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We measured the prevalence of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in swine livestock workers, examined LA-MRSA resistance profile, and associated carriage with the working activities.Information was collected on demographics and occupational history. Swabs were collected and tested for the isolation of S. aureus, examined for antimicrobial susceptibility, and all MRSA underwent ST398qPCR assay.LA-MRSA was isolated in 7.3% of the 396 enrolled workers. LA-MRSA colonization was more likely in farmers than in slaughterhouse workers (Fisher exact P = 0.001). Carriage was associated with herd size, being less frequent in small/medium farms (odds ratio = 0.20; 95% confidence interval = 0.07 to 0.53), and with the number of working days per week (OR = 2.11; 95% confidence interval = 1.07 to 4.19).LA-MRSA carriage is strongly animal-exposure related, and educational intervention informing about the risks related to the activity with livestock is needed.

The caries experience and its potential risk indicators such as socioeconomic status, sweets consumption, toothbrushing habits, dental visit attendance pattern and salivary mutans streptococci (in 12 year old only), were assessed in schoolchildren raised and living in low fluoridated areas (Catanzaro, Italy). Caries-free prevalence in the 6-year-old was 52.9% in their primary dentition; the dmft and dmfs were 2.1 and 5.1, and both DMFT and DMFS were 0.1. Almost 91% of the dmft was attributable to active decay. The proportion of children with a dmft+DMFTor = 1 and the dmft and dmfs were significantly higher in those with low socio-economic status. In the 12-year-old, 52.7% had a history of caries and the DMFT and DMFS were 1.5 and 2.6; the filled component was the dominant proportion. The more likely they visited a dentist for routine checkup, the higher socio-economic status (it was not associated with DMFT), the less frequently they had sweets, and the low level of Streptococcus mutans, the more likely they were caries-free and the less likely they were to have a high DMFT, DMFS, and DT. In the 15-year-old, 68.8% had a history of caries and the DMFT and DMFS were 2.8 and 4.8, with a higher prevalence of the F component. The children who visited a dentist for routine checkup had a significantly lower caries experience, DMFT, DMFS, and DT than the irregular attenders, and those with low socio-economic background were more likely to have a high DMFS.

To assess the effectiveness of the ventilator bundle in the reduction of mortality in ICU patients.PubMed, Scopus, Web of Science, Cochrane Library for studies published until June 2017.Included studies: randomized controlled trials or any kind of nonrandomized intervention studies, made reference to a ventilator bundle approach, assessed mortality in ICU-ventilated adult patients.Items extracted: study characteristics, description of the bundle approach, number of patients in the comparison groups, hospital/ICU mortality, ventilator-associated pneumonia-related mortality, assessment of compliance to ventilator bundle and its score.Thirteen articles were included. The implementation of a ventilator bundle significantly reduced mortality (odds ratio, 0.90; 95% CI, 0.84-0.97), with a stronger effect with a restriction to studies that reported mortality in ventilator-associated pneumonia patients (odds ratio, 0.71; 95% CI, 0.52-0.97), to studies that provided active educational activities was analyzed (odds ratio, 0.88; 95% CI, 0.78-0.99), and when the role of care procedures within the bundle (odds ratio, 0.87; 95% CI, 0.77-0.99). No survival benefit was associated with compliance to ventilator bundles. However, these results may have been confounded by the differential implementation of evidence-based procedures at baseline, which showed improved survival in the study subgroup that did not report implementation of these procedures at baseline (odds ratio, 0.82; 95% CI, 0.70-0.96).Simple interventions in common clinical practice applied in a coordinated way as a part of a bundle care are effective in reducing mortality in ventilated ICU patients. More prospective controlled studies are needed to define the effect of ventilator bundles on survival outcomes.

Background Hospital stay represents the opportunity for a change of therapy, about which patients may not know indications, contraindications, and mode of administration, which may lead to dosing errors, drug interactions, side effects, etc. It is therefore vital to communicate appropriate information to the discharged patient with a new prescription drug. The purpose of the study was to evaluate: 1) how communication about new chronic therapies is managed at hospital discharge and what kind of information is provided to patients; 2) to what extent patients are aware and confident in the management of these medications; 3) whether the way communication is provided affects patients’ awareness and self-confidence in the management of these therapies. Methods Participants were adult patients who were prescribed at least one new chronic medication at hospital discharge. A telephone interview after hospital discharge was performed to assess whether or not hospital healthcare personnel had given information about prescribed therapies and which aspects of therapies had been object of information. Results Five hundred thirty patients were interviewed. 67.7% reported having received counseling by the hospital physician, while 32.3% by discharge form. Basic information on treatment was provided to the great majority of patients, whereas only few patients reported to have been informed about eventual side effects and related behavior in case of side effects. Conclusions Several aspects of patients’ knowledge and self-confidence on long term medications prescribed at hospital discharge need to be improved and the way communication is provided has a crucial role in the empowerment of patients in the management of these medications.

The aim of this survey was to examine the knowledge, attitudes, and behavior of gynecologists in terms of human papillomavirus (HPV) DNA testing as a primary screening tool for cervical cancer. A national cross-sectional web survey was carried out through multistage sampling using an overall sample of 1000 gynecologists. Gynecologists were asked to fill in a self-administered questionnaire exploring their knowledge, attitudes, and practice toward cervical cancer screening and HPV-DNA testing. A total of 582 gynecologists completed the web questionnaire. Of these, 24.5% were uncertain on the higher sensitivity of HPV-DNA compared with the Pap test, whereas 19% were uncertain on the role of the HPV-DNA test as a primary test in women younger than 30 years old and only 44.9% knew that a negative HPV-DNA test allows for an extension of the test interval to 5 years. Most gynecologists showed a definite positive attitude on the role of screening for cervical cancer prevention and were prepared to accept new technologies. The HPV-DNA test was considered highly effective by 86.9%, whereas 94% recommend/perform HPV-DNA tests in women older than 30 years of age; 25.5% performed HPV-DNA as a primary test, followed by a Pap test in those cases that were positive. Only 56.3% recommended/performed HPV-DNA tests 1 year after a positive HPV-DNA test, followed by a negative Pap test, whereas 42.9% recommended colposcopy. Although the use of the HPV-DNA test is very widespread among Italian gynecologists performing cervical cancer screening, there is lack of standardization of practices according to current guidelines.

Immunosenescence makes the elderly more susceptible to influenza complications and less responsive to vaccination. An intradermal formulation (IDflu) is one of several strategies being investigated to increase the immunogenicity of influenza vaccines.The overall goal of the study was to assess the safety and immunogenicity of IDflu compared with the intramuscular route (IMflu) in the elderly.A meta-analysis of randomized controlled trials (RCTs) was performed. Included articles met the following criteria: RCTs; primary studies, not re-analyses or reviews; enrolment of elderly people; comparing the immunogenicity and/or safety of IDflu with IMflu; measuring seroprotection and/or seroconversion rate to assess immunogenicity; measuring local reactions and/or general symptoms and/or other mild local reactions that could affect acceptability of vaccine as safety indicators, according to the European Medicines Agency (EMA) criteria; published through January 2015.The results of our meta-analysis on seroprotection showed that IDflu is comparable to IMflu for each strain (A/H1N1: risk ratio [RR] 1.02, 95% confidence interval [CI] 0.98-1.07; A/H3N2: RR 1.01, 95% CI 0.99-1.04; B 1.02, 95% CI 0.98-1.08). The seroconversion rate achieved with IDflu was comparable to that of the control group (A/H1N1: RR 1.08, 95% CI 0.97-1.2; A/H3N2: RR 1.08, 95% CI 0.96-1.21; B: RR 1.21, 95% CI 1-1.45). Systemic reactogenicity appeared similar in the two groups, while local reactions were significantly more frequent in the IDflu group.The novel IDflu appears to have the adequate balance between immunogenicity and safety in the elderly compared with IMflu, and its utilization may be considered among the possible strategies to enhance the control of seasonal influenza outbreaks according to the existing policy recommendations in the elderly.

Campylobacter spp. is one of the most common cause of sporadic human foodborne illness in industrialized countries, and concern has been raised by the emergence of strains showing antibiotic resistance. The aim of this study was to investigate prevalence of Campylobacter spp. and pattern of antibiotic resistance in samples of poultry raw meat sold in retail outlets in Southern Italy. A total of 208 samples of chicken and turkey raw meat collected from randomly selected retail butchers' shops in Catanzaro (Italy) were processed for the presence of Campylobacter spp. Campylobacter spp. contaminated 43 samples of poultry product. The most frequent isolates were Campylobacter coli (34.9%) and Campylobacter jejuni (32.6%). The lowest resistance was found for gentamycin (27.9%) and cloramphenicol (32.6%). We also investigated prevalence of sensitivity to the most important antibiotics and we found that only 20.9% isolates were sensible to both ciprofloxacin and erythromycin. Our findings revealed a reduction in the overall contamination by Campylobacter spp. in raw meat. However, resistant and particularly multi-resistant strains were alarmingly spread, representing an increasing phenomenon that demands enforced interventions at multidisciplinary levels.

ObjectivesWomen make up approximately half of the world’s one billion migrants. Immigrant women tend to be one of the most vulnerable population groups with respect to healthcare. Cancer screening (CS) and maternal and reproductive health have been included among the 10 main issues pertinent to women’s health. The aim of this study is to explore breast and cervical CS participation and to acquire information regarding access to healthcare services during pregnancy, childbirth and the postpartum period among age eligible immigrant women in Southern Italy.MethodsA structured questionnaire was used to collect data from each participant. Women aged 25–64 years who had not had a hysterectomy and women aged 50–69 years without history of breast cancer were considered eligible for the evaluation of cervical and breast CS participation, respectively. Moreover, women who had delivered at least once in Italy were enrolled to describe antenatal and postpartum care services use. All women were recruited through the third sector and non-profit organisations (NPOs).ResultsRate of cervical CS among the 419 eligible women was low (39.1%), and about one-third had had a Pap test for screening purposes within a 3-year period from interview (32.8%). Regarding breast CS practices, of the 125 eligible women 45.6% had had a mammography for control purposes and less than a quarter (26, 20.8%) had their mammography within the recommended time interval of 2 years. About 80% of the respondents did not report difficulties of access and use of antenatal and postpartum services.ConclusionThis study provides currently unavailable information about adherence to CS and maternal and child health that could encourage future research to develop and test culturally appropriate, women-centred strategies for promoting timely and regular CS among immigrant women in Italy.

The study aims were focused on acquiring information about access to health-care services and to investigate the potential barriers affecting full access to health-care services. The study population consisted of immigrants and refugees aged 18 or more living in Italy for at least 12 months recruited through non-profit organizations. 961 immigrants took part in the study, with a response rate of 98.9 %. Of the participants, 85 % had access to a general practitioner (GP) at least once, and 46.6 and 22.4 % mentioned a minimum one emergency visit and hospital stay, respectively. Diagnostic procedures and/or drug prescriptions (49.7 %), chronic disease control (15.8 %), and preventive interventions (13 %) were the most reported reasons for GP access. This study yielded current and broader insight into the model of health-care utilization among immigrants. The findings adds to our understanding of the third-sector organizations’ role in facilitating immigrants’ access to services offered by the Italian National Health Service, contributing to the extensive discussion on how to best manage migrant health care in Italy.

The high-mobility group A1 (HMGA1) gene has been previously identified as a potential novel candidate gene for susceptibility to insulin resistance and type 2 diabetes (T2D) mellitus. For this reason, several studies have been conducted in recent years examining the association of the HMGA1 gene variant rs146052672 (also designated IVS5-13insC) with T2D. Because of non-univocal data and non-overlapping results among laboratories, we conducted the current meta-analysis with the aim to yield a more precise and reliable conclusion for this association. Using predetermined inclusion criteria, MEDLINE, PubMed, Web of Science, Scopus, Google Scholar and Embase were searched for all relevant available literature published until November 2014. Two of the authors independently evaluated the quality of the included studies and extracted the data. Values from the single studies were combined to determine the meta-analysis pooled estimates. Heterogeneity and publication bias were also examined. Among the articles reviewed, five studies (for a total of 13,789 cases and 13,460 controls) met the predetermined criteria for inclusion in this meta-analysis. The combined adjusted odds ratio estimates revealed that the rs146052672 variant genotype had an overall statistically significant effect on increasing the risk of development of T2D. As most of the study subjects were Caucasian, further studies are needed to establish whether the association of this variant with an increased risk of T2D is generalizable to other populations. Also, in the light of this result, it would appear to be highly desirable that further in-depth investigations should be undertaken to elucidate the biological significance of the HMGA1 rs146052672 variant.

The need to defluoridate and fluoridate the water supplies in areas with drinking water naturally containing above–optimal (≥2.5 mg/l) and suboptimal (≤0.3 mg/l) fluoride concentration and caries and fluorosis prevalence of 12–year–old schoolchildren were assessed in Italy. In the low–fluoride area, 48.4% children were caries–free (DMFT = 0) and the DMFT and DMFS were 1.5 and 2.6; in the high–fluoride area, 46.8% had a DMFT = 0 and the values of the indices were 1.4 and 1.6, respectively. Multiple logistic regression analysis showed a significant association in the caries–free status according to parents' employment status (OR = 1.2, 95% CI = 1.1–1.3) and children's sweets consumption, since children who consumed sweets at least once a day had an adjusted odds ratio of 1.8 (95% CI = 1.4–2.3) compared to those with a lower consumption. Multiple linear regression analysis showed that DMFT and DMFS were significantly higher in children with a lower socioeconomic status and in those who consumed sweets at least once a day, with the DMFS significantly associated also with the area of residence. DT and FT scores were higher in the high– and low–fluoride areas, respectively. No evidence of fluorosis was reported in 94.5 and 55.3% of children in the low– and high–fluoride areas, respectively. The Community Fluorosis Index (CFI) for all permanent teeth was significantly higher in the high–fluoride area, 0.8, than the value, 0.1, found in the low–fluoride community. Our results substantiate the difficulties in defining universal guidelines for the fluoridation or defluoridation of drinking water and the need for an epidemiological approach to the decision as to fluoridate and defluoridate the water supply.

Human-papillomavirus (HPV) DNA testing has been proposed as an alternative to primary cervical cancer screening using cytological testing. Review of the evidence shows that available data are conflicting for some aspects. The overall goal of the study is to update the performance of HPV DNA as stand-alone testing in primary cervical cancer screening, focusing particularly on the aspects related to the specificity profile of the HPV DNA testing in respect to cytology. We performed a meta-analysis of randomized controlled clinical trials. Eight articles were included in the meta-analysis. Three outcomes have been investigated: relative detection, relative specificity, and relative positive predictive value (PPV) of HPV DNA testing versus cytology. Overall evaluation of relative detection showed a significantly higher detection of CIN2+ and CIN3+ for HPV DNA testing versus cytology. Meta-analyses that considered all age groups showed a relative specificity that favored the cytology in detecting both CIN2+ and CIN3+ lesions whereas, in the ≥30 years' group, specificity of HPV DNA and cytology tests was similar in detecting both CIN2+ and CIN3+ lesions. Results of the pooled analysis on relative PPV showed a not significantly lower PPV of HPV DNA test over cytology. A main key finding of the study is that in women aged ≥30, has been found an almost overlapping specificity between the two screening tests in detecting CIN2 and above-grade lesions. Therefore, primary screening of cervical cancer by HPV DNA testing appears to offer the right balance between maximum detection of CIN2+ and adequate specificity, if performed in the age group ≥30 years.

BACKGROUND: This survey was intended to investigate prevalence and severity of early childhood caries (ECC) in a sample of children in Southern Italy and to identify factors that may be related to this condition. METHODS: The study was designed as a cross-sectional survey. The study population (children aged 36-71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure. Parents/guardians of all eligible children were invited to participate filling out a structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school. The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices. The WHO caries diagnostic criteria for deciduous decayed, missing and filled teeth (dmft) and surfaces (dmfs) were used to record ECC and severe-ECC (S-ECC). Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs. RESULTS: 515 children participated in the study. 19% had experienced ECC, and 2.7% severe-ECC (S-ECC), with a mean dmft and dmfs scores of 0.51 and 0.99, respectively. Mean dmft was 2.68 in ECC subjects, and 6.86 in S-ECC subjects. Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 1.95; 95% CI = 1.3-2.91) and duration of breastfeeding (OR = 1.26; 95% CI = 1.01-1.57), whereas it was significantly lower in children of more educated mothers (OR = 0.64; 95% CI = 0.42-0.96), and higher in those who had been visited by a dentist in the previous year (OR = 3.29; 95% CI = 1.72-6.33). CONCLUSIONS: Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population.