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In the last years increasing attention has been given to the connection between genotype/phenotype and cardiovascular events in subjects with familial hypercholesterolemia (FH). MicroRNAs (miRs) bound to high-density lipoprotein (HDL) may contribute to better discriminate the cardiovascular risk of FH subjects. Our aim was to evaluate the HDL-miR panel in heterozygous FH (HeFH) patients with an LDLR null or defective mutation and its association with pulse wave velocity (PWV). We evaluated lipid panel, HDL-miR panel and PWV in 32 LDLR null mutation (LDLR-null group) and 35 LDLR defective variant (LDLR-defective group) HeFH patients. HDL-miR-486 and HDL-miR-92a levels were more expressed in the LDLR-null group than the LDLR-defective group. When we further stratified the study population into three groups according to both the LDLR genotype and history of ASCVD (LDLR-null/not-ASCVD, LDLR-defective/not-ASCVD and LDLR/ASCVD groups), both the LDLR/ASCVD and the LDLR-null/not-ASCVD groups had a higher expression of HDL-miR-486 and HDL-miR-92a than the LDLR-defective/not-ASCVD group. Finally, HDL-miR-486 and HDL-miR-92a were independently associated with PWV. In conclusion, the LDLR-null group exhibited HDL-miR-486 and HDL-miR-92a levels more expressed than the LDLR-defective group. Further studies are needed to evaluate these HDL-miRs as predictive biomarkers of cardiovascular events in FH.

Within the context of evidence-informed decision making, health care professionals are critical consumers of research evidence. Clinician scientists, including nurse researchers, play a central role in producing this research evidence to inform and improve health practice, education, and policy. Health research is commonly conducted within one of three different paradigms: quantitative, qualitative or mixed methods. Each research approach is underpinned with unique philosophic assumptions, methods, and rhetoric. The evidence produced within each paradigm is necessary to provide health care decision-makers with information about the complex, and intrinsically diverse, human experiences of health and illness. Qualitative health research has been defined as a discipline, which has its roots in qualitative research and yet is unique in its focus, methods, and rules. The focus of qualitative health research is to describe, explore, and explain the health-illness continuum and issues specific to health services or policy contexts. Research designs unique to conducting qualitative health research include qualitative description, interpretive description, focused ethnography, and case study. Each qualitative health research design helps to logically and pragmatically determine the appropriate methods to use to: 1) define a purposeful sample; 2) identify appropriate strategies for data collection; 3) rigorously apply analytic techniques to the gathered data; and 4) present valid findings. In health, qualitative studies are often an integral component of program evaluations to identify and describe contextual factors related to individuals, teams, organizations or social structures that inhibit or facilitate the successful adoption, implementation and delivery of an intervention or program. Findings from qualitative studies can also inform the development of theoretically and contextually relevant assessment tools that can be used in practice.

Aims: To describe self-care of T2DM patients and to evaluate outcomes associated with self-care in T2DM patients., Methods: A multicentre cross-sectional study was conducted on a sample of 302 randomly selected T2DM patients. Clinical and socio-demographic data were collected by medical records. The Summary of Diabetes Self-care Activities was used to measure self-care about diet, blood testing, exercise and foot care. The EQ-5D was used to measure perceived quality of life. Multiple regression models were used to evaluate the associations between self-care and body mass index (BMI), glycated haemoglobin (HbA1c), presence of diabetes complications and quality of life (QoL)., Results: Self-care was lower about exercise (median = 2.0) and foot care (median = 3.5) than about diet (median = 5.2) and blood testing (median = 4.5). HbA1c was associated with diet (p = 0.025), exercise (p = 0.017) and blood testing (p = 0.034). BMI was associated with exercise (p = 0.0071). Diabetes complications were associated with exercise (p = 0.031) and blood testing (p < 0.009). QoL was associated with exercise (p < 0.0001), blood testing (p = 0.032) and foot care (p = 0.013)., Conclusions: Self-care influences both clinical outcomes and quality of life of T2DM patients. Although exercise is more frequently associated with positive outcomes, it is particularly poor in T2DM population. Blood testing and foot care should be performed to prevent complications and not only when a health problem is already occurred. Interventions aimed to improve exercise are recommended. Further research is needed to explore barriers to exercise.

Background: Delirium has a high incidence pathology associated with negative outcomes. Although highly preventable, half the cases are not recognized. One major cause of delirium misdiagnosis is the absence of a versatile instrument to measure it., Aims: Our objective was to translate the nursing delirium screening scale (Nu-DESC) and evaluate its performance in Italian settings., Methods: This was a methodological study conducted in two sequential phases. The first was the Italian translation of Nu-DESC through a translation and back-translation process. The second aimed to test the inter-rater reliability, the sensibility and specificity of the instrument on a convenience sample of 101 hospitalized elderly people admitted to relevant wards of the San Gerardo Hospital in Monza. To evaluate the inter-rater reliability, two examiners tested Nu-DESC on 20 patients concurrently without comparison. To measure the sensibility and specificity of Nu-DESC, the confusion assessment method was used as a gold standard measure., Results: The inter-rater reliability (Cohen Kappa) was 0.87-an excellent agreement between examiners. The study of the ROC curve showed an AUC value of 0.9461 suggesting high test accuracy. Using 3 as a cut-off value, Nu-DESC showed 100 % sensibility and 76 % specificity., Discussion and Conclusion: Further research is needed to test Nu-DESC on a larger sample. However, based on our results, Nu-DESC can be used in research and clinical practice in Italian settings because of its very good and similar performances to previous validation studies. The value of 3 appears to be the optimal cut-off in the Italian context.

Objectives: Occupational Health Nurses have gradually changed their role. To provide a national and international overview concerning the Occupational Health Nurse's role and to evaluate which are the regulatory/professional elements currently in force in Italy that may permit to better structure and develop Occupational Health Nurse's technical/scientific knowledges., Methods: Literature and regulatory texts review in Italy and abroad; on sight research in some public and private Occupational Health services., Results: Occupational Health Nurses' role abroad is well established and it's primarily aimed to preventive health interventions and health promotions. In Italy, on the contrary, the role of nurses in Occupational Health is almost always accessory in the implementation of health surveillance and workers' health education. This fact seems to be the result of the absence of a specific training course for those professionals, that could better define their legal profile., Conclusions: We verified the need that the training curricula of the Nursing Degree and of the Post-graduate Degree in Nursing and Midwifery Sciences give more space for teaching specific Occupational Health skills. It seems useful to propose the activation of specific post-graduate training courses for nurses who wish to focus specifically their professional activity in our disciplinary field., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

Aim: Eleven medical care units of nine Lombardy Region hospitals organized by levels of care model or by the traditional departmental model have been analyzed, in order to evaluate if methods for complexity of patient-care evaluation represent an index factor of nursing organizational effectiveness., Method: Survey with nine Nurses in managerial position was conducted between Nov. 2013-Jan. 2014. The following factors have been described: context and nursing care model, staffing, complexity evaluation, patient satisfaction, staff well-being. Data were processed through Microsoft Excel., Results: Among Units analysed ,all Units in levels of care and one organized by the departmental model systematically evaluate nursing complexity. Registered Nurses (RN) and Health Care Assistants (HCA) are on average numerically higher in Units that measure complexity (0.55/ 0.49 RN, 0.38/0.23 HCA - ratio per bed). Adopted measures in relation to changes in complexity are:rewarding systems, supporting interventions, such as moving personnel within different Units or additional required working hours; reduction in number of beds is adopted when no other solution is available. Patient satisfaction is evaluated through Customer Satisfaction questionnaires. Turnover, stress and rate of absenteeism data are not available in all Units., Conclusions: Complexity evaluation through appropriate methods is carried out in all hospitals organized in levels of care with personalized nursing care models, though complexity is detected with different methods. No significant differences in applied managerial strategies are present. Patient's satisfaction is evaluated everywhere. Data on staffing wellbeing is scarcely available. Coordinated regional actions are recommended in order to gather comparable data for research, improve decision making and effectiveness of Nursing care.

Background: Self-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care., Objectives: (1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes., Design: Secondary analysis of data from a multicentre cross-sectional study., Setting: Outpatient clinics from 29 Italian provinces., Participants: 1192 adults with confirmed diagnosis of heart failure., Methods: Socio-demographic and clinical data were abstracted from patients' medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score <70 indicates inadequate self-care. Multiple linear regression analyses were performed., Results: Of 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p=0.12), self-care management (p=0.21) or self-care confidence (p=0.51). Age (p=0.04), number of medications (p=0.01), presence of a caregiver (p=0.04), family income (p=0.009) and self-care confidence (p<0.001) were determinants of self-care maintenance. Gender (p=0.01), number of medications (p=0.004) and self-care confidence (p<0.001) were significant determinants of self-care management. Number of medications (p=0.002) and cognitive function (p<0.001) were determinants of self-care confidence., Conclusions: Self-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aim: To investigate the prevalence of violence towards nurses in a health care structure in the north of Italy., Method: An observational cross-sectional study. Data were collected anonymously with a questionnaire developed by Zampieron et al. (2010) on a stratified sample of 198 nurses working in a major Italian Hospital in the Lombardy Region., Results: 43% of the sample (n=85/198) experienced violence in the previous twelve months with a mean of 4 aggressions each. Aggressors were mainly patients (53.3%) or relatives (26.7%), men (63.1%) aged between 36 and 50 years (27.9%). Of the verbal aggressions, one out of four was by a colleague or a superior. The emotional, physical and professional consequences were serious and the result of both physical and verbal violence. Nevertheless, among those who experienced aggressions, 57% did not ask for help and of those who did (43.0%) about 75% asked for help and support from their colleagues., Conclusions: Violence toward nurses exists and it is commonplace in the workplaces studied, even in the horizontal form. It is important to implement assessment and risk prevention and management measures, via specific training of nurses, and offer support for the victims and an anonymous formal report system guaranteed by the authorities.

Context: Prediabetes is associated with atherosclerotic vascular damage., Objective: We investigated the correlation of endogenous secretory receptor for advanced glycation end-products (esRAGE), total soluble RAGE (sRAGE) and markers of inflammation, with early cardiovascular disease in subjects with prediabetes. We particularly focused on individuals with prediabetes identified only by glycated hemoglobin A1c (HbA1c) (5.7–6.4%) who had normal fasting glucose and were normotolerant after oral glucose tolerance test., Design: This was a cross-sectional study., Setting: The study was conducted in the Department of Clinical and Molecular Medicine, University of Catania, Italy., Main Outcome Measure: sRAGE, esRAGE, carboxymethyl-lysine, S100A12, HbA1c, fasting glycemia, oral glucose tolerance test, pulse wave velocity, and intima-media thickness were evaluated in subjects with prediabetes., Patients: Three hundred eighty subjects without previous history of diabetes were stratified into three groups: controls (n = 99), prediabetes (n = 220), and new-onset type 2 diabetes (n = 61)., Results: Subjects with prediabetes exhibited the following: lower esRAGE (0.29 ± 0.18 vs 0.45 ± 0.26 ng/mL; P < .05) and higher S100A12 levels than controls. RT-PCR analysis in mononuclear cells revealed that the mRNA expression level of the esRAGE splice variant progressively decreased in patients with prediabetes and type 2 diabetes with respect to controls. No difference was observed in sRAGE and carboxymethyl-lysine plasma levels between the groups. After multiple regression analyses, only age, HbA1c, and hs-CRP were independently associated with esRAGE levels. Age, HbA1c, and esRAGE were the major determinants of intima-media thickness, whereas S100A12 and systolic blood pressure were the major determinants of pulse wave velocity. When we analyzed the subjects with HbA1c prediabetes (normal fasting glucose/normotolerant and HbA1c 5.7–6.4%), esRAGE and inflammatory markers plasma levels still remained significantly different in respect to controls., Conclusions: Subjects with HbA1c prediabetes exhibited significantly reduced esRAGE levels and increased levels of markers of inflammation. These alterations are associated with early markers of cardiovascular disease.

Introduction: In recent years, in Italy, population lengthening of life leads to an higher number of individuals with chronic diseases (Osservatorio, 2010). The hospital which deals with the acute phase of diseases needs to be integrated with primary care. This connection is particularly important for the treatment, care and rehabilitation of patient, as well as a general need for more health and social care integrated tools., Objective: At the San Gerardo Hospital in Monza, in the context of the patient's post-acute rehabilitation, we analyze the phase between discharge from hospital and the expected date of hospitalization in facilities providing rehabilitation. The aim of this observational descriptive study is to determine the distribution of days of waiting. Furthermore, several different approach are analysed (i.e. Integrated Home Care) in order to reduce unnecessary days hospitalization and a more intelligent and cost effective use of resources The research question are the follow, to quantify waiting time between discharge and hospitalization in the rehabilitation facility and to ascertain if patients are sent to the correct facility., Result: 1083 individuals were taken into account, of those 55% (N=652) were discharged from the hospital later. This leads to a 4505 days of inappropriate hospitalization., Conclusion: Although the use of home care could be beneficial to the hospital, this can be used only for tiny part of the patients and it is not cost effective. A possible solution can be set up a number of low cost bed entirely managed by nurses due to the low level of intensity care.

The purpose of this historical research project is to examine the contribution of 19th-century religious congregations in the development of the nursing profession, based on the historical example of the Sisters of Charity of Sts. Bartolomea Capitanio and Vincenza Gerosa (or the Sisters of the Holy Child Mary). To this end, sixty three volumes were analysed, all taken from the historical archive of the Generalate of the Sisters of the Holy Child Mary in Milan, in via S. Sofia n.13, with the exception of just one, taken from the Braidense National Library, also in Milan. This research project has highlighted the sociological contribution provided by the Sisters of the Holy Child Mary to the professional nature of nursing, and to the development of the distinctive features of the nursing profession (Greenwood, 1980). All documentary sources were analysed in line with the Chabod historical research method (2006), and for their critical interpretation, a scheme of analysis was created. Two lines of investigation emerged from the data collected: the role of Sister Emilia Vinante as an expert with regard to the nursing profession, and the professional strategies promoted by FIRO (Federation of Italian Religious Nurses). Based on the conclusions of the research project, it may be stated that religious congregations contributed greatly to the nursing profession, leaving a decisive mark on the cultural and professional development of nurses.

Aim: On 6 April 2009, at 3:32 GMT, central Italy was struck by a 6.3-magnitude earthquake with its epicentre near L'Aquila, the capital city of the Abruzzo region. Earthquakes may precipitate psychiatric symptoms. The aim of this study was to investigate cognitive functioning and positive and negative symptoms before and after the 2009 L'Aquila earthquake in patients with first-episode psychosis (FEP) and chronic schizophrenia (CS)., Methods: A total of 54 FEP patients (34 males and 20 females) and 63 CS patients (39 males and 24 females) were investigated. Psychometric scores were submitted to a 2 × 2 mixed analysis of variance, with group (FEP and CS) as the between-subjects variable and time (pre- and post-earthquake) as the within-subjects variable., Results: Positive symptoms increased significantly from the pre- to the post-earthquake assessment in FEP patients but not in those with CS. There were no significant differences between the pre- and post-earthquake period in terms of negative symptoms in both groups. Compared with the pre-earthquake assessment, FEP patients scored significantly worse at the post-earthquake evaluation in terms of Wisconsin Card Sorting Test categories achieved, immediate verbal memory and delayed verbal memory. However, there were no significant differences in cognitive scores between the pre- and post-earthquake periods in patients with CS., Conclusions: Our findings suggest that a disastrous earthquake has a negative impact on cognitive functioning and positive symptoms in FEP patients, but not in those with CS., (© 2011 Blackwell Publishing Asia Pty Ltd.)

One of the difficulties nurses experience in clinical practice in relation to ethical issues in connection with young oncology patients is moral distress. In this descriptive correlational study, the Moral Distress Scale-Paediatric Version (MDS-PV) was translated from the original language and tested on a conventional sample of nurses working in paediatric oncology and haematology wards, in six north paediatric hospitals of Italy. 13.7% of the total respondents claimed that they had changed unit or hospital due to moral distress. The items with the highest mean intensity in the sample were almost all connected with medical and nursing competence and have considerably higher values than frequency. The instrument was found to be reliable. The results confirmed the validity of the MDS-PV (Cronbach's alpha = 0.959). This study represents the first small-scale attempt to validate MDS-PV for use in paediatric oncology-haematology nurses in Italy.

Background: The traditional model for nursing staff management widely used in Italian hospitals assumes that diagnosis determines the amount of nursing required, but this has been widely criticized. In order to quantify and monitor the fluctuation of the complexity in nursing care, a questionnaire, called SIPI (Sistema Informativo della Performance Infermieristica), that is based on the care needs expressed by the patients, has been proposed in the Monza Hospital., Design: A group of trained nurses were asked to indicate their own perception of the level of nursing day-care complexity provided to each patient and then to complete the SIPI., Settings: The Monza Hospital coordinated this multi-centre study that involved 25 Hospitals of North Italy., Participants: Each hospital contributed with a minimum of three units, at least one for each area of intensity of clinical care, as defined by health regulators. All adult in-patients being in the units from at least 24h were included in the survey. Psychiatric wards, neonatology, intensive and semi-intensive care wards were non considered., Methods: A group of nurses trained with the use of SIPI completed the questionnaires based on the nursing file of performed activities. Before filling the questionnaire, the nurses were asked to indicate their perception of the level of complexity of the day-care provided to each patient. In order to calculate the SIPI scores that discriminate different nurse complexity levels, a ROC analysis and the multinomial logistic regression model were used, considering the perceived complexity as the standard of reference., Results: The nursing day-care complexity was measured in 115 wards, for a total of 17,803 completed questionnaires. Nursing complexity was roughly the same in areas of different intensity of clinical care, both according to perception and as measured by SIPI. A cut-off of 49.2 was identified as optimal to distinguish two classes of complexity with a good performance (80% of specificity, 85% of sensitivity)., Conclusions: The SIPI was shown to be a simple and useful tool that may be adopted in the future for an optimal allocation of nursing resources. The results of this study confirmed that elevated intensity of care from the clinical perspective does not necessarily correspond to high nursing complexity., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Hospitalized children live a very critical period of their life, in which they prove the experience of separation from their own family, habits and toys. The nurse can use recreational activities to relate with children in a funny way. This recreational therapy represent a main up to date instrument for the nurse who works in paediatrics. Using the game children express themselves, their feelings and fears. They re-elaborate and understand the different situations they're living and relate with others. This happens normally in the daily life, but in particular during stressful situations such as, for example, hospitalization (Bianchi di Castelbianco et al., 2007). The purpose of this review of literature is to research if there is a connection between the recreational activities used by the nurse and pediatric nursing. The bibliographical review of this topic allows to describe the recreational activities available to the nurse and the way that these activities influence pediatric nursing. From this research, it results that the recreational activities can positively influence the ministering to needs of the hospitalized child.The specific training and putting into practice of up to date recreational activities, allow nurses to utilize this approach in pediatric nursing. Key words: Nursing care, pediatric nursing, hospitalized children, play, recreational activities.

One of the many different skills that nursing students have to achieve is how to dispense care by applying nursing concepts. The authors propose and instrument for evaluating and monitoring various aspects of learning in nursing students and their ability to put them into practice by considering 31 indicators, taking into account the degree of difficulty (D) and discrimination (d) involved in each one. All but 2 of the indicators were found to be reliable for assessing learning in nursing students . An overall statistical analysis and an analysis of the scores obtained enabled the tutors to establish an evaluation score for the nursing plans elaborated by the students.

Introduction: Educational interventions and information for Acute Renal Failure patients delay dialysis and improve several outcomes (Hb values, blood pressure, complications)., Method: The Quality of Life (QoL) of patients referring to 12 North Italian dialysis centres was assessed with the SF-36 and compared between 5 centres that adopted a multidisciplinary educational approach (4-5 individual or multiprofessional group meetings of 45-60 minutes each, with patients and relatives) and 7 routine care. Patients were selected if had started a planned dialysis treatment from 2-6 months., Results: 48 patients were cared with multiprofessional group meetings and with 51 routine care. The two groups were comparable for the main characteristics. On average, patients were on dialysis from 4 months. Mean scores for all dimensions of QoL were higher in multiprofessional group patients except for emotional role, but differences disappeared in multivariate analyses., Conclusions: Although differences are not statistically significant, they suggest a favourable impact of multidisciplinary care. Studies on larger sample are necessary to confirm these results.