Risk perception of heat related disorders on the workplaces: a survey among health and safety representatives from the autonomous province of Trento, Northeastern Italy.

INTRODUCTION: This study will investigate knowledge, attitude and practices towards heat-related health issues in a sample of safety representatives from Northern Italy (H&SRs). METHODS: A cross-sectional questionnaire survey was conducted in 2016-2017 among 298 H&SR. Knowledge status was measured both in general but as well and focusing on first-aid issues. Assessment of risk perception included severity and frequency of heat-related events. Multivariate logistic regression analysis assessed individual and work-related characteristics associated with H&SRs' risk perception. RESULTS: 258 questionnaires were retrieved (participation rate 86.6%; mean age 48.2 ± 8.4 years). Knowledge status was relatively good on technical/preventive issues (62.3% ± 16.8) and first aid measures (72.6% ± 27.2), but a large share of respondents ignored the risk from exertional heat stroke (35.9%), and for heat strokes elicited by non-environmental heat (e.g. machineries, use of protective equipment, etc. 47.9%). The majority of respondents acknowledged the high frequency of extreme events like heat waves (62.0%), but only 44.6% agreed on their potential health threat, with an unsatisfying cumulative risk perception score (55.4% ± 23.5). A specific first-aid formation course was reported by 49.2% of respondents, while 10.9% had any previous interaction with heat-related disorders. Specific countermeasures for heat waves had been put in place by parent company in 20.1% of cases. Eventually, higher educational achievements (mOR 2.239, 95% CI 1.184-4.233) and a better general knowledge status (mOR 1.703, 95% CI 1.073-2.979) were positive predictors for higher risk perception. CONCLUSIONS: Although H&SRs exhibited a good understanding of heat-related health issues, stakeholders should improve the implementation of specific countermeasures on the workplaces.

Knowledge, Attitudes and Practices of Agricultural Workers towards Tetanus Vaccine: a Field Report.

BACKGROUND: Agricultural Workers are both more exposed to tetanus and at higher risk to be inadequately immunized than other usual recipients of the same vaccine. STUDY DESIGN: Our cross-sectional questionnaire-based study aimed to evaluate tetanus vaccination status, knowledge, attitudes and practices in Agricultural Workers in North-Eastern Italy. METHODS: Bivariate and multivariate logistic regression analyses were used to identify, from individual and work-related characteristics, factors significantly associated with appropriate vaccination status. RESULTS: Among 707 participants, 58.4% had an up-to-date immunization status. In 33.1%, last booster was performed by an Emergency Department. The main reason for inadequate immunization was having forgotten the recommended periodic booster (146/707; 20.7%). Attitude towards tetanus vaccination was somehow favourable in 79.5% of participants, and 72.7% correctly identified tetanus vaccination as mandatory for Agricultural Workers. A lower degree of false beliefs and better knowledge of official recommendations were significant predictors of vaccine propensity. The main predictor for an appropriate vaccination status was interaction with a healthcare provider, in general (adjusted Odds Ratio, adjOR 2.516 95%CI 1.707-3.710), and specifically regarding vaccine counseling, (adjOR 6.275 3.184-12.367 and adjOR 9.739 95%CI 3.933-24.111 for general practitioners and occupational physicians, respectively). CONCLUSIONS: Our study enlightens the key role of healthcare providers in recalling and promoting vaccination policies, as well in increasing the general awareness of Agricultural Workers regarding vaccines and official recommendations.

[Autoimmune hepatitis with elevation of CA 19-9 and normalization with immunosuppressant [corrected]treatment: case report and review of the literature]. / Hepatitis autoinmune con elevacion de CA 19-9 y normalización con tratamiento inmunosupresor: reporte de caso y revisión de la literatura.

We describe the case of an 81 year old woman that presented with jaundice, bile duct dilation, hepatic liver tests abnormalities and elevated levels of CA-19-9 (741 UI). Intestinal and pancreatic neoplasia were ruled out. Hepatic biopsy revealed chronic inflammation, cirrhosis and findings consistent with autoimmune hepatitis. The patient was given a course of corticoids and the disease as well as levels of CA-19-9 returned to normal levels.

Hepatitis Autoinmune con elevacion de CA 19-9 y Normalización con tratamiento inmunosupresor: Reporte de Caso y Revisión de La Literatura / Autoimmune hepatitis with elevation of CA 19-9 and Normalization with immunosuppressive treatment: Case Report and Review of Literature

Describimos el caso de una mujer de 82 anos que se presento con ictericia, dilatación de colédoco, alteración de la bioquímica hepática y niveles elevados de CA-19.9 (741 UI). Se descartaron neoplasias pancreáticas e intestinales. La biopsia hepática mostróinflamación crónica, cirrosis y hallazgos consistentes con hepatitis autoinmune. La paciente recibió tratamiento con corticoides y tanto la enfermedad como los niveles de CA -19-9 regresaron a niveles normales.

We describe the case of an 81 year old woman that presented with jaundice, bile ductdilation, hepatic liver tests abnormalities and elevated levels of CA-19-9 (741 UI). Intestinaland pancreatic neoplasia were ruled out. Hepatic biopsy revealed chronic inflammation,cirrhosis and findings consistent with autoimmune hepatitis. The patient was given a courseof corticoids and the disease as well as levels of CA-19-9 returned to normal levels.

Relationship among parameters of lake polluted sediments evaluated by multivariate statistical analysis.

In the attempt to assess the relationship and interdependency among sediment toxic pollutants, in particular heavy metals, polycyclic aromatic hydrocarbons (PAH), and linear alkyl sulfonates (LAS) and some of the sediment typical components: inorganic carbon (IC), organic material (OM) and acid volatile sulphides (AVS), multivariate techniques of statistical analysis have been applied to a set of chemical data obtained by the analysis of the sediments of the Trasimeno Lake, a central Italy lake characterized by a large surface (128 km(2)) and a low mean depth (about 4.5 m). The results of principal component analysis (PCA) show interrelationships between: OM content and PAH, Pb, and Cu concentrations of the sediments, LAS and AVS, and AVS and IC. The effect of the different sampling periods on sediment composition and contamination level, and the clustering of the sampling sites as a consequence of pollutant load are also shown. The principal component bi-plot of the variables and samples indicates that PAH have the greatest influence on the separation of samples in the different sampling periods.

Lack of influence of body exhaust gowns on aerobic bacterial surface counts in a mixed-ventilation operating theatre. A study of 62 hip arthroplasties.

Aerobic bacterial surface contamination was studied with and without the use of body exhaust gowns in an operating room equipped with mixed/turbulent ventilation and separate operating and anaesthetic areas during 62 hip joint arthroplasties. In 31 operations conventional gowns were used, and 31 were performed with body exhaust gowns. Bacterial surface contamination was monitored in the operating and anaesthetic area using 9 cm diameter settle plates (1+1) and nitrocellulose membranes (2+2) transferred after sampling to nutrient pads. Compared with conventional clothing, the use of body exhaust gowns did not significantly reduce the microbial contamination (P=0.1-0.7). On the settle plates 1 m from the patient 279+/-326 cfu/m(2)/h were observed with conventional clothing compared with 142+/-227 cfu/m(2)/h with body exhaust gowns. The first membrane located on the patient in the sterile area detected 250+/-590 cfu/m(2)/h with conventional clothing and 210+/-320 cfu/m(2)/h with exhaust gowns. For the second membrane on the floor, the counts were 1790+/-2700 and 1590+/-1590 cfu/m(2)/h. For all operations the settle plates yielded 210+/-287 cfu/m(2)/h in the operating area and 720+/-564 cfu/m(2)/h in the anaesthetic area (P=0.01). Compared with the membrane placed on the anaesthetic equipment the counts on the membrane placed on patient were also significantly lower (P=0.01) while the membranes placed on the floor in each area showed no difference in counts. In conclusion, compared with conventional clothing, the use of body exhaust gowns could not be proven to provide more protection against microbial contamination. The low number of colony forming units found in the operating area was similar to that expected from an ultraclean laminar airflow unit, although achieved with a cheaper and more energy saving system.

Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study.

The aim of this study was to compare the effect of antihypertensive treatment with valsartan or cavedilol on sexual activity in hypertensive men who were never treated for hypertension. A total of 160 newly diagnosed hypertensive men (diastolic blood pressure [DBP] > or = 95 mm Hg and < 110 mm Hg), aged 40 to 49 years, all married and without any previous sexual disfunction, were enrolled. After a 4-week placebo period, the patients were divided into two groups: a) 120 patients were randomized to receive carvedilol 50 mg once daily or valsartan 80 mg once daily for 16 weeks according to a double-blind, cross-over design; after another 4-week placebo period, patients were crossed over to the alternative regimen for a further 16 weeks; b) 40 patients were treated with placebo according to a single-blind design for 16 weeks. At the screening visit and every 4 weeks thereafter, blood pressure (BP) was evaluated and patients were interviewed by a questionnaire about their sexual activity. Blood pressure was significantly lowered by both treatments, with a 48% of normalization with valsartan and 45% with carvedilol. During the first month of therapy, sexual activity (assessed as number of sexual intercourse episodes per month) declined with both drugs as compared with baseline, although the decrease was statistically significant in the carvedilol (from 8.2 to 4.4 sexual intercourse episodes, P < .01) but not in the valsartan-treated patients (from 8.3 to 6.6 sexual intercourse episodes, not significant). Ongoing with the treatment the sexual activity further worsened with carvedilol (3.7 sexual intercourse episodes per month) while fully recovered and also improved with valsartan (10.2 sexual intercourse episodes per month). The results were confirmed by the cross-over. Erectile dysfunction was a complaint of 15 patients with carvedilol (13.5%), one patient with valsartan (0.9%), and one patient in the placebo group. These findings suggest that carvedilol induces a chronic worsening of sexual activity, whereas valsartan not only does not significantly worsen sexual activity but may even improve it.

Comparative efficiency of nitrocellulose membranes versus RODAC plates in microbial sampling on surfaces.

The efficiency of nitrocelluose membranes in collecting microbial samples from rigid and flat surfaces has been studied and compared with that of RODAC plates. The experimental design was based on multiple samplings in close succession in the same place. The median efficiency of membrane filters (78.55) was higher than that of RODAC plates (65.37). The data demonstrate the reliability of membranes and show that membranes are more efficient than RODAC plates as a sampling method for measuring surface microbial contamination.

Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study.

To evaluate the effect of antihypertensive treatment on sexual activity, 90 hypertensive men, aged 40 to 49 years, all married and without history of sexual dysfunction were treated with 100 mg of atenolol or 20 mg of lisinopril for 16 weeks, according to a double-blind, randomized, cross-over design. During the first month of therapy, sexual activity, assessed as number of sexual intercourse episodes per month, significantly declined with both atenolol (from 7.8 +/- 4.3 to 4.5 +/- 2.8, P < .01 v placebo) and lisinopril (from 7.1 +/- 4.0 to 5.0 +/- 2.5, P < .05 v placebo). Ongoing with the treatment, sexual activity tended toward recovery in the lisinopril (7.7 +/- 4.0 sexual intercourse episodes per month, P = NS v placebo), but not in the atenolol group (4.2 +/- 2.8, P < .01 v placebo), with a statistically significant difference between the two drugs (P < .01). The percentage of patients who complained of sexual dysfunction symptoms was significantly higher in the atenolol- than in the lisinopril-treated group (17% v 3%, P < .05). These findings suggest that atenolol induces a chronic worsening of sexual activity, whereas lisinopril causes only a temporary decline.

Should vein be saved for future operations? A 15-year review of infrainguinal bypasses and the subsequent need for autogenous vein.

The decision to use prosthetic or autogenous vein as the initial conduit for first-time vascular bypass of the lower extremity depends in part on the likelihood of subsequent need for autogenous conduit for another leg or heart bypass. The true frequency of these later events is not known. To answer this question, we analyzed a database of infrainguinal and coronary artery bypasses (CABG) performed at one institution between January 1980 and July 1995, to determine how many patients required subsequent infrainguinal bypass or CABG after their initial leg bypass. Five hundred and seventy-two infrainguinal bypasses were performed on 440 patients (mean age 63.9); average follow-up was 5.6 years. The clinical philosophy favored autogenous vein for first bypass, which was used in 84% of first operations performed during the study period while prosthetic material was used in 16%. For patients in which vein was used for the first operation, and who went on to have a second operation, the use of prosthetic conduit rose from 16% of operations to 27% (p < 0.05). The rate of subsequent CABG after leg bypass was very low, 2% at 5 years, 3% at 10 years. The cumulative probability of requiring a subsequent infrainguinal bypass was 27% at 5 years, 32% at 10 years. Of these, 46% were ipsilateral and 54% were contralateral. Considering only subsequent tibial bypasses (where vein might be considered obligatory), the cumulative 5-year rate of subsequent leg bypass was only 13%. Another bypass was most likely to occur within the first 3 years, rarely thereafter. In summary, after primary infrainguinal bypass, additional procedures using vein may arise in 1/4 to 1/3 of patients, mostly in the first 3 years. However, only 13% will definitely need vein for tibial bypass in 5 years, and subsequent CABG is uncommon.

A short, stereoselective synthesis of (3R,4R)-4-acetoxy-3-[(R)-1'((t-butyldimethylsilyl)oxy)ethyl]-2-azetidin one, key intermediate for the preparation of carbapenem antibiotics.

A short stereoselective synthesis of the acetoxy azetidinone (1), an important precursor of several biologically active beta-lactam antibiotics, has been accomplished in seven steps and 32.8% overall yield from the easily available and inexpensive (R) ethyl 3-hydroxybutanoate.

The limits of generalized cardiac screening tests for predicting cardiac complications after infrainguinal arterial reconstruction.

We examined the relative efficacies of different cardiac screening strategies for infrainguinal arterial bypass. The outcomes of 205 elective leg bypass procedures over a 10-year period, including myocardial infarction (MI), total cardiac complications, and mortality were tallied. Clinical risk factors popularized by Goldman and Eagle, and the results of dipyridamole thallium myocardial imaging (DThal) were recorded. The overall mortality rate was 3.4%, with a 3.4% incidence of MI and a 5.4% total cardiac complication rate. Both abnormal DThal (p = 0.011) and Goldman class II-IV (p = 0.030) were significant predictors of MI and cardiac death, but both suffered from poor specificity and positive predictive value. Because logistic regression analysis identified a correlation between angina, CHF, and an abnormal DThal, a customized screening strategy was developed to include the presence of angina, CHF and an abnormal DThal. Eighty-eight percent of patients suffering MI or death met these criteria, while only 11% of the complication-free group did. This screening strategy provided a superior sensitivity of 88%, specificity of 89%, positive predictive value of 25%, and 99% negative predictive value. A customized screening strategy (angina, CHF, abnormal DThal), developed from a 10-year experience with a single patient group, provided better predictive accuracy than any generalized screening formula.

Prevention of arterial thrombosis using a novel heparin with enhanced antiplatelet activity and reduced anticoagulant activity.

PURPOSE: Thrombosis after arterial injury is often initiated by von Willebrand factor (vWF)-dependent platelet accumulation. A promising antithrombotic strategy is the interruption of platelet/vWF interactions. Previously, we demonstrated how chemical and affinity modification can enhance heparin's anti-vWF activity while reducing conventional anticoagulation. Here, we investigated whether a modified heparin can block platelet-dominated arterial thrombosis. METHODS: Standard heparin was oxidized with periodate, refined to have high vWF affinity and inhibitory potency, and tested in a guinea pig model of platelet-dependent arterial thrombosis. In this model, a controlled mechanical arterial injury yields cyclic flow variations (CFVs) caused by recurrent accumulation of platelet thrombi. RESULTS: All six control animals developed CFVs (mean, 10.4 +/- 2.6 CFVs), and six of seven animals treated with standard heparin also developed CFVs (mean, 7.6 +/- 4.6). Only one of six animals treated with the anti-vWF heparin and one of six treated with AJvW-2 (an anti-vWF antibody) developed CFVs (mean, 2.0 +/- 4.9 and 0.5 +/- 1.2, respectively). Thus both the modified heparin and AJvW-2 were more effective than standard heparin (p < 0.03). Bleeding times and platelet counts were unaffected. A modified activated partial thromboplastin time was less prolonged by the modified high-affinity heparin (91 +/- 17) seconds) than by standard heparin (144 +/- 30 seconds; p < 0.01). CONCLUSIONS: The modified heparin with high vWF affinity was a more effective arterial antithrombotic agent, with fewer conventional anticoagulant effects than standard heparin. Interruption of the vWF/platelet interaction is a promising antithrombotic strategy that may be met by novel heparin-based antithrombotic drugs.

Structural aspects of heparin responsible for interactions with von Willebrand factor.

Unfractionated heparin (UFH) binds von Willebrand factor (vWF) and inhibits the vWF-platelet GP Ib interaction. For vWF, a heparin-binding domain has been identified, but for heparin, the structures that confer such activity are unknown. To investigate this, UFH was depolymerized by methods that yield structurally distinct fragments. The glycosaminoglycans (GAGs) produced were separated into five groups of homogeneous molecular weight (MW). Anti-Xa activity, vWF binding affinity, and vWF-dependent platelet agglutination were measured. Periodate oxidation but not heparinase digestion destroyed anti-Xa activity. At all MWs, periodate conferred greater vWF binding affinity and greater ability to inhibit platelet agglutination than heparinase. As an example, at MW 6100, the binding IC50 was 100+/-19 micromol/L for a periodate-derived GAG and 527+/-70 micromol/L for a heparinase-derived GAG. At the same MW, the agglutination IC50 was 17+/-5 micromol/L for periodate and 135+/-18 micromol/L for heparinase. This suggests that the disaccharide GlcNS[6S]-IdoA2S, destroyed by heparinase but not periodate, is crucial to heparin-vWF interactions. An MW dependency was also noted, with a minimum dodecasaccharide required for activity inhibition. To further investigate the heparin/vWF interaction, affinity fractionation of heparins was performed with an immobilized peptide derived from a heparin-binding domain of vWF. Disaccharide analysis of high-affinity heparins revealed an increased ratio of IdoA2S-GlcN[S/Ac]6S to IdoA2S-GlcN[S/Ac]. Affinity fractionation of oligosaccharides (MW 3500) diminished the relative content of all disaccharides except IdoA2S-GlcNS6S, which was increased. These data suggest that the disaccharide structures IdoA2S-GlcNS6S and GlcNS6S-IdoA2S are crucial to heparin/vWF interactions. Understanding the structural aspects that confer such activity may be useful in designing heparin-based antithrombotic drugs.

Repeated office blood pressure controls reduce the prevalence of white-coat hypertension and detect a group of white-coat normotensive patients.

BACKGROUND: The aim of this study was to evaluate whether repeated office blood pressure controls may change the prevalence of white-coat hypertension among hypertensive patients. METHODS: We studied 221 newly diagnosed, never-treated hypertensive patients, all men, aged 31-60 years. On the first visit, they underwent sitting blood pressure measurements (two readings were taken by mercury sphygmomanometer and averaged) and non-invasive 24 h ambulatory blood pressure monitoring (ABPM) every 15 min. Thereafter, each patient made four further visits over an 8-week period. On each visit, three sitting readings were taken and averaged. On the last visit, ABPM was performed again. Subjects who had hypertension in the clinic but whose daytime ambulatory blood pressure was less than 134/90 mmHg were considered to have white-coat hypertension. RESULTS: On the first visit, all patients were, by definition, clinically hypertensive and ABPM detected a prevalence of white-coat hypertension of 25.8%. On the following visits, the prevalence of clinical hypertensive patients progressively declined; on the last visit, the 82.3% of all patients resulted yet clinical hypertensive: on ambulatory blood pressure 71.9% were sustained hypertensives, whereas 10.4 had white-coat hypertension. Of the patients originally labelled as hypertensive, 17.7% proved to be clinically normotensive: 13.6% had also daytime ambulatory blood pressure in the normal range, whereas 4.1% showed elevated blood pressure during daytime ABPM (white-coat normotensives). CONCLUSION: These data suggest that repeated office blood pressure controls in newly diagnosed hypertensives reduce the number of office hypertensive patients, reduce the number of white-coat hypertensive patients and detect a small group of white-coat normotensive patients.

Evaluation by 24-hour ambulatory blood pressure monitoring of efficacy of manidipine hydrochloride 10, 20 or 40 mg once daily as compared to placebo in treating mild to moderate essential hypertension: a double-blind, randomized, parallel group, placebo-controlled study.

In a double-blind, randomized, placebo-controlled, parallel-group study the ambulatory blood pressure monitoring (ABPM) and relative tolerability of different doses of manidipine hydrochloride (10, 20 and 40 mg) were compared to placebo in patients with mild to moderate essential hypertension. After an initial 2-week run-in period on placebo, 52 patients, 32 males and 20 females, aged 40 to 63 years, were randomized to receive manidipine 10 mg, 20 mg, 40 mg or placebo, all administered once daily for 4 weeks. Patients were checked after the initial placebo phase and every 2 weeks thereafter. At each visit, casual BP and HR were measured. At the end of the placebo period and after 4 weeks of active treatment, non-invasive 24-h ABPM was performed. 24-h, day-time and night-time ambulatory BP as well as the area under the curve (AUC) and casual BP were dose-dependently reduced by manidipine 10, 20 and 40 mg, without changes in the normal BP circadian profile. The trough:peak ratio for both SBP and DBP was higher than 50% for all three manidipine dosage regimens. The percentage of abnormal ambulatory SBP and DBP readings was significantly reduced in all manidipine-treated groups versus placebo. The risk/benefit ratio suggests that the intermediate manidipine dosage (20 mg) could be a suitable dose regimen for the majority of patients with mild to moderate hypertension.

Left ventricular anatomy and function in normotensive young adults with hypertensive parents. Study at rest and during handgrip.

Using digitized M-mode echocardiograms, we evaluated left ventricular (LV) anatomy and function at rest and during handgrip in 24 normotensive young adults with both parents hypertensive (HP+), each matched for age, sex, body weight, and body surface area with one normotensive adult with both parents normotensive (HP-). LV parameters were within the normal range in all HP+ and HP-. At rest, HP+ as compared to HP- had higher systolic and diastolic blood pressure (BP), septal and posterior wall thickness, and LV mass; LV diastolic diameter and end-systolic wall stress were similar in the two groups. Modified midwall fractional shortening, peak shortening rate of LV diameter and peak thickening rate of LV posterior wall, indices of LV systolic function, and peak lengthening rate of LV diameter and peak thinning rate of LV posterior wall, indices of ventricular relaxation, were significantly higher in HP+. Handgrip induced significant (P < .001) and percent-comparable increases of systolic and diastolic BP, heart rate, and cardiac output in HP+ and HP-; peak shortening and lengthening rates of LV diameter and peak thickening and thinning rates of LV posterior wall increased significantly in HP-, whereas in HP+ the value of the four parameters, higher at rest as compared to HP-, did not show any further increase. In conclusion, normotensive young adults with high genetic risk for hypertension have higher BP and thicker and overactive LV as compared to subjects with normotensive parents. Handgrip stimulates LV function in offspring of normotensives, but not the already hyperkinetic LV of hypertensive offspring.

[Effectiveness of ketanserin in the treatment of light-to-moderate arterial hypertension]. / Efficacia della ketanserina nel trattamento dell'ipertensione arteriosa lieve-moderata.

The above study was undertaken in order to demonstrate the efficacy of ketanserin in mild to moderate essential arterial hypertension. Twenty-two patients, mean age 49.7 yrs., were studied during 36 months. After a 15-day washout period with clinical and instrumental assessment of basal conditions, treatment with 40 mg ketanserin every 12 hrs. was started. Pressure, blood chemistry and instrumental investigation were carried out systematically and showed the hypotensive action of ketanserin as well as a significant (about 12%) rise in HDL-cholesterol.