11 research outputs found
Practical method of control of TBC in a population of students belonging to the Sapienza University of Rome, Italy.
No full textTo describe the surveillance and control protocol for tuberculosis in healthcare students in use at the CMO of University "Sapienza" and founded on a dedicated database. Analysis of health certificates through a dedicated data storage software based on Microsoft Access 2007. Students resulting positive to Mantoux test who did not undergo second-level examination (chest X-ray, TB Gold, prophylaxis) are invited to refer themselves within ten days to the infectious disease specialist. the methodological analysis, refined over the years by the CMO staff of the Sapienza University of Rome, allowed to match clinical certification data, to rapidly focus upon TBC spread control among healthcare settings, to register new students time zero before their admission to courses and potential professional exposure, to perform epidemiological studies aimed to increase TBC control through healthcare system released clinical certification confirmation
LA VACCINAZIONE ANTITUBERCOLARE PER GLI STUDENTI DI MEDICINA E CHIRURGIA DELL’UNIVERSITÀ DEGLI STUDI DI ROMA “LA SAPIENZA”: ESPERIENZA DEL CENTRO DI MEDICINA OCCUPAZIONALE
No full textSince early 80’s, tubercolosis cases has present a
gradual increase in all industrial countries.
This study, is being carried out on 4180 vaccination certificates of
nursing students being evaluated by the Occupational Medical Center
(OMC) of the University of Rome “La Sapienza”. From the analysis of
the study, we realize that Tine test is the main screening test, but the lecture
time is not respected (48-72 h) in the public and private structures,
despite informations provide by DPR 456/01 and that there are low percentage
of subjects cuti-positive performing the chest X-ray.
It’s auspicable that the institutions intervene to ensure the standard
time for tuberculin test lecture in all italian center, encouraging the use
of new test blood. The OMC from 2007 to 2008 on a portal designed
biohazard (www.rischiobiologico.org) that contains the registry of occupationally
exposed students designed to be shared by public bodies. This
allows optimization of the cost-benefit balance avoiding the repetition of
clinical screening. The design of educational campaigns and (e-learning)
could be used by students and employers to receive correct information
on how to minimize the risk of exposure and for proper post-exposure
prophylaxis
Skin test screening for tuberculosis among healthcare students: a retrospective cohort study.
No full textAim of the study was to document the baseline prevalence of healthcare students positive to tuberculosis skin tests screening. Between 2008-2010, students admitted to healthcare courses (medicine, nursing, physiotherapy...) at Sapienza university in Rome were requested to carry out personal tuberculosis skin test screening in their local district or town healthcare centers according to the italian guidelines. At the time interferongamma release assays (IGRA) testing was not adopted for large screening. Demographic characteristics, tuberculosis screening results, healthcare course, tuberculosis vaccination status were recorded. A cohort of 2,500 university healthcare students were screened by several Italian Hygiene Offices using tuberculin skin test and Tine test. Overall 131 (5.2%) healthcare students resulted positive to some tuberculosis skin test screening. Tuberculin skin test was carried out on 2,029 students (81.2%) and conversion was observed in 107 (5.3%), whereas Tine test was carried out on 498 students (19.9%) and positive result was observed in 24 (4.8%). The Tine test use and non optimal (<72h) recording of the forearm induration in tuberculin skin tests was related mostly to some healthcare centers in Lazio and Campania regions. Previous BCG vaccination was reported by 27 healthcare students (1.1%), and only two of them showed tuberculin skin test conversion, whereas the large majority 105 (98.1%) of Mantoux positives had not been vaccinated. In univariate analysis positive tuberculin skin test was associated to growing students age (29.2 ± 10.3 vs. 23.1 ± 6.0; p<0.01). Positive tuberculin skin test was recorded in 25 (20.3%) foreign and 82 (4.3%) italian students showing a higher risk for International students (RR 4.72; 95%CI 3.14 - 7.11; p<0.01). There was no significant correlation between the different Italian regions, the various healthcare courses or gender. The study evaluated the baseline positive skin test rate for tuberculosis among healthcare students in their first university year, showing a higher risk for the international group and revealed some problematic screening practices which need to be improved in the future screening programs
CARATTERIZZAZIONE DEL TERRITORIO DEL XIX MUNICIPIO DEL COMUNE DI ROMA PER UN MODELLO DI LETTURA IN GRADO DI ANALIZZARE I RISCHI PER LA SALUTE DEI RESIDENTI
No full textAssociation between socio-demographic factors and eye diseases of italian university employees subjected to health surveillance. An observational study
No full textIntroduzione. I lavoratori esposti a rischi lavorativi per l’apparato oculo-visivo sono obbligatoriamente sottoposti a sorveglianza sanitaria che include tra gli accertamenti la visita oculistica. Obiettivo. Valutare la prevalenza delle patologie oculari tra i dipendenti dell’Ateneo e analizzare l’associazione tra fattori socio-demografici e le patologie tramite l’analisi dei dati informatizzati. Metodi. È stato condotto uno studio cross-sectional sui dati raccolti in una cartella clinica elettronica. È stata effettuata un’analisi univariata e successivamente una regressione logistica per verificare l’associazione tra le patologie oculari e le variabili socio-demografiche come genere ed età. Questo studio è stato effettuato utilizzando un database di cartelle oculistiche informatizzate di un Ateneo romano, riferite al periodo 2017-2018. Risultati. Il campione dello studio è di 4503 dipendenti, 44,86% uomini 55.13 % donne. L’età media è risultata pari a 44,53 anni. Le alterazioni oculo-visive più frequenti nei lavoratori dell’Ateneo risultano essere quelle rifrattive: miopia (53,87%), astigmatismo (37,95%), presbiopia (34,06%), ipermetropia (14,25%). L’analisi multivariata mostra che l’incremento dell’età è associato ad un aumento del rischio con tutte le variabili di esito, eccezione fatta per la miopia (OR = 0.98; IC 95%: 0.97 - 0.98). Il sesso femminile è associato ad un minore rischio di astigmatismo (OR= 0.83; C 95%: 0.73 - 0.94), cheratocono (OR = 0.22; IC 95%: 0.09 - 0.54) e discromatopsia (OR = 0.08; IC 95%: 0.02 - 0.34). Conclusioni. Considerando il numero elevato dei lavoratori coinvolti nello studio, la frequenza di esposizione ai rischi lavorativi e il fatto che alcune categorie di lavoratori siano esposte a più fattori di rischio contemporaneamente, si può concludere che la sorveglianza sanitaria possa essere un utile strumento di monitoraggio e controllo delle patologie oculari nei lavoratori a rischio.Abstract
SUMMARY: Background. Workers exposed to occupational hazards for the ocular apparatus are subject to health surveillance which includes an eye examination. Objectives. To assess the prevalence of eye diseases among University employees and analyze the association between socio-demographic factors and eye conditions by analyzing computerized data. Methods. A cross-sectional study was conducted on the collected data. A univariate analysis and a logistic regression were performed to verify the association between eye diseases and socio-demographic factors, such as gender and age. This study was carried out using a database of computerized eye charts of a University of Rome, referring to the 2017-2018 period. Results. The sample study consists of 4503 employees, 44.86% men 55.13% women. The average age was 44.53 years. The most frequent eye conditions in University workers are refractive ones: myopia (53.87%), astigmatism (37.95%), presbyopia (34.06%), hypermetropia (14.25%). Multivariate analysis shows that increasing age is associated with an increase in risk with all outcome variables, except for myopia (OR = 0.98; 95% CI: 0.97 - 0.98). Moreover, women have a lower risk of astigmatism (OR = 0.83; C 95%: 0.73 - 0.94), keratoconus (OR = 0.22; 95% CI: 0.09 - 0.54) and dyschromatopsia (OR = 0.08; 95% CI: 0.02 - 0.34). Conclusions. Considering the high number of workers involved in the study, the frequency of exposure to occupational risks and the exposure to multiple risk factors at the same time in some categories of workers, the health surveillance resulted to be a useful tool for monitoring and control of eye diseases in workers at risk
Emorragia digestiva da tumore neuroendocrino del duodeno. Aspetti diagnostico-terapeutici e strategia chirurgica in emergenza
No full textViene riportato un raro caso di tumore indifferenziato del duode -
no in un ragazzo di diciassette anni. Il paziente giungeva all’osserva -
zione presentando un quadro di shock emorragico e di perforazione
intestinale. Alla laparatomia esplorativa era presente una voluminosa
neoformazione perforata a partenza dalla parete anterolaterale del
duodeno, circa 2 cm prossimalmente alla papilla di Vater. Veniva
effettuata l’exeresi della lesione, dopo esame istologico estemporaneo
intraoperatorio che deponeva per un tumore indifferenziato a piccole
cellule. L’esame istologico definitivo ha mostrato la presenza di un car -
cinoma neuroendocrino a basso grado di differenziazione, verosimil -
mente primitivo del duodeno.
Il carattere d’urgenza chirurgica e le difficoltà nella caratterizza -
zione istopatologica estemporanea e definitiva della neoplasia costitui -
scono elementi significativi di discussione nell’approfondimento dia -
gnostico della lesione nonché nella stadiazione e nel suo trattamento
successivo chirurgico e/o medico
Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study
No full textIntroduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda. (Globalsurg Collaborative
Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study
No full textBackground: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant
Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study
No full textFunded by DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant (MR/N022114/1) and a National Institute of Health Research (NIHR) Global Health Research Unit Grant (NIHR 17-0799)
Global economic burden of unmet surgical need for appendicitis
No full textBackground: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially
