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Introduction: The first two decades of the third millennium have been characterized by deep economic changes in various countries around the world with an inevitable impact on the job market. The aim of this study is to analyze the data of the last twenty years relating to employment in Italy, compared with European ones, to understand how the 2008 economic crisis affected employment in the following years and how the recent crisis, related to the COVID 19- pandemic emergency, may contribute further. Methods: The study analysed data related to the labor market in Italy and in the European Countries. The 2000-2019 period was analytically evaluated by comparing employment and unemployment rates, and contractual typology. The average annual percent changes (AAPC) of the trends were evaluated from join-point regression analysis. Results and discussion: From 2000 to 2019 the Italian population showed a substantial growth with an increase of +6.03%, almost due to the increase of foreign. The employment rate in Italy (age 15-64) has grown from 55.5% to 59.1% with three different trends: 2000-2007 (AAPC=+0.6%, p

Introduction: Autonomic nervous system activity in cirrhotic portal hypertension is linked to hyperdynamic circulation. Heart rate variability (HRV) is a validated noninvasive method to assess the sympathovagal balance. To investigate the correlation between HRV parameters and degree of portal hypertension, we studied a cohort of patients with cirrhosis accounting for etiology and treatments. Patients and Methods: In this cross-sectional, observational cohort study, 157 outpatients of both sex with nonalcoholic cirrhosis were assessed by upper gastrointestinal endoscopy to search for esophagogastric varices. Twenty-four-hour electrocardiogram Holter monitoring with 3 HRV parameters measurement [SD of the NN intervals, root mean square successive difference of NN intervals, and SD of the averages of NN intervals (SDANN)] according to time-domain analysis were performed in all patients. Sixteen patients with large esophagogastric varices underwent measurements of the HVPG and assessment of HRV parameters at baseline and after 45 days on carvedilol. Results: The liver dysfunction, expressed by Child-Pugh class or MELD score, was directly related to root mean square successive difference of NN intervals and inversely related to SDANN. Presence of ascites was inversely related to SDANN and to SD of the NN intervals. Treatment with carvedilol had an inverse relation with SDANN. Presence and size of esophagogastric varices had an inverse relation to SDANN and SD of the NN intervals. Upon multivariate analysis the associations between SDANN and Child-Pugh class, size of varices and ascites were confirmed. In the subgroup of 16 patients undergoing HVPG measurement, pressure gradient was unrelated to heart rate and HRV parameters. Conclusions: Time-domain HRV parameters in patients with cirrhosis, confirm the autonomic nervous system alteration, and their correlation to the degree of portal hypertension suggesting a role of the ANS in hepatic decompensation.

Background: Leishmaniasis is a widespread infectious disease, but there is not much information about its prevalence in high risk occupational categories. Objectives: Te aim of this study is to assess the prevalence of Leishmania immunological positivity in human skin tissues collected from subjects living in Western Sicily, with suspected cutaneous Leishmania infection, in order to explore the risk possibly related to occupation. Methods: 318 consecutive subjects (M/F ratio=1.0, mean age=40±25.4 years), attending the Dermatology Department of the University of Palermo Hospital from 2013 to 2015, without any previous history of Leishmania infection and performing various occupations, were included. Parasite isolation and PCR-RT test on skin scrapings were performed to evaluate the immunological status; all data were analyzed by the chi square test, comparing all positive results from the different provinces. Results: 81 (50.9%) out of 159 females and 79 (49.7%) out of 159 males were found PCR-RT positive to Leishmania infantum, with a higher risk in the Agrigento district (p

Background: Although influenza vaccination has been demonstrated to be safe and effective, vaccination coverage rates among health care workers and among medical residents appear generally low. Several investigations have been performed worldwide to analyze the healthcare workers' educational deficiencies. This multicentre survey aimed to investigate at a nationwide level training quality and work environment associated with seasonal influenza vaccination uptake among Italian medical residents. Methods: A retrospective cohort study was carried out from April 2012 to June 2012 on medical residents regularly attending the post-graduate medical schools of 18 Italian Universities via an anonymous, self administered, web-based questionnaire. Data have been analyzed by using the R statistical software package. Results: A total of 2506 out of 10,854 medical residents (23.1 %) have been recruited. The quality of training on influenza and influenza vaccination was reported as "fair" or "poor" during both pre-graduate (40.7 % of respondents) and post-graduate medical school (59.6 % of respondents). Vaccination uptake was associated with adherence to seasonal 2011/2012 influenza vaccination of medical school tutors (adjusted OR = 4.4; 95 % CI = 1.35-14.26) and other medical residents (adjusted OR = 2.2; 95 % CI = 1.14-4.23). Moreover, influenza vaccination uptake was also associated with correct knowledge about the virus composition of 2011/2012 influenza vaccine (adjusted OR = 2.43; 95 % CI = 1.64-2.58) and consultation of scientific sources or Institutional recommendations on influenza vaccination (adjusted OR = 6.96; 95 % CI = 3.38-214.36). Conclusions: Medical residency represents an opportunity to implement educational and training interventions aiming to promote appropriate professional behaviors and skills. Our study suggest that appropriate training, adequate education and proactive coworkers feelings can improve influenza vaccination attitudes towards young doctor.

to assess the trends of foodborne diseases in respect of the abolition of food handler certification by Italian Regions.

A major virulence factor of Staphylococcus epidermidis is its ability to form biofilms, permitting it to adhere to a surface and, in turn, to form a mucoid layer on polymer surfaces. Multiple factors have been found to influence bacterial attachment. Currently, this bacterium is commonly associated with hospital infections as a consequence of its ability to colonize, albeit accidentally, medical devices. This study investigated the genetic and phenotypic formation of biofilm in 105 S. epidermidis strains isolated from the skin of hospitalized patients. Fifty-eight of these patients were positive for the mecA gene (MRSE) and 47 were found to be negative (MSSE). Genetic characterizations were performed for the detection of the mecA, icaADBC, atlE, aap, bhp, IS256 and agr groups by PCR. Biofilm production was examined by culturing the strains in TBS medium and TBS with 0.5 and 1% respectively of glucose, and a semiquantitative assay on tissue culture plates was used. Although a molecular analysis estimate of detailed biofilm formation is costly in terms of time and complexity, a semiquantitative assay can be proposed as a rapid and cheap diagnostic method for initial screening to discover virulent strains. We confirmed a close correlation between genetic and phenotypic characteristics, highlighting the fact that, when S. epidermidis isolates were cultured in TSB with 1% of glucose, an increase in biofilm production was observed, as confirmed by positivity for the ica locus by molecular analysis.

BACKGROUND:Endothelial dysfunction is involved in the pathogenesis of atherosclerosis. Consumption of fish is associated with reduced cardiovascular risk, but there is paucity of data concerning its effect on endothelial function. Furthermore, investigation of the effects of fish consumption on health must take into account the ingestion of contaminants, including transition metals and some metalloids, which may have unfavorable effects on health, including those on the cardiovascular system. We investigated the association between fish consumption, endothelial function (flow mediated dilation of the brachial artery), and serum concentration of some toxic metals in apparently healthy people. METHODS:Twenty-nine high fish consumers (at least 3 portions a week) were compared with 25 low fish consumers (less than 1 portion a week). All participants were free of diabetes, cardiovascular or other systemic diseases. Serum metal (antimonium, arsenic, mercury, lead, cobalt, copper, zinc, selenium, strontium) concentrations were measured in subgroups of 24 high fish consumers and 19 low fish consumers. RESULTS:Both groups exhibited similar habitual dietary patterns, age and anthropometric characteristics. The high fish consumers had higher flow mediated dilation (9.7 ± 1.8 vs. 7.3 ± 1.9%; P

Nel 1988, l’Organizzazione mondiale della Sanità (OMS) ha approvato il piano di eradicazione mondiale della poliomielite con l’obiettivo di annullare la circolazione del virus a partire dall’anno 2000. Tale target, per motivi economici, organizzativi, culturali, bellici e financo religiosi, è stato successivamente spostato in avanti negli anni fino a giungere attualmente al 2015. A seguito di questo impegno, negli anni si è registrata una riduzione dell’incidenza di poliomielite di oltre il 99%, passando dai 350.000 casi annui di polio paralitica documentati nel 1988 in 125 paesi, alle poche centinaia di casi riscontrati nel 2013 sia negli ultimi 3 paesi endemici (Nigeria, Afghanistan, Pakistan) sia in paesi polio-free spesso confinanti con quelli endemici ed interessati da un corollario di epidemie di dimensioni variabili.

Background The use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory. Methods This study investigated whether diuretic use is associated with markers of metabolic and cardiovascular risk, such as insulin-resistance and uric acid, in a cohort of adults without known diabetes and/or atherosclerotic cardiovascular disease. Nine hundred sixty-nine randomly selected participants answered a questionnaire on clinical history and dietary habits. Laboratory blood measurements were obtained in 507 participants. Results Previously undiagnosed type 2 diabetes was recognized in 4.2% of participants who were on diuretics (n = 71), and in 2% of those who were not (n = 890; P = 0.53). Pre-diabetes was diagnosed in 38% of patients who were on diuretics, and in 17.4% (P

Parallel to the increase in obesity, the prevalence of metabolic syndrome (MetS) is continually increasing, with increased risk of diabetes and cardiovascular atherosclerosis diseases. Despite the importance of this public health problem, the relative impact of diet and physical activity on MetS prevalence has yet to be established. We investigated the association between lifestyle, in terms of both habitual dietary pattern and physical activity, and MetS in a cohort of adults without known diabetes and atherosclerotic cardiovascular disease. Four hundred seventy-seven randomly selected adult participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire and a questionnaire on physical activity, and underwent routine laboratory blood measurements. MetS was identified in 24.7 % of the cohort. Dietary patterns were not significantly different (P = 0.31) between the groups (with or without MetS). The habitual physical activity level was significantly lower (P = 0.011) in the group with MetS. In particular, the prevalence of sedentary participants was 58.1 % in the group with MetS, and 43.9 % in the group without MetS. Multivariate analysis revealed that MetS was associated with age (OR = 1.06, 95 % CI 1.03–1.08) and physical activity level (light vs. sedentary: OR = 0.53, 95 % CI 0.32–0.87; moderate/heavy vs. sedentary: OR = 0.31, 95 % CI 0.13–0.75). This study suggests that inadequate physical activity level is associated with MetS. Our results are therefore consonant with the notion of healthier lifestyle changes to counteract the epidemic of diabetes and cardiovascular disease, though adequate interventional trials will be needed in high-risk populations.

Street food (SF) is defined as out-of-home food consumption, and generally consists of energy-dense meals rich in saturated fats and poor in fibers, vitamins and antioxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with atherosclerosis has not been considered. The association between habitual SF consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, was therefore investigated. One thousand thirty-five randomly selected adult participants without known diabetes and atherosclerotic cardiovascular diseases were cross-sectionally investigated in Palermo, Italy. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 541 participants. A score of SF consumption was obtained by categorizing each of ten SFs consumed more or less than once a month. Participants were divided into three classes based on the tertiles of SF score distribution. Age, gender distribution, body mass index (BMI), prevalence of hypertension and of clinically silent carotid atherosclerosis (I tertile 20.8 %, II tertile 19.7 %, III tertile 19.0 %; P = 0.85) were not significantly different among the three groups. Clinically silent carotid atherosclerosis was independently associated with age, gender and hypertension. The score of SF consumption was significantly correlated with BMI (r = 0.10; P = 0.04), uric acid (r = 0.16; P = 0.002) and high-density lipoproteins-cholesterol (r = −0.13; P = 0.009) blood concentrations. In conclusion, this study suggests that SF consumption is not associated with clinically silent carotid atherosclerosis. However, given the association of SF consumption with other cardiovascular risk factors, caution requires that this category of food should be limited in patients at high cardiovascular risk.

Minimally invasive video-assisted thyroidectomy (MIVAT) is a surgical technique that has showed increasingly good results, particularly in endocrine surgery centers. The aim of this prospective, non-randomized study was to evaluate feasibility, advantages and critical aspects of MIVAT in a general surgery unit.Two hundred twenty-four patients underwent total thyroidectomy for benign thyroid disease from May, 2008 to April, 2011. They were divided into two groups: one underwent conventional thyroidectomy (CT), and the other underwent MIVAT. The inclusion criteria were thyroid volume ≤35 mL and main nodule size ≤35 mm. For each patient, socio-demographic variables, hospitalization data and outcome measures (complication rate, operating time, post-operative pain, observer and patient scar assessment scale [OSAS and PSAS, respectively]) were collected. Multivariate regression analyses were done to assess the principal covariates affecting these outcome measures.There were 125 MIVATs and 99 CTs performed. The two groups were characterized by difference in age (38.4 vs. 50.9 years) and thyroid volume (18.6 vs. 23.3 mL). OSAS/PSAS scores were statistically significant in the MIVAT group (P0.001 and P0.001, respectively) even after adjusting for age and thyroid volume. Complication rate was similar in the two groups.MIVAT significantly decreased postoperative pain and improved cosmetic results. It can be performed in younger patients and in all cases in which there is a clear indication for the procedure. Its advantages were confirmed in a general surgery unit where correct indications were followed.

BACKGROUND/OBJECTIVES:Dietary habits are important determinants of individual cardiovascular and metabolic risk. This study investigated the association between dietary patterns and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, and metabolic biomarkers of insulin resistance, including the homeostasis model assessment of insulin resistance (HOMA-IR) and the trygliceride/high-density lipoprotein (HDL)-cholesterol (Tg/HDL) ratio in a cohort of adults without known diabetes or atherosclerotic cardiovascular disease.SUBJECTS/METHODS:Nine hundred and twenty-nine randomly selected participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire, and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 507 participants.RESULTS:A dietary pattern that could be defined as unhealthy (high consumption of soft drinks, fried foods, seed oils, cured meats, butter, red meat and sweets) was identified in 21% of the cohort, whereas 34% of the cohort exhibited a dietary pattern that resembled the Mediterranean diet (high intakes of fruit, milk and cheese, olive oil, vegetables, pasta and bread). Intermediate habits characterized the remaining 45%. After adjusting for age, body mass index (BMI), waist circumference, glycated hemoglobin (HbA1c) and hypertension on treatment, the Mediterranean dietary pattern was associated with significantly lower HOMA-IR (β-coefficient=-0.51; P=0.003). After adjusting for gender, BMI and HbA1c, the unhealthy dietary pattern was associated with a significantly higher Tg/HDL-cholesterol ratio (β-coefficient=0.43; P=0.006). No significant association was found between dietary patterns and carotid atherosclerosis.CONCLUSIONS:This study suggests that, independent of measures of adiposity, a Mediterranean dietary pattern is associated with lower insulin resistance.

Background: General practitioners (GPs) have to be considered as key figures of health promotion among health care workers since they are strongly asked to recommend influenza vaccination to their patients and perform on them. Despite this consideration, GPs have influenza vaccination rates that are significantly below the 75% coverage proposed by International Public Health guidelines. In order to increase future coverage of influenza vaccination within GPs, and through them within the population, the aim of this study was to assess determinants associated with influenza vaccine uptake among GP trainees. Methods: A survey was carried out on GP trainees attending the training course in Community Medicine of Western Sicily (Italy). Each participant was interviewed via an anonymous self-administered questionnaire which included questions on attitudes, behaviours and perceptions regarding influenza and influenza vaccination. Results: Vaccination coverage was 26.2% for seasonal 2008-2009 influenza, 20.0% for pandemic A (H1N1) influenza and 18.7% for seasonal 2009-2010 influenza. Considering themselves as a high risk group for developing influenza was significantly associated with seasonal 2009-2010 influenza vaccine (adj-OR 2.35). Vaccination for seasonal 2009-2010 influenza (adj-OR 1 063), pandemic A (H1N1) influenza (adj-OR 16.77) and seasonal 2010-2011 influenza (adj-OR 38.08) were significantly more frequent in GP trainees who had been vaccinated more than three times in the previous five influenza seasons. Conclusion: Influenza vaccine uptake among GP trainees is more a habit than a professional responsibility, and influenza vaccination is still administrated to patients on the basis of GP trainees’ clinical evaluation or patient willingness. Multidisciplinary learning pathways may implement vaccination coverage in the attempt to modify the current GP trainees’ attitude towards recommended influenza vaccination.

In Italy, the introduction of Universal Varicella Vaccination (UVV) has been decided but postponed, as a national programme, until 2015, when data from Regions which have already implemented it will be available. Starting from 2003, eight Italian Regions (Basilicata, Calabria, Friuli Venezia Giulia, Apulia, Sardinia, Sicily, Tuscany and Veneto) have progressively introduced UVV, in their immunization programme, with different schedules in children aged 13–15 months and 5–6 years, currently a two-dose schedule is adopted by all Regions. In June 2013, an Interregional Group on Varicella Vaccination (IGVV) has been established in order to assess the effectiveness of varicella vaccination with standardized and shared tools. The aim of this study was to evaluate the impact of varicella vaccination on the incidence and hospitalizations due to varicella and its complications in the period 2003–2012 in order to support the Italian decision makers on the future national adoption. Preliminary data showed that a general reduction of incidence and hospitalization rates was observed in the study period, resulting in relevant savings for the National Health Service. Immunization coverage with first dose at 24 months of age was high in all Regions (84%–95%) in 2012. Adverse events due to varicella vaccines were rare and without permanent sequelae. Underreporting of varicella cases and delays in the administration of the first dose of varicella vaccines were the main critical issues. In conclusion, solid evidences in support of universal UVV arise from the experiences available today in Italy.

S.pneumoniae is a major cause of morbidity and mortality among children globally. Since 2007 the World Health Organization has recommended anti-pneumococcal vaccination to reduce the burden of invasive pneumococcal diseases (IPD). The aim of this study was to estimate the incidence of IPD in Sicilian children and describe the distribution of serotypes in subjects with IPD following the recent introduction of a universal vaccination program. Active surveillance of IPD (PneumoNet) was carried out in Sicily from 2009 to 2011 by nine reference hospitals (one per province) and one-hundred randomly sampled family pediatricians. Hospital discharge data of participating hospitals were also analyzed and compared with regional surveillance data. During the three-year surveillance period, 136 children with a M/F ratio of 1.03 and a median age of 23.5 months (range 1-57 months), were included in the study (14 in 2009, 66 in 2010 and 56 in 2011). Of the 136 subjects, 43 (36.1%) were recruited from FPs whereas 93 (63.9%) from hospital personnel. Overall, 9 children (6.6%) were positive for IPD. S. pneumoniae serotype 19A was isolated from three children, serotype 15C from three, and serotype 23F from one child. Hospital discharge data from 2009 to 2011 showed that a diagnosis of IPD was reported for 18 of 2,663 subjects, with decreasing annual trend from 1.1% in 2009 to 0.3% in 2011 (Chi-square for trend p=0.063). In conclusion, PneumoNet is shown to be an effective tool for identifying children with IPD. The estimated incidence of IPD in Sicily is lower than that observed in other Italian and European regions, especially before vaccine introduction. These results indicate a good level of pneumococcal disease control in the Sicilian population below 5 years of age and support the implementation of an universal vaccination program. Considering the emergence of serotypes 19A PCV13 vaccine may offer some advantages with respect to the seven-valent pneumococcal conjugate vaccine (PCV7) which does not include 19A.