Stefania Bruno

Non-fermentative gram-negative bacteria in hospital tap water and water used for haemodialysis and bronchoscope flushing: Prevalence and distribution of antibiotic resistant strains

This study provides a detailed description of the distribution of non-fermentative gram-negative bacteria (NFGNB) collected in water sources (tap water and water used for haemodialysis and bronchoscope flushing) from different wards of a tertiary care hospital. The aim is to identify risk practices for patients or to alert clinicians to the possible contamination of environment and medical devices. The resistance profile of NFGNB environmental isolates has shown that more than half (55.56%) of the strains isolated were resistant to one or more antibiotics tested in different antimicrobial categories. In particular, 38.89% of these strains were multidrug resistant (MDR) and 16.67% were extensively drug resistant (XDR). The most prevalent bacterial species recovered in water samples were Pseudomonas aeruginosa, Pseudomonas fluorescens, Ralstonia pickettii and Stenotrophomonas maltophilia. Analysis of antibiotic resistance rates has shown remarkable differences between Pseudomonadaceae (P. aeruginosa and P. fluorescens) and emerging pathogens, such as S. maltophilia and R. pickettii. Multidrug resistance can be relatively common among nosocomial isolates of P. aeruginosa, which represent the large majority of clinical isolates; moreover, our findings highlight that the emergent antibiotic resistant opportunistic pathogens, such as R. pickettii and S. maltophilia, isolated from hospital environments could be potentially more dangerous than other more known waterborne pathogens, if not subjected to surveillance to direct the decontamination procedures.

Tuberculosis in Sheltered Homeless Population of Rome: An Integrated Model of Recruitment for Risk Management

The authors show the results of an integrated model for risk management of tuberculosis in a sample of sheltered homeless in Rome. Tuberculin skin test (TST) was used for evaluating the prevalence of latent infection (LTBI). In TST positives, expectorate was collected and chest X-ray was achieved. Multiple logistic regression analysis was performed to investigate determinants of infection. Out of 288 recruited subjects, 259 returned for the TST reading; 45.56% were positive and referred to a specialized center; 70 accessed the health facility and completed the clinical pathway. The risk factors associated to LTBI were male gender (OR = 3.72), age over 60 years (OR = 3.59), immigrant status (OR = 3.73), and obesity (OR = 2.19). This approach, based on an integrated social network, guarantees high adherence to screening (89.93%), allowing patients testing positive for latent tuberculosis infection to be diagnosed and rapidly referred to a specialized center.

Health inequalities: an analysis of hospitalizations with respect to migrant status, gender and geographical area

BackgroundThe quality of care includes several aspects which may be influenced by social-economic status.This study analyzes hospitalizations for several conditions, such as chronic diseases, cancer and appendectomy, in Italians and immigrant people living in Italy with the aim to evaluate possible inequalities in the quality of health care services due to migrant status, gender and geographical macro-areas (Northern, Central, Southern Italy).MethodsThe data source of hospital discharges for stroke, myocardial infarction, chronic liver disease, cervical cancer, mastectomy and appendectomy was the Ministry of Health. ICD 9 codes were used for data collection. Crude and standardized hospitalization rates per 100.000 were calculated. Italian resident population and an estimate of immigrants living in Italy were used as denominators while standardization was done with respect to the European population. The data we used covers the 2006–2008 period.ResultsImmigrants showed significantly higher hospitalization rates for stroke, cervical cancer and appendectomy and significantly lower hospitalization rates for chronic liver diseases and mastectomy. Males showed significantly higher hospitalization rates than females for myocardial infarction, chronic liver diseases and appendectomy. Notwithstanding, differences related to migrant status and gender varied according to geographical macro-area. With respect to that, Southern Italy showed significantly higher hospitalization rates for stroke, myocardial infarction and chronic liver diseases and significantly lower hospitalization rates for mastectomy and appendectomy.ConclusionsThe results of this study may reflect inequalities in the quality of health care, in particular in primary and secondary prevention, access to specialized care and inappropriateness, due to migrant status and gender. Also, differences between macro-areas suggest heterogeneities in the integration policies and the promotion of immigrants’ health. Research should be endorsed in this field in order to further describe inequalities and their reasons and in the light of supporting policies development.

Prevalence of cutipositivity in a sample of homeless shelter population in Rome in the course of Latent Tuberculosis Infection surveillance plan. Preliminary results

Background : in Europe homelessness is a known risk factor both for active and latent tuberculosis (TB). In Rome 409 cases of TB were notified in 2004, but the real occurrence among homeless people is unknown. Tuberculosis surveillance has been organized with the aim to develop an integrated model for the risk evaluation and management of both Latent Tuberculosis infections (LTBI) and TB in Rome homeless people. Methods : the eligible individuals have been recruited in the homeless’ refuges. The Tuberculin Mantoux test has been used to evaluate the infection prevalence; in case of a positive result, the individual’s expectorate has been collected and the chest X-ray has been performed. A collecting data form has been filled in for evaluating some risk factors. Multiple logistic regression models have been carried out to find statistically significant determinants of infection. Results : out of 120 subjects recruited, 108 came back for the evaluation of the skin test; the prevalence of LTBI was 43.5% (47/108 subjects); no active TB cases were found. According to the multivariate analysis, factors significantly associated to LTBI are gender (for males OR = 4.94; 95% CI: 1.46 – 16.67, 1st model; OR 5.84; 95% CI: 1.26 – 21.10, 2nd model), birth place (for Europe: OR 3.05; 95% CI: 1.02 – 9.13, 1st model; OR 3.12; 95% CI: 1.10 – 8.88, 2nd model; for East Mediterranean native Region OR = 4.34; 95%CI: 1.15-16.39); Body Mass Index class (for obesity OR = 3.34; 95% CI:1.31-8.51). Conclusions : these preliminary results have demonstrated a high prevalence of LTBI among homeless people. Male gender, birth place (Europe and East Mediterranean native Region) and obesity were found to be significant risk factors. The surveillance system allowed positive patients for LTBI to be rapidly directed to a specialized centre for the clinical evaluation and the appropriate therapy in order to prevent the evolution of disease.

Healthcare utilization among urban homeless followed by an outpatient clinic: more intensive use by migrant groups.

Introduction: The increasing share of homeless represents a challenge for the healthcare system. In Rome, Italy, a large ambulatory care centre for the homeless had adopted several measures to improve access to health care facilities by migrants. We aimed to determine the rate of utilization among migrants as compared to the Italian homeless. Methods: We collected data on 2604 homeless adults who had their first medical examination between 2007 and 2011. We conducted Poisson regression to analyse the association of medical and demographic variables with the number of revisits within 1 year after the first contact. Results: As compared to the Italian-born homeless, the number of revisits among the migrants which included undocumented migrants, homeless EU citizens, forced migrants and refugees, was increased. These differences were also noted among those with chronic conditions detected on the first contact. The differences were substantial among males but not among females. A greater frequency of revisits was also observed among the uneducated and those who were not registered with the National Health Service. Conclusion: The specialised services in this clinic were able to achieve relatively high rates of revisits among the homeless of foreign background. This suggests that the utilization of health care services by these people may be effectively increased by the implementation of a series of migrant-oriented practices.

Serum-epidemiological survey in a group of illegal immigrates for the evaluation of immunity against vaccine-preventable diseases in Italy.

Background During the period May 2004 – December 2005 a serum epidemiological survey for preventable diseases through compulsory vaccination in Italy (diphtheria, tetanus, poliovirus, hepatitis B) and rubella in women was performed in a group of adult and illegal immigrants living in Rome, to evaluate the relationship between vaccination coverage and socio-demographic characteristics. Methods It was carried out by Elisa test (for rubella, tetanus, diphtheria and hepatitis B) and by neutralizing antibody titration (Poliovirus). Both descriptive analyses (calculation of mean, median, standard deviation, percentage) and inferential statistics (hypothesis tests) were used. Results Six hundred and sixty-seven immigrants were invited to participate and 318 of them performed the analysis (participation rate = 47.6 %). The percentages of immunized individuals were: 39.1% for diphtheria (basic immunization 59.3%), 74.8% for tetanus, 74.1% for poliomyelitis, and 94.7% for rubella. Only 2.8% was vaccinated against hepatitis B. Conclusion Most immigrants would need a booster dose for diphtheria and tetanus. Among Eastern European subjects Poliovirus vaccination coverage was lower than 70%, implying that the maintenance of high levels of it is strongly necessary. With regard to rubella, African women had the lowest coverage (87.5%) and their young age exposes to congenital rubella. Over half of immigrants were healthy carriers for HBV.

The role of the Student’s involvement in GlobalHealth Medical Education: the results of a surveyconducted in four Medical Schools in Rome

2010 as reached universal salt iodization (USI). After this time, researches on iodine deficiency at the national level were not held in Kazakhstan. Objectives: The evaluation of the situation on iodine intake at the national level by urine iodine excretion, revelation of salt iodization quality and the awareness level of the population on iodine deficiency, comparison of indicators overtime in RK. Methods A cross-sectional survey of 2011 included 64 clusters on 22 women in each cluster. The women of reproductive age (15-49 years) were interviewed and 1145 salt samples were collected from their households for quantitative determination of iodine, and 1296 their urine samples were analyzed on content of iodine by ammonium persulfate digestion method, based on the Sandell-Kolthoff reaction. It was conducted a comparative analysis of the results with data from national studies before adopting USI strategy (1999) and MICS (2006). Results The urinary iodine median at women in 2011 was 181.1 mg/l, in 2006 235.9 mg/l, in 1999 93.9 mg/l. The prevalence of iodine deficiency of women was 22.8% in 2011, it was 15.9% in 2006, and 54.2% in 1999. In 2011 the percentages of salt samples with adequately iodized salt (?15 ppm) were 95.9%, in 2006 91.4 %, in 1999 29%. In 2011 among interviewed women 92.7%, n = 1303 knew that salt is iodized, in 2004 these were 93,3%, n = 1 500, and only 58.6% were aware of the need to use iodized salt, n = 4800 in 1999. Conclusions Since the adoption of the Law on mandatory salt iodization consumption percentage of adequately iodized salt has increased, which in turn affected the rising of urinary iodine levels at the population. After 8 years of USI median of urinary iodine excretion decreased slightly comparing with 2006, but remained in the normal range on the Background of adequately iodized salt coverage more than 90%. It indicates the necessity of periodic biological monitoring and continuing communication activity among population on long-term and constantly basis. Key message After 8 years of USI median of urinary iodine excretion decreased slightly comparing with 2006, but remained in the normal range.

Migrant Health: a value for Public Health

The health matters associated with migration are crucial public health challenges faced by both governments and societies. According to United Nations estimates, 120 million of the approximately 175 million migrants worldwide are migrant workers with their families (1). Legal and illegal workers have a different status and, therefore, varying levels of access to social and health services. The collective health needs and implications of this sizeable population are considerable, and different health determinants and levels of vulnerability could impact on their health (2). The main public health goal is to avoid disparities in health status and access to health services between migrants and the host population (3). The second, closely associated principle, is to ensure migrants’ health rights, as stated during the 4th Conference on Migrant and Ethnic Minority Health in Europe which took place from 21st to 23rd June 2012 in Milan, where Migrants and ethnic minorities were confirmed as a benefit to the society (4).

Il giudizio di accettabilitá degli alimenti pronti al consumo nelle mense ospedaliere: significato, limiti e difficoltá di applicazione

Obiettivi : verificare l’applicabilita di Linee Guida nazionali ed internazionali ai fini dell’espressione del giudizio di accettabilita su alimenti pronti al consumo distribuiti nei servizi di ristorazione ospedaliera. Metodi : su 160 campioni di alimenti pronti al consumo (64 della mensa ospedaliera A e 96 della mensa B) sono state effettuate analisi microbiologiche per la valutazione di specifici indicatori di contaminazione. La carica totale di schizomiceti mesofili (norma ISO 4832: 1991) e stata utilizzata per fornire un giudizio di accettabilita sia secondo le Linee Guida del PHLS (1), sia secondo le Linee Guida della DGR Lazio (2). Risultati: applicando le due Linee Guida alla mensa A, il 98,5% dei campioni risulta soddisfacente, l’1,5% accettabile, nessun campione insoddisfacente o scadente. Nella mensa B, secondo le Linee Guida PHLS il 95% dei campioni e soddisfacente, il 4% accettabile, l’1% insoddisfacente, mentre secondo le Linee Guida della DGR Lazio, il 99% dei campioni e soddisfacente, l’1% accettabile e nessun campione risulta scadente. Conclusioni : la varieta dei piatti pronti al consumo e le variabili che ne condizionano la qualita rendono difficile la definizione e l‘applicazione di Linee Guida di accettabilita sulla base dei soli risultati delle analisi microbiologiche, condizionati anch’essi da molteplici fattori; le categorie di giudizio spesso non corrispondono, proponendo valori soglia differenti per cui e difficile attribuire una standardizzazione per preparazione culinaria alle diverse macrocategorie di prodotti. Fondamentale e, nel contesto ospedaliero, la valutazione del rischio in ospiti particolarmente suscettibili perche ospedalizzati: i parametri da considerare vanno oltre la semplice carica microbica misurata estemporaneamente sul prodotto finito (comprendendo ad esempio i rilievi ispettivi e le analisi della documentazione).