Italian Medical Research Articles

Health Literacy, Vaccine Confidence and Influenza Vaccination Uptake among Nursing Home Staff: A Cross-Sectional Study Conducted in Tuscany.

The aim of this cross-sectional study is to address whether health literacy (HL) and vaccine confidence are related with influenza vaccination uptake among staff of nursing homes (NHs). It was conducted in Tuscany (Italy) in autumn 2018, including the staff of 28 NHs. A questionnaire was used to collect individual data regarding influenza vaccination in 2016–2017 and 2017–2018 seasons; the intention to be vaccinated in 2018–2019; as well as demographic, educational, and health information. It included also the Italian Medical Term Recognition (IMETER) test to measure HL and eight Likert-type statements to calculate a Vaccine Confidence Index (VCI). The number of employees that fulfilled the questionnaire was 710. The percentage of influenza vaccination uptake was low: only 9.6% got vaccinated in 2016–2017 and 2017–2018 and intended to vaccinate in 2018–2019. The VCI score and the IMETER-adjusted scores were weakly correlated (Rho = 0.156). At the multinomial logistic regression analysis, the VCI was a positive predictor of vaccination uptake. In conclusion, vaccine confidence is the strongest predictor of influenza vaccination uptake among the staff of NHs. The development of an adequate vaccine literacy measurement tool could be useful to understand whether skills could be related to vaccine confidence.

Organized to Cooperate: Logics and Professional Collaboration in an Italian Medical Home

Professional collaborations are influenced by Institutional logics and jurisdictional struggles at play in the specific healthcare system, especially in times of organizational change. I investigate professional collaborations pattern in an experimental medical home set up in Italy between 2013 and 2015. For this study, I conducted 36 semi-structured interviews corroborated by direct observations. My results highlight how today’s efficiency-oriented PSFs integrate instances of the former professional logics and other context-specific logics, creating an organizational-specific “mix” that guides interactions at the inter-professional level, helping to define or re- define collaborations inside these peculiar organizational forms.

Management of kidney cancer patients: 2018 guidelines of the Italian Medical Oncology Association (AIOM).

In the past two decades, the treatment landscape for patients with metastatic renal cell carcinoma has significantly changed thanks to the approval of several targeted molecular therapies (VEGF and mTOR inhibitors) and recently immune-checkpoint inhibitors. The Italian Association of Medical Oncology (AIOM) Renal Cell Cancer (RCC) Guidelines Panel has developed clinical guidelines to provide evidence-based information and recommendations to oncologists, urologists and all professionals involved in the management of patients with renal cell cancer.

DisasterSISM: A Multi-Level Blended Learning Program in Disaster Medicine for Medical Students

Introduction:Disaster medicine has been identified as a fundamental discipline for health professionals. In Italy, the role of physicians during disaster response is officially recognized by the Italian Code of Medical Ethics and by the Ministry of Education. Nevertheless, few Italian medical schools include this discipline in their curricula.Aim:With the aim of teaching basic knowledge of disaster medicine to Italian medical students, Research Center in Emergency and Disaster Medicine (CRIMEDIM) and Italian Medical Students’ Association (SISM) developed DisasterSISM, a nationwide training project in disaster medicine.Methods:DisasterSISM consists of three courses: Basic, Advanced, and Train-of-Trainers (ToT). The Basic courses are managed by medical students who are trained during the one-week intense ToT. All courses are delivered using innovative training methodologies, such as e-learning, peer education, table-top exercises, and virtual reality simulations.Results:From 2012 to 2018, a total of 122 courses (111 Basic, 5 Advanced, and 6 ToT) have been delivered. DisasterSISM reached 37 out of 45 Italian medical schools, training more than 2,500 students. A survey conducted after the end of each course showed that participants considered the knowledge in Disaster Medicine essential for their future profession, regardless of the specialty chosen. Students also expressed their appreciation about the blended-learning approach, with a predilection for virtual reality simulations. The comparison between the entrance and the final exam scores showed a significant increase in knowledge.Discussion:In six years, DisasterSISM reached the majority of Italian medical schools, providing disaster medicine knowledge to hundreds of undergraduates. Considering the fast growth and diffusion of the project, the significant increase of knowledge, and the positive feedback received from participants, we suggest that the DisasterSISM model be implemented in other countries to widely disseminate information about prevention and disaster preparedness among medical students and health professionals.

Establishment of the European Medical Students' Neurosurgery Society–A Proposal

Abstract INTRODUCTION Recent years have witnessed the birth in the United States of Neurosurgery Medical Students Chapters aimed at fostering the interest toward neurosurgery and at supporting students willing to pursue a career in academic neurosurgery by making available research and mentoring opportunities. The American Association of Neurological Surgeons has pioneered the support of these programs and medical chapters are currently active in most US medical schools where they receive support from local Neurosurgery Departments and Research Centers. On the contrary, the European network of medical students' neurosurgical interest groups is fragmented and this opportunity is largely unexploited. METHODS The present abstract is intended to propose the establishment of the European Medical Students' Neurosurgery Society which would represent a tremendous opportunity to build a collaborative network and promote students' interest toward neurosurgery with the aim of increasing learning, research and mentoring opportunities. RESULTS The Italian Medical Student Neurosurgery Interest Group is currently underway and will be launched soon. Other medical students' societies active in European countries are invited to join this project to establish a proactive European Neurosurgical Student Network and to advocate the birth of other groups. CONCLUSION The establishment of this society under EANS support would represent the ideal platform for leadership positions in the medical student community at local and national level that will be important to acquire experience and promote a virtuous circle of knowledge and service while also providing the basis for scientific production on the current state of medical students' recruiting in neurosurgery around Europe.

Persistence of Immunity for Hepatitis B Virus among Heathcare Workers and Italian Medical Students 20 Years after Vaccination.

Background: Immunization of healthcare workers (HCWs) and medical students for the hepatitis B virus (HBV) is a crucial part of the hospital infection control programs. The aim of our study was to evaluate the persistence of anti-HBV specific antibodies in HCWs vaccinated during infancy or adolescence. Methods: Medical records of 734 consecutive subjects born after 1980 (481 females, 65.5% and 253 males, 34.5%) who underwent serological testing for anti-hepatitis B surface antibodies (anti-HBs) were evaluated. Results: A non-protective titer (<10 mUI) was found in 88/734 (12.0%) subjects; 84 (47.8%) of them received a booster dose of anti-hepatitis B vaccine and the anti-HBs titer of 58 subjects was measured 1 month after administration. A protective titer (anti-HBs >10 mIU/mL) was observed in almost 90% of subjects receiving the booster dose. Conclusions: A substantial percentage of HCWs had a non-protective anti-HBs titer at the time of the first employment, especially those vaccinated at birth age. However, the response to the booster dose showed that in these subjects, an anti-HBs titer <10 mIU/mL was due to the physiological decline of antibodies over the years. Therefore, primary immunization in childhood is highly effective and provides lasting immunity against HBV infection.

Conscientious Objection to Animal Testing: A Preliminary Survey Among Italian Medical and Veterinary Students.

The use of animals for educational and research purposes is common in both veterinary and human medicine degree courses, and one that involves important ethical considerations. The aim of this study was to assess the extent of differences between the knowledge and attitudes of veterinary students and medical students on animal bioethics, on alternative strategies and on their right to conscientiously object to animal experimentation. To this end, a questionnaire was completed by 733 students (384 human medicine students (HMS) and 349 veterinary medicine students (VMS)). VMS were more aware than HMS (72.2% and 59.6%, respectively) of the existence of an Italian law on the right to conscientiously object to animal experimentation. However, very few of them had exercised this right. Many VMS (43.3%) felt that animal bioethics courses should be mandatory (only 17.4% of HMS felt the same way). More VMS than HMS (81.7% and 59.1%, respectively) expressed an interest in attending a course on alternatives to animal experimentation. The data suggest the need for appropriate educational interventions, in order to allow students to make choices based on ethical principles. Fostering close collaborations between departments of human medicine and veterinary medicine, for example, through shared study modules, could promote the development of ethical competence as a basic skill of students of both veterinary and human medicine courses.

CIPOMO position paper about conflict of interest.

A substantial part of the final cost of health-related products is due to marketing, and the revenue from sales is, at least in some cases, disproportionally higher than the development costs. In this context, financial interests can add to drug pricing and prevail over healthcare issues and equity of access to services. Conflict of interest (COI) is a «condition in which the professional judgment concerning a primary interest (the health of a patient or the reliability of research results or the impartiality of clinical informations) tends to be unduly influenced by a secondary interest (for example an economic gain or a career advantage)». The potential consequences of COI extend from research to guideline drafting, from teaching to clinical decision making. The contiguity of opposing interests can condition the clinician, either consciously or unconsciously. This conditioning, in turn, can have direct consequences on the quality of the provided services, but can also cause insufficient transparency, or distrust of the Health Service. The College of Italian Medical Oncology Directors (CIPOMO) together with all the stakeholders that contribute to the good functioning of cancer care, issues a list of statements that refer to principles of transparency and ethicality in the use of resources. The following recommendations do not intend to establish rules of conduct. Rather, they have the purpose of contributing to awareness of the nature and potential consequences of COI in the clinical community and of promoting constructive reflection within healthcare organizations.

Use and Propensity to Use Substances as Cognitive Enhancers in Italian Medical Students

International media has paid attention to the use of substances by healthy subjects to enhance cognitive performance. Medical students are liable to use cognitive enhancers (CE) with the aim of improving academic performance. The study explored use and attitudes toward the use of CE in Italian medical students. The authors anonymously surveyed 433 medical students of the University of Modena and Reggio Emilia with an ad hoc 36-items questionnaire. CE were broadly defined as any substance taken with the purpose of improving cognitive functions, from readily available beverages and substances, such as coffee, tea, energy drinks, and supplements to prescription only medication, such as psychostimulants and modafinil. Response rate was 83.8% (n = 363). While the majority of the students (74.7%; n = 271) said that they had used substances to improve cognitive functions, only 2 students (0.6%) reported the use of prescription-only medications in the last 30 days. Main reasons for not taking prescription-only drugs were concerns about safety and side effects, reported by 83.3% of students (n = 295). A positive attitude toward use was held by 60.3% (n = 219) subjects. The surveyed Italian medical students used many substances as CE, but this did not seem to apply significantly to psychostimulants. A multivariable analysis showed that the following variables were related to the propensity to use substances as CE: male gender, self-reported memory impairment, concerns about worsening of cognitive performance, lifetime use of at least one illegal substance, use of any substance (both legal or illegal) in the last 30 days.

A Survey on the Knowledge and Attitudes of Italian Medical Students toward Body Donation: Ethical and Scientific Considerations.

Post mortem body donation (PMBD) for medical training and research plays a key role in medical-surgical education. The aim of this study is to evaluate Italian medical students’ awareness and attitudes regarding this practice. A questionnaire was sent to 1781 Italian medical students (MS). A total of 472 MS responded: 406 (92.91%) had a strongly positive attitude to PMBD, while 31 (7.09%) were not in favor. The majority of subjects were Catholic (56.36%), while 185 and 21 subjects, said that they did not hold any religious beliefs, or were of other religions, respectively. Multivariate analysis showed significant associations (p-values < 0.05) between PMBD and religion, as well as perceptions of PMBD as an act of altruism, a tool for learning surgical practices, body mutilation, and an act contrary to faith. Although Italian MS believed cadaver dissection to be an important part of their education, they did not know much about it and had not received training on this altruistic choice. As future doctors, MS can play an important role in raising public awareness of the importance of PMBD for medical education and research. Specific educational programs to improve knowledge of this topic among MS are needed.

Bioethics in Italian Medical and Healthcare Education. A Pilot Study.

Background and aim of the work: Bioethics is relevant in healthcare and medical schools. However, unlike other foreign countries, its teaching in Italy has only been recently introduced, it is less extensively offered and no academic standards for bioethics education have been established. This research aims at understanding whether university bioethics courses attendees appreciate and consider teaching strategies to be effective with the objective of validating a coherent didactic approach to the discipline and stimulate further discussion on ways to improve it. Methods: A standardized survey was administered to 1590 students attending undergraduate degree programs in medicine and healthcare at four Italian universities. Results: The majorityof interviewees (92.5%) had an interest in bioethics, considered it to be important for any life-sciences-related program (73.5%) and most healthcare (77.2%) and medical students (69.2%) suggested its teaching should be included in their curricula and made mandatory (66.3%) and continuous (57.7%), given its usefulness in clinical practice. Students consider bioethics as a care-integrated practice and appreciate teaching methods where it is integrated into clinical cases. Conceptual specificity and interdisciplinarity may affect the learning process and contribute to enhance students’ analytical skills. Conclusions: Italian bioethics education should be revised to meet students’ expectations and preferences. Its complex, multi-disciplinary and transversal nature suggests bioethical education to be flexible and integrated among different disciplines, thus stimulating a broader critical capacity through cases studies and other interactive teaching methods for helping students better deal with bioethics-inherent difficulties and improve the learning process. (www.actabiomedica.it)

Buyers' Ability in Public Procurement: A Structural Analysis of Italian Medical Devices

Using a dataset of medical devices purchased by Italian Public Buyers (PBs), for each purchase, we measure the difference between each item's price and its marginal cost. We define PBs' ability in purchasing as PBs' fixed effect (FE) on that difference. We find that average prices vary substantially amongst PBs, and this variation is largely captured by PBs' FE. We then exploit the exogenous termination of the mandatory reference price regime to assess how discretion affects procurement performance, given each PB's ability. Our results highlight that reduced PBs' discretion - in presence of mandatory prices - determines efficiency gains and losses for low- and high-ability PBs, respectively.

Palm oil and human health. Meeting report of NFI: Nutrition Foundation of Italy symposium

The use of palm oil by the food industry is increasingly criticized, especially in Italy, for its purported negative effects on human health and environment. This paper summarizes the conclusions of a Symposium on this topic, gathered by the Nutrition Foundation of Italy, among experts representing a number of Italian Medical and Nutritional Scientific Societies. Toxicological and environmental issues were not considered.Participants agreed that: no evidence does exist on the specific health effects of palm oil consumption as compared to other saturated fatty acids-rich fats; the stereospecific distribution of saturated fatty acids in the triacylglycerol molecule of palm oil limits their absorption rate and metabolic effects; in agreement with International guidelines, saturated fatty acids intake should be kept <10% of total energy, within a balanced diet; within these limits, no effect of palm oil consumption on human health (and specifically on CVD or cancer risk) can be foreseen.

Blood pressure status and the incidence of diabetic kidney disease in patients with hypertension and type 2 diabetes.

Antihypertensive treatment and blood pressure (BP) reduction are known to retard the progression of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) but long-term real-life clinical data on the incidence of DKD are lacking. In this observational, prospective cohort study, we investigated the association between achievement and maintenance of recommended BP values and the incidence of DKD and its components over a 4-year follow-up in patients with T2DM and hypertension from the Italian Medical Diabetologists registry. Clinical records from a total of 12 995 patients with normal renal function and urine albumin excretion at baseline and regular visits during a 4-year follow-up were retrieved and analyzed. The association between recommended, time-updated BP control (BPC) (i.e. ≥75% of visits with SBP and DBP <140/85 mmHg) and the occurrence of renal outcomes was evaluated. At baseline, 28% of patients (n = 3612) had recommended BP values. Over the 4-year follow-up, 37% (n = 4845) developed DKD, 16% (n = 2061) low glomerular filtration rate and 27% (n = 3487) albuminuria. Patients who failed to achieve and maintain BPC over the study period showed an increased risk of developing DKD [odds ratio (OR) 1.38, P < 0.001], low glomerular filtration rate (OR 1.18, P = 0.03) and albuminuria (OR 1.47, P < 0.001) as compared with those with persistent BPC. These results were consistent after adjustment for covariates and in different subgroups. Long-term BPC is associated with a reduction in the incidence of DKD and its components in patients with hypertension and T2DM.

G.466 - ICTP, Trieste University and Italian Medical Physics: A training opportunity for young physicists from developing countries

G.466 - ICTP, Trieste University and Italian Medical Physics: A training opportunity for young physicists from developing countries

A systematic review of epidemiological cohort studies based on the Italian Medical Birth Register. Is it time to think of a multicentric birth cohort?

birth cohorts are a necessary tool for the study of the effects of exposures which can occur during pregnancy and early life on the development and health status in paediatric and adult life. The Italian Medical Birth Register (CeDAP), linked with other health administrative data, allows to build population based births cohorts to be followed over time. to sistematically review all published scientific papers using data extracted from the (CeDAP) in order to give a picture of their current use for epidemiological aims; to describe advantages and limits of these data and possible future developments for epidemiological purposes. a systematic review was conducted using PubMed, identifying all peer-reviewed research papers in English or Italian published by November 2015, by combining of free text and MeSH terms, where available. Features of included papers have been double checked and possible disagreements have been discussed to reach consensus. the research strategy found 720 papers, 35 of which fulfilling the required criteria. Only few Italian regions used CeDAP data for epidemiological studies, particularly Lazio and Umbria (Central Italy) and Emilia-Romagna and Friuli Venezia Giulia (Northern Italy). About half of the included papers were analytical, while the others were descriptive. Occurrence of caesarean deliveries and the prevalence of malformations were the most recurrent topics. Almost all papers used only data at delivery, whereas 5 papers used a longitudinal design with follow-up after birth. the Italian CeDAP registry is an important source of information for epidemiological research and its use for both aetiological aims and health services assessment should be enhanced. Furthermore, its characteristics, in particular its homogeneity among all Italian regions, might allow to create a multiregional birth cohort to be regularly followed up.

Student’s knowledge and attitude towards direct-to-consumer genetic tests

Aims: This study reports on the attitudes of 179 Italian Medical Students to direct-to-consumer genetic test and to participation in research practices. Methods: Data were collected using a self-completion online questionnaire sent to 380 medical students at the faculty of Medicine of the Universita Cattolica del Sacro Cuore in Rome, Italy. Questions pertained issues related to awareness and attitudes towards genetic testing, reactions to hypothetical results, and views about contributing to scientific research. Results: The response rate was 47.1%. Less than 50% of students were aware of DTC genetic test. Seventy-four percent of the sample were interested in undergoing DTC genetic test, and the main reason was being aware on genetic predisposition to diseases. Among those who were not willing to undergo a genetic test, the main reason was the lack of confidence in the results. In the hypothetical situations of an increased disease risk after undergoing DTC genetic testing, respondents would take actions to reduce that risk, while in the opposite scenario they would feel unaffected because of the probabilistic nature of the test. Conclusions: We reported a good level of awareness about DTC genetic test and a high interest in undergoing DTC genetic test in our sample. Nevertheless, opinions and reactions are strongly dependent by the hypothetical good or bad result that the test could provide and by the context whereby a genetic test could be performed. Respondents seem to be exposed to the risk of psychological harms, and a strong regulation regarding their use is required.

Mutation spectrum of the MTM1 gene in XLMTM patients: 10 years of experience in prenatal and postnatal diagnosis.

X-linked myotubular myopathy (XLMTM) is a congenital neuromuscular disorder defined by severe hypotonia, respiratory failure and histopathologic changes in muscle biopsy. The objective of this report is to inform about our experience of genetic analysis on a group of 25 unrelated XLMTM patients, clinically diagnosed by several Italian and European Medical Institutes from 2006 to 2015. The molecular strategy used for genotyping involved Sanger sequencing of coding and intron/exon regions and the Multiplex Ligation Probe Amplification method. A total of 13 different point variants (6 nonsense, 5 missense, 1 splicing and 1 small deletion) were found in 15 patients (60%). Three were new missense variants: c.185G>T p.(Arg62Ile), c.719T>A p.(Val240Glu), and c.1262G>T p.(Arg421Leu). No large duplications/deletions have been identified. We performed carrier testing of at-risk female relatives. Only one mutation was de novo. Successively, we offered XLMTM prenatal testing for seven pregnancies in five unrelated families. In this context, the aim to propose an effective molecular diagnostic service is to confirm clinical XLMTM diagnosis, to monitor the cause-disease mutation segregation in the family and to offer genetic counseling to have correct information regarding offspring risks and the prenatal testing.

Neuroenhancers Use Amongst Italian Medical Students. a Survey.

Introduction. Increasing use of substances by university students to improve cognitive performance ('neuroenhacement') has been reported. This refers not only to over-the-counter supplements, energy drinks, coffee and tobacco, but also to psychostimulants and modafinil. Little is known about this phenomenon in Italy. To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil) used for this purpose. An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio Emilia. Valid response rate was 83.8% (N=363). 271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%, N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco (10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2 students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3%) students mentioned concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p = 0.036). Italian medical students use many substances as cognitive enhancers, but this seems not to apply to psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other Countries, which warrants further research.

Address to the Italian Medical Biological Union “San Luca”

Address to the Italian Medical Biological Union “San Luca”