Annali Di Igiene[JOURNAL]
Sun
200 papers
Japanese Encephalitis can be devastating.
Lopalco PL, Biasio LR
Ann Ig · 2024 · PMID 38436079 · Publisher ↗
Japanese encephalitis, caused by the JE virus transmitted by mosquitoes, is the most common type of epidemic encephalitis in Asia. It is endemic in most of South and Southeast Asia, but the number of cases can vary great...
Japanese encephalitis, caused by the JE virus transmitted by mosquitoes, is the most common type of epidemic encephalitis in Asia. It is endemic in most of South and Southeast Asia, but the number of cases can vary greatly between areas. While many infections do not lead to disease, the symptomatic cases can be very severe and life-threatening. It mainly affects children, whereas adults are generally immune to the disease due to either being infected in childhood or receiving vaccination. However, individuals who are not immune, such as travelers from non-endemic countries, are susceptible to the disease when exposed to the virus for the first time, regardless of age. Without antiviral treatment options, vaccination is the only strategy to establish effective protection against Japanese encephalitis.
Infectious risk profile and strategies for prevention and control of outbreaks in refugee, asylum seekers and migrant populations in EU/EEA countries: a systematic narrative review of evidence.
Bianchi FP, Fiacchini D, Frisicale EM … +7 more , Gili R, Greco S, Guicciardi S, Riccò M, Zichichi S, Zotti N, Tafuri S
Ann Ig · 2024 · PMID 38436078 · Publisher ↗
INTRODUCTION: The recent surge in migration to and within the European Union and European Economic Area has brought the development of migration policy, including health policy, to the forefront of regional priorities. W...
INTRODUCTION: The recent surge in migration to and within the European Union and European Economic Area has brought the development of migration policy, including health policy, to the forefront of regional priorities. While migrants, in general, do not pose a health threat to the host population, specific subgroups of migrants, including refugees, asylum seekers, and irregular migrants, are particularly vulnerable to infectious diseases. To support public health policies in this area, the Emergency Preparedness and Management' working group of the Italian Society of Hygiene, Preventive Medicine and Public Health has conducted a systematic narrative review with the aim to comprehensively analyze the infectious disease risk within the refugee and asylum seeker populations in EU, EEA, and EU-applicant countries. METHODS: Forty-two studies were systematically selected from scientific articles in the MEDLINE/PubMed database from January 1, 2008, to June 1, 2023. The infectious risk associated with each infectious disease among refugees and asylum seekers, as well as the strategies to prevent and control outbreaks, was collected from all available studies. RESULTS: The congregate living conditions in refugee camps, transit centers, and temporary housing facilities make this population particularly vulnerable to infectious diseases. As such, implementing stringent hygiene and preventive measures is critical to safeguarding the health of refugees and reducing the risk of outbreaks that may affect both the refugee population and the host communities. CONCLUSION: Effective vaccination and preventive strategies for migrants, refugees, and asylum seekers are vital for public health and the well-being of these populations. They should be delivered as part of universal health care. By addressing barriers and implementing tailored programs, we can ensure equitable access to vaccines and protect the health of these vulnerable individuals.
COVID-19 Immunity in the Cohort of IRCCS San Raffaele Hospital Employees after BNT162b2 Vaccination: A Retrospective Observational Study.
Stocchi M, Melodia P, Lucini A … +6 more , De Lorenzo R, Pozzi C, Rovere-Querini P, Odone A, Renzi C, Signorelli C
Ann Ig · 2024 · PMID 38386027 · Publisher ↗
INTRODUCTION: The COVID-19 pandemic represents the most severe health and socioeconomic crisis of our century. It began with the first reports in China, in the Wuhan region in December 2019, and quickly spread worldwide,...
INTRODUCTION: The COVID-19 pandemic represents the most severe health and socioeconomic crisis of our century. It began with the first reports in China, in the Wuhan region in December 2019, and quickly spread worldwide, causing a new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Among the population most at risk of infection and developing severe forms of the disease are the elderly and healthcare workers, who are more exposed to infected individuals. On December 11, 2020, the Food and Drug Administration approved the emergency use of the BNT162b2 vaccine, the first mRNA vaccine in history. Since then, the total number of vaccine doses administered has exceeded 12 billion. Italy was the first European country to be affected by the pandemic, recording the highest number of total COVID-19 cases (25,695,311) and, after the first 70 days, had the highest crude mortality rate (141.0 per 100,000). In this study, we analyze the rate of SARS-CoV-2 infection among healthcare workers at the San Raffaele Scientific Institute in Milan before and after receiving the BNT162b2 vaccine. STUDY DESIGN: Retrospective observational cohort study. METHODS: The study analyzed the immunization status of 858 employees of the San Raffaele Scientific Institute in Milan, including doctors, healthcare workers, and administrative staff. The analysis is based on previous studies on the same cohort and is integrated with extrapolation and additional analysis of data from the Preventive Medicine Service's Biobank dataset of the same hospital to estimate the infection rate, duration of the disease, and antibody levels recorded in the personnel before and after receiving the double BNT162b2 vaccination. RESULTS: The analysis confirms the positive impact achieved by the introduction of mRNA vaccination in reducing the SARS-CoV-2 infection rate and increasing antibody levels in healthcare workers. Although the BNT162b2 vaccination may not provide complete protection against SARS-CoV-2, it appears to be able to reduce the number of infections, particularly the more severe and symptomatic forms often detected in individuals with various risk factors and comorbidities, making them more vulnerable. Healthcare workers, who have extensive contact with patients and record the greatest decrease in the infection rates, represent the population that receives the most benefit from vaccination. CONCLUSIONS: The evidence suggests that vaccinations are essential in protecting high-risk groups, such as healthcare workers, from SARS-CoV-2 infection. Providing adequate vaccination coverage to healthcare workers limits the spread of infections and decreases the severity of disease manifestations, while also reducing their duration.
The role of pharmacies in the implementation of vaccination cover- age in Italy. Insights from the preliminary data of the Lombardy Region.
Pennisi F, Mastrangelo M, De Ponti E … +4 more , Cuciniello R, Mandelli A, Vaia F, Signorelli C
Ann Ig · 2024 · PMID 38386026 · Publisher ↗
INTRODUCTION: The administration of vaccines in pharmacies was not allowed in Italy until 2021. During the COVID-19 pandemic, legislative innovations were introduced that now allow qualified pharmacists to administer ant...
INTRODUCTION: The administration of vaccines in pharmacies was not allowed in Italy until 2021. During the COVID-19 pandemic, legislative innovations were introduced that now allow qualified pharmacists to administer anti-flu and anti-COVID-19 vaccines after completing specific training. METHODS: The article provides an overview of legislation concerning vaccinations in Italian pharmacies, followed by a description of the vaccinations carried out by pharmacies participating in the regional vaccination campaign from 2021 to 2023. The study relies on data extracted from the Lombardy Region's database on vaccine administration in pharmacies. Furthermore, innovative vaccination practices from the Marche Region were also taken into consideration. STUDY DESIGN: Observational Study. RESULTS: Lombardy became the Italian pioneer region in extensively incorporating pharmacy-based vaccinations, starting in 2021. This initiative reached its zenith with 46% of anti-COVID vaccines and 17% of flu vaccines administered within the first six weeks of the autumn 2023 campaign. Pharmacies played a crucial role in meeting the targets outlined in the Italian National Vaccine Prevention Plan for 2023-25. As part of an experimental program, the Marche Region has further expanded pharmacy-based vaccinations, now including anti-zoster and anti-pneumococcus vaccines for the 2023-24 campaign. CONCLUSIONS: The promising outcomes observed in Lombardy and the ongoing experimental efforts in the Marche are encouraging steps toward achieving vaccination coverage targets, albeit still falling below the objectives set by the National Vaccination Plan for 2023-25. The widespread presence of pharmacies throughout the territory makes them well-suited as support structures for vaccination campaigns, especially in reaching the adult, the elderly, and the vulnerable populations.
Vaccination status among COVID-19 patients and duration of Polymerase Chain Reaction test positivity: evaluation of immunization schedule and type of vaccine.
Guerriero P, Cipollone C, Martinelli R … +7 more , Caputo F, Cervellini M, Mammarella L, Muselli M, Mastrantonio R, Mastrangeli G, Fabiani L
Ann Ig · 2024 · PMID 38386025 · Publisher ↗
BACKGROUND: The introduction of the vaccine against SARS-CoV-2 has represented a cornerstone in the containment of the pandemic. Our aim was to assess the vaccination schedules in relation to the infection free interval...
BACKGROUND: The introduction of the vaccine against SARS-CoV-2 has represented a cornerstone in the containment of the pandemic. Our aim was to assess the vaccination schedules in relation to the infection free interval and to the duration of positivity in case of infection. STUDY DESIGN: This study involves the SARS-CoV-2 infected people managed by the Local Health Authority ASL 1 Abruzzo. The data collected included: vaccine administration date, vaccine type, information on the Polymerase Chain Reaction test positivity, and demographic variables, such as age and sex. METHODS: The duration of Polymerase Chain Reaction test positivity was assessed in relation to the vaccination status, the vaccine type and the time interval between the last vaccination dose and the first nasopharyngeal positive swab over the considered period. RESULTS: The infection duration (DAYS) was significantly shorter in subjects vaccinated with a booster dose than unvaccinated subjects (12.8 vs 14.6; p<0.0001) and subjects vaccinated with the primary series only (12.8 vs 14.1; p<0.0001). Duration of PCR positivity was shorter with heterologous immunisation than with other vaccination schedules (p=0.0317). CONCLUSIONS: This study highlights, in a large cohort of patients, the association between vaccination schedule and the response to infection.
Impact of COVID-19 pandemic on emergency and elective surgery. A retrospective observational analysis in Apulia, southern Italy.
Bianchi FP, Daleno A, Rizzi D … +2 more , Migliore G, Tafuri S
Ann Ig · 2024 · PMID 38386024 · Publisher ↗
INTRODUCTION: In Italy, at the beginning of the COVID19 pandemic, only emergency and life-saving elective surgical procedures were allowed with obvious limitations in terms of numbers of operable cases. The aim of our st...
INTRODUCTION: In Italy, at the beginning of the COVID19 pandemic, only emergency and life-saving elective surgical procedures were allowed with obvious limitations in terms of numbers of operable cases. The aim of our study is to evaluate the performance of surgical activities by Apulian healthcare facilities (Southern Italy) under the pandemic emergency pressure. METHODS: The surgical procedures in study were identified via the Apulian regional archive of hospital discharge forms. We used the ICD9 codes in order to define the elective and urgency surgeries in analysis, and we extended our search to all procedures performed from 2019 to 2021. RESULTS: The number of all procedures decreased from 2019 to 2020; the reduction was higher for elective surgery (-43.7%) than urgency surgery (-15.5%). In 2021, an increase compared to 2020 was recorded for all procedures; nevertheless, elective surgeries registered a further slightly decrease compared to 2019 (-12.4%), while a slightly increase was observed for urgency surgeries (+3.5%). No particular variation was observed considering sex and age at surgery of the patients, and days of hospitalization from 2019 to 2021. CONCLUSIONS: The impact of COVID19 on Apulian regional health system has been extremely shocked and has required the implementation of strategies aimed at containing the infection and guaranteeing health services as far as possible. A new paradigm of hospital care for SARS-COV-2 patients in the post-emergency phase in Italy is needed, in order to optimize the resources available and to guarantee high standards of quality and efficiency for citizens.
Trust in Conventional Healthcare and Utilization of Complementary and Alternative Medicine in South Tyrol, Italy: A Population-Based Cross-Sectional Survey.
Barbieri V, Lombardo S, Gärtner T … +3 more , Piccoliori G, Engl A, Wiedermann CJ
Ann Ig · 2024 · PMID 38386023 · Publisher ↗
BACKGROUND: This study explored the link between trust in conventional healthcare and consultations with complementary and alternative medicine (CAM) providers in South Tyrol, Italy's linguistically diverse region. METHO...
BACKGROUND: This study explored the link between trust in conventional healthcare and consultations with complementary and alternative medicine (CAM) providers in South Tyrol, Italy's linguistically diverse region. METHODS: A representative cross-sectional survey of 1,388 South Tyrolean adults assessed trust in conventional healthcare, general practitioners, and complementary and alternative medicine consultation frequencies and their determinants using chi-square tests and Kendall-Tau-b correlations. RESULTS: Seventy percent trusted the traditional healthcare system, with general practitioners as the primary trusted professionals. Trust is correlated with higher education and linguistic compatibility. A 5% subgroup, mostly women and multilinguals with lower education levels, showed uncertain trust. Over 80% had seen a general practitioner in the last year, while distrust was correlated with complementary and alternative medicine consultations. German and Ladin speakers, with higher education levels, were notably inclined towards complementary and alternative medicine consultations. CONCLUSIONS: Trust in South Tyrolean healthcare varied according to education level and language. While general practitioners remain central, there is a marked shift towards complementary and alternative medicine among specific groups.
The contribution of the private healthcare sector during the COVID-19 pandemic: the experience of the Lombardy Region in Northern Italy.
Signorelli C, De Ponti E, Mastrangelo M … +5 more , Pennisi F, Cereda D, Corti F, Beretta D, Pelissero G
Ann Ig · 2024 · PMID 38303641 · Publisher ↗
INTRODUCTION: In Lombardy, the first European region hit by the COVID-19 pandemic, for decades the regional public healthcare service has followed a mixed delivery model with extensive involvement of private accredited p...
INTRODUCTION: In Lombardy, the first European region hit by the COVID-19 pandemic, for decades the regional public healthcare service has followed a mixed delivery model with extensive involvement of private accredited providers. The study aimed at examining the role of the private sector in delivering healthcare services (diagnosis, hospitalization, and vaccination) during the pandemic. STUDY DESIGN: Healthcare system study. METHODS: We analysed regional healthcare data referring to the period from March 2020 onwards to assess the availability of acute care and intensive care hospital beds, SARS-CoV-2 tests, and COVID-19 vaccinations. We specifically examined healthcare offered by private accredited providers within the region. RESULTS: Of the 12,306 converted beds for COVID-19 treatment, 4,975 (40%) were in accredited private hospitals. Intensive care beds increased by 95%, reaching 1,755, with 484 (28%) in accredited private hospitals. Since the pandemic onset, 28.9 million (62%) of SARS-CoV-2 tests were conducted by private accredited facilities including pharmacies. Private sector actively contributed to the COVID-19 vaccination campaign administering over 2.6 million doses in 2021, enhancing vaccination capacity to its peak. CONCLUSIONS: The longstanding relationship between the public and private sectors within the Lombardy regional healthcare service facilitated a rapid increase in hospital bed capacity, the upscaling of SARS-CoV-2 testing capacity, and the achievement of vaccination goals to address the COVID-19 emergency. Therefore, alongside a robust and adequately funded public healthcare service, the private sector serves as an asset to enhance the resilience of healthcare systems, in line with WHO indications.
"Leo&Giulia standing for public health": an animated series to promote the values of public health among school-aged children. Best practices and field-trial protocol.
Odone A, Sgueglia AC, Bertuccio P … +6 more , Vecchio R, Meloni A, Gianfredi V, Traverso L, Gaeta M, Vigezzi GP
Ann Ig · 2024 · PMID 38303640 · Publisher ↗
BACKGROUND: The "Leo&Giulia standing for public health" project is an innovative digital health education model targeting primary school children. The project, developed during the COVID-19 pandemic, aims to educate prim...
BACKGROUND: The "Leo&Giulia standing for public health" project is an innovative digital health education model targeting primary school children. The project, developed during the COVID-19 pandemic, aims to educate primary school-aged children about public health issues through an animated cartoon series. It highlights the importance of early-life health promotion and the potential role of educational settings in shaping health behaviours. STUDY DESIGN: A 2-year school-based cluster-randomized controlled community trial will be conducted among 8-10-year-old pupils in the province of Pavia, Northern Italy. METHODS: The intervention group will receive an educational programme via a new episode of "Leo&Giulia" animated series, focusing on smoking prevention. The study will assess changes in knowledge, attitudes towards smoking, and communication about smoking risks among peers and parents. The trial involves baseline and follow-up assessments through questionnaires targeting both children and parents. RESULTS (EXPECTED): We assume that children in the intervention group will demonstrate increased knowledge and awareness of smoking-related health risks and develop negative attitudes towards tobacco use compared to the control group. Enhanced communication about tobacco harms among peers and between children and parents, as well as increased parental involvement in anti-smoking socialization practices, are expected secondary outcomes. DISCUSSION AND CONCLUSIONS: "Leo&Giulia" integrates health education into the school curriculum, leveraging the appeal of animated content to engage children in public health topics. The project is expected to contribute to the field of health education by demonstrating the effectiveness of digital health interventions in childhood, foreseeing potential long-term impacts on health behaviors and in shaping future public health strategies.
Adverse human health effects of climate change: an update.
Filippini T, Paduano S, Veneri F … +3 more , Barbolini G, Fiore G, Vinceti M
Ann Ig · 2024 · PMID 38303639 · Publisher ↗
BACKGROUND: The world is currently facing a process of climate change, which may adversely impact human health in many different ways. The safety of food, water and urban environments is endangered by the consequences of...
BACKGROUND: The world is currently facing a process of climate change, which may adversely impact human health in many different ways. The safety of food, water and urban environments is endangered by the consequences of climate change. Sea level and temperature rise, along with more frequent and longer heat waves, represent only a few of the effects of climate change. The increased risk of extreme climate events (e.g., cyclones, droughts and floods) is another serious public health issue. These adverse effects are enhanced in areas and countries not having the capacity to effectively deal with climate change. STUDY DESIGN: We primarily aimed at summarizing the impacts of climate change on public health. A further aim was to identify the most concerning consequences of this phenomenon and the vulnerability factors that amplify the negative effects of climate change. METHODS: PubMed and other literature databases were used as literature sources for this narrative review based on the search terms 'climate change' and 'diseases categories' up to January 2024, in order to assess the most recent and relevant scientific evidence about the relation between climate change and public health, identify knowledge gaps and priorities for future research. We also screened the websites of major agencies devoted to human health protection and environmental health. RESULTS AND CONCLUSIONS: Climate change appears to induce a broad spectrum of generally adverse effects on public health. It may increase the risk of infectious diseases, psychiatric disorders, cancer and other diseases. Currently, we are not effectively counteracting this phenomenon, since pollutant and greenhouse gas emissions have been increasing alongside temperatures. A host of measures are required in order to prevent and fight climate change and related health effects. These include the adoption of a holistic approach and the collaboration of different kinds of expertise in order to design more effective strategies. Special attention should be paid to those who live in disadvantaged countries, and those who are more vulnerable to the adverse health consequences of climate change.
Vaccination strategies for high-risk and fragile populations in Lombardy (Italy): a region-wide assessment of hospital-based models and best practices.
Odone A, Vecchio R, Brogonzoli L … +8 more , Sala E, Vigezzi GP, Muzzi A, Borriello CR, Cereda D, Rizzardini G, Venturi A, Iardino R
Ann Ig · 2024 · PMID 38299733 · Publisher ↗
BACKGROUND: Subjects with selected underlying medical conditions are at higher risk of infection and severe outcomes from vaccines preventable diseases. While most countries adopt life-course approaches to vaccination, h...
BACKGROUND: Subjects with selected underlying medical conditions are at higher risk of infection and severe outcomes from vaccines preventable diseases. While most countries adopt life-course approaches to vaccination, high-risk group immunization programmes could maximize individual protection, while contributing to population health. The COVID-19 pandemic stimulated the planning and implementation of successful hospital-based high-risk groups' immunization models. However, in Italy, high-risk subjects' vaccine coverage is not actively monitored at the national or regional level, nor shared guidelines exist yet on hospital-based immunization programmes. STUDY DESIGN: The study reports findings from a region-wide assessment of the availability, characteristics, and setting-specific features of hospital-based immunization programmes for high-risk subjects in the Lombardy region. METHODS: Fondazione The Bridge a not-for-profit organization based in Milan, in collaboration with the Prevention Unit of the Lombardy Region Directorate for Welfare, and the University of Pavia coordinated a project aimed at bringing together regional health institutions, key stakeholders, academic experts, scientific societies and patients' associations to assess high-risk subjects' barriers to vaccine uptake and inform preventive programmes and policies. In this context, we designed and implemented a survey to systematically map the existence and characteristics of hospital-based immunization programmes targeting high-risk subjects. The survey was proposed to all 115 hospital medical directions of the Lombardy region. RESULTS: We collected data from 97 hospital medical directions, with a response rate of 85%. Among respondents, 24% were publi-cly managed hospitals, 17% were Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) and 59% accredited private hospitals. Overall, 51.5% facilities in the Lombardy Region reported to actively administer vaccines to high-risk subjects in hospital settings, the prevalence being 89.6% in public hospitals. Among hospitals where vaccines are actively administered, 46% reported to have centralized vaccines ambulatory clinics, while 54% reported to administer vaccines in the context of inpa-tient care, within clinical wards. In 14% of hospitals vaccination counselling is carried out at the hospital level, while patients are referred to community services for the vaccine administration, 58% have established clinical pathways and formalized internal procedures to integrate vaccine prevention within the clinical care. CONCLUSIONS: Half of hospital facilities in the Lombardy Region administer vaccines to high-risk patients. Hospital-based im-munization models vary widely by vaccines programmes, organizational aspects, vaccines procurement and workforce involved. Identifying best practices and effective models can help tackle current challenges and improve immunization coverage for at-risk groups.
Primary care doctors retirements in the context of an ageing population in Italy.
Dalla Valle Z, Signorelli C, Renzi C
Ann Ig · 2024 · PMID 38299732 · Publisher ↗
BACKGROUND: Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policy...
BACKGROUND: Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policymakers. To support planning of primary healthcare resource allocation we analyzed the geographic distribution of primary care doctors/primary care paediatricians across Italian regions, accounting for area-specific number and age of the population. Additionally, we estimated the number of primary care doctors/primary care paediatricians expected to retire over the next 25 years, with a focus on the next five years. STUDY DESIGN: Ecological study. METHODS: We gathered the list of Italian general practitioners and primary care paediatricians and combined them with the data from the National Federation of Medical Doctors, Surgeons and Dentists. Using data from the National Institutes of Statistics, we calculated the average number of patients per doctor for each region using the number of residents above and under 14 years of age for general practitioners and primary care paediatricians respectively. We also calculated the number of residents over-65 and over-75 years of age per general practitioner, as elderly patients typically have higher healthcare needs. RESULTS: On average the number of patients per general practitioner was 1,447 (SD: 190), while for paediatricians it was 1,139 (SD: 241), with six regions above the threshold of 1,500 patients per general practitioner and only one region under the threshold of 880 patients per paediatrician. We estimated that on average 2,228 general practitioners and 444 paediatricians are going to retire each year for the next five years, reaching more than 70% among the current workforce for some southern regions. The number of elderly patients per general practitioner varies substantially between regions, with two regions having >15% more patients aged over 65 years compared to the expected number. CONCLUSIONS: over 65 years compared to the expected number. Conclusions. The study highlighted that some regions do not currently have the required primary care workforce, and the expec-ted retirements and the ageing of the population will exacerbate the pressure on the already over-stretched healthcare services. A response from healthcare administrations and policymakers is urgently required to allow equitable access to quality primary care across the country.
Variations in avoidable hospital admissions and emergency visits by primary care characteristics: an ecological study in Italy.
Dalla Valle Z, Ricciardi GE, Signorelli C … +1 more , Renzi C
Ann Ig · 2024 · PMID 38299731 · Publisher ↗
BACKGROUND: Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on...
BACKGROUND: Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the characteristics of primary healthcare across Italian regions and health outcomes included in the National Programs Outcomes of the National Agency for Regional Healthcare Services. STUDY DESIGN: Ecological study. METHODS: We analysed healthcare data from the National Agency for Regional Healthcare Services, the public lists of primary care doctors and the National Federation of Surgeons and Dentists and the National Institutes of Statistics referring to the 20 Italian regions. Pearson's correlation and Spearman's correlation were used to assess the relationships between primary healthcare characteristics and health outcomes. RESULTS: Overall, across all Italian regions each general practitioner had on average 1447 patients and was 57.5 years old. The study found positive correlations between the number of patients per general practitioner and non-urgent Emergency Department visits among adult patients (Pearson's r = 0.58, p = 0.008), the number of residents aged 65+ per general practitioner and the rate of chronic obstructive pulmonary disease admissions (Pearson's r = 0.49, p = 0.029), and the age of general practitioners and lower-extremity amputations in diabetes patients (Pearson's r = 0.56, p = 0.011). A negative correlation was observed between the age of general practitioners and urinary tract infection admissions (Pearson's r = -0.76; p < 0.001). A non-linear negative correlation was found between the age of general practitioners and chronic obstructive pulmonary disease admissions (Spearman's ρ = -0.46, p = 0.041). CONCLUSIONS: The findings emphasise the importance of guaranteeing sufficient numbers of primary healthcare physicians to meet patients' needs, and for limiting avoidable hospitalisations and emergency presentations. General practitioners' age might also influence the provision of care, but more research is needed on possible mechanisms.
New Requirements for post-COVID-19 Hospital Inpatient Wards: Evidence, Design Recommendations and Assessment Tools.
Nuvolari-Duodo I, Brambilla A, Ricciardi GE … +2 more , Dolcini M, Capolongo S
Ann Ig · 2024 · PMID 38275084 · Publisher ↗
BACKGROUND: The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic...
BACKGROUND: The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic experience. Although the new emerged needs of user-centeredness, comfort and wellbeing within specific functional areas, there is still a lack of measurable indications for addressing these challenges in-patient wards. STUDY DESIGN: The objective of this study is therefore to provide specific guidelines for the design of the in-patient ward, through measurable criteria and indicators based on evidence from the scientific literature, and to develop an assessment tool for its evaluation. METHODS: A five-step process has been followed: (i) performing a literature review about hospital wards and wellbeing strategies, (ii) conducting a best practice analysis and comparison of a selection of international contemporary healthcare facilities, (iii) defining some dimensional requirements from the comparison, (iv) developing an assessment tool based on extracted criteria, (v) testing the tool on an existing project. RESULTS: Amongst the criteria, several aspects have been highlighted ranging from qualitative indicators, as the clarity of wayfinding or the level of privacy, to quantitative values, as the percentage of single inpatient rooms or the distance between rooms and nursing stations. The assessment tool is composed by 20 indicators, associated to thematic areas and referred to three environmental units of the inpatient ward. Two types of scoring system are proposed. CONCLUSIONS: Starting from those considerations and tool wider applications, the future design of hospital wards could follow guidelines addressing user-centeredness, comfort and wellbeing.
Water fluoridation between public health and public law: an assessment of regulations across countries and their preventive medicine implications.
Vinceti SR, Veneri F, Filippini T
Ann Ig · 2024 · PMID 38265641 · Publisher ↗
BACKGROUND: Among health professionals and health policymakers concern is growing as to the difficulty of balancing the prevention of dental caries through cost-effective interventions and the need to limit unnecessary e...
BACKGROUND: Among health professionals and health policymakers concern is growing as to the difficulty of balancing the prevention of dental caries through cost-effective interventions and the need to limit unnecessary exposure of the population, and especially children, to environmental chemicals. In this respect, the use of water fluoridation to prevent tooth decay epitomizes the dilemma by raising questions relevant to both public health and public law, ranging from the balance of public health and medical self-determination, the division of powers between local or national authorities over water fluoridation, and the need to avoid the adverse effects of socioeconomic inequalities as well as both under- and over-exposure. STUDY DESIGN: We carried out a narrative review by searching the relevant literature about the laws and rules related to drinking water fluoridation at the community level in the US, UK, and Europe, in order to discuss how the issue is handled from both a public health and public law perspective. METHODS: Sources of data for this review were the biomedical and legal literature retrieved by searching online databases, and websites of public health and legal institutions. RESULTS AND CONCLUSIONS: We found that water fluoridation is still largely adopted throughout the US, while in the UK and particularly in the European Union only a minor part of the population is subject to it. In addition, the recommended and maximum allowed amounts of fluoride in drinking water are being adapted to the public health recommendations and the new regulations, within an evolving evaluation of the epidemiologic evidence and the risk assessment currently in progress by two major regulatory agencies, the US National Toxicology Program - NTP and the European Food Safety Authority - EFSA. Under a comparative public law perspective, the three investigated legislations are facing a reassessment of their policies and regulations, to allow for effective and safe public health measures in the field of water fluoridation and more generally for a preferred use of topical fluoride for caries prevention. A consistent trend across these legislations is the choice to centralize at the national level regulatory and management issues related to water fluoridation, and to carefully balance benefits for dental caries prevention in children and the potential risks of systemic overexposure associated with excess fluoride intake, by promptly responding to the evolving indications by the scientific community and the public health professionals.
Quality of hospital care and clinical outcomes: a comparison between the Lombardy Region and the Italian national data.
Signorelli C, Pennisi F, Lunetti C … +3 more , Blandi L, Pellissero G, Fondazione Sanità Futura WG
Ann Ig · 2024 · PMID 38265640 · Publisher ↗
BACKGROUND: Improving the quality and effectiveness of healthcare is a key priority in health policy. The emergence of the COVID-19 pandemic has exerted considerable pressure on hospital networks, requiring unprecedented...
BACKGROUND: Improving the quality and effectiveness of healthcare is a key priority in health policy. The emergence of the COVID-19 pandemic has exerted considerable pressure on hospital networks, requiring unprecedented reorganization and restructuring actions. This study analyzed data from the Italian National Outcomes Program to compare some volumes and outcomes of public and private accredited hospitals in the Lombardy Region with national data. STUDY DESIGN: Observational study. METHODS: A thorough examination of hospital outcomes between 2019 and 2021 was conducted, considering 45 volume indicators and 48 process and outcome indicators, comparing Lombardy with other Italian regions and public versus private accredited hospitals. RESULTS: In 2020, Italy and Lombardy experienced a considerable reduction in overall hospital admissions, with Lombardy showing a deeper decline (21.3% compared with 16.0% in Italy). In 2021, both experienced a partial recovery, especially marked in the Lombardy region (+7.3%, compared with national data). Focusing specifically on the private sector in Lombardy, a recovery of +9.3% in hospitalization was observed. In the analysis of clinical outcomes, Lombardy outperformed the national average for 63% of the indicators in 2020 and 83.3% in 2021. CONCLUSIONS: The study shows the continuing decline in volumes compared to 2019 (pre-COVID), the excellent performance of hospitals in Lombardy and a relevant contribution for the volumes and the quality of outcomes of private accredited hospitals.
Yoga or Mindfulness on Diabetes: Scoping Review for Theoretical Experimental Framework.
Cangelosi G, Acito M, Grappasonni I … +7 more , Nguyen CTT, Tesauro M, Pantanetti P, Morichetti L, Ceroni E, Benni A, Petrelli F
Ann Ig · 2024 · PMID 38265639 · Publisher ↗
BACKGROUND: About one in 11 adults worldwide suffers from diabetic disease with constantly increasing prevalence; from the 529 million patients registered in 2021, the number of people with diabetes was predicted to rise...
BACKGROUND: About one in 11 adults worldwide suffers from diabetic disease with constantly increasing prevalence; from the 529 million patients registered in 2021, the number of people with diabetes was predicted to rise to approximately 1.31 billion in 2050. In Italy, 5.9% of the population is diabetic, with a higher prevalence with increasing age and in the South of the country. Yoga and Mindfulness could represent a valid support for the care of diabetic subjects especially in a stressful caring context such as the Covid-19 pandemic. STUDY DESIGN: A scoping review was conducted to achieve the goals of the study. Yoga or Mindfulness interventions on diabetic subjects were specifically analyzed and qualitative-quantitative data collected in the selected randomized controlled trials were extensive for possible meta-analysis. METHODS: The review was conducted by two independent practitioners and a third one was consulted in case of conflict. The PRISMA method was used for both the selection and reporting of the studies to be included. Specific PICOS and search strategies have been developed on PubMed, Embase and PsycINFO databases. Included in the review were: randomised controlled trials, full dissertation articles and papers in English with a time limit on May 31, 2022. RESULTS: The Review included 22 studies; 12 on Mindfulness, 9 on Yoga and one about both disciplines; among these, one studied patients with Type 1 Diabetes, 14 with Type 2 Diabetes, 6 with both and one with Gestational Diabetes. Only one paper studied adolescent subjects while the other 21 focused on a range of adult subjects. The studies showed that Yoga and Mindfulness have strong potential not only on stress management, but also on clinical-metabolic parameters. CONCLUSIONS: The recent Covid-19 pandemic has certainly redesigned a new way of treating and managing chronic diseases, such as diabetes. An increasingly fragile population, and with the growing need to reduce overall stress levels, could find alternative practices in Yoga and Mindfulness to support conventional therapies.
Impact of the Covid pandemic on timely cancer diagnosis across European healthcare settings: a scoping review.
Pennisi F, Odelli S, Borlini S … +3 more , Morani F, Signorelli C, Renzi C
Ann Ig · 2024 · PMID 38240184 · Publisher ↗
INTRODUCTION: The COVID-19 pandemic presented unprecedented challenges to European healthcare systems. The study aimed to review the available evidence on the impact of the pandemic on the timely diagnosis of cancer acro...
INTRODUCTION: The COVID-19 pandemic presented unprecedented challenges to European healthcare systems. The study aimed to review the available evidence on the impact of the pandemic on the timely diagnosis of cancer across European countries. The primary objective was to examine changes in diagnostic pathways and stage at diagnosis during the pandemic, compared to the pre-pandemic period, across European countries, taking healthcare system characteristics and COVID-19 policies into account. METHODS: We conducted a review of the impact of the pandemic on cancer diagnosis in Europe, analyzing primary studies from 2018 to 2023 using both quantitative and qualitative methods through searches in PubMed and Scopus databases. Study quality was assessed using the Mixed Methods Appraisal Tool. The main explanatory factors analyzed were grouped into two categories: Covid-policies (government responses, using the Oxford COVID-19 Government Response Tracker and its stringency index as key metrics) and healthcare characteristics (healthcare system models, expenditure and resources, including hospital beds and the ratio of medical doctors). STUDY DESIGN: Scoping review. RESULTS: Overall, 127 papers were screened, 80 retrieved for full-text evaluation and 50 articles were included in the review. The studies encompassed a total of 509,753 patients from 17 European countries. The pandemic period was characterised by worse process and outcome measures for all examined cancers, except for lung cancer, compared to the pre-pandemic period. Group-ing countries based on government actions and policy responses (stringency index) did not show any differences in timely cancer diagnosis. Countries with lower healthcare expenditure (per capita expenditure <2,000 euros) or lower investments in prevention reported more cancer diagnostic delays during the pandemic. Countries with >20% of General Practitioners over the total number of physicians and with more hospital beds per population experienced fewer diagnostic delays during the pandemic. CONCLUSIONS: Overall, the review suggests that diagnostic pathways and cancer stage at diagnosis during the COVID-19 pandemic varied across Europe, with countries' healthcare expenditure, investments in prevention, the proportion of General Practitioners and the number of hospital beds per population possibly playing a role. This analysis can inform healthcare policies aimed at addressing post-pandemic challenges and formulating resilience plans for future emergencies.
Healthcare-Associated-Infections: preliminary results from a real-time reporting system of an Italian neurologic research hospital.
Blandi L, Bolcato V, Meloni A … +2 more , Bosone D, Odone A
Ann Ig · 2024 · PMID 38240183 · Publisher ↗
BACKGROUND: Healthcare-Associated-Infections are a critical concern in healthcare settings, posing serious threats to patient safety and causing significant morbidity, mortality, and financial strain. This study aims to...
BACKGROUND: Healthcare-Associated-Infections are a critical concern in healthcare settings, posing serious threats to patient safety and causing significant morbidity, mortality, and financial strain. This study aims to calculate healthcare-associated-infections trends in the hospital setting through an automatic reporting system. STUDY DESIGN: The study is a descriptive analysis of automatically generated trends of an innovative digital tool based on existing hospital information flows. METHODS: An algorithm was developed within a Clinical Information System to create a suite of quality indicators for monitoring healthcare-associated-infections trends. The algorithm used criteria related to admission, laboratory tests and antimicrobial administrations. A descriptive analysis was conducted for patients aged 18 or older, admitted to a neurological or to a neuro-rehabilitation department of a neurologic hospital from 2019 to 2022. RESULTS: The results showed fluctuations in healthcare-associated-infections prevalence from 2.9% to 5.6% and hospital infec-tions prevalence from 4.5% to 10.9%, with notable increases in 2020 and 2021. The majority (70.3%) of healthcare associated infections identified by the tool were confirmed to be potentially hospital-acquired, according to the European Centre of Disease Prevention and Control's definition. DISCUSSION AND CONCLUSIONS: The study posits the algorithm as a vital tool for automatically monitoring hospital infections, providing valuable preliminary results for improving care quality and guiding the infections' prevention and control strategies, with plans to benchmark the algorithm against a gold standard in the future.
Social network characteristics and well-being in Italy: insights from the PHRASI Study.
Berselli N, Caminiti M, Ancona A … +9 more , Stacchini L, Gallinoro V, Catalini A, Cosma C, De Nicolò V, Mazza C, Minutolo G, Cedrone F, Gianfredi V
Ann Ig · 2024 · PMID 38240182 · Publisher ↗
BACKGROUND: Mental well-being should be prioritized in public health as it represents a valuable resource for individuals and communities, influencing behavior, social cohesion and social inclusion. The support individua...
BACKGROUND: Mental well-being should be prioritized in public health as it represents a valuable resource for individuals and communities, influencing behavior, social cohesion and social inclusion. The support individuals receive from their social networks can have a significant impact on mental well-being. This study used data from the Public Health Residents' Anonymous Survey in Italy, a nationwide cross-sectional survey. The objective was to assess the level of well-being among the Public Health Residents and investigate the association between the social network characteristics and the well-being in this population. STUDY DESIGN: The current cross-sectional study targeted 1,600 public health residents enrolled in various Italian public health specialization schools between June 14 and July 26, 2022. METHODS: Participants self-reported both functional and structural characteristics of social network. Well-being was assessed using the WHO-5 well-being index. Linear regression models, adjusted for age and sex, were applied to examine the association between WHO-5 score and social network characteristics. RESULTS: Out of 379 participants, 51.5% reported bad well-being. Those with bad well-being are more likely women, experience lower peer-to-peer and supervisor support, face higher work-to-private life interference, and less frequently have a partner. Greater peer-to-peer support (β=1.13, 95% CI=0.68; 1.57), and increased supervisor support (β=1.26, 95% CI=0.86; 1.67), were associated with higher levels of well-being. Conversely, higher work-to-private life interference was associated with lower perceived well-being. Having a partner resulted in a better perceived well-being (β=1.96, 95% CI=0.94; 2.98). In logistic regression analysis, higher peer-to-peer support (OR=0.68, 95% CI = 0.55;0.85) greater supervisor support (OR=0.60, 95% CI=0.49;0.74) and having a partner (OR=0.51, 95% CI = 0.32;0.82) were associated with reduced odds of bad well-being. Conversely, increased WLI was associated with higher odds of bad well-being (OR=1.47, 95% CI = 1.19;1.82). CONCLUSIONS: The characteristics of an individual's social network play a crucial role in her/his well-being and should be considered both in personal and professional contexts when aimed to enhance mental well-being in communities.
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