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.

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.

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.

The pharmacist's role in health information, vaccination and health promotion.

On the subject of vaccination, owing to complex issues connected to vaccine refusal and vaccine hesitancy, the pharmacist is seen as a professional figure in the health sector who is qualified to improve social accountability with the aim of increasing the consent. In order to provide accurate information, Law no. 119/2007 has confirmed the central role of the pharmacist in the promotion of prophylactic vaccination, explicitly stating under art. 2 that the Ministry will be able to count on the collaboration of pharmacists as well as general practitioners and paediatricians. Pharmacists are pinpointed as new professional figures who could assist the national health service in its vaccine awareness and administration campaigns. Art. 5 comma 1 of Law no.119/2017 states that to meet vaccine goals, each Region will be able to allow vaccines to be booked through the Italian booking system (CUP) and administered free-of-charge in authorized pharmacies.

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.

Training to improve resilience and coping to monitor PTSD in rescue workers.

BACKGROUND: Few studies focus on the role training has on rescue workers who are active as volunteers or actual workers in emergency situations such as an earthquake. In October 2016, a strong earthquake hit Central Italy and in particular the province of Macerata in the Marche region. Lots of rescuers were called to deal with the emergency. The aim of this study was, therefore, to examine their preparation, studying resilience and coping strategies, as these qualities can protect against complications brought on by traumatic situations (post traumatic stress disorder). STUDY DESIGN: An observational study on 70 rescue workers who active in the area affected by the disaster within the province of Macerata was carried out. MATERIALS AND METHODS: The questionnaire proposed by the Coping Inventory for Stressful situations (CISS) was used, while individual resilience levels were measured with the Resilience Scale. Both methods were employed in two separate interviews conducted before and after their intervention in the disaster area. To verify a possible difference between the resilience and coping values before and after the activity of rescue effort, the paired Student t test was applied. RESULTS: The sample showed medium to high levels of coping (91.6%) and resilience (89.6%) were present in both interviews and not significant statistical differences was observed for the resilience (among females t = 1.63, p-value = 0.179, and among males (t = -0.76; p-value = 0.487). In contrast, CISS scores before and after the rescue effort showed significant statistical differences both among females (t = 4.81; p-value = 0.009) and males (t = 10.06; p-value = 0.001).Some areas relative to coping mechanisms, such as social avoidance and distraction are preferred by women, while men prefer avoidance and task-oriented activity. Results for resilience show a slight difference for perseverance in men. CONCLUSIONS: The ability to use mechanisms of self-preservation like coping and resilience helps rescue workers to better respond in emergency situations. Surely one of the most appropriate ways to reach this result is provided by their preparation.

Lifestyles and discomfort in a sample of young Romanian students.

INTRODUCTION: The 40.3% of the Romanian youth population is at risk of poverty or social exclusion, and, in addition, the abuse of substances increases. It was interesting to evaluate the attitudes shared by pupils as well as their knowledge of these substances with a view to analyzing causes and types of risky behaviour in young people. METHODS: This is an observational study on the harassment influence in the lifestyle of a sample of Craiova high-school students The Fagerström Test was applied to evaluate the degree of nicotine dependence, and the data processed to assess the Odds Ratio. RESULTS: The sample was composed by 1,980 students with an average age of 17, of which 1,727 correctly responded to the questionnaire. The 37.4% of students admit to smoke, and the 67% to drink alcohol. The Fagerström test showed that the 68.2% of respondents are not highly addicted to smoke while the 31.8% was associated with a middle-to-high addiction level. A worrying weekly consumption of beer has been registered in the students. Regarding psychological distress caused by harassment a high Odds Ratio was recorded between the smokers and the drug users. CONCLUSIONS: More than half of students did not know about the health consequences of smoking, and the same result was recorded about the consumption of alcohol. A special attention should be done to the understanding of harassment problem in the young people. In fact, almost all the respondents declared to have suffered abuse and admits to use drug and cigarettes.

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.

Mental and physical effects of energy drinks consumption in an Italian young people group: a pilot study.

INTRODUCTION: The primary consumers of energy drinks were athletes, to combat fatigue, but in reality, thanks to their fast expansion and economic growth, young adults and teenagers represent the new target market. Consumption of energy drinks by both recreational and competitive athletes has increased dramatically in recent years, though they are often unaware of what is being ingested, believing to improve their physical and psychological performance. The literature shows contradictions about the capacity of energy drinks to enhance psychophysical results. In relation to probable adverse effects induced by the irregular consumption of energy drinks, which in several cases are not so clear, we decided to investigate the possible relationship between the intake of energy drinks and the presence of mental and physical stress in young people and athletes. METHODS: Two experimental sessions, separated at least by 1 week, according to a randomized cross-over design, following this protocol were conducted: in the first session a mental and physical stress was conducted without the consumption of energy drinks, the second after energy drinks consumption. BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory II) test have been used to test the mental stress, and a "cycle ergometer test" to test the physical stress. RESULTS: BAI and BDI tests results showed that before the consumption of energy drinks, subjects are considered in the range of "minimal level of anxiety", (10 and 60 percentiles) and do not report a level of depression. After the energy drinks consumption, a "mild level of anxiety" has been recorded, and the BDI showed a case with a pathological profile. The physical test recorded a small increase in the maximum heart rate was verified with the intake of an energetic beverage. CONCLUSIONS: The stimulating effect of Energy Drinks EDs on nervous system and cardiovascular system, must be checked and studied in deeper detail, because it may represent a risk for the health of young athletes.

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.

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.

Levels of understanding of the rules of correct medical usage among vietnamese pharmacy students: a cross-sectional study.

BACKGROUND: Comprehensive misunderstanding about medicine usage is often associated with high treatment risks which have led to unexpected and adverse effects or even death. Many researches assessing health literacy have been undertaken, but only in adults. This study was undertaken to evaluate the level of understanding in students of medical terms and its correlation with gender, grade and parental occupation. METHODS: A cross-sectional study was conducted from September to October 2017 with 594 students (28.6% of men and 71.4% of women) of Hanoi University of Pharmacy from freshman to fifth-year students chosen randomly. The knowledge of pharmacy students was assessed by a questionnaire including 25 medical terms. Descriptive statistics and Chi-square test were used with p < 0.05 as level of statistical significance. RESULTS: The level of understanding of students was high with most of medical terms reaching over 70% correct answers. A positive significant association between health literacy and education was found with higher knowledge demonstrated in upper years, while there was no difference among students with and without parents belonging to the medical field. Regarding the relation with gender, there was no significant correlation for most medical terms. CONCLUSIONS: Levels of understanding of medical terms in pharmacy students was high, presenting a significant association with education. This study should be extended in order to assess the level of health literacy in various populations, thereby indirect evaluating implementation of medical preventive programs.

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. Herein, its cytotoxic properties were explored in a human cell model of breast adenocarcinoma. The results supported the multi-target nature of mangiferin action, as the inhibition of three enzymatic systems, namely HMG-CoA reductase, the proteasome and plasmin, respectively in charge of regulating cholesterol homeostasis, protein turnover and cell adhesion, was documented for the first time. Globally, mangiferin was able to selectively block breast cancer cell growth by inducing apoptosis and by arresting cell proliferation through a combined action on cholesterol and proteasome pathways, as well as to inhibit plasmin-mediated mechanisms of cell migration.

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.

Oral health in Alzheimer's disease: a review.

The main data on oral health and dental pathologies affecting Alzheimer's disease (AD) patients were reviewed. Oral health declines and dental pathologies increase with progression of AD. Poor oral hygiene, difficulty in wearing dentures, and the inability to self-care, including carrying out oral hygiene procedures are the most probable cause of impaired oral health in AD. Collection of information on oral/dental conditions from AD patients or their caregivers/relatives is often difficult and scientific literature on the topic is sparse . The majority of data on the subject consist in retrospective studies affected to some extent by subjective views of dental professionals involved. Appropriate dental interventions in adult-onset dementia disorders will decrease pain and oral pathology and consequently could contribute to maintain enough oral and nutritional health in these patients. Dental treatment in early stages of the disease are important and should be finalized at producing a stable oral condition. This could improve the quality of life and contribute to decrease worsening of oral situations in the later stages of the disease when dental treatment may be difficult. The problem of awareness of good oral health for keeping quality of life more acceptable in adult-onset dementia disorders is discussed.

[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]. / Monitoraggio delle acque superficiali alla luce della Direttiva Europea 2000/60/CE. Un approccio metodologico integrato applicato ai fiumi appenninici. Primi dati.

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.

[Protection of the environment, protection of health. Note 2--Monitoring of flood environments: comparison of the results of the different methods and hygienic evaluations]. / Tutela dell'ambiente, tutela della salute. Nota 2--Monitoraggio degli ambienti fluviali: risultati ottenuti da metodi diversi a confronto e considerazioni igienico sanitarie.

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.

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.