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Background: Violence in the workplace is now universally recognized as a significant global public health issue and is one of the most serious issues affecting the healthcare sector. Objectives: To assess the prevalence of workplace violence. Methods: We performed a multicenter cross-sectional study using an anonymous questionnaire submitted to doctors from Northern Italy. The survey investigates socio-demographic information, the number of years of work in the health sector and the physical and verbal aggressions that occurred in the workplace in the last 12 months. Results: The sample consists of 4545 healthcare workers, of whom 2603 (57.27%) are females. The mean age of the sample is 49.79 years (SD ± 12.63). The risk of being victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (aOR 2.09, 95% CI 1.51-2.88), work in the public sector (aOR 2.57, 95% CI 1.72-3.85), being victim of verbal aggression at work in the last 12 months (aOR 22.52, 95% CI 10.97-46.20), work in the operational units of the Medical area (aOR 2.36, 95% CI 1.33-4.21) and the Territorial area (aOR 1.97, 95% CI 1.04-3.74). Discussion: The prevalence of violent behaviour is difficult to assess, because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is necessary to develop effective control strategies at individual, hospital and national levels.

Introduzione. Un tempo "barboni", oggi senzatetto, il loro numero sta aumentando considerevolmente negli ultimi anni. Molti di loro soffrono di malattie croniche, problemi di salute mentale, dipendenze e necessitano di cure mediche complesse. Il loro stato di salute è spesso esacerbato per maggiori difficoltà nell'accesso alle cure primarie rispetto alla popolazione generale. Materiali e Metodi. È stato distribuito un questionario autosomministrato al fine di valutare le condizioni di salute dei senzatetto che vivono a Palermo. È stato utilizzato un modello di regressione logistica multivariata calcolando gli Odds Ratios aggiustati (aOR). Risultati. Il campione è costituito da 52 senzatetto, di cui 35 (67,3%) maschi. La classe di età più rappresentativa (55,8%) ha un'età inferiore a 50 anni e l'88,5% è italiano. L'analisi ha mostrato che il sesso femminile è significativamente associato a: "non svolgere attività fisica regolare" (aOR 4.14, IC 95% 1,20 - 14,32, p=0,025), ad "avere malattie croniche" (aOR 3,52, IC 95% 1,02 - 12,11, p=0,046) e "ad assumere farmaci" (aOR 3,95, IC 95% 1,14 - 13,64, p=0,030). Conclusioni. La rilevanza e la complessità della situazione sociale dei senzatetto attira l'attenzione su questo fenomeno destinato ad avere un forte impatto sulle politiche e sui servizi sanitari. Questa fragile popolazione è esposta a malattie che sono in gran parte prevenibili o curabili attraverso un ampio e precoce accesso alle cure con conseguente riduzione del peggioramento degli esiti clinici e dei relativi costi sociali. Introduction. In Italy, as in the rest of the world, the number of homeless people is increasing considerably. Many of them suffer from chronic conditions, mental health problems and addiction to alcohol, drugs or smoking, and need complex medical care. Their health status is often exacerbated by greater difficulty in accessing primary care. The aim of the present study was to assess health conditions of homeless people living in Palermo, Southern Italy, and to find ways to limit the spread of common infectious diseases that can be prevented by vaccination. Materials and Methods. A self-administered questionnaire was distributed. The questionnaire was structured into two parts including an introduction with socio-demographic information, and a second part investigating health status, chronic diseases and vaccinations. A multivariable logistic regression model was used and adjusted Odds Ratios (aOR) are presented. Results. The sample consisted of 52 homeless, 35 (67.3%) of whom were male and the most represented age class (55.8%) was < 50 years of age. The average age of the sample was 49.6 years (SD ± 15.2) and 88.5% were born in Italy. A multivariable logistic regression model based on 52 observations was used. The analysis showed that the female gender was significantly associated with: not performing regular physical activity (aOR 4.14, 95% C.I. 1.20 - 14.32, p = 0.025), suffering from chronic diseases (aOR 3.52, 95% C.I. 1.02 - 12.11, p = 0.046) and taking medicines (aOR 3.95, 95% C.I. 1.14 - 13.64, p = 0.030). Conclusions. This particularly fragile population is exposed to diseases that are largely preventable or curable through a wider and more early access to care by local health facilities with a subsequent reduction in the worsening of clinical outcomes and related social costs.

The primary aim of this study was to evaluate the temporal correlation between Wikitrends and conventional surveillance data generated for measles infection reported by bulletin of Istituto Superiore di Sanità (ISS). The reported cases of measles were selected from July 2015 to October 2018. Wikipedia Trends was used to assess how many times a specific page was read by users, data were extracted as daily data and aggregated on a weekly and monthly basis. The following data were extracted: number of views by users from 1 July 2015 to 31 October 2018 of the Morbillo, Vaccinazione del Morbillo, Vaccinazione MPR and Macchie di Koplik pages (Measles, Measles Vaccination, MPR Vaccination and Koplik’s spots in English). Cross-correlation results were obtained as product-moment correlations between the two time series. Regarding the database with monthly data, temporal correlation was observed between the bulletin of ISS and Wikipedia search trends: the strongest correlation was at a lag of 0 for Measles (r=0.9164), Measles Vaccination (r=0.8622), MPR Vaccination (r=0.7852) and Koplik’s spots (r=0.8217). Regarding the database with weekly data, both moderate and strong correlation was observed. A possible future application for programming and management interventions of Public Health is proposed.

Introduction: Caregiver is the person who takes care of the patient from the practical point of view, helping him in managing the disease and carrying out daily activities, but also supporting him on an emotional level. Caregiver burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude from positive and caring to negative and unconcerned. The aim of the study was to understand what factors were associated with having panic attacks or crying crises in the caregivers of our study population. Materials and methods: The study design is observational. An anonymous questionnaire was administered to caregivers of the patients of a hospital for the intensive post-acute rehabilitation from April 2016 to December 2018. The statistical significance level chosen for the entire analysis was 0.05. The covariates to be included were selected using a stepwise backward selection process, with a univariate p-value

Aim. Evaluation of the knowledge and behavioral risks related to sexually transmitted infections (STIs) among the students at the University of Palermo. Materials and Methods. Cross-sectional study. An anonymous online questionnaire has been submitted to the students of Palermo University. Survey investigates to socio-demographic information, sexual habits and the level of knowledge of the STIs. Results. The sample consists of 539 students; average age 22.65 (± 2.95). The risk to have unprotected occasional sexual intercourse is related to the following circumstances: the homosexual or bisexual status, the male gender, the age of the occurrence of the first sexual intercourse, that is at 17 year or earlier and the circumstance to have contracted a sexually transmitted infection during life. Conclusions. It is necessary to implement sexual education programs aimed at improving the knowledge in terms of STIs and increase of sexual and reproductive health. The findings presented should be interpreted with a degree of caution. Future studies are needed to as-sess the effectiveness and cost of education programs.

Introduction. On the day of a workshop (named "Vaccino Day") on vaccinations, organized for the students of the University of Palermo by the ERSU (Regional Office for the Right to University Study), the sample of students were given a questionnaire to fill out. The aim of the survey was to investigate the perception of vaccinations on a sample population made up of university students. Materials and Methods. A self-administered paper questionnaire was given to participants of the workshop. The questionnaire is divided into 3 parts: demographic, economic and habits informations have been asked in the first part in the second part, they had to answer the question: "What term do you associate with vaccination?" in the third part, they were posed the question: "Have you ever had any adverse reactions after being vaccinated?". Therefore, the percentage response frequencies and the statistically significant Odds-Ratio (aOR) are presented with a corresponding 95% confidence interval (CI). Statistical analysis was performed using the STATA® 14 software. Results. A total of 350 students were asked to participate and the response rate was 100%, the 61.43% of the interviewed population was made up of females. Taking into account the dependent variable: "at least a moderate-severe adverse reaction after a vaccination" the statistically significant independent variables associated are "Have fear of side effects" (aOR 7.06, 95% CI 1.73-28.57, p=0.006), "I associate the term "vaccination" to Needles/syringes" (aOR 3.82, 95% CI 1.08-13.48, p=0.037), "I associate the term "vaccination" to Protection" (aOR 3.50, 95% CI 1.02-11.98, p=0.046). Discussions and Conclusions. Vaccination is still influenced by emotional factors and lack of campaigns providing adequate information, therefore negative judgement tend to outweigh the real risks and benefits. Considering that the sample was composed of university students, being highly educated and capable of becoming opinion leaders in the future, there is a need to create a more efficient communication protocol that make the student, and then the citizen, better aware of the actual risks associated with vaccinations and their real benefits.

Effects of adenotonsillectomy on neurocognitive and behavioural function in pediatric obstructive sleep apnea syndrome. Objectives: Aim of this study is to verify the presence of neurocognitive, neurobehavioral or sleep disturbances in children affected by adenotonsillar hypertrophy (ATH) and Obstructive Sleep Apnea Syndrome (OSAS) and verify their improvement after Adeno-Tonsillectomy (AT). Methods: Eighty children suffering from adenotonsillar hypertrophy and OSAS were recruited for AT in the ENT Department of the University of Palermo. All the children underwent clinical evaluation, including rhinofibroscopy for grading the obstruction due to the adenotonsillar hypertrophy (before and 6 months after surgery), and polysomnography and 6 months after surgery. Two different rating scales were administered to the parents, the Sleep Disturbance Scale for Children (SDSC) for the evaluation of sleep disturbance and the subscales B and C of the Conners' Parent Rating Scale Revisited (CPRS-R) for the evaluation of behavioral disturbances (before and 6 months after surgery). Results: Children's mean age was 5.3 + 1.6 years with a percentage of 59.2% for male and 40.8% for female. All patients showed adenotonsillar hypertrophy grade III-IV. Polisomnography showed the presence of moderate OSAS in 72.6% of the children and severe in 27.2%. In the preoperative evaluation all the children had pathological values in the CPRS-R, regarding the cognitive and inattention subscale (B) and the hyperactivity subscale (C). In the SDSC results were also pathological, with variables depending on the subscales. After AT, CPRS-R evidenced a statistically significant improvement in scores for all children. Even SDSC scale postoperatively showed a statistically significant improvement in the scores of each subscale. Conclusion: Adenotonsillar hypertrophy is the most frequent cause of snoring and OSAS in children. OSAS in children is a frequent cause of sleep disorders and daytime behavioral changes. AT in children improve significantly both OSAS and behavioral disturbances.

Background. It is necessary to implement current teaching in the healthcare and university sector by promoting new tools for the enhancement of public health, bearing in mind that some health determinants seek to create a context in which to present their own idea of innovative Startup, can represent the opportunity to give your professional contribution to the development of another's idea or to propose an improved solution to the private business. On the other hand, networking with companies and networking between training participants will allow us to recognize the importance of demonstrating their diverse skills as a key element to create a successful Startup or to implement the activities of a reality already consolidated. Methods. This paper describes the research protocol of a Hackathon Public Health (HPH) teaching methodology aimed at: a) increasing public health knowledge; b) changing the proactive approach of the healthcare provider, especially by increasing the sectoral training activity; c) to promote educational and training activities in Italian regions. The subjects involved will be healthcare professionals (doctors, nurses, health professions, psychologists, biologists, assistants in training) who are selected to receive or not the intervention through the implementation of a HPH which also includes training activity. Conclusion. HPH is an innovation in the national health landscape, with the aim of creating environments and training policies aimed at promoting proper clinical risk management as part of the continuous improvement of the quality of healthcare organizations and proper training activities.

Introduction. Seasonal influenza epidemics represent a cost that affects companies in terms of sick leave and lost productivity, theref ore vaccination can improve occupational health. The vaccination of Healthcare Workers (HCW) has a dual function because in addition to protecting the workers, it also protects the most fragile patients. The students of medical and nursing degree courses, as well as other health professions, attend the workplace daily and are similar to workers in Legislative Decree 81/08. The purpose of this research is to assess the prevalence of students who are in favor of the introduction of a mandatory vaccination for healthcare workers, and to investigate what factors predispose them to be favorable. Methods. We performed a multi-center cross-sectional study using a validated questionnaire in a sample of students from different university courses from October 10th, 2017 to September 30th, 2018. For qualitative variables, absolute and relative frequencies, and for categorical variables Pearson's Chi-square test (X2) were calculated. A multivariable logistic regression model was used. Results. A total of 3131 questionnaires were completed by 2132 women and 999 men. The prevalence of students who are favorable to the introduction of a mandatory flu vaccination is 87.3% and that this data is linked to the female gender (aOR 1.52 CI 95% 1.12-2.06), being a medical student compared to nursing (aOR 2.14 CI 95% 1.45-3.17), coming from central Italy (aOR 3.08 CI 95% 2.11-4.51) and northern Italy (aOR 3.09 CI 95% 2.12-4.49) compared to Southern Italy and the Islands, wanting to get vaccinated for the next season (aOR 6.37 CI 95% 3.73-10.88), declaring to have a good/excellent level of knowledge on vaccine-preventable diseases (aOR 1.44 CI 95% 1.04-1.99), planning a recommendation based on ministerial indications (aOR 2.12 CI 95% 1.28-2.30) and having received requests for clarification on vaccinations (aOR 2.02 CI 95% 1.44-2.85). Discussion. The sample of university students showed to be largely in agreement with the introduction of mandatory vaccination for HCW, which is important for the prevention of influenza virus in the workplace. To increase adherence of healthcare workers to vaccination campaigns against seasonal influenza in the workplace, it is necessary that operative strategies are implemented with educational messages.

Purpose Depression is a common and serious medical illness, considered as a public health issue because it interferes with the interpersonal, social and professional functioning of the individual, and its frequency is constantly increasing. According to a recent review, approximately 34 per cent of nursing students had experienced depression worldwide. The university period may represent a moment in which the mental well-being of students is subjected to stress with a relative predisposition to the development of diseases related to mood disorders. The purpose of this study is to estimate the prevalence and examine the socio-demographic correlates of depressive symptomatology. Design/methodology/approach In April 2019, a questionnaire was administered to all the nursing students of University of Palermo of the three years of course, accompanied by informed consent. Multivariable logistic regression was performed. The statistical significance level chosen for all analyses was 0.05. The results were analyzed using the STATA statistical software version 14. Results are expressed as adjusted odds ratio (aOR) with 95 per cent confidence intervals. Findings The sample consists of 493 students who completed the questionnaire, and the average age of the sample participants is 21.88 years. The multivariable logistic regression model shows that the risk to have depressive symptomatology is significantly associated with the following independent variables: female gender (aOR 1.91), being single (aOR 1.87), second year of study (aOR 1.94), third year of study (aOR 1.92), not performing regular physical activity (aOR 1.78) and perceived low health status (aOR 3.08). Originality/value This study shows that belonging to the female gender, being further along in the years of study, having a chronic illness and perceiving a low state of health are all factors that can increase the risk of developing the symptoms of depression; rather, regular physical activity, friendship and romantic relationships can be considered factors protecting them from the risk of falling into depression that can undermine both the study and work performance. Certainly, it is important to analyze all the involved variables to improve the global health not only of the nursing students but of all the students.

Vaccine hesitancy (VH) is a complex and country-specific issue, responsible for the decreasing vaccination rate and subsequent spread of vaccine-preventable diseases. In literature, several questionnaires were developed to assess VH. The aim of this systematic review was to evaluate the published questionnaires assessing parental VH. The search was conducted in PubMed/Medline, Web of Science and The Cochrane Library, in December 2017, following the PRISMA guidelines. The search strategy included 4 types of keywords: parents, vaccine hesitancy/acceptance, immunization and survey. Only English and Italian original papers were included. 17 reviewers independently screened titles and abstracts. Only the included articles were downloaded in full and, after a second screening, data were extracted and recorded in an ad hoc spreadsheet. A total of 5,139 articles were retrieved, after duplicates elimination 3,508 papers were screened. After a screening selection, 334 studies were included in the analysis. Most studies were cross-sectional (92.8%), followed by case-control (4.8%) and cohort studies (2.4%). The population interviewed was mainly parents, without any further details (73.1%); mothers were the only parent surveyed in approximately 20% of the studies, while only 1 study involved selectively the fathers. The sample size ranged from 7 to 59,897. Only 38% of the included studies reported both the number and type of items used. Regarding the type, more than half consisted of closed questions, followed by Likert scales, while open-ended questions were used in 14.8% of the surveys. Frequently, the survey was conducted using a self-reported questionnaire or interview. The questionnaires were mostly administered on paper, while online forms were used in 20.1% of the cases. However, 80.2% of the questionnaires were not attached to the paper. HPV vaccine was the most frequently investigated (39.2%), followed by influenza (13.5%) and measles (10.8%). While 22.4% of the articles referred to paediatrics vaccinations in general. Data about the immunization behaviours were reported in 294 studies: the subjects involved showed a behaviour defined as “acceptance” in 129 studies (38.6%), as “hesitancy/scepticism/doubt” in 145 studies (43.1%) and as “refusal” in 22 studies (6.6%). This information was not reported in 12% of the studies. VH is still a public health challenge, as confirmed by the high number of studies and questionnaires retrieved. This study offers a deeper perspec- tive on the available questionnaires, helping to identify the best one in terms of aim and study setting., Journal of Preventive Medicine and Hygiene, Vol. 61 No. 3 (2020): 2020613

BacKGrOUnD: the aim of the study was to estimate the prevalence of gambling, internet addiction disease and the risk of alcohol consumption among workers of the “Paolo Giaccone” University hospital in Palermo. MethODs: the study employed a cross-sectional study design. an anonymous online survey was provided accompanied by informed consent. The questionnaire was structured into four parts. The first section investigates on socio-demographic information. in the other sections of the questionnaires were administered: internet addiction test, alcohol Use Disorders Identification Test-Consumption and Canadian Problem Gambling Index. A multivariable logistic regression model was used and adjusted odds ratios (aOr) are presented. RESULTS: The final sample size consists of 1482 subjects (response rate 79.42%). The 2.29% of the employees are at risk of pathological alcohol consumption, 0.47% has several problems due to the internet, and 2.77% are considered problematic gambling players. The several problems due to the internet is significantly associated with the following independent variables: age at increasing unit (aOr 0.71), at risk for consumption of alcohol (aOr 92.37), at risk for gambling (aOr 53.67). CONCLUSIONS: Along with the growing availability of information technology, individuals may experience adverse outcomes when internet usage is combined with alcohol risky consumption and gambling. since the increased access to addictive substances/behaviors leads to higher rates of addiction, future prospective studies and preventive measures should be implemented to reduce internet use, alcohol assumption and gambling in this population.

BACKGROUND: abuse of alcohol among students is a problem that has not to be undervalued because it can damage mental and global health and, as a consequence, it can negatively influence the academic and training performance roping at the end on patients’ health. Our study focused particularly on nursing students of the University of Palermo of the three years of course with the aim to estimate the prevalence of risky alcohol consumption and to analyze the associated factors. MethODs: in april 2019 a questionnaire was administered to all the nursing students of University of Palermo of the three years of course, accompanied by informed consent. Multivariable logistic regression was performed. the statistical significance level chosen for all analyzes was 0.05. The results were analyzed using the STATA statistical software version 14. Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (95% CI). resULts: the sample consists of 493 (67.55% female) students that completed the questionnaire. the multivariable logistic regression model shows that the risk to have risky consumption of alcohol is significantly associated with the following independent variables: female gender (aOr 1.91); age class

BACKGROUND: Problematic internet use is a growing problem in modern societies. Internet addiction (IA ) can be defined as a behavioral addiction between human and information technology-machine. Our aim was to identify IA among Palermo University nursing students by means of the Internet Addiction Test. METHODS: The study employed a cross-sectional study design. In April 2019 a survey was provided to students who attend daily lessons. The questionnaire was structured into two parts. The first section investigates on socio-demographic information, year of study, the perception of the economic and health status. In the second section of the questionnaire IAT was administered. A multivariable logistic regression model was used and adjusted Odds Ratios (aOR) are presented. RESULTS: The sample size consists of 413 students. Risk to have several problems due to the internet is significantly associated with the following independent variables: male gender (aOR 1.77, 95% CI : 0.89-3.52,); being single (aOR 3.14, 95% CI : 1.31-7.55); third year of study (aOR 2.99, 95% CI : 1.27-7.05,); to be student off-site (aOR 2.80, 95% CI : 1.07-7.36); low perceived health status (aOR 3.19, 95% CI : 1.52-6.67). CONCLUSIONS : Even though generally lower prevalence has resulted from our study in comparison with different geographical areas, IA is confirmed as an emerging problem among the young population of our Region, potentially threatening the health among university students.

BACKGROUND: One of the often-underestimated aspects of obesity is the psychological one. In particular, there is a growing attention to the correlation between obesity and depression among students from all over the world. And also towards the correlation between alcohol abuse and mood disorders. The objective of the study was to examine if the depressive symptomatology, risk of consumption of alcohol and anxiety symptomatology are correlated with obesity/ overweight in a sample of students of the University of Palermo, Italy. METHODS: The study was a cross-sectional study. A questionnaire is structured in four sections. An anonymous online survey was sent to a random students sample enrolled in the mailing list of the Regional Authority for the Right to University Study (ERSU) of the University of Palermo, who signed an informed consent. Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (95% CI). P value

BACKGROUND: The university student is vulnerable to the adverse effects of many stress factors that can lead to an increase in the burden of illness in young people. The objective of the study was to estimate the prevalence of anxious symptoms in the student population of the degree course in nursing at the University of Palermo. METHODS: The study design is observational. In the month of April 2019, a survey was provided to all nursing students of University of Palermo of the three years of course, accompanied by informed consent. The statistical significance level chosen for all analyzes was 0.05. The results were analyzed using the STATA statistical software version 14.XX Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (95% CI). This study was approved by the ethical committee of the University Hospital "P. Giaccone" of Palermo, Minutes No. 02/2019 (15. Studio A.D.A.3) of February 18, 2019. RESULTS : The sample size consists of 493 students that agreed to the informed consent and completed the questionnaire. The average age of the sample is 21.88 years (standard deviation±3.38), 67.55% of the interviewees are women. Regarding bivariate analysis, statistically significant differences were found for the following variables: "gender," "year of study," "do you perform regular physical activity," "perceived health status." The analysis shows that the risk to have anxious symptomatology moderate-severe is significantly associated with the following independent variables: female gender (aOR 2.83, 95% CI : 1.26-6.38, P=0.012); age class

Background: Adenosine triphosphate bioluminescence produced by the firefly luciferase has been successfullyintroduced to verify cleaning procedures in the food industry according to the Hazard Analysis Critical Control Pointprogram.Our aim was to evaluate the reliability of bioluminescence as a tool to monitor the effectiveness of sanitation in healthcaresettings, in comparison with the microbiological gold standard.Methods: 614 surfaces of various material were randomly sampled in Policlinico University Hospital units in Palermo,Italy, to detect adenosine triphosphate bioluminescence and aerobic colony count. Linear regression model andPearson correlation coefficient were used to estimate the relationship between the two variables of the study.Results: Aerobic colony count median was 1.71 colony forming units/cm2 (interquartile range = 3.8), whereasadenosine triphosphate median was 59.9 relative light units/cm2 (interquartile range = 128.3). Pearson coefficientR2 was 0.09. Sensitivity and specificity of bioluminescence test with respect to microbiology were 46% and 71%,whereas positive predictive value and negative predictive value were 53% and 65%, respectively.Conclusion: According to our results, there seemed to be no linear correlation between aerobic colony countand adenosine triphosphate values, suggesting that current bioluminescence technology has not any proportionalrelationships with culturable microbes contaminating environmental surfaces in health-care settings.