Papers by Emilia Prospero
Journal of Cardiothoracic and Vascular Anesthesia, 2015
Acinetobacter baumannii recently has emerged as an important nosocomial pathogen. The aim of this... more Acinetobacter baumannii recently has emerged as an important nosocomial pathogen. The aim of this study was to assess the impact on mortality of multidrug-resistant A. baumannii (MDR-AB) infection/colonization in patients undergoing cardiac surgery and to investigate microbiologic characteristics, epidemiologic spread of this pathogen, and the relative containment measures. Single-center, retrospective cohort study of prospectively collected data. Cardiac surgery tertiary-care center. Patients with positive MDR-AB cultures from September 1, 2009 to December 31, 2011. Bivariate and multivariate analyses were performed to individualize the risk factors for MDR-AB-infections in cardiac surgery patients. To evaluate the MDR-AB attributable mortality, a retrospective matched cohort study was performed. Incidence density ratio (IDR) was calculated to compare the MDR-AB infection/colonization before and after the introduction of preventive measures adopted following the first cases. MDR-AB acquisition occurred in 14 patients (0,6%) of 2385 patients. At the multivariate analyses, preoperative use of inotropic drugs (OR 18.2, 95% CI 4.6-71.9) and logistic EuroSCORE (OR 1.09, 95% CI 1.06-1.13) were found as independent risk factors. Patients with MDR-AB had 57% cumulative in-hospital mortality; no statistical differences in mortality were observed in the matched group. IDR revealed a significantly decreased incidence of infection/colonization (0.3 per 1,000 days of stay compared with 0.03/1,000 days of stay, p = 0.0001) after the containment measures became effective. Sicker patients are more susceptible to be infected by A. baumannii, but mortality is not significantly higher compared with other patients with similar characteristics. Adequate measures are fundamental to control the spread of the infection.
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PLOS ONE, 2015
Physical fitness has salutary psychological and physical effects in older adults by promoting neu... more Physical fitness has salutary psychological and physical effects in older adults by promoting neuroplasticity and adaptation to stress. In aging, however, the effects of fitness on the hypothalamic-pituitary-adrenal (HPA) axis are mixed. We investigated the association between cardiorespiratory fitness and HPA activity in healthy elderly men (n = 22, mean age 68 y; smokers, obese subjects, those taking drugs or reporting recent stressful events were excluded), by measuring in saliva: i) daily pattern of cortisol secretion (6 samples: 30' post-awakening, and at 12.00, 15.00, 18.00, 21.00, 24.00 h); and ii) the cortisol response to a mental challenge. Cardiorespiratory fitness (VO2max) was estimated using the Rockport Walking Test and the participants were assigned to high-fit (HF, ≥60°, n = 10) and low-fit (LF, ≤35°, n = 12) groups according to age-specific percentiles of VO2max distribution in the general population. At all daytimes, basal cortisol levels were lower in the HF than the LF group, most notably in the evening and midnight samples, with a significant main effect of physical fitness for cortisol levels overall; the area-under-the-curve for total daily cortisol output was significantly smaller in the HF group. Among the subjects who responded to mental stress (baseline-to-peak increment >1.5 nmol/L; n = 13, 5 LF, 8 HF), the amplitude of cortisol response and the steepness of recovery decline displayed an increasing trend in the HF subjects, although between-group differences failed to reach the threshold for significance. In conclusion, cardiorespiratory fitness in healthy aging men is negatively correlated with daily cortisol output and contributes to buffering the HPA dysregulation that occurs with advancing age, thus possibly playing a beneficial role in contrasting age-related cognitive and physical decline.
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Giornale italiano di medicina del lavoro ed ergonomia
Many stuaies investigated adverse effects of rotating shift work, deriving from modifications ofc... more Many stuaies investigated adverse effects of rotating shift work, deriving from modifications ofcircadian rhythms and alimentary behaviours. This may cause the disregulation of glycolipidic metabolism and of insulin secretion, and the development of central obesity. We conducted the present study in order to assess the differences in body mass index (BMI) between day and shift workers, in relation to diet quality and physical activity. Design & Methods: The study included 341 male subjects (165 day workers and 176 shift workers). Body weight, height, BMI, waist and hip circumferences were measured. Physical activity and diet quality were assessed by self-reported questionnaires. Results: Shift workers had higher BMI than day workers (27.6±3.9 vs 26.7I±3.6), and this correlation persisted after adjustment for age. The diet quality was better in shift workers and the level of physical activity was similar in the two groups. Discussion: The results of this study indicate that shift wor...
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Journal of Occupational Health, 2012
The aim of this report is to describe a measles cluster involving health-care workers (HWCs) that... more The aim of this report is to describe a measles cluster involving health-care workers (HWCs) that occurred in a teaching hospital in central Italy during winter 2011 and the efforts made to promptly identify all the susceptible contacts in order to stop, as soon as possible, transmission of the infection within the hospital. An epidemiological investigation took place. The immunization status of all the exposed individuals was assessed by personal interviews (history of measles or measles vaccine). Serologie screening for personnel not immune to measles was performed. Four cases of measles infection in HCWs were identified; of the 72 HCWs tested for measles immunity, 50 reported a past history of measles, while 22 underwent serological screening, which showed that all were IgG positive except for one case, which was excluded from duty as recommended. Strict adherence to use of alcohol-based hand rub and rapid implementation of appropriate isolation precautions are essential but insufficient to prevent measles outbreaks in hospital settings. Vaccination is the only reliable protection against nosocomial spread of measles. Therefore, assessing the immunization status of HCW and implementing vaccination strategies are needed in order to virtually set to zero the risk of acquiring and spreading measles in healthcare settings.
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Journal of Infection and Public Health, 2013
The aim of our study was to describe the distribution of Visceral Leishmaniasis (VL) in Italy, fo... more The aim of our study was to describe the distribution of Visceral Leishmaniasis (VL) in Italy, focusing on HIV-infected patients, to estimate the burden of the disease and the public health actions that should be undertaken. A review of official notifications and hospitalization data has been performed. From 2006 to 2008, a total of 289 cases of VL were notified; the overall notification rate was 1.63/1,000,000 (95% CI 1.45-1.83). In total, 1192 VL-associated hospitalizations were detected, with a hospitalization rate of 6.71/1,000,000 (95% CI 6.34-7.10). For the age group "≤ 24 years", a statistically significant increase was detected (p<0.05). A total of 68.9% (n = 821) of hospitalizations were detected in HIV-positive patients. The geographic distribution of rates revealed a significant increase in the north-eastern area of the country. Our study confirms that the epidemiological pattern of VL is changing and that, in Italy, control measures and preventive strategies should be based on not only the official notification system but also hospital data. This would lead to the identification of areas of parasite spread and to the creation of awareness campaigns geared toward general practitioners in the affected areas. Easy case detection would allow for timely public health actions and strategies for the implementation of more effective interventions for reservoir control.
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Journal of Endocrinological Investigation, 1992
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Epidemiology and Infection, 2012
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J prev med hyg, 2010
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American Journal of Infection Control, 2012
Because catheter-associated urinary tract infections (CAUTI) represent the most frequent health c... more Because catheter-associated urinary tract infections (CAUTI) represent the most frequent health care-associated infection (HAI), we implemented an educational intervention on urinary catheter use to reduce the CAUTI rate. The intervention was focused on correct management of catheterized patients. To assess the participants' knowledge, pre- and post-tests were performed. An active CAUTI surveillance program took place in a 900-bed teaching hospital in central Italy before and after the educational intervention. CAUTI definition, catheterization rate, and CAUTI rate were expressed according to the Centers for Disease and Prevention/National Healthcare Safety Network definitions. The level of significance was set at P ≤ .05. Two hundred ninety-six health care workers attended the educational intervention; the analysis of the pre- and post-tests highlighted a statistically significant improvement (P < .05). Before the intervention, mean catheterization rate was 18.5% (95% confidence interval [CI]:18.1-18.9); 46 cases of CAUTI were detected, with an incidence rate of 6.6/1,000 catheter-days (95% CI: 4.8-8.8). After the intervention, mean catheterization rate was 9.2% (95% CI: 8.9-9.5); 19 cases of CAUTI were detected, with an incidence rate of 5.8/1,000 catheter-days (95% CI: 3.5-9.0). Through an active educational update and thanks to the implementation of a surveillance system, a successful reduction of catheterization rate was achieved. More efforts are needed to preserve this goal and to improve the CAUTI rate also.
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Human …, 2011
We analyzed seasonal flu vaccination rates among the Italian population suffering from Chronic Ob... more We analyzed seasonal flu vaccination rates among the Italian population suffering from Chronic Obstructive Pulmonary Disease (COPD) in order to identify socio-demographic and clinical determinants for vaccination. We used data from the survey "Health and health care use in Italy", which interviewed 5,935 persons (age 15 - 102 years) suffering from COPD in the period 2004-2005. For each respondent, information on socioeconomic and health conditions, smoking status and patterns of health care utilization were retrieved. After bivariate analysis, we used two multilevel regression models to assess determinants of vaccination among the adult and the older Italian population. Overall 30.5% of adults (N=670) and 74.8% (N=2,796) of older people reported being vaccinated against seasonal flu. After controlling for potential confounders, older age increases the odds of vaccine uptake. Single marital status among the older people, smoking and not having contact with GPs in both age groups, are factors associated with non vaccination. Higher-educated elderly are less likely to be vaccinated, while coverage is higher among the wealthier adults. Vaccine coverage among adults with COPD in Italy remains low, especially among those with no comorbidities, and aged less than 44 years. It is only in older age that vaccination rates increase substantially. We found several risk factors for non vaccination, such as smoking, single marital status, and not having contacts with GPs, which should be considered in developing strategies to increase the coverage of influenza vaccine among people with COPD in Italy.
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… DI MEDICINA DEL …, 2007
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Waste management is continuously evolving, moreover, lack of resources and environmental hygiene ... more Waste management is continuously evolving, moreover, lack of resources and environmental hygiene issues have given more importance to recycling, establishing the basis of an increased risk in these workers. The aim of this study was to provide a description of occupational health of Italian waste workers in order to highlight key points for ad hoc interventions. Data about injuries and professional disease were extracted from the Italian National Labour Insurance Institute (INAIL). Waste work is a well-known cause of occupational accidents, however occupational disease appear to be less-known with many "unclassified" events. While new researches are needed in order to clarify these emerging issues, education could be the key to assure the waste workers health safety.
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Italian Journal of Public Health
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Archivio stomatologico
The Authors carried out a survey in dental wards in order to evaluate the qualitative and quantit... more The Authors carried out a survey in dental wards in order to evaluate the qualitative and quantitative microbial contamination level of the air, which is considered a crucial habitat for the transmission of many infectious diseases. A high microbial counts were found in all of the environments tested; the microorganisms isolated belonged to pathogenous species such as Staphylococcus aureus, Staphylococcus haemoliticus, Pseudomonas aeruginosa, Acinetobacter calcoaceticus var. lwoffi. It seems necessary, therefore, to carry out preventive interventions directed to the protection of the personnel of dental care and, in particular, of the patients.
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Giornale italiano di medicina del lavoro ed ergonomia
Many studies investigated adverse effects of rotating shift work, deriving from modifications of ... more Many studies investigated adverse effects of rotating shift work, deriving from modifications of circadian rhythms and alimentary behaviours. This may cause the disregulation of glycolipidic metabolism and of insulin secretion, and the development of central obesity. We conducted the present study in order to assess the differences in body mass index (BMI) between day and shift workers, in relation to diet quality and physical activity. The study included 341 male subjects (165 day workers and 176 shift workers). Body weight, height, BMI, waist and hip circumferences were measured. Physical activity and diet quality were assessed by self-reported questionnaires. Shift workers had higher BMI than day workers (27.6 +/- 3.9 vs 26.7 +/- 3.6), and this correlation persisted after adjustment for age. The diet quality was better in shift workers and the level of physical activity was similar in the two groups. The results of this study indicate that shift work is an independent risk factor...
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Giornale italiano di medicina del lavoro ed ergonomia
Waste management is continuously evolving, moreover, lack of resources and environmental hygiene ... more Waste management is continuously evolving, moreover, lack of resources and environmental hygiene issues have given more importance to recycling, establishing the basis of an increased risk in these workers. The aim of this study was to provide a description of occupational health of Italian waste workers in order to highlight key points for ad hoc interventions. Data about injuries and professional disease were extracted from the Italian National Labour Insurance Institute (INAIL) Waste work is a well-known cause of occupational accidents, however occupational disease appear to be less-known with many "unclassified" events. While new researches are needed in order to clarify these emerging issues, education could be the key to assure the waste workers health safety.
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PloS one, 2015
The aim of this paper was to evaluate socio-economic factors associated to poor primary care util... more The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits. The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use. Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32-6.47) of re-admissions have been registered; the distribution shows a high frequency of events in the age 65-84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37-52.57). The regression model has shown the significant role played by age, type of structure (geriatric acute care), and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38-15.27) of the total...
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Minerva anestesiologica
To assess the impact of an intervention to improve respiratory infection control practices and re... more To assess the impact of an intervention to improve respiratory infection control practices and reduce the ventilator associated pneumonia (VAP) rate in an intensive care unit, at the request of the ICU staff. Design: prospective surveillance before-after study. Baseline VAP rates were determined over a 4-month period of active surveillance without an infection control program (period 1) and compared to VAP rates following implementation of an infection control program (period 2). The ICU staff requested the implementation of infection control practices. Setting: Intensive Care Unit (ICU) at a university teaching hospital in Italy. Patients: A total of 185 patients admitted to the ICU were included in the study. Patients assessed during period 1 were similar to patients assessed during period 2 with regard to age, sex, origin, type of admission and mortality. Patients who were admitted during period 2 had significantly lower simplified acute physiology scores (SAPS) II and acute phys...
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Papers by Emilia Prospero