Role of immunoglobulins in neonatal sepsis.

Neonates, especially VLBW, are at high risk for sepsis related morbidity and mortality for immaturity of their immune system and invasive NICU practices. The paucity of immunoglobulins in preterm neonates consequently to the immaturity of immune system contributes to their high risk for systemic infection. The use of intravenous IgM enriched immunoglobulins, with higher antimicrobial activity than standard IgG, has been demonstrated in a retrospective study to reduce short term mortality in VLBW infant with proven sepsis. Larger, randomized prospective trials given the enormous burden of morbidity and mortality imposed by neonatal sepsis should urgently be addressed not only to validate this results but also to tailor the optimal scheme of treatment.

Job demands-control-social support model and coping strategies: predicting burnout and wellbeing in a group of Italian nurses.

BACKGROUND: Nursing is generally considered to be a stressful profession. OBJECTIVES: The purpose of the present study was to test the core hypotheses of the job demands-control-social support model (JDCS) of Karasek & Theorell (1990). In order to refine and extend the JDCS model, we also analyzed the direct and interactive role of three coping strategies: task- oriented, emotion-oriented, and avoidance-oriented coping. METHODS: Questionnaire data from 1383 nurses (77%female) were collected. RESULTS: Controlling for demographic variables and non-linearity of the associations between job characteristics and outcomes (job satisfaction; burnout dimensions, psychological distress, and somatic complaints), hierarchical regression analyses indicated that job control and social support combined additively (p < 0.001) with job demands to explain the wellbeing outcomes (explained variance between 6% and 28%). Coping strategies accounted for additional variance (p < 0.001; explained variance between 4% and 15%) in all outcomes except in job satisfaction. Support was found for main effects of coping. Coping strategies did not moderate the impact of job characteristics on burnout and wellbeing. Emotion-oriented coping emerged as the most important predictor and was consistently associated with higher burnout levels and lower wellbeing levels. CONCLUSIONS: The results demonstrated the need to include the role of individual variables in the JDCS model. The limitations of the study, and theoretical and practical implications are discussed.

Infant botulism mimicking an acute abdomen.

Botulism is the acute, flaccid paralysis caused by a neurotoxin produced by Clostridium botulinum. In the infant, clinical symptoms are usually unspecific such as poor feeding, weak suck, feeble cry, drooling, followed by a symmetric, descending, flaccid paralysis beginning with the cranial nerve musculature. The initial symptoms of the disease are often similar to several diseases and therefore differential diagnosis is very difficult and rarely suspected by the physician. Since 2004 only 22 cases of infant botulism have been reported in Italy. Since most paediatricians are unfamiliar with the clinical manifestations of infant botulism, the diagnosis can be easily missed. Hence the disease may well be underestimated and underreported. We report a clinical case of botulism presenting initially with abdominal distention, thereby mimicking acute abdomen.

[Measuring the positive dimensions among health care workers: a contribution to the Italian validation of the UWES--Utrecht Work Engagement Scale]. / Misurare le dimensioni positive nel lavoro in sanità: un contribute all'adattamento italiano della UWES--Utrecht Work Engagement Scale.

Engagement is defined as a positive, fulfilling, work-related state of mind that is characterized by vigor, dedication, and absorption. The main purpose of this study was to examine the psychometric properties of the Utrecht Work Engagement Scale (UWES). Data from a sample of health care workers (N=948) were used to test four propositions concerning dimensionality, internal consistency and construct validity. The UWES Italian version and the Multidimensional Organizational Health Questionnaire (MOHQ) were administered to the subjects (a subsample of 225 health care workers also completed the Maslach Burnout Inventory). The factorial structure has been examined through a series of Explorative Factor Analysis (AFE) and Confirmatory Factor Analysis (CFA). As in the original version, we found a three factor solution. Internal consistency indexes were satisfactory. In addition, the correlations between UWES, MOHQ and MBI revealed a good construct validity. It is concluded that the Italian Version of the UWES has acceptable psychometric properties and that the instrument can be used in studies on positive organizational behavior.

[An empirical investigation of the demand-control-social support model: effects on burnout and on somatic complaints among nursing staff]. / Una verifica empirica del modello Domanda-Controllo-Sostegno Sociale: effetti sul burnout e sulla somatizzazione tra il personale infermieristico.

The present study investigated the relationship between job characteristics and well-being dimensions (burnout and somatic complaints) in a group of 271 nurses. The study, based on Karasek and Theorell's theoretic model of demand-control-social support, aimed to test the following hypotheses: (a) that there is a linear association between each job dimension (demand, control, social support) and indexes of stress (emotional exhaustion, depersonalization, personal accomplishment and somatization); (b) whether there is an additive or interactive ("buffer") action among the model variables in predicting stress. Concerning the hypothesis of linearity, regression analysis revealed two non-linear associations: between job control and emotional exhaustion, and between social support and the level of somatic symptoms. Concerning the second hypothesis, controlling for age and gender, results of hierarchical regression indicated that job control and social support combine in different additive patterns with job demands to explain outcomes of well-being. Findings confirmed the significant role of socio-demographic variables (age and gender) in predicting occupational strain.

[Perception of organizational climate and burnout amongst health care workers: the role of alexithymia as a moderator]. / Percezione di clima organizzativo e burnout in ambito sanitario: il ruolo moderatore dell'alessitimia.

This paper reports a study on 238 health care workers from an hospital in central Italy. We examined: 1) how some dimensions regarding perceived quality of the organizational and relational climate (social warmth and quality of working life both in the ward and in the organization) influence various indicators of burnout (emotional exhaustion, depersonalization, personal accomplishment); 2) if it was possible to improve the previous regressive models by including the personality construct, alexithymia. Controlling for age and gender, results of the hierarchical regression showed significant two-way interactions between organizational/relational climate and alexithymia in predicting emotional exhaustion (p = .005 for both the ward and the organization) and personal fulfillment (for ward, p = .020; for perceived relational climate, p = .037). Depersonalization was accounted by the main effect of alexithymia (p = .000). In conclusion, results demonstrate the need to include the alexithymia construct in models predicting the various dimensions of burnout.