Self-perceived cultural competence: a cross-sectional study about nurses' awareness and behavior.

Background: Cultural competence is a valuable and intangible heritage of knowledge, relationships and identity. Cultural competence is fundamental in nursing: sharing the objectives of all patients - not only foreigners - promotes patient's participation in healthcare and supports nurses' professional development, enhancing the intellectual capital that guides quality care. The aim of this study is to evaluate nurses' self-perceived cultural competence. Study Design: This is a cross-sectional study. Methods: A self-administered cultural-competence questionnaire was used. Nurses working in hospitals and territorial healthcare settings in Rome, Italy, were involved in this study, from March 2017 to February 2018. Results: This study involved 192 nurses. The mean age was 46.2 ± 7.9. Most of the nurses (77.6%) were women. The nurses' mean work experience was 21.4 ± 8.8 years; 65.1% of them had never attended any type of course concerning multiculturalism. The mean score of the nurses' cultural competence was 4.19 ± 0.57 (range = 2.75-5.71). In all, 41.7% of the nurses did not consider themselves neither competent nor incompetent. Conclusion: The results show that nurses have an acceptable level of cultural competence, slightly higher in the territorial context.

Validation of a questionnaire about knowledge and perception of biological risk among biomedical students of Sapienza University of Rome.

BACKGROUND ADN AIM: Healthcare workers and Biomedical students are continuously exposed to biological risk in their clinical practice. The objective of this study was to evaluate the validity and reliability of an Italian questionnaire on the knowledge and perception of biological risk in Biomedical students at the beginning of their professional training. MATERIALS AND METHODS: An electronic questionnaire was administered to students attending the second semester of the first year of Biomedical Courses at Sapienza University of Rome. The questionnaire consists of 40 questions divided into five sections collecting sociodemographic data, health status and level of knowledge and perception of biological risk. The statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 25. RESULTS: A total of 309 individuals answered the online questionnaire, with a response rate of 83.5%. The analysis of internal consistency was performed by two dichotomous variables that measured the knowledge level on hygiene behaviour and gloves use. The analysis showed a standardized Cronbach's alpha equal to 0.765, corresponding to a good reliability. A better reliability was found out among physiotherapy and medical students, with a Cronbach's alpha equal to 0.944 and 0.881, respectively. Regarding vaccines, 97.7% of the sample was given a Hepatitis B vaccination and 98.7% of students consider vaccinations essential for healthcare workers. CONCLUSIONS: Results of Cronbach's alpha showed a good reliability of the questionnaire. First-year Biomedical students may be exposed to occupational biological risk mainly because of their inexperience. A training educational path should be implemented in order to acquire competences, knowledge, attitudes and practical skills, correct behaviors and a personal and professional responsibility.

Multimodal surveillance of healthcare associated infections in an intensive care unit of a large teaching hospital

BACKGROUND: Healthcare-associated infections (HAIs), or nosocomial infections, represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients hospitalized in intensive care units (ICUs). Surveillance systems are recommended by national and international institutions to gather data on HAIs in order to develop and evaluate interventions that reduce the risk of HAIs. STUDY DESIGN: Here we describe the methodology and the results of the surveillance system implemented in the ICU of the Policlinico Umberto I, a large teaching hospital in Rome, from April 2016 to October 2018. METHODS: The multimodal infection surveillance system integrates four different approaches: i) active surveillance of inpatients; ii) environmental microbiological surveillance; iii) surveillance of isolated microorganisms; and iv) behavioral surveillance of healthcare personnel. Data were collected on catheter-related bloodstream infections, ventilation-associated pneumonia, catheter-associated urinary tract infections and primary bloodstream infections that developed in patients after 48 h in the ICU. For environmental surveillance 14 points were selected for sampling (i.e. bed edges, medication carts, PC keyboards, sink faucets). The system of active surveillance of HAIs also included surveillance of microorganisms, consisting of the molecular genotyping of bacterial isolates by pulsed-field gel electrophoresis (PFGE). From 1 November 2016, monitoring of compliance with guidelines for hand hygiene (HH) and proper glove or gown use by healthcare personnel was included in the surveillance system. After the first six months (baseline phase), a multimodal intervention to improve adherence to guidelines by healthcare personnel was conducted with the ICU staff. RESULTS: Overall, 773 patients were included in the active surveillance. The overall incidence rate of device-related HAIs was 14.1 (95% CI: 12.2-16.3) per 1000 patient-days. The monthly device-related HAI incident rate showed a decreasing trend over time, with peaks of incidence becoming progressively lower. The most common bacterial isolates were Klebsiella pneumoniae (20.7%), Acinetobacter baumannii (17.2%), Pseudomonas aeruginosa (13.4%) and Staphylococcus aureus (5.4%). Acinetobacter baumannii and Klebsiella pneumoniae showed the highest proportion of isolates with a multidrug-resistant profile. A total of 819 environmental samples were collected, from which 305 bacterial isolates were retrieved. The most frequent bacterial isolates were Acinetobacter baumannii (27.2%), Staphylococcus aureus (12.1%), Enterococcus faecalis (11.1%), Klebsiella pneumoniae (5.2%) and Pseudomonas aeruginosa (4.7%). All Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae environmental isolates were at least multidrug-resistant. Genotyping showed a limited number of major PFGE patterns for both clinical and environmental isolates of Klebsiella pneumoniae and Acinetobacter baumannii. Behavioral compliance rates significantly improved from baseline to post-intervention phase. CONCLUSIONS: By integrating information gathered from active surveillance, environmental microbiological surveillance, surveillance of bacterial isolates and behavioral surveillance of healthcare personnel, the multimodal infection surveillance system returned a precise and detailed view of the infectious risk and microbial ecology of the ICU.

Prevalence survey of healthcare-associated infections in a large teaching hospital.

BACKGROUND: Healthcare-associated infection (HAI) is the most frequent adverse event in healthcare settings. It is associated with increased mortality and antimicrobial resistance, leading to prolonged hospital stays and consistent financial loss for healthcare systems. The objective of this study was to estimate the burden of HAIs and antimicrobial use in the Teaching Hospital Policlinico Umberto I (THPUI) of Rome and to identify the most critical areas for intervention. METHODS: Data were collected according to the most recent ECDC point prevalence survey protocol in November 2018. Descriptive statistics for all variables were calculated. Univariate analysis was used to assess possible associations between variables and HAIs. Variables with a significance level of p<0.25 were included in a multiple logistic regression model. RESULTS: A total of 799 patients were included in the analysis; of these, 13.3% presented with at least one HAI. Bloodstream infection was the most common, accounting for 30.9% of total infections. Overall, 125 microorganisms were isolated, with Enterobacteriaceae being the most frequent (32%). At the time of the survey, 49.1% patients were receiving antimicrobial therapy. The multivariate analysis showed a significant association between HAI and use of medical devices (OR=34.30; 95% CI:3.69-318.66), length of stay (OR=1.01; 95% CI:1.00-1.02) and exposure to prophylactic antimicrobial therapy (OR=0.23; 95% CI:0.11-0.47). CONCLUSIONS: The ECDC methodology proved to be applicable to THPUI, where HAI prevalence was higher than the European standard (6.7%). This highlights the need to implement targeted measures to prevent and control HAIs, including continuous monitoring to evaluate the effectiveness of such interventions.

Perception of Climate Change: validation of a questionnaire in Italy.

BACKGROUND AND AIMS: Climate Change (CC) is a worldwide concern with important consequences for Public Health. A more sustainable and responsible way of living is necessary in order to reduce CC consequences, and adequation to this is directly related to risk perception and knowledge about the phenomenon. The aim of this study was to validate a questionnaire to measure the knowledge of Italians on CC and its consequences. MATERIAL AND METHODS: The questionnaire was administered online to high school students, their parents and teachers that were participating to a meeting at Sapienza University. The questionnaire contained a sociodemographic section and 19 questions on causes and consequences of CC and ways to fight it. The statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 25. RESULTS: Sixty-four individuals answered the online questionnaire. The analysis of internal consistency was performed by 12 dichotomous variables that measured the knowledge level on CC. The analysis showed a standardized Cronbach's alpha equal to 0.39, corresponding to a low reliability. When females were excluded, the alpha value rose to 0.497, and ascended to the reliable value of 0.639 when refining the selection of the included questions. CONCLUSIONS: The Cronbach's alpha value found showed a low reliability but achieves acceptable levels when considering only males and excluding some of the initial questions. Future studies should be performed in order to highlight the reliability of this tool to assess the knowledge about CC among the population.

Proline oxidase-adipose triglyceride lipase pathway restrains adipose cell death and tissue inflammation.

The nutrient-sensing lipolytic enzyme adipose triglyceride lipase (ATGL) has a key role in adipose tissue function, and alterations in its activity have been implicated in many age-related metabolic disorders. In adipose tissue reduced blood vessel density is related to hypoxia state, cell death and inflammation. Here we demonstrate that adipocytes of poorly vascularized enlarged visceral adipose tissue (i.e. adipose tissue of old mice) suffer from limited nutrient delivery. In particular, nutrient starvation elicits increased activity of mitochondrial proline oxidase/dehydrogenase (POX/PRODH) that is causal in triggering a ROS-dependent induction of ATGL. We demonstrate that ATGL promotes the expression of genes related to mitochondrial oxidative metabolism (peroxisome proliferator-activated receptor-α, peroxisome proliferator-activated receptor-γ coactivator-1α), thus setting a metabolic switch towards fat utilization that supplies energy to starved adipocytes and prevents cell death, as well as adipose tissue inflammation. Taken together, these results identify ATGL as a stress resistance mediator in adipocytes, restraining visceral adipose tissue dysfunction typical of age-related metabolic disorders.

FoxO1 controls lysosomal acid lipase in adipocytes: implication of lipophagy during nutrient restriction and metformin treatment.

Finding new molecular pathways and strategies modulating lipolysis in adipocytes is an attractive goal of the current research. Indeed, it is becoming clear that several human age-related pathologies are caused by adipose tissue expansion and altered lipid metabolism. In the present work, we show that transcription factor forkhead homeobox type protein O1 (FoxO1) is upregulated by nutrient restriction (NR) in adipocytes and exerts the transcriptional control of lipid catabolism via the induction of lysosomal acid lipase (Lipa). An increased autophagy and colocalization of lipid droplets (LDs) with lysosomes was observed implying lipophagy in Lipa-mediated LDs degradation. Interestingly, we found that metformin (Metf), a biguanide drug commonly used to treat type-2 diabetes, exerts effects comparable to that of NR. Actually, it was able to elicit FoxO1-dependent Lipa induction as well as LDs degradation through lipophagy. Moreover, we demonstrate that, during NR or Metf treatment, free fatty acids released by Lipa are directed toward AMP-activated protein kinase-mediated mitochondrial oxidation, thus maintaining energetic homeostasis in adipocytes. In conclusion, our data show that lysosomal-mediated lipid catabolism is activated by NR in adipocytes and give further support to the use of Metf as a NR mimetic to combat age-related diseases associated with altered lipid metabolism.

[Dietary intervention programs in the workplace: an effective prevention strategy]. / I programmi di intervento nutrizionale nei luoghi di lavoro: una interessante strategia preventiva.

The main purpose of our meta-analysis was to investigate the effect of workplace dietary intervention on several variables. We made a systematic literature search by selecting articles published up to September 2009. Only 18 studies were deemed suitable for inclusion criteria considered in our meta-analysis. Among the dietary variables there was significant difference between the two groups after the administration of nutritional intervention programs. A significant improvement was also observed between the anthropometric and metabolic variables. No significant change was instead documented in relation to functional variables (systolic and diastolic pressure). Workplace dietary intervention, improving nutritional, anthropometrical and metabolic variables, can be identified as effective prevention strategy toward chronic diseases.

Local affine-connection approach to the elastic constants of nematic liquid crystals.

In this paper, the affine connection approach [D. Baalss and S. Hess, Phys. Rev. Lett. 57, 86 (1986)] will be defined in terms of a local transformation. Accordingly, the macroscopic anisotropy of the nematic medium will be conceived as resulting from a local transformation where, at each point of the sample, the spherical molecules of an idealized hypothetic isotropic liquid have their shape changed to the ellipsoidal form of the nematic liquid crystals molecules. When such local character is imposed to this transformation, the patterns determined by the director configuration of the nematic medium acquire an intrinsic curvature whose correct treatment requires the replacement of the techniques and methods of the usual calculus by those of the differential geometry of nonflat surfaces. Such an approach will be used in the calculus of the nematic elastic constants. As a result, the dependence of the elastic constants on the scalar order parameter, on the eccentricity of the nematic molecules, and on the interaction between them will be determined and compared with the experimental data of the 4-methoxybenzylidene-4-n-butylaniline.

Atrial natriuretic peptide (ANP) gene promoter variant and increased susceptibility to early development of hypertension in humans.

Previous evidence supports a role of atrial natriuretic peptide (ANP) as a candidate gene for hypertension. We characterized an ANP gene promoter variant, which has been associated with lower peptide levels, in a sample of young male subjects from Southern Italy (n=395, mean age=35.2+/-2 years) followed up for 28 years. In this cohort, the ANP gene variant was associated with early blood pressure increase and predisposition to develop hypertension.

Optimal pruning in neural networks.

We study pruning strategies in simple perceptrons subjected to supervised learning. Our analytical results, obtained through the statistical mechanics approach to learning theory, are independent of the learning algorithm used in the training process. We calculate the post-training distribution P(J) of synaptic weights, which depends only on the overlap rho(0) achieved by the learning algorithm before pruning and the fraction kappa of relevant weights in the teacher network. From this distribution, we calculate the optimal pruning strategy for deleting small weights. The optimal pruning threshold grows from zero as straight theta(opt)(rho(0), kappa) approximately [rho(0)-rho(c)(kappa)](1/2) above some critical value rho(c)(kappa). Thus, the elimination of weak synapses enhances the network performance only after a critical learning period. Possible implications for biological pruning phenomena are discussed.

Intraoperative esophageal manometry: our experience.

In order to improve the results of functional surgical procedures on the esophagus, the authors, after a number of experimental studies, proposed the use of intraoperative esophageal manometry (IEM). The technique was performed for the first time in 1972. IEM has been employed in the course of Heller's cardiamyotomies and Nissen-Rossetti (N-R) fundoplications, respectively, to document the ablation of the lower esophageal sphincter (LES) high-pressure zone (HPZ) and to calibrate the pressure of the fundal wrap between values ranging from 20 to 40 mmHg ('hypercalibrated Nissen'). This hypercalibration resulted from the retrospective evaluation of a former series when, at the beginning of our experience, we used to calibrate the fundoplication to pressure values similar to those of a normal sphincter ('normocalibrated Nissen': 10-20 mmHg). This experience, in fact, was followed by a high rate of gastroesophageal reflux (GER) recurrence (28.5%) in the first 12 months after surgery. Since 1985 to date, IEM has been employed in the course of 309 functional surgical procedures on the esophagus. This paper, however, reports on 281 patients: 144 with achalasia treated with Heller's myotomy + Nissen-Rossetti fundoplication and 137 with gastroesophageal reflux disease (GER-D) submitted to Nissen-Rossetti fundoplication. Our data suggest that IEM can be a useful tool in the field of functional surgery of the esophagus, and its routine use seems to be able to improve the postoperative results. In this series, in fact, IEM was able to detect the persistence of an HPZ in 15.2% of apparently complete myotomies, all performed with the aid of intraoperative endoscopy. As regards the manometric calibration of the n-HPZ, our results seem to confirm the validity of the technique, yet some findings still remain unexplained: i.e. two patients with a hypotonic n-HPZ and GER recurrence and two with an n-HPZ, exceeding 20 mmHg with postoperative persistent dysphagia. Finally, we would like to emphasize that the concept of a 'hypercalibrated Nissen' contrasts with the 'floppy Nissen' of Donahue and DeMeester; our wrap is also loose around the esophagus and does not impair the esophagogastric transit.

[Congenital left sinus of Valsalva aneurysm]. / Aneurisma congênito do seio de Valsalva esquerdo.

Two cases of left sinus of Valsalva congenital aneurysm (SVCA), incidentally found are described. The authors call attention on rarity of them, and present new concepts about their morphogenesis and incidence. They also suggested a higher incidence of asymptomatic and undiagnosed cases of SVCA should be considered.

An educational program for training physicians in personnel recruitment.

Practice management curriculum must evolve to more thoroughly address the areas of personnel recruitment. A recent report by the Medical Group Management Association indicated that nearly half of a family practitioner's practice overhead goes for personnel. This paper presents a recruitment curriculum designed as a joint venture between a family practice residency program and a junior college medical assistant program. The outcome of this joint venture was unanimous agreement among the participants that the curriculum should be continued in both programs.