In recent years, an increase in vaccine hesitancy has led to a decrease in vaccination coverage in several countries. We conducted a systematic review of studies that assessed knowledge of and ...attitudes toward pediatric vaccinations, and the vaccination choices and their determinants among pregnant women. A total of 6,277 records were retrieved, and 16 full texts were included in the narrative synthesis. The published literature on the topic shows that, overall, pregnant women believe that vaccines are important for the protection of their children and the community, but various concerns and misunderstandings persist around vaccine safety and efficacy, which reduce the trust of expectant mothers in immunization. Nevertheless, such attitudes and choices vary depending on the vaccine being considered and the corresponding determinants should therefore be studied in the context of each specific vaccination. Further research on this topic is needed, particularly in non-western countries.
ObjectivePrecarious employment is characterised by instability, lack of protection and economic vulnerability. The objective of this study was to assess the association between temporary contracts ...and mortality.DesignCohort study.SettingRome, Italy.ParticipantsAll employees, aged 25–65 years, from the Rome Longitudinal Study, followed from 21 October 2001 to the first date among death, migration from Rome, or 31 December 2015.Primary and secondary outcome measuresWe investigated all-cause, cardiovascular and accidental mortality. We considered gender, age, place of birth, education, temporary versus permanent contract and sector of employment. We used Cox models to investigate the association between type of contract and total, cardiovascular and accidental mortality in men and women, overall and by employment sector.ResultsWe analysed 597 834 subjects. The proportion of temporary contracts varied by gender (9.6% in men and 13.3% in women) and by employment sector, ranging from 4.5% (public administration) to 27% (recreational, cultural, sports activities) in men. During the study period, 21 136 subjects died. Men with temporary contracts, compared with those with permanent positions, had greater overall mortality risk (HR=1.16, 95% CI 1.09 to 1.24), cardiovascular mortality (HR=1.29, 95% CI 1.14 to 1.45) and accidental mortality (HR=1.27, 95% CI 1.04 to 1.57). In men, the association varied widely among different economic sectors, with greater risks in the industry, building constructions and social services sectors. In women, there was no evidence of association between temporary contracts and mortality. A statistically significant association between temporary contracts and mortality in women was found in the sector of sales and transports only.ConclusionsTemporary work should be considered a determinant of health, particularly for specific economic sectors.
Abstract
Background
Despite mergers have increasingly affected hospitals in the recent decades, literature on the impact of hospitals mergers on healthcare quality measures (HQM) is still lacking. ...Our research aimed to systematically review evidence regarding the impact of hospital mergers on HQM focusing especially on process indicators and clinical outcomes.
Methods
The search was carried out until January 2020 using the Population, Intervention, Comparison and Outcome model, querying electronic databases (MEDLINE, Scopus, Web Of Science) and refining the search with hand search. Studies that assessed HQM of hospitals that have undergone a merger were included. HQMs were analyzed through a narrative synthesis and a strength of the evidence analysis based on the quality of the studies and the consistency of the findings.
Results
The 16 articles, included in the narrative synthesis, reported inconsistent findings and few statistically significant results. All indicators analyzed showed an insufficient strength of evidence to achieve conclusive results. However, a tendency in the decrease of the number of beds, hospital staff and inpatient admissions and an increase in both mortality and readmission rate for acute myocardial infarction and stroke emerged in our analysis.
Conclusions
In our study, there is no strong evidence of improvement or worsening of HQM in hospital mergers. Since a limited amount of studies currently exists, additional studies are needed. In the meanwhile, hospital managers involved in mergers should adopt a clear evaluation framework with indicators that help to periodically and systematically assess HQM ascertaining that mergers ensure and primarily do not reduce the quality of care.
Since limited data are available about the prevalence of Merkel cell polyomavirus (MCPyV) and the genetic variability of its noncoding control region (NCCR) in the context of immunosuppression, this ...study aimed to investigate the distribution of MCPyV in anatomical sites other than the skin and the behavior of NCCR among an HIV-1-positive population.
Urine, plasma, and rectal swabs specimens from a cohort of 66 HIV-1-positive patients were collected and subjected to quantitative real-time polymerase chain reaction (qPCR) for MCPyV DNA detection. MCPyV-positive samples were amplified by nested PCR targeting the NCCR, and NCCRs alignment was carried out to evaluate the occurrence of mutations and to identify putative binding sites for cellular factors.
MCPyV DNA was detected in 10/66 urine, in 7/66 plasma, and in 23/66 rectal samples, with a median value of 5 × 10
copies/mL, 1.5 × 10
copies/mL, and 2.3 × 10
copies/mL, respectively. NCCR sequence analysis revealed a high degree of homology with the MCC350 reference strain in urine, whereas transitions, transversions, and single or double deletions were observed in plasma and rectal swabs. In these latter samples, representative GTT and GTTGA insertions were also observed. Search for putative binding sites of cellular transcription factors showed that in several strains, deletions, insertions, or single base substitutions altered the NCCR canonical configuration.
Sequencing analysis revealed the presence of numerous mutations in the NCCR, including insertions and deletions. Whether these mutations may have an impact on the pathogenic features of the virus remains to be determined. qPCR measured on average a low viral load in the specimens analyzed, with the exception of those with the GTTGA insertion.
Audit and Feedback (A&F) is one of the most common strategies used to improve quality in healthcare. However, there is still lack of awareness regarding the enabling factors and barriers that could ...influence its effectiveness. The aim of this study was to develop a questionnaire to measure the knowledge, attitudes and behaviors of general practitioners (GPs) regarding A&F. The study was performed in the context of the EASY-NET program (project code NET-2016-02364191).
The survey was developed according to two steps. Firstly, a scoping review was performed in order to map the literature on the existing similar instruments with the aim of identifying the sub-domains and possible items to include in a preliminary version of the questionnaire. In the second phase, the questionnaire was reviewed by a multidisciplinary group of experts and administrated to a convenience sample in a pilot survey.
Ten papers were included in the scoping review. The survey target and development methodology were heterogenous among the studies. The knowledge, attitudes and behaviors domains were assessed in six, nine and seven studies, respectively. In the first step, 126 pertinent items were extracted and categorized as follows: 8 investigated knowledge, 93 investigated attitudes, and 25 investigated behaviors. Then, 2 sub-domains were identified for knowledge, 14 for attitudes and 7 for behavior. Based on these results, a first version of the survey was developed via consensus among two authors and then revised by the multidisciplinary group of experts in the field of A&F. The final version of the survey included 36 items: 8 in the knowledge domain, 19 in the attitudes domain and 9 in the behaviors domain. The results of the pilot study among 15 GPs suggested a good acceptability and item relevance and accuracy, with positive answers totaling 100% and 93.3% in the proposed questions.
The methodology used has shown to be a good strategy for the development of the survey. The survey will be administrated before and after the implementation of an A&F intervention to assess both baseline characteristics and changes after the intervention.
Job satisfaction plays an important role in healthcare organization and management; it is critical for maintaining and improving staff efficiency and consequently the quality of care provided. ...Organizational restructuring processes, including mergers, are likely to affect job satisfaction levels, but evidence of the impact they have is surprisingly scarce. The aim of the study was to describe a methodology used to measure job satisfaction of the employees at a Local Health Unit (LHU) in Italy immediately after a merger and to assess the determinants associated with any reduction in worker satisfaction. The study was conducted among employees of the LHU of the Sardinia Region in July 2018, after a merger of eight subregional LHUs had taken place. The entire staff was enrolled, of which a total of 1,737 employees were surveyed. We used a questionnaire exploring socio-demographic and working characteristics of the employees, the various areas related to job satisfaction and interviewee opinions on the merger process. Multivariable stepwise backward logistic regression models were built to identify factors independently associated with lower job satisfaction. The results of a multivariable analysis showed that lower job satisfaction was more likely in employees with an administrative role (aOR: 2.34, 95% CI: 1.37-4.00) or a career demotion (aOR: 1.84, 95%CI: 1.11-3.03). High levels of mental stress were strongly associated with lower job satisfaction (aOR: 5.64, 95%CI: 4.16-7.64). "More equity of employee rewards" was the only example of a set of responder suggestions found to be associated with lower job satisfaction (aOR: 2.30, 95%CI: 1.51-3.47). Generally, responders showed a good level of job satisfaction-and this was also the case following the merger-but some job profile determinants were strongly associated with low employee satisfaction. The results of the study highlighted several challenging areas and critical issues relating to working conditions. Further surveys are required to confirm these results and to monitor their evolution over time.
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
(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.
Assessing the population structure and understanding growth patterns is crucial to manage freshwater resources and to solve fundamental questions concerning endangered species conservation. ...Austropotamobius pallipes (Lereboullet, 1858) species complex has been declining on a widespread basis in Europe, including Italy, but detailed data on population structure and growth are lacking. In four mountain streams populated by the species, water temperature data were collected by data-loggers. In July 2012, a total of 746 crayfish were collected at night and their length was measured. Females and males size distributions were analysed separately for each stream using Bhattacharya’s Method. Age was assigned to each length class. The mean values of the age classes were used to evaluate the growth rate of Von Bertalanffy, by the seasonalized equation. Up to six age classes were identified in two populations. Results show that three out of four populations are well-structured, and they confirm that A. pallipes complex is a K-selected species. We stress the need for long-term monitoring and the importance of obtained results in development of conservation plans of endangered crayfish.
O queijo artesanal serrano é um queijo tradicional de leite cru no sul do Brasil. Para o consumo seguro de produtos lácteos nao pasteurizados, a maturaçao é um período crítico para reduzir populaçöes ...de microrganismos patogénicos e deteriorantes, sendo, portanto, necessário o conhecimento da cinética de inativaçao de microrganismos para garantir a segurança e a qualidade dos alimentos. No presente trabalho, a cinética de inativaçao de patógenos de origem alimentar exigida pela regulamentaçao brasileira em queijos artesanais foi avaliada estatisticamente durante a maturaçao. Salmonella spp., Listeria monocytogenes, Staphylococcus aureus coagulase positivo e coliformes fecais foram analisados por até 60 dias. Os dados experimentais foram ajustados aos modelos de primeira ordem de inativaçao, Weibull e log-linear + ombro. Os resultados mostraram que os queijos sao seguros para a presença de Salmonella spp. e L. monogyatogenes ao longo do período estudado. Os modelos de primeira ordem e Weibull apresentaram bom desempenho para representar S. aureus coagulase positiva e coliformes fecais durante a maturaçao, embora a distribuiçao de Weibull tenha se mostrado melhor para descrever os dados experimentais. A equaçao log-linear + ombro foi descartada para descrever a reduçao na contagem de microrganismos por critérios físicos. A cinética mostrou resistencia inicial dos coliformes fecais a serem inativados, diferentemente da populaçao de S. aureus coagulase positiva. A análise de modelagem permitiu estimar o período de maturaçao do queijo serrano em mais de 33 dias para a obtençao de um produto seguro, de acordo com as normas brasileiras.
Fragmented data are available on the human polyomaviruses (HPyVs) prevalence in the gastrointestinal tract. Rearrangements in the non-coding control region (NCCR) of JCPyV and BKPyV have been ...extensively studied and correlated to clinical outcome; instead, little information is available for KIPyV, WUPyV and MCPyV NCCRs. To get insights into the role of HPyVs in the gastrointestinal tract, we investigated JCPyV, BKPyV, KIPyV, WUPyV and MCPyV distribution among hematological patients in concomitance with gastrointestinal symptoms. In addition, NCCRs and VP1 sequences were examined to characterize the strains circulating among the enrolled patients. DNA was extracted from 62 stool samples and qPCR was carried out to detect and quantify JCPyV, BKPyV, KIPyV, WUPyV and MCPyV genomes. Positive samples were subsequently amplified and sequenced for NCCR and VP1 regions. A phylogenetic tree was constructed aligning the obtained VP1 sequences to a set of reference sequences. qPCR revealed low viral loads for all HPyVs searched. Mono and co-infections were detected. A significant correlation was found between gastrointestinal complications and KIPyV infection. Archetype-like NCCRs were found for JCPyV and BKPyV, and a high degree of NCCRs stability was observed for KIPyV, WUPyV and MCPyV. Analysis of the VP1 sequences revealed a 99% identity with the VP1 reference sequences. The study adds important information on HPyVs prevalence and persistence in the gastrointestinal tract. Gastrointestinal signs were correlated with the presence of KIPyV, although definitive conclusions cannot be drawn. HPyVs NCCRs showed a high degree of sequence stability, suggesting that sequence rearrangements are rare in this anatomical site.
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