Guglielmo Bonaccorsi

Vaccination against hepatitis B in health care workers.

Hepatitis B is the most important infectious occupational disease for health care workers. The high risk of being infected is the consequence of the prevalence of virus carriers in the assisted population, the high frequency of exposure to blood and other body fluids and the high contagiousness of hepatitis B virus (HBV). Vaccination is able to prevent the most threatening consequences of the infection (acute disease and chronic carriage) in responders, even after loss of detectable antibodies. Non-responders to the primary series may benefit from administration of up to three more doses of vaccine (40-70% of initial non-responders show seroconversion to the new series). However, newly developed vaccines that seem more immunogenic are presently under evaluation and should further decrease the number of non-immune workers in the near future. In the mean time, coverage with standard vaccines should be improved also by supplying complete information on the risks of hepatitis B and on the safety and efficacy of active immunisation.

Predictive factors associated with the acceptance of pandemic and seasonal influenza vaccination in health care workers and students in Tuscany, Central Italy

Assessing the beliefs and attitudes of Health Care Workers (HCW) to influenza and influenza vaccination can be useful in overcoming low compliance rates. The purpose of our study is to evaluate the opinion of HCW and students regarding influenza, influenza vaccine and the factors associated with vaccination compliance. A survey was conducted between October 2010 and April 2011 in the Florence metropolitan area. A questionnaire was administered to HCW in three local healthcare units and at Careggi University Teaching Hospital. Students matriculating in health degree programs at Florence University were also surveyed. The coverage with vaccination against seasonal and pandemic influenza is generally low, and it is lower in students than in HCW (12.5% vs 15% for the seasonal vaccination, 8.5% vs 18% for the pandemic vaccination). Individuals comply with vaccination offer mainly to protect themselves and their contacts. Individuals not receiving vaccination did not consider themselves at risk, had never been vaccinated before or believed that pandemic influenza was not a public health concern. Physicians had the highest compliance to vaccination and women were less frequently vaccinated than men. HCW do not appear to perceive their possible influenza infections as a risk for patients: HCW receive vaccination mainly as a form of personal protection. Low compliance to vaccination is determined by various factors and therefore requires a multi-faceted strategy of response. This should include short-term actions to overcome organizational barriers, in addition to long-term interventions to raise HCW’s level of knowledge about influenza and influenza vaccination.

Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients

BACKGROUND Since most hip fractures occur in fragile patients, an important step forward in the treatment may be a co-managed, multidisciplinary treatment approach with orthopaedic surgeons and geriatricians. This multidisciplinary care model (MCM) is implemented in some Tuscan hospitals, while in hospitals with the usual care model (UCM) medical consultation is required only as deemed necessary by the admitting surgeon. The primary aim of this study was to assess the effect of the MCM on 30-day mortality, compared with the UCM. METHODS A retrospective study was conducted on patients with main diagnosis of hip fracture, as reported in the hospital admission discharge reports, aged 65 years and older, who underwent surgery in Tuscan hospitals from 2010 to 2013. A multilevel logistic regression model was performed to assess the effect of the MCM vs the UCM. The Charlson Comorbidity Index (CCI) was used as a proxy for case mix complexity. RESULTS 23,973 patients were included: 23% men and 77% women; the mean age was 83.5 years. The multilevel analysis showed that mortality was significantly higher in the UCM, after adjusting for gender, age, comorbidity and timing of surgery (OR=1.32; 95% CI 1.09-1.59; p=0.004). Surgical delay was not significantly associated with higher mortality rates. CONCLUSIONS A co-managed approach to hip fracture, with orthopaedic surgeons and geriatricians, offers a multidisciplinary pathway for the elderly and leads to a reduction in mortality after hip fracture surgery.

Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy.

Immunization of health care workers (HCWs) against influenza has been associated with improvements in patient safety. The aim of this study is to assess the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza. An anonymous questionnaire was distributed to HCWs in three local Florentine healthcare units, at Careggi University Teaching Hospital, and to students in health profession degree programs. A total of 2576 questionnaires were fully completed. A total of 12.3% of subjects responded that they were “always vaccinated” in all three of the seasonal vaccination campaigns studied (2007–2008 to 2009–2010), 13.1% had been vaccinated once or twice, and 74.6% had not received vaccinations. Although the enrolled subjects tended to respond that they were “never vaccinated,” they considered influenza to be a serious illness and believed that the influenza vaccine is effective. The subjects who refused vaccination more frequently believed that the vaccine could cause influenza and that it could have serious side effects. More than 60% of the “always vaccinated” group completely agreed that HCWs should be vaccinated. Self-protection and protecting family members or other people close to the respondent from being infected and representing potential sources of influenza infection can be considered motivating factors for vaccination. The results highlight the importance of improving vaccination rates among all HCWs through multi-component interventions. Knowledge of influenza should be reinforced.

Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence

Objective To estimate the effects of cycling promotion on major non-communicable diseases (NCDs) and costs from the public healthcare payer’s perspective. Design Health impact assessment and economic evaluation using a dynamic model over a ten-year period and according to two cycling promotion scenarios. Setting Cycling to work or school in Florence, Italy. Population All individuals aged 15 and older commuting to work or school in Florence. Main outcome measures The primary outcome measures were changes in NCD incidence and healthcare direct costs for the Tuscany Regional Health Service (SST) due to increased cycling. The secondary outcome was change in road traffic accidents. Results Increasing cycling modal share in Florence from 7.5% to about 17% (Scenario 1) or 27% (Scenario 2) could decrease the incidence of type 2 diabetes by 1.2% or 2.5%, and the incidence of acute myocardial infarction (AMI) and stroke by 0.6% or 1.2%. Within 10 years, the number of cases that can be prevented is 280 or 549 for type 2 diabetes, 51 or 100 for AMI, and 51 or 99 for stroke in Scenario 1 or Scenario 2, respectively. Average annual discounted savings for the SST are estimated to amount to €400,804 or €771,201 in Scenario 1 or Scenario 2, respectively. In Florence, due to the high use of vulnerable motorized vehicles (such as scooters, mopeds, and motorcycles), road traffic accidents are expected to decline in both our scenarios. Sensitivity analyses showed that health benefits and savings for the SST are substantial, the most sensitive parameters being the relative risk estimates of NCDs and active commuting. Conclusions Effective policies and programs to promote a modal shift towards cycling among students and workers in Florence will contribute to reducing the NCD burden and helping long-term economic sustainability of the SST.

GHPSS multicenter Italian survey: Smoking prevalence, knowledge and attitudes, and tobacco cessation training among third-year medical students

AIMS AND BACKGROUND Healthcare professionals have an important role to play both as advisers - influencing smoking cessation - and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach. METHODS AND STUDY DESIGN A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows. RESULTS Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03-3.97). CONCLUSIONS This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Body composition assessment in a sample of eight-year-old children

OBJECTIVE We assessed the body composition of 8-y-old children living in Livorno through the integration of bioelectrical and anthropometric evaluations. METHODS The study, conducted during December 2005, involved 8-y-old third graders of Livorno, Italy. We collected for each subject (449 children, 210 female and 239 male) anthropometric parameters and carried out bioelectrical impedance test with a STA/BIA Soft Tissue Analyzer. Data were processed with SPSS 14.0. RESULTS According to anthropometric parameters, a statistically significant difference between genders was found only for height. Percentages of overweight and obese children by gender were 13.9 and 2.4 for girls and 21.3 and 2.1 for boys (P<0.05). No significant differences were observed for weight, height, and body mass index percentiles from national reference values, whereras significant differences were found in mid-upper arm circumference between our sample and-lacking national data-the reference (U.S.) population for age and gender. With regard to bioelectrical impedance analysis, a common trend of distribution was observed in both genders toward the left and the area above the spatial ellipses and a statistically significant difference between genders for all parameters with the exception of phase angle. A gradual mean impedance shortening vector was observed with an increase of body mass index or mid-upper arm circumference. The comparison of the two techniques showed a good relation between anthropometric and bioelectrical parameters. CONCLUSION An integrated interpretation of bioelectrical impedance analysis and anthropometry, demonstrated by the correlation of many parameters between the two techniques, seems to emerge as a good indication of nutritional status for most children of both genders.

Risk of malnutrition in a sample of nonagenarians: Specific versus classic bioelectrical impedance vector analysis

OBJECTIVES The aims were to describe the body composition and the risk of malnutrition in a sample of nonagenarians and to identify what bioelectrical impedance vector analysis (BIVA) approach (classic or specific) is more correlated with either the risk of malnutrition or various anthropometric parameters. METHODS In the Mugello area (Italy), a representative sample of nonagenarians was enrolled in a survey aimed at investigating various health issues, including those related to nutritional status. The nutritional status was investigated using body mass index (BMI), mid-upper arm circumference (MUAC), calf circumference (CC), Malnutrition Universal Screening Tool (MUST), and BIVA. Two different approaches were used for the BIVA data analysis: the classic method and the specific method. RESULTS All measurements were obtained from 321 nonagenarians (65.7% of the enrolled sample; 92 men and 229 women); 74.8% of the subjects were at low risk of malnutrition according to MUST, 62.5% exhibited CC values higher than 31 cm, and 86.8% exhibited MUAC values higher than 22 cm. The bioelectrical parameters varied with nutritional status, independent of the nutritional indicator used; the parameters also varied based on sex and BIVA approach. The bioelectrical parameters obtained by the specific BIVA approach were more strongly correlated with MUST score, MUAC, and CC values compared with the parameters calculated using the classic approach. CONCLUSIONS Our study produced findings relevant to particular aspects of population aging. Above all, the specific BIVA was more effective at assessing nutritional status based on both anthropometric parameters and the risk of malnutrition.

Serum trace elements and risk of malnutrition in institutionalised elderly

Objective:The objective of this work is to evaluate the association between Selenium (Se)-, Copper (Cu)- and Zinc (Zn)-circulating concentrations and indicators of nutritional status.Subjects/Methods:This study enroled 428 institutionalised elderly. The diagnostic tools used are a form to collect data regarding gender, age, duration of stay in nursing home, number of prescribed drugs, chronic diseases, Mini Nutritional Assessment (MNA), anthropometric measurements, albumin, transferrin and serum concentrations of Se, Cu and Zn. The collected data were analysed with descriptive assessments of the differences χ2, Student’s t-test and analysis of variance. Multivariate linear regression were performed to evaluate the association between the concentrations of each trace elements and the other variables.Results:The study population was represented by 327 women and 101 men, of whom 13.8% were 65–75 years old and 47.4% were older than 85 years. According to the MNA score, 58.4% were at risk of malnutrition and 21.3% were malnourished. The results show a significant reduction in the average concentrations of Se and Zn in women when the nutritional status gets worse. The same trend, although not statistically significant, is also observed in men. In both genders, the Cu concentration does not show a statistically significant association with nutritional status. Multivariate linear regression show some positive or negative associations.Conclusions:Our study seems to confirm the association between Se and nutritional status, as well as with some blood chemistry parameters. The length of institutionalisation seems to be an independent predictor of Se concentration.

Health services and health literacy: from the rationale to the many facets of a fundamental concept. A literature review.

BACKGROUND The aim of this study is to make a critical analysis of the different definitions of health literacy to provide a framework of the concept. METHODS A literature search was conducted in PubMed, Embase, PsycINFO, ERIC, Health Evidence, Centre for Reviews and Dissemination and Cochrane Library. Google and OpenGrey were searched to find additional papers and unpublished works. RESULTS Among 7000 papers founded, we selected 26 works. During the 1990s, authors began to systematically study the relationship between health literacy and health status, according to a public health view. In the first decade of the new century, a new fundamental definition established three progressive degrees of health literacy: functional, interactive and critical health literacy. Sørensen (in 2012) provided a framework for the development of new assessment tools and interventions. CONCLUSION The improvement of health literacy is a powerful tool for the development of a new type of relationship between individuals and the health system.