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Abstract Two diazotrophic cyanobacteria (Anabaena cylindrica PCC 7122 and Nostoc sp. PCC 7120) were cultivated to produce cyanophycin, a nitrogen reserve compound, under nitrogen fixing conditions. In preliminary continuous experiments, Nostoc sp. was shown to be more efficient, accumulating a higher amount of cyanophycin and showing a greater capability to fix atmospheric nitrogen in the biomass (67 mgN d−1 of fixed nitrogen per liter of culture). The operating conditions were then optimized to maximize the cyanophycin productivity: the effect of incident light intensity, residence time and nitrogen availability were investigated. Nitrogen availability and/or pH played a major role with respect to biomass production, whereas phosphorus limitation was the main variable to maximize cyanophycin accumulation. In this way, it was possible to achieve a stable and continuous production of cyanophycin (CGP) under diazotrophic conditions, obtaining a maximum cyanophycin productivity of 15 mgCGP L−1 d−1. Key points • Diazotrophic cyanobacteria produce stable amount of cyanophycin in continuous PBR. • Nostoc sp. proved to be more efficient in producing cyanophycin than Anabaena sp. • P deprivation is the major variable to increase cyanophycin productivity in continuous.

Background. Shared decision-making implies that patients and healthcare professionals make decisions together about clinical exams, available treatments, choice of options, and the benefit or downside of every choice. Patients involved in the shared decision-making process are more compliant with treatments and have a reduced risk of complications related to the pathology. In Italy, patient involvement in caring processes is still barely investigated. Aim. To investigate patients’ perceptions about shared decision-making with physicians and nurses, respectively, and to examine the relationship between shared decision-making and patient satisfaction and perceived quality of care/treatment. Methods. The study was performed between March and June 2019 in two wards of one Italian hospital. A questionnaire was administered to inpatients at the time of admission and again at discharge, including demographic information and measurement scales regarding patient involvement in shared decision-making, patient satisfaction, and perceived quality of treatment/care. Results. A total of 151 out of 301 patients completed questionnaires at both admission and discharge. Patients’ scores for shared decision-making (information, patient needs, treatment planning) were significantly different for physicians and nurses. At both admission and discharge, patients rated shared decision-making significantly higher for physicians compared to nurses, while there were no differences in their satisfaction ratings. Patient ratings of physicians did not change from admission (information: mean (M) = 3.50, standard deviation (SD) = 0.81; patient need: M = 3.05, SD = 1.05; treatment planning: M = 2.75, SD = 1.23) to discharge (information: M = 3.50, SD = 0.79; patient need: M = 3.17, SD = 1.02; treatment planning: M = 2.66, SD = 1.23) (p = 0.924, p = 0.098, p = 0.293, respectively), but patients’ ratings of nurses’ behavior increased significantly from admission (information: M = 2.44, SD = 1.23; patient need: M = 2.27, SD = 1.17; treatment planning: M = 2.12, SD = 1.19) to discharge (information: M = 2.62, SD = 1.22; patient need: M = 2.53, SD = 1.24; treatment planning: M = 2.35, SD = 1.21) (p = 0.019, p = 0.001, p = 0.003, respectively). Attention to patients’ needs was the key determinant of both satisfaction with nurses (OR = 3.65, 95% CI = 1.31–10.14, p = 0.013) and perceived quality of care (OR = 3.97, 95% CI = 1.49–10.55, p = 0.006). Providing appropriate information about disease progress and treatments was a key determinant of both satisfaction with physicians (OR = 19.75, 95% CI = 7.29–53.55, p < 0.001) and perceived quality of treatment (OR = 8.03, 95% CI = 3.25–19.81, p < 0.001). Discussion. Nurses should be sensitized to involving patients in the decision-making process, especially upon hospital admission. Specific training about effective communication techniques can be implemented to manage relationships with patients in different caring situations. Practical implications and future directions are discussed.

Since the beginning of the COVID-19 pandemic, public discourse has been characterized by a massive use of war metaphors. At the same time, this use has been harshly attacked as inappropriate and potentially dangerous. The article proposes a reflection on this debate by questioning the demonization of the war metaphor. Indeed, the appropriateness and the efficacy of a metaphor are not absolute values but depend on many factors such as context, audience and communicative purposes. Therefore, instead of attacking war metaphors it would be more useful to enrich the range of expressions to talk about the pandemic. What is really important is to never forget that expressive choices are never only words but a constitutive part of our experience of the world.

Two diazotrophic cyanobacteria (Anabaena cylindrica PCC 7122 and Nostoc sp. PCC 7120) were cultivated to produce cyanophycin, a nitrogen reserve compound, under nitrogen fixing conditions. In preliminary continuous experiments, Nostoc sp. was shown to be more efficient, accumulating a higher amount of cyanophycin and showing a greater capability to fix atmospheric nitrogen in the biomass (67 mg

Vaccinations against

Background: From January 2017 to June 2018 more than 7000 measles cases were reported in Italy, of which more than 400 among unvaccinated healthcare workers. We described a measles outbreak occurred in Western Liguria, Italy, characterized by a high involvement of healthcare workers and hospital visitors. Methods: Suspected measles cases and data regarding vaccination status and clinical management of the patients were collected by reviewing 3 different surveillance systems: the routine mandatory notification system, the National Integrated Surveillance System for Measles and Rubella and the regional reference laboratory for measles diagnosis. Results: Thirty-six cases were reported, with a median age of 31 years and >95% in unvaccinated subjects. One death occurred, 15 cases were hospitalized. Hospital transmission was confirmed or suspected in 12 cases; amongst this cases, 5 were healthcare workers (a gynaecologist, an obstetric nurse, a radiologist, a physiotherapist and a nurse working in an infectious disease ward), all certified unvaccinated. Phylogenetic analysis revealed the circulation of a single B3 genotype variant. Conclusions: Our experience highlighted the key role of nosocomial transmission and the need for targeted strategies, in particular (i) to implement a measles catch-up immunization campaign in susceptible groups, especially in healthcare workers, (ii) to intensify the check of immunisation status of healthcare workers and to offer vaccination for those who need it, (iii) to improve timeliness and completeness of surveillance systems. Efforts are needed to guarantee the safety of the hospital and the reliability of the healthcare workers. Only high vaccination coverage among HCWs can prevent the diffusion of measles in the hospital setting. Keywords: Measles outbreak, Epidemiological surveillance, Laboratory surveillance, Healthcare workers, Nosocomial transmission

Literature suggested that COVID-19 patients experienced hospitalization as a physically and psychologically stressful event, with the risk to develop post-traumatic stress symptoms. The study aimed to understand psychological experiences of COVID-19 survivors with severe complications during and after ICU hospitalization, and any relevant health consequences. From October 2020 to January 2021, a qualitative study was conducted in Italy via semi-structured interviews by phone or video call addressed to COVID-19 survivors, randomly enrolled among people who released their stories publicly on newspapers, television, or social media. Fifteen individuals (three women and twelve men with average age of 56.4 years) were interviewed. Four main themes emerged: (i) emotion of fear; (ii) isolation and loneliness; (iii) unawareness about the gravity of the situation as a protective factor; (iv) “Long COVID” as consequences of the disease on physical and psychological health. During hospitalization, 66.7% of participants had mild or moderate values of anxiety and depression. After discharge, 86.7% moved to normal values. The results suggest that long-COVID is an important problem to manage to improve patients’ quality of life. It is essential to guarantee a holistic take in charge starting before the discharge and continuing care after discharge in the community where they live.

Despite the availability of vaccines against Streptococcus pneumoniae, the global incidence and economic cost of pneumococcal disease (PD) among adults is still high. This retrospective cohort analysis estimated the cost of emergency department (ED) visits/hospitalizations associated with non-invasive pneumonia and invasive pneumococcal disease among individuals ≥15 years of age in the Liguria region of Italy during 2012–2018. Data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse were used, including hospital admission date, length of stay, discharge date, outpatient visits, and laboratory/imaging procedures. A ≥30-day gap between two events defined a new episode, and patients with ≥1 ED or inpatient claim for PD were identified. The total mean annual number of hospitalizations for PD was 13,450, costing ~€49 million per year. Pneumonia accounted for the majority of hospitalization costs. The median annual cost of hospitalization for all-cause pneumonia was €38,416,440 (per-capita cost: €26.78) and was €30,353,928 (per-capita cost: €20.88) for pneumococcal and unspecified pneumonia. The total number and associated costs of ED visits/hospitalizations generally increased over the study period. PD still incurs high economic costs in adults in the Liguria region of Italy.

Background: We conducted a population-based cohort study to estimate mortality before, during and after the COVID-19 peak and to compare mortality in 2020 with rates reported in previous years, with a view to helping decision makers to apply containment measures for high-risk groups. Methods: All deaths were collected between 2015 and 2020 from municipal registry database. In 2020, weeks 1-26 were stratified in three periods: before, during and after the COVID mortality peak. The Poisson Generalized Linear regression Model showed the ���harvesting effect���. Three logistic regressions for 8 dependent variables (age and comorbidities) and a t-test of differences described all-cause mortality risk factors in 2019 and 2020 and differences between COVID and non-COVID patients. Results: A total of 47,876 deaths were collected. All-cause deaths increased by 38.5% during the COVID peak and decreased by 18% during the post-peak period in comparison with the average registered during the control period (2015-19), with significant mortality displacement in 2020. Except for chronic renal injuries in subjects aged 45-64 years, diabetes and chronic cardiovascular diseases in those aged 65-84 years, and neuropathies in those aged >84 years, the weight of comorbidities in deaths was similar or lower in COVID subjects than in non-COVID subjects. Discussions: Surprisingly, the weight of comorbidities in death, compared to weight in non-COVID subjects allows you to highlight some surprising results such as COPD, IBD and Cancer. The excess mortality that we observed in the entire period were modest in comparison with initial estimates during the peak, owing to the mild influenza season and the harvesting effect starting from the second half of May., Journal of Preventive Medicine and Hygiene, Vol. 62 No. 4 (2021): 2021624

Nell’attuale dibattito sul tema della post-verità le emozioni sono generalmente pensate in contrapposizione o ai ‘fatti’ o alle ‘ragioni’. Tale contrapposizione sottintende una forte svalutazione della sfera emotiva, percepita come sostanzialmente ‘irrazionale’ e pertanto pericolosa. L'articolo intende mostrare l’inadeguatezza di questa idea facendo ricorso all' apparato concettuale della Retorica di Aristotele. Il limite principale della dicotomia emozioni/ragioni consiste nel non tenere nel debito conto il fatto che l’azione umana (cui il discorso persuasivo in ultima istanza mira) non può mai prescindere dalla componente del desiderio, che è invece centrale nella prospettiva aristotelica. In questa prospettiva, il ricorso all’appello emotivo nel discorso con finalità persuasive non solo non ha niente di “irrazionale”, ma non va inteso nemmeno come un ripiego necessario dinanzi ad interlocutori dalle ridotte capacità cognitive. È, al contrario, una condizione ineliminabile di un discorso che voglia davvero aver presa sull’ascoltatore. Se ciò è vero in generale, lo è a maggior ragione nei i casi in cui ad essere in gioco sono questioni che riguardano la salute, e quindi la vita stessa dell’individuo coinvolto. Non si tratta dunque di ipotizzare — anche solo come ideale regolativo — un discorso del tutto privo di tonalità emotiva, fatto solo di argomenti ‘razionali’ e appello ai ‘fatti’ (e, per ciò stesso, garanzia di ‘verità’) ma di domandarsi quali emozioni siano più pertinenti rispetto agli argomenti in gioco e più capaci, eventualmente, di motivare l’ascoltatore in modo da renderlo parte attiva del processo persuasivo. Questo significa che identificare la parola corrotta e manipolativa con quella emotiva non ci aiuta davvero a capire come affrontare questioni così urgenti come la perdita di fiducia negli esperti o il successo delle ideologie anti-scientifiche. La sfida è piuttosto quella di provare a comprendere che anche la "pancia" ha le sue ragioni e che dobbiamo imparare ad ascoltarle.

Objective: To assess healthcare workers&rsquo, knowledge and attitudes about human papillomavirus (HPV) infection, related diseases, and prevention. Methods: A cross-sectional multicenter survey about HPV and its prevention, targeted to healthcare workers involved in HPV vaccine counseling, was performed from May 2017 to December 2018. Results: The overall median knowledge and attitude scores were 69.2% (25&ndash, 75, p = 61.5&ndash, 84.6) and 5 (25&ndash, 75, p = 4&ndash, 5), respectively. Both knowledge and attitudes statistically significantly differ between physicians and healthcare professions. The median propensity score before and after the educational intervention was stable and high, at 10 (25&ndash, 75, p = 9&ndash, 10). The predictors of statistically significantly high knowledge scores are to be a physician, general practitioner, or pediatrician, attending courses/congresses, and consulting technical product characteristics and scientific literature to obtain information about the HPV vaccine. Being a physician and consulting scientific literature to obtain information about the HPV vaccine were found also as predictors of statistically significantly different attitude scores among study participants. Conclusions: Although healthcare workers showed overall positive attitudes towards the relevance of HPV burden and prevention tools, demonstrated knowledge was largely suboptimal, particularly that shown by healthcare professions. Obtained results allow highlighting knowledge gaps, and thus improving counselling to HPV vaccine targets.

L’intento principale del saggio è mostrare quanto possa essere vantaggioso guardare al fenomeno della comprensione linguistica utilizzando l’apparato concettuale della retorica classica, messo in fruttuoso dialogo con la pragmatica contemporanea. La legittimità di tale operazione si fonda sulla convinzione che sia proficuo estendere lo specifico punto di vista della retorica al discorso ordinario nel suo complesso. Tale estensione non implica in alcun modo negare la specificità del punto di vista retorico sul linguaggio ma mira anzi a sfruttarla, per fare emergere aspetti altrimenti poco valorizzati. È vero, infatti, che la retorica si occupa tradizionalmente di un tipo particolare di discorsi (i discorsi pubblici con evidente e consapevole finalità persuasiva) ma è anche vero che proprio questo specifico interesse per i discorsi con finalità persuasiva è ciò che consente di mettere in luce alcuni aspetti del parlare che altre prospettive hanno invece trascurato o del tutto ignorato. Infatti, nelle tipiche situazioni discorsive di cui tradizionalmente la retorica si è occupata emergono con maggiore chiarezza aspetti che non sono in realtà esclusivi di quelle situazioni ma appartengono al linguaggio ordinario. L’assunzione di fondo che rende possibile questa estensione è che parlare non è mai (o non è mai soltanto) trasferire informazioni ma cercare di modificare le credenze (e/o i comportamenti) del nostro interlocutore. Di conseguenza, comprendere non è mai soltanto un “recepire” (e nemmeno soltanto un “interpretare”) ma sempre, in qualche modo, un “rispondere". Se ciò è vero, il fenomeno della persuasione non è limitato a particolari situazioni comunicative, ma riguarda il parlare nel suo complesso e pertanto l’apparato concettuale della retorica può essere proficuamente esteso all’intero linguaggio umano.

Il linguaggio è un’alternativa alla violenza o un suo strumento? Mettendo in discussione la separazione tra violenza verbale e violenza fisica, il libro mette a fuoco il rapporto che lega linguaggio, violenza e natura umana, nel contesto della madre di tutte le guerre, quella combattuta a Troia e raccontata nell’Iliade, dove armi e parole concorrono a realizzare una violenza distruttiva. Le vicende narrate nel poema omerico diventano allora casi esemplari, utili a illustrare il potere che il linguaggio ha di inaugurare nuove forme di violenza esclusive dell’animale che parla.

L'articolo mira a mostrare la rilevanza filosofica della lettura della Retorica di Aristotele proposta da Heidegger durante il corso tenuto a Marburgo nel 1924 (Grundbegriffe der Aristotelischen Philosophie). L'obiettivo principale non è discutere la correttezza filologica dell'interpretazione di Heidegger o il ruolo che il corso ha svolto nello sviluppo del pensiero successivo del filosofo tedesco. Piuttosto, l'intento è mostrare come (e perché) la lettura heideggeriana ci consenta di (ri)valorizzare la Retorica aristotelica inserendola nel dibattito filosofico contemporaneo. La tesi sostenuta è che la forza principale della lettura heideggeriana della Retorica è la sua capacità di mettere in evidenza, in linea con la prospettiva aristotelica, l'intreccio tra corpo, linguaggio e socialità nell'essere umano. The paper aims to show the philosophical relevance of the reading of Aristotle’s Rhetoric proposed by Heidegger during the course held in Marburg in 1924 (Grundbegriffe der Aristotelischen Philosophie). The main objective is not to discuss the philological correctness of Heidegger’s interpretation or the role that the course played in the development of Heidegger’s next thought. Rather, the intent is to show how and why the Heideggerian reading allows us to enhance the Aristotelian rhetoric in contemporary philosophical debate. The thesis argued is that the main strength of the Heideggerian reading of rhetoric is its ability to bring out, in line with the Aristotelian perspective, the interweaving of body, language and sociality in the human being.

The article proposes a reflection on the ability of words to soothe pain and, more generally, the ability of language to have (positive or negative) effects on our lives. This ambivalent power represents an interesting phenomenon to better understand the role that language plays in the construction (and/or dissolution) of our social bonds. The reflection is guided by some intuitions of psychoanalysis which have their roots in ancient Greek culture and especially in classical rhetoric.

Two sets of benzimidazole derivatives were synthesised and tested in vitro for activity against promastigotes of Leishmania tropica and L. infantum. Most of the tested compounds resulted active against both Leishmania species, with IC50 values in the low micromolar/sub-micromolar range. Among the set of 2-(long chain)alkyl benzimidazoles, whose heterocyclic head was quaternised, compound 8 resulted about 100-/200-fold more potent than miltefosine, even if the selectivity index (SI) versus HMEC-1 cells was only moderately improved. In the set of 2-benzyl and 2-phenyl benzimidazoles, bearing a basic side chain in position 1, compound 28 (2-(4-chlorobenzyl)-1-lupinyl-5-trifluoromethylbenzimidazole) was 12-/7-fold more potent than miltefosine, but exhibited a further improved SI. Therefore, compounds 8 and 28 represent interesting hit compounds, susceptible of structural modification to improve their safety profiles., Graphical Abstract

Purpose The purpose of this study was to investigate patients' and caregivers' health needs for a re-orientation program based on principles of health promotion in an Oncology Department from an Italian University Hospital. Method A Cross-sectional design with qualitative and quantitative approaches was used. Participants included cancer patients and their caregivers. Information about disease concerns were collected using a survey form. Information about healthy lifestyle was obtained using motivational interviews. Information about perceived quality of oncology services was collected by a self-administered questionnaire. Results A total of 403 information requests were collected about patients' disease, 203 motivational interviews were carried out, and 219 questionnaires were collected. Overall, the results showed that patients and caregivers have healthy lifestyles even if meat consumption was high. Weak points were: poor physical space organization in the Service, long waiting times, and limited access to healthcare providers for patients. Conclusions This study revealed the need for an approach based on health-promotion principles, with a particular focus on patient wellbeing and quality of life. The study increases awareness about the influence that an environment has on patient health, thus suggesting that changes in culture, attitude, and health services re-organization are crucial to meet total needs of the individual as a whole process.

Despite infections due to HPV nowadays represent the most common sexually transmitted diseases worldwide with recognized effective and safe preventive strategies, knowledge, attitudes; however, awareness on HPV is considerably low. The present study has two main objectives: 1. To conduct a literature review to analyze the evolution of preventive tools, the complexity of the vaccine choice process, and the challenges posed by HPV vaccine hesitancy and refusal among pre-adolescents and their parents; 2. To assess knowledge, practices and attitudes toward HPV infection and vaccination in a sample of Italian pre-adolescents and their parents. The observational study was carried out through the use of two anonymous and self-administered pre- and postintervention questionnaires dedicated to the target populations. Between the administrations of the pre- and postintervention questionnaires, an educational intervention on HPV infection and related diseases, and prevention strategies was conducted. All participants demonstrated suboptimal knowledge and positive attitudes in the preintervention questionnaire. Higher levels of knowledge and attitudes were observed among pre-adolescents thatused social networks and had heard of sexually transmitted diseases at home/school/physician and from parents and also who had heard of HPV from General Practitioners, Gynecologists, family members and newspapers. A significant increase in HPV vaccination awareness was observed among pre-adolescents after the educational sessions. Health education programs aimed at increasing knowledge, attitudes and awareness on HPV are needed to implement the outcomes of HPV immunization programs, especially if supported by the physicians involved in counselling and recommendation processes.

Influenza occurs worldwide and causes significant disease burden in terms of morbidity, associated complications, hospitalizations, and deaths. Vaccination constitutes the primary approach for controlling influenza. Current influenza vaccines elicit a strain-specific response yet occasionally exhibit suboptimal effectiveness. This review describes the limits of available immunization tools and the future prospects and potentiality of universal influenza vaccines.New 'universal' vaccines, which are presently under development, are expected to overcome the problems related to the high variability of influenza viruses, such as the need for seasonal vaccine updates and re-vaccination. Here, we explore vaccines based on the highly conserved epitopes of the HA, NA, or extracellular domain of the influenza M2 protein, along with those based on the internal proteins such as NP and M1.The development of a universal influenza vaccine that confers protection against homologous, drifted, and shifted influenza virus strains could obviate the need for annual reformulation and mitigate disease burden. The scientific community has long been awaiting the advent of universal influenza vaccines; these are currently under development in laboratories worldwide. If such vaccines are immunogenic, efficacious, and able to confer long-lasting immunity, they might be integrated with or supplant traditional influenza vaccines.

L’articolo è dedicato alla nozione aristotelica di eustochia (la capacità di fare buone congetture), nella convinzione che essa possa contribuire al ripensamento della nostra costitutiva precarietà. Diversamente da una lettura tradizionale che vede Aristotele principalmente come il filosofo del ragionamento deduttivo, l’articolo sostiene invece l’importanza di questa capacità cognitiva nel pensiero aristotelico. Con questo scopo, vengono analizzati i tre principali contesti in cui Aristotele fa riferimento all’eustochia: la costruzione del sillogismo (APo, 89b 10), il raggiungimento della virtù (EN, 1106b 16) e la creazione di metafore ((Rh. 1412a 13). Nonostante le evidenti differenze, queste tre situazioni condividono la componente di incertezza, rispetto alla quale l’eustochia rappresenta una preziosa risorsa. Le caratteristiche principali di questa abilità cognitiva sono la fallibilità e la velocità, due caratteristiche che la rendono particolarmente flessibile ed adatta a far fronte alle situazioni di incertezza e precarietà. This paper will focus on the Aristotelian concept of eustochia (shrewdness or good ability to conjecture). Composed by the adverb eu (well) and the verb stochazesthai (to conjecture, to guess), the word eustochia refers to the capacity to successfully guess. More in general, it can indicate the ability to achieve the target we are aiming at. The main characteristic of this skill is its fallibility. Indeed, we have no guarantee that the process of stochazein (guessing) will be successful. In modern terminology, we can say that eustochia is a reasonable but not algorithmic procedure for problem solving in uncertain conditions. The paper pursues a twofold objective. Firstly, we will show that eustochia plays a crucial role in Aristotelian philosophy (contrary to the traditional image of Aristotle as the philosopher of deductive reasoning). Indeed, Aristotle especially refers to eustochia in three different but important situations: 1. the construction of syllogisms (A Po, 89b 10); 2. the achievement of virtue (EN, 1106b 16); 3. the creation of metaphors (Rhet. 1412a 13). In the Aristotelian perspective, each of these activities plays a crucial role and they all need eustochia. It is noteworthy that this kind of ability is typical to the rhetorician (see also (Rh. 1395b 10 sgg.), as the reference to metaphors clearly shows. Indeed, the domain of rhetoric is inherently undeterminate, although not irrational. This is the domain of fallibility and uncertainty where eustochia is a necessary skill. Therefore, Aristotelian Rhetoric can give us useful suggestions in order to better understand eustochia and, more in general, knowledge under uncertainty. Secondly, we intend to show that eustochia is a difficult but essential human ability. It is both a result of a natural talent and experience. The intrinsic uncertainty of this typical rhetorical activity is not a fault but an important resource in order to face the precariousness of human life. Cette contribution porte sur la notion aristotélicienne d’eustochia (qui désigne la connaissance intuitive ; le fait de viser juste) et s’intéresse successivement à la construction des syllogismes, à la réalisation de la vertu et au façonnage des métaphores. Trois situations qui sont traversées par l’incertitude et le flou. L’analyse permet dès lors d’apprécier ce qui caractérise l’eustochia en propre, à savoir, la faillibilité, d’une part, la vitesse, de l ’autre.

Background Research in Human Resources Management has highlighted that implementing strategies for increasing employees' motivation can be an advantage for organizations because this improves their performance. Objective Self Determination Theory (SDT) was used to analyze the mediating role of autonomous vs. controlled motivation on the relationship between organizational factors (perceived organizational support and job autonomy) and work outcomes (affective commitment, job satisfaction, and intent to quit). Methods A total of 304 nurses from an Italian hospital participated in the study. Results The results supported the importance of the mediating role of autonomous motivation on the relationship between both perceived organizational support (POS) and job autonomy, and work outcomes. Conversely, controlled motivation did not show mediating effects on that relationship. POS was directly related to affective commitment and job satisfaction. Conclusions Practical implications for organizations and employees are discussed along with a call for further research in this area.

Background Influenza-like illnesses (ILIs) and lower respiratory tract infections (LRTIs) cause substantial morbidity and mortality worldwide. The study assessed the health and economic burden of ILI and LRTI according to age and comorbidities, since available evidence is limited and heterogeneous. Method The prevalence of comorbidities, the seasonal incidence rates and the mean and per capita direct costs of ED accesses for ILI/LRTI, whether followed by hospitalization or not, recorded in adults aged ≥50 years over the last 6 years, in the referral hospitals located in the Genoese metropolitan area (Liguria, Italy) where the syndromic surveillance system is active, were evaluated through a retrospective observational study. Comorbidities were estimated through the Chronic Condition Data Warehouse that integrates multiple Medicare data sources. A comparison with the administrative healthcare International Classification of Diseases-9th revision-Clinical Modification (ICD-9-CM)-based data was also conducted. Results The prevalence of subjects with ≥1 comorbidity ranged from 23.49 to 59.92%. The most prevalent all-age comorbidities were cardiovascular diseases and cancer. The overall ILI/LRTI incidence rate was 6.73/1000 person-years, almost double the value derived from routine data, and increased with age. The highest rates were observed in patients with renal failure and bronchopneumopathies. The mean cost of ED accesses/hospitalization for ILI/LRTI was €3353 and was almost twice as high in the ≥85 years as in the youngest age-group. The highest mean costs were observed in patients with renal failure and cancer. The per capita costs increased from €4 to €71 with age, and were highest in patients with renal failure and bronchopneumopathy. Conclusion The burden of ILIs/LRTIs in terms of ED accesses and hospitalizations in adults aged ≥50 years is heavy, and is related to increasing age and, especially, to specific comorbidities. These results could contribute to revising age- and risk-based anti-influenza and -pneumococcus immunization strategies. Electronic supplementary material The online version of this article (10.1186/s12913-019-4412-7) contains supplementary material, which is available to authorized users.

Objective. The study aimed to assess the impact of HPV immunization campaigns organizational aspects, the characteristics of immunization program (vaccination targets and type of offer), and communicative strategies adopted by four Italian administrative regions on vaccination coverage observed. Methods. From November 2017 to March 2018, regional and Local Health Units (LHUs) representatives were invited to complete an online survey including 54 questions evaluating vaccination invite systems, access systems to vaccination centres, reminder and recall systems, and adverse events surveillance. An overall descriptive analysis was conducted. Since observed vaccine coverage (VC) obtained in females (2002-2004 birth cohorts) was lower than objectives fixed by the Italian Ministry of Health, variables were assessed using the national VC mean obtained in the 2003 girls birth cohort as outcome. Results. Twenty-six LHUs belonging to 4 Northern and Southern Italian regions participated in the study. Organizational aspects significantly related to VC lower than the national mean were access to vaccine centres without appointment and parents’ reservation as appointment planning system. Recall systems for both the first and the second dose, including the appointment in the invitation letter, the availability of regional immunization registry, and education of healthcare workers on universal HPV immunization strategies, instead, were related to higher VC. As regards preadolescent immunization strategies, both VC obtained in girls and boys were far from the Ministerial goals. Only 20% of LHUs introduced multicohort female strategies while all LHUs adopted copayment targeting both men and women. Immunizations strategies targeting subjects at risk were implemented only in half of participating LHUs. Conclusions. VC observed in participating LHUs are largely lower than the national objectives in all anti-HPV vaccine targets. Both organizational and educational strategies have to be implemented to improve the VC goals.

The topic of this paper is the complex phenomenon of verbal abuse. The aim is to show the productivity of a pragma-rhetorical approach in addressing this issue. Indeed, integrating modern pragmatics with classical rhetoric, this approach does not isolate words from social practices and therefore is not exclusively focused on slurs (as is the case in the current debate on this topic in the field of the philosophy of language) but it concerns verbal abuse in general. I argue that this wider approach, especially thanks to its focus on the intertwining of linguistic and social components, is more adapted to shedding light on the role that words play in performing violence. Particularly, I take into account three (interrelated) controversial issues: (1). the question of whether intrinsically offensive words exist; (2). the problem concerning the existence of the so-called “neutral-counterpart” of a slurring word; (3). the reclamation or rehabilitation of a slur. Finally, I briefly focus on the case of the N-word as a paradigmatic example able to show the advantages of the pragma-rhetorical approach.

Starting from Sperber and Mercier’s theory (2011) on the relationship between reasoning and arguing, we will try to rethink the link between rhetoric and argumentation. Using Aristotelian rhetoric as a theoretical framework, we will focus on two related features: 1) the nature and the role of argumentation inferences in classical models of rhetoric; 2) the role of normativity in assessing a naturalistic description of what we make when we argue.

Bloodstream infections (BSIs) associated with insertion and maintenance of central venous catheters (CRBSIs) are the most frequent causes of healthcare-associated infections in intensive care units (ICUs). They are responsible for increased length of hospital stay and additional healthcare costs.To investigate whether an educational programme aimed at healthcare workers resulted in a significant change in the level and trend of infections.The research was conducted in five Italian ICUs from July 2012 to August 2014. Surveillance and educational interventions to control infections were applied. Compliance with hand hygiene procedures was assessed via relative risk and 95% confidence interval. Interrupted time-series analysis was used to investigate the change in level and trend of infection during the intervention.Compliance with hand hygiene procedures improved during the intervention for all staff groups, but physicians showed the lowest compliance rates (nurses from 52.4% to 92.1%; nurse aides from 71.0% to 92%; physicians from 71.0% to 92%; P 0.001). Significant reductions of 21-55% in CRBSI were observed during the intervention. Small improvements in the monthly infection trend were also observed, but these were not statistically significant.An educational programme focusing on general good infection control practice, rather than CVC care bundles, led to a decreased CRBSI rate, even if the improvement was not sustained over time. Continuous performance feedback should be provided to promote long-term adherence to guidelines among all health workers.

Introduction Several studies have shown that high demand and low control jobs are associated with poor physical and mental wellbeing. Aim of our study was to test the association between job strain and the QTc interval on the electrocardiogram, an indicator of autonomic function, blood pressure, body mass index (BMI), and fasting glycaemia level. Methods Overall 280 male workers of a logistic support company for secure communication and intelligence were included in our study population. We measured work-related stress using the HSE indicator tool, general wellbeing using the Well-being Index (WHO5); affectivity was measured by the short version of the positive and negative affect schedule (PANAS); the frequency corrected QT (QTc) interval on the electrocardiogram was measured using the Bazett’s formula; QT index (QTi) value, blood pressure, BMI, and fasting glycaemia were also recorded, as well as medications, lifestyles and comorbidities. Based on the Karasek’s taxonomy, we compared high strain jobs, low strain jobs, active jobs and passive jobs with respect to WHO5, PANAS, QTc, QTi, blood pressure, BMI and glycaemia. Group differences were analysed by means of parametric and non parametric tests. Results Results showed that low strain jobs were associated with a lower frequency of negative affectivity than high strain jobs (Fisher test = 3.63, p Conclusions In our study population, we did not observe a reduction in cardiac vagal control, as indicated by a prolonged QTi, among subjects employed in high strain and low control jobs.

The European Agency for Safety and Health at Work declared, for the next decades, an increase in the proportion of ageing workers. Thus, the health and the safety at work is necessary to ensure an active ageing through the promotion of healthy lifestyles, prevention of diseases and improvement of quality of life. Methods From 09/2014 to 03/2016, a trained health visitor started a semi structural interview in a sample of 980 healthcare personnel (HCP) (mean age 46, range 18–68 years, SD ± 11.3) from five Italian hospitals. Information about dietary habits, physical activity, vaccination coverage, biological risk and exposure to biomechanical overload at work were collected. Information about health opportunities on all the variables analysed were provided for each participant during the counselling. Results The 57% of HCP ate fruit and vegetables less than 3 times/day and 33% consumed meat more than 3 times per week. The 25% practiced physical activity less than 2 days/week. The 12% of HCP was vaccinated against influenza and 72% against hepatitis B. HCP did not know their antibody coverage status against varicella, measles, rubella, mumps and related occupational risks. The 19% of HCP reported a biological injury and the 18% of them did not follow the post exposure protocols. The 37% of HCP performed manual handling of patients. Among them, 26% and 43% had not available minor and major assistive devices, respectively. Discussion The results suggest the need for a re-orientation process of services to protect ageing HCP in order to foster the adoption of healthy lifestyles and prevent occupational injuries and diseases. Ageing HCP’s well-being represent a key point also in order to improve the quality of care in healthcare settings. The study was conducted with the financial support of the Italian Ministry of Health, CCM Program 2013.

Introduction Hepatitis B (HBV) represents a main occupational infectious disease. Nursing students (NSs) are a risk group for acquiring HBV occupational infection after accidental contact with blood or body fluids contaminated with the virus. During their everyday clinical learning, they are exposed to needle stick injuries and sharp injuries (NSSIs) probably due to limited experience in handling needles. Objectives We assessed the risk of HBV infection and NSSIs rate among italian NSs. Methods We evaluated the seroprevalence of HBV markers in a sample of 247 NSs. We analysed the rate of NSSIs in a sample of 640 third-year students. Results The 54% of students were anti-HBs positive, 42% were negative, and 4% had a borderline value (10–11 Ul/ml). One student was serologically HBsAg negative and was positive for anti-HBc (IgG). All participants were negative for HBsAG and Anti HCV. Regarding injuries, 43/640 (7%) occurred among NSs. Among these, 37/43 (86.1%) were caused by NSSIs. The most part of NSSIs occurred in wards of Internal Medicine. NSSIs occurred more frequently during the drawing of patients’ venous blood (24%) and the most commonly injured body area was the first finger (38%). Discussion Results from NSSIs, as well as those from non-responders, showed that the incidence of injuries among NSs without immunisation is rare. Nevertheless, in case of injury, the risk to contract HBV can be high. This suggests the importance of serological screening and vaccination against HBV. Furthermore, making NSs clinical learning more effective and safe by improving information, education and training are crucial to better manage the HBV infection risk during their internship. The study was conducted with the support of the Italian Ministry of Health, CCM Program 2013.

Background Nursing students can be exposed to patients with hepatitis A virus (HAV) and can represent a vehicle of transmission both for health personnel, patients and relatives. The aim of this study was to assess the risk of HAV infection in nursing students during their internship. Methods A seroprevalence survey on HAV infection was performed on nursing students at the Cagliari university-hospital, together with the assessment of the compliance to preventive measures to decrease the risk of infection during their internship. Blood specimens were obtained from 253 students. All serum samples were tested for anti-HAV antibodies (IgG) by the enzyme-linked immunosorbent assay (ELISA). Compliance to preventive measures was recorded by trained personnel. Results Overall HAV seropositivity in nursing students (mean age 24, range 17–45 years) was 3%. Compliance to preventive measures was not uniform (6%–76%) and extremely low in some specific measures targeted to decrease the oral-faecal transmission. Conclusions The high proportion of susceptible nursing students can contribute to an increase in the risk of nosocomial transmission, especially when specific preventive measures are not completely applied. Nursing education packages, before starting medical internship, should be implemented in order to increase their compliance to preventive measures, especially in wards at higher risk. Vaccination should be considered in wards at higher risk. The study was conducted with the support of the Italian Ministry of Health, CCM Program 2013.

Today it is generally accepted that the main differences between the "Rhetoric to Alexander" and Aristotle’s "Rhetoric" depend on the different aims of each work’s author: essentially practical in the first case, theoretical in the second one. The difference is clearly visible in the classification of pisteis (proofs). Our basic assumption is that this difference depends on the two majors elements of novelty in Aristotle's Rhetoric: 1. the introduction in the rhetorical field of the logico-dialectical apparatus (above all, the concept of syllogismos); 2. the consideration of ethos and pathos as entechnoi pisteis. In order to specify this general consideration, the paper focuses on enthymema and paradeigma: thanks to the position these pisteis have in Aristotle's "Rhetoric", they represent a suitable starting point for the comparison with the Rh. ad Al.

Background: Nursing students can be exposed to patients with hepatitis A virus (HAV) and can represent a vehicle of transmission both for health personnel, patients and relatives. Objectives: The aim of this study was to assess the risk of HAV infection in nursing students during their internship. Patients and Methods: A seroprevalence survey on HAV infection was performed on nursing students at the Cagliari university- hospital, together with the assessment of the compliance to preventive measures to decrease the risk of infection during their intern- ship. Blood specimens were obtained from 253 students. All serum samples were tested for anti-HAV antibodies (IgG) by the enzyme- linked immunosorbent assay (ELISA). Compliance to preventive measures was recorded by trained personnel. Results: Overall HAV seropositivity in nursing students (mean age 24, range 17 - 45 years) was 3%. Compliance to preventive measures was not uniform (6% - 76%) and extremely low in some specific measures targeted to decrease the oral-fecal transmission. Conclusions: The high proportion of susceptible nursing students can contribute to an increase in the risk of nosocomial transmis- sion, especially when specific preventive measures are not completely applied. Nursing education packages, before starting medical internship, should be implemented in order to increase their compliance to preventive measures, especially in wards at higher risk. Vaccination should be considered in wards at higher risk.