In Italy,a nationwide population-based colorectal cancer(CRC)screening initiative has been in place since 2006.In recent years,there has been a growing interest in involving community pharmacies in this activity.This ...In Italy,a nationwide population-based colorectal cancer(CRC)screening initiative has been in place since 2006.In recent years,there has been a growing interest in involving community pharmacies in this activity.This commentary provides an insightful analysis of the integration between the screening program of the Local Health Authority(LHA)of Bologna(Northern Italy)and community pharmacies.A horizontal integration at the micro level with service and clinical integrations supported by meso-level policy(regional authority)was applied.Four types of integration such as normative,informational,financial and functional serving as enablers were implemented.A high level of depth of consensus,connectivity,communication,and trust was pursued.The program achieved large participation from community pharmacies,with 91.1%(n=234)of pharmacies in the LHA territory actively participating.On average,each pharmacy served 1,228(range,1,021-1,519)target citizens.Between 2021(the first full year under the community pharmacy model)and 2022,pharmacies delivered an annual mean of 68,295 kits(range,12-840).In 2021,there was a remarkably high level of screening completion,with 93.7%of fecal immunochemical tests being returned to pharmacies.This percentage increased by 3.3%in 2022.In our setting,pharmacy involvement improved service quality by introducing complete traceability of kits and specimen flow,as well as temperature control.It also led to a 4.6%increase in attendance rates compared to the previous organizational model(61.6%vs.57%;P<0.001).Finally,additional European experiences involving community pharmacies in organized CRC screening programs,resembling the Bologna setting,are reported.展开更多
<span style="font-family:Verdana;"><strong>Background:</strong> The outbreak of COVID-19 has continued to threaten the existence of the human race. The novelty and unstable epidemiologic pa...<span style="font-family:Verdana;"><strong>Background:</strong> The outbreak of COVID-19 has continued to threaten the existence of the human race. The novelty and unstable epidemiologic pattern of the virus had generated so much concern among the global health experts. These concerns were found to be escalated among the frontline health care workers to the extent of impeding the timeliness of the response activities. To slow down the spread of the already established community transmission through the surveillance activities, the concern of the health workers at the community level needs to be addressed. Therefore, this study assessed the concern about COVID-19 pandemic among primary health workers in Oyo State, Nigeria. <strong>Methods:</strong> This was an online cross-sectional survey conducted among primary health care workers in Oyo State between March and April 2020. Using a two-stage sampling technique, we recruited 284 respondents. A semi-structured questionnaire linked to the Google form was used to collect data. Data were analyzed using IBM SPSS version 25;bivariate analysis was done using Chi-square and binary logistic regression was used to identify the predictors of health workers’ concern at 5% level of significance. <strong>Results:</strong> The mean age of respondents was 45.0 ± 9.0 years. The proportion of the respondents who had good knowledge of COVID-19 was 52.5%. In the domains of concern, 66.9%, 53.2%, 51.4%, and 46.5% of the respondents expressed government-related, self-satisfaction related, work-related and social-status related concerns respectively. Male respondents were less likely to express concern about COVID-19 compared with their female counterparts (aOR = 0.39, 95% CI = 0.20 - 0.76). Nurses/midwives (aOR = 0.21, 95% CI = 0.05 - 0.85) had lesser likelihood of expressing concern about COVID-19 while middle staff (aOR = 2.5, 95% CI = 1.18 - 5.39) and income earner of ≥N200,000 (aOR = 2.3, 95% CI = 1.34 - 3.92) had higher likelihood of expressing concern about COVID-19. <strong>Conclusion:</strong> The study highlights an average knowledge of COVID-19 among the respondents. Government-related and self-satisfaction related concerns were expressed by the majority of the Primary Health Care (PHC) workers. Now that the second wave of COVID-19 is moving with much more fatality across much of Africa, including Nigeria, it is therefore imperative to address these concerns through a holistic policy that addresses the welfare, safety and capacity building of the health care workers (HCWs).</span>展开更多
Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
AIM:To ascertain whether carotid lesions are more prevalent in outpatients with incidental findings of nonalcoholic fatty liver disease (NAFLD) at abdominal ultrasound (US).METHODS: One hundred and fifty-four consecut...AIM:To ascertain whether carotid lesions are more prevalent in outpatients with incidental findings of nonalcoholic fatty liver disease (NAFLD) at abdominal ultrasound (US).METHODS: One hundred and fifty-four consecutive outpatients (age range 24-90 years, both sexes) referred by general practitioners for abdominal US, and drinking less than 20 g alcohol/day, underwent carotid US for an assessment of carotid intima-media thickness (c-IMT) and carotid plaque prevalence. Hepatic steatosis, visceral fat thickness and subcutaneous fat thickness were also assessed at ultrasonography.RESULTS: Higher c-IMT values were found in the presence of NAFLD (90 patients), even after adjustment for indices of general and abdominal obesity and for the principal cardiovascular risk factors (0.84±0.10 mm vs 0.71±0.10 mm, P<0.001). The prevalence of carotid plaques was 57.8% in the patients with NAFLD vs 37.5% in the patients without this condition (P=0.02). The adjusted relative risk of having carotid plaques for patients with NAFLD was 1.85 (95% CI:1.33-2.57, P<0.001).CONCLUSION: An incidental finding of hepatic steatosis may suggest the presence of silent carotid atherosclerotic lesions.展开更多
The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience...The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience continuity during care transition of older patients from hospital to municipal health care? How would nurses describe an optimal care transition? Nurses have a pivotal role during care transitions of older patients. More knowledge about their experiences is necessary to develop favorable improvements for this important period in the older patient’s treatment and care. The study has a qualitative explorative design with follow-up focus group interviews. Nurses (N = 30) working in hospital (n = 16) and municipal (n = 14) health care were organized in five mixed focus groups during the period October-January 2014/2015. The focus groups met twice, answering the research questions following a previously circulated semi-structured interview guide. The interview analysis was inspired by content analysis. The analysis resulted in the themes “Administrative demands challenge terms for collaboration” and “Essentials for nursing determine optimal care transitions for older patients”. Administrative demands may prevent nurses’ professional dialogue and collaboration across health care levels. Older patients’ best interests should be ensured through a collaborative relationship between hospital and municipal nurses, to form continuous care across health care levels. Clinical practice should be aware of essentials for nursing, which could influence and facilitate a more individualized and continuous transition for older patients.展开更多
AIM: To examine trends of uncontrolled total serum cholesterol, treatment and control in a Mediterranean region(Campania). METHODS: We considered and compared the data collected as part of "Montecorvino Rovella P...AIM: To examine trends of uncontrolled total serum cholesterol, treatment and control in a Mediterranean region(Campania). METHODS: We considered and compared the data collected as part of "Montecorvino Rovella Project" 1988-1989 and cross-sectional data from the two phases of the "VIP Project-Valle dell'Irno Prevenzione": 1998-1999(1stphase) and 2008-2009(2ndphase), in the 35-74-year-old-population. RESULTS: Data show a reduction of mean cholesterolemia in the last twenty years of 7.3 mg/dL for men and unchanged values for women. In the three surveys the mean values for serum cholesterol are in men: 205.2 ±47.1 mg/dL(1988/89), 200 ± 38.9 mg/dL(1998/99) and 197.9 ± 40.2 mg/dL(2008/09); in the women: 203.1 ± 42.5 mg/dL(1988/89), 198.9 ± 37.9 mg/dL(1998/99) and 203.3 ± 39.3 mg/dL(2008/09). Prevalence of uncontrolled high cholesterol ≥ 240 mg/dL for men decreased from 20.8%(1988/89) to 14.3%(1998/99) and 13.9%(2008/9), P = 0.002; for women the values decreased from 19.9%(1988/89), to 18.2%(1998/99) and 18.1%(2008/09), P = 0.007. Is statistically increased the number of patients treated and those treated to target. CONCLUSION: Encouraging increases in awareness, treatment, and control of hypercholesterolemia occurred from 1988 through 2008. Nevertheless, control of hypercholesterolemia remains poor.展开更多
AIM:To assess the acceptance,safety and efficacy of care and treatment for chronic hepatitis C(CHC)in drug addicts.METHODS:We designed a multidisciplinary,phase IV prospective cohort study.All illicit drug users(IDUs)...AIM:To assess the acceptance,safety and efficacy of care and treatment for chronic hepatitis C(CHC)in drug addicts.METHODS:We designed a multidisciplinary,phase IV prospective cohort study.All illicit drug users(IDUs)visited a Territorial Addiction Service(SerT)in the District of Brescia,and hepatitis C antibody(HCVAb)testing positive were offered as part of a standardised hepatologic visit in our Gastroenterology Unit.Patients with confirmed CHC and without medical contraindications were administered peginterferon alfa-2b 1.5μg/kg per week plus ribavirin(800-1400 mg/d)for 16-48wk.All IDUs were unselected because of ongoing addiction and read and signed an informed consent form.Virologic responses at weeks 4 and 12 of therapy,at the end of treatment and 24 wk after the end of treatment were the main measures of efficacy.Adherence was estimated according to the 80/80/80 criteria.RESULTS:From November 2007 to December 2009,162 HCVAb+IDUs were identified.Sixty-seven patients(41%of the initial cohort)completed the diagnostic procedure,and CHC was diagnosed in 54(33%of the total).Forty-nine patients were offered therapy,and 39agreed(80%of acceptance rate).The prevalent HCV genotype was type 1,and the HCV RNA baseline level was over 5.6 log/mL in 61%of cases.Five patients dropped out,two because of severe adverse events(SAEs)and three without medical need.Twenty-three and 14 patients achieved end of treatment responses(ETRs;59%)and sustained virologic responses(SVRs;36%),respectively.Thirty-one patients were fully compliant with the study protocol(80%adherence).The prevalence of host and viral characteristics negatively affecting the treatment response was high:age over40 years(54%),male gender(85%),overweight body type(36%),previous unsuccessful antiviral therapy(21%),HCV genotype and viral load(60%and 62%,respectively),earlier contact with HBV(40%)and steatosis and fibrosis(44%and 17%,respectively).In a univariate analysis,alcohol intake was associated with a non-response(P=0.0018,95%CI:0.0058-0.4565).CONCLUSION:Drug addicts with CHC can be successfully treated in a multidisciplinary setting using standard antiviral combination therapy,despite several"difficult to reach,manage and treat"characteristics.展开更多
Quality of life (QoL) is an important measure to verify the effectiveness of therapy in substance use disorders (SUD). In this cross-sectional, multicenter study QoL has been measured in 1057 heroin dependents attendi...Quality of life (QoL) is an important measure to verify the effectiveness of therapy in substance use disorders (SUD). In this cross-sectional, multicenter study QoL has been measured in 1057 heroin dependents attending SerDs (“Servizi per le Dipendenze”, Italian National Health System Services for Addictions) and has been correlated with demographic variables and drug treatment. QoL has been measured by using GHQ-12 (12-item General Health Questionnaire), a self-administered questionnaire whose value is inversely correlated with the QoL. The median value of GHQ-12 in the study population was 12 (interquartile range [IQ] 9 - 18): 640 patients (60.6%) scored 20 points at the GHQ-12, which relates with a bad QoL. Female population showed higher GHQ12 scores when compared to male population (14 [IQ 9 - 19] vs. 12 [IQ 9 - 17], p = 0.03). Similarly, unemployed patients showed higher GHQ12 scores when compared to employed patients (15 [IQ 10 - 20] vs. 12 [IQ 8 - 16], p 20. Results show that most of patients receiving care for heroin dependence at SerDs have a positive assessment of their quality of life, and that being unemployed and having a dual diagnosis are predictors of poor QoL. Besides, data suggest that assuming buprenorphine could be a protective factor for QoL.展开更多
As an advanced theory of evolution,neo-Darwinism broadens the concept of Darwinism,in which natural selection intervenes to ensure that those genes that best meet the need for adaptation to the environment are conserv...As an advanced theory of evolution,neo-Darwinism broadens the concept of Darwinism,in which natural selection intervenes to ensure that those genes that best meet the need for adaptation to the environment are conserved in the genetic background.Culture,which in human beings contributes to biological adaptation,is the sum of all the knowledge and technical innovation deriving from individual practical contributions handed down from one generation to the next,continuously influencing and changing biological life.As an unforeseen mechanism of adaptation,culture has enabled human beings to survive and to adapt to situations of environmental change and crisis.Indeed,climate change determines both cultural and genetic changes.The deterioration of the climate can have a significant impact on the spread of infectious diseases,to the point that the random mutation of a virus,such as SARS-Cov2 can easily result in a pandemic.We have violated biological ecosystems,destroying the environment and the communities that inhabit it.Spillover is what happens when an agent of disease,be it a virus or a bacterium,for any of a number of reasons,passes from one species to another,generating a zoonosis,i.e.,an infectious agent that can affect human beings.The mechanisms of biological evolution act on them rapidly,generating new biological potential and transforming spillovers into pandemics.We need to invest in multidisciplinary scientific and technological research,which entails interaction between various fields of knowledge including ecological,meteorological,anthropological,cultural,medical,and environmental.All these disciplines are closely connected to each other and to the health of animals,human beings,and ecosystems,and it is only by coordinating them that we can hope to respond rapidly to the new health and environmental emergencies and provide political decision-makers with correct information that can protect the human population from decline and extinction.展开更多
Introduction: On March 11, 2020, the World Health Organization (WHO) declared that the entire World was overrun by a pandemic. Science has managed, in a short time, to characterize a new disease, sequence a new viral ...Introduction: On March 11, 2020, the World Health Organization (WHO) declared that the entire World was overrun by a pandemic. Science has managed, in a short time, to characterize a new disease, sequence a new viral genome, develop diagnostics, produce treatment protocols and establish the efficacy of drugs and vaccines in randomized controlled trials. In this paper we have dealt with different topics regarding the pandemic linked to COVID-19. Objectives: Aim of this paper is to compare the number of deaths attributable to COVID-19, that occurred in the different Italian macro-areas, in the different pandemic waves;we studied the trend of the curves relating to the proportion of deaths to the number of infected in the Italian macro-areas for the pandemic waves and analysed the mortality data, focusing on the Italian context and comparing it with other foreign countries. We examined the data regarding swabs, hospitalizations, home isolation, admissions to intensive care and deaths registered in pandemic period. Results: Geographically, Italy was differently affected by the pandemic. Northern Italy was the most affected area. In comparison with some foreign countries, Italy is one of the nations that paid the most in terms of deaths, due to: delays in understanding the seriousness of the emergency;the slow management in the tracking systems of contagions;the high number of hospitalizations;a corporate organizational system poorly planned. Conclusion: The years 2020 and 2021 have been dramatic and unprecedented. The year 2021 was the year of redemption, where, despite social, economic and health difficulties, thanks to mass vaccination, we were able to give a real strong response to the pandemic. Trust in science has led to a drastic decrease in mortality throughout the world.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"> Worldwide, the burden of cardiovascular (CV) risk factors is rising with devastating impacts on the productive workforce. In ...<strong>Background:</strong><span style="font-family:Verdana;"> Worldwide, the burden of cardiovascular (CV) risk factors is rising with devastating impacts on the productive workforce. In developing nations, it has further led to an unstable population pyramid as a result of premature deaths of her workforce leading to the continued tapering of the pyramidal apex. Inspite of this, many studies were conducted among the general population neglecting the local government civil servants who are seen as policy implementers. Therefore, the study assessed the pattern of CV risk factors in South-western Nigeria.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A cross-sectional study was conducted among 260 local government workers selected by multistage sampling technique from July to September 2017. A pretested, interviewer-administered questionnaire was administered to obtain socio-demographic and behavioural information. Lipid analysis, anthropometric, blood pressure, fasting blood glucose measurements were done according to protocols. Data were analyzed using IBM SPSS version 25;bivariate analysis was done using Chi-square. Level of significance was at 5%. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean age of respondents was 46.0 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 6.7 years. The proportion of participants with good knowledge of risk factors was 57.7%. The proportion of respondent with hypertension, visceral obesity, general obesity, diabetes, smoking and physical inactivity was 40.4%, 35.0%, 52.2%, 38.2%, 5.8% and 75.8% respectively. The prevalence of elevated total cholesterol (</span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">TC)</span><span style="font-family:Verdana;">, raised low-density lipoprotein (</span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">LDLc), low high-density lipoprotein (</span><span style="font-family:Verdana;">↓</span><span style="font-family:Verdana;">HDLc) and elevated triglycerides (</span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">TGs) w</span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> 55.4%, 85.0%, 70.4% and 3.1% respectively. There was a higher proportion of elevated total cholesterol (TC) and LDLc among female respondents (p = 0.002;p = 0.009). Senior cadre staff had a higher proportion of respondents with raised </span><span style="font-family:Verdana;">↓</span><span style="font-family:Verdana;">HDLc and </span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">TGs (p =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.031;p = 0.036). Age was associated with hypertension and was highest among respondents in 45 </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> 54 </span><span style="font-family:Verdana;">years </span><span style="font-family:Verdana;">age category (p < 0.001).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The prevalence of CV risk factors was higher compared with other studies in Nigeria and Africa. The findings illuminated a poor response to the rising burden of CV risk factors despite interventions put in place. This underscores the need for holistic preventive and control strategies with a view to reduc</span><span style="font-family:Verdana;">ing</span><span style="font-family:Verdana;"> the incidence of cardiovascular diseases in Nigeria.</span>展开更多
Objective: The aim of this study was to establish the knowledge and attitude of family physcians offering primary health care, towards adult vaccination and their own vaccination coverage. Methods: This descriptive st...Objective: The aim of this study was to establish the knowledge and attitude of family physcians offering primary health care, towards adult vaccination and their own vaccination coverage. Methods: This descriptive study was performed in May 2009 in Kayseri, Turkey. 282 family physician accepted to fill a questionnaire about adult vaccination. Results: Most of the family physcians (83.0%) thought adult vaccination as a modality of protection and 66.7% wanted a vaccination scheme just like the one in childhood. Their own vaccination rate for Hepatitis B was 67.0% and 58.5% for influenza at any time. Only half of the physcians were vaccinated within the season for influenza. Only 9.2% of the doctors have stated that they ask questions to their patients about their vaccination status. When physcians were questioned about the vaccines they advise to their patients aged 65 and more;70.6% stated influenza and 39.7% stated pneumococcus. Conclusion: In spite of being in the risk group, family physicians have low vaccination coverage rates. Suggestion of the necessary vaccines to the risk groups or to their patients at risk is low as well.展开更多
文摘In Italy,a nationwide population-based colorectal cancer(CRC)screening initiative has been in place since 2006.In recent years,there has been a growing interest in involving community pharmacies in this activity.This commentary provides an insightful analysis of the integration between the screening program of the Local Health Authority(LHA)of Bologna(Northern Italy)and community pharmacies.A horizontal integration at the micro level with service and clinical integrations supported by meso-level policy(regional authority)was applied.Four types of integration such as normative,informational,financial and functional serving as enablers were implemented.A high level of depth of consensus,connectivity,communication,and trust was pursued.The program achieved large participation from community pharmacies,with 91.1%(n=234)of pharmacies in the LHA territory actively participating.On average,each pharmacy served 1,228(range,1,021-1,519)target citizens.Between 2021(the first full year under the community pharmacy model)and 2022,pharmacies delivered an annual mean of 68,295 kits(range,12-840).In 2021,there was a remarkably high level of screening completion,with 93.7%of fecal immunochemical tests being returned to pharmacies.This percentage increased by 3.3%in 2022.In our setting,pharmacy involvement improved service quality by introducing complete traceability of kits and specimen flow,as well as temperature control.It also led to a 4.6%increase in attendance rates compared to the previous organizational model(61.6%vs.57%;P<0.001).Finally,additional European experiences involving community pharmacies in organized CRC screening programs,resembling the Bologna setting,are reported.
文摘<span style="font-family:Verdana;"><strong>Background:</strong> The outbreak of COVID-19 has continued to threaten the existence of the human race. The novelty and unstable epidemiologic pattern of the virus had generated so much concern among the global health experts. These concerns were found to be escalated among the frontline health care workers to the extent of impeding the timeliness of the response activities. To slow down the spread of the already established community transmission through the surveillance activities, the concern of the health workers at the community level needs to be addressed. Therefore, this study assessed the concern about COVID-19 pandemic among primary health workers in Oyo State, Nigeria. <strong>Methods:</strong> This was an online cross-sectional survey conducted among primary health care workers in Oyo State between March and April 2020. Using a two-stage sampling technique, we recruited 284 respondents. A semi-structured questionnaire linked to the Google form was used to collect data. Data were analyzed using IBM SPSS version 25;bivariate analysis was done using Chi-square and binary logistic regression was used to identify the predictors of health workers’ concern at 5% level of significance. <strong>Results:</strong> The mean age of respondents was 45.0 ± 9.0 years. The proportion of the respondents who had good knowledge of COVID-19 was 52.5%. In the domains of concern, 66.9%, 53.2%, 51.4%, and 46.5% of the respondents expressed government-related, self-satisfaction related, work-related and social-status related concerns respectively. Male respondents were less likely to express concern about COVID-19 compared with their female counterparts (aOR = 0.39, 95% CI = 0.20 - 0.76). Nurses/midwives (aOR = 0.21, 95% CI = 0.05 - 0.85) had lesser likelihood of expressing concern about COVID-19 while middle staff (aOR = 2.5, 95% CI = 1.18 - 5.39) and income earner of ≥N200,000 (aOR = 2.3, 95% CI = 1.34 - 3.92) had higher likelihood of expressing concern about COVID-19. <strong>Conclusion:</strong> The study highlights an average knowledge of COVID-19 among the respondents. Government-related and self-satisfaction related concerns were expressed by the majority of the Primary Health Care (PHC) workers. Now that the second wave of COVID-19 is moving with much more fatality across much of Africa, including Nigeria, it is therefore imperative to address these concerns through a holistic policy that addresses the welfare, safety and capacity building of the health care workers (HCWs).</span>
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
基金Supported by (in part) A grant from Gruppo Italiano di Ultrasonologia in Medicina Interna (GIUMI)
文摘AIM:To ascertain whether carotid lesions are more prevalent in outpatients with incidental findings of nonalcoholic fatty liver disease (NAFLD) at abdominal ultrasound (US).METHODS: One hundred and fifty-four consecutive outpatients (age range 24-90 years, both sexes) referred by general practitioners for abdominal US, and drinking less than 20 g alcohol/day, underwent carotid US for an assessment of carotid intima-media thickness (c-IMT) and carotid plaque prevalence. Hepatic steatosis, visceral fat thickness and subcutaneous fat thickness were also assessed at ultrasonography.RESULTS: Higher c-IMT values were found in the presence of NAFLD (90 patients), even after adjustment for indices of general and abdominal obesity and for the principal cardiovascular risk factors (0.84±0.10 mm vs 0.71±0.10 mm, P<0.001). The prevalence of carotid plaques was 57.8% in the patients with NAFLD vs 37.5% in the patients without this condition (P=0.02). The adjusted relative risk of having carotid plaques for patients with NAFLD was 1.85 (95% CI:1.33-2.57, P<0.001).CONCLUSION: An incidental finding of hepatic steatosis may suggest the presence of silent carotid atherosclerotic lesions.
文摘The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience continuity during care transition of older patients from hospital to municipal health care? How would nurses describe an optimal care transition? Nurses have a pivotal role during care transitions of older patients. More knowledge about their experiences is necessary to develop favorable improvements for this important period in the older patient’s treatment and care. The study has a qualitative explorative design with follow-up focus group interviews. Nurses (N = 30) working in hospital (n = 16) and municipal (n = 14) health care were organized in five mixed focus groups during the period October-January 2014/2015. The focus groups met twice, answering the research questions following a previously circulated semi-structured interview guide. The interview analysis was inspired by content analysis. The analysis resulted in the themes “Administrative demands challenge terms for collaboration” and “Essentials for nursing determine optimal care transitions for older patients”. Administrative demands may prevent nurses’ professional dialogue and collaboration across health care levels. Older patients’ best interests should be ensured through a collaborative relationship between hospital and municipal nurses, to form continuous care across health care levels. Clinical practice should be aware of essentials for nursing, which could influence and facilitate a more individualized and continuous transition for older patients.
文摘AIM: To examine trends of uncontrolled total serum cholesterol, treatment and control in a Mediterranean region(Campania). METHODS: We considered and compared the data collected as part of "Montecorvino Rovella Project" 1988-1989 and cross-sectional data from the two phases of the "VIP Project-Valle dell'Irno Prevenzione": 1998-1999(1stphase) and 2008-2009(2ndphase), in the 35-74-year-old-population. RESULTS: Data show a reduction of mean cholesterolemia in the last twenty years of 7.3 mg/dL for men and unchanged values for women. In the three surveys the mean values for serum cholesterol are in men: 205.2 ±47.1 mg/dL(1988/89), 200 ± 38.9 mg/dL(1998/99) and 197.9 ± 40.2 mg/dL(2008/09); in the women: 203.1 ± 42.5 mg/dL(1988/89), 198.9 ± 37.9 mg/dL(1998/99) and 203.3 ± 39.3 mg/dL(2008/09). Prevalence of uncontrolled high cholesterol ≥ 240 mg/dL for men decreased from 20.8%(1988/89) to 14.3%(1998/99) and 13.9%(2008/9), P = 0.002; for women the values decreased from 19.9%(1988/89), to 18.2%(1998/99) and 18.1%(2008/09), P = 0.007. Is statistically increased the number of patients treated and those treated to target. CONCLUSION: Encouraging increases in awareness, treatment, and control of hypercholesterolemia occurred from 1988 through 2008. Nevertheless, control of hypercholesterolemia remains poor.
文摘AIM:To assess the acceptance,safety and efficacy of care and treatment for chronic hepatitis C(CHC)in drug addicts.METHODS:We designed a multidisciplinary,phase IV prospective cohort study.All illicit drug users(IDUs)visited a Territorial Addiction Service(SerT)in the District of Brescia,and hepatitis C antibody(HCVAb)testing positive were offered as part of a standardised hepatologic visit in our Gastroenterology Unit.Patients with confirmed CHC and without medical contraindications were administered peginterferon alfa-2b 1.5μg/kg per week plus ribavirin(800-1400 mg/d)for 16-48wk.All IDUs were unselected because of ongoing addiction and read and signed an informed consent form.Virologic responses at weeks 4 and 12 of therapy,at the end of treatment and 24 wk after the end of treatment were the main measures of efficacy.Adherence was estimated according to the 80/80/80 criteria.RESULTS:From November 2007 to December 2009,162 HCVAb+IDUs were identified.Sixty-seven patients(41%of the initial cohort)completed the diagnostic procedure,and CHC was diagnosed in 54(33%of the total).Forty-nine patients were offered therapy,and 39agreed(80%of acceptance rate).The prevalent HCV genotype was type 1,and the HCV RNA baseline level was over 5.6 log/mL in 61%of cases.Five patients dropped out,two because of severe adverse events(SAEs)and three without medical need.Twenty-three and 14 patients achieved end of treatment responses(ETRs;59%)and sustained virologic responses(SVRs;36%),respectively.Thirty-one patients were fully compliant with the study protocol(80%adherence).The prevalence of host and viral characteristics negatively affecting the treatment response was high:age over40 years(54%),male gender(85%),overweight body type(36%),previous unsuccessful antiviral therapy(21%),HCV genotype and viral load(60%and 62%,respectively),earlier contact with HBV(40%)and steatosis and fibrosis(44%and 17%,respectively).In a univariate analysis,alcohol intake was associated with a non-response(P=0.0018,95%CI:0.0058-0.4565).CONCLUSION:Drug addicts with CHC can be successfully treated in a multidisciplinary setting using standard antiviral combination therapy,despite several"difficult to reach,manage and treat"characteristics.
文摘Quality of life (QoL) is an important measure to verify the effectiveness of therapy in substance use disorders (SUD). In this cross-sectional, multicenter study QoL has been measured in 1057 heroin dependents attending SerDs (“Servizi per le Dipendenze”, Italian National Health System Services for Addictions) and has been correlated with demographic variables and drug treatment. QoL has been measured by using GHQ-12 (12-item General Health Questionnaire), a self-administered questionnaire whose value is inversely correlated with the QoL. The median value of GHQ-12 in the study population was 12 (interquartile range [IQ] 9 - 18): 640 patients (60.6%) scored 20 points at the GHQ-12, which relates with a bad QoL. Female population showed higher GHQ12 scores when compared to male population (14 [IQ 9 - 19] vs. 12 [IQ 9 - 17], p = 0.03). Similarly, unemployed patients showed higher GHQ12 scores when compared to employed patients (15 [IQ 10 - 20] vs. 12 [IQ 8 - 16], p 20. Results show that most of patients receiving care for heroin dependence at SerDs have a positive assessment of their quality of life, and that being unemployed and having a dual diagnosis are predictors of poor QoL. Besides, data suggest that assuming buprenorphine could be a protective factor for QoL.
文摘As an advanced theory of evolution,neo-Darwinism broadens the concept of Darwinism,in which natural selection intervenes to ensure that those genes that best meet the need for adaptation to the environment are conserved in the genetic background.Culture,which in human beings contributes to biological adaptation,is the sum of all the knowledge and technical innovation deriving from individual practical contributions handed down from one generation to the next,continuously influencing and changing biological life.As an unforeseen mechanism of adaptation,culture has enabled human beings to survive and to adapt to situations of environmental change and crisis.Indeed,climate change determines both cultural and genetic changes.The deterioration of the climate can have a significant impact on the spread of infectious diseases,to the point that the random mutation of a virus,such as SARS-Cov2 can easily result in a pandemic.We have violated biological ecosystems,destroying the environment and the communities that inhabit it.Spillover is what happens when an agent of disease,be it a virus or a bacterium,for any of a number of reasons,passes from one species to another,generating a zoonosis,i.e.,an infectious agent that can affect human beings.The mechanisms of biological evolution act on them rapidly,generating new biological potential and transforming spillovers into pandemics.We need to invest in multidisciplinary scientific and technological research,which entails interaction between various fields of knowledge including ecological,meteorological,anthropological,cultural,medical,and environmental.All these disciplines are closely connected to each other and to the health of animals,human beings,and ecosystems,and it is only by coordinating them that we can hope to respond rapidly to the new health and environmental emergencies and provide political decision-makers with correct information that can protect the human population from decline and extinction.
文摘Introduction: On March 11, 2020, the World Health Organization (WHO) declared that the entire World was overrun by a pandemic. Science has managed, in a short time, to characterize a new disease, sequence a new viral genome, develop diagnostics, produce treatment protocols and establish the efficacy of drugs and vaccines in randomized controlled trials. In this paper we have dealt with different topics regarding the pandemic linked to COVID-19. Objectives: Aim of this paper is to compare the number of deaths attributable to COVID-19, that occurred in the different Italian macro-areas, in the different pandemic waves;we studied the trend of the curves relating to the proportion of deaths to the number of infected in the Italian macro-areas for the pandemic waves and analysed the mortality data, focusing on the Italian context and comparing it with other foreign countries. We examined the data regarding swabs, hospitalizations, home isolation, admissions to intensive care and deaths registered in pandemic period. Results: Geographically, Italy was differently affected by the pandemic. Northern Italy was the most affected area. In comparison with some foreign countries, Italy is one of the nations that paid the most in terms of deaths, due to: delays in understanding the seriousness of the emergency;the slow management in the tracking systems of contagions;the high number of hospitalizations;a corporate organizational system poorly planned. Conclusion: The years 2020 and 2021 have been dramatic and unprecedented. The year 2021 was the year of redemption, where, despite social, economic and health difficulties, thanks to mass vaccination, we were able to give a real strong response to the pandemic. Trust in science has led to a drastic decrease in mortality throughout the world.
文摘<strong>Background:</strong><span style="font-family:Verdana;"> Worldwide, the burden of cardiovascular (CV) risk factors is rising with devastating impacts on the productive workforce. In developing nations, it has further led to an unstable population pyramid as a result of premature deaths of her workforce leading to the continued tapering of the pyramidal apex. Inspite of this, many studies were conducted among the general population neglecting the local government civil servants who are seen as policy implementers. Therefore, the study assessed the pattern of CV risk factors in South-western Nigeria.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> A cross-sectional study was conducted among 260 local government workers selected by multistage sampling technique from July to September 2017. A pretested, interviewer-administered questionnaire was administered to obtain socio-demographic and behavioural information. Lipid analysis, anthropometric, blood pressure, fasting blood glucose measurements were done according to protocols. Data were analyzed using IBM SPSS version 25;bivariate analysis was done using Chi-square. Level of significance was at 5%. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The mean age of respondents was 46.0 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 6.7 years. The proportion of participants with good knowledge of risk factors was 57.7%. The proportion of respondent with hypertension, visceral obesity, general obesity, diabetes, smoking and physical inactivity was 40.4%, 35.0%, 52.2%, 38.2%, 5.8% and 75.8% respectively. The prevalence of elevated total cholesterol (</span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">TC)</span><span style="font-family:Verdana;">, raised low-density lipoprotein (</span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">LDLc), low high-density lipoprotein (</span><span style="font-family:Verdana;">↓</span><span style="font-family:Verdana;">HDLc) and elevated triglycerides (</span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">TGs) w</span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> 55.4%, 85.0%, 70.4% and 3.1% respectively. There was a higher proportion of elevated total cholesterol (TC) and LDLc among female respondents (p = 0.002;p = 0.009). Senior cadre staff had a higher proportion of respondents with raised </span><span style="font-family:Verdana;">↓</span><span style="font-family:Verdana;">HDLc and </span><span style="font-family:Verdana;">↑</span><span style="font-family:Verdana;">TGs (p =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.031;p = 0.036). Age was associated with hypertension and was highest among respondents in 45 </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> 54 </span><span style="font-family:Verdana;">years </span><span style="font-family:Verdana;">age category (p < 0.001).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The prevalence of CV risk factors was higher compared with other studies in Nigeria and Africa. The findings illuminated a poor response to the rising burden of CV risk factors despite interventions put in place. This underscores the need for holistic preventive and control strategies with a view to reduc</span><span style="font-family:Verdana;">ing</span><span style="font-family:Verdana;"> the incidence of cardiovascular diseases in Nigeria.</span>
文摘Objective: The aim of this study was to establish the knowledge and attitude of family physcians offering primary health care, towards adult vaccination and their own vaccination coverage. Methods: This descriptive study was performed in May 2009 in Kayseri, Turkey. 282 family physician accepted to fill a questionnaire about adult vaccination. Results: Most of the family physcians (83.0%) thought adult vaccination as a modality of protection and 66.7% wanted a vaccination scheme just like the one in childhood. Their own vaccination rate for Hepatitis B was 67.0% and 58.5% for influenza at any time. Only half of the physcians were vaccinated within the season for influenza. Only 9.2% of the doctors have stated that they ask questions to their patients about their vaccination status. When physcians were questioned about the vaccines they advise to their patients aged 65 and more;70.6% stated influenza and 39.7% stated pneumococcus. Conclusion: In spite of being in the risk group, family physicians have low vaccination coverage rates. Suggestion of the necessary vaccines to the risk groups or to their patients at risk is low as well.
