Nurse Case Manager Lifestyle Medicine (NCMLM) in the Type Two Diabetes patient concerning post COVID-19 Pandemic management: Integrated-Scoping literature review

BACKGROUND

The American Case Manager Association defines Case Management, in Lifestyle Medicine perspective, a collaborative practice between all the actors involved in the care process. The goal of this review was to evaluate the Nurse Case Manager role in Type 2 Diabetes patients, analyzing the quali/quan-titative data related to Nurse Case Management programs in Lifestyle Medicine view.

STUDY DESIGN AND METHODS

Three independent operators were involved in two distinct phases, applying the Prisma method, specifics PICOS and research strategies from PubMed and Cinahl. The first part integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus, while the second part evaluated the Nurse Case Manager interventions in Lifestyle Medicine view.

RESULTS

The first part includes 13 studies and the second 6. The glycemic control was improved in the Nurse Case Manager groups in Lifestyle Medicine perspective. Good results were appreciated in secondary outcomes: lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to Lifestyle Medicine programs are encouraging.

CONCLUSIONS

It emerged unequivocally that, taking care and supporting the diabetic subject, leads to significant benefits in the general health and to reduction of possible complications. After the Covid-19 Pandemic, the Nurse Case Manager Lifestyle Medicine could represent a valid alternative of health management for the improvement of care in Type 2 Diabetic patients.

Healthcare acquired infections: malpractice and litigation issues

BACKGROUND

Healthcare acquired infections (HAIs) represent a significant burden for hospitalized patients in terms of mortality, morbidity, length of stay and costs. Also cause medical liability and medical malpractice litigation.

METHODS

Specific keywords combinations were analitically searched in PubMed and Scopus databases. Publications concerning medical liability, medical malpractice and litigation issues were reviewed.

RESULTS

The authors outlined the healthcare workers and healthcare settings mandatory duties in consideration of the Italian law. In case of infections occurred in hospital environment the patients must demonstrate the guilty nature of the physicians and healthcare settings, the existence of a harm and causal connection. Physicians and healthcare facilities defence is mainly based on demonstration that protocols and aseptic measures were adopted scrupulously applying the up to date scientific knowledge.

CONCLUSIONS

HAI are a complex issue which need a multitask strategy and a surveillance system to control the phenomenon and help physicians and healthcare facilities to reduce malpractice litigation.

Burnout syndrome: a preliminary study of a population of nurses in italian prisons

INTRODUCTION

Burnout is a set of psychological manifestations ("emotional exhaustion", "depersonalization" and reduced "personal accomplishment") that principally affects healthcare professionals.

OBJECTIVES

Analysis of the level of burnout among twelve nurses who work in two Italian prisons.

MATERIAL AND METHODS

The Maslach Burnout Inventory was administered. In order to explore possible correlations between the three dimensions of the Maslach Burnout Inventory and such variables as age, years of service in general and years of service in prisons, multiple regression based on the ordinary least squares method (OLS model) was performed.

RESULTS

The response rate was 100%, of whom 66.6% female and 33.4% male. The average age is 38.1 years. Over half of the sample had worked from 0 to 10 years in prisons (58.4%), and only one respondent had done so between 21 and 30 years (8.3%). The data indicate that the highest levels of burnout concerned the dimension of "depersonalization" (66.7%) and "personal accomplishment" (41.6%). Emotional exhaustion of nurses in carrying out their work diminished with the increase of the independent variable of "personal accomplishment" (p-value 0.0361); it increased with the increase of the age variable (p-value 0.0117). Personal accomplishment decreased with the increase of the independent variables of emotional exhaustion (p-value 0.0361) and years of service in prisons (p-value 0.0238). For depersonalization, no statistically significant coefficients were observed. Model 1 of multiple regression showed a significant statistical association between the emotional exhaustion (dependent variable) and personal achievement (p-value 0.0361), and increase in age (p-value 0.0117). Model 2 showed significant statistical association between personal achievement (dependent variable) and emotional exhaustion (p=value 0.0361) and years of service nursing in prisons (p-value 0.0238). Model 3 showed no statistical association between depersonalization (dependent variable) and the other variables.

CONCLUSIONS

While twelve nurses formed this small sample, the study nonetheless indicated how the variables examined can influence the levels of burnout. Given that thorough inquiries into the levels of burnout among nurses who work in Italian prisons, specifically in the Marche Region, have yet to be conducted, this pilot study can serve as a point of reference for future research to improve evidence-based medicine.

Campaign manufacturing of highly active or sensitizing drugs: a comparison between the GMPs of various Regulatory Agencies

BACKGROUND

Cross-contamination and mix-ups are among the problems which could have a negative impact on the quality of the finished product during the production of highly active or sensitizing drugs with campaign manufacturing. Standardised, validated procedures ensure quality standards are maintained during production. In spite of this, the operating conditions and applicability of methods adopted by the various regulatory agencies manifest significant differences which could consequently compromise the safety of the finished product. This work has analysed and compared the GMP of various Regulatory Agencies to examine issues connected to campaign manufacturing highly active or sensitizing drugs.

METHODS

The GMP of the following Regulatory Agencies have been studied: EMA, CFDA, COFEPRIS, FDA, Health Canada, ANVISA, CDSCO, PIC/S and WHO. The study was carried out for the purpose of understanding which agencies consent to the use of campaign manufacturing for the following categories of medicinal products: hormones, immunosuppressants, cytotoxic agents, highly active pharmaceutical ingredients (APIs), biological preparations, steroids, sensitizing pharmaceutical materials, antibiotics, cephalosporins, penicillins, carbapenems and beta-lactam derivatives.

RESULTS

The GMP of Health Canada, EMA, PIC/S and FDA show a number of similarities, starting with the fact that they allow campaign manufacturing for similar categories of pharmaceutical products after an appropriate risk evaluation has been performed. CFDA, WHO, ANVISA authorise campaign manufacturing in "exceptional circumstances", though they do not always define what they mean by this. COFEPRIS authorises campaign manufacturing for certain classes of drugs, while there is no mention of campaign manufacturing in the CDSCO regulations.

CONCLUSIONS

Quite a few significant differences have been found in the various regulations concerning the use of campaign manufacturing and the classes of drugs that can be produced with this method. In the light of this, it is obvious that efforts to harmonise legislation internationally have not yet been successful: currently, states can adopt different quality standards. The pharmaceutical industry could use this situation to its advantage by delocalising production on the basis of existing standards. The need to harmonise GMPs is a priority which must be achieved as soon as possible.

Knowledge and Attitudes on Food Hygiene among Food Services Staff on Board Ships

BACKGROUND

Ships have long been sites for outbreaks of infectious diseases, particularly gastrointestinal diseases. The ship environment has the potential to facilitate the spread of such diseases, infecting susceptible cohorts of embarked passengers and crew. Gastrointestinal disorders among seafarers are fairly common and usually represent the first or second cause of requests for medical assistance aboard ships in international waters.

STUDY DESIGN

The purpose of this study was to evaluate food safety and the level of knowledge among food service personnel on board merchant ships, where food handlers could be a cause of health problems for all crew members.

METHODS

An anonymous self-administered questionnaire containing specific questions about food hygiene and safety knowledge was administered.

RESULTS

The overall score of correct answers for the food safety aspects tested was 51.77 (SD 3.87) out of 76 points, corresponding to 68.12% of questions answered correctly. Food workers who followed a training course showed higher mean knowledge score (p < 0.05) compared to not-trained workers. The most relevant significant differences (p < 0.05) were noticeable in the personal hygiene, cross-contamination, safe storage, and knowledge of foodborne pathogens sections.

CONCLUSION

Food services staff on board cargo ships should be adequately trained and should understand basic and fundamental aspects of food hygiene, related pathologies and sanitation, as they are responsible for the health and wellbeing of many seafarers.

Implications of modified food choices and food-related lifestyles following the economic crisis in the Marche Region of Italy

BACKGROUND

The economic crisis in Italy has led to profound changes in resource management not only at the macro level but also for individual families, causing substantial changes in different habits of Italians.

STUDY DESIGN

The purpose of this research was to conduct a study on changes in family eating habits potentially triggered by the economic crisis was conducted in an area of the Marche Region in central Italy.

METHODS

The research was conducted in the period 2016 - 2017 by administering a specific and anonymous questionnaire.

RESULTS

The interviewed people has reduced its food consumption. In particular, analyzing the results for the animal protein food group, there has been a reduction in purchase of beef, and an increase in that of pork. Overall fish consumption has decreased by 44%, with a decrease in the purchase of fresh fish, and an increase in that of canned fish products. Finally, consumers have reduced their purchases of fresh and canned legumes, fresh vegetables, and fresh fruit.

CONCLUSION

The economic crisis seems to have changed the eating habits and food-related lifestyle choices of the subjects studied, especially in the urban area affected by the deeper economic depression. These changes are likely to have permanent social consequences, and deserve to be analyzed also in smaller territories in order to better understand the dynamics of individual choices and the social framework.

Fighting obesity in children from European World Health Organization member states. Epidemiological data, medical-social aspects, and prevention programs

Childhood obesity is one of the most serious public health chal-lenges of this century. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. In the WHO European Region one child out of 3, is overweight or obese. Over 60% of children who are overweight before puberty will be overweight in early adulthood. Children and adolescents, aged 5-19 have shown rising obesity rates in almost all nations, including where the situation was far from alarming 40 years ago. Several nations have seen the prevalence almost double: Israel has gone from 5.8% in 1975 to 11.9% in 2016, Andorra from 6.2% to 12.8%, and Malta from 7.4% to 13.4%. Analyzing overweight and obesity, we can see that they follow similar trends and patterns. In 1975 the majority of European countries had a prevalence less than 10% and obesity less than 5%, while no European country had overweight prevalence higher than 30% and obe-sity higher than 10%. In 2016 the trend reversed, showing a worrying increase in the number of European countries with a high prevalence of overweight (over 30%) and obesity (over 10%) (Fig. 1)(29). Starting from the analysis of epidemiological data on obesity in the WHO European Region, the paper analyzes the adopted prevention programs in order to assess their effectiveness and figure out the best strategies to reduce the prevalence of overweight and obesity. The WHO European Childhood Obesity Surveillance Initiative reported that children tend to overeat and not to do enough physical exercise. Different preventive programs have identified different areas of action and corresponding measures: consumption of healthy foods, physical exercise, care before conception and during pregnancy, early childhood, school age children, weight management, monitoring and evaluation. Primary prevention is essential to reduce obesity incidence: it is easier to act on the adoption of healthy eating habits than intervene with diets on children who already have weight issues. Working on pre-vention programs represents an investment for the future of children's health. By simply acting on prevention, particularly on body weight reduction, it could be possible to tackle the spreading of correlated di-seases. Therefore, prevention programs ought to be prioritized priority at a national and international level.

Immunization in Vietnam

Since the Expanded Program on Immunization was proposed by the World Health Organization in 1981, it has been promptly adopted by Vietnam as one of the country's national priority programs. In 1986, Vietnam achieved some remarkable goals, including polio-free status and the elimination of neonatal tetanus. At the same time, however, barriers and difficulties have also emerged. This article aims to provide an overview of both achievements and barriers to the implementation of the program and proposes some solutions.

Energy drink consumption: a survey in high school students and associated psychological effects

Introduction

Energy drinks represent an emerging health problem among young people. Energy drinks generally refer to a class of beverages containing sugars and various combinations of bioactive ingredients such as caffeine, taurine etc. Also the mix of energy drinks with alcohol is fairly frequent among young people and could be associated with dangerous effects.

Methods

In 2016-2017, a cross-sectional study was conducted in 1581 students attending eight high school in the Marche Region. Data were collected via an anonymous self-administered questionnaire.

Results

The 27.7% of students use energy drinks and the majority, corresponding with the 93.0%, are aware of the main ingredients contained in energy drinks. The main activities for which young people use these drinks are: sport, leisure, pleasure, study. Young people who admit to using alcohol mixed with energy drinks more than 4 times a month are an alarming fact.

Conclusions

This research confirms that energy drinks are used more by young males and especially by those who practice sports. Furthermore, the use these beverages to increase the concentration in the study and to be more brilliant in free time, is confirmed.

Mangiferin blocks proliferation and induces apoptosis of breast cancer cells via suppression of the mevalonate pathway and by proteasome inhibition

Mangiferin is a natural xanthone glycoside with therapeutic potential.

Cold exposure increases exercise-induced oxidative stress

AIM

We determined the combined effects of cold and exercise on oxidative stress during submaximal exercise.

METHODS

Sixteen amateur male cyclists pedaled at a constant speed corresponding to 85% of maximal HR as determined in normal conditions. Eight athletes pedaled indoors at 23 °C while 8 athletes pedaled outdoors at a temperature of 4-6 °C. We then evaluated the levels of reactive oxygen metabolites and plasma levels of antioxidants after exercise.

RESULTS

Performing a physical task in cold conditions increased the free radical production, as demonstrated by the augmented levels of reactive oxygen metabolites and the concomitant decrease of plasma levels of antioxidants in outdoors cyclists as compared to indoors cyclists. The overall ANOVA and the post-hoc comparisons revealed a significant exercise and temperature effect. The mean level of reactive oxygen metabolites in athletes who exercised indoors was significantly lower than that of the outdoor athletes. Moreover, the outdoors group presented plasma levels of antioxidants significantly lower than those of the indoors group.

CONCLUSION

Since several sports are performed outdoors during the winter season, the increased risk of oxidative stress in cold conditions must be considered in these disciplines. Cyclists, football and rugby players, and runners are all affected by the elevation in oxygen radicals induced by cold and should take appropriate precautions, such as specific antioxidant integration.

[The monitoring of watercourses on the basis of the Water Framework Directive 2000/60/CE. An integrated methodological approach applied to the appenninici rivers. First data]

The pollution of the watercourses is one of the principal causes of the water emergency and, under the sanitary profile, one of the most complex and urgent problem within the Environmental Hygiene. The European Water Framework Directive 2000/60, has confirmed that for a correct qualitative evaluation of the superficial waters the monitoring must be inspired to the prevention and not only to the improvement. In our work we have experimented a new methodological approach to read and to understand the river ecosystem. The River Tronto and the River Tenna has been studied under the chemical-bacteriological profile and under the biological profile, through the Extended Biotic Index. The river continuum has been studied through the Functional Fluvial Index. The data have been correlated among through Principal Component Analysis. The statistic analysis underlines a direct correlation among the two biological indexes and a strong indirect correlation among these last ones and those of chemical-bacteriological nature. The pollution of the watercourses is one of the principal causes of the water emergency and, under the sanitary profile, one of the most complex and urgent problem within the Environmental hygiene. The European Water Framework Directive 2000/60, has confirmed that for a correct qualitative evaluation of the superficial waters the monitoring must be inspires to the prevention and not only to the improvement. In our job we have experimented a new methodological approach to read and to interpret the river ecosystem. The River Tronto and the River Tenna has been studied under the chemical-bacteriological profile and under the biological profile, through the Extended Biotic Index. The river continuum has been studied through the Functional Fluvial Index. The data have been correlated through Principal Component Analysis. The statistic analysis underlines a direct correlation among the two biological indexes and a strong indirect correlation among these last ones and those of chemical-bacteriological nature.

Health care system in the Czech Republic

This article reviews the health care system in the Czech Republic. It is aimed to point out the different matters in contrast to the Italian system. It summarizes the historical changes regarding the health care after the "fall of communism" in 1989 and the split of Czechoslovakia (1993) and basic organizational questions; particular consideration is devoted to the pharmaceutical care, hospitals accreditation, a responsibility of the physician and free and informed consent. The health care system in the Czech Republic has underwent many changes during the last years and its further transformation reflecting social requests can be expected.

[Protection of the environment, protection of health. Note 2--Monitoring of flood environments: comparison of the results of the different methods and hygienic evaluations]

The authors take into consideration the results obtained from the application of the different methods and systems of river monitoring (E.B.I, Law 152/99, I.F.F), and they evaluate the agreement of the final judgment. The comparative analysis is conducted pointing out the conceptual and methodological differences of the three systems of the river monitoring. A good agreement of judgement arises from the correlation.

[Protection of the environment, protection of the health. Note 1 - fluvial monitoring: cultural evolution and methodological evolution]

The article underlines the fundamental importance of the protection and promotion of environmental quality for the human health. The evolution of fluvial monitoring techniques is contemplated from chemical and bacteriological analysis until the Index Functional Index (I.F.F). This evolution it's very important because shows a new methodological and cultural maturation that has carried from a anthropocentric vision until an ecocentric vision. The target of this ecological vision is the re-establishment of ecological functionality of the rivers, eliminating the consumer's vision of the water considered only as a usable resource. The importance of an correct monitoring of a river is confirmed, even though the preventive approach priority remains.

Staged discharge out of hospital of the Novacor left ventricular assist system (LVAS) recipients

The mobility afforded by the wearable Novacor LVAS provides the possibility for the recipients to leave the hospital, with undoubted improvements in their quality of life. A staged program for discharging LVAS recipients from the hospital has been set up at the Policlinico San Matteo of Pavia together with the Rehabilitation Center of Montescano and Baxter Novacor Service support, in order to proceed smoothly towards patient's self sufficiency and to minimize any associated risk. The steps are: stay in the hospital ward, discharge to Rehabilitation Center and discharge to home. Several excursions with and without an LVAS team member are encouraged before final discharge to home. Simple criteria of eligibility must be fulfilled to move to the next step. Every move towards a reduced presence of specialized personnel includes an appropriate training of the patient and relatives and a technical checkout of the needed equipment. During the stay at the Rehabilitation Center primarily the physical training and psychological preparation are taken care of by means of tailored programs. When the patient is discharged to home, the check of patient condition is performed weekly at the Rehab Center, bloodwork and technical evaluation is assessed once every two weeks and technical inspections at home twice per year. Complications are reported as in hospital protocol. Control parameters of the LVAS are reported only in case of alarms or abnormal operation. Periodic review of patient training is performed during the check visits, mostly focused on how to address emergency situations. The hospital is responsible for providing one LVAS operator available on call (all hours). Up to date, 11 patients received an implant of LVAS, 9 of them with the wearable system. All of these 9 patients made excursions out of the hospital and 4 patients have successfully undergone the staged program, showing a satisfactory general condition and restoration to social life.

Clinical experience with a new pulsatile pump for infant and pediatric cardiopulmonary bypass

A pulsatile pump of new concept has been developed for infant and pediatric cardiopulmonary bypass (cpb) (Parenzan-Fumero pump). A segment of elastic tubing is compressed by a pneumatically driven pushing plate under control of a microprocessor. Flow parameters such as pulse rate and stroke volume can be set. The pump can be synchronized with the patient's ECG for counterpulsation heart assist. A total of 87 open-heart procedures were performed using randomly either a conventional roller pump or the Parenzan-Fumero pump (respectively 39 and 48 patients). A previously published cpb protocol and anesthetic regimen were adopted in all cases. The results show increased cooling and rewarming rate (p less than 0.05) and urinary output, decreased vascular resistance, intensive care unit time and need for blood transfusion in the pulsatile group compared to the continuous perfusion group. In the pulsatile group, mortality was significantly lower (10.4% vs 25.6%) and low cardiac output syndrome was less frequent in the post-operative course.