Sleep deprivation, sleep disorders, fatigue, stress and the risk of occupational injuries and errors among health-care workers: a multi-approach epidemiological study

Objectives. The aim of the study was to assess the effects of acute and chronic sleepiness, of sleep disorders, and stress on the risk of occupational injuries and commuting accidents among the workers of the University Hospital of Udine, and the effect of organizational stress at the hospital Unit level on the number of adverse events and near-misses on the patients. Methods. We used different epidemiological study designs depending on the xposures and outcomes: case-crossover, case-control, ecologic. In addition to the information on exposures collected through interviews with structured questionnaires, we also conducted neurological tests (polysomnographies and maintenance of wakefulness tests) to assess the characteristics of sleep and the ability to stay awake of the workers. Results. Through the case-crossover study, we identified occupational transient exposures associated with increased risk of injury: fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger. Through the case-control design, the number of reported sleep disturbances was positively related with the outcome, whereas no association was found between usual sleep hours and injuries. Chronotype, assessed through the Horne-Ostberg questionnaire, was not significantly associated with injury, although we noticed a decreasing trend from earlier to later chronotypes. The ability to maintain wakefulness appeared reduced among workers who reported injuries. The ecologic study showed that the proportion of female workers in a unit, the average number of sick-leave days and of overtime hours, the number of medical examinations requested by employees, and being a surgical unit were significantly associated with the number of adverse events and near-miss. Conclusions. This study allowed the identification of individual and environmental stress-related factors associated with increased risk of injuries and adverse events, thus providing useful information for planning preventive interventions and for improving safety in the hospital settingObiettivi. Lo studio si proponeva di valutare gli effetti della sonnolenza acuta e cronica, di disturbi del sonno e di situazioni stressanti sul rischio di infortuni in itinere ed occupazionali tra i dipendenti dell\u2019Azienda Ospedaliero-Universitaria di Udine. Inoltre \ue8 stato indagato l\u2019effetto dello stress organizzativo a livello di Struttura/Dipartimento ospedaliero sul rischio di incidenti sui pazienti o near-miss. Metodi. Sono stati impiegati diversi disegni di studio epidemiologico, a seconda dell\u2019esposizione e dell\u2019outcome considerati: case-crossover, caso-controllo, ecologico. Ad integrazione delle informazioni sulle esposizioni raccolte mediante interviste con questionari strutturati, sono stati condotti anche esami strumentali (polisonnografia) e test neurologici (test di mantenimento della veglia) per valutare le caratteristiche del sonno e le capacit\ue0 di mantenere la veglia da parte dei lavoratori. Risultati. Tramite lo studio case-crossover, sono state identificate esposizioni occupazionali transitorie associate ad un significativo aumento del rischio di infortunio sul lavoro: stanchezza, fretta, distrazione, situazioni di emergenza, attivit\ue0 didattiche, pazienti non collaboranti, campo operatorio con sangue, rumore eccessivo, procedure complesse e stati di arrabbiatura. Tramite il disegno caso-controllo, \ue8 emerso che il numero di disturbi del sonno riferito dai lavoratori si associa positivamente al rischio di infortunio, mentre il numero medio di ore di sonno non si \ue8 associato al rischio di infortunio. Bench\ue9 non in maniera significativa, I cronotipi pi\uf9 mattutini, identificati tramite questionario di Horne-Ostberg, sembrerebbero a rischio aumentato. La capacit\ue0 di mantenere la veglia sembrerebbe ridotta nei lavoratori che hanno riferito un infortunio. Lo studio ecologico ha mostrato che la proporzione di lavoratori di sesso femminile in ogni Unit\ue0, il numero medio di giorni di malattia e di ore di straordinario, il numero di visite anticipate richieste al medico competente e il tipo di dipartimento di appartenenza sono risultati significativamente associati al numero di eventi avversi e near-miss. Conclusioni. Questo studio ha permesso di individuare fattori stressanti individuali ed ambientali che si associano ad un aumentato rischio di infortuni tra i lavoratori ed errori sui pazienti, fornendo informazioni utili per la programmazione di interventi di prevenzione e il miglioramento della sicurezza in ambiente ospedalier

Polypharmacy in the general population of a Northern Italian area: analysis of administrative data

Introduction: The aim of this study was to estimate the prevalence and assess patient-related determinants of polypharmacy in the general population of the Italian area around Udine.Materials and methods: A retrospective cohort study was conducted using administrative databases: drug prescriptions, hospital discharges, ambulatory care prescriptions, exemptions from medical charges. Various definitions of polypharmacy were adopted (co-prescription of multiple medications, use of multiple medications for overlapping time periods). The role of patient’s characteristics on polypharmacy was assessed through regression analyses.Results: In 2017, 63.7% of the general population received at least one drug prescription. 25,218 persons were co-prescribed ≥5 medications at least once. The prevalence of co-prescriptions among persons ≥65 years was 31.7%. 20,793 persons used ≥60 DDDs of ≥5 medications. The prevalence of all these phenomena was much higher in the elderly than in children and adults. The number of comorbidities significantly affected all types of polypharmacy.Conclusions: In this area, the prevalence of polypharmacy is alarming, particularly among the elderly. Age and comorbidities significantly affect the risk. Further research will aim at evaluating the health effects of polyphamacy. 

A population-based study of the years of life lost in the Friuli Venezia Giulia region, Italy

Background. The number of years of life lost (YLL) in a population depends not only on the number of deaths but also on the age at which the deaths have occurred, and, as a measure of the burden of premature mortality, is an important piece of information for public health professionals. Methods. We calculated YLL in the population of Friuli Venezia Giulia, a 1 200 000 inhabitant Italian region, in 2013 and the trend in the past 14 years, through a populationbased study using the regional mortality database as the source of information. The same projected life expectancy estimates for 2050 were used for calculating YLL both in males and females, for each calendar year. Results. In 2013, we counted 14 080 deaths and estimated 220 961 YLL. Malignant neoplasms and cardiovascular diseases accounted for the greatest number of YLL. Injuries had the highest number of YLL per death. Overall, YLL decreased from 2000 to 2013, but differences were observed for different causes of death. Cancers, cardiovascular diseases, and unintentional injuries showed a decreasing trend, whereas infectious diseases resulted increasing over time. Conclusion. This study, estimating the relative impact of different conditions on the society though the YLL, is a relevant input for the regional public health agenda

Diabetes mellitus and colorectal cancer screening in the population of the Italian region Friuli Venezia Giulia

Aims: Colorectal cancer is the most common cancer in Italy, where screening programs are now in place all over the country. We conducted a research to assess whether the use and outcomes of colorectal cancer screening are different between diabetics, who are at increased risk of developing colorectal cancer, and non-diabetics in the Italian Northeastern region Friuli Venezia Giulia. Methods: This was a retrospective population-based study which used the administrative databases of the regional health information system as the sources of information. For the two screening rounds 2010-2011 and 2012-2013, we compared adherence to the program and the results of the fecal occult blood tests and of the colonoscopy among diabetic and non-diabetic residents. Results: Overall, more than 300,000 persons were invited for the colorectal cancer screening in each round. Of them, approximately 8.8% were diabetic. In the regional population, adherence to the screening program was significantly lower among diabetics than among non-diabetics. The proportion of positive fecal occult blood tests was higher among diabetics than among non-diabetics. Among diabetics, the detection rate for initial and advanced adenomas was higher than among non-diabetics, whereas no clear pattern was observed for the detection of cancers. Conclusion: In Friuli Venezia Giulia, efforts should be directed at improving the management of diabetic patients and at reducing the inequalities in access to care due to this comorbidity

Sexually transmitted infections and the HPV-related burden: evolution of Italian epidemiology and policy

Sexually transmitted infections (STIs) are a major public health problem worldwide, with a high prevalence between the ages of 15 and 25 in most Western countries. High notification rates of chlamydia, gonorrhea, and syphilis are reported in the WHO European Region, with differences between countries. In Italy, the total number of STIs alerts increased by 18% from 2020 to 2021. HPV is the most common sexually transmitted infection; globally one in seven women is infected by this virus, and certain sexual behaviors are important risk factors for HPV-related cancers, particularly cervical cancer (CC), anogenital cancers and cancers of the head and neck. The burden of CC is relevant worldwide, in particular in Europe CC is the third leading cause of cancer-related deaths in women aged 15–44. This HPV-related tumor is preventable through a combined strategy of vaccination and screening for precursor lesions. In Italy, the coverage of organized screening varies from region to region and the average HPV vaccination rate is still far from the expected optimal threshold of 95% at the age of 12. To address the challenges of health promotion and HPV prevention, priority actions are needed such as: promoting education and information at every level, from schools to healthcare professionals. In Italy, education of adolescents on sexual and reproductive health, still remains critical, regionally inhomogeneous and much lower than in other European countries. Equitable measures need to be taken, and schools are an important place for health promotion activities

Hospital discharge diagnoses in patientswith positive blood cultures in an Italian academic hospital

Objective. To assess the sensitivity of hospital discharge diagnoses for identifying sepsis in patients with blood culture confirmation.Methods. A cross-sectional study was conducted at the Italian 1000-bed University Hospital of Udine. The administrative databases of the Hospital were used as the source of information. Laboratory data were linked with hospital discharge data. We estimated the proportion of hospitalizations with at least 2 positive blood culture tests in which at least one discharge diagnosis indicated bloodstream infection.Results. From 2011 to 2017, 3571 hospitalizations (1.2%) had positive blood culture tests. Of them, only 49.5% had at least one ICD-9-CM discharge diagnosis code of sepsis, with lower proportions in surgical than in medical wards.Conclusions. The sensitivity of ICD-9-CM discharge codes for sepsis is low as compared with the blood culture gold standard. Using discharge codes for epidemiological estimates of sepsis, health planning and risk management may yield biased results. Audits and ICD coding training are needed

A case-crossover study of alcohol consumption, meals and the risk of road traffic crashes

<p>Abstract</p> <p>Background</p> <p>The case-crossover (CC) design has proved effective to investigate the association between alcohol use and injuries in general, but has never been applied to study alcohol use and road traffic crashes (RTCs) specifically. This study aims at investigating the association between alcohol and meal consumption and the risk of RTCs using intrapersonal comparisons of subjects while driving.</p> <p>Methods</p> <p>Drivers admitted to an Italian emergency room (ER) after RTCs in 2007 were interviewed about personal, vehicle, and crash characteristics as well as hourly patterns of driving, and alcohol and food intake in the 24 hours before the crash. The odds ratio (OR) of a RTC was estimated through a CC, matched pair interval approach. Alcohol and meal consumption 6 and 2 hours before the RTC (case exposure window) were compared with exposures in earlier control windows of analogous length.</p> <p>Results</p> <p>Of 574 patients enrolled, 326 (56.8%) reported previous driving from 6 to 18 hours before the RTC and were eligible for analysis. The ORs (mutually adjusted) were 2.25 (95%CI 1.11-4.57) for alcohol and 0.94 (0.47-1.88) for meals. OR for alcohol was already increased at low (1-2 units) doses - 2.17 (1.03-4.57) and the trend of increase for each unit was significant - 1.64 (95%CI 1.05-2.57). In drivers at fault the OR for alcohol was 21.22 (2.31-194.79). The OR estimate for meal consumption seemed to increase in case of previous sleep deprivation, 2.06 (0.25-17.00).</p> <p>Conclusion</p> <p>Each single unit of acute alcohol consumption increases the risk of RTCs, in contrast with the 'legal' threshold allowed in some countries. Meal consumption is not associated with RTCs, but its combined effects with sleepiness need further elucidation.</p

ISS mapped from ICD-9-CM by a novel freeware versus traditional coding: a comparative study

<p>Abstract</p> <p>Background</p> <p>Injury severity measures are based either on the Abbreviated Injury Scale (AIS) or the International Classification of diseases (ICD). The latter is more convenient because routinely collected by clinicians for administrative reasons. To exploit this advantage, a proprietary program that maps ICD-9-CM into AIS codes has been used for many years. Recently, a program called ICDPIC trauma and developed in the USA has become available free of charge for registered STATA^®users. We compared the ICDPIC calculated Injury Severity Score (ISS) with the one from direct, prospective AIS coding by expert trauma registrars (dAIS).</p> <p>Methods</p> <p>The administrative records of the 289 major trauma cases admitted to the hospital of Udine-Italy from 1 July 2004 to 30 June 2005 and enrolled in the Italian Trauma Registry were retrieved and ICDPIC-ISS was calculated. The agreement between ICDPIC-ISS and dAIS-ISS was assessed by Cohen's Kappa and Bland-Altman charts. We then plotted the differences between the 2 scores against the ratio between the number of traumatic ICD-9-CM codes and the number of dAIS codes for each patient (DIARATIO). We also compared the absolute differences in ISS among 3 groups identified by DIARATIO. The discriminative power for survival of both scores was finally calculated by ROC curves.</p> <p>Results</p> <p>The scores matched in 33/272 patients (12.1%, k 0.07) and, when categorized, in 80/272 (22.4%, k 0.09). The Bland-Altman average difference was 6.36 (limits: minus 22.0 to plus 34.7). ICDPIC-ISS of 75 was particularly unreliable. The differences increased (p < 0.01) as DIARATIO increased indicating incomplete administrative coding as a cause of the differences. The area under the curve of ICDPIC-ISS was lower (0.63 vs. 0.76, p = 0.02).</p> <p>Conclusions</p> <p>Despite its great potential convenience, ICPIC-ISS agreed poorly with its conventionally calculated counterpart. Its discriminative power for survival was also significantly lower. Incomplete ICD-9-CM coding was a main cause of these findings. Because this quality of coding is standard in Italy and probably in other European countries, its effects on the performances of other trauma scores based on ICD administrative data deserve further research. Mapping ICD-9-CM code 862.8 to AIS of 6 is an overestimation.</p

The influence of patients’ complexity and general practitioners’ characteristics on referrals to outpatient health services in an Italian region

Background. Patient referrals to outpatient health services may affect both health outcomes and health expenditures. General practitioners (GP) have a crucial role in driving the use of outpatient services and recognizing factors which affect referrals is important for health managers and planners. Objectives. We investigated patient- and physician-related determinants of patient referrals in an Italian region. Methods. This was cross-sectional study based on the individual linkage of administrative databases from the health information system of the Friuli Venezia Giulia region. For each GP of the region, the association of the number of patient referrals to different types of outpatient services with the proportion of patients with chronic conditions, with the number of hospital admissions and drug prescriptions in 2012, and with GP’s characteristics was investigated through multilevel multivariable Poisson regression models. Results. Some chronic conditions (e.g., cancer, autoimmune diseases, endocrine diseases, digestive system diseases) were positively associated with the number of referrals, as were hospital admissions and drug prescriptions. Time since GP’s graduation was inversely related with referrals. Conclusion. Patient complexity and GP’s experience affect referral rates. These factors should be considered in case of a reorganization of the general practice structure in Friuli Venezia Giulia