The role of the nursing coordinator and the leadership style in the Italian healthcare organizations.

BACKGROUND AND AIM: The leadership of the Nursing Coordinator is essential to ensure quality care and to empower the nursing staff. To identify the leadership style used by the coordinator as nurses and the support staff perceive the leadership behaviors of the coordinator. METHODS: Data were collected through an online questionnaire including the Empowering Leadership Questionnaire. RESULTS: Positive associations were recorded between participants' satisfaction levels and high standards of job performance (p<0.001), being a good example for the whole group (p=0.004) and to encourage sharing ideas and suggestions (p=0.003), hearing ideas and suggestions (p=0.013), giving the opportunity to express their opinions (p=0.046); in the "Coaching" dimension, according to attitudes to help the group to become aware (p<0.001), among all group members (p=0.044); by focusing on their goals (p<0.001); in the "Informing" dimension according to levels and attitudes to explain decisions (p<0.017) and rules and expectations (p=0.046); in the "Showing Concern/Interacting with the Team" dimension according to attitude in personal problems (p<0.028); to discuss concerns (p=0.033); to show interest (p<0.040) and to chat with members (p=0.003). Negative association was registered between the ability to make decisions based solely on the coordinator's ideas (p=0.010), ability to pay attention to the group's efforts (p<0.015). CONCLUSIONS: The role of the Nursing Coordinator within the work setting is very fundamental. The latter must be able to guarantee, through good leadership, a serene work environment so that professionals can provide optimal care to patients and safeguard their profession.

Breast Cancer Prevention: The Key Role of Population Screening, Breast Self-Examination (BSE) and Technological Tools. Survey of Italian Women.

Breast cancer is the most common tumor among women worldwide and still remains the leading cause of death in women in Italy. Although survival from this pathology has increased, this disease and its treatment can have lasting or delayed effects that can greatly affect a woman's quality of life. Primary and secondary prevention are currently the best strategies to combat this cancer: improved lifestyle, early adherence to screening, Breast Self-Examination (BSE), and even now the use of technology, have become among the most important tools to ensure increasingly early diagnosis of this disease, which is a major cause of suffering and premature mortality in women. Indeed, early diagnosis of the disease can lead to a good prognosis and a high survival rate. This study investigates the attitude of Italian women to perform clinical checkups aimed at cancer prevention, particularly adherence to free screening programs offered by the National Health Service (NHS) for women in the 50-69 age group. The knowledge, use and emotional approach toward BSE as a screening tool and the use of dedicated apps for this purpose are also investigated. Low adherence to screening programs, lack of BSE practice, and nonuse of dedicated apps are just some of the results observed in this study. Therefore, it becomes essential to spread the culture of prevention, cancer awareness and the importance of screening throughout life.

Clinical Features of Takotsubo Syndrome and Its Differential Diagnostic Criteria in Clinical Nursing Practice: A Review of the Literature.

PURPOSE OF REVIEW: Takotsubo cardiomyopathy (TCM) is a heart disease that mimics the symptoms of a myocardial infarction (MI). The exact cause of TCM is unknown, but the main theory is that the syndrome is triggered by an excessive release of catecholamines, a consequence of factors related to stress or severe emotional distress. The aim of this review is to summarize the various scientific journal articles on the nursing differential diagnosis of TCM, on the specific nurse training (particularly the role of the Advanced Practice Nurse, APN), and on the nursing educational support for the patient after hospital discharge. RECENT FINDINGS: A literature review was conducted on Medline (via PubMed), Web of Science (WoS), Scopus, and Google Scholar databases. Relevant indexed articles that investigated the elements characterizing TCM in nursing differential diagnosis and the role of the APN were identified. RESULTS: Sixteen studies were included in the review; they highlighted the role of the nurse in identifying and educating patients with TCM. Nurses must have a thorough understanding of the syndrome, the onset symptoms, the unusual characteristics, and the probable etiology of TCM in order to recognize and promptly treat patients affected by this syndrome and have the opportunity to educate them after hospital discharge to reduce the possibility of recurrence.

Transcultural Nursing in Italy: An Explorative Study.

The health profile of foreigners in Italy is affected by multiple factors and events, including environmental, microbiological, cultural, and behavioral. To explore nurses' basic cross-cultural knowledge, and their perceptions of problems that arise in encounters with clients from outside the country, and to suggest solution strategies, we enrolled 327 nurses in an observational, cross-sectional, multicenter study. The findings suggested a need to improve sociocultural skills related to working in a multiethnic society, as early as the first level courses and possibly continue with appropriate master's degrees and research projects.

Corrigendum: Characterization of the "gut microbiota-immunity axis" and microbial lipid metabolites in atrophic and potential celiac disease.

[This corrects the article DOI: 10.3389/fmicb.2022.886008.].

How knowledge time influenced anxiety, depression, stress and quality of life levels in patients suffering from Crohn disease: a cross-sectional multicenter study.

BACKGROUND AND AIM OF THE WORK: The diagnosis of Crohn Disease (CD) represents a turning point in the life of patients, which inevitably marks them. The present study represents a direct "feed-back" from patients suffering from Crohn disease, in order to reveal how the diagnosis of CD changed lifestyles and psychological conditions in their patients. METHODS: An observational, cross sectional, online, snowball sampling study was conducted through participants suffered from CD and belonged to social networks and Facebook groups. For each participant, sampling characteristics, a series of lifestyle habits Before to After the diagnosis of CD and anxiety, depression, and stress conditions were investigated. RESULTS: A total of 785 participants agreed to participate. As Participants underwent significant challenges in their lifestyles after the CD diagnosis (p<0.001), specifically their reduced their smoking habits, alcohol and drugs intakes and also their diets both in high sugar and fatty compositions. Anxiety and stress levels were not statistical different among participants according to years of the knowledge of their CDs. Meanwhile, as regards depression condition, significantly higher levels were recorded among participants who knew their CD until 5 and 25 years, respectively (p=0.031). CONCLUSIONS: From the study emerges several aspects of quality of life compromised, a fact supported by the analysis of psychophysical sequelae, which allowed to lay the groundwork for further studies, studying the comorbidity of this disease with other factors. Future randomized controlled trials should deepen the correlation between eating disorders and CD, a link little explored in the literature.

Diagnostic delay in adult coeliac disease: An Italian multicentre study.

BACKGROUND: There are few data regarding the diagnostic delay and its predisposing factors in coeliac disease (CD). AIMS: To investigate the overall, the patient-dependant, and the physician-dependant diagnostic delays in CD. METHODS: CD adult patients were retrospectively enroled at 19 Italian CD outpatient clinics (2011-2021). Overall, patient-dependant, and physician-dependant diagnostic delays were assessed. Extreme diagnostic, i.e., lying above the third quartile of our population, was also analysed. Multivariable regression models for factors affecting the delay were fitted. RESULTS: Overall, 2362 CD patients (median age at diagnosis 38 years, IQR 27-46; M:F ratio=1:3) were included. The median overall diagnostic delay was 8 months (IQR 5-14), while patient- and physician-dependant delays were 3 (IQR 2-6) and 4 (IQR 2-6) months, respectively. Previous misdiagnosis was associated with greater physician-dependant (1.076, p = 0.005) and overall (0.659, p = 0.001) diagnostic delays. Neurological symptoms (odds ratio 2.311, p = 0.005) and a previous misdiagnosis (coefficient 9.807, p = 0.000) were associated with a greater extreme physician-dependant delay. Gastrointestinal symptoms (OR 1.880, p = 0.004), neurological symptoms (OR 2.313, p = 0.042), and previous misdiagnosis (OR 4.265, p = 0.000) were associated with increased extreme overall diagnostic delay. CONCLUSION: We identified some factors that hamper CD diagnosis. A proper screening strategy for CD should be implemented.

Gambling and internet addiction: a pilot study among a Population of Italian Healthcare : Gambling and Internet Addition in a Healthcare Group.

AIM: Measuring the phenomenon of gambling and Internet addiction, with analysis of attitudes and psychophysical consequences among nurses working in different care settings. METHODS: An observational, cross sectional, multicenter study was conducted from April to September 2020. Participants' socio-demographic information, the "Internet Addiction Test" (IAT) scale, and the "South Oaks Gambling Screen" (SOGS) were collected in order to assess the overuse of and whether an individual has a problematic relationship with gambling, respectively. RESULTS: 502 nurses were enrolled in the study. Significant correlations were found (p < .001) between the IAT score and gender, number of years of work experience, job role, educational qualification; and between the SOGS and gender, number of years of work experience, job role and regions of Italy. CONCLUSIONS: The study highlighted an emerging social problem, and the results may be just the tip of the iceberg. Given the lack of knowledge of these phenomena and a high percentage of people who suffer from them but are afraid to admit it and get help, this study could also be useful in expanding knowledge and allow more professionals to get help and learn about possible treatments and cures for the resolution of these addictions.

Acute myocardium infarction: difficulties and interventions perceived by Italian nurses and physicians.

BACKGROUND: Among cardiovascular diseases, acute coronary syndrome is the main cause of mortality and morbidity in the Western industrialized countries. Evidence suggested how continuous updating in cardiovascular area both for nurses and physicians was essential to improve patient outcomes in clinical process, welfare and rehabilitation, since physicians and nurses could play a key role in empowering the care of patients affected by the acute myocardium infarction (AMI). Although the correlation between continuous training and improvement of nursing care was therefore clear, the difficulties that nurses encountered in AMI patients' management remained unexplored. The present study aimed to identify any difficulties that both nurses and physicians in emergency/urgent departments encountered in the AMI patient care. METHODS: An observational, cross sectional, multicenter online study was conducted, in online mode. An ad hoc questionnaire was created and publicized through social networks, collecting only nurses and physicians. RESULTS: A total of 401 nurses and physicians were recruited. Significant association was assessed between the importance of the re-training participation and the item regarding: "To implement strategies to avoid excessive patient stress," since healthcare workers who constantly re-trained their competences encountered less difficulties than the others (P=0.002). By considering associations between the re-training condition and any interventions implemented by the interviewer to prevent or reduce the psycho-physical stress in AMI patients, a significant association (P=0.017) was assessed between the re-training condition and the improvement of the sleep-rest model (item no. 20), since healthcare professionals who re-trained their competences in the AMI care promoted regular rest condition in the AMI patients. CONCLUSIONS: The study highlighted the importance of basic and advanced training both for physicians and nurses in the AMI patient care, by demonstrating how health promotion and therapeutic education and information could be important to the AMI patient care.

Which socio-demographic patterns influence nursing managers' empowerment perceptions among nurses? An investigatory study.

AIM OF THE WORK: Nurses were the most numerous healthcare workers employed in the current Italian healthcare systems. By considering them the driving force of the healthcare systems, the present study aimed to investigate which socio-demographic characteristics in nurses could influence empowerment promoted by their managers, by understanding what socio-demographic characteristics influenced the nursing manager empowerment and could help nursing managers to perform their empowerment approaches by highlighting strengths or weaknesses. METHODS: An on-line, observational, multicenter, cross- sectional study was conducted by recruiting a total of 126 nurses. RESULTS: Negative and significant correlations and associations were recorded between all the Empowering Leadership Questionnaire sub dimensions and age (p<.05). Data reported linear and significant associations between all the five sub dimensions of the ELQ and age (p<.05), as younger nurses more perceived their nursing managers' empowerment presence than their older colleagues, too. CONCLUSIONS: Empowerment is a very complex topic in the nursing practice in which managers should be aware of the role of empowerment in promoting work engagement and effectiveness and differential effects on new graduates and more experienced nurses.

Transcultural health: attitudes, perceptions, knowledge of Italian nurses. An observational study.

BACKGROUND AND AIM OF THE WORK: The Italian health profile of foreigners depends from several factors and events, such as: environmental, microbiological, cultural and / or behavioral. Healthcare professionals might to have greater and better basic and post-basic training in approaching foreign users. Listening and empathy, with complementary training can help to reduce distances and better understand the patient's socio-cultural background. The aim of the study is to explore the basic intercultural knowledge of the Italian nurses, the perception of the problems encountered during the interaction with foreign users and any solution strategies. METHODS: From December 2020 to March 2021 a national observational study was conducted by involving 327 nurses. RESULTS: 85.5% among participants were females and most of them aged between 20 and 30 years (20.20%) and were employed in medical wards (22.60%). Among the hindering barriers explored, linguistic ones are highlighted (41.30%), specifically for the description of hospital rules (34.90%) and of social and health regulations (34.90%). CONCLUSIONS: From the present findings, it emerges that the cultural competence of nurses could be developed by offering a multicultural education through basic and post-basic courses. (www.actabiomedica.it).

Characterization of the "gut microbiota-immunity axis" and microbial lipid metabolites in atrophic and potential celiac disease.

Introduction: Potential celiac disease (pCD) is characterized by genetic predisposition, positive anti-endomysial and anti-tissue transglutaminase antibodies, but a normal or almost normal jejunal mucosa (e.g., minor histological abnormalities without villous atrophy). To gain further insights into basic mechanisms involved in the development of intestinal villous atrophy, we evaluated and compared the microbial, lipid, and immunological signatures of pCD and atrophic CD (aCD). Materials and methods: This study included 17 aCD patients, 10 pCD patients, and 12 healthy controls (HC). Serum samples from all participants were collected to analyze free fatty acids (FFAs). Duodenal mucosa samples of aCD and pCD patients were taken to evaluate histology, tissue microbiota composition, and mucosal immune response. Results: We found no significant differences in the mucosa-associated microbiota composition of pCD and aCD patients. On the other hand, in pCD patients, the overall abundance of serum FFAs showed relevant and significant differences in comparison with aCD patients and HC. In detail, compared to HC, pCD patients displayed higher levels of propionic, butyric, valeric, 2-ethylhexanoic, tetradecanoic, hexadecanoic, and octadecanoic acids. Instead, aCD patients showed increased levels of propionic, isohexanoic, and 2-ethylhexanoic acids, and a lower abundance of isovaleric and 2-methylbutyricacids when compared to HC. In addition, compared to aCD patients, pCD patients showed a higher abundance of isobutyric and octadecanoic acid. Finally, the immunological analysis of duodenal biopsy revealed a lower percentage of CD4+ T lymphocytes in pCD infiltrate compared to that observed in aCD patients. The functional characterization of T cells documented a pro-inflammatory immune response in both aCD and pCD patients, but the pCD patients showed a higher percentage of Th0/Th17 and a lower percentage of Th1/Th17. Conclusion: The results of the present study show, for the first time, that the duodenal microbiota of patients with pCD does not differ substantially from that of aCD; however, serum FFAs and local T cells displayed a distinctive profile between pCD, aCD, and HC. In conclusion, our result may help to shed new light on the "gut microbiota-immunity axis," lipid metabolites, and duodenal immune response in overt CD and pCD patients, opening new paradigms in understanding the pathogenesis behind CD progression.

Autism Spectrum Disorders and inclusion attitudes in the Italian school environments: teachers' knowledge, attitudes, perceptions and their necessity to consult a healthcare multidisciplinary team.

BACKGROUND: Schools play a key role in detecting early signs of autism and creating a targeted pathway of study and inclusion. This becomes complicated when faced with unknown situations, such as managing a student with Autism Spectrum Disorders (ASD). MATERIALS AND METHODS: A nationwide study involving teachers (n=235) was conducted from March to August 2021. The survey instrument consisted of a questionnaire administered online through social networks containing socio-demographic data, attitudes, knowledge and inclusion plans from school teachers towards students with ASD. RESULTS: Statistical significant differences were registered for the item no.13: among the main deficits caused by ADS are reduced social cognition, language abnormalities, and impaired sensory functioning. (p=.025); the item no.8 (p=.011): if an intervention works for one child with ASD, it is certain to work on another child with ASD; the item no.3(p=.002): genetic factors play an important role in the causes of ASD. By also considering teacher's attitudes towards ASD according to the presence of a healthcare worker in the school environment, significant differences were registered for the item no.1 (p=.032): the interpretation that the diagnostic criteria for Asperger's syndrome are the same as for high-functioning autism; the item no.6 (p=.025): children with ADS are very similar to each other, and the item no.7(p=.015): early intervention does not lead to additional benefits for children with ASD. CONCLUSIONS: The presence of professionals with advanced skills could be a benefit and represent a strong point in the application of measures of prevention and containment of community pathologies.

Correlations between performance and shift work in the nursing activities: a pilot approach.

BACKGROUND AND AIM OF THE WORK: Performance assessment is a key administrative function and an essential component of organizational quality programs, by quantifying it in relation to set goals, standards, expectations and guides to improvement initiatives. The present study aimed to correlate the nursing performance levels perceived by the nurses themselves with the levels of organizational well-being.  Methods. An on-line questionnaire was administered to Italian nurses in order to assess nursing performance, thanks to the Six-Dimension on Nursing performance questionnaire and also the wll-being of nursing organization was explored thanks to the Questionnaire on nursing organization- brief form questionnaire (QISO brief form). RESULTS: Significant correlations were assessed between the nursing performance sub dimensions on frequency sub scale and each sub-dimensions of the well-being questionnaire (p<.001). Also in Teaching/Collaboration sub-dimension of the quality nursing performance sub scale, positive correlations were recorded with the QISO brief form. CONCLUSIONS: Findings were in agreement with the little current literature on this topic, as: the nursing sector might implement reforms and instill an organizational culture in which staff feel they own their profession and will be intimately involved in the vision and mission of their organizations. To help achieve this and improve health services, nurses' organizational engagement enhancement policies should be implemented as an organizational issue requiring the development of strategies for recruiting, attracting and retaining engaged nurses.

A New Berlin Questionnaire Simplified by Machine Learning Techniques in a Population of Italian Healthcare Workers to Highlight the Suspicion of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) syndrome is a condition characterized by the presence of repeated complete or partial collapse of the upper airways during sleep associated with episodes of intermittent hypoxia, leading to fragmentation of sleep, sympathetic nervous system activation, and oxidative stress. To date, one of the major aims of research is to find out a simplified non-invasive screening system for this still underdiagnosed disease. The Berlin questionnaire (BQ) is the most widely used questionnaire for OSA and is a beneficial screening tool devised to select subjects with a high likelihood of having OSA. We administered the original ten-question Berlin questionnaire, enriched with a set of questions purposely prepared by our team and completing the socio-demographic, clinical, and anamnestic picture, to a sample of Italian professional nurses in order to investigate the possible impact of OSA disease on healthcare systems. According to the Berlin questionnaire, respondents were categorized as high-risk and low-risk of having OSA. For both risk groups, baseline characteristics, work information, clinical factors, and symptoms were assessed. Anthropometric data, work information, health status, and symptoms were significantly different between OSA high-risk and low-risk groups. Through supervised feature selection and Machine Learning, we also reduced the original BQ to a very limited set of items which seem capable of reproducing the outcome of the full BQ: this reduced group of questions may be useful to determine the risk of sleep apnea in screening cases where questionnaire compilation time must be kept as short as possible.

The satisfaction level perceived by Italians during the first phase of the Covid-19 pandemic phase.

Aim of the work.  To survey the degree of satisfaction of the Italian population in reference to the health care provided throughout the national territory in the period of emergency COVID-19. METHODS: Observational, cross sectional, multicenter study conducted during the first phase of the pandemic (May-June 2020) involving the national population (n=889) subjects, through an online survey. RESULTS: 889 people participated in the study. Among the perceptions regarding the level of satisfaction with the care received during the first pandemic wave, significant differences were found in the level of satisfaction with the health care received in general (p=.049), the degree of satisfaction toward the health care to people admitted to the hospital (p=. 046), to the treatment received for the COVID-19 test (p=.002), to the difficulty of contacting the general practitioner (.032), to the treatment received by their own health care company (p=.006), to the treatment received by the toll-free number (p<.001) and the 1500 number (p<.001) and the treatment received for one's own relative (p<.001). The greatest difficulty for all detected was finding surgical masks to protect themselves from infection. CONCLUSIONS: The COVID-19 pandemic seems not to have created new problems, rather it has shown - in a violent way - many of the challenges that have been looming for some time in the health services (and not only the Italian one) and, for these reasons, it is necessary to start from what has been learned in the last few months and draw new guidelines for the future.

Communicating bad news: attitudes and modes of communication of the health professions.

SUMMARY: TBackground. Information regarding ominous prognoses, which may cause concern and distress, should be provided carefully and cautiously, using non-traumatizing terminology, accommodating the patient's fears, and not excluding elements of hope. Goal. To analyze the difficulties of health care providers in the process of communicating bad news. Materials and Methods. An observational, cross-sectional, multicenter study was conducted from March to August 2021 among Italian Physicians and Nurses. Results. The results of the study indicate a greater participation of Nurse practitioners than Physicians, a fact that may indicate how necessary it is, to overcome the belief that the communication of bad news is of exclusive medical relevance. Among the participants in the study, about half, equal to 46.7% stated that they had no specific training, while the remainder claimed to have attended master's or higher education courses in 8.5% of cases, 23% attended conferences, while 21.8% acquired their skills through work experience. Conclusions. The communication of bad news, needs to be recognized in the same way as those procedures that characterize care itself, and for which the highest possible quality is sought.

The psychological impact of the Coronavirus emergency on physicians and nurses: an Italian observational study.

BACKGROUND: The Coronavirus has put a strain on the response capacity of health systems and there are various psychological effects on health workers. AIM OF THE STUDY: To investigate the psychological impact of the coronavirus emergency on physicians and nurses. MATERIALS AND METHODS: A study was conducted on a sample of nurses and physicians (n=770), who were asked to fill in a questionnaire investigating physical and psychological problems. It also included the IES (Impact Event Scale), STAI (State Trait Anxiety Inventory) scale and BDI (Beck Depression Inventory). RESULTS: 87.7% of the sample was represented by nurses (n=675), 12.3% (n=95) by physicians. 52.3% (n=403) of the participants believed that they had not received good training on the correct use of Personal Protective Equipment. 18.2% (n=140) declared that they had experienced a moment in which they had had to choose among the patients whom to treat for an essential therapy. Among the psychological symptoms, stress (76.2%; n=587), anxiety (59.4%; n=457) and depression (11.8%) prevailed and only 3.9% of the healthcare personnel sought help from a psychologist. The total score of the IES-R scale was 3.47. A significant association emerged between exposure and the risk of contagion (p-value = 0.003), stress was more present among nurses than among physicians (77.5% vs. 67.4%; p = 0.003). Among physical symptoms, headache (52.2%; n=402) and pressure injuries (24.8% n= 191) prevailed. CONCLUSIONS: The results of the study show that mental health monitoring of health workers, who are at risk of developing major psychological disorders, is a priority.

Work environment and related burnout levels: survey among healthcare workers in two hospitals of Southern Italy.

BACKGROUND AND AIM OF THE WORK: Safety in hospitals is a structural variable on which depends not only on health, but also on physical safety of patients and employees, whom are increasingly exposed to risks as a result of which they may suffer from occupational diseases and/or develop important psycho-physical consequences. The study aimed to evaluate the association between work environment and perceived burnout levels in two hospitals of Southern Italy. METHOD: From March to August 2019 an observational study was carried out through a survey consisting of four sections: sociodemographic data; the Post Occupancy Evaluation (POE) questionnaire; the perception of the environment and possible causes of stress; the burnout levels perceived through the Maslach Burnout Inventory (MBI). A convenience sample of 169 healthcare workers participated in the study. All nurses (including nursing coordinators), clinicians, support staff of the "Vito Fazzi" Hospital of Lecce (Le) and "San Giuseppe da Copertino" Hospital of Copertino (Le) with at least one year of work experience and who signed the informed consent were recruited. RESULTS: The healthcare workers involved in the survey declared limits in handling and usability of the equipment, both for the patient n=77 (45.6%) and for the healthcare worker n=75 (44.4%), a lack of visual privacy n=89 (52.6%) and acoustic n=128 (75.7%).  The analysis also shows higher scores on the 'depersonalization' scale among the health care workers of San Giuseppe da Copertino" Hospital (LE) (M= 9.36; DS= 9.439) and higher levels on the 'emotional exhaustion' scale in the surgical areas (M= 22.0; DS= 11.86) and in the female gender (M= 23.10; DS=. 12.01).  Conclusions. The study reveals a poor condition of environmental comfort and safety, which generate high levels of stress and burnout in healthcare workers. Such a study can encourage further multicenter studies.