No abstract

Workforce aging is becoming a significant public health problem due to the resulting emergence of age-related diseases, such as osteoporosis. The prevention and early detection of osteoporosis is important to avoid bone fractures and their socio-economic burden. The aim of this study is to evaluate the sustainability of a screening workplace program able to detect workers with osteoporosis. The screening process included a questionnaire-based risk assessment of 1050 healthcare workers followed by measurement of the bone mass density (BMD) with a pulse-echo ultrasound (PEUS) at the proximal tibia in the at-risk subjects. Workers with a BMD value ≤ 0.783 g/cm² were referred to a specialist visit ensuring a diagnosis and the consequent prescriptions. Any possible association between the outcome variable BMD ≤ 0.783 g/cm² and the risk factors was evaluated. The costs were calculated with a full costing method. We identified 60 pathological subjects. We observed increased risks for women, older ages, and menopause (p < 0.01). The yearly cost of our screening program estimated for this study was 8242 euros, and, considering the fragility bone fracture costs, we hypothesize a considerable economic savings, with a possible positive benefits/cost ratio of 2.07. We can say that the margin between the investment and results leads to a preference for this type of screening program. Osteoporosis is an occupational health problem, and a workplace screening program could be a cost-effective intervention.

Longitudinal mapping of antibody-based SARS-CoV-2 immunity is critical for public health control of the pandemic and vaccine development. We performed a longitudinal analysis of the antibody-based immune response in a cohort of 100 COVID-19 individuals who were infected during the first wave of infection in northern Italy. The SARS-CoV-2 humoral response was tested using the COVID-SeroIndex, Kantaro Quantitative SARS-CoV-2 IgG Antibody RUO Kit (R&D Systems, Bio-Techne, Minneapolis, USA) and pseudotype-based neutralizing antibody assay. Using sequential serum samples collected from 100 COVID-19 recovered individuals from northern Italy—mostly with mild disease—at 2 and 10 months after their first positive PCR test, we show that 93% of them seroconverted at 2 months, with a geometric mean (GeoMean) half-maximal neutralization titer (NT50) of 387.9. Among the 35 unvaccinated subjects retested at 10 months, 7 resulted seronegative, with an 80% drop in seropositivity, while 28 showed decreased anti-receptor binding domain (RBD) and anti-spike (S) IgG titers, with a GeoMean NT50 neutralization titer dropping to 163.5. As an NT50 > 100 is known to confer protection from SARS-CoV-2 re-infection, our data show that the neutralizing activity elicited by the natural infection has lasted for at least 10 months in a large fraction of subjects.

Background 5A’s counselling is recommended for screening and treating patients with smoking addiction. The emergency department (ED) setting might be a suitable environment for conducting interventions for smoking cessation. The present study aims to determine the feasibility and effectiveness on smoking cessation of 5A’s counselling administered to ED patients by nurses. Methods Parallel group randomized trial assessing 5A’s counselling for smoking cessation vs. usual care at a University Hospital in the North of Italy. The primary end-point was prevalence of tobacco-free patients. The secondary outcomes at 6- and 12-month follow-up were (i) consecutive past 30-day smoking abstinence; (ii) past 7-day 50%, or more, decrease in daily tobacco consumption over baseline; and (iii) number of attempts to quit smoking. Results A total of 480 patients were randomized to intervention (n = 262) or usual care (n = 218). Intention to treat analysis displayed no differences in primary and secondary outcomes between groups. A slight but not statistically significant enhancement in cessation was recorded in the intervention group [relative risk (RR) = 1.04, 95% confidence interval (CI) = 0.58–1.87] at 6 months, whereas a reversed observation at 12 months (RR = 0.86, 95% CI = 0.50–1.47). Similar results were obtained for the secondary outcomes. Per protocol analysis increased the size of the results. Of the 126 smokers receiving counselling, 18 were visited and treated at the local smoking cessation centre, with 12 of them successfully completing the treatment. Conclusion The results of this study indicate that the ED is not a suited environment for 5A’s counselling.

BACKGROUND The topic of Complementary and Alternative Medicine (CAM) has been widely discussed in the scientific literature, including two highly-cited editorials that appeared in NEJM 1 and JAMA 2 in 1998. These articles agreed on a fundamental point, that is that the only accepted form of medicine should be based on evidence. Since then, many authors have tried to define what is CAM. A positive definition, describing CAM by what it is, rather than by what it is not, has been proposed by Ernst et al.: CAM is any "diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine". 3 Surveys from several European countries suggest a European-wide increase in the use of CAM during the last decades. 4 The prevalence of the use of CAM among adults in European countries, varies from 6-49% according to different studies 5 ˒ 6 ˒ 7 ˒ 8 ˒ 9 ˒ 10. Data for Italy is contradictory. According to a national survey, in 2005 at least 13.6% of population have used CAM during the last three years 11 , but a study conducted in Turin in 2008 estimates a prevalence of use of 43% in paediatric age during the previous year 12. This figure is consistent with other studies which have underlined that approximately 20% to 40% of healthy children seen in outpatient paediatric clinics 13 ˒ 14 ˒ 15 and more than 50% of children with chronic, recurrent, and incurable conditions use CAM, almost always in addition or conjunction with mainstream care 16. Children's health is not self-determined and depends on their parent's' choice. Considering the spread of the CAM use and the lack of recent studies estimating prevalence of CAM use in Italy , we believe in the importance of better understanding the amount and modality of CAM use in the paediatric population in order to identify any possible risk and health problem.