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OBJECTIVE: The aim of this study was to assess the synergistic effect of non-adherence to the Mediterranean Diet (MD) and lifestyle habits on the occurrence of breast cancer (BC). PATIENTS AND METHODS: A case-control study was carried out from September 2018 to February 2019 at the Teaching Hospital “Umberto I” in Rome. A Food Frequency Questionnaire was used for assessing the level of adherence to MD, the IPAQ Questionnaire to measure physical activity, and AUDIT-C to estimate alcohol consumption. The possible interaction between risk factors was tested using the synergism index. RESULTS: A total of 94 cases and 88 controls were enrolled (median age 55.8 for cases and 57.9 for controls). The MD Score over 6 was associated with low odds of having breast cancer (OR = 0.29; 95% CI: 0.12-0.69). There is a clear indication for the additivity and synergism between non-adherence to MD and many risk factors on the occurrence of BC: current smoker (S = 2.02; 95% CI 0.62-8.07), physical inactivity (S = 2.14; 95% CI 0.71 2-8.28) and alcohol consumption (S = 3.02; 95% CI 0.91-12.95). CONCLUSIONS: Primary prevention of BC can benefit from intervention targeting nutritional and lifestyle factors that act synergistically. [ABSTRACT FROM AUTHOR]

Background Prevalence of overweight and obesity during childhood is still elevated in high-income countries. GiochiAMO is a health promotion program that uses knowledge-based education and games to teach healthy nutrition and physical activity among children (6–8 years old). Methods This study was a single arm field trial. Second and third grade classes of primary school attended an oral presentation about nutrition and physical activity and then were involved in three game sessions. Two multiple-choice questionnaires were administered at the beginning and at the end of the trail. The following scores were measured: nutrition behavior score (NTs), physical activity behavior score (PAs) and delta score (Ds). Wilcoxon, T -test and Mann Whitney were used to perform the univariate analysis. Results A total number of 74 and 76 children participated in the physical activity and nutrition interventions. NTs was 4.17 (SD: 2.23) before and 5.03 (SD: 2.79) after the intervention (P  = 0.005). PAs was 27.4 (SD: 9.6) before and 30.5 (SD: 10.7) after the intervention (P  = 0.003). No significant differences were obtained comparing males and females for all scores. Ds was 0.86 for nutrition and 3.1 for physical activity. Univariate analysis of Delta scores obtained no significant differences. Conclusions The present results confirm the effectiveness of 'GiochiAMO' to change nutrition and physical activity behavior. [ABSTRACT FROM AUTHOR]

Background Renal transplant is the gold standard treatment for patients with end-stage renal disease. Employment after transplant is an important marker of recovery and a key component of general well-being with important social implications. Aims To evaluate employment status after renal transplant and to investigate facilitators of and barriers to return to work for renal transplant patients. Methods We searched PubMed, Scopus and the Cochrane Library in March 2019 using the following algorithms: 'return to work' AND kidney AND transplant. Eligible studies were selected by two independent researchers. Quality assessment was performed using the following tools: International Narrative Systematic Assessment (INSA) and Newcastle–Ottawa Scale (NOS) for cross-sectional and cohort studies. Results The review included 18 papers: 10 cross-sectional studies, 6 cohort studies and 2 narrative reviews. The weighted mean percentage for return to work within 1 year was 39.4% (95% CI 39.3–39.6%). Employment status was influenced by modifiable and non-modifiable factors, such as pre-transplant employment, sociodemographic characteristics, clinical conditions and comorbidities, operative technique (invasive or not), type of transplants (living donor or cadaver), pre-transplant dialysis, psychosocial support, educational level and participation in education programmes. Conclusion Return to work after kidney transplant is a dynamic process influenced by numerous factors. It is vital to implement multidimensional interventions focused on rehabilitation and influencing modifiable factors to improve return to work after kidney transplant. This systematic review updates knowledge in the field of transplant and of disability management. [ABSTRACT FROM AUTHOR]

Aims. The aim of the study was to investigate the frequency, type, causes and consequences of violence and aggression experienced by Emergency Department workers during their interactions with patient, their relatives or companions and whether the phenomenon of violence at work is a specific risk factor predicting stress and possible stress related pathologies in emergency health workers. The study proposes a model of effective intervention for the prevention and management of violence and stress. Methods. A cross-sectional retrospective study was performed with a sample of 323 healthcare workers at Department of Emergency and Acceptance of Level II and the Psychiatric Services of Diagnosis and Care of the University Hospital Policlinico Umberto I, in Rome, Italy, between June 2016 and February 2017. Data collection was conducted by a psychiatrist by means of a questionnaire method administered to each participant and by carrying out individual interviews. The two questionnaires used, both the Health Violence Questionnaire (QVS) and the Workers' Stress Perception Questionnaire (SPQR) were designed ad hoc, after some test sessions intended for the creation of their content. Results. Eighty-seven percent of emergency healthcare workers experienced workplace violence by patients or their relatives. More than half of healthcare workers reported multiple consequences on their emotional sphere, in particular female healthcare professionals and all those who have suffered frequent incidents of violence. Regarding the effects on lifestyle, one third reported an increase in consumption of tobacco, food and sleep disorders and changes from social relationships to social isolation and avoidance of some places. More than one third of healthcare workers reported consequences on their well-being and health, especially the female workers. Distress was associated with frequent workplace violence. Healthcare workers who experienced frequent violence indicated lack of support from hospital administration and ED management as barriers to reporting workplace violence. Conclusions. The study confirms the diffusion of the workplace violence by patients and/or their relatives against the emergency healthcare professionals, related to the gender, the professional qualification, the role in the organization and the workplace. Almost all male and female healthcare workers reported they had suffered the effects on lifestyle, working habits and wellbeing and health following the workplace violence. Precipitating factors to violent incidents identified by healthcare professionals are consistent with the research literature. Commitment from hospital administrators, ED managers and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED healthcare workers. Our study emphasizes the importance of analyzing, in addition to general job demands, the specific job demands such as the phenomenon of violence, considered a key risk factor, predictor of stress and possible mental disorders in healthcare workers operating in high-risk environments. This study confirms the importance of application of the modified model by Brough and Biggs of integrated multidimensional intervention on the prevention and management of workplace violence and work stress and shall be implemented on all three levels: individual, organizational and situational. The study also highlights the need to implement support strategies for the victims of violence. [ABSTRACT FROM AUTHOR]

Background. Improvements in breast cancer diagnosis and treatment led to an increased incidence of survivors' rate. The healthcare system has to face new problems related not only to the treatment of the disease, but also to the management of the quality of life after the diagnosis. The aim of this study was to validate the Italian version of the Functional Assessment of Cancer Therapy - Breast (FACT-B+4) questionnaire and to evaluate its reliability. Methods. The questionnaire was administered twice, with an interval of three days between each administration, to a cohort of women of the Breast Surgical Unit, PoliclincoUmberto I. Cronbach's alpha was used as a measure of the internal consistency of the Italian version. Results. The Italian version of the tool was administered to 55 subjects. The Cronbach's alpha for most scores registered values >0.7, both at baseline and at the follow-up analysis, therefore the subscale showed good internal consistency. Conclusions. The Italian version of FACT-B+4 demonstrated acceptable reliability properties in the Breast Unit patients. The use of this questionnaire seemed to be effective and in line with the results derived from the English and Spanishversions. Internal consistency and validity had similar performance results. [ABSTRACT FROM AUTHOR]

Background: Higher survival rates for breast cancer patients have led to concerns in dealing with short- and long-term side effects. The most common complications are impairment of shoulder functions, pain, lymphedema, and dysesthesia of the injured arm; psychological consequences concern: emotional distress, anxiety, and depression, thereby, deeply impacting/affecting daily living activity, and health-related quality of life.Objective: To perform a systematic review for assessing the efficacy or effectiveness of interventions aiming at improving health-related quality of life, return to daily activity, and correct lifestyles among breast cancer patients.Methods: A literature search was conducted in December 2016 using the databases PubMed and Scopus. Search terms included: (counseling) AND (breast cancer) AND (quality of life). Articles on counseling interventions to improve quality of life, physical and psychological outcomes were included.Results: Thirty-five articles met the inclusion criteria. The interventions were grouped in five main areas: concerning lifestyle counseling interventions, related to combined interventions (physical activity and nutritional counseling), physical therapy, peer counseling, multidisciplinary approach, included psychological, psycho-educational interventions, and cognitive-behavior therapy (CBT). Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength. Psychological therapies such as psychoeducation and CBT may help to realize a social and psychological rehabilitation.Conclusion: A multidisciplinary approach can help in sustaining and restoring impaired physical, psychosocial, and occupational outcomes of breast cancer patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the methodological quality of systematic reviews published in occupational medicine journals from 2014 to 2021. Methods: Papers edited between 2014 and 2021 in the 14 open access journals with the highest impact were assessed for their quality. Studies were included if they were systematic reviews and meta-analyses, and if they were published in English. Results: The study included 335 studies. Among these, 149 were meta-analyses and 186 were systematic reviews. The values of the AMSTAR-2 score range between three and fourteen with a mean value of 9.85 (SD = 2.37). The factors that significantly and directly associate to a higher AMSTAR-2 score were impact factor (p = 0.003), number of consulted research databases (p = 0.011), declaration of PRISMA statement (p = 0.003), year of publication (p < 0.001) and performing a meta-analysis (p < 0.001).The R² values from the multivariate analysis showed that the AMSTAR-2 score could be predicted by the inclusion of these parameters by up to 23%. Conclusions: This study suggests a quality assessment methodology that could help readers in a fast identification of good systematic reviews or meta-analyses. Future studies should analyze more journals without applying language restrictions and consider a wider range of years of publication in order to give a more robust evidence for results.

Summary: Background. Disability Management (DM) was born to improve workers' health and to optimize return to work for people with disabilities. Objectives. The objective of this study was to elaborate a review of reviews published in literature on the use of Disability Management in international contexts and the strategies used to facilitate the return to work for individuals with cronic disabilities or post injury. Methods. The present review was carried out by consulting the Pubmed and Scopus database from 1994 to January 2021, according to the PRISMA guidelines. Initially, the duplicates were removed. Then, the eligible studies were selected through a multistep approach (title evaluation, abstract and full-text). The systematic reviews were evaluated using the AMSTAR method, while for the narrative reviews the INSA scale was used. Results. The research produced 186 results. Following the removal of the duplicates and articles with no available or not pertinent full text, 51 reviews were included: 17 systematic and 34 narrative. The analyzed studies were related to the DM policies of the United States, Canada and UK. Ten topics emerged, the most frequent ones including: possible solutions to adopt in the event of workers with musculo-skeletal diseases (50% of the studies); legal matters regarding issues of mental health and stress (41.2%). The quality of the articles was generally high. Discussion. The systematic review showed that the research activity on DM is conducted mainly in the Anglo-Saxon world. This review can give some interesting insights for the full implementation of DM at the national level., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

Hepatitis B virus (HBV) infection is one the most common in the world. Aim of this study is to perform a systematic review on the relationship between HBV vaccination and multiple sclerosis. Research was conducted on Pubmed, ISI Web of Science, and Scopus. Terms " hepatitis b vaccination " and " multiple sclerosis " were used. Meta-analysis and metaregression were performed. 414 papers were found. Seven articles were selected. For the reported crude risk estimates for MS no statistically significant association was observed with pooled OR 1,19 (95%CI: 0,96-1,49). For the adjusted ORs, the pooled odds ratio (OR) was 0, 965 (95%CI: 0,886- 1,051). Meta regression show that year of publication is negatively (β: -0,019; P < 0.001) and NOS score and publishing in Europe are positively associated with O.R. value. Funnel plot showed the presence of publication bias. Results showed that Hepatitis B vaccination is not associated with an increased risk of developing MS.

Objectives: The objective of this study was to measure the burden of burnout in a sample of healthcare workers (HCWs) consisting of general practitioners, professors from the Faculty of Medicine and Surgery, nurses, medical students and nursing students., Study Design: Cross-sectional questionnaire survey., Methods: A descriptive analysis was carried out, using averages, medians, standard deviations (SD) and ranges for quantitative variables. Univariate, bivariate and multivariate analyses were also performed., Results: In total, 535 HCWs completed the survey. Multivariate analysis shows that increasing age (β = -0.183; P = 0.047), being a university professor (β = -0.118; P = 0.001), having a high physical score (β = -0.370; P < 0.001) and a high mental score (β = -0.574; P < 0.001) resulted in less personal burnout. Low work burnout was associated with being a student (β = -0.144; P < 0.001), a university professor (β = -0.146; P < 0.001), having a high physical score (β = -0.366; P < 0.001) and having a high mental score (β = -0.648; P < 0.001). Being female (β = -0.122; P < 0.001), a university professor (β = -0.333; P = 0.001), a student (β = -0.433; P < 0.001), having a high physical score (β = -0.26; P < 0.01) and having a high mental score (β = -0.460; P < 0.001) were predictors for reduced client burnout. However, high client burnout was seen in individuals who had a commuting time >30 min (β = 0.084; P = 0.012) predicts., Conclusions: This study shows that burnout is an important issue among HCWs and that prevention strategies must be considered, with a particular focus on physical and mental health., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: A high level of organizational well-being improves employee performance and influences the physical and mental health of healthcare providers and students., Objective: This study investigates the relationship between the work context, organizational well-being, and the psychophysical health of healthcare providers., Methods: A multicentre cross-sectional descriptive study was conducted on a sample of healthcare providers (physicians and nurses) and healthcare students (medical students and nursing students). A self-report questionnaire was administered between September and November 2016. -Results: Of the 300 questionnaires administered, 201 (67%) were correctly completed. Overall, both the physical and mental health of the healthcare providers and students are explained by the variables of the organizational context: organizational well-being and socio-demographic/work characteristics. In particular, the results show a dependence on gender and age. Furthermore, decision latitude had a positive effect on physical health (b=.134) while job demands had a negative effect (b=-.160) explaining 21% of the PCS of the healthcare providers and students (R2=.209). Mental health improved via the satisfaction (b=.345), and positivity (b=.222) of healthcare professionals and students of these disciplines., Discussion: The results are significant because they directly impact the quality of care provided as well as patient safety.

The aim of the study was to investigate the presence of subclinical vascular damage in polymyalgia rheumatica (PMR). We enrolled PMR patients having major cardiovascular risk factors (MCVRF) and, as controls, patients with MCVRF. All underwent: color Doppler ultrasound to evaluate the common carotid intima-media thickness (IMT), the anterior-posterior abdominal aortic diameter (APAD), and the prevalence of carotid artery stenosis; the cardio-ankle vascular index (CAVI) to measure arterial stiffness together with the ankle-brachial index (ABI) to investigate the presence of lower-extremity peripheral arterial disease. Finally, we measured the serum levels of adipocytokines implicated in vascular dysfunction. As a result, 48 PMR and 56 MCVRF patients were included. An increase of IMT (1.07/0.8-1.2 vs 0.8/0.8-1.05; p = 0.0001), CAVI (8.7/7.8-9.3 vs 7.6/6.9-7.8; p < 0.0001) and APAD values (21.15/18.1-25.6 vs 18/16-22; p = 0.0013) was found in PMR patients with respect to controls. No differences were reported in the prevalence of carotid artery stenosis or ABI values between the two groups. A significant correlation between IMT and CAVI in PMR and MCVRF subjects (r 2  = 0.845 and r 2  = 0.556, respectively; p < 0.01) was found. Leptin levels (pg/mL; median/25th-75th percentile) were higher in PMR than in MCVRF subjects (145.1/67-398.6 vs 59.5/39.3-194.3; p = 0.04). Serum levels of adiponectin (ng/mL) were higher in PMR patients (15.9/10.65-24.1 vs 6.1/2.8-22.7; p = 0.01), while no difference in serum levels of resistin (ng/mL) was found between PMR and MCVRF subjects (0.37/0.16-0.66 vs 0.26/0.14-1.24). Our study shows an increased subclinical vascular damage in PMR patients compared to those with MCVRF, paving the way for further studies aimed at planning primary cardiovascular prevention in this population.

Background: Vaccines simulate the first contact with infectious agents and evoke the immunological response without causing the disease and its complications. High rates of immunization among the population guarantee the interruption of the transmission chain of infectious diseases. Therefore, the population should be aware of the value of vaccination and motivated. In order to implement the spread of a correct culture about these issues, schools were recognized as a privileged operational setting. The aim of this project was to transmit knowledge and convey educational messages on the importance of vaccines, through the use of games, in elementary school children, their families and teachers., Materials and Methods: A field trial study was implemented between April and October 2019. Sample size calculations highlighted the need to recruit at least 136 students in the schools. The intervention involved 10 classes (five first grade and five s grade classes) and was structured in frontal teaching sessions and gaming sessions. Knowledge was assessed comparing the results of a questionnaire administered before and after the intervention. The questionnaires referred to the following items: dangerousness of bacteria and viruses; capability of defending from microorganisms; the role of antibodies; functioning of the vaccine in a child; type of disease for which a vaccine is efficacious; duration of a vaccine; mother- child transmission of antibodies; herd immunity., Results: 143 children participated in all the phases of the study. The comparison between the scores at the beginning and end of the intervention showed a significant increase in the knowledge about vaccines and immunity. The mean knowledge score arose from 3.52 (SD = 1.67) to 5.97 (SD = 1.81)., Conclusions: This study suggests that the use of games in an elementary school effectively increase the knowledge related to the important topic of vaccination starting at childhood.

Objectives: To evaluate the efficacy of the "GiochiAMO" prevention program on modifying children's knowledge and belief regarding the use and abuse of alcohol and tobacco smoking. Materials and Methods: "GiochiAMO" is a multicomponent single-arm field trial based on card and board games to teach and enhance knowledge about risk factors related to smoking and alcohol consumption. A structured questionnaire was administered before and after the intervention to assess any change in knowledge. Results: A total of 167 students between 9 and 11 years of age took part in the intervention. Data concerning knowledge about cigarette smoking showed a statistically significant improvement ( P  = 0.008) with an increase of the mean scores from 5.93 (standard deviation [SD] = 2.05) to 7.90 (SD = 2.03). The scores related to the life skills of the intervention performed in the fourth grade classes demonstrated statistically significant improvements ( P  = 0.027). The scores related to the knowledge about alcohol consumption highlighted a statistically significant improvement ( P  < 0.001), with mean scores that rose from 7.44 (SD = 1.99) to 9.41 (SD = 1.94). The scores related to the life skills of the intervention performed in the fifth grade classes demonstrated improvements, although they were not statistically significant ( P  = 0.770). Conclusions: "GiochiAMO" demonstrated significantly improved knowledge about the risk and consequences of cigarette smoking and alcohol consumption on health. Longer follow-up studies, including a larger sample size, will be needed.

Summary: Background. The phenomenon of accidents during the university course is a public health problem. Students spend a lot of time at university and in structure for training. This this leads them to be exposed to biological, chemical and ergonomic risk of accidents or occupational diseases. Aim. The aim of this study is to describe accidents that occurred to students of Sapienza University in Rome during the period 2010-2015. Materials and Methods. Retrospective study conducted on a cohort of students from Sapienza University in the years 2010-2015. As a source of data was used register of accidents reported by the students. Results. During the period considered, injuries were recorded in 791 students, mainly female (71.8%). Nursing students were the most affected (92.8%), followed by medical students (5.7%) and finally students of other faculties (1.5%). Point wounds were the most frequent (n=462) representing 58.4% of the total and occur mainly at the wrist and hand (n=380); the second most frequent type of injury is contact with biological liquid (n=159) followed by contusions (n=72), the most affected site in this case are the head and the face (n=81; n=23). Contusions often also involve multiple regions (n=17). In lesser numbers there are also the distortions (n=55), and fractures (n=26) the most frequent first ankle and foot (25.5%), the second most frequent wrist and hand (34.6%) The incidence of accidents ranged from 0.079% in 2011 to 0.161% in 2012. Conclusion. There is a need to design measures for more intensive specific training on biomedical students, especially nursing students, as the most exposed category, in order to reduce the accident phenomenon. Particular attention should be paid to the safe handling of sharp objects. It would be beneficial to include in the course of teaching lessons aimed at security and greater awareness of the risk., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

The concentration of road transport emissions impacts on air quality, is responsible for climate change and increases the average temperatures. The aim of this study was to analyze the trends of atmospheric emissions within the road transport sector in Italy between 1990 and 2016. A principal component analysis (PCA) was carried out to investigate the pollutants that showed similar trends over time. The Kendall's rank correlation coefficient was studied to establish the statistically dependent variables. Finally, a joinpoint regression analysis was performed to evaluate the time-trends of pollutants' emissions. The Pearson's correlation coefficients were positive for all pollutants except for CO 2 , that demonstrated an inverse relationship with CH 4 (-0.07), NOx (-0.089) and NMVOC (-0.128); NO 2 demonstrated inverse relationship with all other pollutants. According to the main component analysis, most pollutants were assimilable in their behavior, except for NO 2 , CO2 and N 2 O. The joinpoint analysis describes a general decrease of emissions over time with exception of N 2 O, NO 2 and CO 2 , that showed different trends. This study shows that road traffic-related emissions in Italy, between 1990 and 2016, recorded significant reductions for most of the recorded pollutants. However, CO 2 and N 2 O maintained a stable trend while NO 2 showed an increasing trend., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Aggressions to healthcare personnel are a growing and underestimated phenomenon. The damage to the individual and to the community is real, since the assaults increase work stress and can also lead to sickness absence. Moreover, the consequences on the quality of care and economic repercussions need to be taken into account., Objective: To estimate the prevalence of violence towards medical personnel of the College of Physicians and Surgeons of Rome and to evaluate its association with socio-demographic variables., Methods: Cross-sectional study. espondents completed an online questionnaire composed of 30 questions on personal information, work, any aggression suffered and opinions about the phenomenon. Descriptive statistical analysis, univariate, bivariate and multivariate analyses were performed., Results: Out of 956 responders, 66.5% experienced at least one episode of aggression during their working life. Women were more likely victims than men (71%), especially due to verbal aggression (OR 1.53, 95%CI: 1.16-2.02). Age acts as a protective factor (OR 0.97; 95%CI: 0.96-0.99). The subjects with a full time position (OR 2.1; 95%CI: 1.46-3.05) seem to be more at risk. In addition, the doctors employed in the territorial structures of the National Health System (OR 2.08; 95%CI: 1.36-3.18), as well as in the local emergency services (OR 3.39; 95%CI: 1.14-10.05) and in social security institutions (OR 9.58; 95%CI:1.2-76.41) were more at risk., Conclusions: The results of this study reveal that the phenomenon of aggression is not negligible, and that awareness on the issue and staff training is essential.

Objectives: Working in such circumstances can lead to a typical emotional stress called "burnout". The aim of this study was to evaluate the perceived state of physical and mental health, and verify the existence of burnout among health care workers of Hematology unit in a Teaching Hospital., Methods: Anonymous questionnaires were administered to healthcare professionals (physicians, nurses, health care workers). It includes socio demographic variables, the Maslach Burnout Inventory (MBI) and SF12 also. The MBI captures three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (RP); whereas the SF12 defines two quality of life scores: Mental Score (MCS) and Physical Score (PCS)., Results: Of 120 operators 70 individuals responded to the study. The questionnaire shows that the burnout levels were high in the followed part of the sample: 40% have high level of EE; 24% of DP; 15% of RP. The correlation analysis between SF12 and MBI undelines followed significance: r = -0.576 with p minor than 0.001 between EE and MCS; r = 0.557 with p minor than 0.001 between EE and DP. The three multivariate analysis refer that: the EE is associated indirectly to PCS and MCS with p mionr than 0.05; the DP is directly and significantly (p minor than 0.05) associated to MCS, "years of work" and to female gender. The RP dimension no underlines significant associations with variables studied., Conclusions: The findings were consistent with the type of work and assisted patients (chronic patient, often with poor prognosis and low expectations in terms of care and survival) that contribute to stressful situations. Personal fulfillment, instead, seems to be quite high in this contest. The relatively small sample couldn't represent the world of health care workers in hematological units, but there is no doubt that a systematic assessment of burnout, to investigate the causes of burnout are main elements to identify the potential solutions to address the phenomenon. Additional investigations of the MBI dimensions using biggest samples would be useful to confirm the results in order to generate burnout reduction measures by institutional and national policies., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

Objectives: to estimate the effect on the return to work of patients with neoplastic colorectal disease. Specifically, it was assessed whether and how the return to work affects the quality of life, and the psychological and social sphere of patients with colorectal carcinoma., Design: in June 2018, a systematic review of the literature was performed, investigating the Medline (PubMed) and Scopus databases., Setting and Participants: the studies included in the review focused on patients with a diagnosis of colorectal cancer as a test population., Main Outcome Measures: return to work in patients with a diagnosis of colorectal cancer., Results: after the screening process, 10 articles were included in the research: • 6 studies assessed the effects that work and return to employment have on patients diagnosed with cancer; • 1 study assessed the effects of the disease and treatments on personal finances; • 1 study assessed the influence of medical treatments on the ability to return to work; • 1 study assessed the effect of the diagnosis of cancer on employment; • 1 study assessed the management of cancer diseases by employers. The included studies show a significant impact on the subjects' emotional sphere, with repercussions on employment levels that fall from 39% to 31% in the first 15 months after diagnosis. Complications and critical issues related to therapeutic pathways influence private finances. When compared to healthy subjects, cancer patients show a greater reduction in expenses for food or clothing (39% vs. 27%; p=0.001) and a higher probability of requiring loans (18% vs. 11%; p=0.007)., Conclusion: among the interventions that protect the well-being of the patient after the tumour disease, the returning to work is a crucial aspect. The impact that employment has on the quality of life of the patient and on the achievement of economic and social well-being for the individual and for the community are important.

Aims: The aim of the study was to investigate the frequency, type, causes and consequences of violence and aggression experienced by Emergency Department workers during their interactions with patient, their relatives or companions and whether the phenomenon of violence at work is a specific risk factor predicting stress and possible stress related pathologies in emergency health workers. The study proposes a model of effective intervention for the prevention and management of violence and stress., Methods: A cross-sectional retrospective study was performed with a sample of 323 healthcare workers at Department of Emergency and Acceptance of Level II and the Psychiatric Services of Diagnosis and Care of the University Hospital Policlinico Umberto I, in Rome, Italy, between June 2016 and February 2017. Data collection was conducted by a psychiatrist by means of a questionnaire method administered to each participant and by carrying out individual interviews. The two questionnaires used, both the Health Violence Questionnaire (QVS) and the Workers' Stress Perception Questionnaire (SPQR) were designed ad hoc, after some test sessions intended for the creation of their content., Results: Eighty-seven percent of emergency healthcare workers experienced workplace violence by patients or their relatives. More than half of healthcare workers reported multiple consequences on their emotional sphere, in particular female healthcare professionals and all those who have suffered frequent incidents of violence. Regarding the effects on lifestyle, one third reported an increase in consumption of tobacco, food and sleep disorders and changes from social relationships to social isolation and avoidance of some places. More than one third of healthcare workers reported consequences on their well-being and health, especially the female workers. Distress was associated with frequent workplace violence. Healthcare workers who experienced frequent violence indicated lack of support from hospital administration and ED management as barriers to reporting workplace violence., Conclusions: The study confirms the diffusion of the workplace violence by patients and/or their relatives against the emergency healthcare professionals, related to the gender, the professional qualification, the role in the organization and the workplace. Almost all male and female healthcare workers reported they had suffered the effects on lifestyle, working habits and wellbeing and health following the workplace violence. Precipitating factors to violent incidents identified by healthcare professionals are consistent with the research literature. Commitment from hospital administrators, ED managers and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED healthcare workers. Our study emphasizes the importance of analyzing, in addition to general job demands, the specific job demands such as the phenomenon of violence, considered a key risk factor, predictor of stress and possible mental disorders in healthcare workers operating in high-risk environments. This study confirms the importance of application of the modified model by Brough and Biggs of integrated multidimensional intervention on the prevention and management of workplace violence and work stress and shall be implemented on all three levels: individual, organizational and situational. The study also highlights the need to implement support strategies for the victims of violence.

Background: The aim of this study is to analyse the correlation between regional values of Gross Domestic Product (GDP) and passive smoking in Italy., Methods: The outcome measures were smoking ban respect in public places, workplaces and at home, derived from the PASSI surveillance for the period 2011⁻2017. The explanatory variable was GDP per capita. The statistical analysis was carried out using bivariate and linear regression analyses, taking into consideration two different periods, Years 2011⁻2014 and 2014⁻2017., Results: GDP is showed to be positively correlated with smoking ban respect in public places ( r = 0.779 p < 0.001; r = 0.723 p < 0.001 in the two periods, respectively), as well as smoking ban respect in the workplace ( r = 0.662 p = 0.001; r = 0.603 p = 0.004) and no smoking at home adherence ( r = 0.424 p = 0.056; r = 0.362 p = 0.107). In multiple linear regression GDP is significantly associated to smoking ban respect in public places (adjusted β = 0.730 p < 0.001; β = 0.698 p < 0.001 in the two periods, respectively), smoking ban in workplaces (adjusted β = 0.525 p = 0.020; β = 0.570 p = 0.009) and no smoking at home (adjusted β = 0.332 p = 0.070; β = 0.362 p = 0.052)., Conclusions: Smoking ban is more respected in Regions with higher GDP. For a better health promotion, systematic vigilance and sanctions should be maintained and strengthened, particularly in regions with low compliance with smoking bans.

Academics often have to face with burnout syndrome at work. This cross-sectional study evaluates the reliability of the Italian version of the Copenhagen Burnout Inventory (CBI) in a sample of Academics of Sapienza University of Faculty of Medicine and Pharmacy, through an online questionnaire composed of the CBI, SF12 Health Survey, and Positivity Scale. Univariate, bivariate, multivariate analyses, and Cronbach α coefficients of CBI were performed. Ninety-five participants completed the questionnaire (response rate 85%). Cronbach's α of the three domains were high (0.892, 0.868, and 0.836). Women, younger and part time professors reported higher score in personal ( p = 0.025; 0.060) and work burnout. In multivariate analysis decreasing age (β = -0.263; p = 0.001); being a professor in environmental technicians (β = -0.120; p = 0.098); and low mental (β = -0.263; p = 0.020), physical (β = -0.319; p ≤ 0.001) and positivity scores (β = -0.237; p = 0.031) predict significantly higher personal burnout. Low physical (β = -0.346; p < 0.001) and mental (β = - 0.249; p = 0.013) positivity (β = -0.345; p = 0.001) scores; fewer years of work (β = -0.269; p ≤ 0.001); and being a medical or nursing professor (β = 0.169; p = 0.016) predicts high work burnout. Low MCS predicts a high level of student burnout. Results suggest that the Italian version of the CBI is a reliable instrument. Further research should focus on the prevalence of burnout in academics.

Background: Young people who begin to smoke at an early age are at a higher risk of becoming occasional or regular smokers and establishing a premature dependence. It is fundamental to act as soon as possible, from very early childhood, to prevent harmful behaviors for health such as smoking and drinking alcohol. Young people must be encouraged to adopt healthy lifestyles., Objectives: The aim of the study is two-fold. First, increasing the knowledge about the negative health effects of cigarette smoking and alcohol consumption among children aged 9-10 years; and second, to introduce and reinforce life skills in order to learn how to tackle social influences that encourage children to smoke and to drink alcohol., Methods: A pilot randomized field trial was conducted in May-June 2017. Four primary school classes in Rome were randomized to either the intervention or the control group. Both groups participated in an oral presentation about the risks and consequences of smoking and alcohol consumption, and the concept of life skills. The intervention group participated in two gaming sessions, each lasting 1.5 hours. Children were involved in six games aiming to deliver and reinforce knowledge about the target themes of the study. A 21 multi-response questions questionnaire was handed out to both groups at the beginning and at the end of the study. Eleven questions were about smoking; five questions about alcohol; five questions about life skills. Each question item included one correct answer. For each domain, a score was computed (total; smoking; alcohol; life skills)., Results: 67 children participated in the study (34 in the intervention and 33 in the control group). Univariate analyses showed significant differences among the intervention group before and after the intervention for total score (p<0.001), smoke score (p<0.001), and life skills score (p=0.003). No significant differences among the intervention group before and after the intervention were reported for alcohol score (p=0.076). Regarding the control group univariate analysis showed significant differences in total score (p=0,001) and life skills score (p=0.005). Multivariate analysis revealed that enrollment in the intervention was the only variable that had a significant positive influence on smoking knowledge score (beta=1.070, p=0.05)., Conclusion: This pilot study shows that the intervention was effective among the intervention group for all the scores: total score, smoke score and life skills score, but ineffective for alcohol. Overall, the combination of a presentation and games was effective in increasing life skills knowledge.

The aim of this work is investigate relationship between health-related quality of life and work-related stress and the impact of gender, education level, and age on this relationship. A cross-sectional study was conducted among workers of various setting in Rome and Frosinone. Work-related stress was measured with a demand-control questionnaire and health-related functioning by SF (short form)-12 health survey. There were 611 participants. Men reported high mental composite summary (MCS) and physical composite summary (PCS). In multivariate analysis age, gender ( p < 0.001) and job demand (0.045) predicted low PCS. Low MCS predicted poor PCS. Job demand and educational level resulted negatively associated with MCS. In an analysis stratified for age, gender, and educational level, gender and age resulted effect modifier for MCS, gender and education level for PCS. In women increase of decision latitude predict ( p = 0.001) an increase in MCS; a low job demand predict high MCS in male ( p ≤ 0.001). In younger workers, a lower level of job demand predicted high MCS (<0.001). For PCS, gender and education level resulted effect modifier. In women, high decision latitude predicted higher PCS ( p = 0.001) and lower level of job demand results in higher PCS ( p ≤ 0.001). Higher educational level resulted predictor of low PCS. Management of risk about work-related stress should consider socio-demographic factors., Competing Interests: The authors declare no conflict of interest.

Health care workers (HCWs) in university hematology units (UHUs) face high job demand that can have adverse health effects. This cross-sectional study investigated the relationship between some job stressors and health-related quality of life among HCWs of 3 UHUs in Rome. Work-related stress was measured with the Demand-Control Questionnaire; health-related functioning with the mental component score (MCS) and physical component score (PCS) of the Short Form 12 Survey; positivity with the Positivity Scale. Data of 201 respondents were analyzed. Job demand was inversely associated with MCS (p = .05) and PCS (p = .049); job control was directly associated with PCS (p < .001) and MCS (p = .024). A high positivity scale score and high decision latitude score predicted high MCS and PCS. High job demand score predicted low MCS and PCS scores. Reduced job stressors and enhanced positive attitudes can improve HCWs' health-related quality of life.

Background: The aim of this study was to increase the knowledge of healthy eating, to encourage change in nutritional behavior in accordance with the Mediterranean diet and to promote physical activity in children aged 7 to 9 years and their parents in a school setting through the use of cards and board games of the project Giochiamo (Let us play)., Methods: This experimental randomized field trial enrolled children in a school setting. The trial consisted of two phases. The first phase, including both intervention and control groups, encompassed a informative session about the food pyramid and physical activity (PA) by experts of public health and preventive medicine. The second phase, including only the experimental groups, involved games focusing on the main concepts of the food pyramid and PA. A questionnaire was administered before the intervention and after one month in order to assess changing in knowledge and behavior scores., Results: Eighty-nine children were randomly allocated in the intervention (22 children of the fourth year, 22 children of the second year) and the control group (23 children of the fourth year, 22 children of the second year). The univariate analyses showed significant differences (p = 0,004) between intervention and control groups for behavior score after the intervention. In particular, in a stratified analysis classes of the second year showed significant differences for knowledge score (p = 0,005) and for behavior score (p = 0,002), resulting higher among the intervention group. No significant differences resulted in classes of the fourth year for both scores., Conclusions: The results of the Giochiamo project clearly demonstrate that the lecture and the games were effective to improve knowledge and behavior habits on the Mediterranean diet and PA. Second year students showed significant differences for knowledge and behavior score in comparison to fourth year students suggesting that, the earlier the intervention occurs, the better are the results in terms of improvement of knowledge and eating habits and PA behaviors.

Background: Several fatal cases of bodybuilders, following a myocardial infarction after long exposure to androgenic-anabolic steroids (AAS), are reported. In recent years, evidence has emerged of cases of heart failure related to AAS consumption, with no signs of coronary or aorta atherosclerosis. This study aims to further investigate the pathogenesis of the ventricular AAS-related remodeling performing immunohistochemistry (IHC)., Method: In order to examine innate immunity activity and myocytes and endothelial cell apoptosis, IHC analyses were performed on heart tissue of two cases of bodybuilders who died after years of supratherapeutic use of metelonone and nandrolone and where no atherosclerosis or thrombosis were found, using the following antibodies: anti-CD68, anti-iNOS, anti-CD163, anti-CD 15, anti-CD8, anti-CD4, anti-HIF1 α, and in situ TUNEL staining., Results: Results confirm the experimental findings of recent research that, in the absence of other pathological factors, if intensive training is combined with AAS abuse, myocytes and endothelial cells undergo apoptotic alterations. The absence of inflammatory reactions and the presence of an increased number of M2 macrophages in the areas of fibrotic remodeling confirm that the fibrotic changes in the heart are apoptosis-related and not necrosis-related., Conclusions: In conclusion, the study indicates that, in very young subjects with chronic hypoxia-related alterations of the heart, signs of a heart failure in the other organs and a history of AAS abuse, death can be ascribed to progressive heart failure due to the direct apoptotic cardiac and endothelial changes produced by AAS.

Introduction: Chronic diseases are the leading cause of death and disability in almost all over the world; in Europe causing over 9 million deaths per year according to WHO estimates. A promising health organization model for chronic disease management is represented by the Chronic Care Model (CCM). In the 12th district of the ASL Roma 2 since 4 years was implemented a CCM for the management of patients affected by diabetes and/or at high cardiovascular risk., Objective: Aim of this study is to evaluate the effectiveness of the Chronic Care Model (CCM) for the management of chronic disease in terms of mortality reduction, avoidable hospitalizations reduction and improvement of clinical parameters., Materials and Methods: A retrospective cohort study will involve patients of 12th district of the ASL Roma 2 affected by diabetes and at high cardiovascular risk assisted through the CCM. Their health outcomes will be compared with those of patients in the same clinical conditions, residents in the same district but not assisted with CCM. The sample will be composed by adults (> 18 years) with a diagnosis of diabetes mellitus type 2 (DM2) or metabolic syndrome and / or arterial hypertension (IT) and two or more risk factors. Outcomes will be mortality from all causes and from causes related to DM and IT, preventable hospitalizations as defined in the Prevention Quality Indicators (PQI) by the Agency for Healthcare Research and Quality, and 10 clinical parameters. The data sources will be the records of causes of death (RENCAM), the hospital discharge records (SDO) and information systems for primary healthcare., Conclusion: Data from the experience of CCM in Tuscany seem promising especially in the evaluation of patient satisfaction and clinical outcomes particularly on cardiovascular and neurological complications and long-term mortality.

More than ten years after law n. 40 of February 19, 2004 became effective, regulation on medically assisted reproduction has dramatically changed outlook. The authors report on the steps that led to these changes through Courts' rulings, the Supreme Court's verdicts and the European Court of Human Rights' decisions, as well as ministerial regulations and guidelines concerning medically assisted reproduction. The aforementioned jurisprudential evolution was set to reach a new balance between the embryo's right to its own dignity and the woman's right to health and freedom of self-determination in reproduction. No court ruling denies that embryos have also to be safeguarded. In fact, there are still numerous prohibitions, including using embryos for experimental purposes. Judges aim primarily at avoiding that embryos' rights overcome the right to parenthood. The authors review the legislation of the various European countries: some have adopted a legislation to regulate medically assisted reproduction, while others have developed in this field some recommendations or guidelines. This is why they call for enactment of a European law governing the implementation/operational methods of medically assisted reproduction in order to avoid the scourge of procreative tourism to countries that have a more permissive law.

A serene workplace environment can provide significant benefits to employees. The aim of the present study was to assess wellbeing of employees in a university department, by administering validated questionnaires (Karasek and INAIL) and to determine any similarities and / or differences. The sample consisted of 48 employees (22.9 % male and 77.1% female) in various job categories including doctors, biologists, nurses, and technical and administrative staff. Results obtained from the Karasek questionnaire allowed us to calculate the values of Decision latidude and Job demand. The intersection of the medians of the two components, respectively 56 and 30, allowed us to divide participants into four quadrants consisting of high "strain" workers, active and passive and low "strain" workers. Thirty seven percent of the sample was found to be at high risk of stress. Significant differences in responses were identified in relation to gender, age, job seniority and educational level. Responses to the two questionnaires compared favorably. Seventeen questions were compared, and for eleven of these there was sufficient agreement, with kappa test values comprised between 0.194 and 0.408 (p&lt;0.05). Results confirm that work-related stress is a relevant issue. Karasek and INAIL questionnaires, while investigating similar issues, should not be used alternatively but rather administered simultaneously.