Prevalence and predictors of hand hygiene compliance in clinical, surgical and intensive care unit wards: results of a second cross sectional study at the Umberto I teaching hospital of Rome.

Introduction: Hand hygiene is the most cost-effective procedure for the prevention of healthcare-associated infections, but healthcare worker compliance is often insufficient. Research Design: The objective of this second cross-sectional study was to quantify hand hygiene compliance among the healthcare workers of a large teaching hospital, to explore associated factors and to compare results to those of the 2021 study. Methods: In 2022, educational sessions were conducted within each hospital department during which hospital healthcare workers received tailored feedback on the hand hygiene compliance registered in the previous year. Then, one month later, direct observations hand hygiene compliance with five World Health Organization recommendations were collected again by anonymous observers in each ward. Data were grouped by healthcare area (clinical, surgical and intensive care), and three multivariable logistic regression models were built to identify predictors of hand hygiene compliance. Result: Overall, 5,426 observations were collected by 73 observers in three weeks. Hand hygiene compliance was 79.7%, 73.5% and 63.1% in clinical, surgical and intensive care areas, respectively, increasing in clinical wards but decreasing in surgical departments compared to the 2021 study. The multivariable analyses showed that hand hygiene compliance after patient contact was consistently higher than before patient contact, while there was some variability in compliance with other factors across the three areas. Conclusion: The study found suboptimal adherence to good hand hygiene practice, with the lowest rates observed before patient interaction, which, together with the variability recorded across departments, underscores the challenges involved in achieving a uniform level of compliance. Hence, additional training is essential to raise awareness among healthcare workers, while repeating this survey over time will also be crucial, so that hand hygiene compliance can be monitored and any major issue identified.

Smoking at the workplaces in Italy after the smoking ban in the Lazio Region.

BACKGROUND: In Italy, an anti-smoking law was issued in 2003, with the aim of reducing tobacco smoking inside public places. OBJECTIVES: The aim of the study was to assess the observance of the smoking ban in Italy, during the period 2010-2014, in several workplaces and to evaluate the perception of workers, both smokers and non-smokers, on this issue. METHODS: This cross-sectional study analyzed data resulting from a self-administered questionnaires in 59 companies, from several working sectors (transport, healthcare and building), in the Latium Region in Italy. RESULTS: Out of 7200 questionnaires, 6996 were included in the analysis: 43.7% of the employees think that the smoking ban is respected in the workplace; women are more prone to think that the ban is not observed. Smokers tend to perceive the ban to be respected (AOR: 0.69; 95% CI: 0.62-0.77) while non-smokers feel more exposed to second-hand smoke (AOR: 1.57; 95% CI: 1.39-1.77). Workers in intellectual and highly specialized professions (AOR: 1.63; 95% CI: 1.25-2.13), technical professions (AOR: 1.64; 95% CI: 1.28-2.10) and craftsmen, skilled workers and farmers (AOR: 1.42; 95% CI: 1.09-1.85) tend to perceive the smoking ban not to be observed and the last two classes are the ones who feel the most exposed to second-hand smoke (AOR: 6.68; 95% CI: 0.50-0.90; AOR: 0.52; 95% CI: 0.38-0.70). DISCUSSION: The results of this study can be used as a starting point for the implementation of new strategies to reduce tobacco addiction, beginning from the compliance with the ban on smoking in the workplace and the promotion of a healthy lifestyle.

Assessing knowledge, attitude, and practice of healthcare personnel regarding biomedical waste management: a systematic review of available tools.

Biomedical waste (BMW) management is an important commitment of hospitals both in terms of the possible infectious risk and from the financial point of view. Monitoring the knowledge, attitude, and practice (KAP) of healthcare professionals on this topic represents a source of information on BMW management. The aim of this study is to perform a systematic review to identify the reliable and valid tools able to assess the KAP of professionals in healthcare centers to manage BMW. Two databases (PubMed and Scopus) were searched on 10 May 2018 for cross-sectional studies with tools on BWM management, including original research studies from peer-reviewed journals, case studies, and review studies. Information on validation and reliability were collected. Methodological quality was assessed using the Newcastle-Ottawa scale for cross-sectional studies. Fifty-three articles were included, of which 19 presented a questionnaire on BMW for healthcare workers. Nine proposed a validated questionnaire: four reported Cronbach's alpha, which ranged from 0.62 to 0.86. Results further emphasize the prevalence of Asian studies facing the problem of assessing KAP about BMW management using specific tools. Overall, 14 questionnaires were designed in Asia, two in Africa, one in America, one in Australia, and one questionnaire was elaborated in Europe, in Spain. This systematic review highlighted the need of creation of validated and methodologically high-quality questionnaires. Therefore, there is the need of new cross-sectional studies to investigate these problems, improving generalization, and facilitating international comparison of research findings.

[Assessment of burnout in health care personnel in hematological unit of a teaching hospital]. / Valutazione del burnout nel personale dipendente del reparto di Ematologia di un Policlinico Universitario.

OBJECTIVES: Working in such circumstances can lead to a typical emotional stress called "burnout". The aim of this study was to evaluate the perceived state of physical and mental health, and verify the existence of burnout among health care workers of Hematology unit in a Teaching Hospital. METHODS: Anonymous questionnaires were administered to healthcare professionals (physicians, nurses, health care workers). It includes socio demographic variables, the Maslach Burnout Inventory (MBI) and SF12 also. The MBI captures three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (RP); whereas the SF12 defines two quality of life scores: Mental Score (MCS) and Physical Score (PCS). RESULTS: Of 120 operators 70 individuals responded to the study. The questionnaire shows that the burnout levels were high in the followed part of the sample: 40% have high level of EE; 24% of DP; 15% of RP. The correlation analysis between SF12 and MBI undelines followed significance: r = -0.576 with p minor than 0.001 between EE and MCS; r = 0.557 with p minor than 0.001 between EE and DP. The three multivariate analysis refer that: the EE is associated indirectly to PCS and MCS with p mionr than 0.05; the DP is directly and significantly (p minor than 0.05) associated to MCS, "years of work" and to female gender. The RP dimension no underlines significant associations with variables studied. CONCLUSIONS: The findings were consistent with the type of work and assisted patients (chronic patient, often with poor prognosis and low expectations in terms of care and survival) that contribute to stressful situations. Personal fulfillment, instead, seems to be quite high in this contest. The relatively small sample couldn't represent the world of health care workers in hematological units, but there is no doubt that a systematic assessment of burnout, to investigate the causes of burnout are main elements to identify the potential solutions to address the phenomenon. Additional investigations of the MBI dimensions using biggest samples would be useful to confirm the results in order to generate burnout reduction measures by institutional and national policies.

[Employee Wellbeing in a University Department, Italy]. / Il benessere organizzativo in un dipartimento universitario.

A serene workplace environment can provide significant benefits to employees. The aim of the present study was to assess wellbeing of employees in a university department, by administering validated questionnaires (Karasek and INAIL) and to determine any similarities and / or differences. The sample consisted of 48 employees (22.9 % male and 77.1% female) in various job categories including doctors, biologists, nurses, and technical and administrative staff. Results obtained from the Karasek questionnaire allowed us to calculate the values of Decision latidude and Job demand. The intersection of the medians of the two components, respectively 56 and 30, allowed us to divide participants into four quadrants consisting of high "strain" workers, active and passive and low "strain" workers. Thirty seven percent of the sample was found to be at high risk of stress. Significant differences in responses were identified in relation to gender, age, job seniority and educational level. Responses to the two questionnaires compared favorably. Seventeen questions were compared, and for eleven of these there was sufficient agreement, with kappa test values comprised between 0.194 and 0.408 (p<0.05). Results confirm that work-related stress is a relevant issue. Karasek and INAIL questionnaires, while investigating similar issues, should not be used alternatively but rather administered simultaneously.

Meat intake and non-Hodgkin lymphoma: a meta-analysis of observational studies.

PURPOSE: High intake of meat has been inconsistently associated with increased risk of non-Hodgkin lymphoma (NHL). We carried out a meta-analysis to summarize the evidence of published observational studies reporting association between red meat and processed meat intake and NHL risk. METHODS: Analytical studies reporting relative risks with 95 % confidence intervals (95 % CI) for the association between intake of red and/or processed meat and NHL or major histological subtypes were eligible. We conducted random-effects meta-analysis comparing lowest and highest intake categories and dose-response meta-analysis when risk estimates and intake levels were available for more than three exposure classes. RESULTS: Fourteen studies (four cohort and ten case-control) were included in the meta-analysis, involving a total of 10,121 NHL cases. The overall relative risks of NHL for the highest versus the lowest category of consumption were 1.14 (95 % CI 1.03, 1.26) for red meat and 1.06 (95 % CI 0.98, 1.15) for processed meat. Significant associations were present when the analysis was restricted to case-control studies but not when restricted to cohort studies. No significant associations were found for major NHL etiological subtypes. Dose-response meta-analysis could be based only on eight studies that provided sufficient data, and compared to no meat consumption, the overall NHL relative risk increased nonlinearly with increased daily intake of red meat. CONCLUSION: The observed positive association between red meat consumption and NHL is mainly supported by the effect estimates coming from case-control studies and is affected by multiple sources of heterogeneity. This meta-analysis provided mixed and inconclusive evidences on the supposed relationship between red and processed meat consumption and NHL.

Is swimming in recreational water associated with the occurrence of respiratory illness? A systematic review and meta-analysis.

This study represents the first systematic review and meta-analysis conducted to assess the association between swimming in recreational water and the occurrence of respiratory illness. Most studies focus their attention on gastrointestinal illnesses occurring after exposure to microbial polluted water. Fourteen independent studies that included 50,117 patients with significant heterogeneity (I(2) = 95.3%) were reviewed. The meta-analysis reports that people exposed to recreational water (swimmers/bathers) present a higher risk of respiratory illness compared to non-swimmers/non-bathers [relative risk (RR) = 1.63 (confidence interval at 95% [95% CI]: 1.34-1.98)]. This percentage increases if adjusted RR by age and gender [RR = 2.24 (95% CI: 1.81-2.78)] are considered. A clear association between swimming in recreational water and the occurrence of respiratory illness was found. The surveillance of water quality monitoring systems is crucial not only for gastrointestinal illness, but also for respiratory ones.

Pseudo-outbreak of Mycobacterium gordonae in a teaching hospital: importance of strictly following decontamination procedures and emerging issues concerning sterilization.

Aim of this study was to investigate a pseudo-outbreak of Mycobacterium gordonae analyzing isolates detected from clinical and environmental samples. Mycobacterium gordonae was detected in 7 out of 497 broncho-alveolar lavage (BAL) samples after bronchoscopy procedure in patients admitted to a teaching hospital between January and April 2013. During this pseudo-outbreak clinical, epidemiological, environmental and molecular investigations were performed. None of the patients met the criteria for non-tuberculous mycobacterial (NTM) lung disease and were treated for M. gordonae lung disease. Environmental investigation revealed M. gordonae in 3 samples: in tap water and in the water supply channel of the washer disinfector. All the isolates were subjected to genotyping by pulsed-field gel electrophoresis (PFGE). The PFGE revealed that only patients' isolates presented the same band pattern but no correlation with the environmental strain was detected. Surveillance of the outbreak and the strict adherence to the reprocessing procedure and its supplies resulted afterwards in no detection of M. gordonae in clinical respiratory samples. Clinical surveillance of patients was crucial to establish the start of NTM treatment. Regular screening of tap water and endoscopic equipment should be adopted to compare the clinical strains with the environmental ones when an outbreak occurs.

Microbiological safety of glasses dispensed at 3D movie theatres.

Recent popularity of three-dimensional movies raised some concern about microbiological safety of glasses dispensed into movie theatres. In this study, we analysed the level of microbiological contamination on them before and after use and between theatres adopting manual and automatic sanitation systems. The manual sanitation system was more effective in reducing the total mesophilic count levels compared with the automatic system (P < 0.05), but no differences were found for coagulase-positive staphylococci levels (P = 0.22). No differences were found for mould and yeast between before and after levels (P = 0.21) and between sanitation systems (P = 0.44). We conclude that more evidences are needed to support microbiological risk evaluation.

Factors influencing persistence of Legionella pneumophila serogroup 1 in laboratory cocultures.

BACKGROUND: Risk for infections from Legionella pneumophila for immunocompromised individuals increases greatly when this species is present within the biofilm of the water distribution systems of hospitals or other health facilities. Multiplication and persistence of Legionella may dependent also upon planktonic growth in alternative to sessile growth. Here we compared the persistence of L. pneumophila serogroup 1 in experimental planktonic co-cultures subsided with iron, Pseudomonas aeruginosa and other non Legionella bacteria (quantified as Heterotrophic Plate Count, HPC at 37°C), isolated from drinking water sources of a large hospital. RESULTS: Concentrations of L. pneumophila showed a decreasing pattern with incubation time in all co-cultures, the degree of reduction depending on the experimental treatment. In co-cultures with added P. aeruginosa, no L. pneumophila was detectable already after 4 days of incubation. In contrast in co-cultures without P. aeruginosa, HPC but not iron were significant factors in explaining the pattern of L. pneumophila, although the HPC effect was different according to the incubation time (HPC x time interaction, p < 0.01). CONCLUSIONS: Our results highlight the need of controlling for both HPC and metal constituents of the water systems of buildings used by individuals at particular risk to the effects of Legionella exposure.

Legionella control in the water system of antiquated hospital buildings by shock and continuous hyperchlorination: 5 years experience.

BACKGROUND: To control the presence of Legionella in an old hospital water system, an integrated strategy of water disinfection-filtration was implemented in the university hospital Umberto I in Rome. METHODS: Due to antiquated buildings, hospital water system design and hospital extension (38 buildings), shock hyperchlorination (sodium hypochlorite, 20-50 ppm of free chlorine at distal points for 1-2 h) followed by continuous hyperchlorination (0.5-1.0 mg/L at distal points) were adopted, and microbiological and chemical monitoring of the water supply was carried out in the university hospital (December 2006-December 2011). RESULTS: Overall, 1308 samples of cold <20°C (44.5%), mixed ≥20°C ≤ 45°C (37.7%) and hot >45°C (17.8%) water were collected, determining residual free chlorine (0.43 ± 0.44 mg/L), pH (7.43 ± 0.29) and trihalomethanes (8.97 ± 18.56 µg/L). Legionella was isolated in 102 (9.8%) out of 1.041 water samples without filters (L. pneumophila sg 1 17.6%, L. pneumophila sg 2-14 28.4%, L. non pneumophila 53.9%), and in none of the 267 samples with filters. Legionella was recovered in 23 buildings out of 38 and 29 samples (28.4%) exceeded 103 cfu/L. When considering the disinfection treatment Legionella was isolated: before shock hyperchlorination (21.1%), 15 days after shock hyperchlorination (7.8%), 30 days after shock hyperchlorination (3.5%), during continuous hyperchlorination (5.5%) and without continuous hyperchlorination (27.3%). Continuous hyperchlorination following the shock treatment achieved >70% reduction of positive samples, whereas no continuous hyperchlorination after shock treatment was more frequently associated to Legionella isolation (OR 6.41; 95% CI 3.10-13.26; p <0.001). Independent risk factors for Legionella isolation were: residual free chlorine <0.5 mg/L (OR 13.0; 95% CI 1.37 - 123.2; p <0.03), water T° ≥20°C ≤ 45°C (OR 12.0; 95% CI 1.28 - 111.48; p <0.03) and no continuous hyperchlorination after shock treatment (OR 10.3; 95% CI 1.06 - 100.05; p <0.05). CONCLUSIONS: Shock and continuous hyperchlorination achieved significant Legionella reduction, but effective chlorine levels (>0.5 < 1.0 mg/L) deteriorated water quality (organoleptic and chemical). However, shock and continuous hyperchlorination remains a valid-term option in old buildings with no water system rational design, managing problems due to hospital extension and absence of a proper hot water recirculation system.

Cost and Cost-Effectiveness of the Mediterranean Diet: An Update of a Systematic Review.

It is well known that the Mediterranean diet (DM) is beneficial for health, as years of research globally have confirmed. The aim of this study was to update a previous systematic review that assessed the cost-effectiveness of adherence to the DM as a strategy for the prevention of degenerative diseases by evaluating the economic performance of this diet. The research approach utilized three electronic databases: PubMed, Scopus, and Web of Science. A comprehensive search was conducted to retrieve articles based on a PRISMA-compliant protocol registered in PROSPERO: CRD 42023493562. Data extraction and analysis were performed on all included studies. One thousand two hundred and eighty-two articles were retrieved, and once duplicates and irrelevant articles were removed, fifteen useful articles were reviewed. The studies indicated a clear link between dietary habits, health, and economic aspects related to dietary cost and health spending. Recognizing the significant health benefits associated with adopting DM and the potential savings on health care spending, it is important for national public health programs to consider policies that support this lifestyle.

Compliance with hand-hygiene guidelines among healthcare workers: a cross-sectional study at the Umberto I teaching hospital of Rome, Italy.

INTRODUCTION: Healthcare-associated infections are often associated with poor hand hygiene (HH) by healthcare workers (HCWs). The objective of this cross-sectional study at the Umberto I teaching hospital in Rome was to quantify compliance with HH by direct observation following a multimodal strategy devised by the World Health Organisation and to map critical areas for improvement. METHODS: Predictors of HH compliance were identified using a multivariable logistic regression model. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Eighty-four trained observers from 50 wards collected 4,081 observations showing that overall HH compliance was 71.9%. The multivariable analysis found a positive association with the outcome for midwives compared to physicians (aOR=2.5, 95% CI: 1.5-4.1), and a negative association for healthcare assistants (aOR=0.5, 95% CI: 0.3-0.8). There was greater compliance during public holidays and weekends (aOR=1.5, 95% CI: 1.1-2.1), but compliance was lower for external staff (aOR=0.7, 95% CI: 0.5-0.9). We found a positive association with all HH indications after interaction with a patient or with patient surroundings compared with the indication "before touching a patient" (all p<0.001); the highest association was with the indication "after contact with biological fluids" (aOR=7.7, 95% CI: 4.7-12.5). CONCLUSION: Overall, we observed reasonable compliance levels, but it is important to increase adherence to HH practice and monitor any behaviour change.

[Risk communication during health crises: results of a cross-sectional study to evaluate the effectiveness of adopted corporate communication strategies during the H1N1 influenza pandemic in Italy and on the training needs of health professionals]. / La comunicazione del rischio in situazioni di crisi sanitaria: risultati di una survey sulla valutazione dell'efficacia della comunicazione istituzionale adottata per fronteggiare la pandemia influenzale AH1N1 in Italia e sui fabbisogni formativi dei professionisti sanitari.

The objectives of this study were to evaluate the effectiveness of corporate communication activities carried out during the A(H1N1) pandemic influenza in Italy and to identify educational needs of health professionals with regards to crisis communication. The study compared two samples representing respectively the general population and health professionals, living in different regions of northern, central and southern Italy. A self-administered questionnaire was used, with questions on knowledge about preventive measures during a pandemic and on satisfaction with the adopted communication campaigns. Study results highlight that both samples had very little knowledge of appropriate preventive behaviors to be adopted during a pandemic. The sample of health professionals received a greater amount of information about the pandemic with respect to the general population and showed a strong interest toward the problem of receiving adequate training in risk communication. The degree of knowledge about preventive measures is directly proportional to the existence of institutional communication activities and to having consulted a health professional.

Acinetobacter baumannii Isolates from COVID-19 Patients in a Hospital Intensive Care Unit: Molecular Typing and Risk Factors.

Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78-9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented.

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit.

The COVID-19 pandemic has increased the healthcare-associated infection (HAI) risk in intensive care unit (ICU) patients. However, a comparison between patients with and without COVID-19 in terms of HAI incidence has been rarely explored. In this study, we characterized the occurrence of HAI among patients with and without COVID-19 admitted to the ICU of the Umberto I hospital of Rome during the first 16 months of the pandemic and also identified risk factors for HAI acquisition. Patients were divided into four groups according to their ICU admission date. A multivariable conditional risk set regression model for multiple events was constructed for each admission period. Adjusted hazard ratios and 95% confidence intervals were calculated. Overall, 352 COVID-19 and 130 non-COVID-19 patients were included, and a total of 361 HAIs were recorded. We found small differences between patients with and without COVID-19 in the occurrence and type of HAI, but the infections in the two cohorts mostly involved different microorganisms. The results indicate that patient management was likely an important factor influencing the HAI occurrence during the pandemic. Effective prevention and control strategies to reduce HAI rates should be implemented.

Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case-Control Study.

Epidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case-control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associated infections (HAIs) sustained by MDR Klebsiella pneumoniae (MDR-Kp) in intensive care unit patients. Cases were defined as patients who developed an MDR-Kp HAI. Controls matched on sex and the length of intensive care unit (ICU) stay were randomly selected from the at-risk population. Any antibiotic agent received in systemic administration before the onset of infection was considered as antibiotic exposure. Multivariable conditional logistic regression analyses were performed to estimate the effect of prior exposure to each antibiotic class (Model 1) or its duration (Model 2) on the onset of HAIs sustained by MDR-Kp. Overall, 87 cases and 261 gender-matched controls were compared. In Model 1, aminoglycosides and linezolid independently increased the likelihood of developing an MDR-Kp HAI, whereas exposure to both linezolid and penicillins reduced the effect of linezolid alone. In Model 2, cumulative exposure to aminoglycosides increased the likelihood of the outcome, as well as cumulative exposures to penicillins and colistin, while a previous exposure to both penicillins and colistin reduced the influence of the two antibiotic classes alone. Our study confirms that aminoglycosides, penicillins, linezolid, and colistin may play a role in favoring the infections sustained by MDR-Kp. However, several double exposures in the time window before HAI onset seemed to hinder the selective pressure exerted by individual agents.

[Model for microbiological surveillance of operating rooms: analysis of the efficacy of total mesophilic load and air particle counts]. / Modello di sorveglianza igienico sanitaria in sala operatoria: analisi di efficacia della carica mesofila totale e del particolato aerodisperso.

Methodologies and procedures for environmental hygiene surveillance of operating room theatres are not uniform across Italy. The aim of this study was to implement a surveillance model based on total mesophilic load and particle count, and evaluating the model's efficacy and sensitivity. The surveillance model was introduced in 2008 for the evaluation of hygienic-sanitary conditions of seven operating theatres in two hospitals in Rome (Italy). In total 924 samples were tested. The correlation between total mesophilic load and particle count seem to indicate the efficacy of this model, although the two indicators appear to be complementary and cannot substitute one another.

Effect of Urban Wastewater Discharge on the Abundance of Antibiotic Resistance Genes and Antibiotic-Resistant Escherichia coli in Two Italian Rivers.

BACKGROUND: Wastewater treatment plants (WWTPs) are microbial factories aimed to reduce the amount of nutrients and pathogenic microorganisms in the treated wastewater before its discharge into the environment. We studied the impact of urban WWTP effluents on the abundance of antibiotic resistance genes (ARGs) and antibiotic-resistant Escherichia coli (AR-E. coli) in the last stretch of two rivers (Arrone and Tiber) in Central Italy that differ in size and flow volume. METHODS: Water samples were collected in three seasons upstream and downstream of the WWTP, at the WWTP outlet, and at sea sites near the river mouth, and analyzed for the abundance of ARGs by qPCR and AR-E. coli using cultivation followed by disk diffusion assays. RESULTS: For all studied genes (16S rRNA, intI1, sul1, ermB, blaTEM, tetW and qnrS), absolute concentrations were significantly higher in the Tiber than in the Arrone at all sampling sites, despite their collection date, but the prevalence of target ARGs within bacterial communities in both rivers was similar. The absolute concentrations of most ARGs were also generally higher in the WWTP effluent with median levels between log 4 and log 6 copies per ml but did not show differences along the studied stretches of rivers. Statistically significant site effect was found for E. coli phenotypic resistance to tetracycline and ciprofloxacin in the Arrone but not in the Tiber. CONCLUSIONS: In both rivers, diffuse or point pollution sources other than the studied WWTP effluents may account for the observed resistance pattern, although the Arrone appears as more sensitive to the wastewater impact considering its lower flow volume.

Physicians' knowledge, attitudes and professional use of RCTs and meta-analyses: a cross-sectional survey.

BACKGROUND: Familiarity with Randomized Control Trials (RCTs) and meta-analyses is essential to practice Evidence Based Medicine (EBM). The aims of this study were to describe knowledge, attitudes and professional behavior of physicians towards methods to evaluate the efficacy of health interventions, particularly meta-analysis and to find out their possible associated factors. METHODS: A cross-sectional survey was carried out on a random sample of Italian physicians through a self-administered questionnaire. RESULTS: A response rate of 70.1% was achieved (654 questionnaires). Despite satisfactory knowledge and substantial positive attitudes, Italian physicians have not integrated the use of RCTs and meta-analyses into their practice to a large extent, because they infrequently read and use RCTs and meta-analyses to make decisions in clinical practice. There is a high correlation between knowledge, attitudes and professional use of RCTs and meta-analyses. Moreover, the results of our multivariate analysis show that the probability of an appropriate professional use, that is higher for doctors who know the English language, have internet access and dedicate a proper amount of time to continuing medical education, increases significantly with a previous exposure to meta-analysis during graduate/post-graduate training (OR 2.25, 95% CI 1.44-3.52), and with the attendance of post-graduate courses about EBM (OR 1.75, 95% CI 1.09-2.82). Finally, Italian physicians demonstrate a high level of interest in further training. CONCLUSIONS: The association between the EBM educational background of doctors and the appropriate professional use of RCTs and meta-analyses suggest that EBM training may promote a more evidence-based practice among physicians.