Exploring patient safety culture in preventive medicine settings: an experience from Northern Italy.

INTRODUCTION: Patient safety and quality in healthcare are inseparable. Examining patient safety culture in staff members contributes to further develop quality in healthcare. In Italy there has been some experience in assessing patient safety culture in staff working in hospital. In this pilot study we explored patient safety culture in public health staff working in Italian Local Health Authorities. METHODS: We carried out a descriptive cross sectional study in four Italian territorial Prevention facilities in Northern Italy. We administrated an adapted Italian version of the US Hospital Survey of Patient Safety Culture to all the staff within these facilities. The survey consisted of 10 dimensions based on 33 items, according to the results of a previous psychometric validation. RESULTS: Seventy per cent of the staff responded to the survey (N = 479). Overall, six out of the 10 dimensions exhibited composite scores of positive response frequency for patient safety culture below 50%. While "communication openness" (65%) was the most developed factor, "teamwork across Units" (37%) was the least developed. The work areas with the highest composite scores were Management and the Public Health Laboratory, while in terms of professional categories, Physicians had the highest scores. Patient safety culture in the staff participating in this study was lower than in hospital staff. DISCUSSION: Our descriptive cross sectional study is the first to be carried out in Preventive medicine settings in Italy. It has clearly indicated the need of improvement. Consequently, several interventions with this aim have been implemented.

[The network of health promoting companies (WHP) in the province of Bergamo]. / La rete WHP delle aziende che promuovono la salute nella provincia di Bergamo.

OBJECTIVES: To create, by 2012, a network of Promoting Health companies in the Province of Bergamo, with at least 10% of companies with over 90 employees (about 10,000 workers) adherent, and attending up to 15% by 2015. METHODS: The work was carried out by building partnerships and collaboration with Confindustria Bergamo and the main healthcare and Union stakeholders in the province, selecting good practices and experimenting feasibility and effectiveness in two mid-sized companies, before extending the proposal A system of accreditation was defined. Member companies should implement a at least 18 good practices in three years. The areas of good practices are: nutrition, tobacco, physical activity, road safety, alcohol and substance and wellbeing. The results are surprising in terms of network and adhesion. Currently 46 companies are involved (over 9,200 employees). CONCLUSIONS: The model seems to work well and in our opinion is extensible on a larger scale.

[Courses for smoking cessation in the workplaces: results and opportunities]. / Corsi per smettere di fumare in azienda: risultati ed opportunità.

In the context of the "WHP- District Network Project", 6 group-treatments for smoking cessation have been performed in five companies, with the voluntary participation of 88 smokers. Health professionals, with specific training, conducted the groups according to specific guidelines. The quitting rate recorded at the end of the course (and confirmed, in two groups, by measurement of exhaled CO) was on average 49% (range 34-70%). The abstainers at one year, recorded by a telephonic follow-up, mounted to 38% (range 29-50%, 4 courses out of 6). The courses have proved to be a good tool to help people to quit smoking and so reducing smoking-associated risks and its synergism with occupational risk factors.

[Training individuals of the construction sector in the province of Bergamo: a shared path division and an operative proposal]. / La formazione delle figure di sistema del comparto edilizia nella provincia di Bergamo: un percorso condiviso ed una proposta operativa.

With this presentation it will be introduced the experience of the work group native of Bergamo who is taken care to plan the formation course for the professional figures of system in building. The group is formed from the greater agencies present on the territory, their work is to ensure the protection of the health and the emergency of the workers in the field of the constructions. The objective is to use the formation course in order to diffuse one culture of the emergency. In the specific one they will come to describe the various planning phases of the course of formation for employers that mean to elect himself Responsible of the Service of Prevention and Protection (RSPP).

Effects of a 4-week treatment with prostaglandin E1 on plasma endothelin-1 release in patients with intermittent claudication.

OBJECTIVE: Endothelin-1 (ET-1) is a vasoconstrictor mitogenic peptide whose plasma concentrations are increased in patients with peripheral arterial occlusive disease (PAOD). The aim of this study was to investigate whether changes in plasma ET-1 concentrations occur after a 4-week treatment with prostaglandin (PG) E1 in patients with intermittent claudication. PATIENTS, MATERIAL AND METHODS: Twenty-four non-trained outpatients with Fontaine stage II PAOD (20 men and 4 women, mean age 63+/-7 years, age range 48-72 years) were randomized to receive over a 4-week period either PGE1 (60 microg given daily i.v. over 2 hours in 250 ml saline, n = 12) or placebo (250 ml saline, n = 12). Plasma levels of ET-1 were measured by radioimmunoassay at baseline and after treatment period. Before and after treatment pain-free walking distance (PFWD) and maximum walking distance (MWD) were evaluated by treadmill walking test as the target parameters for assessing treatment efficacy. RESULTS: At week 4, PFWD and MWD significantly increased in comparison to baseline only in PGE1 treatment group (from 136+/-38 m to 246+/-95 m, p = 0.0004, and from 238+/-54 m to 411+/-137 m, p = 0.0001, respectively). At the end of the treatment period with PGE1, ET-1 plasma concentration decreased from 4.50+/-0.8 pmol/l to 3.6+/-1.1 pmol/l (p = 0.002), whereas it remained unchanged in placebo group. A significant correlation between the decrease in ET-1 plasma levels and the increase in the PFWD and MWD (r = -0.92, p < 0.0001; r = -0.78, p = 0.002, respectively) was detected in PGE1 treatment group. CONCLUSIONS: Reduced ET-1 plasma concentrations after PGE1 treatment could be an index of improved endothelial function and/or could contribute to a reduction in vascular resistance and vessel wall growth in PAOD patients. Moreover, plasma ET-1 could be a marker of clinical improvement in these patients.

Plasma endothelin-1 levels in patients with peripheral arterial occlusive disease at different Fontaine's stages.

UNLABELLED: Endothelin-1 (ET-1) is a potent vasoconstrictor and mitogenic peptide produced and secreted by endothelial cells, which can play a potential role in the development of atherosclerosis and in the pathophysiology of extreme vasoconstriction of various diseases. METHODS: To assess plasma endothelin-1 (ET-1) concentrations in patients with peripheral arterial occlusive disease (PAOD) at different Fontaine's stages, we measured plasma ET-1 by radioimmunoassay in 14 stage II PAOD patients (12 men, 2 women; mean age 59.5 +/- 3.4 years) and in 10 stage III-IV PAOD patients (8 men, 2 women, mean age 61.2 +/- 3.3 years). Ten normal subjects (8 men, 2 women, mean age 58.1 +/- 7.2 years) were considered as controls. RESULTS: Mean (+/- SD) plasma ET-1 levels, as measured by radioimmunoassay, were significantly greater in stage II and stage III-IV PAOD patients than in control subjects (4 +/- 0.4 and 5 +/- 0.4 pmol/L vs 2.5 +/- 0.6 pmol/L, respectively, p < 0.001). Furthermore, plasma levels of ET-1 in stage III-IV patients were significantly higher than in stage II patients (p < 0.01). A significant correlation was found between plasma ET-1 levels and number of the arterial obstructive lesions in PAOD patients (r = 0.698; p < 0.0001). No significant correlation was found between plasma ET-1 concentrations and pain-free walking distance (r = -0.279, p = 0.333, in stage II patients; r = 0.137, p = 0.705, in stage III-IV patients), and between plasma ET-1 levels and ankle/arm pressor index (r = 0.032, p = 0.913, in stage II patients; r = 0.149, p = 0.681, in stage III-IV patients) in the PAOD patients. CONCLUSIONS: Raised plasma ET-1 could be a sensible marker both of endothelial damage and disease extension. It could also promote the progression of atherosclerotic plaques and enhance the microvascular resistance in these patients.