety, the UK Management Standards Indicator tool questionnaire was used to assess work adjustment. A descriptive analysis, a multivariate analysis, as well as logistic regression models were used to assess the health outcomes related to stress. Results: A total of 292 workers participated in the study; 100% of participants had a Centre for Epidemiologic Studies - Depression Scale score over the cut-off; 41.78% had a Self rating Anxiety Scale score over the cut-off; the results support a correlation between the Centre for Epidemiologic Studies - Depression Scale results and the UK Management Standards Indicator tool results; and a correlation between Self-rating Anxiety Scale results and the UK Management Standards Indicator tool results. Conclusions: The Demand, Management, Support and Relationship results were associated with mental health outcomes, and it could be a useful tool in occupational medicine, to identify workers at risk for negative mental health outcomes, becoming an essential tool in workers' health assessment and for prevention of mental health disorders.

Is the pandemic leading to a crisis of trust? Insights from an Italian nationwide study.

OBJECTIVES: Along with mistrust toward politics and journalism, the pandemic is amplifying mistrust in healthcare. To explore trust in key professionals among the Italian population, we focused on perceived change in trust during the pandemic. STUDY DESIGN: Nationwide online cross-sectional survey (called COCOS). METHODS: COCOS was conducted in Italy in two periods: the end of the first lockdown (T1: April-May 2020) and the end of 2020 (T2: November-December 2020). Descriptive analyses and multivariable logistic regressions were performed (sample size = 2673). RESULTS: Trust in healthcare workers (HCWs) was reduced in 1.5% of participants (T1) and 2.8% (T2). Trust in scientists/researchers was reduced in 5.8% (T1) and 7.6% (T2). Trust in politicians was reduced in 37.6% (T1) and 52.3% (T2). Trust in journalists was reduced in 41.7% (T1) and 48.3% (T2). Considering multivariable models, participants of the second period, participants who were HCWs, participants with anxiety symptoms, and those experiencing economic struggle due to the pandemic had a higher likelihood of having a reduced trust. The period had the strongest association with reduced trust. CONCLUSIONS: We argue that a central role might be played by the pandemic fatigue. We suggest leading figures should be more aware of the relationship between communication and trust. The pandemic is a real-world experiment in reshaping mediated communication and, although social media play an important role, other approaches might be successful. As a notable part of the population is trusting politicians and media less and less, Italian key professionals should implement initiatives to reinvigorate public support.

Which is the best communication strategy, based on anti-tobacco ads, to impress teenagers? A multicenter cross-sectional study.

BACKGROUND: Well-planned mass-media campaigns can increase health literacy and raise awareness about the consequences of tobacco use. This study aims to evaluate the emotions and opinions of adolescents about several anti-tobacco spots delivered by the mass media over the world. STUDY DESIGN: Cross-sectional study. METHODS: The study was conducted in Italy in 2016-2017 among students aged 13-17 years. Students expressed their emotions and opinions about seven anti-tobacco spots from all over the world on different topics and styles. RESULTS: 499 students attended. The video "Sponge" was found to be the most impressive (30.2%) and what they would have chosen if they had been responsible for campaign launched by the Minister of Health (40.5%). The "Icons" spot ranged second, with 19.2% and 17.4%, respectively. CONCLUSIONS: In summary, this study showed that the communication strategies most effective, according to the students interviewed, are those that give clear messages with a scientific profile or that discover the false stereotypes, as in the video "Icons". However, further research is needed to investigate the effectiveness of TV campaigns against smoking, in terms of habits and knowledge in young people.

Tobacco vs. electronic cigarettes: absence of harm reduction after six years of follow-up.

OBJECTIVE: Information on the long-term safety of electronic cigarettes (e-cig) is still limited. We report the results after six years of follow-up of the first observational study assessing e-cig long-term effectiveness and safety. PATIENTS AND METHODS: Participants were adults who smoked ≥1 tobacco cigarette/day (tobacco smokers); or used any type of e-cig inhaling ≥50 puffs weekly (e-cig users); or used both (dual users). Participants were contacted directly or by phone and/or internet interviews. Hospital discharge abstract data and carbon monoxide level tests were also used. RESULTS: Data were available for 228 e-cig users (all ex-smokers), 469 tobacco smokers, 215 dual users. A possibly smoking-related disease (PSRD) was recorded in 90 subjects (9.9%); 11 deceased (1.2%). No differences were observed across groups in PSRD rates, with minor changes in self-reported health. Among e-cig users, 64.0% remained tobacco abstinent. Dual users and tobacco smokers did not significantly differ in the rate of cessation of tobacco (38.6% vs. 33.9%, respectively) and all products (23.7% vs. 26.4%). A comparable decrease in daily cigarettes was also observed. 39.5% of the sample switched at least once (tobacco smokers: 15.1%; dual users: 83.3%). CONCLUSIONS: After six years, no evidence of harm reduction was found among e-cig or dual users. The complete switch to e-cig might support tobacco quitters remain abstinent, but the use of e-cig in addition to tobacco did not improve smoking cessation or reduction.

Knowledge, attitudes and eating habits red and processed meat among gym users: a cross-sectional survey.

AIMS: In 2015, the International Agency for Research on Cancer (IARC) classified red meat (RM) and processed meat (PM) intakes as 'probably carcinogenic' and 'carcinogenic' to humans, respectively. The aim of the study was to evaluate eating behaviours and knowledge on the potential risks of RM-PM consumption among gym users. METHODS: In 2018, a cross-sectional survey was conducted in 20 gyms in Turin using a 48-item questionnaire assessing sociodemographic, sports, dietary information and knowledge about RM-PM (sample size = 298). Multivariable logistic and linear regressions were performed. The significance level was p ⩽ 0.05. RESULTS: Around 75% of the sample consumed RM and PM at least once a week, with an average of 240.55 ± 435.99 g and 106.50 ± 157.88 g consumed weekly, respectively. Only 7.69% exceeded 700 g of raw RM weekly. Females, those with higher education, those who practise sport outside gyms and those who declared to practise sport to stay healthy, declared to consume less RM. Those who practise sport at a competitive level, those who are on a diet for athletic needs, those with higher body mass index (BMI) and those who consume more eggs and alcohol had a higher RM intake. The association with PM consumption was negative for females and positive for those living without a partner. The likelihood of answering incorrectly to one of the knowledge outcomes was lower for those who had a healthcare-related background and declared to practise sport to stay healthy, while it was higher for participants who stated to have a sport-related background, to be on a diet to lose weight, to read rarely/never the RM-PM nutrition labels and to consume <400 g of fruit and vegetables daily. CONCLUSIONS: Given the relatively low knowledge of the potential risks of RM-PM consumption, it would be advisable to implement campaigns specifically focused on male athletes and people with lower socioeconomic status, in order to raise awareness about this topic.

Could shared decision making affect staying in hospital? A cross-sectional pilot study.

BACKGROUND: Shared Decision Making (SDM) is an approach where clinicians and patients share the best available evidence to make decision and where patients opinions are considered. This approach provides benefits for patients, clinicians and health care system. The aim of the present study is to investigate the patients' perception of their participation in treatment choices and to identify the possible influences of variables in decision aids and therapeutic choices. Furthermore the present study evaluates the impact of SDM on the length of hospital stay and the health expenditure in Piemonte, an Italian region. METHODS: A cross-sectional study was performed in 2016. The patients were selected after hospitalization to clinical and surgical units at the Rivoli and Susa Hospital. Data were collected through the questionnaire and the Hospital Discharge Registers. STROBE guidelines for observational studies were used. A descriptive analysis was conducted. Frequencies and percentages of the categorical variables were reported. Statistical analyses were performed using t-test, chi-square test and Mann-Whitney test. RESULTS: The final sample was made of 174 subjects. More than half of the sample reported a SDM approach. Female gender (p = 0.027) and lower age (p = 0.047) are associated with an increased possibility to report SDM. Receiving "good" or "excellent" information, having their own request fulfilled and their opinions took into account by healthcare professionals, were all found to be predictors for an approach recognized as SDM (p ≤ 0.05). The perception that healthcare professionals spent a proper amount of time with the patients and used an understendable language are factors increase the chance of a "shared" decision process (p ≤ 0.05). The patients trust in the information given by the healthcare professional is not affecting their perception about the decision making process (P = 0.195). No significant difference where recorded in length of stay and hospital expenditure. CONCLUSIONS: The data show the role played by different dimension of the patients-clinician relationship and that the strongest determinant of a perceived shared decision making approach are healthcare professional-depending.

E-tools for hospital management: An overview of smartphone applications for health professionals.

BACKGROUND: Commonly, management of the main hospital activities is organized by different software packages that run on desktop computers, which may not always allow fast and practical use by health operators. This problem could be alleviated by combining these software packages with mobile health. The aim of this study is to provide an overview of smartphone and tablet applications used for hospital management and administration in order to evaluate their features and analyze them according to their content, number of downloads and field of application. METHODS: Researchers performed the survey on the two main application stores available on the Internet: iTunes for Apple devices and Google Play for Android devices. Using specific keywords, 47 apps that met the inclusion criteria were identified. RESULTS: Most of the applications were designed for health operators and patient management (76.6%); 12.8% of the apps were focused on the organization and setting of hospital resources, and 10.6% of the apps could help hospital administrators perform self-evaluations of their structures, processes and outcomes. The large majority of apps (80.7%) counted less than 1000 downloads. Most of them (87.5%) were in English and free to download (93.6%). DISCUSSION: The results of the first attempt to provide an overview of this emerging topic showed that, despite the existence of several applications for hospital management purposes, these tools appear to be not very widespread. In our opinion, there is a strong need to further assess the quality of these applications; thus, it may be worth continuing to monitor this field in order to analyze eventual improvements in the design and distribution of these apps.

Cohort study of electronic cigarette use: safety and effectiveness after 4 years of follow-up.

OBJECTIVE: More than a decade after e-cigarette (e-cig) market launch, limited information are available on their safety after 24 months of use. In 2013, we started the first observational study assessing e-cig long-term effectiveness and safety, directly comparing tobacco smokers and e-cig users. Here we report the results after four years of follow-up. PATIENTS AND METHODS: Adults (30-75 years) were included if: smokers of ≥1 tobacco cigarette/day (tobacco smokers); users of any type of e-cig inhaling ≥50 puffs weekly (e-cig users); users of both tobacco and e-cig (dual users). Data were collected by phone and/or internet, and carbon monoxide levels tested in 50% of those declaring tobacco abstinence. Main outcomes were: possibly smoking-related diseases (PSRD; validated through hospital discharge data or visit in 62.6% of the sample); 4-year tobacco abstinence; number of tobacco cigarettes/day. RESULTS: Data were available for 228 e-cig users (all ex-smokers), 471 tobacco smokers, 216 dual users. A PSRD was observed in 73 subjects (8.0%). No differences emerged across groups in PSRD rates, with negligible variations in self-reported health. Of e-cig users, 63.6% remained tobacco abstinent; dual users and tobacco smokers showed non-significantly different rates of tobacco (33.8% vs. 26.8%) and all-product (20.2% vs. 19.4%) cessation, and a similar decrease in cigarettes/day. Almost 40% of the sample switched at least once (tobacco smokers: 17.2%; dual users: 81.9%). CONCLUSIONS: After four years, a scarce, non-significant harm reduction was observed among e-cig or dual users. Given the long-lasting health effects of tobacco smoking, the benefits of e-cig use may start being detectable at the next follow-up (six years). The complete switch to e-cig may help tobacco quitters remain abstinent, but e-cig use in addition to tobacco did not increase the likelihood of smoking cessation or reduction.

Knowledge, attitudes and beliefs towards compulsory vaccination: a systematic review.

Currently, many countries are dealing with groups refusing available recommended vaccinations. Despite several studies having demonstrated the efficacy of mandatory vaccinations in ensuring herd immunity, opposition is widespread. The aim of our study was to systematically review published studies evaluating attitudes towards mandatory vaccination programs. PubMed and Scopus scientific databases were searched and 4,198 results were returned, of these 29 met the inclusion criteria. Twenty-two studies assessed attitudes towards mandatory vaccination programs in general, while 9 papers focused specifically on the Human Papilloma Virus (HPV) vaccine. Most of the studies were performed in Europe and North America. According to the assessed studies, the majority of the population seems to be in favour of compulsory vaccinations, although attitudes differed among studies. The results presented in this review could be an important starting point to further understand the issue of vaccine hesitancy and support the implementation of effective vaccination strategies.

Advertisement of electronic cigarettes in Italy: characteristics of online videos and the most popular promotional messages.

Given the increasing popularity of electronic cigarettes (ECs) and a lack of regulation of EC advertising, this study aimed to analyse online videos promoting ECs to assess the main marketing messages that could influence consumers' perceptions of associated risks and benefits. A web search of EC advertising videos was performed on YouTube by using keywords related to EC promotion. An evaluation grid was used to analyse promotional messages contained in each video. The most frequent promotional messages were related to health benefits (67.7%) and to the possibility of quitting smoking (57.4%). Messages that could also be appealing to adolescents and young adults, such as those promoting the multiple flavors available and the technological improvement of ECs, were present in 41.2% and 42.7% of the videos respectively. ECs similar to traditional cigarettes in appearance were included in 52.9% of the videos. EC promotional videos address messages not only to smokers who want to quit or decrease tobacco consumption but also to nonsmokers, especially young people. The use of ECs similar to traditional cigarettes may be a gateway to tobacco cigarette use. Since EC use may represent an important public health concern, regulatory policies on EC advertising should be established.

Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study.

BACKGROUND: Vaccine hesitancy is a considerable issue in European countries and leads to low coverage rates. After a long debate, Italy has made vaccination mandatory for admission to its schools. METHODS: In the NAVIDAD study (a cross-sectional multicentre study), a 63-item questionnaire was administered to 1820 pregnant women from 15 Italian cities. The questionnaire assessed the interviewee's opinion on mandatory vaccines, as well as their socioeconomic status, sources of information about vaccines, confidence in the Italian National Healthcare Service (NHS), and intention to vaccinate their newborn. RESULTS: Information sources play a key role in determining the opinion on restoration of mandatory vaccines; in particular, women who obtained information from anti-vaccination movements are less likely to accept the vaccines (OR: 0.35, 95% CI: 0.21-0.58, p < 0.001). Women who had confidence in healthcare professional information agreed more on mandatory vaccination than did the other women (OR: 2.66, 95% CI: 1.62-4.36, p < 0.001); those who perceived that healthcare professionals have economic interest in child immunization and who declared that healthcare providers inform only on vaccinations benefits not on risks were less likely to agree on compulsory vaccination (OR: 0.66, CI 95%: 0.46-0.96, p = 0.03; OR: 0.66, CI 95%: 0.46-0.95, p = 0.03, respectively). CONCLUSION: Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. To increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened.

Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis.

The prognostic significance of histological regression in primary melanoma has been debated for many years. We aim to review the evidence to see how histological regression may affect prognosis. A systematic review was performed by searching in MEDLINE, Scopus and the Cochrane Library from 1 January 1966 to 1 August 2015. All studies reporting hazard ratios or data on survival and histological regression were included. Primary random-effects meta-analyses were used to summarize outcome measures. Heterogeneity was assessed using the χ2 -test and I2 -statistic. To assess the potential bias of small studies we used funnel plots and the Begg and Mazumdar adjusted rank correlation method. Summaries of survival outcomes were measured as hazard ratios or relative risk of death at 5 years according to the presence of histological regression of primary melanoma. In total, 183 articles were reviewed out of 1876 retrieved. Ten studies comprising 8557 patients were included. Patients with histological regression had a lower relative risk of death (0·77, 95% confidence interval 0·61-0·97) than those without. Examination of the funnel plot did not provide evidence of publication bias. The results showed that histological regression is a protective factor for survival.

The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials.

OBJECTIVE: Literature shows bibliotherapy can be helpful for moderate depression treatment. The aim of this systematic review is to verify the long-term effects of bibliotherapy. METHODS: After bibliographic research, we included RCTs articles about bibliotherapy programme treatment of depression published in English language between 1990 and July 2017. All RCTs were assessed with Cochrane's Risk of Bias tool. RESULTS: Ten articles (reporting 8 studies involving 1347 subjects) out of 306 retrieved results were included. All studies analyze the effects of bibliotherapy after follow-up periods ranging from 3months to 3years and show quiet good quality in methods and analyses. The treatment was compared to standard treatments or no intervention in all studies. After long-term period follow-ups, six studies, including adults, reported a decrease of depressive symptoms, while four studies including young people did not show significant results. CONCLUSION: Bibliotherapy appears to be effective in the reduction of adults depressive symptoms in the long-term period, providing an affordable prompt treatment that could reduce further medications. The results of the present review suggest that bibliotherapy could play an important role in the treatment of a serious mental health issue. Further studies should be conducted to strengthen the evidence of bibliotherapy's efficacy.

Cross sectional study investigating the differences in knowledge and behaviors about HPV between vaccinated and non-vaccinated girls.

INTRODUCTION: The aim of the presents study was to compare the level of knowledge about Human Papilloma Virus (HPV) in vaccinated and non-vaccinated girls and to highlight the reasons why non-vaccinated girls refuse vaccination. METHODS: A cross-sectional study was conducted from October 2012 to June 2013 in Turin (Piemonte Region, Italy). Questionnaires were administered to girls attending secondary and high schools randomly selected. RESULTS: A total of 576 were compiled. The principle sources of information were parents and health workers. The main reported reasons for non-adherence to vaccination were the disagreement of the parents among the 11-12 years group (45.3%) and the lack of evidence on efficacy among the 18 years group (26.8%). By comparing the level of knowledge there was a statistically significant difference between groups: vaccinated girls reported higher score than the unvaccinated group in several questions (p ≤ 0.05). CONCLUSIONS: Our findings show a lack of information about HPV infection. Parents, school and health care workers have a central role in girl's education and choices about HPV vaccination. The communication campaign for the prevention of cervical cancer must therefore be characterised by messages able to clarify and consolidate messages that may have been partially received or misunderstood.

Pregnancy and internet: sociodemographic and geographic differences in e-health practice. Results from an Italian multicenter study.

OBJECTIVES: Since the new millennium, the number of e-health users has significantly increased. Among these, a particular category of people who are interested by this phenomenon is the one of pregnant women. The aim of the present study is to assess the sociodemographic and geographic differences existing in a sample of Italian pregnant women who search for information on the web. STUDY DESIGN: Multicenter cross-sectional survey. METHODS: The present study has been conducted from November 2011 to September 2012, in seven Italian cities, located in the North, in the Centre and in the South of Italy. Data were collected through an anonymous questionnaire, administered in waiting rooms of outpatient departments by trained medical doctors. Data were analysed through multivariate logistic regression models. RESULTS: Overall, 1347 responders were interviewed. Eighty-six percent of them declared to surf the internet to retrieve pregnancy-related information. The most searched topics were fetal development (51.3%), healthy lifestyle during pregnancy (48.7%), physiology of pregnancy (39.8%), generic and specific tips/advices during pregnancy (37.2%) and lactation (36.8%). Statistically significant differences (P < 0.05) according to geographic origin, age and educational level were found with regard to the most frequently searched information on the Web, the reasons that pushed pregnant women to practice e-health, and the possibility to change lifestyles after e-health. CONCLUSIONS: Our findings suggest that the phenomenon of pregnancy e-health is widespread and show social and geographic differences, in particular about city of residence, age and educational level. It might encourage healthcare professionals to be more available and exhaustive during routine visits and to be more careful about web content on this topic, also addressing the different needs into different geographic contexts.

Systematic review of studies investigating the association between dietary habits and cutaneous malignant melanoma.

OBJECTIVE: Several papers have dealt with diet as a risk factor for cutaneous malignant melanoma (CMM). This study aimed to synthesize available data on the topic. STUDY DESIGN: A systematic review of observational studies assessing the association between dietary habits and CMM was performed. METHODS: Electronic databases were used to identify eligible articles. Quality was assessed through the Newcastle-Ottawa scale. Case-control and cohort studies evaluating the intake of food/nutrients through the assessment of dietary habits and the occurrence of CMM were considered eligible. Data comparing the highest and lowest levels of consumption were collected from single studies and described qualitatively as data combination was not possible. Results were reported as percentages on the basis of relative risks and odds ratios. RESULTS: Eighteen studies reported in 21 articles were selected. Cohort studies showed better quality than case-control studies. Most articles did not detect any significant association between food/nutrient intake and CMM, except for limited evidence of a protective role associated with fish, vegetables and fruit. Risk reduction was shown to be 35-37%, 40-57% and 34-46%, respectively, in studies reporting significant results. Similarly, few articles showed protective roles of beta-carotene and vitamins A, C, D and E, with risk reduction of 64%, 37-43%, 41%, 15-39% and 50-66%, respectively. CONCLUSION: A trend towards reduced risk of CMM associated with higher intake of fish, vegetables and fruit, as well as beta-carotene and vitamins A, C, D and E, has been shown but further research is needed to provide decisive data.

Microbiological contamination of radiological equipment.

BACKGROUND: Important changes have occurred in radiological departments (RDs) over the past 30 years. The procedures have become more complex and the number of patients has increased. This scenario could have important implications for public health and infection control but, to date, the scientific literature has dealt little with matters relating to microbiological monitoring in RDs. PURPOSE: To examine the level of microbiological contamination in the main RDs of Turin, a city in northern Italy, in order to analyze the presence of a possible biological risk. MATERIAL AND METHODS: We analyzed data from 12 RDs. Samples were taken from X-ray tubes, control panels, radiographic cassettes, and imaging plates. We used the French guidelines "Standards NF S 90--351" in order to obtain the threshold values of reference. Through a questionnaire we investigated the use of personal protective equipment by the chiefs of the RDs. RESULTS: We found values out of limits in 41.7% of the X-ray tubes sampled, in 91.7% of the control panels and imaging plates, while only 8% of the radiographic cassettes were contaminated. A total of 58.3% of RDs reported values above the threshold for three out of four samples. In 16.7% of the RDs only one surface presented acceptable values. CONCLUSION: Healthcare-associated infections are a cogent issue for the RDs, and knowledge of how to prevent them is increasingly required by health professionals. This study is meant to be a first analysis of the issue that highlights the need of further investigations, maybe with a more detailed monitoring through the characterization of the microbial species involved. Moreover, the development of shared and maybe official standards for the evaluation of microbiological contamination in RDs is strongly suggested.