ObjectiveTo provide an overview of the currently available risk prediction models (RPMs) for cardiovascular diseases (CVDs), diabetes and hypertension, and to compare their effectiveness in proper recognition of patients at risk of developing these diseases.DesignUmbrella systematic review.Data sourcesPubMed, Scopus, Cochrane Library.Eligibility criteriaSystematic reviews or meta-analysis examining and comparing performances of RPMs for CVDs, hypertension or diabetes in healthy adult (18–65 years old) population, published in English language.Data extraction and synthesisData were extracted according to the following parameters: number of studies included, intervention (RPMs applied/assessed), comparison, performance, validation and outcomes. A narrative synthesis was performed. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Study selection3612 studies were identified. After title/abstract screening and removal of duplicate articles, 37 studies met the eligibility criteria. After reading the full text, 13 were deemed relevant for inclusion. Three further papers from the reference lists of these articles were then added.Study appraisalThe methodological quality of the included studies was assessed using the AMSTAR tool.Risk of bias in individual studiesRisk of Bias evaluation was carried out using the ROBIS tool.ResultsSixteen studies met the inclusion criteria: six focused on diabetes, two on hypertension and eight on CVDs. Globally, prediction models for diabetes and hypertension showed no significant difference in effectiveness. Conversely, some promising differences among prediction tools were highlighted for CVDs. The Ankle-Brachial Index, in association with the Framingham tool, and QRISK scores provided some evidence of a certain superiority compared with Framingham alone.LimitationsDue to the significant heterogeneity of the studies, it was not possible to perform a meta-analysis. The electronic search was limited to studies in English and to three major international databases (MEDLINE/PubMed, Scopus and Cochrane Library), with additional works derived from the reference list of other studies; grey literature with unpublished documents was not included in the search. Furthermore, no assessment of potential adverse effects of RPMs was carried out.ConclusionsConsistent evidence is available only for CVD prediction: the Framingham score, alone or in combination with the Ankle-Brachial Index, and the QRISK score can be confirmed as the gold standard. Further efforts should not be concentrated on creating new scores, but rather on performing external validation of the existing ones, in particular on high-risk groups. Benefits could be further improved by supplementing existing models with information on lifestyle, personal habits, family and employment history, social network relationships, income and education.PROSPERO registration numberCRD42018088012.
Background: Measles is a highly contagious viral disease with serious complications. Currently, in Italy, measles vaccination is not mandatory for health care workers (HCWs) and medical students, and the free offer of the Measles Mumps Rubella (MMR) vaccine is the only national prevention measure to increase the coverage rate among these subjects. Aims: The aim of our study was to evaluate the impact on vaccination rate of the National Plan of Vaccine Prevention (NPVP) implemented in 2017. Material and Methods: This is a retrospective observational study that evaluated the measles-specific IgG immunity status of medical students at the University Tor Vergata of Rome, which underwent occupational health surveillance from 1 January to 31 December 2018. Results: In 2018, 84 of 319 students (26.30%) were serologically non-immune to measles; among these, 16 (19%) had previously been vaccinated, and 35 of the remaining 68 students accepted the MMR vaccine. Therefore, 33 out of 319 students did not undergo vaccination in 2018. These data are similar to those obtained in the previous year. In the 2017 screening, 84/314 (26.75%) students tested negative at the serological screening, whereas 15/85 (17.8%) among them documented a previous vaccination with two doses of the MMR vaccine; 69 students tested as unprotected. Vaccine compliance was 51.44%. Conclusions: No change in vaccination coverage occurred after the introduction of the last NPVP. Further efforts are needed to sensitize target populations about the relevance of vaccination; providing pre-employment screening for measles and free vaccine might be useful for this purpose.
Background: Healthcare workers (HCWs) are considered at higher risk for hepatitis B virus infection compared to the general population, due to their potential contact with blood or body fluids and possible needle stick injuries. In turn, infected HCWs may be a risk for patients. Hepatitis B vaccination programs represent a strategic approach to control the infection. Objectives: In this study, we aimed to evaluate the serological status of HCWs employed at the teaching hospital of Rome Tor Vergata and their risk of occupational injuries after the adoption of directive 2010/32/EU. Methods: Medical records of 539 HCWs were evaluated during their occupational medical examination at the Tor Vergata teaching hospital (PTV). All subjects were screened for specific viral markers: Hepatitis B surface antibodies (anti-HBs IgG), antibodies to hepatitis core antigen (anti-HBc IgG), and hepatitis B surface antigen (HBsAg). Data regarding needlestick injuries were collected by the prevention service team during the same year. Results: In this sample population, we found five subjects (0.9%) positive to the HBsAg, and most of them (four) were born in foreign countries. Moreover, seven subjects (1.3% of our population) were HBsAg-positive and anti-HBc-positive. A protective anti-HBs titer was found in 462 out of 527 (85.7%) subjects. The risk of being serologically unprotected was higher in males and subjects aged 40 years or older. The nurses were more protected than other healthcare professionals considering the anti-hepatitis B surface antibody titer. In 2018, 16 needlestick injuries were reported among our population of HCWs, with a global risk of 2.9% per year. Conclusions: Although hepatitis B virus (HBV) infection rate among HCWs was similar to that of the general population, the risk of HBV transmission in HCWs was likely to be high due to suboptimal vaccination coverage.
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