Measuring Knowledge of Healthcare Providers on Pediatric Palliative Care with an Online Questionnaire Based on the National Core Curriculum in Italy.

There is a lack of highly reliable tools evaluating healthcare professionals' competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of healthcare workers on PPC/PT. The tool was built on the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists. Face validity, internal consistency and the underlying structure were evaluated after a field testing in a referral hospital, Friuli-Venezia Giulia, Italy. One hundred five respondents completed the questionnaire. High internal consistency for both scales of Perceived and Wished Knowledge was found (α = 0.95 and α = 0.94, respectively). Psychologists reported higher levels of self-Perceived skills on the psychosocial needs of the child and family at the end of life (p = 0.006), mourning (p = 0.003) and ethics and deontology in PT/PC (p = 0.049). Moreover, when Actual Knowledge was tested, they also provided the highest number of correct answers (p = 0.022). No differences were found by profession for Wished Knowledge. The questionnaire showed promising psychometric properties. Our findings suggest the need of continuous training in this field and identify contents to be addressed in future training programs.

Validating a biophysical dispersal model with the early life-history traits of common sole (Solea solea L.).

Larval dispersal and juvenile survival are crucial in determining variation in recruitment, stock size and adult distribution of commercially important fish. This study investigates the dispersal of early-life stages of common sole (Solea solea L.) in the southern North Sea, both empirically and through modeling. Age at different life-history events of juvenile flatfish sampled along the coasts of Belgium, the Netherlands and the United Kingdom in 2013, 2014 and 2016, was determined through the counting of daily growth rings in the otoliths. Juveniles captured between August and October were estimated to be on average 140 days old with an average pelagic larval duration of 34 days. The hatching period was estimated between early April and mid-May followed by arrival and settlement in the nurseries between May and mid-June. Growth rates were higher off the Belgian coast than in the other nursery areas, especially in 2013, possibly due to a post-settlement differentiation. Empirical pelagic larval duration and settlement distributions were compared with the Larvae&Co larval dispersal model, which combines local hydrodynamics in the North Sea with sole larval behavior. Yearly predicted and observed settlement matched partially, but the model estimated a longer pelagic phase. The observations fitted even better with the modelled average (1995-2015) distribution curves. Aberrant results for the small juvenile sole sampled along the UK coast in March 2016, led to the hypothesis of a winter disruption in the deposition of daily growth rings, potentially related to starvation and lower food availability. The similarities between measured and modelled distribution curves cross-validated both types of estimations and accredited daily ageing of juveniles as a useful method to calibrate biophysical models and to understand early-life history of fish, both important tools in support of efficient fisheries management strategies.

[Disability management in the international context: a systematic review of reviews]. / L'uso del Disability Management in contesti internazionali: revisione sistematica di revisioni.

SUMMARY: Background. Disability Management (DM) was born to improve workers' health and to optimize return to work for people with disabilities. Objectives. The objective of this study was to elaborate a review of reviews published in literature on the use of Disability Management in international contexts and the strategies used to facilitate the return to work for individuals with cronic disabilities or post injury. Methods. The present review was carried out by consulting the Pubmed and Scopus database from 1994 to January 2021, according to the PRISMA guidelines. Initially, the duplicates were removed. Then, the eligible studies were selected through a multistep approach (title evaluation, abstract and full-text). The systematic reviews were evaluated using the AMSTAR method, while for the narrative reviews the INSA scale was used. Results. The research produced 186 results. Following the removal of the duplicates and articles with no available or not pertinent full text, 51 reviews were included: 17 systematic and 34 narrative. The analyzed studies were related to the DM policies of the United States, Canada and UK. Ten topics emerged, the most frequent ones including: possible solutions to adopt in the event of workers with musculo-skeletal diseases (50% of the studies); legal matters regarding issues of mental health and stress (41.2%). The quality of the articles was generally high. Discussion. The systematic review showed that the research activity on DM is conducted mainly in the Anglo-Saxon world. This review can give some interesting insights for the full implementation of DM at the national level.

Iodine deficiency among Italian children and adolescents assessed through 24-hour urinary iodine excretion.

BACKGROUND: Iodine is an essential micronutrient for intellectual development in children. Information on iodine intakes based on 24-h urinary iodine excretion (UIE) is scant, because iodine status is only assessed by the measurement of urinary iodine concentration (UIC) in spot urine samples. OBJECTIVES: The aim of our study was to evaluate the iodine intake of school-age children and adolescents, using UIE measurement in 24-h urine collections. METHODS: The study population included 1270 healthy subjects (677 boys, 593 girls) aged 6-18 y (mean age ± SD: 10.3 ± 2.9) from 10 Italian regions. Daily iodine intake was estimated as UIE/0.92, based on the notion that $\sim$92% of the dietary iodine intake is absorbed. The adequacy of intakes was assessed according to the Dietary Reference Values for iodine of the European Food Safety Authority (EFSA). Body mass index (BMI) and UIC were also measured for each subject. RESULTS: Based on the scientific opinion of EFSA, 600 of 1270 subjects (47.2%) had a lower than adequate iodine intake, with a higher prevalence among girls (54.6%) compared with boys (40.2%) (P < 0.001). Although UIE and 24-h urinary volumes increased with age (P < 0.001), a progressive decrease in the percentage of subjects with iodine excretion <100 µg/24 h (P < 0.001) was observed, without any significant difference in the percentage of subjects with UIC <100 µg/L. No significant association was detected between BMI z-score and UIE (P = 0.603) or UIC (P = 0.869). CONCLUSIONS: A sizable proportion of our population, especially girls, appeared to be at risk of iodine inadequacy. The simple measurement of UIC could lead to underestimation of the occurrence of iodine deficiency in younger children, because of the age-related smaller urine volumes producing spuriously higher iodine concentrations.

Practices and Perceptions of Family Centered Care among Healthcare Providers: A Cross-sectional Study in a Pediatric Hospital.

PURPOSE: This study aimed to: (1) investigate the extent to which Family Centered Care (FCC) principles are currently applied in clinical practice by healthcare providers working in inpatient units; (2) evaluate the extent to which FCC principles are perceived as necessary; and (3) examine the associations between FCC principles and socio-demographic and job characteristics of participants. Design and Methods A cross-sectional study was conducted at a large pediatric hospital using the Italian version of the FCC Questionnaire Revised (FCCQ-R). Univariate and multivariate analyses were performed. RESULTS: Data from 469 healthcare providers were used for analysis. Scores for the FCC daily practices (Current activities) were significantly lower than those for their perceived necessity (Necessary activities) (p < .001). Participants who were male, younger, with work experience >20 years and working in rehabilitation reported a significantly higher perception of Current activities of FCC than others. The older and the more educated the participants, the greater was the perceived necessity of FCC activities. Female, older, and less experienced participants employed by the hospital but not working in the rehabilitation setting perceived a greater gap between Necessary and Current activities of FCC. CONCLUSIONS: Scores for the Current and Necessary activities of FCC were lower than those reported in other studies. The lower scores in the Current activities and the significant gap can be due to organizational barriers or lack of skills, but the lower scores in the Necessary activities should be interpreted as a deficit of knowledge about FCC. PRACTICE IMPLICATIONS: There is a need for further education about FCC in order to increase its perceived relevance in clinical practice.

A rapid diagnostic workflow for cefotaxime-resistant Escherichia coli and Klebsiella pneumoniae detection from blood cultures by MALDI-TOF mass spectrometry.

BACKGROUND: Nowadays, the global spread of resistance to oxyimino-cephalosporins in Enterobacteriaceae implies the need for novel diagnostics that can rapidly target resistant organisms from these bacterial species. METHODS: In this study, we developed and evaluated a Direct Mass Spectrometry assay for Beta-Lactamase (D-MSBL) that allows direct identification of (oxyimino)cephalosporin-resistant Escherichia coli or Klebsiella pneumoniae from positive blood cultures (BCs), by using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) technology. RESULTS: The D-MSBL assay was performed on 93 E. coli or K. pneumoniae growing BC samples that were shortly co-incubated with cefotaxime (CTX) as the indicator cephalosporin. Susceptibility and resistance defining peaks from the samples' mass spectra were analyzed by a novel algorithm for bacterial organism classification. The D-MSBL assay allowed discrimination between E. coli and K. pneumoniae that were resistant or susceptible to CTX with a sensitivity of 86.8% and a specificity of 98.2%. CONCLUSION: The proposed algorithm-based D-MSBL assay, if integrated in the routine laboratory diagnostic workflow, may be useful to enhance the establishment of appropriate antibiotic therapy and to control the threat of oxyimino-cephalosporin resistance in hospital.

High sodium and low potassium intake among Italian children: relationship with age, body mass and blood pressure.

BACKGROUND: Hypertension is the leading cause of death in developed countries and reduction of salt intake is recommended as a key preventive measure. OBJECTIVE: To assess the dietary sodium and potassium intakes in a national sample of Italian children and adolescents and to examine their relationships with BMI and blood pressure (BP) in the framework of the MINISAL survey, a program supported by the Italian Ministry of Health. POPULATION AND METHODS: The study population included 1424 healthy subjects (766 boys, 658 girls) aged 6-18 years (mean age: 10.1±2.9) who were consecutively recruited in participating National Health Service centers in 10 Italian regions. Electrolyte intake was estimated from 24 hour urine collections tested for completeness by the concomitant measurement of creatinine content. Anthropometric indices and BP were measured with standardized procedures. RESULTS: The average estimated sodium intake was 129 mmol (7.4 g of salt) per day among boys and 117 mmol (6.7 g of salt) among girls. Ninety-three percent of the boys and 89% of the girls had a consumption higher than the recommended age-specific standard dietary target. The estimated average daily potassium intakes were 39 mmol (1.53 g) and 36 mmol (1.40 g), respectively, over 96% of the boys and 98% of the girls having a potassium intake lower than the recommended adequate intake. The mean sodium/potassium ratio was similar among boys and girls (3.5 and 3.4, respectively) and over 3-fold greater than the desirable level. Sodium intake was directly related to age, body mass and BP in the whole population. CONCLUSIONS: The Italian pediatric population is characterized by excessive sodium and deficient potassium intake. These data suggest that future campaigns should focus on children and adolescents as a major target in the framework of a population strategy of cardiovascular prevention.