Can legionellosis be considered an occupational risk in the healthcare sector? A systematic review and meta-analysis.

OBJECTIVES: According to current knowledge about legionella transmission, healthcare workers (HCWs) are at an increased risk of exposure. The aim of this research was to systematically review the literature about HCWs' exposure to legionella and establish whether there is an occupational risk. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: PubMed, Scopus and Web of Science were searched to identify studies regarding the occupational risk of legionellosis for HCWs. Keywords used in the search were 'Legionella pneumophila', 'occupational medicine', 'occupational' and 'risk'. Selected studies were reviewed to assess the quality and meta-analysed. Finally, the nine epidemiological principles of Bradford-Hill criteria were used to assess whether legionellosis could be considered an occupational risk for HCWs. RESULTS: The search strategy retrieved 124 studies, and 10 studies were included in the present review. The overall study quality was low. The pooled odds ratio estimate was 2.45 (95% confidence interval: 1.52-3.96). The assessment using Bradford-Hill criteria showed that only two criteria (plausibility and coherence) were met, which is insufficient to establish an occupational risk. CONCLUSIONS: This systematic review suggests that there is a higher risk of legionella exposure for HCWs, but there is currently no clinical evidence. Further studies with appropriate study design are needed to determine whether legionella infection is an occupational risk for HCWs.

Microbiological surveillance of endoscopes and implications for current reprocessing procedures adopted by an Italian teaching hospital.

BACKGROUND: Hospital acquired infections have been associated with the contamination of flexible endoscopes caused by a failure of the reprocessing procedure. Microbiological surveillance of endoscope reprocessing is valuable for assessing contamination by pathogens. The aim of this study is to evaluate microbiological contamination of endoscopes after reprocessing, and the involvement of reprocessing procedures adopted in endoscopy units of an Italian teaching-hospital. METHODS: The study was carried out, on several dates in 2014, in 11 endoscopic operation units equipped with 100 endoscopes (18 bronchoscopes, 41 gastroduodenoscopes, 29 colonoscopes, 12 laryngoscopes) and 9 Automated Endoscope Reprocessors. Presence/absence of common pathogens and indicator micro-organisms (including multi-drug resistant bacteria) and Total Microbiological Count (TMC) were obtained from the biopsy channels of endoscopes after reprocessing, from final rinse water of automated endoscope reprocessors and from tap water applying standard microbiological culture methods. Following the European Guidelines for quality assurance in reprocessing, the post-reprocessing criteria were "absence of indicator micro-organisms and absence of TMC in samples obtained from endoscopes' channels". RESULTS: A total of 180 samples were collected (143 endoscopes, 25 Automated Endoscope Reprocessors and 12 water supply). Compliance to the European Guidelines was achieved for 112 out of the 180 (62.2%) samples analyzed. Presence of indicator micro-organisms (mainly Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and other Gram-negative non-fermenting bacteria) was found in 51 out of 143 endoscopes (35.7%). Multi-drug resistant bacteria were also found. Presence of pathogen micro-organisms was statistically associated with the increase of TMC level, but not with time after reprocessing. CONCLUSION: The study provides information about the microbiological quality of endoscope reprocessing procedures adopted by different endoscopic operation units. The high prevalence of contaminated endoscopes provides evidence of the need to improve the quality of reprocessing.

Return to work after kidney transplant: a systematic review.

BACKGROUND: Renal transplant is the gold standard treatment for patients with end-stage renal disease. Employment after transplant is an important marker of recovery and a key component of general well-being with important social implications. AIMS: To evaluate employment status after renal transplant and to investigate facilitators of and barriers to return to work for renal transplant patients. METHODS: We searched PubMed, Scopus and the Cochrane Library in March 2019 using the following algorithms: 'return to work' AND kidney AND transplant. Eligible studies were selected by two independent researchers. Quality assessment was performed using the following tools: International Narrative Systematic Assessment (INSA) and Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort studies. RESULTS: The review included 18 papers: 10 cross-sectional studies, 6 cohort studies and 2 narrative reviews. The weighted mean percentage for return to work within 1 year was 39.4% (95% CI 39.3-39.6%). Employment status was influenced by modifiable and non-modifiable factors, such as pre-transplant employment, sociodemographic characteristics, clinical conditions and comorbidities, operative technique (invasive or not), type of transplants (living donor or cadaver), pre-transplant dialysis, psychosocial support, educational level and participation in education programmes. CONCLUSION: Return to work after kidney transplant is a dynamic process influenced by numerous factors. It is vital to implement multidimensional interventions focused on rehabilitation and influencing modifiable factors to improve return to work after kidney transplant. This systematic review updates knowledge in the field of transplant and of disability management.

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.

Evaluation of timing of re-appearance of VBNC Legionella for risk assessment in hospital water distribution systems.

BACKGROUND: In this study we estimated the presence of Legionella species, viable but non-culturable (VBNC), in hospital water networks. We also evaluated the time and load of Legionella appearance in samples found negative using the standard culture method. METHODS: A total of 42 samples was obtained from the tap water of five hospital buildings. The samples were tested for Legionella by the standard culture method and were monitored for up to 12 months for the appearance of VBNC Legionella. RESULTS: All the 42 samples were negative at the time of collection. Seven of the 42 samples (17.0%) became positive for Legionella at different times of monitoring. The time to the appearance of VBNC Legionella was extremely variable, from 15 days to 9 months from sampling. The most frequent Legionella species observed were Legionella spp and L. anisa and only in one sample L. pneumophila srg.1. CONCLUSIONS: Our study confirms the presence of VBNC Legionella in samples resulting negative using the standard culture method and highlights the different time to its appearance that can occur several months after sampling. The results are important for risk assessment and risk management of engineered water systems.

Quality of life and physical activity in liver transplantation patients: results of a case-control study in Italy.

The aim of the study was to assess the quality of life (QOL) and the physical activity of liver transplant recipients compared with the general population. The case-controlled pilot study was accomplished through the administration of 2 questionnaires: 36-item Medical Outcomes Study, Short-Form General Health Survey (SF-36) for quality of life (10 scores) and International Physical Activity Questionnaire (IPAQ) to estimate the physical activity (metabolic equivalent score). Fifty-four patients who underwent liver transplantation using the piggyback technique and 108 controls from the general population at the orthopedic ambulatories were enrolled between 2002 and 2009. Participants had a mean age of 55 years (range, 41-73). The multivariate analysis showed significant differences for some scales of the SF-36: liver transplant recipients displayed lower values for "Mental Composite Score" (P = .043), "physical activity" (P = .001), "role limitations due to physical health" (P = .006), "role limitations due to the emotional state" (P = .006), and "mental health" (P = .010). The metabolic equivalent positively associated with all examined SF-36 scales. The present study focused on the QOL and physical activity of liver transplant recipients, demonstrating that transplant recipients scored lower than the general population. Liver transplantation may allow full recovery of health status, but the physical and social problems persist in some patients. Interventions aimed at improving rehabilitation programs, regular psychosocial support, and follow-up in all phases of treatment may give patients a more satisfying lifestyle after transplantation.

[Health care reforms in Italy: towards an health system with national rights and local responsibilities]. / Dalla "riforma-ter" alle modifiche al titolo V della parte seconda della Costituzione: verso un sistema sanitario nazionale nelle garanzie e regionale nelle responsabilità.

The aim of the article is to describe the new Italian National Health Service outlined by the third health care reform ("riforma-ter"), the fiscal federalism and the modifications to the title V of the second part of the Constitution. The authors examine the present "performance" of the Italian National Health Service in terms of health status of the population, perceived quality of care and health care expenditure, analyzing the international and national context in which the new reforms were developed. The most significant changes in health care programming, organization and functioning of the system, financing of the National Health Service and medical education are described. The authors conclude outlining research priorities to be addressed.

[Drinking water: use, consume and biological hazard]. / L'acqua: usi, consumi, rischio biologico.

The Authors drew the attention to the rising danger of water crisis also in countries usually immune from this problem. The most important causes of these crisis are presented along with some of the most important laws concerning civil use of water. The Authors underline the biological risk induced by new aetiologycal agents (i.e. aeromonas hydrophyla, Criptococcus, Escherichia coli (O:127 H7) found in drinking water too. Some of the health problems correlated to the civil use of water are also presented: water supply of hospitals, schools and hotels. The Authors conclude underlining that the answer to this problem must be found in a good management of water sources which requires efficient monitoring systems.