Prevention and control of respiratory tract infections in the network of Italian Centers for Cystic Fibrosis

Infections caused by respiratory pathogens such as Burkholderia cepacia and Pseudomonas aeruginosa are associated with an increased morbidity and mortality in people affected by cystic fibrosis, the most common lethal genetic disease in Caucasian populations. Preventing the acquisition of these pathogens is paramount for these patients. The goal of this survey was to assess the distribution and the prevalence of the measures adopted for the prevention and control of infections caused by respiratory pathogens in the 28 italian centres for cystic fibrosis. 21 questionnaires were returned and some important differences can be observed in the adoption of segregation measures. Although results may be influenced by other factors, specific segregation policies appear to be more directly associated than other measures (e.g., intensive disinfection; behavioural rules to minimise patient' contacts) with lower prevalence of Pseudomonas aeruginosa (OR 0.36 CI95% 0.31-0.42), of multidrug-resistant Pseudomonas aeruginosa (OR 0.30 CI95% 0.22-0.40), and of methicillin-resistant Staphylococcus aureus (OR 0.67 CI95% 0.48-0.94).     

Bone mineral density in cystic fibrosis patients under the age of 18 years

AIM: The increase in life expectancy of cystic fibrosis (CF) patients has brought about a rise in new clinical problems in these patients, such as a decrease in bone mineral density (BMD). The cause of diminished BMD in CF is multi-factorial. METHODS: The aim of this cross-sectional study, conducted on 39 CF patients under the age of 18 years, was to evaluate the degree of bone mineralization and the prevalence of low BMD in these patients during a follow-up at the Cystic Fibrosis Regional Center of Tuscany, using a dual energy X-ray absorptiometry (DXA) scan, and to then study the factors correlated with low BMD. RESULTS: Areas BMD values (g/cm2) and Z-score values were determined. Eighteen patients (46%) out of the our sample had decreased BMD, while 21 patients (54%) had normal values. A statistically significant association was found between BMD Z-score values and pancreatic insufficiency, BMI<5th percentile and DeltaF508 homozygosis. Subjects treated with oral steroid therapy had a 3.9 times greater risk of developing osteoporosis compared to non-treated subjects (95% C.I.: 1.07-22.6; R.R. 4.9). An association was found between BMD Z-score values and FEV1 values (r=0.29; P=0.06), physical activity total score values (r=0.22; P=0.19) and the Chrispin-Norman chest radiographic score (r=-0.31; P=0.06). CONCLUSION: Early identification of reduced bone mass values would permit early intervention to prevent the development of osteoporosis. Maintaining pulmonary function, guaranteeing optimal nutritional status, following an adequate program of physical activity and controlling steroid intake could maintain BMD over time.     

Isolation measures for prevention of infection with respiratory pathogens in cystic fibrosis: a systematic review

Respiratory infections are the most important cause of morbidity and mortality in patients with cystic fibrosis (CF). These infections are typically caused by a limited number of respiratory pathogens, particularly Burkholderia cepacia complex (BCC) and Pseudomonas aeruginosa (PA). Since the 1980s, several outbreaks of unique strains of PA and BCC among CF patients attending the same CF care centres have been described, leading to a sharp decline in the patients' health. One of the measures adopted in CF centres to interrupt ongoing outbreaks is the separation of patients with a respiratory tract culture that is positive for PA or BCC from patients who are not infected. This type of measure has been implemented routinely in many CF centres to prevent cross-transmission of PA and BCC. The aim of this review was to determine what evidence is available to support the efficacy of isolation (or segregation) practices in preventing, delaying or reducing the risk for CF patients of acquiring PA and BCC. A systematic review of scientific literature from 1980 to 31 December 2004 was performed. Existing guidelines regarding infection control in CF were also analysed. In total, 398 relevant papers were retrieved. Only 10 well-designed studies were found that evaluated the efficacy of isolation practices in preventing the transmission of respiratory pathogens in CF care centres (one prospective controlled study, one retrospective cohort study, five 'before-after' studies and three cross-sectional studies. No systematic reviews or randomized controlled trials exist on this subject. In the absence of studies with an experimental, controlled design, the efficacy of isolation practices in preventing the transmission of respiratory pathogens in CF remains unproven. However, notwithstanding the considerable limits represented by the study designs, which were mainly retrospective, the observational studies reviewed seem to support the implementation of isolation (or segregation) measures to reduce the risk of transmission of BCC and PA in CF patients.     

Commuting patterns among Italian nurses: a cross-sectional study

FESTINI F., CIOFI D. & BISOGNI S. (2011) Commuting patterns among Italian nurses: a cross‐sectional study. International Nursing Review 58 , 354–360 Commuting is an additional burden that affects working stress, reduces leisure time and raises the risk of accidents. Little data are available about nurses' commuting patterns or the impact of commuting on their lives. Objectives: The study aims to describe commuting patterns among Italian nurses and to explore possible associations with nurses' intention to change job. Methods: This is a cross‐sectional study carried out in central Italy. Nurses were invited to participate through a variety of public measures. Those participating completed an online questionnaire available on a website established for this specific purpose. Results: Five hundred sixty‐five nurses participated. The mean distance covered every day to go to work and back home is 30.8 km. A total of 43.3% of nurses cover 25 km or more every day to work; 5.7% cover 100 km or more. The mean time spent in commuting is 52.9 min daily. Furthermore, 14.5% of nurses spend every month commuting a time equal to or longer than the working time of 1 week. The mean monthly expenditure is 87.30 Euro (6% of mean salary). Nurses younger than 30 cover longer distances (P = 0.0006), spend more time (P = 0.001) and have higher expenditure (P = 0.003) than their older colleagues. Willingness to change job seems associated with the use of public means of transportation (P = 0.04). Nurses from the population under study cover longer distances, spend longer time in daily commuting and have higher monthly costs than the rest of the Italian workers' population. Conclusions: Travelling to work represents a non‐negligible burden for nurses, particularly for younger nurses. Nurses seem to have lesser opportunities to rest and to recover energies than other workers. The Italian nurses' recruiting system may have a role in explaining our data. Further studies are needed to investigate the impact of nurses' commuting on the healthcare system.     

囊性纤维化患儿的妊娠期和新生儿期特点：一项队列研究

目的:调查囊性纤维化(CF)患儿的出生体重(BW)以及早产、低出生体重(LBW)和小于胎龄(SGA)的风险是否与非CF者相同。研究设计:回顾性队列研究,作者调查1991—2002年在意大利托斯卡纳市出生的所有CF患儿(n=70),并与同期出生的非CF患儿的整个人群(n=290059)进行比较。结果:CF新生儿