Uncovering influential factors in human antibiotic prescribing: a meta-synthesis study informed by the Theoretical Domains Framework

This study aimed to identify modifiable determinants (facilitators and barriers) related to the choice of prescribing antibiotics in human medicine across clinical settings. Enhanced management of antibiotics can help slow the spread of resistant bacteria. A qualitative meta-synthesis approach was used, according to Sandelowski and Barroso's method. Included studies were evaluated using the Critical Appraisal Skills Programme. Findings were extracted and organized to form a qualitative meta-summary. The Theoretical Domains Framework, the Capabilities-Opportunities-Motivation (COM-B) model and the Behaviour Change Wheel were used as a coding matrix for data interpretation. The analysis of 63 included studies revealed barriers and facilitators in 12 of 14 domains specified by the Theoretical Domains Framework. Prescribers' capabilities, motivation and opportunities were found to be the main drivers of antibiotic prescribing behaviour. Knowledge, skills, beliefs, expectations, the influence of patients and colleagues, organizational culture and infrastructure characteristics have a significant impact on prescribing behaviours. A comprehensive inventory of factors related to antibiotic prescribing has been compiled. Interventions to promote appropriate antibiotic prescribing should take a systemic approach rather than focusing solely on individual-level variables. Furthermore, the adoption of co-design approaches for such interventions is desirable to ensure greater applicability and sustainability in the real-world context of organizations.

Providing freedom or financial remuneration? A cross-sectional study on the role of monetary and legal incentives on COVID-19 further booster vaccination intention in the Italian context

Vaccine hesitancy became a more and more important issue during the COVID-19 pandemic. Due to the emergence of new variants, many international health agencies have already begun administering booster doses of the vaccine in response to these threats. Studies have emphasized the effectiveness of different types of incentive-based strategies to increase vaccination behaviors. The purpose of the present study was to identify the correlation between different types of incentives (legal or financial) with people's intentions to get a COVID-19 booster vaccine. We conducted a cross-sectional study between 29 January 2022 and 03 February 2022. An online quantitative survey was carried out in Italy. One thousand and twenty-two Italian adults were recruited by a professional panel provider. Descriptive statistics were computed for the five variables concerning the incentives (monetary, tax, fee, health certification, travel) toward vaccination. A general linear model (GLM) was then computed to compare the scores of the five different variables within the subjects. The general linear model showed a significant within-subjects main effect. Post-hoc comparisons showed that among the financial incentive, the monetary reward is rated lower than all the others. Tax and fees both resulted lower than both the legal incentives. Finally, COVID-19 health certification and travel did not result significantly different from each other. This study offers an important contribution to public policy literature and to policymakers in their efforts to explain and steer booster vaccination acceptance while facing an ongoing pandemic.

Public views on the Covid-19 immunity certificate: A scoping review

INTRODUCTION

Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance.

METHODS

We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions.

RESULTS

We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure.

CONCLUSION

The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure.

PATIENT OR PUBLIC CONTRIBUTION

This does not apply to our work as it was a review paper.

Public Perceptions of Harms and Benefit of COVID-19 Immunity Certificate: A Cross-Sectional Study in the Italian Setting

A cross-sectional survey between 29 January 2022 and 3 February 2022 was conducted to understand the public rationale for accepting or rejecting the use of COVID-19 immunity certificates and to identify the psychosocial factors that mostly predict the positive/negative individuals’ perceptions of this measure. One thousand twenty-two Italian adults were recruited by a professional panel provider by employing a stratified sampling strategy controlled for gender, age, geographical area of residence, size of the urban centre of residence, employment, and wage. Eight Welch’s ANOVAs were then carried out to compare the perception of benefits and the perception of harms among different population groups. Multiple linear regression was carried out to measure the explained variance of benefits perception and harms perception by age, trust in institutions, and concern for health emergencies. The results shows that age, trust in institution, and concern for the COVID-19 emergency explain more variance of perceived benefits than of perceived harms of COVID-19 immunity certificates but the opposite regarding political orientation which explains perceived harms better than perceived benefits. The need for policy improvements is pressing because a large share of the world’s population remains unvaccinated. Moreover, our results can serve as vital information for similar health crises that may occur in the future. In addition, our results are expected to offer useful insights into public feelings around the use of digital health information tools.

The timing of the operatingroom: a 2019 Italian exsperience

Background

The lack of economic resources for health systems is a public health issue that Europe needs to address in order to guarantee quality and safety of care for patients. Any initiative aimed to reduce waste are welcomed. In this context, the City of Health and Science of Turin (Italy) performed a study aimed to analyse the timing of operating rooms to improve efficacy, efficiency and quality standards in the surgical field.

Methods

A multidisciplinary working group created in 2019 a checklist aimed to record the operating times of the first intervention of the day in 5 Hospital Departments (including 12 operating rooms). We registered the time between the moment in which the operating room is considered available for the start of activities and the surgical incision (benchmark: within 60 minutes). All the times needed for nursing, anesthetic and surgical activities were collected and evaluated for a descriptive statistical analysis.

Results

In consideration of a room opening time scheduled for 7:00 and room availability scheduled for 7:30, the goal can be considered achieved if the time of the surgical incision does not exceed 8:30 in the morning. Three out of 5 departments (Ginecology, Orthopaedic and General surgery) reached this aim in more than 80% of interventions, while neurosurgery and thoracic surgery exceeds the time by about 40 minutes. The checklist showed that in many cases is possible to reduce the time between the end of anesthesia and surgical incision.

Conclusions

To analyse the operating times allows not only to optimize the resources but also to reduce waste of time and waiting lists for surgery in election. We described, in a sample of surgical interventions, when and how is possible to improve the efficiency of the operating room. This experience and the checklist created could be useful not only for us but every European hospital.

Key messages

The efficiency of operating rooms is related to several factors. Neurosurgery and thoracic surgery needs longer time to prepare patients and start intervention. A checklist aimed to monitor the times of activities in surgical operating rooms can be useful to reduce waste of time and resources in European hospitals.

Detection of benzo[a]pyrene-diol-epoxide-DNA adducts in white blood cells of psoriatic patients treated with coal tar

An enzyme-linked immunosorbent assay (ELISA) was used to detect BPDE-DNA adducts in white blood cells of 23 psoriatic patients undergoing clinical coal tar therapy. Ten of these patients were reanalyzed 2-5 months after the end of the coal tar treatments. The results show that the mean adduct level during the treatment period was 0.26 +/- 0.16 fmole BPDE/micrograms DNA (7.7 +/- 4.9 adducts/10(8) nucleotides), while 2-5 months later the mean adduct level had decreased significantly (P less than 0.005) to 0.11 +/- 0.08 fmole BPDE/micrograms DNA (3.3 +/- 2.4 adducts/10(8) nucleotides). No relationship could be ascertained between the level of exposure and the amount of BPDE-DNA adducts. In addition, no difference in the level of DNA adducts was found between smoking and non-smoking patients.

Biological monitoring of human exposure to coal tar. Urinary excretion of total polycyclic aromatic hydrocarbons, 1-hydroxypyrene and mutagens in psoriatic patients

Three methods for the biological monitoring of human exposure to coal tar were compared. Levels of 1-hydroxypyrene(1-OH PYR), polycyclic aromatic hydrocarbons (PAH) and mutagens (Ames plate incorporation assay using Salmonella typhimurium strain TA98 in the presence of S9 and beta-glucuronidase) were determined in urinary samples from psoriatic patients undergoing topical treatment with mineral coal tar. A single sample of urine with a high content of PAH was diluted with urine of nonexposed, non-smoking subjects in order to obtain nine samples with a decreasing content of PAh metabolites. Mutagenicity of the extracts was detectable down to the dilution corresponding to a content in 1-OH PYR of about 50 micrograms/g creatinine and total PAH of 7 micrograms/g creatinine. In a second phase the three indicators of exposure to PAH were compared in 16 urinary samples from four psoriatic patients. The total PAH levels determined by the acidic deconjugation/reduction method were confirmed to be nearly always lower than the corresponding levels of 1-OH PYR alone. Most of the extracts were mutagenic, however, some of the samples with a high content in PAh metabolites were not mutagenic. In all the urinary samples analyzed the excretion of 1-OH PYR was markedly greater than in control subjects. 1-OH PYR and urinary mutagenicity levels were well correlated. The present data suggest that both the determination of mutagenicity and 1-OH PYR in urine may be used to monitor occupational exposure to PAH, the latter method being cheaper and of greater specificity and sensitivity.

Evidence for substantial formation of r-7,t-8-dihydroxy-c-9,10-oxy-7,8,9,10-tetrahydrobenzo[a]pyrene- deoxyguanosine in human lymphocytes treated in vitro with benzo[a]pyrene

The possibility that the amounts of r-7,t-8-dihydroxy-t-9,10-oxy-7,8,9,10-tetrahydrobenzo[a]pyrene- deoxyguanosine (anti-BaP diol epoxide-dGuo) and r-7,t-8-dihydroxy-c-9,10-oxy-7,8,9,10-tetrahydrobenzo[a]pyrene- deoxyguanosine (syn-BaP diol epoxide-dGuo) may vary in human lymphocyte cultures from different donors was investigated by comparing DNA adducts formed after treatment with [G-3H]benzo[a]-pyrene (4 microM) for 24 h. In most cases, greater than 50% of the DNA adducts were derived from r-7,t-8-dihydroxy-c-9,10-oxy-7,8,9,10-tetrahydrobenzo[a]pyrene (syn-BaP diol epoxide).

Induction of SOS response in Escherichia coli strain PQ37 by 16 chemical compounds and human urine extracts

The SOS Chromotest on Escherichia coli strain PQ37 was used to detect DNA damage induced by 16 chemical compounds and urine samples from smokers and a non-smoking psoriatic patient treated with mineral coal tar. The results confirmed the strong SOS inducing activity of 2-aminoanthracene and benzo[a]pyrene with metabolic activation and N-methyl-N'-nitro-N-nitrosoguanidine, mitomycin C and 4-nitroquinoline-N-oxide without metabolic activation. A weaker response in the absence of microsomal enzymes was observed with hydroxyurea (only at high doses) and the soluble Cr(VI) compounds potassium chromate and potassium dichromate. No effect was observed with ampicillin, cadmium chloride, cyclophosphamide, griseofulvin, the insoluble Cr(VI) compound lead chromate, the soluble Cr(III) compounds chromium nitrate, chromium chloride, chromium potassium sulphate, and the chelating agent sodium nitrilotriacetate. Among the Cr(III) compounds only chromium acetate produced a low but significant increase of SOS inducing activity. Solubilization by nitrilotriacetate of genotoxic Cr(VI) from insoluble lead chromate was observed, whereas no interaction occurred between nitrilotriacetate and the soluble Cr(VI) and Cr(III) compounds. Using urinary XAD-2 extracts, we found the SOS Chromotest poorly sensitive to the mutagens present in urine from tobacco smokers which, on the other hand, were detected by the gene mutation assay in Salmonella typhimurium (Ames test). A urine sample obtained from a psoriatic patient, therapeutically treated with mineral coal tar, had a significant SOS inducing activity with and even without metabolic activation, whereas in the Ames test it was active only in the presence of metabolic activation.(ABSTRACT TRUNCATED AT 250 WORDS)

Nitrilotriacetic acid (NTA) does not induce chromosomal damage in mammalian cells either in vitro or in vivo

We used human lymphocyte cultures to repeat the experiments under the very particular conditions of nitrilotriacetic acid (NTA) treatments (high doses: up to 10(-2) M; very long exposure times: up to 5 days) which have been described as being able to induce chromosomal aberrations, and we also performed the more conventional treatments (24-48 h of exposure) as suggested in the protocols adopted by the EEC-OECD. Mitomycin C was routinely used as a positive clastogenic control. NTA did not significantly increase the frequency of chromosomal aberrations in any of the different experimental conditions adopted. Furthermore, no induction of micronuclei was observed in mouse polychromatic erythrocytes after treatment in vivo for up to 48 h with NTA (200-400 mg/kg b.w.), whereas the frequency of micronuclei was significantly increased by mitomycin C (1 mg/kg b.w.).

Etiology and the prevention of wars. (Preliminary thoughts)

There is a suggestion in the previous paper that a way out to convey the overwhelming progress and "heavy" civilization of humanity may be to explore the Space, the Universe, and it, indeeed, results in an excellent job what American and Soviets together are these days endeavoring toward new exploration in Space. Let us see now, is this way out going to give the solution of our problem, hence avoid wars in the world?

Psychiatry on the prevention of crime

The main endeavor of Forensic Psychiatry is to find out the causes, to investigate the psychodynamics of crime, hence based on them, to try to prevent or to treat them. In this connection, I will not enter into details today about the position of delinquency into psychodynamics, as they have elsewhere been described; I only would emphasize some cases which take place during the state so-called "hystero-epilepsy" of Charcot.

Psychiatry on the prevention of crime

The main endeavor of Forensic Psychiatry is to find out the causes, to investigate the psychodynamics of crime, hence based on them, to try to prevent or to treat them. In this connection, I will not enter into details today about the position of delinquency into psychodynamics, as they have elsewhere been described, I only would emphasize so-called "hystero-epilepsy" of Charcot.

Etiology and the prevention of wars (preliminary thoughts)

There is a suggestion in the previous paper that a way out to convey the overwhelming progress and "heavy" civilization of humanity may be to explore the Space, the Universe, and it, indeed, results in an excellent job what American and Soviets together are these days endeavoring toward new exploration in Space. Let us see now, is this way out going to give the solution of our problem, hence avoid wars in the world?