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1. Mental health of medical students belonging to sexual minorities: A focus on help-seeking behavior in an Italian multicenter survey

Author

Lo Moro, G., Leombruni, P., Bert, F., Siliquini, R., PRIMES Collaborating Group, Corradi, A., Gualano, M. R., Olivero, E., Rossello, P., Barello, S., Acampora, A., Arzani, D., Agodi, A., Barchitta, M., Brunelli, L., Brusaferro, S., Celotto, D., Chironna, M., Loconsole, D., Baldo, V., Cocchio, S., Cofini, V., D'Onofrio, S., D'Errico, M. M., D'Errico, M., Marzuillo, C., Baccolini, V., Pasquarella, C., Di Fonzo, D., Pavia, M., Restivo, V., Casuccio, A., Lo Moro G., Leombruni P., Bert F., Siliquini R., Corradi A., Gualano M.R., Olivero E., Rossello P., Barello S., Acampora A., Arzani D., Agodi A., Barchitta M., Brunelli L., Brusaferro S., Celotto D., Chironna M., Loconsole D., Baldo V., Cocchio S., Cofini V., D'Onofrio S., D'Errico M.M., D'Errico M., Marzuillo C., Baccolini V., Pasquarella C., Di Fonzo D., Pavia M., Restivo V., Casuccio A., Lo Moro, G., Leombruni, P., Bert, F., Siliquini, R., Corradi, A., Gualano, M. R., Olivero, E., Rossello, P., Barello, S., Acampora, A., Arzani, D., Agodi, A., Barchitta, M., Brunelli, L., Brusaferro, S., Celotto, D., Chironna, M., Loconsole, D., Baldo, V., Cocchio, S., Cofini, V., D'Onofrio, S., D'Errico, M. M., D'Errico, M., Marzuillo, C., Baccolini, V., Pasquarella, C., Di Fonzo, D., Pavia, M., Restivo, V., and Casuccio, A.

Subjects
Medical student, 05 social sciences, medical students, 050109 social psychology, Mental health, Sexual minoritie, 050105 experimental psychology, Help seeking behavior, Sexual minority, Social support, help-seeking behavior, sexual minorities, Multicenter survey, Psychological support, mental health, 0501 psychology and cognitive sciences, Psychology, General Psychology, Depressive symptoms, Depression (differential diagnoses), Clinical psychology
Abstract

The aim was to examine social, university, health-related differences among heterosexual and Sexual Minority Medical students (SM-Meds), and explore predictors of help-seeking behavior (i.e., current psychological support and hypothetical university counseling use). A multicenter cross-sectional study was conducted in Italy (2018). Questionnaires included socio-demographic items and Beck Depression Inventory-II (BDI-II). Chi-squared tests and multivariable regressions adjusted for BDI-II score were performed (sample size = 2513). SM-Meds were 13.9%. SM-Meds with depressive symptoms were 40.5%. Both considering overall and non-depressed students, SM-Meds exercised less and had worst relationships with family and classmates. Psychological support was reported by 6.1% (SM-Meds: 12.8%) and hypothetical counseling use by 42.7% (SM-Meds: 47.1%). Multivariable models showed SM-Meds had significant higher likelihood of psychological support. Therefore, SM-Meds reported higher help-seeking behavior, lower physical activity and social support. Universities should promote more inclusive learning climate and activities to increase exercise, especially among SM-Meds.

Published
2021

3. Monitoring healthcare-associated infections and antimicrobial use at regional level through repeated point prevalence surveys: what can be learnt?

Author

Arnoldo, L, Smaniotto, C, Celotto, D, Brunelli, L, Cocconi, R, Tignonsini, D, Faruzzo, A, Brusaferro, S, Collazzo, R, Mansutti, M, Martellotta, F, Giacomini, M, Del Ben, G, Vigo, C, Marino, M, Farneti, F, Franca, G, Calligaris, L, Giuliani, C, Perossa, R, Carlovich, C, Valentinis, A, Compassi, S, Guarneri, S, Rasman, W, Kette, F, Toscani, P, Crapis, M, Santarossa, A, Bigaran, A, Maggiore, A, Croci, E, Germanis, L, Perulli, A, Monteverdi, D, Zobec, S, Benedetti, G, Montesi, Mc, Petronio, L, Sfreddo, P, Giurco, C, Rieppi, C, Alessandrini, V, Zuliani, P, Polonia, M, Pipan, C, and the FVG Regional 'safety Care' Group

Subjects
Adult, Male, Microbiology (medical), Healthcare associated infections, Infection prevention and control, animal structures, Adolescent, Prevalence, 030501 epidemiology, Young Adult, 03 medical and health sciences, Environmental health, Humans, Medicine, Infection control, Healthcare-associated infection, Child, Aged, Aged, 80 and over, Repeated prevalence, Cross Infection, Infection Control, 0303 health sciences, 030306 microbiology, business.industry, Infant, Newborn, Infant, virus diseases, General Medicine, Middle Aged, Drug Utilization, Hospitals, Anti-Bacterial Agents, Friuli venezia giulia, Antimicrobial use, Infectious Diseases, Italy, Child, Preschool, Female, Disease prevention, Health Services Research, 0305 other medical science, business
Abstract

Healthcare-associated infections (HAIs) surveillance is an essential part of any infection prevention and control programme. Repeated point prevalence surveys (PPSs) according to European Centre for Disease Prevention and Control (ECDC) protocol have been implemented in all Friuli Venezia Giulia (FVG) region (Italy) acute hospitals to reduce and control HAIs.Using the repeated PPSs within a regional-healthcare system (RHS) to promote and evaluate infection prevention and control (IPC) programmes.The standard versions of the ECDC PPS protocols were used in all four surveys (2011, 2013, 2015, 2017). All RHS public and private accredited hospitals were involved within the 'safe care network' programme.The numbers of surveyed patients in the four PPSs were 3172, 3253, 2969 and 3036, respectively. Prevalence of HAIs and antimicrobial use (AU) decreased significantly from 2011: HAIs (P0.05) 7.1%, 6.3%, 5.5%, 5.8% and AU (P0.01) 40.4%, 39.2%, 36.0%, 37.2%, respectively. The appropriateness of duration of surgical prophylaxis increased significantly (24 h increased through surveys related to one in 2011: odds ratio (OR), 95% confidence interval (CI) 1.29, 0.92-1.81; 1.95, 1.31-2.91; 1.78, 1.20-2.64, respectively). The most frequently detected HAIs were: bloodstream, urinary tract, pneumonia and surgical site (more than the 70% of HAIs in each PPS).The FVG regional approach to HAIs and AU surveillance was able to contribute to reduce prevalence over a 7-year period. Furthermore, it was able to keep hospital attention on HAIs and AU through the years and to guarantee a standardized and comparable evaluation of HAIs and AU burden in all RHS hospitals, as well as impacting on HAIs and AU regional programmes.

Published
2019

7. Lp spherical multipliers on homogeneous trees

Author

Celotto, D, Meda, S, Wróbel, B, Celotto, D, Meda, S, and Wróbel, B

Abstract

We characterise, for each $p$ in $[1,infty) setminus $, the class of $L^p$ spherical multipliers on homogeneous trees in terms of $L^p$ Fourier multipliers on the torus

Published
2019

9. La qualità dell’aria in sala operatoria: l’indagine dell’EUNETIPS

Author

Pasquarella, C., Agodi, A., Barchitta, M., Celotto, D., Albertini, R., Di Fonzo, D., Vegas, A., Assadian, O., Bergervoet, J. P., Cookson, B., Gallagher, R., Grzesiowski, P., Hvingelby, H., Kiernan, M., Kjerulf, A., Licker, M., Lytsy, B., O’Connor, H., Parneix, P., Popp, W., Tholander-Hasselrot, M., Tomberg, O., Wójkowska-Mach, J., and Brusaferro, S.

Published
2018

11. On the analogue of the Fefferman–Stein theorem on graphs with the Cheeger property

Author

Celotto, D, Meda, S, Celotto, D, and Meda, S

Abstract

In this paper, we consider connected locally finite graphs g that possess the Cheeger isoperimetric property. We investigate the Hardy spaces H-R(1)(g), H-H(1)(g) and H-P(1)(g), defined in terms of the Riesz transform, the heat and the Poisson maximal operator on g, respectively. Quite surprisingly, we prove that contrary to what happens in the Euclidean case, these three spaces are distinct. In addition, we prove that if g is an homogeneous tree, then H-R(1)(g) does not admit an atomic decomposition. Applications to the boundedness of the purely imaginary powers of the nearest neighbour Laplacian and of the associated Riesz transform are given.

Published
2018

18. Riesz transforms, spectral multipliers and Hardy spaces on graphs

Author

Celotto, D, MEDA, STEFANO, CELOTTO, DARIO, Celotto, D, MEDA, STEFANO, and CELOTTO, DARIO

Abstract

In this thesis we consider a connected locally finite graph G that possesses the Cheeger isoperimetric property. We define a decreasing one parameter family of Hardy-type spaces associated with the standard nearest neighbour Laplacian on G. We show that the space with parameter 1⁄2 is the space of all integrable functions whose Riesz transform is integrable. We show that if G has bounded geometry and the parameter is an integer, the corresponding Hardy-type space admits an atomic decomposition. We also show that if G is a homogeneous tree and the parameter is not an integer, the corresponding Hardy-type space does not admit an atomic decomposition. Furthermore, we consider the Hardy-type spaces defined in terms of the heat and Poisson maximal operators, and we analyse their relationships with the family of spaces defined previously. We also show that the space associated with the heat maximal operator is properly contained in the one associated with the heat maximal operator, a phenomenon which has no counterpart in the euclidean setting. Applications to the purely imaginary powers of the Laplacian are also given. Finally, we characterise, for every p, the class of spherical multipliers on the p-integrable functions on homogeneous trees in terms of Fourier multipliers on the torus. Furthermore we give a sharp sufficient condition on spherical multipliers on the product of homogeneous trees.

Published
2016

19. $L^p$ spherical multipliers on homogeneous trees

Author

Błażej Wróbel, Stefano Meda, Dario Celotto, Celotto, D, Meda, S, and Wróbel, B

Subjects
Mathematics - Functional Analysi, Class (set theory), Pure mathematics, General Mathematics, Torus, Functional Analysis (math.FA), Mathematics - Functional Analysis, symbols.namesake, Fourier transform, Homogeneous, FOS: Mathematics, symbols, MAT/05 - ANALISI MATEMATICA, Mathematics
Abstract

We characterise, for each $p$ in $[1,\infty) \setminus \{2\}$, the class of $L^p$ spherical multipliers on homogeneous trees in terms of $L^p$ Fourier multipliers on the torus.

Published
2019

20. THE EFFICACY AND SAFETY OF INFLUENZA VACCINATION IN OLDER PEOPLE: AN UMBRELLA REVIEW OF EVIDENCE FROM META-ANALYSES OF BOTH OBSERVATIONAL AND RANDOMIZED CONTROLLED STUDIES

Author

Marco Solmi, Pier Luigi Lopalco, Stefano Celotto, Lee Smith, Jean-Pierre Michel, Elena Righi, Charlotte Beaudart, Gabriel Torbahn, Damiano Pizzol, Dolores Sánchez-Rodríguez, Cafer Balci, Nicola Veronese, Jacopo Demurtas, D Celotto, Stefania Maggi, Vania Noventa, Francesco Di Gennaro, Pinar Soysal, SOYSAL, PINAR, Demurtas, J., Celotto, S., Beaudart, C., Sanchez-Rodriguez, D., Balci, C., Soysal, P., Solmi, M., Celotto, D., Righi, E., Smith, L., Lopalco, P.L., Noventa, V., Michel, J.P., Torbahn, G., Di Gennaro, F., Pizzol, D., Veronese, N., and Maggi, S.

Subjects
0301 basic medicine, Aging, medicine.medical_specialty, Flu, Population, Biochemistry, law.invention, Cohort Studies, older people, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Influenza, Human, medicine, Risk of mortality, Humans, flu, influenza, umbrella review, vaccination, Prospective Studies, efficacy and safety of influenza vaccination, education, Molecular Biology, Aged, Randomized Controlled Trials as Topic, Aged, 80 and over, education.field_of_study, Influenza, Older people, Vaccination, business.industry, Public health, Observational Studies as Topic, 030104 developmental biology, Systematic review, Neurology, Influenza Vaccines, Emergency medicine, Observational study, An umbrella review of evidence from meta-analyses of both observational and randomized controlled studies-, AGEING RESEARCH REVIEWS, cilt.62, 2020 [Demurtas J., Celotto S., Beaudart C., Sanchez-Rodriguez D., Balci C., SOYSAL P., Solmi M., Celotto D., Righi E., Smith L., et al., -The efficacy and safety of influenza vaccination in older people], business, 030217 neurology & neurosurgery, Biotechnology, Cohort study
Abstract

Vaccination is the main public health intervention to prevent influenza. We aimed to evaluate the efficacy and safety of influenza vaccination including systematic reviews and meta-analyses of observational studies and randomized controlled trials (RCTs). Peer-reviewed systematic reviews with meta-analyses of prospective studies that investigated the association of influenza vaccination with any health-related outcome, as well as RCTs that investigated the efficacy and safety of influenza vaccination, were included. Among 1240 references, 6 meta-analyses were included. In cohort studies of community-dwelling older people influenza vaccination was associated with a lower risk of hospitalization for heart disease and for influenza/pneumonia (strength of evidence: convincing). Evidence in lowering the risk of mortality in community-dwelling older people, of all deaths/severe respiratory diseases in high risk community-dwelling older people and of hospitalization for influenza/pneumonia in case-control studies, was highly suggestive. In RCTs, influenza vaccination, compared to placebo/no intervention, was associated to higher risk of local tenderness/sore arm and to a reduced risk of influenza like-illness. Both these associations showed moderate evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation). In conclusion, influenza vaccination in older people seems safe and effective. Further, the evidence on safety and efficacy of vaccines in this population might benefit by an extension of the follow-up period both in RCTs and in longitudinal studies, beyond the usual 6-month period, in order to be able to evaluate the impact of vaccination on long term outcomes. © 2020 Elsevier B.V.

Published
2020

21. On the analogue of the Fefferman–Stein theorem on graphs with the Cheeger property

Author

Stefano Meda, Dario Celotto, Celotto, D, and Meda, S

Subjects
Homogeneous tree, Riesz transforms, Mathematics::General Topology, Hardy space, 01 natural sciences, Exponential growth, Combinatorics, Riesz transform, symbols.namesake, Cheeger property, Euclidean geometry, Maximal operator, 0101 mathematics, Mathematics::Representation Theory, MAT/05 - ANALISI MATEMATICA, Imaginary power, Physics, Mathematics::Functional Analysis, Applied Mathematics, 010102 general mathematics, Nearest neighbour, 010101 applied mathematics, symbols, Isoperimetric inequality, Laplace operator
Abstract

In this paper, we consider connected locally finite graphs $${\mathscr {G}}$$ that possess the Cheeger isoperimetric property. We investigate the Hardy spaces $$H_{{\mathscr {R}}}^1({\mathscr {G}})$$ , $${H_{{\mathscr {H}}}}^{1}({\mathscr {G}})$$ and $$H_{{\mathscr {P}}}^1({\mathscr {G}})$$ , defined in terms of the Riesz transform, the heat and the Poisson maximal operator on $${\mathscr {G}}$$ , respectively. Quite surprisingly, we prove that contrary to what happens in the Euclidean case, these three spaces are distinct. In addition, we prove that if $${\mathscr {G}}$$ is an homogeneous tree, then $$H_{{\mathscr {R}}}^1({\mathscr {G}})$$ does not admit an atomic decomposition. Applications to the boundedness of the purely imaginary powers of the nearest neighbour Laplacian and of the associated Riesz transform are given.

Published
2018

22. Riesz transforms, spectral multipliers and Hardy spaces on graphs

Author

CELOTTO, DARIO, Celotto, D, and MEDA, STEFANO

Subjects
Hardy space, atom, exponential growth, imaginary powers, Riesz transform, maximal operator, multiplier, MAT/05 - ANALISI MATEMATICA
Abstract

In this thesis we consider a connected locally finite graph G that possesses the Cheeger isoperimetric property. We define a decreasing one parameter family of Hardy-type spaces associated with the standard nearest neighbour Laplacian on G. We show that the space with parameter ½ is the space of all integrable functions whose Riesz transform is integrable. We show that if G has bounded geometry and the parameter is an integer, the corresponding Hardy-type space admits an atomic decomposition. We also show that if G is a homogeneous tree and the parameter is not an integer, the corresponding Hardy-type space does not admit an atomic decomposition. Furthermore, we consider the Hardy-type spaces defined in terms of the heat and Poisson maximal operators, and we analyse their relationships with the family of spaces defined previously. We also show that the space associated with the heat maximal operator is properly contained in the one associated with the heat maximal operator, a phenomenon which has no counterpart in the euclidean setting. Applications to the purely imaginary powers of the Laplacian are also given. Finally, we characterise, for every p, the class of spherical multipliers on the p-integrable functions on homogeneous trees in terms of Fourier multipliers on the torus. Furthermore we give a sharp sufficient condition on spherical multipliers on the product of homogeneous trees.

Published
2016

23. A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B.

Author

Brunelli L, Miotto E, Del Pin M, Celotto D, Moccia A, Borghi G, De Monte A, Macor C, Cocconi R, Lattuada L, Brusaferro S, and Arnoldo L

Abstract

Objective: The urgent transfer of an intensive care unit (ICU) is particularly challenging because it carries a high clinical and infectious risk and is a critical node in a hospital's patient flow. In early 2017, exceptional rainfall damaged the roof of the tertiary hospital in Udine, necessitating the relocation of one of the three ICUs for six months. We decided to assess the impact of this transfer on quality of care and patient safety using a set of indicators, primarily considering the incidence of healthcare-associated infections (HAIs) and mortality rates., Methods: We performed a retrospective, observational analysis of structural, process, and outcome indicators comparing the pre- and posttransfer phases. Specifically, we analyzed data between July 2016 and June 2017 for the transferred ICU and examined mortality and the incidence of HAI., Results: Despite significant changes in structural and organizational aspects of the unit, no differences in mortality rates or cumulative incidence of HAIs were observed before/after transfer. We collected data for all 393 patients (133 women, 260 men) admitted to the ICU before (49.4%) and after transfer (50.6%). The mortality rate for 100 days in the ICU was 1.90 (34/1791) before and 2.88 (37/1258) after transfer ( p  = 0.063). The evaluation of the occurrence of at least one HAI included 304 patients (102 women and 202 men), as 89 of them were excluded due to a length of stay in the ICU of less than 48 h; again, there was no statistical difference between the two cumulative incidences (13.1% vs. 6.9%, p  = 0.075)., Conclusion: In the case studied, no adverse effects on patient outcomes were observed after urgent transfer of the injured ICU. The indicators used in this study may be an initial suggestion for further discussion., 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 © 2023 Brunelli, Miotto, Del Pin, Celotto, Moccia, Borghi, De Monte, Macor, Cocconi, Lattuada, Brusaferro and Arnoldo.)

Published
2023
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24. Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study.

Author

Leombruni P, Corradi A, Lo Moro G, Acampora A, Agodi A, Celotto D, Chironna M, Cocchio S, Cofini V, D'Errico MM, Marzuillo C, Pavia M, Restivo V, Veronesi L, Gualano MR, Bert F, Siliquini R, and On Behalf Of The Primes Collaborating Group

Subjects
Adaptation, Psychological, Adult, Cross-Sectional Studies, Female, Humans, Schools, Medical, Stress, Psychological epidemiology, Surveys and Questionnaires, Young Adult, Students, Medical
Abstract

Medical students (MSs) are healthcare workers and must also cope with education-related stressors. This study aims to assess factors associated with perceived stress in Italian MSs. A cross-sectional study was conducted in 12 Italian medical schools (MSCs) in November 2018. A questionnaire assessed socio-demographic characteristics, habits, opinions about MSC, and concerns about the future. Stress was assessed with the PSS-10. Descriptive and univariable tests were performed. A linear model was fitted to find associations of the PSS-10 score with characteristics. There were 2513 collected questionnaires. Median PSS-10 score was 18 (IQR 11). Median age was 22 (IQR 4) and 61% of the sample was female. Female gender, being part of a sexual minority, poor financial situation, competitive atmosphere, having hobbies, resting, and sleeping hindered by MSC were characteristics associated with higher PSS-10 scores. Current relationship, good family relationship, and no concerns about the future were protective factors. Being part of sexual minorities had greater effects in students not living away from home, while in the other group it was not having satisfying friendships. Medical students suffer higher levels of stress than the general population, and many MSC stressors are associated. Living away from home modifies risk and protective factors, offering the possibility to tailor group-specific interventions.

Published
2022
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25. Fattori che influenzano lo screening nutrizionale nei pazienti ricoverati in ospedali per acuti: un'indagine di prevalenza regionale (2017).

Author

Brunelli L, Battistella C, Celotto D, Lesa L, Arnoldo L, and Brusaferro S

Subjects
Aged, Health Surveys, Hospitalization, Humans, Italy epidemiology, Prevalence, Inpatients statistics & numerical data, Malnutrition epidemiology, Nutrition Assessment
Abstract

Background: the prevalence of malnutrition among hospitalized patients varies between 19.8% and 50%, with approximately 31% of all hospital patients considered malnourished or at nutritional risk, both in European and in Italian hospitals. Nutritional screening is necessary to identify nutrition-related problems, but it is not largely performed at the admission or during hospitalization., Objectives: to identify factors associated with the probability of performing nutritional screening during hospitalization and to describe BMI among inpatients in acute facilities of Friuli Venezia Giulia (FVG) Region (Northern Italy)., Design: point prevalence survey., Setting and Participants: the study was conducted in all the 18 hospitals of the FVG regional healthcare system; 58 trained surveyors collected data from 2nd to 30th October 2017., Main Outcome Measures: weight and height, presence of parenteral and enteral nutrition data of 2,553 patients were collected., Results: BMI was determinable for 77.2% of people under study. Negative predictors for BMI screening were: spoke hospital (p<0.001), age over 65 years (p=0.005), both 'ultimately fatal' (p<0.001) and 'rapidly fatal' (p<0.001) McCabe score, presence of minimally invasive surgery (p=0.02); major surgery was a positive predictor (p<0.001). Prevalence of parenteral and enteral nutrition prescription was 4.0% and 3.6%, respectively; statistical differences were found according to care units and McCabe score (p<0.001)., Conclusions: globally, BMI for inpatients in the surveyed hospitals is often assessed, but more investigations are needed to understand the reasons why the reported differences exist.

Published
2021
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26. The efficacy and safety of influenza vaccination in older people: An umbrella review of evidence from meta-analyses of both observational and randomized controlled studies.

Author

Demurtas J, Celotto S, Beaudart C, Sanchez-Rodriguez D, Balci C, Soysal P, Solmi M, Celotto D, Righi E, Smith L, Lopalco PL, Noventa V, Michel JP, Torbahn G, Di Gennaro F, Pizzol D, Veronese N, and Maggi S

Subjects
Aged, Aged, 80 and over, Cohort Studies, Humans, Influenza Vaccines adverse effects, Observational Studies as Topic, Prospective Studies, Randomized Controlled Trials as Topic, Vaccination, Influenza, Human prevention & control
Abstract

Vaccination is the main public health intervention to prevent influenza. We aimed to evaluate the efficacy and safety of influenza vaccination including systematic reviews and meta-analyses of observational studies and randomized controlled trials (RCTs). Peer-reviewed systematic reviews with meta-analyses of prospective studies that investigated the association of influenza vaccination with any health-related outcome, as well as RCTs that investigated the efficacy and safety of influenza vaccination, were included. Among 1240 references, 6 meta-analyses were included. In cohort studies of community-dwelling older people influenza vaccination was associated with a lower risk of hospitalization for heart disease and for influenza/pneumonia (strength of evidence: convincing). Evidence in lowering the risk of mortality in community-dwelling older people, of all deaths/severe respiratory diseases in high risk community-dwelling older people and of hospitalization for influenza/pneumonia in case-control studies, was highly suggestive. In RCTs, influenza vaccination, compared to placebo/no intervention, was associated to higher risk of local tenderness/sore arm and to a reduced risk of influenza like-illness. Both these associations showed moderate evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation). In conclusion, influenza vaccination in older people seems safe and effective. Further, the evidence on safety and efficacy of vaccines in this population might benefit by an extension of the follow-up period both in RCTs and in longitudinal studies, beyond the usual 6-month period, in order to be able to evaluate the impact of vaccination on long term outcomes., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Published
2020
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27. Absences from work among healthcare workers: are they related to influenza shot adherence?

Author

Antinolfi F, Battistella C, Brunelli L, Malacarne F, Bucci FG, Celotto D, Cocconi R, and Brusaferro S

Subjects
Adult, Female, Humans, Influenza, Human prevention & control, Italy, Male, Middle Aged, Retrospective Studies, Absenteeism, Health Personnel statistics & numerical data, Influenza Vaccines administration & dosage, Vaccination Coverage statistics & numerical data
Abstract

Background: The coverage for influenza vaccination among healthcare workers (HCWs) is inadequate in many countries despite strong recommendations; is there evidence that influenza vaccination is effective in preventing absenteeism? Aim of the study is to evaluate the influenza vaccination coverage and its effects on absences from work among HCWs of an Italian academic healthcare trust during the 2017-2018 influenza season., Methods: We performed a retrospective study to identify predictive characteristics for vaccination, and a retrospective cohort study to establish the effect of vaccination on absences among the vaccinated and non-vaccinated cohorts between December 2017 and May 2018. Overall absence rates over the whole observation period and sub-rates over 14-days intervals were calculated; then comparison between the two groups were conducted applying Chi-square test., Results: Influenza vaccination coverage among 4419 HCWs was 14.5%. Age, university degree, medical care area and physician profile were positively associated with vaccine uptake. Globally during influenza season non-vaccinated HCWs lost 2.47/100 person-days of work compared to 1.92/100 person-days of work among vaccinated HCWs (p < 0.001); significant differences in absences rates resulted when focusing on the influenza epidemic peak., Conclusions: Factors predicting influenza uptake among HCWs were male sex, working within medical care area and being a physician. Absenteeism among HCWs resulted to be negatively correlated with vaccination against influenza. These findings add evidence to the urgent need to implement better influenza vaccination strategies towards HCWs to tackle vaccine hesitancy among professionals.

Published
2020
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28. Assessment of the impact of clinical recommendations on antibiotic use for CAP and HCAP: results from an implementation program in an Academic Hospital.

Author

Cattani G, Madia A, Arnoldo L, Brunelli L, Celotto D, Grillone L, Valent F, Castriotta L, Pea F, Bassetti M, and Brusaferro S

Subjects
Academic Medical Centers, Aged, Aged, 80 and over, Antimicrobial Stewardship, Female, Guideline Adherence, Humans, Italy, Levofloxacin administration & dosage, Male, Middle Aged, Practice Guidelines as Topic, Retrospective Studies, Anti-Bacterial Agents administration & dosage, Community-Acquired Infections drug therapy, Healthcare-Associated Pneumonia drug therapy, Pneumonia drug therapy
Abstract

Background: Local guidelines and recommendations to treat common infectious diseases are a cornerstone of most Antimicrobial Stewardship programs. The evaluation of the adherence to guidelines is an effective quality measure of the programs themselves; the proposed evaluation model aimed at examining antibiotic treatment for pneumonia., Study Design: A retrospective pre-post intervention study was conducted in a North-Eastern Italian Academic Hospital., Methods: 231 patients with Community-Acquired Pneumonia and 95 with Healthcare-Associated Pneumonia were divided into pre- and post-intervention groups (188 and 138, respectively). A course and a pocket summary of Pneumonia Regional Recommendations were the stewardship activities adopted. The compliance degree of prescriptions with Regional Recommendations was tested for drug(s), dosage and duration of treatment in both groups for Community-Acquired and Healthcare-Associated Pneumonia and a comparison with International guidelines was performed., Results: A significant improvement in the compliance with Regional Recommendations for the variable drug emerged for Community-Acquired (38.8% vs 52.2%), but not for Healthcare-Associated Pneumonia; no significant variation in compliance was registered for dosage and duration of treatment. The significant decrease in consumption of levofloxacin showed the positive impact of the Regional Antimicrobial Stewardship programs. A high level of adherence to International Guidelines for the variable drug for Community-Acquired Pneumonia was found in both groups (75.5% and 77.2%, respectively)., Conclusions: Our study highlighted that room for improvement in antibiotic prescription in Community-Acquired and Healthcare-Associated Pneumonia currently remains. New strategies for a better use of the adopted tools and definition of new antimicrobial stewardship initiatives are needed to improve compliance to Regional Recommendations.

Published
2020
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29. Nutrition therapy in intensive care unit setting: what can be learned from a 6 months survey in a large academic hospital?

Author

Brunelli L, Bravo G, Arnoldo L, Lesa L, Celotto D, Battistella C, Malacarne F, d'Angelo M, Parpinel M, and Brusaferro S

Subjects
Academic Medical Centers, Adult, Aged, Aged, 80 and over, Critical Care methods, Female, Hospital Mortality, Humans, Italy, Length of Stay, Male, Middle Aged, Nutritional Status, Practice Patterns, Physicians' statistics & numerical data, Retrospective Studies, Surveys and Questionnaires, Enteral Nutrition methods, Intensive Care Units, Malnutrition therapy, Parenteral Nutrition methods
Abstract

Background: Malnutrition in Intensive Care Unit patients has been associated with worse clinical outcomes such as mortality and length of stay (LOS) in Intensive Care Unit (ICU), and nutritional status of Intensive Care Unit patients in particular seemed to be a significant predictor of mortality. Promptness of clinical nutrition administration is a key of nutritional support whenever volitional intake is unfeasible. Early enteral nutrition is associated with better clinical outcomes (reduced complications, LOS in ICU and in Hospital). The aim of this study is to investigate the nutrition therapy management in a large Academic Hospital, evaluating its effects on mortality and LOS in ICU and in the Hospital., Study Design: Data were collected retrospectively from clinical records. Six physicians were trained on the data collection protocol and they reviewed every clinical record of patients included in the survey., Methods: Data of 426 patients admitted to ICUs between November 2016, 1st and April 2017, 30th were collected. A multivariate logistic adjusted regression, with backward variables selection method, was performed in order to identify predictors of enteral and parenteral nutrition conducted within 48 hours after admission to the ICU. The relation between medical nutrition therapy, mortality and LOS in ICU and in the Hospital were also evaluated., Results: Patients were given prompt parenteral and enteral nutrition in 25.12% and 27.46% of cases, respectively. No association was found between medical nutrition therapy and ICU or hospital mortality. Predictors of early enteral nutrition were type of admission and surgery before admission; early parenteral nutrition predictors were gender, ICU (A vs B), impaired immunity status and Central Venous Catheter presence at admission., Conclusions: Our study stresses the need of monitoring nutrition prescribing behaviors in acute hospitals in order to better set up tailored interventions to standardize clinicians' practices and to focus on specific training targets.

Published
2020
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30. Factors predicting influenza vaccination adherence among patients in dialysis: an Italian survey.

Author

Battistella C, Quattrin R, Celotto D, d'Angelo M, Fabbro E, Brusaferro S, Agodi A, Astengo M, Baldo V, Baldovin T, Bert F, Biancone L, Calò LA, Canale A, Castellino P, Carli A, Icardi G, Lopalco PL, Righi A, Siliquini R, Tardivo S, Tassinari F, and Veroux M

Subjects
Aged, Cross-Sectional Studies, Female, General Practitioners, Humans, Influenza Vaccines administration & dosage, Male, Surveys and Questionnaires, Vaccination, Health Knowledge, Attitudes, Practice, Influenza, Human prevention & control, Patient Compliance psychology, Renal Dialysis, Vaccination Coverage statistics & numerical data
Abstract

Introduction : The aim of this study was to investigate knowledge and practices about influenza among patients on dialysis services of Italian hospitals at risk of severe influenza infection and vaccine and to identify predictive factors to vaccination adherence. Methods : A cross-sectional observational study was carried out from January 2017 to July 2017 after the 2016/2017 influenza vaccination campaign. The questionnaire was administered to all patients treated in seven large Italian dialysis services. It consisted of influenza vaccination coverage, knowledge about influenza and its vaccination, perceived risk of influenza complications, recommendations on influenza uptake received by general practitioner (GP) and nephrologist. Results : Response rate was 90% (703/781). Patients' knowledge about influenza infection and vaccine were detected by nine closed questions: 35.6% of responders answered correctly to ≥ 6 sentences, 47.5% of them reported that "influenza vaccine can cause influenza" and 45.7% believed that "antibiotics are a correct strategy to treat influenza". Levels of perceived risks of hospitalisation and death were low in 39.3% and 16.5% of patients respectively. The adherence to the last seasonal influenza vaccination was 57.5%. The multivariate predictors of influenza vaccination uptake resulted: age ≥65, male, consulting TV/radio, asking information to GP and/or nephrologist. Conclusions : The study reveals the low adherence to influenza vaccination and the subotpimal level of knowledge in dialysis patients. Different strategies, including a greater alliance among nephrologists and GPs to prevent influenza should be encouraged to improve the adherence to influenza vaccination in this at risk group.

Published
2019
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