bluuebunny/crossref_metadata_2025 huggingface dataset:
Intensive specialists’ consultation combined with antibiotic stewardship programmes
Authors: Allen R , Zimmermann N , Fink G , Först G , Kern WV , Farin-Glattacker E , Rieg SR
Published: October 2021

Background

Antibiotic Stewardship Programmes (ASP) combine measures to optimise antibiotic (AB) therapies and ensure high AB prescription quality. Studies have shown that ASP in combination with an infectious disease (ID) consultation, can significantly improve the rational use of AB. This study aims to improve the quality of care and treatment of ID patients after implementing ASP activities, with or without ID consultation.

Methods

This is a study protocol of a prospective, two-arm, clustered intervention study with before-after-analyses conducted in ten hospitals (excl. university hospitals) in Germany over a period of three years. The intervention includes the implementation of ASP, with or without consultation by an ID specialist. We will gather information on ID inpatients (diagnosed with community-acquired pneumonia (CAP) N = 335 and Staphylococcus aureus bacteraemia (SAB) N = 110) aged >18 years. We will compare patient-related outcomes (changes in SAB score as an indicator of difficult-to-treat infections, and CAP score as an indicator of common infections), as well as the quality and quantity of AB prescriptions. Secondary endpoints comprise quality and quantity of AB prescriptions as well as hospital-related and health economic outcomes. The statistical analysis includes a multilevel analysis. In addition, we will conduct a process evaluation, using interviews to analyse the process and the feasibility of the interventions.

Results

The baseline-data collection process started in April 2021. We will provide data for the broader ID and public health research communities, and publish the results in international journals to contribute to the ongoing global effort addressing AB resistance.

Conclusions

We highlight the purview, in terms of the multicentre, comprehensive interventions and the mixed-method approach.

Key messages

The study results will shed light on whether ASP+ID consultation improves AB prescription quality. We expect enhanced treatment results of ID patients in the public health sector.
Evaluation of pertussis antibody levels and related factors in maternal and cord blood, 2020
Authors: Ece Erik H , Fadıloğlu E , Hasçelik G , Akın L
Published: October 2021

Background

Pregnancy immunization is recommended to protect babies against pertussis, which has a high mortality and morbidity during infancy, but whooping cough vaccine is not given to pregnant women in Turkey. In this study, pertussis antibodies in maternal and cord blood were investigated.

Methods

The study group was one hundred and fifty-four mothers who gave birth at Hacettepe University Hospitals in Ankara, from July to October 2020. The information of the mothers was collected by questionnaire and sera were taken. In this descriptive epidemiological study, anti-PT and anti-FHA were investigated with ELISA (EUROIMMUN B. Pertussis toxin (PT) IgG, Filamentous Hemagglutinin (FHA) IgG) method in maternal and cord-paired sera, the limit value was accepted as 10 IU/ml. Anti-ACT was investigated in the sera of 79 mothers who were anti-PT or anti-FHA positive by Immunblot (EUROIMMUN Adenylate Cyclase Toxin (ACT) IgG) method. Correlation analysis of continuous numerical variables was performed. The difference between categorical variables was evaluated with the Chi-Square test.

Results

Mean (SD) maternal age, gestational age and birth weight were 30.1 (5.1) years, 38.5 (0.9) weeks, 3307 (441) g, respectively. Anti-PT and anti-FHA are at protective levels in 18.8% and 48.1% of the mothers, respectively. Anti-PT and anti-FHA are at the protective level in 38.3% and 55.8% of the cord, respectively. Anti-FHA positivity is 63.3% between the ages of 25 and under, 38.6% between the ages of 26-35, and 69.6% at the age of 36 and over (p = 0.005). 72.4% of mothers with anti-PT positive and 67.6% of mothers with anti-FHA positive were anti-ACT antibody positive. Anti-ACT positive mothers were immunized by having the disease, not by vaccine. Anti-PT and anti-FHA antibody levels in maternal and cord blood are highly correlated.

Conclusions

Protective level of pertussis antibodies in maternal and cord blood is low. Most mothers are immunized with pertussis infection, not vaccine.

Key messages

The amount of pertussis antibodies in maternal and cord blood is low in Turkey and maternal immunization is needed. The addition of pertussis-containing vaccines to pregnant immunization is important to protect babies from whooping cough disease, which remains a major public health problem.
Efficacy of nearuv-a to inactive microbial growth
Authors: Messina G , Manetti C , Amodeo D , De Palma I , Petri C , Nante N , Cevenini G
Published: October 2021

Background

Microbes are less able to develop resistance towards antimicrobial blue light (aBL), at 405nm, towards disinfectants/antibiotics. In addition, Near UV-A light (nUV) is less harmful to host cell compared to UV-C irradiation. This study aimed to assess the efficiency aBL in reducing microbial growth on surfaces.

Methods

This cross-sectional study, run between July-October 2020. Petri dishes were contaminated with P. Aeruginosa, E. Coli, S. Aureus, S. Typhimurium, K. Pneumoniae at a concentration of 1.5x104 CFU/mL and were placed at 2 and 3m of distances from the light source having an irradiance of 967,39 and 497,33 µW/cm2 for 12 hours. The air confined the room was sampled for two weeks with two air samplers (SAS), before and after the exposition to the nUV light source to estimate the reduction of the environmental microbial contamination. The analysis was conducted using Stata software. Final results were expressed as logarithmic reduction mean with 95% confidence interval.

Results

The highest microbial reduction was reached 2m directly under the light. Significant (p < 0.05) log-reduction were achieved for S. Typhimurium, 2.93 (IC 2.44-3.40), K.Pneumoniae, 2.30 (IC 2.14-2.46), S.Aureus, 3.98 (IC 3.78-4.12), E.Coli, 3.83 (IC 3.17-4.50), P. Aeruginosa, 3.86 (IC 3.22-4.48). At 3m of distance from the light source, it was observed a significant logarithmic reduction for S. Aureus, 3.49 (IC 3.34-3.65), and P. Aeruginosa, 3.80 (IC 3.11-4.47). In the air tests, we observed a mean percentage microbial reduction of about 70% after 12 h of exposure to nUV light.

Conclusions

nUV has proven to contrast microbial growth on the plates. It is possible to implement this technology in the environment for controlling microbial presence in “ad hoc” scenario but also in common areas. Mitigating the energy, it is possible to use this technology in presence of persons.

Key messages

In this experimental study, nearUV-A has proven to be efficient to reduce the microbial growth and to disinfect air and surface. NearUV light (nUV) can be use as an innovative technology for decreasing bacterial contamination, also in presence of people.
Flu vaccination during COVID-19 pandemic: a lesson from an Italian teaching hospital
Authors: D'Ambrosio F , Pascucci D , Nurchis MC , Di Pumpo M , Foti F , Vetrugno G , Pignataro R , Cambieri A , Damiani G , Laurenti P
Published: October 2021

Influenza is an acute viral respiratory infection that causes significant morbidity and mortality worldwide, with indirect costs considerably exceeding direct costs on patients and society. Flu vaccination is one of the major strategies for preventing it, especially among healthcare workers (HCWs), to avoid onward transmission to patients and colleagues. The aim of this research is to analyze the flu vaccination coverage rate among HCWs and to study which factors conditioned their adherence. The observational study was conducted in an Italian teaching hospital located in Rome (Italy) and data were collected from October to December 2020. A total of 6,568 HCWs was included considering physicians, nurses and other HCWs as job categories. Age class, gender and job category variables were analyzed. Statistically significant differences among groups were tested through χ2 test. Univariate analyses and a multivariate logistic regression (p < 0.05) were performed to assess differences in flu vaccination adherence. The flu vaccination coverage rate was 60.94%. Considering the job categories, physicians reached the highest coverage (76.09%) followed by others HCWs (64.25%) and nurses (49.09%). According to the logistic regression, belonging to 20-40 age class was significantly associated with higher flu vaccination adherence, as well as being nurses (OR 0.26, 95% CI 0.22-0.31) or other HCWs (OR 0.48, 95% CI 0.40-0.58). Findings showed an encouraging vaccination coverage rate among HCWs. Deeper knowledge of the value of vaccination among younger HCWs could be probably a reason for higher adherence as well as the wrong perception of being at low risk of illness or transmitting infections may explains job categories differences. Especially when considering the disrupting impact of the SARS-CoV-2 pandemic, an improved attitude towards flu vaccination would reduce stress on hospitals and preserve scarce medical resources.

Key messages

Reaching high coverage rates for flu vaccination could save healthcare resources. It is crucial to preserve this positive trend for the future years by spreading the message to all the involved stakeholders.
Understanding the determinants of vaccine hesitancy among adolescents: a systematic review
Authors: Messina R , Cadeddu C , Castagna C , Lanza TE , Sapienza M , Chiavarini M , de Waure C
Published: October 2021

Background

The WHO defines vaccine hesitancy (VH) as ‘a delay in acceptance or refusal of vaccines despite the availability of vaccine services'. In spite of the models explaining VH and the tools used to address it, VH still represents a current problem and has been declared one of the top ten global health threats by WHO in 2019. This is mainly true for the adolescents who represents 25% of the global population. This systematic review aims to address the determinants of VH in this target population.

Methods

PubMed, Web of Science and Scopus were searched to retrieve articles, published in English, assessing adolescents' attitudes and confidence towards vaccinations with any study design (qualitative or quantitative) from the inception until Dec 2020. A methodological quality assessment of the articles was performed based on the study designs.

Results

Out of 14,704 articles, 20 studies were included in the qualitative analysis. Ten out of 20 studies were evaluated as of “good quality”, while nine had “moderate quality” and only one had “poor quality”. Factors associated to a positive attitude towards vaccination included knowledge of vaccine preventable diseases, the awareness of vaccines, their efficacy, safety and free of charge, higher education level and active involvement in decision-making. An association between VH and socio-economic conditions was also highlighted.

Conclusions

This systematic review elucidated a better understanding of the determinants of VH among the adolescent population. Adolescence represents a crucial phase of life in which boys and girls begin to make significant choices about their health and develop attitudes and behaviours that continue into adulthood. Indeed, their concerns and needs in respect to vaccination should be widely examined and taken into consideration to plan tailored interventions to promote vaccination and reduce VH.

Key messages

Vaccine hesitancy among adolescents is a major global health priority. This problem is little studied and further studies and initiatives aimed at increasing awareness of the problem should be deserved.
From infections to preventive actions monitoring in health facilities: an experience on MDROs
Authors: Marziali E , D'Ambrosio F , Lontano A , Vincenti S , Raponi M , Nurchis MC , Fiori B , Di Donato M , Damiani G , Laurenti P
Published: October 2021

Healthcare-Associated Infections (HAIs) and Antimicrobial Resistance (AMR) involve high costs both in health and economic terms for patients and health systems. Implementing Infection Prevention and Control (IPC) programs is critical to decrease infectious agents' transmission in healthcare settings. The aim of this study is to assess if the monitoring of Contact Precautions could decrease the incidence of Multi-Drug Resistant Organisms (MRDOs) infections. This pilot study was conducted in a teaching hospital in Rome. A checklist of 16 items was developed to assess the compliance to Contact Precautions in 11 hospital wards in which MRDOs were detected between November and December 2020. It was administered on-site both interviewing healthcare professionals and through direct observation. A paired t-test with α = 5% was used to compare the number of alert organisms in the first quarter of 2020 respect to the first quarter of 2021 before and after implementing the surveillance checklist. A total of 30 checklists were analyzed. The rate of compliance to Contact Precautions was high for the proper use of personal protective equipment (100%), the intensified room cleaning (100%) and the presence of isolation mark (100%), while it was low for the active screening of contacts (53%). Mean MDROs infections rate decreased from 4.94 to 4.37 for every 1000 hospitalization day, with an average decrease of 0.57. However, the paired t-test showed that there was no statistically significant difference between the mean number of MDROs infections before and after the implementation of the checklist (p > 0.05). Despite the good adherence to IPC program, the low infection rate decrease, is probably due to the impact of COVID-19 on the HAIs surveillance and prevention practices. Even if the check-list administration could be a useful tool to reduce MDROs infections, it should be associated to other prevention strategies during the COVID-19 pandemic in order to achieve a successful outcome.

Key messages

Preventing Healthcare-Associated Infections represents a priority public health challenge in order to improve patient safety and health system economic sustainability. The COVID-19 pandemic has shown that healthcare facilities should enhance efforts in their IPC programs to reduce Healthcare-Associated Infections.
Prevalence survey on antimicrobial use & multidrug resistance in tertiary level university hospital
Authors: Maamri H , Ben Ayed H , Ketata N , Yaich S , Baklouti M , Karray R , Feki H , Damak J
Published: October 2021

Introduction

Excessive and inappropriate use of antibiotics is highly associated with the emergence of antibiotic resistance. Antibiotic resistance reduces the effectiveness and number of options for antibiotic treatment, leading to increased morbidity, mortality, and health care expenditures. This study aimed to characterize antimicrobial prescriptions and to determine multidrug resistance (MDR prevalence in tertiary-level university hospitals (TLUH).

Methods

It was a point-prevalence survey of antimicrobial use in the two TLUH of Southern Tunisia, in 2019. For inpatients receiving antimicrobials, detailed information was collected.

Results

Totally, 1047 inpatients were included in our study. The sex ratio (male/female) was 1.1. The mean age was 50 ± 12 years. Overall, 410 cases (39.2%) were on antimicrobials. A significant association was noted between receiving antimicrobial drugs and admission in intensive care units (ICU) (65.% vs 30.2%; p < 0.001), having a surgical history, notably minimal invasive (81.9% vs 30.7%; p < 0.001)and indwelling invasive medical devices such as urinary (17.6% vs 3.9%; p < 0.001). and central vascular catheters (8.6% vs 2.2%; p < 0.001). Main antimicrobials were penicillin (26.7%), fluoroquinolones (20%) and third-generation cephalosporins (16.5%). Prophylactic indication constituted 24.9% (102 cases) of prescriptions, among which 81.3% were judged inappropriate for dose or timing while health-care associated infections accounted for 46.4% of all prescriptions. Parenteral route was prescribed in 302 cases (73%). Antibiotic indications were documented 221 cases (53.9%). Of 78 isolates, 50% were multidrug resistant strains, among which the commonest pathogen was extending-spectrum-beta lactamase producing Escherichia Coli (10 cases,25.6%).

Conclusions

This study demonstrated a high prevalence of antimicrobial use and MDR which needs addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.

Key messages

High prevalence of multidrug resistance. The needs to addressing especially for surgical prophylaxis and empirical broad-spectrum antimicrobial prescriptions.
Disentangling the roles of demographic and temporal trends in musculoskeletal disorders
Authors: Bouziri H , Descatha A , Dab W , Jean K
Published: October 2021

Background

Musculoskeletal disorders (MSDs) affect nearly 40 million European workers in 2017. Since age constitutes an important risk factor for MSDs, the overall aging of the working population is expected to influence the burden of disease. However, factors other than aging that may explain global trends in MSDs are unknown. We conducted a systematic review to summarise the evidence on the role of demographic and temporal changes in the occurrence of MSDs.

Methods

Following the PRISMA guidelines, we searched Pubmed, ScienceDirect and Web of Science over the 1990-2020 period for articles reporting temporal trends in MSDs incidence or prevalence in the general working-age population. We only included articles controlling for age in the analysis. To assure the quality of the articles, the bias risk was assessed using the RoB-SPEO tool. The main indicators we extracted were age-controlled time trends in MSDs incidence or prevalence.

Results

Among 966 articles, 16 fulfilled the inclusion criteria, representing 23 results according to the indicators extracted. No study was found with high risk of bias. Nine used a definition of MSDs based on pain and 14 based on repercussions on work or social life. Twelve results presented time trends in prevalence and 11 in incidence. After controlling for age, temporal trends in MSDs presented some heterogeneity. Indeed, 10 results documented increases and 12 reported non-monotonic changes. Only one result reported a decreasing trend in MSDs incidence. Several factors other than aging were suggested to explain temporal trends in MSDs, mainly trends in obesity, changing occupational exposures and cultural factors in tolerance to pain.

Conclusions

This review shows that factors additional to aging of the working population may contribute to varying or increasing trends in MSDs. Results also highlight the scarcity of available evidence on time trends in MSDs burden and their underlying causes.

Key messages

Despite a scarcity of evidence, our results suggest that factors additional to aging of the working population may contribute to varying or increasing trends in MSDs. Several factors other than aging were suggested to explain temporal trends in MSDs, mainly trends in obesity, changing occupational exposures and cultural factors in tolerance to pain.
The relationship between soil and household dust metals and the impact on olfaction in children
Authors: Renzetti S , Placidi D , Borgese L , Cagna G , Conversano M , Patrono A , Peli M , Ranzi R , van Thriel C , Lucchini RG
Published: October 2021

Background

Through this study we aimed to test the association between the exposure to metals measured in soil, outdoor and indoor dust and olfactory function among children living close to ferromanganese alloy plants. Moreover, we investigated how metal concentrations vary with the distance from the plants and the relationships among the different environmental media.

Methods

A total of 130 children between 6 and 13 years old were enrolled in the province of Brescia in Italy. The olfactory performance was assessed through the Sniffin' Sticks test. The concentration of 20 metals in dust and soil samples was determined through an X-ray fluorescence portable analyzer (p-XRF). Weighted Quantile Sum (WQS) regression was applied to test for the association between the multi-media environmental markers (MMEM) and olfactory function while restricted cubic splines were used to evaluate the relationship between metal concentrations and distance from the closest plant and deviation from the main wind direction.

Results

WQS regression showed a negative significant association between the MMEM and the Sniffin' Sticks score (beta=-0.028; 95%CI -0.047, -0.009) identifying As, Fe, Rb, Pd, K and Pb as the elements with the higher weights. Except Rb, all elements together with Mn (one of the main elements released by the plants), showed a decreasing trend for soil and outdoor dust concentration at increasing distance from the source or at increasing deviation from the main wind direction. A positive association between outdoor and indoor dust and between soil and outdoor dust was also observed.

Conclusions

This work highlights the risk of the exposure to metal mixtures on child olfactory function which is known to be associated with neurodegenerative diseases in older age. Moreover, this analysis can contribute in terms of public health policies assessing the risk of being exposed as a function of the distance from the plants and the deviation from the main wind direction.

Key messages

Metal mixture concentration in dust is associated with decreased smell identification ability. Indoor metal concentrations can be affected by external source of exposure.
Magnitude of general obesity, abdominal obesity and related risk factors among medical students
Authors: Maamri H , Ben Ayed H , Ketata N , Yaich S , Baklouti M , Karray R , Feki H , Damak J
Published: October 2021

Introduction

Obesity is recognized to be one of the greatest public health problems worldwide. In addition to physical health problems, obesity is also linked to an increased risk of mental health disorders. We aimed to estimate the magnitude of overweight/obesity among medical students, to identify their risk factors and to assess their impact on mental health.

Methods

We conducted a cross-sectional questionnaire survey among 524 medical students randomized from different levels, at the Faculty of Medicine of Sfax, Tunisia, on October 2019.

Results

The prevalence of combined overweight/obesity and abdominal obesity were 21.9% and 22.3%, respectively. The independent risk factors of overweight/obesity were male gender (OR = 3.2; 95% confidence interval (CI) = [1.96-5.2]), internship (OR = 2; 95% CI = [1.1-3.9]) and residency (OR = 3.2; 95% CI = [1.7-6]) levels, as well as moderate (OR = 3.4; 95% CI = [1.4-8.3]) and high (OR = 6.7; 95% CI = [2.6-16.9]) stress scale. However, daily fresh vegetables (OR = 0.4, CI95% = [0.2-0.8]) and high-fiber cereals whole-grain bread (OR = 0.5; 95%CI = [0.28-0.83]) consumption, light (OR = 0.37; 95% CI = [0.16-0.86]), moderate (OR = 0.24; 95% CI = [0.06-0.89]) and vigorous exercise (OR = 0.091; 95% CI = [0.01-0.74]) were independent protective factors of overweight/obesity. Severe consequences of obesity were noted, such as less ability to concentrate (37.9% vs 47.6%; p = 0.024), living under stress (72.2% vs 60.6%; p = 0.023), feeling unhappy and depressed (57.4% vs 44.7% p = 0.016), losing confidence (45.2% vs 20.5%; p < 0.001) and inability to enjoy normal activities (53.9% vs 38.7% p = 0.03).

Conclusions

Unhealthy lifestyle was relatively high among students with obesity. Our study confirms the data from the literature, and underlines the need to set up a plans including nutrition and lifestyle education in their curriculum.

Key messages

Unhealthy lifestyle was relatively high among students. The need to set up a plans including nutrition and lifestyle education.
When policy and opportunity meet: Barcelona's first gender responsive shelter for homeless drug users
Authors: Barbaglia G , Pasarin M , Aranda E , Clotas C , Garrido A , Gotsens M , Parés-Badell O , Bartroli M
Published: October 2021

Issue/problem

Drug policies in Barcelona have been guided by the Barcelona City Drug Action Plan (PADB). This four-year plan aims to prioritise and evaluate drug policies. The need to have a low-threshold residential resource for homeless people using drugs (HPWUD) is an objective that had been present in successive plans, but unfortunately could not be realised so far. In Spain, the covid-19 pandemic led to a total country lockdown. A great intersectoral coordination effort involving Barcelona City Council and the Public Health Agency of Barcelona together with third sector organisations resulted in the opening of the first gender responsive low-threshold residential resource for HPWUD in Barcelona.

Description of the problem

Pending a broader evaluation, quantitative indicators are available for 6 months (3 April to 3 October 2021), informing about: How many people were accommodated? What are their profiles? What drugs do they use? How many overdoses were reverted? How many successful discharges? How many people confined/isolated due to covid-19? What are the challenges?

Results

Preliminary results showed that during first 6 months, 120 people (74 men, 42 women and 4 non-binary) were accommodated. All places reserved for women were covered. About 44% were Spaniards; being opioids and alcohol, the main used in the HPWUD. Thirty overdoses reverted (60% due to stimulants). There were 39 people confined and 2 residents isolated due to covid-19. The challenges are to continue to improve the new alcohol harm reduction program, work on adherence and mainstreaming gender.

Lessons

Barcelona PADB is instrumental to guide evidence-based interventions to reduce health and social inequalities in highly vulnerable and underserved population. This new gender-responsive residential setting for HPWUD with a comprehensive harm reduction program together with health and social care is unique in Barcelona.

Key messages

Drug policy to guide evidence-based interventions to reduce health and social inequalities in highly vulnerable and underserved population. First low-threshold gender responsive residential resource for homeless people using drugs has opened in Barcelona.
Knowledge and attitudes of physicians in caring for transgender and transsexual patients
Authors: Garcia Marquez CG , Villegas Dominguez JE , Espinoza Mejia E , Morales Aguilar AM , Marquez Celedonio FG
Published: October 2021

Background

Currently, care for the community of transgender and transsexual patients has been specialized in different countries of the European Union, thereby favoring better medical care for this community of patients, however, in countries like Mexico there is still no these spaces, thereby favoring the lack of dignified treatment.

Objective

To determine the correlation between knowledge and attitudes of doctors in the care of transgender and transsexual patients in doctors from the State of Veracruz Ignacio de la Llave.

Material and methods

A cross-sectional, prospective, observational, analytical and correlational study was carried out. Doctors from the state of Veracruz were included and the tests of ‘Knowledge about transsexuality' and ‘evaluation of attitudes towards the transgender and transsexual community' (Cronbach's alpha of 0.75 and 0.85) were applied by means of electronic surveys, being selected by non-probability sampling.

Results

359 doctors were included, of which 201 (56%) were men, with Catholic religion in 197 (54.4%) of the cases, cisgender in 333 (92.8%), hetero sexual 296 (82.5%) with older age. frequent between 23 to 29 years (56.3%). The correlation between the level of knowledge about transsexuality and the scale of attitude towards the transgender community was -0.08, while that of the level of knowledge about transsexuality and the scale of attitude towards the transgender community was -0.39. The Catholic religion, being a biological man, and being heterosexual showed values of p < 0.05 with respect to the presence of prejudices for the transgender and transsexual community.

Conclusions

There is no correlation between knowledge about transsexuality and the attitude towards this group by the doctors of the state of Veracruz.

Key messages

There is no correlation between knowledge about transsexuality and the attitude towards this group by the doctors of the state of Veracruz. To practice the catholic religion, being a biological man, and being heterosexual its associated to the presence of prejudices for the transgender and transsexual community.
Scabies in wildlife animals, pets and humans: a re-emerging zoonosis?
Authors: Rubini S , Zaghi S , Tazzari A , Lo Chiano F , Govoni G , Cavazzini M , Taddei R , Fontana MC , Barbieri S , Defilippo F
Published: October 2021

Background

Scabies or sarcoptic mange is an infestation of the skin caused by the mite Sarcoptes scabiei. Transmission from animals to humans occurs through close contact. The most common symptoms are papules, erythema, excoriations, hyperkeratosis, and hypotrichosis. In the province of Ferrara (Emilia Romagna, Italy) mange is endemic in wild animals, mostly in foxes, which can act as vectors for domestic animals and humans.

Methods

From 2012 to 2020, 564 foxes were surveyed within the Wildlife Health Surveillance Re-gional Program, including microscopic examination in cases of skin lesions referable to scabies. In 2018, a domestic dog (10-year border collie, male), frequenting an uncultivated area colonized by foxes and located in the outskirts of Ferrara, showed scabby lesions mainly on the nose, around the eyes and on the back.

Results

11 out of 564 foxes resulted positive (1,95%), 6 cases out of 38 being in 2018 (15,8%). The parasite was detected by skin biopsy and direct microscopic examination in the domestic dog. The parasite was transmitted by the dog to the owner and the other two family members.

Conclusions

The increased density of dogs and foxes in the Ferrara province, and the attitude of foxes to live near to human settlements, increase the risk of contacts between foxes, domestic animals and humans, even though stray dogs are uncommon. This case illustrates the interdependencies between animal health, human health and environment, a synergy that can enable exacerbation of diseases of zoonotic origin as highlighted by the One Health concept. It is therefore important to increase the investigation on paths as well as vectors of diseases and to find collaborative, multi-sectorial and transversal approaches to ensure quality health outcomes. The control of the disease requires an appropriate monitoring of dogs' health being skin lesions in both, humans and animals, very similar to allergic dermatitis, which can delay the proper diagnosis of the disease.

Key messages

Sarcoptic mange is a zoonosis still present in Emilia Romagna, Italy. The One Health approach is key to control the cycle of the zoonotic sarcoptic mange.
Genotyping of Listeria monocytogenes strains in Italian food-processing environments
Authors: Torresi M , Chiaverini A , Acciari VA , Centorame P , Centorotola G , Guidi F , Russini V , Pomilio F
Published: October 2021

Background

In 2019, case fatality from Listeria monocytogenes (Lm) was higher than the previous years confirming Lm as a major public health problem. Food is the main source of Lm infection and cross-contamination from the food-processing environment (FPEs) is the most common route of contamination. The aim of this work was to characterize FPEs Lm strains collected from the National Reference Laboratory (NRL) for Lm in order to evaluate circulating clonal complexes (CCs) and their environmental adaptation.

Methods

NRL Lm database actually consists of 798 FPEs sequenced strains. In silico MLST was evaluated. Sequences related to prevalent CCs were further investigated using Pasteur's cgMLST scheme and detecting metal and detergent resistance genes and stress survival islet (SSI).

Results

MLST identified 25 CCs and 4 singleton. Nine isolates gave inexact match with existing alleles and were not classified. CC9 (17.4%) and CC121 (14.2%) were the prevalent clones. CC9 cgMLST analysis revealed a relatedness among strains isolated from the same establishment type (meat or dairy), even if sampled in different regions. Indeed, CC121 cgMLST clustering analysis was strictly associated to the point of sampling. Regarding stress adaptation genes, SSI1 and brcABC genes were detected in 100% and 2.9% of the CC9 strains, respectively. Meanwhile, SSI2 and transposon Tn6188 were detected, respectively, in 100% and 97.3% of CC121 strains.

Conclusions

Results confirmed, in Italian FPEs, prevalence of hypovirulent Lm strains, as previously observed in Italian food. Tested isolates highlighted adaptation to low pH and high salt concentration (SSI1 genes for CC9), to alkaline and oxidative stress (SSI2 genes for CC121) and benzalkonium chloride tolerance (Tn6188 in CC121) resulting in a best survival under stress conditions. Interestingly, CC9 clustering denoted allelic proximity among strains isolated in different Italian regions paying attention to clones spreading at national level.

Key messages

Listeria monocytogenes CC9 and CC121 prevalence in Italian establishment confirms environment is the main route of food contamination at production level. Prevalent food-processing environmental Italian Listeria monocytogenes strains denotes adaptation to environmental stress and clones spreading at national level.
Shiga-toxin producing Escherichia coli detection in samples from Abruzzo and Molise regions, Italy
Authors: Ciarrocchi A , Iannetti L , Cornacchia A , Di Marzio V , Torresi M , Centorotola G , Antoci S , Pomilio F , Marfoglia C
Published: October 2021

Background

Top five serogroups (O157, O111, O26, O103 and O145) of Shiga-toxin producing Escherichia coli (STEC) represent the third most important increasing zoonosis reported in European Union. The ISO methods of analysis, used in foods and environmental samples, quite often does not confirm the molecular detection of STEC genes (stx1 and stx2) in enrichment broth. The aim of this study was to summarize the results of the tests carried out at Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise in the last six years (2016-2021), comparing genes detection in enrichment broth and in colonies grown on agar plates.

Methods

Along the 2016-2021, a total of 1716 foods and environmental samples from Abruzzo and Molise regions were tested, according to ISO/TS 13136:2012.

Results

Out of 1716 samples, 16 (0.9%) shown presumptive positive presence of STEC (stx1 and/or stx2) in broth. In spite of that, the presence of STEC (positive colonies for stx1 and/or stx2) was confirmed only in 4 out of 16 samples (one sample of cheese and 3 of minced meat). Then, eae gene was found in 54 samples in broth and only in 3 samples from colonies, during a foodborne outbreak investigation. Serogroup specific targets were detected in 6 broth samples (O26, O145 and O157) and confirmed in colonies only in 2 minced meat samples (O157).

Conclusions

STEC are a heavy hazard for the consumers and the number of cases is slightly increasing since 2015. Our results highlight a low number of presumptive positive samples and even lower number of STEC detection obtained with the ISO classical method. Furthermore, detection of the target genes in broth was rarely confirmed after plating, highlighting a weak point of the analytical method that needs to be investigated. Efforts are necessary to improve the method and the STEC confirmation from colonies. Immunomagnetic beads targeting the top five serogroups and digital PCR could help in increasing the recovery rate of cultivable STEC.

Key messages

The presumptive positive samples for STEC genes in foodstuffs from the Abruzzo and Molise regions are quite rare, even lower is the number of confirmed colonies by agar plate isolation. Specific immunomagnetic beads for the top five STEC serogroups could improve the method and the STEC colonies detection, increasing the recovery rate of cultivable strains.
Drinking water quality surveillance status for Amazonas state's 62 counties
Authors: Menezes MDS , Ribeiro NL , Melo GSB , Magalhaes ALTG , Figueira EAM , Menezes ACS , Araujo VC
Published: October 2021

Introduction

The state of Amazonas is the largest state in Brazil and it has 62 counties, including Manaus, its capital, all of which have plenty of water resources. The control and surveillance of water quality, as well as the sewage treatment must be carried out satisfactorily in order to avoid a favorable environment for the development of pathogens that cause water related diseases.

Objectives

Assess the quality of the water supplied to the population of the 62 counties in the period of 2015-2019.

Methods

Quantitative and qualitative descriptive study, based on secondary data taken from Water Quality Surveillance Information System for Human Consumption. and analyzed from the available database at the Health Surveillance Foundation. Information was gathered on the type of collection, treatment, control, surveillance and microbiological (total coliforms and Escherichia coli).

Results

it was observed that 73% of the counties use underground water (well), 19% superficial (rivers) and 8% mixed combination (underground and superficial); 35% undergo chlorine treatment; less than 50%, averaging 26 counties, carry out control, surveillance and/or combined control and surveillance activities; on average: 29% have control data; 23% of surveillance and of these, 19% embody it effectively (≥ 7 months/year) and 19% of control and surveillance simultaneously. During the study, 46,670 microbiological analysis were carried out and of these 10,603 (23%) presented total coliforms and 2.265, approximately 4.9%, unsatisfactory result for human consumption due to the presence of Escherichia coli. The data demonstrate that the control and surveillance of water quality is carried out in an unsatisfactory manner, highlighting the need to strengthen the performance of the health sector and those responsible for an alternative water supply system or alternative solution in the state Amazonas.

Key messages

Measuring the effectiveness of surveillance actions are necessary for water quality control. Vigilance actions are important to reduce morbidity and mortality due to water transmission problems.
Health literacy in phases of health information processing in the Czech population
Authors: Polcrova A , Lustigova M , Pavlovska I , Maranhao Neto GA , Pikhart H , Kucera Z , Gonzalez-Rivas JP
Published: October 2021

Background

Low level of health literacy (HL), defined as an individual's ability to process health information, is strongly associated with higher mortality and morbidity. In earlier analysis of cross-sectional survey in Czechia in 2014, 59% of subjects showed a low level of HL, with particularly worrying results in area of health promotion (64% with low levels of HL). The levels of HL in phases of health information processing, however, were not included.

Aim

To describe the level of HL in phases of obtaining, understanding, evaluating, and applying health information, and to assess social determinants of HL in these phases.

Methods

18 to 65 years old subjects from a random population-based Czech sample from 2014 were evaluated using a cross-sectional design. The level of HL was determined by Health Literacy Index (HLI, range 0-50). A low level of HL was defined as HLI <33. Logistic regression was used to assess the association between a low level of HL and social status.

Results

In total, 996 participants (51% females) were included. The prevalence of low level of HL was 64% in obtaining, 56% in understanding, 70% in evaluating and 64% in applying. A low level of HL was associated with a low perceived social status in all phases of information processing even after adjustment for age, gender, education, self-reported health condition, physical activity, BMI and smoking status (ORs 3.2, 2.0, 3.4 and 2.8, respectively, for obtaining, understanding, evaluating and applying, all p-values<0.05).

Conclusions

People with lower social status have a higher risk of a low level of HL in all phases, with the highest risk in the phase of health information evaluation which was determined as the most problematic. Further intervention should aim to support individual skills in decision making and actions in fields of healthcare, disease prevention, and health promotion including the availability of relevant understandable information for all social groups in the population.

Key messages

The most problematic area of health literacy is health information evaluation. People with lower social status have a higher risk of a low level of health literacy.
Why Are Black People Less Likely to Find a Stem Cell Donor Match?
Authors: Merrick Lois
Published: October 2021

Building trust in the health care system could increase the number of donors.
Exercise Plus Weight Loss Improves Aortic Stiffness in Obese Older Adults
Authors: Rosenberg Karen
Published: October 2021

According to this study:

In obese older adults, combining aerobic exercise with moderate caloric restriction leads to greater improvement in proximal aortic stiffness than exercise alone.
More Nursing Home Staff Linked to More COVID-19 Cases
Authors: Rosenberg Karen
Published: October 2021

According to this study:

A higher number of nursing home staff members was associated with a higher number of COVID-19 cases, independent of the size of the facility.

Decreasing the number of staff members but not the number of direct care hours could help improve patient safety.
The Use of Different Sepsis Risk Stratification Tools on the Wards and in Emergency Departments Uncovers Different Mortality Risks: Results of the Three Welsh National Multicenter Point-Prevalence Studies
Authors: Unwin Harry J. A. , Kopczynska Maja , Pugh Richard , Tan Laura J. P. , Subbe Christian P. , Ellis Gemma , Morgan Paul , Havalda Peter , Sharif Ben , Burke John , Szakmany Tamas
Published: October 2021

OBJECTIVES:

To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments.

DESIGN:

Secondary analysis of three annual 24-hour point-prevalence study periods.

SETTING:

The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019.

PATIENTS:

We screened all patients presenting to the emergency department and on the general wards.

MEASUREMENTS AND MAIN RESULTS:

We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points.

CONCLUSIONS:

Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.
Gram-negative endocarditis: disease presentation, diagnosis and treatment
Authors: Bouza Emilio , Muñoz Patricia , Burillo Almudena
Published: October 2021

Purpose of review

Gram-negative bacilli (GNB) cause between 1% and 10% of infective endocarditis (IE). Most episodes are caused by microorganisms of the Haemophilus spp., Aggregatibacter spp. Cardiobacterium spp., Eikenella spp., and Kingella spp (HACEK) group. The frequency of IE caused by non-HACEK (GNB-IE) has increased in recent years. Uncertainties persist regarding its best medical treatment and the appropriateness and timing of surgical treatment. In addition, there are new drugs with activity against multiresistant microorganisms, of which there is little experience in this disease. We review this topic by answering the most frequently asked questions that arise among our colleagues.

Recent findings

HACEK microorganisms cause 1.5–2% of IE with only a 2% mortality. In contrast, non-HACEK GNB-IE accounts for 2.5–3% of all IE cases and is associated with nosocomial acquisition, advanced age, solid organ transplantation and 20–30% mortality. Drug addiction is important in areas with epidemic opioid abuse.

The frequency of IE caused by GNB has been modified in recent years. HACEK episodes are no longer treated with ampicillin and aminoglycosides. In non-HACEK GNB-IE, combination therapy with a beta-lactam and a quinolone or aminoglycoside is recommended. The surgical indication and its value are evident in many patients. Management should rely on a collaborative group with experience in this disease.
Accuracy of 3 Soft Tissue Prediction Methods After Double-Jaw Orthognathic Surgery in Class III Patients
Authors: Demirsoy Kevser Kurt , Kurt Gökmen
Published: October 2021

Purpose

We aimed to evaluate the accuracy and validity of conventional manual prediction method (CM) and 2-dimensional and 3-dimensional (3D) soft tissue prediction methods for Class III bimaxillary orthognathic surgery patients.

Methods

Twenty skeletal Class III patients were included in this study. Soft tissue prediction was achieved with a traditional manual technique, 2-dimensional software (Dolphin Imaging, version 11.5), and 3-dimensional software (SimPlant Master, version 16.0) on preoperative lateral cephalometric radiographs and cone beam computurized tomography (CBCT) images and then compared with postoperative lateral cephalometric radiographs obtained at least 6 months after surgery (mean, 11.5 ± 6.77 months). Forty-eight measurements were done to determine the reliability of the methods.

Results

All prediction methods have limited postsurgery prediction accuracy for the subnasal upper lip area. Most of the differences were not more than 3 mm for all study groups, except the 3D software, which predicted the upper lip area to be, on average, 3.08 ± 1.38 mm further back (P < 0.001). Although the conventional method predicted 20 of 48 measurements similar to the final results, the poorest predictions were found at the nasal and labiomental areas (P < 0.001). Two-dimensional software predicted 23 of 48 measurements very close to the final results but made significantly different predictions for the nasolabial and labiomental angles, labrale superius point, and the chin area.

Conclusions

The 3D method predicted, especially the upper lip area, to be significantly and clinically incorrect, and its soft tissue prediction was insufficient compared with the other 2 methods. The 3D software needs to be updated, especially in evaluating soft tissue A point and upper lip changes after surgery.