Healthcare Workers’ attitudes towards mandatory influenza vaccination: a systematic review

Background

Influenza affects approximately between 5 to 10% of general population every year, leading to 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths. Healthcare Workers (HCWs) play a crucial role in spreading the infection to patients. Although the strong recommendations provided, influenza vaccination coverage rates among HCWs are globally well below the coverage target set by WHO. The aim of this study is to assess attitudes towards mandatory influenza vaccination programs among HCWs, in order to make a quantitative synthesis of the phenomenon.

Methods

The present study systematically reviewed published cross-sectional studies investigating attitudes towards compulsory influenza vaccination in Healthcare Workers. PubMed and Scopus scientific databases were searched and 4,198 results were returned. Of these, 23 met the inclusion criteria for the review and 13 were eligible for the meta-analyses. PRISMA statements were followed.

Results

Thirteen studies were conducted in North America, 4 were conducted in Europe, 3 in Asia, 2 were performed in Australia and one study collected data both from Europe and Asia. According to the assessed studies, the percentage of agreement ranged from 44% to 95% for different compulsory vaccination programs. A combined prevalence of 59.8% (95%CI 50.1-68.8) was found in the meta-analysis. Having been vaccinated against influenza in the previous year increases the likelihood (OR 4.1; 95%CI 2.8-6.1) of being in favour of mandatory vaccination policies.

Conclusions

Compulsory influenza vaccination programs are generally accepted by the majority of health professionals, especially by those who have already been vaccinated previously. These results could be important to improve European vaccination strategies, in order to increase influenza vaccination rates among Healthcare Workers.

Key messages

Mandatory influenza vaccination programs are accepted by the majority of Healthcare Workers. Having been previously vaccinated against influenza increases the likelihood of being in favor of a mandatory vaccination policy.

Depressive symptoms and suicidal ideation among medical students: a cross-sectional survey in Turin

Background

A high prevalence of mental illnesseshave been detected in medical students (MS) during college. The aim of this study was to evaluate depressive symptoms (DS) and suicidal ideation (SI) in MS and estimate factors that can influence these conditions.

Methods

In November 2018 a cross-sectional survey was conducted at the School of Medicine of Turin, Italy. The questionnaire consisted of a 30-item sociodemographic part and 3 psychometric tests, including the Beck Depression Inventory II (BDI-II). Overall, 506 surveys were collected. Multivariable logistic regressions were performed mainly. The significance level was p ≤ 0.05.

Results

Females were 65% and median age was 22 (IQR 19-24). Median BDI-II score was 9 (IQR 4-15). Presence of DS (BDI-II score>13) and of SI was found in 29% and 15% of the sample, respectively. Preliminary results showed that females (OR 2.03, CI: 1.16-3.56), non-heterosexuals (OR 2.69, CI: 1.49-4-84), participants negative about their college choice (OR 4.79, CI: 2.78-8.26) had a higher risk to report DS. MS who consider unsatisfying their friendships with classmates had a higher likelihood of reporting DS and SI (OR 3.10, CI: 1.16-8.30; OR 2.91, CI: 1.10-7.68, respectively). While the opposite was for those with good economic condition (OR 0.39, CI: 0.16-0.91; OR 0.21, CI: 0.09-0.52, respectively) and those practicing sports more than 90 min/week (OR 0.60, CI: 0.37-0.99; OR 0.47, CI: 0.25-0.89, respectively). Choosing Medicine for profit was related to a higher risk of reporting SI (OR 3.36, CI: 1.43-7.92), having a good family bond to a lower risk instead (OR 0.42, CI: 0.20-0.84).

Conclusions

Since depression is the leading cause of disability worldwide, it has to be a public health priority in Europe. It is essential to consider MS as at risk and set up interventions to improve factors surrounding them and help them to face difficulties in personal and academic life, without forgetting that they will be the future health professionals.

Key messages

Females, non-heterosexuals, students negative about Medical School choice and students unsatisfied with their friendships with classmates had a higher risk of reporting depressive symptoms. Students unsatisfied with their friendships with classmates and students who chose Medical School for profit had a higher risk of reporting suicidal ideation.

Vaccination apps: a missing opportunity from various perspectives?

Introduction

Apps for vaccination are rarely a topic in scientific literature, despite the growth of interest in mobile applications about physical exercise, food intake and even chronic diseases management. Since 2014 WHO is wishing and technically supporting the development of a pan-European vaccination app to overcome the trending vaccine hesitancy, and instituted this year a Department of Digital Health. This research aims to evaluate apps for general population, and parents in particular.

Methods

We looked for apps from Google Play Store, the official Android store, searching single words related to vaccination with an Italian IP address, then exporting results. The research provided 1086 univocal apps that underwent a selection based on title, marketplace description and website if available, and further classified by category and other variables.

Results

The 117 selected apps were downloaded 15 million times in total. The most common category is vaccination reminder and recorder (41% of apps with 2.4 mln downloads - DL), alone or as a part of a broad health manager, mostly designed for parents. The second one is medical education apps (35%, 343k DL) most of which in English and designed for healthcare professionals, then games (10.3% of apps but the most downloaded with 12 mln DL), appointment makers (7.7%, 122k DL) powered by Regional Healthcare Service, and vaccination travel managers (6%, 13k DL). Only 26.5% provided both description and app content in Italian.

Conclusions

While literature states reminding apps may be a helpful resource to ease the completion of vaccinal duty, the n° of downloads shows a lack of interest or expose flaws in their features (e.g. absence of translation). This study also displays offer fragmentation regarding these new technological opportunities to raise vaccination awareness among peoples: neither a single Italian app is provided by the Ministry, nor a pan-European app by E.U., making WHO’s wishes even more actual today.

Key messages

Vaccination reminder apps are a helpful but under-utilized tool for parents, maybe due to offer fragmentation, lack of translation and need of country adaptations. The creation of a centralized information service for mobile users is a challenge for European Digital Health in times of trending vaccine hesitancy.

Knowledge, false myths and beliefs on vaccines among pregnant women: results from NAVIDAD study

Background

The diffusion of false myths and vaccine hesitancy are alarming phenomena in European countries and leads to decreasing trends in infant vaccine coverages. Aim of the study was to analyse the level of confidence and correct awareness about immunization, which are crucial for the success of vaccination programs.

Methods

As part of the NAVIDAD multicentre study, we examined vaccination confidence and complacency, among a sample of 1820 pregnant women from 14 Italian cities. The questionnaire assessed the interviewee’s knowledge, beliefs and misconceptions, as well as their socioeconomic status, sources of information about vaccines and confidence in the Italian National Healthcare Service.

Results

Of the participants, only 9% of women completely believed to efficacy, necessity and safety of vaccinations. Almost 20% of them had misconceptions on the majority of the themes. There was a significant difference in level of knowledge considering educational level: women with a high educational level have less probability to obtain a low knowledge score (OR 0.43 [95%CI 0.34-0.54]). The level of knowledge was influenced also by the sources of information: women who got information from General Practitioner and from Institutional Web sites have significantly less chance to have misconceptions (OR 0.74 [95%CI 0.58-0.96]; OR 0.59 [95%CI 0.46-0.74]). Finally, results underlined the influence of trust in healthcare professional information on likelihood of having misconceptions (OR 0.49 [95%CI 0.27-0.89]).

Conclusions

Data suggest the efficacy of healthcare professionals and Institutional Web sites as source of information to contrast misconceptions and underline the importance of confidence in the healthcare system to increase complacency and confidence on vaccines.

Key messages

There is a general lack of knowledge about vaccinations among future mothers. Most of misconceptions regarding vaccinations are related to their safety: this could affect confidence and complacency. To increase vaccine confidence, there is a strong need to inform future mothers: our data show the importance and efficacy of Health Professionals and Institutional Web sites as information sources.

An automatic platform to monitor Web 2.0 presence of Healthcare Providers in Italy

Background

Healthcare providers (HP) need to involve the population to spread correct and useful health information and to gather feedback on the perceived quality of the service. Web 2.0, based on the use of Social Networks (SN), allows direct communication between the HP and the population. We built an automatic platform which monitors Web 2.0 usage by Italian public and private HP.

Methods

For each HP the platform finds the relative website using Google searches and extracts the links to SN. For Facebook and Twitter, it retrieves one year of content and identifies common topics via natural language processing. Finally, it compares the Web 2.0 usage patterns and topics with the type of HP and geographical position.

Results

In 2017, on 540 HP screened 97.8% had a website (309 unique sites, many HP have a common site). 37.5% of the websites had links to SN in the homepage: Youtube (YT) was the most common (74.1%), then Facebook (FB, 72.4%) and Twitter (TW, 51.7%). The presence of SN was lower in the south (OR: 0.63; p < 0.001) while is higher for research centers (OR: 5.12; p < 0.001) and private hospitals (OR: 2.12; p = 0.004). Local Health Trusts were the most active on FB (1.86 more posts, p = 0.004) but research centers had more fans RR: 5.32; p = 0.003) and likes per post (RR: 4.95; p < 0.001). On TW private hospitals had the most followers (RR: 3.35; p = 0.002) and likes per tweet (RR: 3.95; p < 0.001). The most posted topics were on healthy behaviors and organizational changes, while a lower number of posts were on healthy food and vaccines. Posts on specific pathologies information and healthy behaviors received more likes.

Conclusions

We propose an automatic platform that monitors the internet presence of HP in Italy, helping to define the best strategies for effective health communication. We found that in the south and in the public sector the importance of this tool is less perceived, with a lower SN presence and a gap between posted topics and those appreciated by the public.

Key messages

We propose an automatic platform that reports and monitors the web 2.0 presence and usage by HP in Italy, helping to define the best strategies to spread effective health communication. In Italy the presence of SN among HP is lower in the south and in the public, while is higher for research centers. HP have to engage the population maximizing the potentiality of web 2.0.

Childhood life events and disturbed eating behaviors in a population-based cohort in the Netherlands

Background

Adversities such as maltreatment and physical and emotional abuse are recognized risk factors for eating disorders (EDs) in adolescents and adults, but whether such adversities are also associated with eating behaviors in childhood has been less explored. Our aim was to examine whether a wide range of life events can predict emotional overeating and restrained eating in childhood, which are potential precursors of EDs.

Methods

The study is embedded in Generation R, a prospective population-based cohort. The sample included 4653 children aged 10 years. Emotional overeating was assessed with the Children’s Eating Behavior Questionnaire, and restrained eating with the Dutch Eating Behavior Questionnaire. Mothers reported the occurrence of 24 adverse events in their offspring’s childhood. Regression analyses were conducted, both unadjusted and adjusted for gender, ethnicity, and parental education and psychopathology.

Results

Unadjusted models showed that a higher number of life events is associated with more emotional overeating and more restrained eating; effect estimates attenuated slightly in the adjusted model, but remained significant (per 1 more life event: B = 0.05, 95%CI 0.02-0.08; B = 0.04, 95%CI 0.02-0.07, respectively). Particularly, participants who experienced at least 3 life events had high levels of emotional overeating and restrained eating (adjusted model: B = 0.20, 95%CI 0.06-0.33; B = 0.21, 95%CI 0.08-0.33, respectively). The specific maltreatment related life events were not significantly associated with eating behaviors, probably due to low prevalence of these events (n = 149).

Conclusions

This novel, population-based study shows that early life adversities may predict disordered eating behaviors in childhood. The results are in line with clinical studies on life events and EDs. If the studied eating behaviors are indeed precursors of EDs, these results may offer potential for prevention and early intervention to avoid the development of full-blown EDs.

Key messages

Eating disorders account for more than 2% of the global disease burden, thus representing a major Public Mental Health topic in the EU; more and new measures are required for early detection purposes. Life adversities predict disordered eating behaviors in childhood, which are considered precursors of eating disorders: early detection of this association may avoid development of eating disorders.

Compulsory vaccination policies: a systematic review about knowledge, attitudes and believes

Background

Vaccine hesitancy is a considerable issue in European Countries and leads to low coverage rates. Consequently, the implementation of national immunization programmes including the introduction of compulsory vaccination are required. It is interesting to determine citizens’ knowledge, attitudes and believes about vaccination policies, in order to more effectively define vaccination programs.

Methods

The present study systematically reviewed published studies evaluating attitudes towards mandatory vaccination programs. PubMed and Scopus scientific databases were searched and 4,198 results were returned, of these 29 met the inclusion criteria. PRISMA statements were followed.

Results

Twenty-two studies assessed attitudes towards mandatory vaccination programs in general, while 9 papers focused specifically on the Human Papilloma Virus (HPV) vaccine. Most of the studies were performed in Europe and North America. According to the assessed studies, the majority of the population seems to be in favour of compulsory vaccinations, from 53% to 97% for different vaccination programs. More resistance has been recorded for the HPV vaccination: the percentage of agreement for mandatory HPV vaccinations ranged from 27% to 63.5%. Furthermore, some studies investigated healthcare workers’ attitudes towards childhood and adult vaccinations. They pointed out that the general population is generally more in favour of mandatory vaccination policies than healthcare workers. The studies highlighted that the support to mandatory policies increased after their implementations.

Conclusions

The results presented in this review could be an important starting point to further understand the issue of vaccine hesitancy and support the implementation of effective vaccination strategies in Europe.

Key messages

Mandatory vaccination policies are generally well accepted among general population. More resistance is recorded for specific vaccination (HPV) or among specific population (healthcare workers).

Waiting times in cardiology and quality of care: analysis of performances in an Italian hospital

Background

The identification of diseases in an early stage is essential to improve prognosis and survival of patients. Consequently, waiting times for cardiological performances are widely recognized in Europe as evaluation items for healthcare quality. Our study aims to analyse waiting times of the main procedures in the cardiology ward of a huge hospital of Northern Italy and to compare them with the regional benchmark.

Methods

Data of the cardiology ward of “Molinette” hospital (Turin, Italy) about the waiting times for clinical procedures in the period 2016-2017 were collected. In particular, we gathered number of health care services and mean waiting times (MWT) for “Echocardiography” (EC), “First Cardiological Visit” (FCV), “Holter ECG” (HECG), “Percutaneous Transluminal Coronary Angioplasty performed within 2 days for people with myocardial infarction” (PTCA). We compared then our results with the benchmarks identified by the regional law.

Results

In the period considered, in “Molinette” hospital 11,565 ECs were performed, with a MWT of 31 days in 2016 and 16 days in 2017, well below the benchmark (40 days). The total number of FCVs was 5,156 with a MWT of 18 and 13 days in 2016 and 2017 respectively, again under the benchmark (30 days). The HECGs were 3,805, with a MWT of 53 (2016) and 32 (2017) days (benchmark 40 days). PTCAs performed within 2 days (benchmark 85%) were 160 (77.7%) in 2016 and 138 (85.2%) in 2017.

Discussion

In 2017, the waiting times of “Molinette” hospital were inferior to the regional benchmarks, for all the cardiological procedures considered. Shorter MWTs allow a more rapid planning of further diagnostic tests and treatments and, therefore, a consequent better quality of care. It’s important for European hospitals to assess and compare these indicators in order to guarantee a fast and appropriate care to their patients.

Key messages

Waiting times are an indicator of early diagnosis and treatment and are useful to assess the quickness and quality of health care provided in European hospitals. Cardiological procedures in “Molinette” hospital of Turin are provided with waiting times shorter than benchmarks. It would be interesting to compare these results with other big European hospitals.

Could shared decision making affect staying in hospital? A cross-sectional pilot study

Background

Shared Decision Making (SDM) is an approach where clinicians and patients share the best available evidence to make decision and where patients opinions are considered. This approach provides benefits for patients, clinicians and health care system. The aim of the present study is to investigate the patients’ perception of their participation in treatment choices and to identify the possible influences of variables in decision aids and therapeutic choices. Furthermore the present study evaluates the impact of SDM on the length of hospital stay and the health expenditure in Piemonte, an Italian region.

Methods

A cross-sectional study was performed in 2016. The patients were selected after hospitalization to clinical and surgical units at the Rivoli and Susa Hospital. Data were collected through the questionnaire and the Hospital Discharge Registers. STROBE guidelines for observational studies were used. A descriptive analysis was conducted. Frequencies and percentages of the categorical variables were reported. Statistical analyses were performed using t-test, chi-square test and Mann-Whitney test.

Results

The final sample was made of 174 subjects. More than half of the sample reported a SDM approach. Female gender (p = 0.027) and lower age (p = 0.047) are associated with an increased possibility to report SDM. Receiving “good” or “excellent” information, having their own request fulfilled and their opinions took into account by healthcare professionals, were all found to be predictors for an approach recognized as SDM (p ≤ 0.05). The perception that healthcare professionals spent a proper amount of time with the patients and used an understendable language are factors increase the chance of a “shared” decision process (p ≤ 0.05). The patients trust in the information given by the healthcare professional is not affecting their perception about the decision making process (P = 0.195). No significant difference where recorded in length of stay and hospital expenditure.

Conclusions

The data show the role played by different dimension of the patients-clinician relationship and that the strongest determinant of a perceived shared decision making approach are healthcare professional-depending.

Knowledge, attitudes and beliefs towards compulsory vaccination: a systematic review

Currently, many countries are dealing with groups refusing available recommended vaccinations. Despite several studies having demonstrated the efficacy of mandatory vaccinations in ensuring herd immunity, opposition is widespread. The aim of our study was to systematically review published studies evaluating attitudes towards mandatory vaccination programs. PubMed and Scopus scientific databases were searched and 4,198 results were returned, of these 29 met the inclusion criteria. Twenty-two studies assessed attitudes towards mandatory vaccination programs in general, while 9 papers focused specifically on the Human Papilloma Virus (HPV) vaccine. Most of the studies were performed in Europe and North America. According to the assessed studies, the majority of the population seems to be in favour of compulsory vaccinations, although attitudes differed among studies. The results presented in this review could be an important starting point to further understand the issue of vaccine hesitancy and support the implementation of effective vaccination strategies.

E-tools for hospital management: An overview of smartphone applications for health professionals

BACKGROUND

Commonly, management of the main hospital activities is organized by different software packages that run on desktop computers, which may not always allow fast and practical use by health operators. This problem could be alleviated by combining these software packages with mobile health. The aim of this study is to provide an overview of smartphone and tablet applications used for hospital management and administration in order to evaluate their features and analyze them according to their content, number of downloads and field of application.

METHODS

Researchers performed the survey on the two main application stores available on the Internet: iTunes for Apple devices and Google Play for Android devices. Using specific keywords, 47 apps that met the inclusion criteria were identified.

RESULTS

Most of the applications were designed for health operators and patient management (76.6%); 12.8% of the apps were focused on the organization and setting of hospital resources, and 10.6% of the apps could help hospital administrators perform self-evaluations of their structures, processes and outcomes. The large majority of apps (80.7%) counted less than 1000 downloads. Most of them (87.5%) were in English and free to download (93.6%).

DISCUSSION

The results of the first attempt to provide an overview of this emerging topic showed that, despite the existence of several applications for hospital management purposes, these tools appear to be not very widespread. In our opinion, there is a strong need to further assess the quality of these applications; thus, it may be worth continuing to monitor this field in order to analyze eventual improvements in the design and distribution of these apps.

Advertisement of electronic cigarettes in Italy: characteristics of online videos and the most popular promotional messages

Given the increasing popularity of electronic cigarettes (ECs) and a lack of regulation of EC advertising, this study aimed to analyse online videos promoting ECs to assess the main marketing messages that could influence consumers' perceptions of associated risks and benefits. A web search of EC advertising videos was performed on YouTube by using keywords related to EC promotion. An evaluation grid was used to analyse promotional messages contained in each video. The most frequent promotional messages were related to health benefits (67.7%) and to the possibility of quitting smoking (57.4%). Messages that could also be appealing to adolescents and young adults, such as those promoting the multiple flavors available and the technological improvement of ECs, were present in 41.2% and 42.7% of the videos respectively. ECs similar to traditional cigarettes in appearance were included in 52.9% of the videos. EC promotional videos address messages not only to smokers who want to quit or decrease tobacco consumption but also to nonsmokers, especially young people. The use of ECs similar to traditional cigarettes may be a gateway to tobacco cigarette use. Since EC use may represent an important public health concern, regulatory policies on EC advertising should be established.

Counseling intervention to improve quality of life in patients with pre-existing acute myocardial infarction (AMI) or chronic obstructive pulmonary disease (COPD): a pilot study

BACKGROUND

In the light of diagnostic and therapeutic advances, patients with a previous myocardial infarction or with a diagnosis of chronic obstructive pulmonary disease are vulnerable and need continuous monitoring over time. These pathological frameworks have a strong impact on the economy and on the status of the population and require effective and low-cost solutions.

AIMS

The objective of this clinical trial is to evaluate the efficacy in the short term of a telephone counseling intervention to modify the lifestyles of these two patient populations.

METHODS

In May 2015, all the patients included in the study underwent a questionnaire to evaluate their eating and smoking habits and their quality of life. After randomization in two groups, the intervention group received telephone counseling related to the correct lifestyles. The control group did not undergo any intervention. In September-October 2015, the same initial questionnaire was administered to evaluate changes in patients' behavior.

RESULTS

64 patients were included in the study: 34 were assigned to the intervention group and 30 to the control group. The outcomes evaluated were: quality of life, assessment of eating habits and smoking status. After the telephone counseling, the intervention group (34 persons) showed a significant improvement in the score of adherence to the Mediterranean diet (p = 0.01) and a significant reduction in the percentage of smokers (p = 0.01) compared to the population that did not receive any intervention (30 persons). On the other hand, the changes related to the quality of life questionnaire were not significant.

CONCLUSIONS

A single telephone counseling intervention is effective in modifying the lifestyles of patients with a previous myocardial infarction or diagnosed with chronic obstructive pulmonary disease in the short term, reducing their risk profile.

Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study

BACKGROUND

Vaccine hesitancy is a considerable issue in European countries and leads to low coverage rates. After a long debate, Italy has made vaccination mandatory for admission to its schools.

METHODS

In the NAVIDAD study (a cross-sectional multicentre study), a 63-item questionnaire was administered to 1820 pregnant women from 15 Italian cities. The questionnaire assessed the interviewee's opinion on mandatory vaccines, as well as their socioeconomic status, sources of information about vaccines, confidence in the Italian National Healthcare Service (NHS), and intention to vaccinate their newborn.

RESULTS

Information sources play a key role in determining the opinion on restoration of mandatory vaccines; in particular, women who obtained information from anti-vaccination movements are less likely to accept the vaccines (OR: 0.35, 95% CI: 0.21-0.58, p < 0.001). Women who had confidence in healthcare professional information agreed more on mandatory vaccination than did the other women (OR: 2.66, 95% CI: 1.62-4.36, p < 0.001); those who perceived that healthcare professionals have economic interest in child immunization and who declared that healthcare providers inform only on vaccinations benefits not on risks were less likely to agree on compulsory vaccination (OR: 0.66, CI 95%: 0.46-0.96, p = 0.03; OR: 0.66, CI 95%: 0.46-0.95, p = 0.03, respectively).

CONCLUSION

Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. To increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened.

Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis

The prognostic significance of histological regression in primary melanoma has been debated for many years. We aim to review the evidence to see how histological regression may affect prognosis. A systematic review was performed by searching in MEDLINE, Scopus and the Cochrane Library from 1 January 1966 to 1 August 2015. All studies reporting hazard ratios or data on survival and histological regression were included. Primary random-effects meta-analyses were used to summarize outcome measures. Heterogeneity was assessed using the χ² -test and I² -statistic. To assess the potential bias of small studies we used funnel plots and the Begg and Mazumdar adjusted rank correlation method. Summaries of survival outcomes were measured as hazard ratios or relative risk of death at 5 years according to the presence of histological regression of primary melanoma. In total, 183 articles were reviewed out of 1876 retrieved. Ten studies comprising 8557 patients were included. Patients with histological regression had a lower relative risk of death (0·77, 95% confidence interval 0·61-0·97) than those without. Examination of the funnel plot did not provide evidence of publication bias. The results showed that histological regression is a protective factor for survival.