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Aim: To comparatively investigate the effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients after hospital discharge., Methods: Our series consisted of 733 patients aged ≥65 consecutively enrolled in a multicenter observational longitudinal study. PIMs were defined on the basis of updated versions of Beers and STOPP criteria. The occurrence of functional decline was defined as the loss of independency in at least 1 basic activity of daily living (BADL) from discharge through 3-month follow-up visit., Results: After adjusting for several potential confounders, hyperpolypharmacy (OR = 2.20; 95%CI = 1.11-4.37) and Beers violations (OR = 1.99; 95%CI = 1.17-3.49) were significantly associated with functional decline, while STOPP (OR = 1.10; 95%CI = 0.64-1.88) and combined Beers + STOPP violations (OR = 1.72; 95%CI = 0.97-3.05) were not. In logistic regression models simultaneously including both hyperpolypharmacy and PIMs, hyperpolypharmacy was always associated with functional decline (OR = 1.98; 95%CI = 1.0-3.97 in the model including Beers violations; OR = 2.19; 95%CI = 1.11-4.35 in the model including STOPP violations; OR = 2.04; 95%CI = 1.02-4.06 in the model including combined Beers and STOPP violations). Beers violations (OR = 1.89; 95%CI = 1.09-3.28) also remained significantly associated with the outcome in this latter analysis, but not STOPP or combined Beers and STOPP violations., Conclusions: Hyperpolypharmacy, and to a lesser extent Beers violations predict functional decline in older patients discharged from acute care hospitals, whilst STOPP criteria are no longer associated with the outcome after adjusting for potential confounders. Hyperpolypharmacy is associated with functional decline independent of PIMs., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction . Elder abuse is often a hidden phenomenon and, in many cases, screening practices are difficult to implement among older people with dementia. The Caregiver Abuse Screen (CASE) is a useful tool which is administered to family caregivers for detecting their potential abusive behavior. Objectives . To validate the Italian version of the CASE tool in the context of family caregiving of older people with Alzheimer's disease (AD) and to identify risk factors for elder abuse in Italy. Methods . The CASE test was administered to 438 caregivers, recruited in the Up-Tech study. Validity and reliability were evaluated using Spearman's correlation coefficients, principal-component analysis, and Cronbach's alphas. The association between the CASE and other variables potentially associated with elder abuse was also analyzed. Results . The factor analysis suggested the presence of a single factor, with a strong internal consistency (Cronbach's alpha = 0.86). CASE score was strongly correlated with well-known risk factors of abuse. At multivariate level, main factors associated with CASE total score were caregiver burden and AD-related behavioral disturbances. Conclusions . The Italian version of the CASE is a reliable and consistent screening tool for tackling the risk of being or becoming perpetrators of abuse by family caregivers of people with AD., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.

Unlabelled: Understanding the reasons which underlie absence from work due to illness can allow us to prevent harmful events, either in private life or professional activity, which represent a risk for the health of workers and can reduce their personal and professional capacities., Objectives: To describe the frequency of illness in a population of workers employed by the Marche region, showing: the most common pathological events, their length and the differences in occurrence linked to gender and age of the workers., Materials and Methods: We analyzed the Marche Region INPS data bank regarding medical certificates presented by workers for the years 1999 and 2000. These medical certificates were registered by the Institute according to the nosological code (ICD-9-CM classification), length of illness, gender and age of workers., Results: The incidence of illness in the specified two years decreases in the second year of observation passing from 0.67 to 0.64. The number of certificates for the two years is similar for males but increases significantly for females ((p < 0.001). In general the most frequent illnesses were infectious or parasitical ones (31%), followed by those affecting the respiratory apparatus (17%). Compared to women, men presented a higher risk for: burns, traumas and poisoning (OR 1.92 IC 1.81-2.03) and diseases of the cardio-circulatory apparatus (OR 1.75 IC 1.55-1.97). Regarding length of absence, the most common was between 4 and 7 days, even though a reversal of tendency was registered in 2000 with a decrease in short and very short absences from work in favour of average and long ones. The older workers, those over 40 years of age, tend to produce fewer certificates compared to their younger colleagues, but of longer absence. The highest number of days off work can be found among the older workers., Conclusions: According to the data we analyzed, absence from work due to illness is a complex phenomenon regarding not only gender differences but also the age of workers and the kind of work they perform.

The resistance of Yersinia enterocolitica O:9, Escherichia coli O157:H7 and natural microflora against lactic acid (LA), ascorbic acid (AA), and freezing-thawing in noninoculated and inoculated fresh sausages was studied. Samples were stored at -18 degrees C for 28 days and thawed in microwave (MW), at room temperature (RT), in refrigerator (R) and under flowing of tap water (F) on days 7, 14, 21 and 28. Plate Count Agar (PCA), Sorbitol Mac Conkey agar (SMC) and Mac Conkey agar (MC) were used for microbial counts. A maximal reduction of 1.57 log in mesophilic aerobes and no significant changes in total and fecal coliform levels with respect to the initial counts in natural microflora were observed along storage. In inoculated fresh sausages, reductions of 1.37 log on PCA and 2.17 log on SMC were obtained in E. coli O157:H7 populations as compared to the control groups on day 0. Similarly, reductions of 1.69 log on PCA and 2.79 log on MC as compared to the initial level were observed in counts of Y. enterocolitica inoculated samples. Salmonella Anatum, P. aeruginosa, Y. enterocolitica B1A O:7,8-8-8,19 and E. coli non O157:H7 strains were recovered from the natural microflora by enrichment techniques. Thawing in refrigerator was more frequently related to the best reductions of total mesophilic aerobe, E. coli O157:H7 and Y. enterocolitica O:9 counts than the other thawing methods. Reductions of microbial populations observed in LA treated samples were similar to those observed in AA treated samples. Although the acidic and freezing treatments might reduce the microbial levels in natural microflora of fresh sausages, they appeared to be ineffective in the total elimination of high inocula of pathogens like E. coli O157:H7 and Y. enterocolitica O:9.

Objective: We evaluated if work conditions or job strain related to professional activity or to life styles represent a risk factor for arterial hypertension and whether this effect of hypertension is independent of age., Design: through data collection of epidemiological inquiries ESTEV and VISAT, applied in Italy on a cohort of workers, 32-52 year-old, employed in different productive sectors, we analyzed the relationships on working conditions (exposure to certain risks or job strain), life styles and self evaluation of health and arterial hypertension. Hypertension was considered as SAP > or =160 mm/Hg and/or DAP > or =90 mm/Hg, or current antihypertensive treatment., Results: the results refer to 1104 workers, 76% men and 24% women. Prevalence of hypertension was found to be higher among the men than women (33% vs. 22%). Risk estimation in multivariate analysis, by logistic regression model, showed a statistically significant association with certain work-related factors such as: shift work, awkward posture, standing work, doing several tasks contemporarily, being interrupted at work, not being able to take eyes off work. The variables referred to cognitive aspects and work organization tended to be associated to arterial hypertension even when exposure ceased., Conclusions: both physical and cognitive organisational aspects of work are strongly associated with arterial hypertension. The subjective assessment that workers give to their work is a relevant element. This aspects should be considered as a possible reducible risk factor.

Musculoskeletal disorders are frequent among nurses. The literature so far focused mainly on back pain while paying little attention to disorders of the upper and lower limbs. Back pain is associated to patients' handling, but we know very little on the effect of awkward postures due to frequent bending and twisting and of work organisation which could also be involved in the genesis of these disorders. The pain localised to the musculoskeletal apparatus, including the presence of multiple complaints, was studied in a group of 70 nurses, with Estev and Vistat questionnaires, together with the possible association to work conditions. An ergonomic analysis of nursing activities (the postures and cognitive workload) was carried out to uncover associations to the risk of developing musculoskeletal disorders. Results show an involvement of all musculoskeletal sites and a high prevalence of multiple pain complaints (54% of the nurses). Ergonomic analysis highlighted the adoption of awkward postures for prolonged times. Moreover, nurses are frequently interrupted and their working pace is under continuous time pressure. Cognitive workload and work organisation should also be addressed, besides the postures, as factors which could compromise the health of nurses and influence the quality of care.

Objectives: The problem of ageing of health women workers and musculoskeletal disorders (MSD) associated working activity is faced by studying the presence of two or more complaints in the back, upper limbs and lower limbs., Methods: A survey, using a questionnaire (the shortened Italian version of the ESTEV-VISAT), was carried out in several wards of the geriatric hospital to determine the prevalence of MSD in a sample of health workers (nurses and physiotherapists). Several working conditions were considered: physical variables (awkward postures, heavy loads, rapid and frequent walking, etc), organisational (time pressure, to be interrupted at work, etc) and psychosocial (appreciation and recognition). Using both simple and multiple linear regression, the association between the presence of two or more complaints and cumulative index of exposure to 2 or more risks at work was evaluated. The importance of the age factor was also analysed. Ergonomic study was also carried out by observing whole work shifts., Results and Discussion: The distribution of pain is mainly concentrated in the back (81% of the sample) but can also be consistently found in the upper limbs (39%) and lower ones (54%). More than 50% of the workers reported 2 or more complaints in different muscoloskeletal regions. In nurses these problems already appear before the age of 40, suggesting, for this professional category, a possible risk of pathological ageing of the muscoloskeletal apparatus. The presence of 2 or more complaints was found to be associated with physical cumulative index for physiotherapists and with organisational cumulative index for nurses. Ergonomic work analysis showed that caregiving determines the maintenance of awkward postures, such as stooping more than 45 degrees and bending and twisting the trunk for prolonged lengths of time (up to 5 hours consecutively), which represents a physical risk. Besides, the fact that the MSD are mainly associated with organisational characteristics of work, and especially with work pressure, suggests that greater attention must be given to work organisation.

A longitudinal epidemiological study into the relationships between age/health/work is currently under way in different geographical areas throughout Italy. The research is co-ordinated by INRCA (Italian National Research Centres on Aging) in Ancona with the collaboration of the Universities of Ancona, Verona and Bari. This study concerns a population of approximately 2,000 employees from a variety of production sectors. The sample is made up of 5 groups of workers selected according to the year they were born and aged: 32, 37, 42, 47 and 52 years. The chosen research tool is modelled on ESTEV and VISAT researches, the former conducted on a sample of 20,000 French workers, the latter on approximately 3,000 workers and still under way. It involves a set of three questionnaires which allow for a number of variables to be taken into consideration: the first questionnaire concentrates on information regarding the occupation, both past and present; the second on the life style and self-assessed health according to the Nottingham Health Profile (NHP); the third, completed by the occupational physician, contains information on current and previous illnesses, the presence of disorders of the musculo-skeletal apparatus, the taking of any drugs and some anthropometrical and clinical-instrumental parameters (Respiratory Functionality Test, Visiotest and Audiogram). The study with be carried out in two phases: a first survey (under way) and a second one five years later on the same subjects. The results of the analysis will be compared with those of other European countries.

MR imaging, like other imaging techniques, can cause emotional and psychological reactions in the patients. Although reversible, these reactions sometimes lead the patient to absolutely refuse the examination or to make it impossible to carry it through. To investigate the patients' emotional distress, a study group of 28 subjects was examined. They were heterogeneous in sex, age, and pathologic condition. The main psychological reactions were analyzed, and anxiety--both of state and of trait. The anxiety parameter was evaluated as a specific index in the psycho-behavioral modifications induced by MR examination. The influence was also considered of the "fantasies" related to examination results on the patients' psyche. Talks and STAI X1 and STAI X2 were employed to this purpose, to identify possible disturbing elements related to both patients' character and examination situations. Our results point to anxiety as the major reaction observed in the subjects undergoing MR examination; it seems to be related to different parameters, which are difficult to identify. Claustrophobia, pathofobia, and the fear of an unknown examination play a major role. Talking to the patients and informing them of the characteristics of the examination proved useful to significantly reduce their emotional distress.

On the basis of personal experience of the surgical treatment of hemorrhoidal lesions of the third stage, the Authors describe a new technique for radical hemorrhoidectomy. Sixty-one patients (67% males and 33% females) affected by hemorrhoidal lesions of the third (96%) and second (2%) stage were treated using this method at the INRCA Surgical Centre in Ancona. 19% of patients also suffered from chronic anal fissure which were treated by internal lateral sphincterotomy. No major complications were observed, although minimum postoperative bleeding (17%) and a congestive edematous suffusion (20%) were observed, as was the partial leakage of the mucous-cutaneous suture in 7% of cases. The follow-up after 24 months of 50 patients revealed only one relapse (2%) and persistent soiling for approximately 90 days in 22% of cases.