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Introduction: Ovarian cancer is the third most frequent gynecological cancer. In early stage ovarian cancer (ESOC) comprehensive surgical staging is recommended. Surgical staging is traditionally approached by laparotomy, although minimally invasive surgery can be a valid alternative in selected patients. This study aims to analyze the surgical and oncological outcomes of three different surgical approaches in a large series of patients., Methods: We retrospectively included all histologically proven ESOC cases treated between January 2014 and December 2017. ESOC was defined as stage IA to IIB according to the 2018 FIGO staging system. Subjects were divided into groups 1, 2, and 3, based on the surgical approach (open abdominal, laparoscopic, or robotic, respectively)., Results: Within patients enrolled during the study period, 455 met the inclusion criteria. No difference in intraoperative complications was recorded in the three groups ( p = 0.709). Conversely, a significant difference occurred in postoperative complications (16.2 vs. 3.8 vs. 11.1%, in groups 1, 2, and 3 respectively, p = 0.004). No difference was found in overall survival (OS) (32 vs. 31 vs. 25 months, p = 0.481) and disease-free survival (DFS) (26 vs. 29 vs. 24 months, p = 0.178) in groups 1, 2, and 3, respectively. At univariate analysis FIGO stage I ( p = 0.004) showed a lower recurrence rate compared to FIGO stage II., Conclusion: No significant difference was found in OS and DFS among the three groups (open, laparoscopic, and robotic). The minimally invasive approach showed lower rate of complications than the laparotomic approach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cianci, Capozzi, Rosati, Rumolo, Corrado, Uccella, Gueli Alletti, Riccò, Fagotti, Scambia and Cosentino.)

Respiratory syncytial virus (RSV) is a lead cause of morbidity and hospitalizations in infants. RSV vaccines are currently under development, and preventive options are limited to monoclonal antibodies (mAb). We assessed the knowledge, attitudes and practices for RSV in a sample of general practitioners (GPs) from north-eastern Italy (2021), focusing on the risk perception for infants (age < 8 years) and its potential effectors. We administered an internet survey to 543 GPs, with a response rate of 28.9%. Knowledge status was unsatisfactory, with substantial knowledge gaps found on the epidemiology of RSV and its prevention through mAb. The main effectors of risk perception were identified as having a background in pediatrics (adjusted odds ratio (aOR): 55.398 and 95% confidence interval (95% CI): 6.796−451.604), being favorable towards RSV vaccines when available (aOR: 4.728, 95% CI: 1.999−11.187), while having previously managed an RSV case (aOR: 0.114, 95% CI: 0.024−0.552) and previously recommended hospitalization for cases (aOR: 0.240, 95% CI: 0.066−0.869) were identified as negative effectors. In summary, the significant extent of knowledge gaps and the erratic risk perception, associated with the increasing occurrence in RSV infections, collectively stress the importance of appropriate information campaigns among primary care providers.

Background and Aim: In order to cope with the requirements of COVID-19 pandemic and prevent overwhelming of the healthcare systems, during 2020 social distancing measures were proposed, and generalized lockdown. Aim of our study is to ascertain whether non-pharmaceutical intervention did have any impact on the epidemiology of Legionnaires' disease (LD), a respiratory infectious disease without interhuman spreading., Methods: Official national reports from 4 index countries in European Union (i.e. Germany, France, Italy, and Spain) were retrieved. The study included all cases notified during 2020 COVID-19 outbreak, versus the cases referred during the same period in 2019. Subgroup analyses for hospital-associated and travel-associated LD cases, as well as for lethality estimates were performed., Results: A sustained drop for incidence rate was confirmed, at EU-level (3.5 per 100,000 vs. 5.3 per 100,000) as well as in the national estimates. The decrease was particularly evident in Italy (RR 0.880, 95%CI 0.839 to 0.905), despite a transient surge in notification rates during the month of June, 2020. Subgroup analyses demonstrated a fall in travel-associated cases (-66.8% at EU level), while hospital-associated cases decreased in absolute number when compared to 2019, but where substantially stable in terms when compared to EU estimates. While Case Fatality Ratio increased in comparison with 2019, no significant trend was similarly identified in comparison to EU estimates.  Conclusions. Lockdown measures have impacted on the epidemiology of LD in Europe during 2020, but some heterogeneities were identified both across the assessed countries, and the various subgroup. Even though the absolute number of total cases did substantially decrease in 2020 compared to 2019, the effect of non-pharmaceutical interventions was mostly indirect, through a reduced interaction of individuals with environments at potentially high-risk for human infections (e.g. hospitals, accommodation sites, etc.).

Legionnaires' Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila . Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129-0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2- Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.

Background: Exoskeleton technology (ExT) has potential to significantly improve occupational health and safety. However, studies on stakeholders' perspectives are lacking. To facilitate the implementation of ExT on the workplaces, a study was undertaken exploring specific knowledge, attitudes and perspectives (KAP) of Health and Safety Consultants (HSC)., Methods: An online survey with quantitative and qualitative components was conducted with HSC participating to a series of qualification courses focusing on new technologies in occupational settings. Respondents rated whether they would use or recommend an exoskeleton, being assessed regarding their knowledge on ExT through a specifically designed knowledge test. Design features (n = 16) and expected benefits (n = 12) were rated and compared in terms of their importance. Regression analysis was used to identify factors significantly affecting the propensity towards the implementation of ExT., Results: A total of 59 HSC participated to the survey (participation rate, 90.8%): of them, 20 (33.9%) were somehow favorable towards the use of ExT on the workplaces. The most highly rated reason for potential use/recommendation of ExT was reducing the stress on joints and tendons (74.6%), followed by reducing muscle fatigue (71.2%). Among design features, higher ratings were identified for: comfort (4.53 ± 0.68), ease of setup (4.37 ± 0.72), portability (4.32 ± 0.97), minimization of falls risk (4.31 ± 0.93), ease of putting on/taking off the device (4.12 ± 1.16), and amount of physical energy needed for use (4.14 ± 0.92). Overall knowledge of ExT was quite low (knowledge score 43.2% ± 18.2), with high rate of false beliefs on the protective role of ExT on musculoskeletal disorders and physical efforts, positive effects on productivity. In multivariate analysis, age < 50 years and being an internal HSC were identified as significant effectors for a positive attitude towards ExT., Conclusions: This study emphasizes the opportunity to spread better knowledge of actual ExT features among potential stakeholders. Moreover, design of future exoskeleton should focus on devices comfortable, highly portable, ease to setup, with a reduced risk of falls.

Basketball is among the third most popular team sport in Italy. Albeit not usually perceived as being at high risk for tetanus, the Italian legal framework (Law No. 292 of 1963; Presidential Decree 1301/1965) requires tetanus vaccination (TeV) even for amateur practice. Even though some previous reports have suggested a relatively low adherence towards vaccination practice among basketball player, corresponding knowledge, attitudes and practices towards TeV remain largely unknown. Our study specifically investigated such topics in a total of 270 amateur basketball players participating into an internet-based survey by completing a structured questionnaire. Of them, 73.0% had a proper vaccination status, but a third of respondents (33.3%) exhibited some degree of vaccine hesitancy. The average understanding of TeV and tetanus (79.8% with a potential range 0-100) as well as the risk perception for natural infection (63.9% ± 26.6) were quite good. Even though unmotivated fears towards TeV were more scarcely reported (14.0% ± 15.4), they still represented the main reasons for having missed vaccination shots (63.0%). Knowledge status and risk perception for natural infection and TeV were well correlated (R = 0.22 and R = -0.64, respectively). Appropriate TeV status was more likely in respondents not exhibiting vaccine hesitancy (Odds Ratio (OR) 0.114, 95% Confidence Interval (95%CI) 0.059-0.225). In turn, vaccine hesitancy was more frequently reported among individuals of male gender (OR 3.148, 95%CI 1.072-9.244), while better formal education (OR 0.065, 95%CI 0.013-0.319) and working in healthcare settings (OR 0.042, 95%CI 0.007-0.265) were characterized as negative effectors. Vaccinations in athletes represent an often overlooked issue, with a considerable lack of available evidence. The results stress the opportunity for appropriate TeV screening programs among amateur athletes and the potential relevance of interventions aimed at raising the perceived significance of TeV in order to cope with a significant share of vaccine-hesitant athletes.

Enhanced surveillance for dengue virus (DENV) infections in Italy has been implemented since 2012, with annual reports from the National Health Institute. In this study, we summarize available evidence on the epidemiology of officially notified DENV infections from 2010-2021. In total, 1043 DENV infection cases were diagnosed, and most of them occurred in travelers, with only 11 autochthonous cases. The annual incidence rates of DENV infections peaked during 2019 with 0.277 cases per 100,000 (95% confidence interval [95% CI] 0.187-0.267), (age-adjusted incidence rate: 0.328, 95% CI 0.314-0.314). Cases of DENV were clustered during the summer months of July (11.4%), August (19.3%), and September (12.7%). The areas characterized by higher notification rates were north-western (29.0%), and mostly north-eastern Italy (41.3%). The risk for DENV infection in travelers increased in the time period 2015-2019 (risk ratio [RR] 1.808, 95% CI 1.594-2.051) and even during 2020-2021 (RR 1.771, 95% CI 1.238-2.543). Higher risk for DENV was additionally reported in male subjects compared with females subjects, and aged 25 to 44 years, and in individuals from northern and central Italy compared to southern regions and islands. In a multivariable Poisson regression model, the increased number of travelers per 100 inhabitants (incidence rate ratio [IRR] 1.065, 95% CI 1.036-1.096), the incidence in other countries (IRR 1.323, 95% CI 1.165-1.481), the share of individuals aged 25 to 44 years (IRR 1.622, 95% CI 1.338-1.968), and foreign-born residents (IRR 2.717, 95% CI 1.555-3.881), were identified as effectors of annual incidence. In summary, although the circulation of DENV remains clustered among travelers, enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.

Background: SARS-CoV-2 infection has become a global public health concern globally. Even though Healthcare Workers (HCWs) are supposedly at increased risk for SARS-CoV-2 infection, to date no pooled evidence has been collected., Materials and Methods: We searched online electronic databases (PubMed, Embase, medRxiv.org for pre-prints) for all available contribution (up to May 20, 2019). Two Authors independently screened articles and extracted the data. The pooled prevalence of SARS-CoV-2 was analyzed using the random-effects model. The possible sources of heterogeneity were analyzed through subgroup analysis, and meta-regression., Results: The overall pooled prevalence of SARS-CoV-2 was 3.5% (95%CI 1.8-6.6) for studies based on molecular assays, 5.5% (95%CI 2.1-14.1) for studies based on serological assays, and 6.5% (95%CI 2.5-15.6) for point-of-care capillary blood tests. Among subgroups, serological tests identified higher risk for SARS-CoV-2 seropositivity in physicians than in nurses (OR 1.436, 95%CI 1.026 to 2.008). Regression analysis indicated the possible presence of publication bias only for molecular tests (t -3.3526, p-value 0.002648)., Conclusions: The overall pooled prevalence of SARS-CoV-2 was lower than previously expected, but available studies were affected by significant heterogeneity, and the molecular studies by significant publication bias. Therefore, further high-quality research in the field is warranted.

Hantaviruses are zoonotic pathogens that can cause serious human disorders, including hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. As the main risk factor for human infections is the interaction with rodents, occupational groups such as farmers and forestry workers are reportedly at high risk, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of hantaviruses in farmers and forestry workers. Data were extracted using a standardized assessment form, and results of such analyses were systematically reported, summarized and compared. We identified a total of 42 articles, including a total of 28 estimates on farmers, and 22 on forestry workers, with a total workforce of 15,043 cases (821 positive cases, 5.5%). A pooled seroprevalence of 3.7% (95% confidence interval [95% CI] 2.2-6.2) was identified in farmers, compared to 3.8% (95% CI 2.6-5.7) in forestry workers. Compared to the reference population, an increased occurrence was reported for both occupational groups (odds ratio [OR] 1.875, 95% CI 1.438-2.445 and OR 2.892, 95% CI 2.079-4.023 for farmers and forestry workers, respectively). In summary, our analyses stress the actual occurrence of hantaviruses in selected occupational groups. Improved understanding of appropriate preventive measures, as well as further studies on hantavirus infection rates in reservoir host species (rodents, shrews, and bats) and virus transmission to humans, is needed to prevent future outbreaks.

Legionnaires' disease (LD) incidence has been increasing in several European countries since 2011. Currently, Italy is experiencing high notification rates for LD, whose cause still remains scarcely understood. We sought to summarize the available evidence on the epidemiology of LD in Italy (2004-2019), characterizing the risk of LD by region, sex, age group, and settings of the case (i.e., community, healthcare, or travel-associated cases). Environmental factors (e.g., average air temperatures and relative humidity) were also included in a Poisson regression model in order to assess their potential role on the annual incidence of new LD cases. National surveillance data included a total of 23,554 LD cases occurring between 2004 and 2019 (70.4% of them were of male gender, 94.1% were aged 40 years and older), with age-adjusted incidence rates increasing from 1.053 cases per 100,000 in 2004 to 4.559 per 100,000 in 2019. The majority of incident cases came from northern Italy (43.2% from northwestern Italy, 25.6% from northeastern Italy). Of these, 5.9% were healthcare-related, and 21.1% were travel-associated. A case-fatality ratio of 5.2% was calculated for the whole of the assessed timeframe, with a pooled estimate for mortality of 0.122 events per 100,000 population per year. Poisson regression analysis was associated with conflicting results, as any increase in average air temperature resulted in reduced risk for LD cases (Incidence Rate Ratio [IRR] 0.807, 95% Confidence Interval [95% CI] 0.744-0.874), while higher annual income in older individuals was associated with an increased IRR (1.238, 95% CI 1.134-1.351). The relative differences in incidence between Italian regions could not be explained by demographic factors (i.e., age and sex distribution of the population), and also a critical reappraisal of environmental factors failed to substantiate both the varying incidence across the country and the decennial trend we were able to identify.

Hantaviruses are viral pathogens usually endemic in rodent populations. Human exposure follows inhalation of dusts contaminated with rodent excreta, and most individuals have been infected in occupational settings heavily contaminated with rodent droppings, such as agricultural and forestry. To date, knowledge, attitudes and practices of medical professionals, especially occupational physicians (OP), regarding hantavirus disease in at-risk workers have been scarcely investigated. We investigated these topics through a structured questionnaire administered through an online survey of 223 medical professionals (42.2% of them working as OP). Adequate general knowledge of hantavirus disease was found in 48.9% of respondents, with OP exhibiting a better understanding of clinical features of human hantavirus infections. OP aware of the endemic status of hantavirus in North-Eastern Italy exhibited higher risk perception for agricultural workers (odds ratio 21,193, 95% confidence interval 3.666-122.505). On the contrary, a better knowledge of hantaviruses was association with acknowledging an increased risk of hantavirus infection in forestry workers (odds ratio 5.880, 95% confidence interval 1.620-21.343). Hantavirus in Italy represent an often-overlooked biological risk in occupational settings. The lack of preventive immunization, the inappropriate risk perception and the unsatisfying awareness of hantavirus issues collectively stress the importance of appropriate information campaigns among health care providers.

Background: Hantaviruses can cause serious human diseases including hemorrhagic fever with renal syndrome (HFRS) and Hantavirus Cardiopulmonary Syndrome (HCPS). European Hantavirus are usually associated with HFRS, and their geographical distribution mirrors the ecology of reservoir host species. Epidemiology of HFRS is well-studied in Western Europe, but data from Italy are fragmentary., Methods: We searched into two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of Hantaviruses in Italy. Data were extracted using a standardized assessment form, and results of the analyses were systematically reported, summarized and compared., Results: We identified a total of 18 articles, including 12 reports (total population: 5,336 subjects, 1981-2019) and 6 case reports (1984-2019). In total, 200 subjects exhibited some degree of seropositivity, with a pooled seroprevalence of 1.7% (95% confidence interval 0.7%-4.0%) in the general population. Higher occurrence was reported in selected subgroups, i.e. acute (28.7%, 95%CI 22.1-36.2) and chronic (6.6%, 95%CI 4.7-9.1) renal failure, forestry workers (3.0%, 95%CI 1.4-6.5, actual range 0.0 to 10.8%)., Conclusions: In the last decade, no human cases of hantavirus infection have been officially reported in Italy. However, our analysis stresses the actual occurrence of Hantavirus among general population and in selected population groups. Further studies on hantavirus infection rates in reservoir host species (rodents, shrews, and bats) and virus transmission to humans are needed to prevent outbreaks in the future.

Vaccinations used to prevent coronavirus disease (COVID-19)-the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-are critical in order to contain the ongoing pandemic. However, SARS-CoV-2/COVID-19 vaccination rates have only slowly increased since the beginning of the vaccination campaign, even with at-risk workers (e.g., HCWs), presumptively because of vaccine hesitancy. Vaccination mandates are considered instrumental in order to rapidly improve immunization rates (but they minimize the impact of vaccination campaigns). In this study, we investigated the acceptance (i.e., knowledge, attitudes, and practices) from occupational physicians (OPs)) in regard to SARS-CoV-2/COVID-19 vaccination mandates. A total of 166 OPs participated in an internet-based survey by completing structured questionnaires. Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of OPs. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.5% regarding its occurrence, 81.9% regarding its potential severity). SARS-CoV-2/COVID-19 vaccination was endorsed by 90.4% of respondents, acceptance for SARS-CoV-2 vaccine was quite larger for mRNA formulates (89.8%) over adenoviral ones (59.8%). Endorsement of vaccination mandates was reported by 60.2% of respondents, and was more likely endorsed by OPs who exhibited higher concern for SARS-CoV-2 infection occurrence (odds ratio 3.462, 95% confidence intervals 1.060-11.310), who were likely to accept some sort of payment/copayment for SARS-CoV-2/COVID-19 vaccination (3.896; 1.607; 9.449), or who were more likely to believe HCWs not vaccinates against SARS-CoV-2 as unfit for work (4.562; 1.935; 10.753). In conclusion, OPs exhibited wide acceptance of SARS-CoV-2/COVID-19 vaccinations, and the majority endorsed vaccination mandates for HCWs, which may help improve vaccination rates in occupational settings.

Introduction: Obesity is a known independent risk factor for endometrial cancer (EC), and obese patients have a 4.7-fold increased risk compared to the general population to develop the neoplasm. To date, a general pre and postoperative tumor grading agreement from 53 % to 82 % is reported for endometrial analysis, and a consensus on which factors might influence the tumor grading discordance is still absent. Furthermore, although obesity alters the endometrial microenvironment, no studies investigated the role of obesity in the grading agreement of EC patients. This study aims to analyze the role of obesity in the pre and postoperative tumor grading agreement., Materials and Methods: A retrospective analysis was conducted on EC cancer women subjected to surgical treatment. Upgrading discordance was defined as higher tumor grading on final pathological analysis compared to tumor grading on the preoperative examination. Downgrading discordance was defined as a lower tumor grading at the postoperative surgical specimen analysis compared to the preoperative biopsy., Results: Of the 293 selected patients, 245 were included in the analysis. One hundred and forty nine (60.8 %) patients were tumor grade G1, 52 (21.2 %) G2, and 44 (18.0 %) G3. Grading agreement was 83.9 % for G1 patients, 51.9 % for G2 patients, and 83.3 % for G3 patients. The multivariate analysis showed obesity (BMI > 30 kg/m 2 ) as significant factor influencing pre and postoperative grading agreement (p = 0.014, Odds Ratio 2.036, 95 % Confidence Interval 1.141-3.635)., Conclusions: Our study for the first time showed obesity as the only factor in the multivariate analysis lowering the pre and postoperative tumor grading concordance. Grade 2 tumor was the factor that most frequently disagreed with the final surgical specimen analysis both in the general and in obese patients., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Endometrial cancer is the most frequently diagnosed gynecological tumour. Transvaginal ultrasound has a leading role in the preoperative evaluation of endometrial cancer patients. The study aimed to identify factors that can worsen the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients. We retrospectively analysed 290 patients with histological diagnosis of endometrial adenocarcinoma. Two-dimensional (2D) gray-scale ultrasound and power Doppler imaging were performed. Age, menopause status, obesity, parity, Figo stage and benign uterine disorders were evaluated as possible factors worsening the diagnostic accuracy of the ultrasonography. FIGO stage IB was the main significant confounding factor in the univariate analysis ( p  = .004). Furthermore, 2D transvaginal ultrasound showed worse diagnostic accuracy in endometrial cancer patients with concomitant benign uterine pathologies.Impact statement What is already known on this subject? Many studies have analysed the reliability and diagnostic accuracy of transvaginal ultrasound in predicting myometrial invasion, but few studies have underlined the importance of confounding factors. Shin et al. (2011) showed that diffuse fibromatosis is a quality ultrasound confounding factor. Furthermore, Fischerova et al. (2014) showed that body mass index (BMI) did not influence the diagnostic accuracy of ultrasound assessment. What do the results of this study add? FIGO stage IB is the main factor worsening the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients ( p  = .004). Among the 82 patients with histologically proven FIGO stage IB, 27 (32.9%) had a wrong ultrasound prediction of myometrial infiltration. Twenty-one (36.2%) patients in whom there was no agreement between ultrasound prediction of myometrial infiltration and pathological analysis had fibromatosis and/or adenomyosis ( p  = 0.04). What are the implications of these findings for clinical practice and/or further research? Two-dimensional ultrasound represents a useful tool in the correct pre-operative setting of patients with endometrial cancer. In FIGO stages IB endometrial cancer patients and in conjunction with benign uterine pathologies, 2D transvaginal ultrasound has less diagnostic accuracy. In these cases, MRI still plays a leading role.

During the last decade, cases of West Nile Virus (WNV) have occurred in the Emilia Romagna Region (ERR). Even though the notification rates remain relatively low, ranging from 0.06 to 1.83 cases/100,000 inhabitants, the persistent pathogen's circulation in settings characterized by favorable environmental characteristics suggests that WNV is becoming endemic to the Po River Valley. This study assesses knowledge, attitudes, and preventive practices toward WNV prevention among residents from 10 high-risk municipalities from the provinces of Parma and Reggio Emilia (total population: 82,317 inhabitants, census 2020). A web-based survey, based on the health belief model, was performed during the month of January 2021, with a convenience sampling of 469 participants from a series of closed discussion groups on social media (i.e., 2.1% of the potential responders). A total of 243 participants knew the meaning of WNV: Of them, 61.3% were aware of previous WNV infections in ERR, 76.5% acknowledged WNV infection as a severe one, but only 31.3% expressed any worry about WNV. Our results irregularly report preventive practices, either collective (e.g., draining standing water from items and the environment, 50.7%; spraying pesticides around the home, 33.0%) or individual (e.g., use of skin repellants when going outdoors, 42.6%). In a multivariate analysis, performed through binary logistic regression, participants reporting any worry towards WNV were more likely to characterize WNV as a severe disease (adjusted odds ratio [aOR] = 20.288, 95% confidence interval [CI] = 5.083-80.972). On the contrary, respondents supporting community mosquito control programs were more likely among people working with animals/livestock (aOR = 13.948, 95%CI = 2.793-69.653), and supporting tax exemptions for mosquito control programs (aOR = 4.069, 95%CI 2.098-7.893). In conclusion, our results suggest that future interventions promoting WNV prevention among residents in ERR should focus on perceptions of vulnerability to WNV, emphasizing the benefits of personal protective behaviors.

Introduction: The favorable effects of bariatric surgery (BS) on overall pulmonary function and obesity-related comorbidities could influence SARS-CoV-2 clinical expression. This has been investigated comparing COVID-19 incidence and clinical course between a cohort of patients submitted to BS and a cohort of candidates for BS during the spring outbreak in Italy., Materials and Methods: From April to August 2020, 594 patients from 6 major bariatric centers in Emilia-Romagna were administered an 87-item telephonic questionnaire. Demographics, COVID-19 incidence, suggestive symptoms, and clinical outcome parameters of operated patients and candidates to BS were compared. The incidence of symptomatic COVID-19 was assessed including the clinical definition of probable case, according to World Health Organization criteria., Results: Three hundred fifty-three operated patients (Op) and 169 candidates for BS (C) were finally included in the statistical analysis. While COVID-19 incidence confirmed by laboratory tests was similar in the two groups (5.7% vs 5.9%), lower incidence of most of COVID-19-related symptoms, such as anosmia (p: 0.046), dysgeusia (p: 0.049), fever with rapid onset (p: 0.046) were recorded among Op patients, resulting in a lower rate of probable cases (14.4% vs 23.7%; p: 0.009). Hospitalization was more frequent in C patients (2.4% vs 0.3%, p: 0.02). One death in each group was reported (0.3% vs 0.6%). Previous pneumonia and malignancies resulted to be associated with symptomatic COVID-19 at univariate and multivariate analysis., Conclusion: Patients submitted to BS seem to develop less severe SARS-CoV-2 infection than subjects suffering from obesity.

A mass vaccination center is a location, normally used for nonhealthcare activities, set up for high-volume and high-speed vaccinations during infectious disease emergencies. The high contagiousness and mortality of COVID-19 and the complete lack of population immunity posed an extraordinary threat for global health. The aim of our research was to collect and review previous experiences on mass vaccination centers. On 4 April 2021, we developed a rapid review searching four electronic databases: PubMed/Medline, Scopus, EMBASE, Google Scholar and medRxiv. From a total of 2312 papers, 15 of them were included in the current review. Among them, only one article described a COVID-19 vaccination center; all of the others referred to other vaccinations, in particular influenza. The majority were conducted in the United States, and were simulations or single-day experiences to practice a mass vaccination after bioterrorist attacks. Indeed, all of them were published after September 11 attacks. Regarding staff, timing and performance, the data were highly heterogenous. Several studies used as a model the Center for Disease Control and Prevention guidelines. Results highlighted the differences around the definition, layout and management of a mass vaccination center, but some aspects can be considered as a core aspect. In light of this, we suggested a potential definition. The current review answers to the urgency of organizing a mass vaccination center during the COVID-19 pandemic, highlighting the most important organizational aspects that should be considered in the planning.

In Italy, human cases of West Nile virus (WNV) infection have been recorded since 2008, and seasonal outbreaks have occurred almost annually. In this study, we summarize available evidences on the epidemiology of WNV and West Nile neuro-invasive disease (WNND) in humans reported between 2012 and 2020. In total, 1145 WNV infection cases were diagnosed; of them 487 (42.5%) had WNND. A significant circulation of the pathogen was suggested by studies on blood donors, with annual incidence rates ranging from 1.353 (95% confidence intervals (95% CI) 0.279-3.953) to 19.069 cases per 100,000 specimens (95% CI 13.494-26.174). The annual incidence rates of WNND increased during the study period from 0.047 cases per 100,000 (95% CI 0.031-0.068) in 2012, to 0.074 cases per 100,000 (95% CI 0.054-0.099) in 2020, peaking to 0.377 cases per 100,000 (95% CI 0.330-0.429) in 2018. There were 60 deaths. Cases of WNND were clustered in Northern Italy, particularly in the Po River Valley, during the months of August (56.7%) and September (27.5%). Higher risk for WNND was reported in subjects of male sex (risk ratio (RR) 1.545, 95% CI 1.392-1.673 compared to females), and in older age groups (RR 24.46, 95% CI 15.61-38.32 for 65-74 y.o.; RR 43.7, 95% CI 28.33-67.41 for subjects older than 75 years), while main effectors were identified in average air temperatures (incidence rate ratio (IRR) 1.3219, 95% CI 1.0053-1.7383), population density (IRR 1.0004, 95% CI 1.0001-1.0008), and occurrence of cases in the nearby provinces (IRR 1.0442, 95% CI 1.0340-1.0545). In summary, an enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.

COVID-19 is a novel infectious disease which has rapidly spread around the globe, disrupting several aspects of public life over the past year. After numerous infection clusters emerged among travelers hosted in ski resorts in early 2020, several European countries closed ski areas. These measures were mostly upheld throughout the 2020 and 2021 winter season, generating significant economic loss for mountain communities. The aim of this rapid systematic review was to explore the association between recreational skiing and the spread of COVID-19. This review was conducted according to the WHO practical guidelines on rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, MedRxiv and Promed-mail were screened to identify relevant scientific and grey literature published since the emergence of COVID-19. Among the 11 articles included, seven focused on cases recorded during the first epidemic wave, when COVID-19 containment measures were not yet mandatory. Most infection clusters could be directly linked to public gatherings which took place without the enforcement of restrictions. There is currently no evidence to suggest an association between COVID-19 spread and recreational skiing. It may be reasonable to consider the reopening of ski areas in compliance with strict rules and preventive measures.

Burnout syndrome (BOS) is a work-related constellation of symptoms characterized by emotional exhaustion, depersonalization, and personal accomplishment. A cross-sectional survey was performed to study the prevalence of BOS among a randomly selected sample of 280 Italian Red Cross volunteers. A socio-demographic questionnaire and the Maslach Burnout Inventory (MBI)-HSS were used to collect data. 241 volunteers participated (response rate: 86.1%). A significant proportion of the workers had BOS subscale scores in the highest tertile: emotional exhaustion 8.0%, depersonalization 35.9% and perceived lack of accomplishment 23.5%, respectively. Volunteers in emergency care reported higher levels of emotional exhaustion (p=0.004) and depersonalization (p=0.001), and lower level of personal accomplishment (p=0.042) than volunteers engaged in non-healthcare social and administrative duties. These findings support the opportunity of a set of administrative, organizational and individual preventive interventions for emergency volunteers' mental health.

Objective: Incomplete hippocampal inversion (IHI) is a relatively frequent radiological finding at visual inspection in both epilepsy and healthy controls, but its clinical significance is unclear. Here, we systematically retrieve and assess the association between epilepsy and IHI using a meta-analytic approach. Additionally, we estimate the prevalence of IHI in patients with malformation of cortical development (MCD)., Methods: We systematically searched two databases (Embase and PubMed) to identify potentially eligible studies from their inception to December 2019. For inclusion, studies were population-based, case-control, observational studies reporting on epilepsy and IHI. The risk of developing epilepsy in IHI (estimated with odds ratio [ORs]) and the frequency of IHI among patients with MCD are provided., Results: We screened 3601 records and assessed eligibility of 2812 full-text articles. The final material included 13 studies involving 1630 subjects. Seven studies (1329 subjects: 952 epileptic and 377 nonepileptic) were included for the estimation of the risk of developing epilepsy in the presence of IHI. The estimated OR of active epilepsy in IHI was 1.699 (95% confidence interval = 0.880-3.281), with moderate heterogeneity across studies (I 2  = 71%). Seven studies (591 patients) provided information about the frequency of IHI in MCD. Up to one third of patients with MCD (27.9%) presented coexistent IHI., Significance: The present findings confirm that IHI is commonly observed in patients with MCD especially in periventricular nodular heterotopia or polymicrogyria. However, the estimated OR indicates overall weak increased odds of epilepsy in people with IHI, suggesting that the presence of isolated IHI cannot be considered a strong independent predictor for epilepsy development. Clear-cut neuroradiological criteria for IHI and advanced postprocessing analyses on structural magnetic resonance imaging scans are recommended to highlight differences between epileptogenic and nonepileptogenic IHI., (© 2020 International League Against Epilepsy.)

Background: Occupational Eye Injury (OEI) represents a common world-wide event accounting for between 3.3% and 6.1% of all occupational compensation claims. In this retrospective study we evaluated all the recorded OEI which occurred in the Autonomous Province of Trento (APT) during the period 2000-2013., Methods: Data on OEI for all of APT were retrieved an institutional archive and the analysis included demographics of the injured, as well as characteristics and settings of the OEI. In order to assess the risk of OEI in Agricultural Workers (AWs) vs. all other Occupational groups, a multivariate analysis was eventually performed through a logistic regression analysis., Results: A total of 141,139 work-related injuries were recorded, including 5,065 (3.6%) OEI. 91.9% of all cases occurred in males, of Italian origin (77.2%), with a mean age of 38.4±11.7 years. The industrial sector reported the higher share of OEI (70.7%), whereas higher incidence rates were reported among AWs (6.04 vs. 3.85/1,000 workers/year). Agricultural OEI occurred in older workers (45.6±13.3 vs. 37.1±11.0 years), being more likely associated with "contusions" (OR 2.042, 95% 1.602-2.602) and "lacerations" (OR 2.386, 95%CI 1.877-3.033), and less frequently with exposures to chemicals, gases and vapours (OR 0.478, 95%CI 0.279-0.817)., Conclusions: Despite a relatively low frequency of OEI, AWs were affected with a seemly higher incidence than that reported in other occupational groups. OEI in AWs exhibited a specific pattern, both in terms of lesion, and settings of the events, recommending tailored interventions in order to improve promotion strategies. (www.actabiomedica.it).

Background/aim: Signet-ring cell carcinoma (SRCC) is an uncommon histological variant of colorectal cancer (CRC). Knowledge is scarce due to its rarity. Our aim was to better evaluate the clinicopathologic and prognostic features of this little-known malignancy., Patients and Methods: Thirty-nine consecutive patients with non-metastatic colorectal SRCC undergoing curative resection at University Hospital of Parma between 2000 and 2018 were examined in this retrospective analysis., Results: Mean overall (OS) and disease-free survival (DFS) were 33.6 and 31.5 months, respectively. At univariate analysis, the lymph-related parameters (nodal status, Stage III, metastatic lymph node ratio and lymphovascular invasion) were significantly associated with shorter OS and poorer DFS. At multivariate analysis, Stage III and a metastatic lymph node ratio ≥25% were found to be the only independent prognostic factors significantly correlated with worse OS and DFS., Conclusion: Nodal and lymphatic status should be carefully pondered when planning the most appropriate management of patients with colorectal SRCC., (Copyright © 2020 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Describing knowledge, attitudes and beliefs about leprosy amongst Medical Professionals in a nonendemic area (Parma Province, North-Western Italy)., Methods: A cross-sectional study was carried among a sample of Medical Professionals (MP; No. 242) during June and July 2019 as an on-line self-administered questionnaire including 21 true/false items about epidemiology, diagnosis, and clinical characteristics of leprosy. Effectors of better knowledge status (KS) and higher risk perception (RP) were assessed through calculation of respective multivariate odds ratios (OR) and 95% confidence intervals (95%CI) in two logistic regression analysis models., Results: A total of 102 questionnaires were retrieved (participation rate 42.1%; 67.6% of respondents < 50 year-old). Of them, 10.8% had previously interacted with at least one leprosy case. Knowledge status (KS) was unsatisfying (59.7% correct answers), and also RP was relatively low, as 91.2% of them acknowledged leprosy as a severe disease, but only 42.2% identified leprosy as highly communicable. Knowledge gaps affected particularly understanding of epidemiology and non-dermatological issues. Moreover, 30.4% of respondents ignored that a treated leprosy case may remain in the community before disease eradication. The main effector of KS was having interacted with a leprosy case (OR 4.881 95%CI 1.245-36.905), while RP was negatively associated with a better KS (OR 0.094 95%CI 0.027-0.334), and working as general practitioner (OR 0.133 95%CI 0.031-0.562)., Conclusions: While individual expertise of European MP on leprosy slowly disappears, significant knowledge gaps and the high share of misconceptions collectively stress that refresher training may improve early diagnosis and management of incident cases.

Background: Early bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. However, few data are available regarding the willingness to perform CPR among First Aid Attendants on the Workplace (FAAWs) in Italy. The present study was performed in order to identify current attitudes of Italian FAAWs towards CPR., Methods: Between February and June 2017, FAAWs from the Autonomous Province of Trento were asked about their willingness to perform CPR through a structured questionnaire assessing their knowledge about CPR, and the reasons for hesitancy. A cumulative knowledge score (KS) was eventually calculated., Results: A total of 123 FAAWs (male 57.7%, mean age 45.2 years ± 10.1) completed the questionnaire. About 1/3 of participants (32.5%) had previously performed First Aid procedures. Overall, 77.2% exhibited willingness to perform CPR, and such attitude was more frequently reported by subjects younger than 40 years (29.5% vs. 10.7% in older subjects; p = 0.045), perceiving First Aid training as useful (98.9% vs. 84.7%, p = 0.002), and exhibiting a better knowledge of CPR (KS ≥ 75%: 47.4% vs. 15.3%). The reasons for the unwillingness were inadequate knowledge and doubt regarding whether they could perform the techniques effectively. Eventually, KS was identified as the main predictor for willingness to perform CPR (OR 4.450, 95%CI 1.442 - 14.350)., Conclusions: Willingness to perform CPR was seemingly high, and knowledge of CPR techniques was its main predictor. These findings emphasize the importance for an accurate CPR training, as well as for the surveillance of the quality of qualification courses.

Using muon-spin spectroscopy, we study the exceptional dynamical properties of rotating molecular struts engineered within a Zn-based metal-organic framework at cryogenic temperatures, where the internal motions of almost any other organic substance are quenched. Muon-spin spectroscopy is particularly suited for this aim, as the experimental evidence suggests several implantation sites for the muons, among which at least one directly onto the rotating moiety. The dynamics of the molecular rotors are characterized by the exceptionally low activation energy E A ∼ 30 cal mol -1 . At the same time, we evidence a highly unusual temperature dependence of the dipolar interaction of muons with nuclear magnetic moments on the rotors, suggesting a complex influence of the rotations on the muon implantation and diffusion.

Background and Aim of the Work: The ongoing pandemic has elicited an increasing interest regarding the SARS-CoV-2 viral RNA detection in saliva specimens rather than through nasopharyngeal swabs. Our aim was to conduct a meta-analysis on the sensitivity and specificity of SARS-CoV-2 viral RNA detection through RT-qPCR based on salivary specimens compared to conventional nasopharyngeal swabs., Methods: We reported our meta-analysis according to the PRISMA statement. We searched Pubmed, Embase, and pre-print archive medRxiv.og for eligible studies published up to June 1st, 2020. Raw data included true/false positive and negative tests, and the total number of tests. Sensitivity and specificity data were calculated for every study, and then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure. Reporting bias was assessed by means of funnel plots and regression analysis., Results: The systematic review eventually retrieved 14 studies including a total of 15 estimates, the were included in quantitative synthesis. We found a pooled specificity of 97.7% (95%CI 93.8-99.2) and a pooled sensitivity of 83.4% (95%CI 73.1-90.4), with an overall agreement assessed by means of Cohen's kappa equals to 0.750, 95%CI 0.62-0.88 (i.e. moderate agreement), with high heterogeneity and risk of reporting bias., Conclusions: In conclusion, diagnostic tests based on salivary specimens are somewhat reliable, but relatively few studies have been carried out. Moreover, such studies are characterized by low numbers and low sample power. Therefore, the of salivary samples is currently questionable for clinical purposes and cannot substitute other more conventional RT-qPCR based on nasopharyngeal swabs.

Introduction: Parkinson's disease (PD) is a common disease of unknown etiology. Even though accurate information on the epidemiology of PD is critical for defining appropriate health policies, epidemiological data on Parkinson's disease (PD) in Italy are often defined as scant or conflicting. Our study attempted to provide an overview on the prevalence of (PD) by means of a systematic review and metanalysis of existing data.   Material and methods. We searched into two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of PD in Italy. Data were extracted using a standardized assessment form, and results of such analyses were systematically reported, summarized and compared.   Results. A total of 16 studies were eventually included in the analyses, with a prevalence rate of 193.7/100,000. Available reports were heterogeneous both in design and in eventual figures, and also prevalence estimates were affected by substantial heterogeneity. Interestingly, prevalence rates ranged from 37.8/100,000 inhabitants in subjects aged 0 to 64 years, to 578.7 in age group 65 to 75 years, and 1235.7 in age group 75 years or older. PD was significantly associated with male sex, but only in older age groups (i.e. Odds Ratio, OR 1.37 95%CI 1.22-1.53, and OR 1.31, 95%CI 1.21-1.42 for age groups 65-74 years and 75 years or more, respectively).   Discussion and conclusion. While the observed variations in prevalence rates may result from environmental or genetic factors, differences in methodologies for case ascertainment and diagnostic criteria may have significantly affected our estimates. As a consequence, the comparability of existing studies is limited.

Nowadays, the best treatment option for ovarian cancer recurrence is often subjective, can vary in the different centers and depend on personal experience. Arbeitsgemeinschaft Gynaekologische Onkologie (AGO)-DESKTOP studies have identified a population of patients who could benefit from secondary surgery. The results of the Gynecologic Oncology Group (GOG)-0213 study were recently published, which showed no advantage in terms of overall survival (OS) in patients with platinum-sensitive recurrent epithelial ovarian undergoing secondary cytoreductive surgery (SCS) compared to chemotherapy alone. Aim of this narrative review is to summarize the best aspects that can make ovarian cancer recurrence patients suitable for SCS. A narrative review analyzing all the literature of the past 30 years has been performed. PubMed, Scopus, Web of Science and Ovid MEDLINE were used for research. All non-English-language articles have been excluded. The following keywords were searched: 'recurrent ovarian cancer', 'secondary surgery', 'secondary cytoreductive surgery', 'platinum-sensitive ovarian cancer', 'platinum-resistant ovarian cancer'. We divided eligible patients for secondary cytoreduction in relation to the following factors: platinum-sensitivity, AGO-score or Tian model, unresectable lesions, surgical generic contraindication, woman's personal choice. The selection of truly suitable patients for surgery seems an essential requirement for the patient's best therapeutic choice. In case of absent post-surgical residual tumor, good performance status, single recurrence, and platinum-sensitive ovarian recurrence, surgery could be performed., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-326). The series “Ovarian Cancer Recurrence” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare., (2020 Gland Surgery. All rights reserved.)

Background: Obesity represents an urgent problem that needs to be properly addressed, especially among children. Public and global health policy- and decision-makers need timely, reliable quantitative information to develop effective interventions aimed at counteracting the burden generated by high body mass index (BMI). Few studies have assessed the high-BMI-related burden on a global scale., Methods and Findings: Following the methodology framework and analytical strategies used in the Global Burden of Disease Study (GBD) 2017, the global deaths and disability-adjusted life years (DALYs) attributable to high BMI were analyzed by age, sex, year, and geographical location and by Socio-demographic Index (SDI). All causes of death and DALYs estimated in GBD 2017 were organized into 4 hierarchical levels: level 1 contained 3 broad cause groupings, level 2 included more specific categories within the level 1 groupings, level 3 comprised more detailed causes within the level 2 categories, and level 4 included sub-causes of some level 3 causes. From 1990 to 2017, the global deaths and DALYs attributable to high BMI have more than doubled for both females and males. However, during the study period, the age-standardized rate of high-BMI-related deaths remained stable for females and only increased by 14.5% for males, and the age-standardized rate of high-BMI-related DALYs only increased by 12.7% for females and 26.8% for males. In 2017, the 6 leading GBD level 3 causes of high-BMI-related DALYs were ischemic heart disease, stroke, diabetes mellitus, chronic kidney disease, hypertensive heart disease, and low back pain. For most GBD level 3 causes of high-BMI-related DALYs, high-income North America had the highest attributable proportions of age-standardized DALYs due to high BMI among the 21 GBD regions in both sexes, whereas the lowest attributable proportions were observed in high-income Asia Pacific for females and in eastern sub-Saharan Africa for males. The association between SDI and high-BMI-related DALYs suggested that the lowest age-standardized DALY rates were found in countries in the low-SDI quintile and high-SDI quintile in 2017, and from 1990 to 2017, the age-standardized DALY rates tended to increase in regions with the lowest SDI, but declined in regions with the highest SDI, with the exception of high-income North America. The study's main limitations included the use of information collected from some self-reported data, the employment of cutoff values that may not be adequate for all populations and groups at risk, and the use of a metric that cannot distinguish between lean and fat mass., Conclusions: In this study, we observed that the number of global deaths and DALYs attributable to high BMI has substantially increased between 1990 and 2017. Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases. Given the large variations in high-BMI-related burden of disease by SDI, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status., Competing Interests: The authors have declared that no competing interests exist.

Tick-Borne Encephalitis (TBE) is an occupational health threat with increasing incidence in the geographic area of Italy. Despite this, TBE vaccination rates have ranged from 10% to 40% in Italy, even in at-risk workers. The reasons for this low rate are investigated in this present study of the knowledge, attitudes, and practices of occupational physicians (OP) regarding TBE disease and vaccination in at-risk workers. A total of 229 OP participated in an internet-based survey by completing a structured questionnaire. Adequate general knowledge of TBE disease was found in 58% of OP. Accurate perception of TBE risk in occupational settings was found in 20%. TBE vaccination for at-risk workers was recommended by 19%. Willingness to recommend TBE vaccination was more likely by OP practicing in endemic areas (Odds Ratio 3.10, 95% confidence intervals 1.47-6.55), who knew the existence of the term "arboviruses" (3.10, 1.29-7.44), or exhibited a better understanding of TBE (2.38, 1.11-5.12)-and were positive predictors for promoting TBE vaccine, while acknowledging that TBE as a severe disease was a negative one. Tick-borne disorders in Italy are a still rare (but increasing) occupational health threat, and vaccination gaps for TBE virus may find an explanation in OP incomplete knowledge of evidence-based recommendations.

SARS-CoV-2 become pandemics and there is still a dearth of data about its the potentially among dermatological patients under biologics. We aimed to assess health literacy, disease knowledge, treatment dissatisfaction and biologics attitudes toward COVID-19. We performed a cross-sectional, questionnaire-based survey on 98/105 consecutive dermatological patients treated with biologics-51 suffering from plaque psoriasis, 22 from atopic dermatitis, and 25 from hidradenitis suppurativa. An ad hoc, validated questionnaire has 44 items investigating the following domains: knowledge of COVID-19 related to (a) epidemiology, (b) pathogenesis, (c) clinical symptoms, (d) preventive measures, and (e) attitudes. Patients data and questionnaires were collected. Despite only 8.1% thought that biologics may increase the risk of COVID-19, 18.4% and 21.4% of the patients were evaluating the possibility to discontinue or modify the dosage of the current biologic therapy, respectively. Globally, male patients (P = .001) with higher scholarity level (P = .005) displayed higher knowledge of COVID-19. Patients with lower DLQI (P = .006), longer disease duration (P = .051) and lower scholarity (P = .007) have thought to discontinue/modify autonomously their biologic therapy. At the multivariate logistic regression, only the knowledge of epidemiology and preventive measures resulted independent predictors of continuation vs discontinuation and modification vs no modification, respectively. Dermatologists should promote COVID-19 knowledge to prevent biologics disruption., (© 2020 Wiley Periodicals LLC.)

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements., Design: Instrument development and cross-sectional study for psychometric testing., Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018-January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed., Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50-1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of "personal exposure" (4.06, SD 3.78) were reported by third-year students. Higher scores for "perceived benefits" of preventive behaviours (13.6, SD 1.46) were reported by second-year students., Competing Interests: Roger Watson, Editor in Chief, and Mark Hayter, Editor of the Journal of Advanced Nursing, hold honorary positions at the University of Genoa where the study was conducted., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Introduction: High environmental temperatures are associated with an increased risk for occupational injuries (OIs), particularly where environmental exposure and heat sources in the workplace, are associated with internal heat generation by strenuous muscular work. As a consequence, Agricultural Workers (AWs) are among the most heavily affected occupational groups., Methods and Aims: The aim of this study was to assess the relationship between environmental temperatures and OIs in AWs from the Po River Valley in the Northern Italy (27,736,158 total inhabitants; mean agricultural workforce of 312,195.6 individuals). Data about OIs from 2013 to 2017, and daily weather for the administrative unit of occurrence were retrieved. Days were classified by a) mininum (Tmin) / maximum (Tmax) air temperatures; b) average day temperature (Tday); c) daily temperature variation (TV), d) relative humidity. Risk for daily OIs was calculated as correspondent Odds Ratios (OR) through a Poisson regression model., Results: Estimated incidence for OIs was 66.3/1,000 workers-year. In regression analysis, for every Tday percentile increase equal to 2.5, an OR 1.007 (95% CI, 1.003 to 1.010) was reported. More precisely, higher risk for OIs was associated to Tmax > 25°C (OR 1.143, 95%CI 1.125-1.160) and to Tmax > 25°C + Tmin > 20°C (OR 1.158, 95%CI 1.138-1.179), Tmin < 0°C were associated with a significantly reduced risk (OR 0.879, 95%CI 0.850-0.910), with the notable exception of older age groups (OR 1.348, 95%CI 1.254; 1.449). During timeframes characterized by Tmax > 35°C (i.e. HW time period), the risk was higher during the first day (OR 1.266; 95%CI 1.206-1.330), and again from the fourth day onwards (OR 1.090; 95%CI 1.048 - 1.133). Analysis of TV identified an increased risk for occupational injuries in days characterized by higher variability, and particularly for TV ranging 4.0 - 4.9 (OR 1.042, 95%CI 1.017 - 1.068), and equals to 5.0 or greater (OR 1.143, 95%CI 1.118 - 1.167). Also increased relative humidity was associated with higher risk for OIs (OR 1.096, 95%CI 1.081-1.126, and OR 1.154, 95%CI 1.135-1.173 for relative humidity 70 - 89%, and ≥ 90%)., Conclusions: Our findings recommend policymakers to develop appropriate procedures and guidelines, in particular for the HW time periods.

SARS-CoV-2 is responsible for a highly contagious infection, known as COVID-19. SARS-CoV-2 was discovered in late December 2019 and, since then, has become a global pandemic. Timely and accurate COVID-19 laboratory testing is an essential step in the management of the COVID-19 outbreak. To date, assays based on the reverse-transcription polymerase chain reaction (RT-PCR) in respiratory samples are the gold standard for COVID-19 diagnosis. Unfortunately, RT-PCR has several practical limitations. Consequently, alternative diagnostic methods are urgently required, both for alleviating the pressure on laboratories and healthcare facilities and for expanding testing capacity to enable large-scale screening and ensure a timely therapeutic intervention. To date, few studies have been conducted concerning the potential utilization of rapid testing for COVID-19, with some conflicting results. Therefore, the present systematic review and meta-analysis was undertaken to explore the feasibility of rapid diagnostic tests in the management of the COVID-19 outbreak. Based on ten studies, we computed a pooled sensitivity of 64.8% (95%CI 54.5-74.0), and specificity of 98.0% (95%CI 95.8-99.0), with high heterogeneity and risk of reporting bias. We can conclude that: (1) rapid diagnostic tests for COVID-19 are necessary, but should be adequately sensitive and specific; (2) few studies have been carried out to date; (3) the studies included are characterized by low numbers and low sample power, and (4) in light of these results, the use of available tests is currently questionable for clinical purposes and cannot substitute other more reliable molecular tests, such as assays based on RT-PCR.

Introduction: The present study aims to characterize knowledge, attitudes and beliefs in a sample of medical professionals towards point-of-care (POC) rapid tests for SARS-CoV-2 in Italy (April 2020)., Material and Methods: A total of 561 professionals (42.6% males, 26.9% ≥ 50-year-old) compiled a specifically designed web questionnaire on characteristics of POC rapid tests. They were asked whether they would change daily practice and make clinical decisions according to POC tests. Multivariate odds ratios (aOR) for predictors of propensity towards the aforementioned behavioral outcomes were calculated through regression analysis., Results: Overall, only 51.9% knew the official recommendations of the Italian Health Authorities for POC tests, while 26.0% of respondents considered POC tests for COVID-19 highly reliable. Still, 40.3% of respondents would change daily practice because of such tests, and 38.5% would make clinical decisions based of their results. Actual understanding of specificity and sensitivity of POC tests was not associated with assessed behavioral outcomes: main positive effectors were identified in perceived reliability and usefulness of rapid tests, acknowledging the existence of official recommendations, understanding the limited clinical implications of POC tests, and working as occupational physicians were characterized as negative effectors.  Conclusions. Propensity of sampled professionals towards POC tests for COVID-19 was diffusely unsatisfying. While actual understanding of accuracy of such tests was not a main effector of propensity, previous experiences with other POC tests in daily practice, particularly among occupational physicians may have impaired overall acceptance of such instruments.

Since the beginning of the COVID-19 epidemic, a possible explanation for the high heterogeneity of infection/mortality rates across involved countries was hinted in the prevalence of tuberculosis vaccination with Bacille Calmette-Guérin (BCG). A systematic review was therefore performed on May 2, 2020. A total of 13 articles were ultimately retrieved, 12 of them as preprint papers. All articles were ecological studies of low quality. Most of them did not include main confounding factors (i.e. demographic of the assessed countries, share of peo- ple residing in urban settings, etc.), and simply assessed the differences among incidence/mortality of COVID-19 with vaccination rates or by having vs. having not any vaccination policy for BCG. Even though all studies shared the very same information sources (i.e. international registries for BCG vaccination rates and open source data for COVID-19 epidemics), results were conflicting, with later studies apparently denying any true correlation between COVID-19 occurrence and BCG vaccination rates and/or policies. As a consequence, there is no sound evidence to recommend BCG vaccination for the prevention of COVID-19.

Introduction: To investigate actual knowledge of official recommendations towards seasonal influenza (SID), and Tetanus-diphtheria acellular-pertussis (Tdap) vaccines in obstetrics/gynecologists (OBGYN)., Methods: PubMed and EMBASE databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) among case controls, cross-sectional studies, either questionnaire or laboratory exams based.  Results. A total of 6 studies met inclusion criteria, including 1323 OBGYN from 5 different countries. Overall, around 99% of sampled professionals were aware that official recommendations towards SID in pregnancy do exist, compared to 92% for Tdap, with significant heterogeneity (I2 > 95%, p < 0.001). Concerns about vaccine safety was reported by 10% of respondents for Tdap, and by 6.0% for SID, but again available studies were substantially heterogenous (I2 = 86.7% and 86.0%, p < 0.001). Eventually, 93% of respondents actively recommended SID in pregnancy, compared to 88% for Tdap (I2 98.8% and I2 95.9%, respectively p < 0.001). The evidence of significant publication bias was initially subjectively identified from the funnel plot, and then objectively confirmed through the regression test for all analyses., Conclusions: These results suggest an appropriated understanding of official recommendation among sampled OBGYN, with high shares of professionals actively promoting vaccination practices among their patients. Despite the high heterogeneity and the significant publication bias we identified, our results also hint towards extensive knowledge gaps of OBGYN, and particularly regarding unmotivated concerns about vaccine safety. As a consequence, appropriate information and formation campaigns should be appropriately tailored.