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Onagbiye S, Guddemi A, Baruwa OJ, Alberti F, Odone A, Ricci H, Gaeta M, Schmid D, Ricci C. Association of sedentary time with risk of cardiovascular diseases and cardiovascular mortality: A systematic review and meta-analysis of prospective cohort studies. Prev Med 2024; 179:107812. [PMID: 38081421 DOI: 10.1016/j.ypmed.2023.107812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/25/2023]
Abstract
Given the high prevalence of cardiovascular disease (CVD), we meta-analysed CVD relative risk (RR) in relation to high vs. low categories of self-reported and objectively assessed sedentary behaviours from cohort studies; in a sub-sample (n = 4 studies), the theoretical substitution of one hour spent sedentary with the same amount of time spent in light-intense physical activity was evaluated. Based on 19 studies (60,526 fatal and non-fatal CVD, 1,473,354 individuals and 13,559,139 persons-year) we estimated a 30% increased CVD risk for high vs. low categories of sedentary behaviour (RR = 1.29, confidence interval (CI) = 1.22;1.37). Every hour spent sedentary corresponds to a 5% increased fatal and non-fatal CVD risk (RR = 1.05, CI = 1.02;1.07). Dose-response meta-analysis revealed that sedentary behaviour is statistically significantly associated to fatal and non-fatal CVD risk following a J-shaped relation. Substituting one hour spent sedentary with physical activity of light intensity reduced the risk of fatal and non-fatal CVD events by one-fifth (RR =0.84, CI = 0.73;0.97). In meta-regression analysis, potential influential factors such as age, sex, and medical condition did not essentially alter the results.
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Affiliation(s)
- S Onagbiye
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa; Health & Exercise Science, Frederick Community College, MD, USA; Kinesiology & Nutrition Sciences, University of Nevada, Las Vegas, USA
| | - A Guddemi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - O J Baruwa
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa; UMIT TIROL - University for Health Sciences and Technology, Tirol, Austria
| | - F Alberti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - A Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - H Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - M Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - D Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, UMIT TIROL - University for Health Sciences and Technology, Hall i. Tirol, Austria
| | - C Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa.
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Della Valle PG, Deandrea S, Battisti F, Brusa P, Mantellini P, Mantovani W, Narne E, Odone A, Senore C. The community pharmacy model for colorectal cancer screening: Policy insights from a national programme. Res Social Adm Pharm 2023; 19:1595-1601. [PMID: 37657965 DOI: 10.1016/j.sapharm.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND In Italy, a recent national project has expanded local collaboration between colorectal (CRC) screening programmes and pharmacies to the national level. OBJECTIVE The objective of this study is to provide an overview of the existing agreements between regional authorities and pharmacy owners in Italy regarding CRC screening programmes, to make internationally available the most qualifying elements of the collaboration. METHODS We analyzed the agreements, in force on 01/08/2021, arranged between the Regions and their respective pharmacy owners, describing the process phases addressed such as the faecal occult blood test pathway and supplementary activities provided by the pharmacies together with the CRC screening kit delivery. RESULTS Agreements were received from 18 Regions (86% of the total). The amount of money paid for each kit varies a lot, with a range from 0 to 18 EUR. The number of process phases covered by the agreements ranged from a maximum of 16 (out of 18) to a minimum of 0. The processes most frequently covered were the supply/delivery of kits and education/awareness of CRC screening (68.8%). Less covered processes were warehouse management and awareness of other healthcare initiatives (12.5%), and delivery of preparation for intestinal cleansing (6.3%). CONCLUSIONS Arrangements between pharmacies and CRC screening programmes in Italy vary widely and lack a unified model. Collaboration quality standards should be set at the national/international level.
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Affiliation(s)
| | - S Deandrea
- University of Pavia, Pavia, Italy; Pavia Health Protection Agency, Pavia, Italy; Directorate General for Health, Lombardy Region, Milan, Italy.
| | - F Battisti
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - P Brusa
- Dipartimento di Scienza e Tecnologia del Farmaco, Università degli Studi di Torino, Torino, Italy
| | - P Mantellini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - W Mantovani
- Azienda Provinciale per i Servizi Sanitari di Trento, Trento, Italy
| | | | - A Odone
- University of Pavia, Pavia, Italy
| | - C Senore
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
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3
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Blandi L, Bertuccio P, Amorosi A, Clemens T, Brand H, Odone A. 20-Year trends of hospitalisation among people with dementia: a region-wide retrospective cohort study from Lombardy, Italy. Public Health 2023; 222:21-28. [PMID: 37499438 DOI: 10.1016/j.puhe.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the trends of hospitalisations among people with dementia, linking region-wide hospital and demographic health records. STUDY DESIGN A retrospective cohort study was conducted using hospitalisation health records from the Lombardy region in Italy. METHODS The study included people aged ≥65 years with a diagnosis of dementia who were hospitalised between 2002 and 2020 in Lombardy, which is the most populated region in Italy with 10 million inhabitants. Using data on resident population, this study computed rates of hospitalisation by calendar year, age, sex and cause of hospitalisation. RESULTS In total, 340,144 hospitalised patients with dementia were included in the study. The rate of hospitalisation was 100.6 per 10,000 in 2002 and progressively decreased to 65.1 per 10,000 in 2020. The average age at hospitalisation in 2002 was 78.9 years for men and 81.8 years for women, which increased to 82.0 years and 84.2 years, respectively, in 2020. Respiratory diseases caused 10.4% of all hospitalisations in 2002 and grew steadily to 26.8% in 2020, becoming the leading cause of hospital admissions since 2017. CONCLUSIONS Hospitalisation patterns for people with dementia have changed over the last 20 years, reflecting evolving epidemiological trends and the impact of healthcare policies. Region-wide administrative health record data analysis should be further utilised to explore the health needs of people with dementia and inform the planning, implementation and monitoring of effective prevention strategies in this population group.
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Affiliation(s)
- L Blandi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; Welfare General Directorate, Regione Lombardia, Milan, Italy; Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - P Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - A Amorosi
- Welfare General Directorate, Regione Lombardia, Milan, Italy
| | - T Clemens
- Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - H Brand
- Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - A Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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4
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Mosconi G, Vigezzi GP, Bertuccio P, Amerio A, Odone A. Transition to retirement impact on risk of depression and suicidality: results from a longitudinal analysis of the Survey of Health, Ageing and Retirement in Europe (SHARE). Epidemiol Psychiatr Sci 2023; 32:e34. [PMID: 37165784 DOI: 10.1017/s2045796023000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
AIMS Depression is among the main contributors to older adults' mental health burden. Retirement, one of the major life transitions, has been claimed to influence mental health substantially. Following up on a previous meta-analysis, the study aims to assess from a longitudinal perspective short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe. METHODS We conducted a longitudinal study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) and 95% confidence intervals (95% CIs) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalized estimating equation models for repeated measures. RESULTS We included 8,998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81-0.99), 9% lower after 2 years (RR 0.91; 95% CI 0.82-1.00) and after 3 years (RR 0.91; 95% CI 0.81-1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country's median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05-1.40) and late retirees (RR 1.37; 95% CI 1.16-1.63). No heterogeneity emerged among strata. As for suicidality, we reported an increase in risk only 5 years or more after retirement, namely +30% 5-9 years after retirement (RR 1.30; 95% CI 1.04-1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09-1.98). Sensitivity analyses excluding subjects who reported a diagnosis of depression over the study period and those retirees who declared to receive a disability pension confirmed the results obtained in the overall analysis. CONCLUSIONS Longitudinal adjusted data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. Such trends are particularly evident among selected subgroups of elderly populations. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions. In an ageing society, welfare policies should be evaluated, considering their long-term impact on mental health.
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Affiliation(s)
- G Mosconi
- Department of Public Health, Experimental and Forensic Medicine, Università degli Studi di Pavia, Pavia, Italy
| | - G P Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, Università degli Studi di Pavia, Pavia, Italy
- Ca' della Paglia College, Fondazione Ghislieri, Pavia, Italy
| | - P Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, Università degli Studi di Pavia, Pavia, Italy
| | - A Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genoa, Italy
| | - A Odone
- Department of Public Health, Experimental and Forensic Medicine, Università degli Studi di Pavia, Pavia, Italy
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5
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Blandi L, Odone A. The synergies of University Education and Primary Health Care to meet populations health needs. Ann Ig 2023; 35:121-124. [PMID: 36222606 DOI: 10.7416/ai.2022.2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In the last decades, the World Health Organization has sensitized all countries to adopt a Primary Health Care approach in their health systems. It is also important to invest in education about primary health care. Indeed, we need to spread this comprehensive culture of health, starting from university education, and continuing during the whole work-life cycle. Due the current medical model, approaching patient by specific pathology or discipline, inefficiencies have been generated due to a lack of communication and integrated management of chronicity. Public Health can build dynamic models and mechanisms that pursue the health needs expressed by populations and education plays a crucial role in enhancing a country's resilience and protecting the health of its inhabitants. All the health workers should consider all the aspects of health, beyond the specific phases of diagnosis and treatment. Continuous education and training are key elements to focus on, to satisfy our population's health needs.
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Affiliation(s)
- L Blandi
- School of Hygiene and preventive medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - A Odone
- School of Hygiene and preventive medicine, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
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6
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Dallagiacoma G, Ferrara P, Alberti F, Vecchio R, Vigezzi GP, Odone A. The use of digital tools to promote health in children: A systematic review of intervention studies. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Early childhood health interventions and educational programs are key to keeping children healthy and preventing disease during adulthood. Since several preventive strategies and campaigns targeting children have been proposed, the aim of this systematic review is to evaluate the effectiveness of digital-based interventions (e.g., cartoons, videos, video games, mobile apps, etc.) in promoting healthy behaviours in primary school-aged children.
Methods
Following PRISMA guidelines, we searched three electronic databases (Medline, Embase, and Scopus) up to April 11, 2022. We included randomized and non-randomized experimental studies quantifying the effectiveness of digital or audio-visual-based health promotion interventions in childhood (up to 12 years of age).
Results
The search strategy yielded a total of 1640 articles. Retrieved studies covered a wide range of health interventions - including a healthy diet, physical activity promotion, oral hygiene, skin cancer prevention, and different educational approaches (such as cartoons, interactive video games, etc.), mainly implemented in a school setting and comparing digital interventions to teacher-led interventions or no intervention at all. Data pooling suggests that digital and audio-visual-based health promotion interventions targeting children are effective in improving health literacy and healthy behaviours.
Conclusions
This systematic review adds to the body of knowledge on health promotion in children and provides actionable measures to implement straightforward educational approaches in this specific population, empowering them to adopt preventive behaviours, and ultimately promoting health at the household and societal level.
Key messages
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Affiliation(s)
- G Dallagiacoma
- Department of Public Health, University of Pavia , Pavia, Italy
| | - P Ferrara
- Department of Public Health, University of Pavia , Pavia, Italy
| | - F Alberti
- Department of Public Health, University of Pavia , Pavia, Italy
| | - R Vecchio
- Department of Public Health, University of Pavia , Pavia, Italy
| | - GP Vigezzi
- Department of Public Health, University of Pavia , Pavia, Italy
- Ca’ della Paglia College, Ghislieri Foundation , Pavia, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
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7
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Blandi L, Amorosi A, Bertuccio P, Odone A. Trends of hospital admissions and mortality of patients with dementia: descriptive study in Lombardy. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In 2017 the amount of people globally affected by dementia was estimated about 50 million and is predicted to increase to 132 million by 2050. Coping with dementia is one of the most important challenges of governmental organizations’ agenda. The objective of this study is to analyse the hospital admissions trends and monitor the overall mortality in a population of older patients with dementia over the last two decades in northern Italy.
Methods
This study is based on the healthcare utilization database of the Lombardy region (Italy), considering on hospital discharge records and death registry flows. Primary or secondary diagnosis at admission of dementia was coded according to the ICD9-CM. We carried out descriptive analyses of hospital admissions’ data from 1 Jan 1999 to 31 Dec 2020 of older patients aged 65 or more. We then conducted a temporal analysis of mortality rate over the study period.
Results
A total of 15,683,024 hospital admissions occurred during the study period. Over the last two decades, the prevalence of dementia among patients admitted to acute care hospitals remained around 1.1-1.3%. Considering the total of 183,268 patients with dementia over the study period, the average age at admission increased from 80.2 in 1999 to 83.3 years old in 2020, whereas annual mortality rate increased from about 1,950 to 3,230 deaths per 10,000 person-years. The mortality rate ratio of patients with versus without dementia fluctuated between 1.28 and 1.70.
Conclusions
Our findings suggest that there is an ever-greater appropriateness of hospitalizations over the last two decades, supported by out-of-hospital care that led patients to hospitalization in increasingly late and serious phases of the disease. The present study has a great future potential as well as limitations, due to the dependence on a correct coding of cases by clinicians according to the ICD9-CM system.
Key messages
• We observed an increased mortality among older people with dementia admitted to hospital over the last two decades.
• Our descriptive study, based on the Lombardy regional healthcare database, provides evidence of an increasing appropriateness of hospitalizations.
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Affiliation(s)
- L Blandi
- Public Health, Università di Pavia , Pavia, Italy
- Welfare Directorate , Regione Lombardia, Milan, Italy
| | - A Amorosi
- Welfare Directorate , Regione Lombardia, Milan, Italy
| | - P Bertuccio
- Public Health, Università di Pavia , Pavia, Italy
| | - A Odone
- Public Health, Università di Pavia , Pavia, Italy
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8
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Bosetti C, Rognoni M, Ciampichini R, Scala M, Cavalieri d'Oro L, Zucchi A, Amerio A, Iacoviello L, Odone A, Gallus S. COVID-19 impact on hospitalizations in older adults with chronic conditions: a real-world analysis from Lombardy, Italy. Eur J Public Health 2022. [PMCID: PMC9594552 DOI: 10.1093/eurpub/ckac129.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. Methods We investigated such impact among all adults with chronic conditions aged ≥65 years, identified through the electronic health databases of two local health agencies - ATS Brianza and ATS Bergamo - from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs). Results Overall, in 2017-2019 there were a mean of 374,855 older adults with ≥1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Conclusions Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients’ health in the medium and long run.
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Affiliation(s)
- C Bosetti
- Department of Oncology, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - M Rognoni
- Brianza Health Protection Agency , Monza, Italy
| | | | - M Scala
- Brianza Health Protection Agency , Monza, Italy
| | | | - A Zucchi
- Bergamo Health Protection Agency , Bergamo, Italy
| | - A Amerio
- DINOGMI, University of Genoa , Genoa, Italy
- IRCCS San Martino Polyclinic Hospital , Genoa, Italy
| | - L Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
- EPIMED, Insubria University , Varese, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
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9
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Bertuccio P, Vigezzi GP, Signorelli C, Zucchi A, Cavalieri d'Oro L, Stuckler D, Iacoviello L, Gallus S, Odone A. Healthcare services access during the COVID-19 pandemic among older people. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The COVID-19 pandemic strongly impacted older people, not only in terms of clinical outcome but also in care provision. Investigating trends of changes in healthcare services access among older subjects during the pandemic, along with studying potential determinants, is of utmost interest to identify the most at-risk individuals. We used data from LOST in Lombardia, a cross-sectional study conducted on a representative sample of 4,400 older adults (aged 65 or more) in autumn 2020. Data were collected about lifestyles, mental health, and access to healthcare services before and during the pandemic. To investigate potential determinants of changes in healthcare access, we presented prevalence ratios (PRs) estimated through multivariable log-binomial regression models. Twenty-one per cent of the participants increased telephone contacts with general practitioner (GP), 9.6% specialist visits for a fee, while 22.4% decreased GP visits, 7.5% ED access, 6% hospitalisations, 12.3% outpatient visits, 9.1% diagnostic exams. The prevalence of the cancellation or delay of medical appointments by the patient's decision was 23.8%, with higher proportions among men, among individuals aged 75 or over as compared to those aged 65-74, and among individuals with a higher self-reported economic status (p-value<0.05). People with comorbidities more frequently cancelled or postponed visits, reduced ED access or hospitalisations. Moreover, individuals with worsened mental health status showed a higher prevalence to cancel or delay visits and to reduce ED access. The decrease in healthcare provision and consultations could result in mortality and morbidity excess. Our results should inform targeted intervention to bridge the gaps and overcome the health inequalities that the pandemic has deepened. Exploring the underlying reasons and determinants for healthcare avoiding or delaying among the most vulnerable groups is crucial for epidemic preparedness and planning future interventions.
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Affiliation(s)
- P Bertuccio
- Department of Public Health, University of Pavia , Pavia, Italy
| | - GP Vigezzi
- Department of Public Health, University of Pavia , Pavia, Italy
- Ca’ della Paglia College, Ghislieri Foundation , Pavia, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Zucchi
- Bergamo Health Protection Agency , Bergamo, Italy
| | | | - D Stuckler
- Department of Social Sciences and Politics, Bocconi University , Milan, Italy
| | - L Iacoviello
- EPIMED, Insubria University , Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
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10
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Amerio A, Stival C, Lugo A, Fanucchi T, Cavalieri d'Oro L, Iacoviello L, Odone A, Zucchi A, Gallus S, Serafini G. It never rains but it pours: COVID-19 pandemic impact on mental health in older adults. Eur J Public Health 2022. [PMCID: PMC9620166 DOI: 10.1093/eurpub/ckac129.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Italy was the first country to be hit by the 2019 coronavirus disease (COVID-19) in Europe holding one of the highest clinical burdens. Older adults are those paying the highest price for the COVID-19 emergency. Within the Lost in Lombardy project, a web-based cross-sectional study assessing the prevalence of depressive and anxiety symptoms, hopelessness and insomnia before and during the COVID-19 pandemic, was conducted on a representative sample of 4,400 older adults aged 65 years or more from the Lombardy region recruited between November 17th and 30th 2020. The prevalence of depressive symptoms increased by + 112% during the pandemic, anxiety symptoms by + 136%, insufficient sleep by + 12%, unsatisfactory sleep by + 15%. Feelings of hopelessness were more frequent among women compared to men (15.1% vs. 10.4%) and increased with increasing age. A worsening in each of the four specific mental health outcomes was more frequently observed in women (OR = 1.50, depression; OR = 1.31, anxiety; OR = 1.57, sleep quality; OR = 1.38, sleep quantity), in subjects who decreased their physical activity during the pandemic (OR = 1.64, depression; OR = 1.48, anxiety; OR = 2.05, sleep quality; OR = 1.28, sleep quantity), and with increasing number of pre-existing chronic diseases (p for trend<0.001 for depression and anxiety; p for trend=0.010 for sleep quality; p for trend=0.012 for sleep quantity). A worsening in depressive symptoms was more frequently observed in more educated subjects (p for trend=0.008), while a worsening in anxiety symptoms in subjects living in main towns compared to outskirt with an economic status below the mean. The use of at least one psychotropic drug - mostly antidepressants/anxiolytics - increased by + 26% compared to pre-pandemic. The protection of the mental health status of this vulnerable segment of population needs to be recognized as a real public health priority.
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Affiliation(s)
- A Amerio
- DINOGMI, University of Genoa , Genoa, Italy
- IRCCS San Martino Polyclinic Hospital , Genoa, Italy
| | - C Stival
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - A Lugo
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - T Fanucchi
- Unit of Alcohology, Careggi Hospital , Firenze, Italy
| | | | - L Iacoviello
- EPIMED, Insubria University , Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Zucchi
- Bergamo Health Protection Agency , Bergamo, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - G Serafini
- DINOGMI, University of Genoa , Genoa, Italy
- IRCCS San Martino Polyclinic Hospital , Genoa, Italy
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11
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Vigezzi GP, Zeduri M, Carioli G, Lugo A, Amerio A, Gorini G, Pacifici R, Politi P, Gallus S, Odone A. COVID-19 impact on familial relationships and mental health in a representative sample of adults. Eur J Public Health 2022. [PMCID: PMC9619818 DOI: 10.1093/eurpub/ckac130.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Benefits of the stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be weighed against its impact on citizens’ health. In a country with a solid familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have worsened mental health. Methods A web-based cross-sectional study (LOST in Italy) was conducted on a representative sample of Italian adults during lockdown (27th of April-3rd of May 2020). We asked 3156 subjects to report on reduced help in housework and childcare from retired parents to assess confinement impact on mental health through validated scales before and during the lockdown. Results Overall, 1484 (47.0%) subjects reported reduced housework help from parents, and 769 (64.0%, of the 1202 subjects with children) diminished babysitting support. Subjects reporting reduced housework help had worsened sleep quality (multivariate odds ratio, OR 1.74, 95% confidence interval, CI 1.49-2.03) and quantity (OR 1.50, 95%CI 1.28-1.76), depressive (OR 1.32, 95% CI 1.14-1.53) and anxiety symptoms (OR 1.53, 95%CI 1.32-1.78), compared to those reporting unreduced help. Worsening in sleep quality (OR 2.32, 95%CI 1.76-3.05) and quantity (OR 1.80, 95%CI 1.36-2.37), depressive (OR 1.79, 95%CI 1.39-2.31) and anxiety symptoms (OR 1.90, 95%CI 1.48-2.46) was also associated with reduced babysitting help. In subjects with poorer housing and teleworking, mental health outcomes were worse. Conclusions Confinement came along with reduced familial support from parents, negatively impacting mental health. Social networks and support within families provided by older relatives act as a resilience factor and a potential vulnerability that affects mental health outcomes. Health and social services response should be designed to address mental health needs and mitigate long-term health costs caused by the pandemic's unprecedented stressfulness and unknown duration. Key messages
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Affiliation(s)
- GP Vigezzi
- Department of Public Health, University of Pavia , Pavia, Italy
- Ca’ della Paglia College, Ghislieri Foundation , Pavia, Italy
| | - M Zeduri
- Department of Public Health, University of Pavia , Pavia, Italy
| | - G Carioli
- Department of Community Health, University of Milan , Milan, Italy
| | - A Lugo
- Department of Environmental Health Sciences, IIRCCS Mario Negri Institute for Pharmacological Research , Milan, Italy
| | - A Amerio
- DINOGMI, University of Genoa , Genoa, Italy
- IRCCS San Martino Polyclinic Hospital , Genoa, Italy
| | - G Gorini
- Oncologic Network, Prevention and Research Institute , Firenze, Italy
| | - R Pacifici
- National Centre on Addiction and Doping, Italian National Institute of Health , Rome, Italy
| | - P Politi
- Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IIRCCS Mario Negri Institute for Pharmacological Research , Milan, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
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12
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Vigezzi GP, Guddemi A, Bucci D, Colucci S, La Fauci D, Calsolaro R, Foglia E, Chiesa R, Bertoglio L, Odone A. HTA supporting clinical practice: the case of surgical repair of thoracoabdominal aortic aneurysms. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Thoracoabdominal aortic aneurysms (TAAAs) are defined as those aortic aneurysms involving renovisceral arteries. They account for around 10% of aortic aneurysms, and their treatment is burdened by considerable mortality and morbidity. Open surgical repair has been practised as the standard of care since the 1950s. In 2001 endovascular repair was introduced to reduce treatment invasiveness, and the technology is still evolving. The potential benefits of endovascular repair over open surgery should be carefully weighed in a multidimensional framework.
Methods
We applied the Health Technology Assessment (HTA) framework (EUnetHTA core model with 9 dimensions) to conduct a report comparing the two technologies. A multidisciplinary working group was established. We derived and pooled: i) secondary data derived from systematic literature reviews, and ii) original data from IRCCS San Raffaele Hospital, Milan, a national referral centre for TAAA (qualitative and economic data).
Results
Endovascular repair resulted superior to the traditional open surgery in terms of efficacy and safety, as justified by the meta-analysis we performed. Despite the higher costs, a significant impact on budget and slightly lower cost-effectiveness, the endovascular protheses’ adoption could provide conspicuous benefits in terms of social and ethical dimensions without affecting long-term organisational and legal aspects.
Conclusions
The multi-criteria decision analysis carried out from a hospital point of view shows that there is no significant difference (final score endovascular repair 0.68 vs open surgery 0.63) between the two procedures considering all the dimensions. Still, the endovascular repair is slightly superior to the open surgery in terms of safety, effectiveness, social, ethical, legal, and organisational impact. From the policy maker’s point of view, technologies with a score superior to 0.6 are equally valuable, and the final decision should be left to the clinicians.
Key messages
• Further research is needed to compare endovascular prostheses and open surgery’s long-term population benefits, balancing clinical, economic, organisational and patient-related outcomes.
• HTA methodology offers substantial support to compare in-use technologies, informing clinicians’ and decision-makers’ choices to strengthen healthcare provision equity and preparedness.
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Affiliation(s)
- GP Vigezzi
- Department of Public Health, University of Pavia , Pavia, Italy
- Ca’ della Paglia College, Ghislieri Foundation , Pavia, Italy
| | - A Guddemi
- Department of Public Health, University of Pavia , Pavia, Italy
| | - D Bucci
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - S Colucci
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - D La Fauci
- Administrative Direction, IRCCS San Raffaele Hospital , Milan, Italy
- HTA Commission, IRCCS San Raffaele Hospital , Milan, Italy
| | - R Calsolaro
- Department of Public Health, University of Pavia , Pavia, Italy
| | - E Foglia
- LIUC Business School, LIUC Carlo Cattaneo University , Castellanza, Italy
| | - R Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University , Milan, Italy
| | - L Bertoglio
- Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University , Milan, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- HTA Commission, IRCCS San Raffaele Hospital , Milan, Italy
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13
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Bertolotti M, Betti M, Ferrante D, Giacchero F, Odone A, Franceschetti G, Carotenuto M, Pacileo G, Maconi A. Mortality in Covid-19 patients hospitalized in a teaching hospital in Italy during the first 3 waves. Eur J Public Health 2022. [PMCID: PMC9593931 DOI: 10.1093/eurpub/ckac131.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction In Italy a Covid-19 pandemic pattern was observed, characterized by several waves, with an excess total mortality of 178000 deaths. Alessandria, Italy is the Piedmont province with the highest proportion of mortality from Covid-19 in the first 4 months of 2020, compared to the rest of the region. Objectives To analyze mortality in patients hospitalized for Covid-19 in the Alessandria Hospital (AO AL), considering the first 3 waves. Materials and methods Subjects aged ≥18 with a diagnosis of Covid-19 admitted to the AO AL in the first 50 days of the first 3 waves were included. The first wave started on 24 February 2020 (first day of available data by the Ministry of Health), the second wave on 14 September 2020 (first day of the 2020/21 school year), the third wave on 15 February 2021 (peak of cases detected by the Italian College of Health). The causes of death were obtained from the National Institute of Statistics death cards and codified according to the International Classification of Diseases, 9th revision, classification. Results We included 825 subjects (median age: 73 years; male prevalence: 60.7%). The subjects hospitalized in the first wave were 464, in the second wave 255, in the third wave 106. A total of 309 subjects died (37.5%), of which 218 in the first wave (70.6%), 69 in the second wave (22.3%), 22 in the third wave (7.1%). The most frequent causes of death were “Covid-19 pneumonia” (61.5%) and “respiratory distress syndrome” (19.4%). Death occurred after hospital discharge in 40% of cases. 6 months after admission, the survival rate was 53% among patients of the first wave, 73% and 78% for those of the second and third wave. Patients hospitalized in the first and second waves showed a greater risk of death compared to patients of the third wave (HR = 2.8; 95% CI 1.8-4.4 and HR = 1.4; 95% CI 0.8-2.2). Conclusions Data showed a difference in mortality between the 3 waves with a statistically significant variation between the first and third waves. Key messages • Data showed a difference in mortality between the 3 waves. • Data showed a statistically significant variation in mortality between the first and third waves.
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Affiliation(s)
- M Bertolotti
- Research Training Innovation Infrastructure , Alessandria, Italy
| | - M Betti
- Research Training Innovation Infrastructure , Alessandria, Italy
| | - D Ferrante
- Department of Translational Medicine, University of Eastern Piedmont , Novara, Italy
| | - F Giacchero
- Research Training Innovation Infrastructure , Alessandria, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
| | - G Franceschetti
- Department of Public Health, University of Pavia , Pavia, Italy
- Medical Directorate , Alessandria, Italy
| | - M Carotenuto
- Department of Public Health, University of Pavia , Pavia, Italy
| | - G Pacileo
- Department of Integrated Activities Research, Local Health Company , Alessandria, Italy
| | - A Maconi
- Research Training Innovation Infrastructure , Alessandria, Italy
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14
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Bonaccio M, Gianfagna F, Stival C, Amerio A, Bosetti C, Cavalieri d'Oro L, Odone A, Zucchi A, Gallus S, Iacoviello L. Gender and socioeconomic inequalities in changes in a Mediterranean lifestyle among elderly Italians. Eur J Public Health 2022. [PMCID: PMC9620532 DOI: 10.1093/eurpub/ckac129.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 pandemic and the adoption of restrictive measurements to control the SARS-CoV-2 spread disrupted general population lifestyles including dietary behaviours. However, there is poor knowledge on potential socioeconomic and gender disparities in dietary changes. We conducted a telephone-based survey during fall 2020 on a sample of 4,400 participants representative of the population aged 65-99 years living in Lombardy, Italy. Changes in a Mediterranean lifestyle were assessed retrospectively by asking participants to report modifications in the consumption of nine food groups and five diet-related behaviours (e.g., consumption of organic and local foods) compared to the previous year (2019). We then computed a Mediterranean COVID-19 Pandemic Score (MedCovid-19 Score), reflecting changes during pandemic, ranging from -14 to 14, with increasing values indicating improvements in line with a Mediterranean lifestyle. Overall, 18.3% of the study participants worsened their Mediterranean lifestyle (MedCovid-19 Score <0), 35.1% remained stable (MedCovid-19 Score = 0), while 46.6% reported improvements (MedCovid-19 Score ≥1). Predictors of favourable changes toward a Mediterranean lifestyle were educational level (OR = 1.52; 95% CI 1.19-1.95 for postgraduate vs lower education), wealth (OR = 1.52; 1.14-2.02 for high vs low wealth), and skilled manual occupations (OR = 1.57; 1.28-1.92 vs white collars). Women were more likely than men to move away from a Mediterranean lifestyle (OR = 1.86; 1.58-2.21). In conclusion, improvements in line with a Mediterranean lifestyle prevailed in almost half of a large sample of elderly Italians surveyed during the COVID-19 pandemic. However, changes towards a Mediterranean lifestyle were disproportionately distributed across gender and socioeconomic strata. These findings were similar to those from the general population of the Moli-sani study, where it was observed that healthful dietary changes were associated greater wealth.
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Affiliation(s)
- M Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
| | - F Gianfagna
- EPIMED, Insubria University , Varese, Italy
- Mediterranea Cardiocentro , Naples, Italy
| | - C Stival
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - A Amerio
- DINOGMI, University of Genoa , Genoa, Italy
- IRCCS San Martino Polyclinic Hospital , Genoa, Italy
| | - C Bosetti
- Department of Oncology, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | | | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Zucchi
- Bergamo Health Protection Agency , Bergamo, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - L Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
- EPIMED, Insubria University , Varese, Italy
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15
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Zeduri M, Sgueglia AC, Vigezzi GP, Ferrara P, Lanave M, Galvi R, Abela S, Novelli V, Muzzi A, Odone A. Hospital hand hygiene after COVID-19: has the pandemic heightened healthcare workers’ awareness? Eur J Public Health 2022. [PMCID: PMC9620791 DOI: 10.1093/eurpub/ckac129.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Hand hygiene (HH) is the leading measure for preventing the transmission of healthcare-associated infections (HAI), and a cornerstone to prevent COVID-19 spread. Aim of the research was the assessment of HCWs’ adherence to the application of WHO optimal practices, with the goal to promote a culture of safety and quality infection prevention and control (IPC) activities. Methods Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, implemented a HH monitoring plan in which HCWs’ adherence to HH procedures is evaluated using WHO guidelines, technical manual and observation form. Direct field observations took place in March and April 2022 by trained personnel. Process index was HH adherence, stratified by profession, opportunity and unit, which has been visited at least twice. Results Overall, 302 HCWs were observed from 18 hospital units (105 physicians, 108 nurses, 84 healthcare assistants and 5 students). Out of 1382 opportunities, global adherence was 52% with 190 handwashing and 598 hand rubbing. The indication with the highest adherence was “after body fluid exposure risk” (76%), whereas the lowest were “after touching the patient's setting” (40%) and “before touching a patient” (43%). Adherence was higher in specialistic surgeries and haematology units, while the worst performances were reported in general medicine ward (29%). Physicians’ and nurses’ adherence was respectively 45% and 61%. Audits occasionally revealed non-conformities in glove use (i.e., unnecessary use, not changed between patients, hand rubbing on gloves). Conclusions These preliminary findings could be directly linked to habits acquired during the pandemic, when HW tended to consider COVID-19 patients as a unique block to shield themselves from infections, rather than safeguarding individual patient units. HH awareness could have changed in the wake of COVID-19 pandemic and our study described how HCWs’ adherence to optimal practices needs specific initiatives to promote correct HH. Key messages • The COVID‐19 pandemic reinforced the importance of handwashing and IPC, showing the key role of the HCWs’ adherence to hand hygiene (HH) procedures. • HH audits play a leading part in clinical governance and IPC, aiming at enhancing the quality of care and patient safety, particularly to strengthen health system resilience in post-COVID era.
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Affiliation(s)
- M Zeduri
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - AC Sgueglia
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - GP Vigezzi
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - P Ferrara
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - M Lanave
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - R Galvi
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - S Abela
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - V Novelli
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - A Muzzi
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - A Odone
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
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16
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Lamloum D, Ferrara P, Arghittu A, Castiglia P, Gaeta M, Odone A, Campus G. Appraising the quality of guidelines for caries management using AGREE II: a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Caries is one among the most prevalent dental disease and its prevention and treatment are crucial from both dental care and public health perspectives. Yet, caries’ management greatly varies across contexts according to the availability of specific Clinical Practice Guidelines (CPGs). Here, we present the results of a systematic review aimed at the appraisal of the current available CPGs on caries prevention and treatment.
Methods
A literature search was performed in PubMed, EMBASE, SCOPUS, and seven relevant guidelines databases up to March 2022, exploring CPGs published from 2012. The literature review was conducted in accordance with PRISMA guidelines. The Appraisal of Guidelines, Research and Evaluation (AGREE) II checklist was used to measure the methodological rigour and quality of the retrieved CPGs.
Results
The systematic search resulted in a total of 1403 records, and 21 CPGs met the inclusion criteria. Overall, these considered different aspects of caries prevention and treatment. Regarding the appraisal through the AGREE II tool, the overall median score was 60.2% and 11 out of 21 CPGs were classified as “Recommended”, while the others as “Recommended with modification”. The domain analysis showed that the highest median scores were reached for Scope and Purpose (88.9%), Clarity of Presentation (86.9%), and Rigor of Development (67.8%), while the lowest were seen for Stakeholder Involvement (63.3%), Applicability (17.5%), and Editorial Independence (50%).
Conclusions
This systematic review showed that the rigor of CPGs for caries prevention and treatment remained suboptimal according to AGREE II evaluation, and highlighted that more efforts are needed to improve their quality. The AGREE II checklist is a comprehensive and easy-to-use tool for the development of CPGs, and its use ensures that evidence-based approaches are incorporated into consistent recommendations for the translation of evidence into practice.
Key messages
• The rigor of CPGs for caries prevention and treatment is suboptimal according to AGREE II evaluation, however, more efforts are needed to improve their quality.
• The AGREE II checklist is a comprehensive and easy-to-use tool for the development of CPGs.
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Affiliation(s)
- D Lamloum
- Department of Public Health, University of Pavia , Pavia, Italy
- Department of Dentistry, University of Bern , Bern, Switzerland
| | - P Ferrara
- Department of Public Health, University of Pavia , Pavia, Italy
| | - A Arghittu
- Department of Dentistry, University of Sassari , Sassari, Italy
| | - P Castiglia
- Department of Dentistry, University of Sassari , Sassari, Italy
| | - M Gaeta
- Department of Public Health, University of Pavia , Pavia, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
| | - G Campus
- Department of Dentistry, University of Bern , Bern, Switzerland
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17
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Mosconi G, Stival C, Signorelli C, Amerio A, Cavalieri d'Oro L, Iacoviello L, Stuckler D, Zucchi A, Odone A, Gallus S. Assessing determinants of SARS-CoV-2 infection in a large older adult representative sample. Eur J Public Health 2022. [PMCID: PMC9594361 DOI: 10.1093/eurpub/ckac129.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Most COVID-19-related deaths occurred in older adults, however to date, evidence on determinants of SARS-CoV-2 infection in this population is limited and mostly based on case series without a comparison group. A telephone-based cross-sectional study was conducted in November 2020 on a representative sample of 4,400 people aged ≥65 years from the Italian region of Lombardy. We determined the prevalence of participants reporting a SARS-CoV-2 infection in the period between the onset of the pandemic and the time of the interview. To investigate the determinants of the infection, we estimated odds ratios (OR) and their corresponding 95% confidence intervals (CI) thorough unconditional multiple logistic models. We further evaluated if the infection was a determinant of a worsening in mental health wellbeing. Overall, 4.9% of participants reported a history of SARS-CoV-2 infection. No significant relationship between sex and infection was observed. SARS-CoV-2 infection was less frequently reported in subjects aged ≥70 (OR = 0.55; 95% 0.41-0.74) compared to 65-69 years. We didn't observe any trend after 70 years of age. Participants reporting at least one chronic condition had a lower infection rate compared to healthy subjects (OR = 0.68 95% CI: 0.49-0.93). Separated/divorced subjects more frequently reported infection than married/cohabiting ones (OR = 2.33 95% CI: 1.29-4.20). Self-reported history of SARS-CoV-2 infection resulted being a determinant of an increase in depressive symptoms (OR = 1.57; 95% CI: 1.17-2.10). In this large study - among the few assessing the determinants of SARS-CoV-2 infection in a representative sample of older adults -, the prevalence of a history of infection in November 2020 approached 5%. We found that persons aged 70 and above and those with chronic conditions, thus individuals with likely less social interactions, were less frequently exposed to SARS-CoV-2 infection.
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Affiliation(s)
- G Mosconi
- Department of Public Health, University of Pavia , Pavia, Italy
| | - C Stival
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Amerio
- DINOGMI, University of Genoa , Genoa, Italy
- IRCCS San Martino Polyclinic Hospital , Genoa, Italy
| | | | - L Iacoviello
- EPIMED, Insubria University , Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
| | - D Stuckler
- Department of Social Sciences and Politics, Bocconi University , Milan, Italy
| | - A Zucchi
- Bergamo Health Protection Agency , Bergamo, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
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18
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Ancona A, Godoy M, Bertuccio P, Gentile L, Odone A, Signorelli C. Can YouTube be used as a credible source of information for COVID-19 vaccination in Italy? Eur J Public Health 2022. [PMCID: PMC9593524 DOI: 10.1093/eurpub/ckac131.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The COVID-19 pandemic led to an ‘infodemic', as defined by the WHO, which made it difficult to be accurately informed on public health topics. For this purpose, many people use social media as a source of information, mainly YouTube. Given the great resonance of this platform, our study aims at assessing quality and reliability of its content regarding the COVID-19 vaccination. Methods During March 2022, six searches were performed on the Italian YouTube platform using the following terms: “Covid vaccination”, “Covid vaccine”, “Coronavirus vaccination”, “Coronavirus vaccine”, “Sars-Cov-2 vaccination” and “Sars-Cov-2 vaccine”. A total of 329 videos were analysed, after removing 271 duplicated videos, and classified in seven types of channel. The reliability of the content was evaluated through the HoNCode score, while quality was tested using the validated DISCERN tool. Results The most frequent category was ‘Internet Media’ (33%), while the less frequent one was ‘Educational Medical’ (7%). The content reliability (i.e. HoNCode score) resulted higher for videos produced by medical healthcare workers than non-medical ones. Concerning the quality, the DISCERN score resulted significantly higher for the Educational channels (median 46.0 for medical and 41.3 non-medical ones) as compared to Internet Media (26.5) and New Agencies (24.3). Conclusions Although YouTube has implemented a policy against misinformation related to the COVID-19 vaccination, the study highlights that there is extreme heterogeneity in reliability and quality of videos. Content produced by non-medical users, especially “Internet Media” and “News Agencies” categories should be evaluated with attention by users, as their quality is not appropriate to the importance of the topic. Key messages • Because of to the heterogeneity of its content, YouTube should be evaluated carefully when used as a source of information for Covid-19 vaccination. • Content produced by non-medical users, is generally of poor quality, not appropriate to the importance of the topic.
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Affiliation(s)
- A Ancona
- School of Public Health, University Vita-Salute San Raffaele , Milan, Italy
| | - M Godoy
- School of Public Health, University Vita-Salute San Raffaele , Milan, Italy
| | - P Bertuccio
- Department of Public Health, University of Pavia , Pavia, Italy
| | - L Gentile
- School of Public Health, University Vita-Salute San Raffaele , Milan, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
| | - C Signorelli
- School of Public Health, University Vita-Salute San Raffaele , Milan, Italy
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19
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Deandrea S, Della Valle PG, Battisti F, Mantellini P, Mantovani W, Narne E, Odone A, Senore C, Brusa P, Calsolaro R. The community pharmacy model for colorectal cancer screening: policy insights from Italy. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite its effectiveness, compliance to colorectal cancer (CRC) screening remains low. Different strategies to improve the adherence were identified, such as the involvement of new stakeholders as the community pharmacists. In Italy a recent national project fuelled the development of this strategy, scaling-up the collaboration between screening programmes and pharmacies formerly at the local level up to the national level.
Methods
The regional representatives of the CRC screening programmes provided to the National Screening Monitoring Centre the agreements arranged between the Regions/Autonomous provinces and their respective pharmacy owners representatives. The agreement decrees were analysed describing the fecal occult blood test pathway (e.g. kit supply and delivery) and supplementary activities provided by the pharmacies together with the CRC screening kit delivery, such as health promotion ones.
Results
Information was received from 18 Regions and Autonomous provinces (86% of the total). Regarding the economic compensation, the amount of money paid for each kit varies a lot, with a range from 0 to 18 EUR. The number of process phases covered by the agreements ranged from a maximum of 16 (out of 18) to a minimum of 0. The processes that were included most often were the supply of the kit, the delivery of the kit, and education/awareness of CRC screening (68.8%), followed by sample transfer to the laboratory, test tube tracing and counselling (62.5%). Among the processes less covered there were the warehouse management and awareness of other healthcare initiatives (12.5%), and only in one case a supplementary agreement on delivery of preparation for intestinal cleansing was included.
Conclusions
The arrangements between pharmacies and CRC screening programmes in Italy are very diverse and unique model is missing. Collaboration between programs and pharmacies is promising and quality standards of the service should be set at international level.
Key messages
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Affiliation(s)
- S Deandrea
- Pavia Health Protection Agency , Pavia, Italy
| | | | - F Battisti
- Istituto per lo Studio, Prevenzione e la Rete Oncologica , Firenze, Italy
| | - P Mantellini
- Istituto per lo Studio, Prevenzione e la Rete Oncologica , Firenze, Italy
| | - W Mantovani
- Azienda Provinciale per i Servizi Sanitari di Trento , Trento, Italy
| | | | - A Odone
- University of Pavia , Pavia, Italy
| | - C Senore
- AOU Città della Salute e della Scienza di Torino , Turin, Italy
| | - P Brusa
- Università degli Studi di Torino , Turin, Italy
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20
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Vecchio R, Meloni A, Gentile L, Gaeta M, Signorelli C, Odone A. Leo&Giulia: a cartoon series to promote health and prevention in primary school-aged children. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronavirus (COVID-19) pandemic control measures actively involved people who were called to adopt new and unusual lifestyles. In this context, children had to stay home from school for weeks, had to adapt to new teaching methods and give up socializing. In many countries, not much attention was paid to the educational sector, and, ultimately, to children's physical and psychological well-being.
Objectives
In this context, we developed an innovative health education audio-visual model to teach children about public health, empower them to adopt preventive behaviours and limit the risk of infection transmission in schools and in the community.
Results
We designed and produced the animated cartoon series “Leo&Giulia” to convey solid scientific content and key public health messages related to the ongoing COVID-19 pandemic to primary school-aged children. Contents and dialogues were validated by a scientific committee composed of experts in the fields of public health, paediatrics, infectious diseases, and neuroscience, as well as communication experts. The first episode of Leo&Giulia focused on COVID-19 and explained to children what SARS-CoV2 was, its transmission and why schools were closed. Endorsed by the European Commission, it was broadcasted by national public and private television channels and went viral on social media. The second episode of Leo&Giulia, funded by the Italian Ministry of Research, was launched in April 2022 and focused on vaccines and immunization explaining to children how vaccines work and why herd immunity is important for collective health.
Conclusions
Leo&Giulia is an innovative health education project to help children to better understand how to cope with COVID-19 as a public health challenge. More broadly, the series aims to increase youth engagement by promoting public health values and healthy behaviours.
Key messages
• Health promotion targeting children is important and contributes to societal health and wellbeing.
• Cartoon series are an innovative digital health education tool that effectively increase youth engagement on public health values.
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Affiliation(s)
- R Vecchio
- Department of Public Health, University of Pavia , Pavia, Italy
| | - A Meloni
- Department of Public Health, University of Pavia , Pavia, Italy
| | - L Gentile
- Department of Public Health, University of Pavia , Pavia, Italy
| | - M Gaeta
- Department of Public Health, University of Pavia , Pavia, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
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21
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Paladini A, Lanza TE, Gianfredi V, Blandi L, Ricciardi W, Damiani G, Signorelli C, Odone A, Cadeddu C. Training needs assessment of European healthcare workers on vaccinology and vaccine acceptance. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Healthcare workers (HCWs) are at the frontline of interaction with those that are taking decisions around vaccination. They need adequate training. The general aim of this systematic review is to assess HCWs’ training needs on vaccinology and vaccine acceptance. This work was performed for the European Centre for Disease Control (ECDC) under the specific contract No 1ECD.12108 ID.12922 implementing the framework contract number ECDC/2021/005.
Methods
The search was performed using MEDLINE, Scopus and Google Scholar databases in February 2022. The following inclusion criteria were used: date (from 01/01/2011 to 24/02/2022); language (English, Italian, Portuguese, Spanish, French and Romanian); geographic location of the study (Europe). Appraisal tool for Cross-Sectional Studies (AXIS checklist) was used to assess the methodological quality of the included papers.
Results
The scientific literature search retrieved 640 results on PubMed, 556 on Scopus and 15 on Google Scholar. In total, 1211 records were identified. After the duplicate removal and the title/abstract assessment, 132 publications were assessed for eligibility. Finally, after the full-text assessment, only 25 articles were included. As regards for the quality assessment, all studies were judged of moderate-good quality. The majority of studies stressed the need to deepen general knowledge of vaccine preventable diseases, vaccine efficacy, vaccination schedule and adverse effects of vaccines.
Conclusions
Considering their role in the community, especially as source of information and trust for vaccine acceptance, educational initiatives in vaccinology and vaccine hesitancy should be prioritized for HCWs, aimed at increasing their knowledge, awareness, and attitudes. An important heterogeneity of educational backgrounds, activities performed and training needs of the HCWs involved in vaccination at European level was one of the main critical issue to be addressed for future actions.
Key messages
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Affiliation(s)
- A Paladini
- Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - TE Lanza
- Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - V Gianfredi
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - L Blandi
- Public Health, University of Pavia , Pavia, Italy
| | - W Ricciardi
- Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - G Damiani
- Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Odone
- Public Health, University of Pavia , Pavia, Italy
| | - C Cadeddu
- Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy
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22
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Sgueglia AC, Zeduri M, Rissone M, Bertuccio P, Cavallini A, Martignoni A, Muzzi A, Cutti S, Ambrosio AG, Odone A. Hospital discharge for stroke patients: Transitional Care is Brain. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Among cerebrovascular disease, stroke is a life-threatening neurological event and a main cause of serious long-term disability, with relevant healthcare and economic burden. Treatment of stroke is time dependent and organised integrated stroke care enables quick and effective responses to reduce stroke-related death and disability. This study aimed at evaluating the amount of hospital discharge to transitional care facilities for stroke patients to support integrated care models in the city of Pavia (Italy).
Methods
In 2017 in Pavia, Fondazione IRCCS Policlinico San Matteo started a partnership with Fondazione Mondino to build a specific stroke pathway, becoming a leading centre for stroke treatment. We conducted a retrospective chart review (RCR) of patient-centred data to quantify the volume of discharge for stroke patients. Two trained public health residents reviewed medical records with stroke admission diagnosis during 2021, analysing onset (e.g., Emergency Room, other hospital, emergency network), ward, treatment and discharge types (e.g., home, death, transitional care facility).
Results
Our RCR found 669 patients with a stroke diagnosis treated at San Matteo hospital in 2021, the vast majority of which were admitted to the neurology ward (375 patients, 56%). The recanalization rate was 32% (150 on 464 ischemic stroke patients). Regarding the discharge type, 299 patients (45%) were sent home, while 297 patients (44%) needed transfer to rehabilitation or long-term care facilities. About 8% (52 patients) of the overall sample died in hospital.
Conclusions
Our analysis showed that, while most stroke patients were discharged and sent home, more than two-third need to be transferred to continue to get the right healthcare from the right professional. Transitional care facilities should receive the greatest consideration by systems and providers seeking to implement care models to reduce residual neurological disabilities for stroke patients.
Key messages
• A fast and accessible emergency chain is essential to reduce residual neurological disabilities and the related healthcare and economic burden in stroke patients.
• Extending the stroke path model to other time-dependent diseases is increasingly high-priority to shape a strong and resilient healthcare system, ensuring qualified health coverage.
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Affiliation(s)
- AC Sgueglia
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - M Zeduri
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - M Rissone
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - P Bertuccio
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
| | - A Cavallini
- Cerebrovascular Department, IRCCS Mondino Foundation , Pavia, Italy
| | - A Martignoni
- Fondazione IRCCS Policlinico San Matteo Unit of Cardiac and Cerebrovascular Disease, , Pavia, Italy
| | - A Muzzi
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - S Cutti
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - AG Ambrosio
- Medical Direction, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - A Odone
- Department of Public Health, Università degli Studi di Pavia , Pavia, Italy
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23
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Maffeo M, Mazziotta F, Pierini E, Della Valle PG, Gramegna M, Tirani M, Crottogini L, Odone A, Castaldi S, Cereda D. Infectious diseases other than Covid-19 in 2020, a report from Lombardy Region. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non pharmaceutical interventions (NPIs) put in place to reduce the spread of Sars-Cov-2 had an impact also on other infections. Aim of this research is to describe the incidence of other infections and vaccination coverage rate (VCR) in Lombardy region from 2018 to 2020.
Methods
We analysed data coming from the regional surveillance system of notifiable infectious diseases and vaccination registry from 2018 to 2020.
Results
13206 infectious diseases' cases were notified in 2020 compared to 36847 in 2019 and 42610 in 2018, this corresponding to, respectively, a 64.1% and 69% decrease. Some interesting data:
measles; 24 cases in 2020, 542 in 2019 and 220 in 2018, with an incidence rate (IR) per 100.000 respectively of 0,2; 5,4 and 2,2; chicken pox; 2357 cases in 2020, 13478 in 2019 and 19463 in 2018 (IR 23,5; 134,3; 193,9) tubercolosis; 586 in 2020, 857 in 2019 and 945 in 2018 (IR 5,8; 8,6; 9,4) invasive bacterial diseases; 378 in 2020, 890 in 2019 and 882 in 2018 (IR 3,7;8,8;8,7) infectious diarrhea; 2080 in 2020, 3716 in 2019 and 4347 in 2018 (IR 20,7; 37,1; 43,3) legionellosis cases; 806 in 2020, 1051 in 2019 and 1096 in 2018 (IR 8; 10,5; 10,9) arbovirus infections (chikunguya, dengue, west nile, zika) were 118, in 2020, 126 in 2019 and 8 in 2018 (IC 1,2; 1,3; 0,1)
In 2020 VCR at 24 months of age remained above 95% for hexavalent and measles-mumps-rubella vaccination while there was a decline for others vaccines.
Conclusions
During the COVID-19 outbreak in 2020 there was a decline in all notified infectious diseases compared to the previous years, likely due to massive NPIs adoption, as well as, possibly, to decreased access to care and preventive services that caused difficulties to the surveillance system to detect notifiable infectious diseases. VCRs were still high for most important vaccines while there was a decline for other vaccines as evidence of the impact of the pandemic on vaccination activities.
Key messages
NPIs had a deep impact on the reduction of airborne diseases. The decline for non-airborne infections is likely due to NPIs and limitations in the access to the healthcare system.
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Affiliation(s)
- M Maffeo
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - F Mazziotta
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - E Pierini
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - PG Della Valle
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - M Gramegna
- DG Welfare, Lombardy Region, Milan, Italy
| | - M Tirani
- DG Welfare, Lombardy Region, Milan, Italy
| | | | - A Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - S Castaldi
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - D Cereda
- DG Welfare, Lombardy Region, Milan, Italy
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24
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Della Valle PG, Mosconi G, Nucci D, Gianfagna F, Iacoviello L, Bonaccio M, Odone A. Adherence to the Mediterranean Diet during COVID-19 national lockdowns: a systematic review. Eur J Public Health 2021. [PMCID: PMC8574834 DOI: 10.1093/eurpub/ckab165.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The Mediterranean Diet (MD) is one of the healthy eating plans recommended to promote health and prevent chronic diseases. During the COVID-19 pandemic, many countries adopted restrictive measures to mitigate infection spread, which might have influenced people's lifestyle and dietary habits. We conducted a systematic review to evaluate the impact of stay-at home orders' implementation on adherence to MD. Methods Studies were identified searching Medline, Embase, and Web Of Science, the search strategy was developed using a combination of free text and mesh terms referring to COVID-19 pandemic, lockdown, and MD. Studies published until March 31st, 2021 were included. We only considered studies reporting original data from quantitative analysis and assessing modifications of adherence to the MD through validated dietary scores or any change in consumption of food categories that are typically ascribed to the MD. Data extraction, pooling and quality appraisal of the included studies, were conducted applying PRISMA guidelines. Results 42 studies were retrieved. After duplicates removal, and in-blind two-step screening, 10 studies met our a priori defined inclusion criteria and were included in the review. 71.4% of the studies reporting a rate of change in adherence, measured through validated questionnaire both before and during lockdown, reported an increase, while 28.6% reported no significative changes. All included studies reporting the percentage of participants having a high adherence to the MD, based on their results on MEDAS questionnaire, before and during the lockdown, found an increase in this percentage. Conclusions Adherence to the MD could have raised in people undergoing lockdowns due to COVID-19. Key messages The impact of restrictive measures on determinants of health must be monitored. Despite the literature suggests adherence to MD has declined in the last years, this trend may have reversed or, at least, slowed during the initial phases of the current pandemic.
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Affiliation(s)
- PG Della Valle
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - G Mosconi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - D Nucci
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - F Gianfagna
- Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - L Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy
- Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - M Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy
| | - A Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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25
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Odone A. Digital Public Health Role in promoting Mores Sustainable Care practices. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
As digitalization is progressively permeating all aspects of healthcare. Here we will address how can we address the potential of applying digital tools to public health and discuss some key challenges. We have identified the strategic pillars for a successful European strategy for public health digitalization and we outlined how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health. Here we will link these pillars to the impact on climate change. From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient and mitigate climate change.
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Affiliation(s)
- A Odone
- Public Health, University of Pavia, Pavia, Italy
- EUPHA-DH
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26
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Pegollo L, Mazza C, Girardi D, Maggioni E, Valente G, Gaeta M, Odone A. Use and effectiveness of Digital Contact Tracing during COVID-19 pandemic: a systematic review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Contact tracing (CT) is a pillar of infection control during outbreaks and its implementation has been great ally in the context of the COVID-19 pandemic that pressured national health systems. Digital CT (DCT) aids manual CT by logging proximity contacts and timely notifying contacts of positive cases, contributing to greater epidemic. We aim to systematically review and critically appraise the available evidence on adoption, effectiveness, acceptance and barriers to access of available CT apps.
Methods
We conducted a systematic literature review by means of Pubmed, Embase, Cochrane and Web of Science and applying the PRISMA guidelines. We classified studies according to selected characteristics (eg, original data, mathematical models, policy papers, overview of the experience with national CT apps) in order to better outline our results.
Results
Our queries yielded 1201 articles, of which 790 remained after duplicates' removal. After applying a priori selected inclusion criteria, 428 (54.17%) were eliminated after screening by title and abstract. 362 records were included in our study: of them 33.7% were original studies, 54.1% were opinion papers not reporting quantitative data, 14.91% were mathematical models, 6% were systematic reviews on DCT-related topics. Among original studies, 11.47% described national experiences and 25.40% discussed adoption dynamics.
Conclusions
DCT adoption still faces several cultural, normative and technical barriers, ranging from adoption mandates to privacy issues, to device compatibility. Overall, scant evidence is available on the impact of DCT in controlling infection spread and wide heterogeneity persists within studies in term of design and assessed outcomes Future research is needed based on shared evaluation frameworks.
Key messages
Digital contact tracing apps are a powerful but underestimated tool to counter epidemiological emergencies. Future epidemiological challenges will require a shared implementation and evaluation protocol for digital contact tracing apps.
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Affiliation(s)
- L Pegollo
- School of Public Health, Università di Pavia, Pavia, Italy
| | - C Mazza
- School of Public Health, Università di Pavia, Pavia, Italy
| | - D Girardi
- School of Public Health, Università di Pavia, Pavia, Italy
| | - E Maggioni
- School of Public Health, Università di Pavia, Pavia, Italy
| | - G Valente
- School of Public Health, Università di Pavia, Pavia, Italy
| | - M Gaeta
- School of Public Health, Università di Pavia, Pavia, Italy
| | - A Odone
- School of Public Health, Università di Pavia, Pavia, Italy
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27
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Gianfredi V, Buffoli M, Rebecchi A, Croci R, Oradini-Alacreu A, Stirparo G, Marino A, Odone A, Capolongo S, Signorelli C. Urban Green Spaces and Public Health Outcomes: a systematic review of literature. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
As stressed by COVID-19 pandemic, urbanicity might represent a risk factor for chronic non-communicable diseases or generally impacting on healthy lifestyle, among them physical activity.
Methods
In light of this, we performed a systematic review aimed to explore the association between urban greenspaces and two important health indicators for both mental and physical health. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure, and mental health outcomes (MH) and objectively-measured physical activity (PA). The review was conducted from 2000/01/01 to 2020/09/30 searching in two electronic databases: PubMed/Medline and Excerpta Medica dataBASE (EMBASE). Only articles in English were included.
Results
Out of 356, a total of 34 studies were included in our review, of which 19 assessed MH outcomes, the remaining dealt with PA. Only a few included studies found a non-effect or a negative effect on MH outcomes, whereas, all the others demonstrated a positive effect of urban greenspace and both MH and PA. However, our results stressed not only the importance of green space presence, but also the importance of maintenance, renovation, closeness to residential areas, the presence of interactive activities, and perceived security aspects.
Conclusions
To conclude, even some methodological limitations of the included studies, results are concordant in demonstrating that urban greenspaces show potentially beneficial effects on mental health and physical activity. Our results are significant for public health experts and policymakers involved in urban planning, community health promotion, and improvement of health and social equity.
Key messages
Urban green spaces are important factors, impacting on both physical and mental health. Policymakers involved in urban planning should pay more attention in urban green spaces.
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Affiliation(s)
- V Gianfredi
- University Vita-Salute San Raffaele, Milan, Italy
| | - M Buffoli
- Architecture, Built Environment and Construction Engineering Department, Politecnico di Milano, Milan, Italy
| | - A Rebecchi
- Architecture, Built Environment and Construction Engineering Department, Politecnico di Milano, Milan, Italy
| | - R Croci
- University Vita-Salute San Raffaele, Milan, Italy
| | | | - G Stirparo
- University Vita-Salute San Raffaele, Milan, Italy
| | - A Marino
- University Vita-Salute San Raffaele, Milan, Italy
| | - A Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - S Capolongo
- Architecture, Built Environment and Construction Engineering Department, Politecnico di Milano, Milan, Italy
| | - C Signorelli
- University Vita-Salute San Raffaele, Milan, Italy
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28
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Vigezzi GP, Barchiesi AT, Alquati M, Voltini E, Gianfredi V, Odone A, Signorelli C. Urban health guidelines implementation: evidence and practice. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Urban planning plays a crucial role in healthy lifestyle promotion, impacting physical activity and non-communicable diseases prevalence. National and regional strategies rely on an integrated approach. Under the chapter of collective prevention and public health, the new LEA (Assistance Essential Levels) include evaluating land-use plans (PGT in Italy) with a preventive assessment on the relationship between health and urban environment.
Description of the problem
The Italian Ministry of Health and the Lombardy Region with Polytechnic University of Milan proposed good practices for health impact evaluation of urban and environmental interventions of regeneration and redevelopment. After bibliographic research, on-site and on-field training, community practice and experts' evaluation, a multicriterial tool was built. A set of indicators (7 macro-areas) was selected to measure the propensity of urban plans to promote health. In 2020 the new guidelines were introduced in the administrative process of health impact assessment for receptors and of quinquennial PGT re-evaluation.
Results
The Health Protection Agency of the Po Valley (provinces of Cremona and Mantova, in Northern Italy) was asked to produce 344 judgements on civil buildings during 2020. Among them, 12 opinions referred to partial variations of PGT in 12 different municipalities. No comprehensive urban plan evaluation was requested in 2020.
Lessons
PGT evaluation through the proposed tool allows estimating the capacity to control population risk factors and promote a context organized to satisfy social needs and improve quality of life. In the rural context of small municipalities of Cremona and Mantova, an encountered limitation was the small size of urban centres. Thus, applying strategies conceived for metropolitan areas was challenging. A contextual evaluation of bordering municipalities urban plans would be desirable to promote bigger-scale interventions about transports, soil use and emission sources.
Key messages
Applying urban health good practices to land-use plan evaluation in rural areas with small municipalities poses some issues due to reduced interventions scale. It would be helpful to promote the simultaneous evaluation of bordering municipalities' urban plans so as to suggest integrated health interventions on a larger scale.
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Affiliation(s)
- GP Vigezzi
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - AT Barchiesi
- Hygiene and Public Health, Environmental Health Unit, Agenzia di Tutela della Salute della Val Padana, Cremona, Italy
| | - M Alquati
- Hygiene and Public Health, Environmental Health Unit, Agenzia di Tutela della Salute della Val Padana, Cremona, Italy
| | - E Voltini
- Hygiene and Public Health, Environmental Health Unit, Agenzia di Tutela della Salute della Val Padana, Cremona, Italy
| | - V Gianfredi
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - A Odone
- Department of Public Health, Università degli Studi di Pavia, Pavia, Italy
| | - C Signorelli
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
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29
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Sorbello S, Bossi E, Zandalasini C, Carioli G, Pleet A, Signorelli C, Ciceri F, Ambrosio A, Odone A. After Action Reviews to assess COVID-19 hospital responses. Eur J Public Health 2021. [PMCID: PMC8574688 DOI: 10.1093/eurpub/ckab164.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction After-Action Reviews (AARs) are healthcare management tools applied to evaluate responses to public health emergencies, identifying best practices and challenges. They are included in the International Health Regulations (IHR) and recommended by the World Health Organization (WHO). The aim of this study was to adapt the WHO AAR guidelines to assess the response during the COVID-19 first epidemic wave (February 22nd-May 3rd, 2020) at San Raffaele Scientific Institute, a large university hospital in Milan, Italy. The hospital treated 951 patients and underwent massive re-organization. Methods We developed a hospital-oriented AAR based on the key-informant interview format. After establishing an AAR planning and analysis team, an ad-hoc questionnaire was designed to explore four areas: i)Staff management; ii)Logistics and supplies; iii)Diagnosis and clinical management; iv)Communication. The questionnaire was used to support 36 semi-structured interviews of professionals with executive, clinical, technical and administrative roles within the hospital. Results The hospital response was rated as overall effective and sufficiently prompt. Participants stressed the key roles played by: i)strong governance and coordination; ii)readiness and availability of healthcare personnel; iii)multidisciplinary model of care based on levels of intensity. Major challenges concerned communication strategies and staff training. In addition, participants highlighted the need for greater collaboration among hospitals and primary care services. Conclusions This study represents one of the first applications of an AAR to the COVID-19 emergency and to the hospital setting. The tool provided San Raffaele's hospital management with a multi-layered analysis of the emergency response that informed the critical planning for next phases of the pandemic response. The tool can be adapted to other settings to pursue continuous operational improvement. Key messages After-action reviews are healthcare managements tools used to to evaluate a country or government’s response to infectious disease outbreaks, environmental or natural disasters and societal crises. After Action Reviews can be adapted or scaled for other settings to pursue continuous operational improvement and support preparedness strategies for future public health emergencies.
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Affiliation(s)
- S Sorbello
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
- Department of Public Health, Experimental, Forensic Medicine, University of Pavia, Pavia, Italy
| | - E Bossi
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - G Carioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - A Pleet
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - C Signorelli
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - F Ciceri
- San Raffaele Scientific Institute, Milan, Italy
| | - A Ambrosio
- San Raffaele Scientific Institute, Milan, Italy
| | - A Odone
- Department of Public Health, Experimental, Forensic Medicine, University of Pavia, Pavia, Italy
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Moro M, Vigezzi GP, Chiappa F, Salvati S, Cocciolo G, Oradini Alacreu A, Capraro M, Nizzero P, Odone A, Signorelli C. Hospital hand hygiene monitoring: internal audits and the role of public health residents. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Healthcare workers (HCW) adherence to hand hygiene (HH) is the most effective infection prevention and control (IPC) measure to fight healthcare-associated infections (HAI) and is a crucial component for standard precautions, especially in a pandemic context. As suggested by the WHO and Joint Commission Network Project, evaluating adherence to HH is essential to identify deficiencies and promote improvement interventions.
Methods
San Raffaele Hospital in Milan, Italy, adopted internal audits to measure HCWs' adherence to HH according to WHO Guidelines. Public health (PH) residents were enrolled as auditors. They were trained with WHO technical manual for observers and handovers among residents. WHO observation form was used for collection. Process index was HH adherence, stratified by profession, unit, opportunity and indication.
Results
8 PH medical residents carried out observations from January 2018 to December 2019. 434 HCWs were observed in 26 hospital units (191 nurses, 148 physicians, 83 healthcare assistants and 11 other professionals). Global adherence was 53%, calculated on 1,969 opportunities, and 2,221 indications observed, followed by 932 hands rubbing and 110 handwashing. Most observations involved nurses (adherence of 53%) and physicians (54%). Global adherence was generally higher in medicine, specialist surgery and intensive-care units while lower in general surgery and rehabilitation units. Indications with the highest adherence were “after body fluid exposure risk” (69%) and “after touching a patient” (64%). The lowest adherence (44%) was observed for “before clean/aseptic procedure” indication. The belief that gloves use may replace HH might partially explain the data.
Conclusions
Global HH adherence was in line with significant published data and was far better than 2016 data but slightly lower than observations in 2018 when the program started. We believe 2020 HH compliance could have changed due to HCW involvement in IPC against COVID-19.
Key messages
Hand hygiene (HH) audits represent a crucial tool of clinical governance and risk management: auditors’ training, monthly and annual reports, and feedbacks allowed to structure a virtuous process. If HH audits aim to improve practice we should understand when HH is most beneficial, assessing quality, improving performances through achievable targets using reproducible methods and technologies.
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Affiliation(s)
- M Moro
- Infection Control Committee, IRCCS Ospedale San Raffaele, Milan, Italy
| | - GP Vigezzi
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - F Chiappa
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - S Salvati
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - G Cocciolo
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - A Oradini Alacreu
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - M Capraro
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
| | - P Nizzero
- Infection Control Committee, IRCCS Ospedale San Raffaele, Milan, Italy
| | - A Odone
- Department of Public Health, Università degli Studi di Pavia, Pavia, Italy
| | - C Signorelli
- School of Public Health, Università Vita-Salute San Raffaele, Milan, Italy
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Signorelli C, Odone A, Gianfredi V, Capraro M, Kacerik E, Chiecca G, Scardoni A, Minerva M, Mantecca R, Musarò P, Brazzoli P, Basteri P, Bertini B, Esposti F, Ferri C, Alberti VA, Gastaldi G. Application of the "immunization islands" model to improve quality, efficiency and safety of a COVID-19 mass vaccination site. Ann Ig 2021; 33:499-512. [PMID: 34113956 DOI: 10.7416/ai.2021.2456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.
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Affiliation(s)
- C Signorelli
- Università Vita-Salute San Raffaele, Milano, Italy.,IRCCS Ospedale San Raffaele, Milano, Italy
| | - A Odone
- IRCCS Ospedale San Raffaele, Milano, Italy
| | - V Gianfredi
- Università Vita-Salute San Raffaele, Milano, Italy.,IRCCS Ospedale San Raffaele, Milano, Italy
| | - M Capraro
- Università Vita-Salute San Raffaele, Milano, Italy
| | - E Kacerik
- Università Vita-Salute San Raffaele, Milano, Italy
| | - G Chiecca
- Università Vita-Salute San Raffaele, Milano, Italy
| | - A Scardoni
- Università Vita-Salute San Raffaele, Milano, Italy.,Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy
| | - M Minerva
- Università Vita-Salute San Raffaele, Milano, Italy
| | - R Mantecca
- IRCCS Ospedale San Raffaele, Milano, Italy
| | - P Musarò
- IRCCS Ospedale San Raffaele, Milano, Italy
| | - P Brazzoli
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy
| | - P Basteri
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy
| | - B Bertini
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy
| | - F Esposti
- IRCCS Ospedale San Raffaele, Milano, Italy
| | - C Ferri
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy
| | - V A Alberti
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy
| | - G Gastaldi
- Presidenza Gruppo San Donato, expert in Public Health and Health Organization, Milano, Italy
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Chiappa F, Frascella B, Vigezzi GP, Moro M, Diamanti L, Gentile L, Lago P, Clementi N, Signorelli C, Mancini N, Odone A. The efficacy of ultraviolet light-emitting technology against coronaviruses: a systematic review. J Hosp Infect 2021; 114:63-78. [PMID: 34029626 PMCID: PMC8139389 DOI: 10.1016/j.jhin.2021.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
The ongoing pandemic of COVID-19 has underlined the importance of adopting effective infection prevention and control (IPC) measures in hospital and community settings. Ultraviolet (UV)-based technologies represent promising IPC tools: their effective application for sanitation has been extensively evaluated in the past but scant, heterogeneous and inconclusive evidence is available on their effect on SARS-CoV-2 transmission. With the aim of pooling the available evidence on the efficacy of UV technologies against coronaviruses, we conducted a systematic review following PRISMA guidelines, searching Medline, Embase and the Cochrane Library, and the main clinical trials' registries (WHO ICTRP, ClinicalTrials.gov, Cochrane and EU Clinical Trial Register). Quantitative data on studies' interventions were summarized in tables, pooled by different coronavirus species and strain, UV source, characteristics of UV light exposure and outcomes. Eighteen papers met our inclusion criteria, published between 1972 and 2020. Six focused on SARS-CoV-2, four on SARS-CoV-1, one on MERS-CoV, three on seasonal coronaviruses, and four on animal coronaviruses. All were experimental studies. Overall, despite wide heterogenicity within included studies, complete inactivation of coronaviruses on surfaces or aerosolized, including SARS-CoV-2, was reported to take a maximum exposure time of 15 min and to need a maximum distance from the UV emitter of up to 1 m. Advances in UV-based technologies in the field of sanitation and their proved high virucidal potential against SARS-CoV-2 support their use for IPC in hospital and community settings and their contribution towards ending the COVID-19 pandemic. National and international guidelines are to be updated and parameters and conditions of use need to be identified to ensure both efficacy and safety of UV technology application for effective infection prevention and control in both healthcare and non-healthcare settings.
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Affiliation(s)
- F Chiappa
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - B Frascella
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - G P Vigezzi
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - M Moro
- Infection Control Committee, IRCCS San Raffaele Hospital, Milan, Italy
| | - L Diamanti
- Clinical Engineering Unit, IRCCS San Raffaele Hospital, Milan, Italy; HTA Committee, IRCCS San Raffaele Hospital, Milan, Italy
| | - L Gentile
- Clinical Engineering Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Lago
- Clinical Engineering Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - N Clementi
- Laboratory of Microbiology and Virology, University Vita-Salute San Raffaele, Milan, Italy
| | - C Signorelli
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - N Mancini
- Laboratory of Microbiology and Virology, University Vita-Salute San Raffaele, Milan, Italy
| | - A Odone
- HTA Committee, IRCCS San Raffaele Hospital, Milan, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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Amerio A, Odone A, Aguglia A, Gianfredi V, Bellini L, Bucci D, Gaetti G, Capraro M, Salvati S, Serafini G, Signorelli C, Amore M, Ghaemi S. La casa de papel: A pandemic in a pandemic. J Affect Disord 2020; 277:53-54. [PMID: 32795715 PMCID: PMC7409922 DOI: 10.1016/j.jad.2020.07.134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022]
Affiliation(s)
- A. Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, RCCS San Martino, L.go R. Benzi 10, 16132 Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy,Department of Psychiatry, Tufts University, Boston, MA, USA,Corresponding author at: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, RCCS San Martino, L.go R. Benzi 10, 16132 Genoa, Italy
| | - A. Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy,Clinical Epidemiology and HTA, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A. Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, RCCS San Martino, L.go R. Benzi 10, 16132 Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - V. Gianfredi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - L. Bellini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - D. Bucci
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - G. Gaetti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - M. Capraro
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - S. Salvati
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - G. Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, RCCS San Martino, L.go R. Benzi 10, 16132 Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C. Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - M. Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, RCCS San Martino, L.go R. Benzi 10, 16132 Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S.N. Ghaemi
- Department of Psychiatry, Tufts University, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Odone A, Delmonte D, Gaetti G, Signorelli C. Doubled mortality rate during the COVID-19 pandemic in Italy: quantifying what is not captured by surveillance. Public Health 2020; 190:108-115. [PMID: 33412438 PMCID: PMC7703200 DOI: 10.1016/j.puhe.2020.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
Objectives It is important to quantify the true burden of coronavirus disease 2019 (COVID-19) in different countries, to enable informed decisions about imposing and relaxing control measures. COVID-19 surveillance data fails in this respect, as it is influenced by different definitions, control policies and capacities. This article aims to quantify excess mortality and estimate the distribution between COVID-19 and non-COVID-19 causes of death. Study design Observational study and mathematical modelling. Methods Publicly available data from multiple institutional sources were used and an in-depth analysis was carried out of deaths from all causes between 2015 and 2020 in Italy at the national, regional and local level. Excess mortality over time and space was first explored, followed by an assessment of how this related to COVID-19 surveillance and, ultimately, assuming a fixed male:female ratio, a model was developed and applied to estimate the proportions of COVID-19 and non-COVID-19 excess mortality in 2020. Results In Italy, the mortality rate doubled in March and April 2020 compared with data from 2015 to 2019 (+109%, when considering municipalites with >10.000 inhabitants), with excess mortality reaching >600% in large municipalities in northern areas. Notified COVID-19 deaths accounted for only 43.5% (regional range: 43–62%) of excess mortality. It is estimated that more than two-thirds of excess deaths that were not captured by surveillance are non-COVID-19 deaths, which could be a result of the excess burden on the health systems, in addition to reduced demand and supply of other non-COVID healthcare services. Conclusions The impact of COVID-19 during the early stages of the pandemic is much larger than official figures have reported. Monitoring excess mortality helps to capture the full effect of the COVID-19 pandemic, which differs between regions in Italy and which might have resulted in significant indirect effects on the well-being of the population. In addition, the COVID-19 pandemic has also resulted in significant indirect effects on the well-being of the population.
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Affiliation(s)
- A Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
| | - D Delmonte
- Italian National Research Council - IMEM, Parma, Italy
| | - G Gaetti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Signorelli C, Odone A, Ricciardi W, Lorenzin B. The social responsibility of public health: Italy's lesson on vaccine hesitancy. Eur J Public Health 2020; 29:1003-1004. [PMID: 31808818 DOI: 10.1093/eurpub/ckz135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Signorelli
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.,Italian Association of Hygiene, Preventive Medicine & Public Health - SItI (2014-16)
| | - A Odone
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - W Ricciardi
- School of Medicine, University Cattolica del Sacro Cuore, Rome, Italy.,National Health Institute - ISS (2014-18)
| | - B Lorenzin
- Italian Minister of Health, Rome, Italy (2013-18)
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Morganti A, Brambilla A, Amerio A, Aguglia A, Odone A, Costanza A, Signorelli C, Serafini G, Amore M, Capolongo S. COVID-19 lockdown: housing built environment’s effects on mental health. Eur J Public Health 2020. [PMCID: PMC7543536 DOI: 10.1093/eurpub/ckaa165.426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on March 11th, severe 'lockdown' measures have been adopted by the Italian Government. For over two months of stay-at-home, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures had on mental health and wellbeing.
Methods
We conducted a large web-based survey on 9261 subjects in Northern Italy, one of the Regions most heavily hit by the pandemic in Europe. Participants were recruited among university staff, faculty and students. The questions included socio-demographic features of the participants; international evaluation scales designed to recognize depressive-, anxiety- and sleep-related symptoms, impulsivity, quality of life; architectural parameters investigating housing physical characteristics.
Results
As emerges from our analysis poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments < 60 m2, with poor quality view and indoor area is associated with, respectively, 1.31 (95CI), 1.368 (95CI), and 2.253 (95CI) time the risk of moderate/severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95%CI).
Conclusions
Our findings suggest housing played a major role in influencing people mental health and wellbeing during COVID-19 pandemic. We argue strengthened multi-interdisciplinary approach involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to inform the planning implementation and monitoring of housing policies centered on population health.
Key messages
COVID-19 lockdown mitigation measures strongly impacted on Mental Health. Living in apartments < 60 m2, with poor quality view and indoor area significatively increase the risk of moderate and severe depressive symptoms.
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Affiliation(s)
- A Morganti
- DABC, Politecnico di Milano, Milan, Italy
| | | | - A Amerio
- DINOGMI, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, USA
| | - A Aguglia
- DINOGMI, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Epidemiology and HTA, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Costanza
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - G Serafini
- DINOGMI, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Amore
- DINOGMI, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Pasquarella C, Pompili M, Valeriani F, Morgado M, Milicia GM, Veronesi L, Odone A, Zoni R, Saccani E, Savino G, Persi Y, Pinelli M, Liguori G, Gallè F, Di Onofrio V, Fallace P, Romano Spica V. The prevention of doping and the improper use of drugs and food supplements in sports and physical activities: a survey on the activity of the prevention departments of Italian local health authorities. Ann Ig 2020; 31:533-547. [PMID: 31616898 DOI: 10.7416/ai.2019.2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Doping is an important public health problem widespread not only among elite athletes, but also among amateur and recreational athletes and the general population. In Italy the introduction of doping prevention within the Essential Levels of Care (LEA) with the DPCM 12/1/2017 represents a crucial step towards the implementation of education and health promotion interventions. In this context, the Departments of Prevention (DP) of the Local Health Authorities (LHA) have to play a fundamental role, becoming the cultural and operational reference on this issue. As part of the "Doping prevention: development of a permanent educational tool coordinated by the National Health Service Prevention Departments" project, funded by the Italian Ministry of Health, a survey was conducted on the activities carried out by the DP regarding doping prevention and improper use and abuse of drugs and food supplements in sports and physical activities, as a basis for the harmonization of organizational structures and prevention programs and the creation of a collaboration network at a regional and national level. METHODS A semi-structured questionnaire consisting of 11 questions, prepared on an electronic platform, was sent to the DP of all the Italian LHA. RESULTS A total of 38 DP out of 131 (29%) completed the questionnaire, with representation from all regions. 42.1% of DP carried out or are still running programs for the prevention of doping, a percentage that decreases to 27% considering the programs for the prevention of misuse and abuse of drugs and food supplements in sports and in physical activities; in less than half of the DP, 37.5% and 41.7%, respectively, dedicated funds have been allocated. The professionals most involved in prevention of doping are the Specialists in Sport Medicine (81.3%) followed by Specialists in Hygiene (43.8%) and Psychologists (37.5%), while Health Care Assistants (50%) are the professionals most involved in the prevention of the improper use of drugs and food supplements, followed by Specialists in Hygiene and Specialists in Sport Medicine (40%). Most of the DP (71.9%) believe that the introduction of programs to prevent and counteract doping in the LEA will have repercussions on their approach against doping. CONCLUSIONS The survey, although conducted on a limited sample, has provided an important framework relating to programs for the prevention of doping and the misuse and abuse of drugs and food supplements in sports and in the physical activities carried out by DP. A remarkable heterogeneity has been highlighted, both at national and regional level. It is urgent to provide DP with homogeneous and effective organizational models and adequate operational tools, paying particular attention to the training of all the professionals involved. It is also essential to implement permanent monitoring tools.
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Affiliation(s)
- C Pasquarella
- Department of Medicine and Surgery, University of Parma, Parma, Italy - WDPP, Working Group Doping Prevention Project
| | - M Pompili
- Local Health Autority Area Vasta n.1, Fano, Italy - RRN, Regional Referents Network
| | - F Valeriani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - M Morgado
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G M Milicia
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Odone
- University Vita-Salute San Raffaele, Milan, Italy
| | - R Zoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - E Saccani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Savino
- Emilia-Romagna Antidoping Center, AUSL Modena, Modena, Italy - WDPP, Working Group Doping Prevention Project
| | - Y Persi
- Emilia-Romagna Antidoping Center, AUSL Modena, Modena, Italy
| | - M Pinelli
- Emilia-Romagna Antidoping Center, AUSL Modena, Modena, Italy
| | - G Liguori
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy - GSMS-SItI, Working Group on Movement Sciences for Health, Italian Society of Hygiene Preventive Medicine and Public Health - WDPP, Working Group Doping Prevention Project
| | - F Gallè
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, Italy
| | - V Di Onofrio
- Department of Sciences and Technologies, University of Naples "Parthenope", Naples, Ital
| | - P Fallace
- Prevention Department of ASL Napoli 2 Nord, Naples, Italy - WDPP, Working Group Doping Prevention Project - RRN, Regional Referents Network
| | - V Romano Spica
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy - WDPP, Working Group Doping Prevention Project
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Abstract
Abstract
Aim
Due to the improving of life conditions, life expectancy is steadily increasing, especially in developed countries. In this perspective, Governments have to face important challenges as guaranteeing the welfare state, providing pensions and long-term healthcare for an increasing number of people. To maintain the sustainability of the pension system, many developed countries are rising the proportion of elderly persons in paid employment by both extending working life through a higher official retirement age and preventing premature exit from paid employment. However, postponing the exit from work exposes workers to potential stressors for a longer period. Stress is one of the risk factors for depression, that represent one of the leading causes of burden of disease. Our aim is to retrieve evidence in order to understand the association between retirement and risk of depression.
Methods
This is a systematic literature review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In January 2020, the following databases PubMed/Medline, Embase, Psycoinfo, and Cochrane were used to perform the search, using a combination of three components of keywords: depression, aging and retirement.
Results
A total of 2,203 studies were retrieved of which 782 were excluded because duplicates. Screening of 1,421 retrieved studies is in progress and data will be showed in tables and summarized in narrative form. Results are preliminary.
Conclusions
The present research intends to bridge the lack of knowledge on the association between retirement and depression, to tackle these methodological limitations of the evidence, and to contribute to the advancement of scientific knowledge on the link between work life extension and mental health. Poor mental health is a major source of disability. Improving mental health of workers remains a critical goal if future populations need to reach older age in good health and continue to work.
Key messages
Work life has been extended but low information are available regarding its impact on depression. Depression is a leading cause of burden of disease and studies aimed to reduce its incidence are extremely needed.
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Affiliation(s)
- V Gianfredi
- School of Public Health, Vita-Salute San Raffaele University Milan, Milan, Italy
| | - A Patti
- School of Public Health, Vita-Salute San Raffaele University Milan, Milan, Italy
| | - A Amerio
- Section of Psychiatry, University of Genoa, Genoa, Italy
| | - B Fracella
- School of Public Health, Vita-Salute San Raffaele University Milan, Milan, Italy
| | - G Gaetti
- School of Public Health, Vita-Salute San Raffaele University Milan, Milan, Italy
| | - G P Vigezzi
- School of Public Health, Vita-Salute San Raffaele University Milan, Milan, Italy
| | - A Odone
- School of Public Health, Vita-Salute San Raffaele University Milan, Milan, Italy
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Restivo V, Gaeta M, Odone A, Trucchi C, Battaglini A, Carli A, Capraro M, Minutolo G, Casuccio A, Favaretti C. The effectiveness of leadership: meta-analysis of trial, cross-sectional, and before after studies. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The clinical and surgical procedures are often based on scientifical evidence but 30-40% of patients do not receive treatment according to evidence based medicine. The main aim of this review and meta-analysis is to assess the effectiveness of leadership in healthcare setting.
Methods
It was conducted a literature research on MEDLINE, Pubmed and Scopus with publication year between 2015 and 2019. The inclusion criteria were studies involving healthcare workers that evaluated effectiveness of opinion leaders in improving behaviour of healthcare workers, according to clinical or patient related outcomes. The quality of studies were assesed with the NHLBI for before after studies and the NOS for other study designs. The effect of leadership was assessed as risk difference for all studies with the exception of cross sectional studies. For the last it was evaluated correlation between leadership level and outcome measurment.
Results
A total of 3,155 articles were screened and 284 were fully assessed including 22 of them in the final database: 1 randomized trial, 9 cross sectional and 12 before after studies. For the cross-sectional studies there was a correlation of 0.22 (95% CI 0.15-0.28) between leadership level and outcome measurment. In the metaregression analysis the only factor that increased the correlation was private setting (meta regression coefficent =0.52, p = 0.022). The pooled efficacy was 24% (95% CI 10%-17%) for before after studies. Furthermore, a higher effectiveness was revealed in studies conducted on multi professional (24%) than single professional (9%) healthcare workers.
Conclusions
According to results, the guidelines adherence and task performance increased in a setting with leadership implementation. The leadership effectiveness appears comparable to other strategies as audit and feedback used to implement evidence-based practice in worldwide healthcare.
Key messages
The translation of evidence into clinical practice is often difficult but this study suggests that leaderhip can had higher effectiveness in multiprofessional healthcare workers and private setting. The effectiveness of leadership in this review suggests that it can be of help in order to make aware healthcare professionals about effectiveness of comply with evidence-based practice.
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Affiliation(s)
- V Restivo
- Department PROMISE, University of Palermo, Palermo, Italy
| | - M Gaeta
- Department of Public Health, Experimental and Forensic Medic, University of Pavia, Pavia, Italy
| | - A Odone
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - C Trucchi
- Department of Health Sciences, University of Genoa and IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Battaglini
- Department of Health Sciences, University of Genoa and IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Carli
- Department of Medical Direction, Maggiore della Carità University Hospital of Novara, Novara, Italy
| | - M Capraro
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - G Minutolo
- Department PROMISE, University of Palermo, Palermo, Italy
| | - A Casuccio
- Department PROMISE, University of Palermo, Palermo, Italy
| | - C Favaretti
- Centre for Leadership in Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Sechi GM, Migliori M, Dassi G, Pagliosa A, Bonora R, Oradini-Alacreu A, Odone A, Signorelli C, Zoli A. Management of Emergency Services in Lombardy during COVID-19 epidemic using Business Intelligence. Eur J Public Health 2020. [PMCID: PMC7543410 DOI: 10.1093/eurpub/ckaa165.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In Italy on the 20th of February, the first Italian patient was tested positive for Coronavirus Disease 2019 (COVID-19) in the Lombardy region. The Regional Emergency Medical Services (EMS) Trust (Azienda Regionale Emergenza Urgenza, AREU) of the Lombardy region decided to apply a Business Intelligence (BI) System to take timely decisions on the management of EMS and to monitor the spread of the disease in the region in order to better respond to the outbreak. Methods Since the beginning of the COVID-19 outbreak, AREU developed a BI System to track the daily number of first aid requests received from 1.1.2. (Public Safety Answering Point 1). BI evaluates the number of requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview. Moreover, BI analyses the pattern of the epidemic, identifying the numerical trend of episodes in each municipality (increasing, stable, decreasing). Currently, AREU is still implementing the BI as the epidemic is still ongoing. Results In the Lombardy region on the 20th of February the number of the first aid requests for respiratory and/or infectious episodes were 314. This figure increased sharply during the month of February and March reaching its peak on the 16th of March with 1537 episodes. In the area around Bergamo, this number experienced a greater rise compared to the rest of the Lombardy territory, going from 74 episodes on the 20th of February to 694 on the 13th of March. Therefore, AREU decided to reallocate in the territory the resources (ambulances and human resources) based on the real-time data elaborated by the BI system. Conclusions The BI System has been of paramount importance in taking timely decisions on the management of EMS during the COVID-19 outbreak in the Lombardy region. Indeed, BI can be usefully applied to promptly identify the trend of the COVID-19 epidemic and, consequently, make informed decisions to improve the response to the outbreak. Key messages The Emergency Medical Services Trust of the Lombardy region applied a Business Intelligence System to promptly respond to the outbreak of COVID-19 and reallocate the resources based on real-time data. AREU used a Business Intelligence System to track the daily number of first aid requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview.
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Affiliation(s)
- G M Sechi
- Azienda Regionale Emergenza Urgenza, Regione Lombardia, Milan, Italy
| | - M Migliori
- Azienda Regionale Emergenza Urgenza, Regione Lombardia, Milan, Italy
| | - G Dassi
- Azienda Regionale Emergenza Urgenza, Regione Lombardia, Milan, Italy
| | - A Pagliosa
- Azienda Regionale Emergenza Urgenza, Regione Lombardia, Milan, Italy
| | - R Bonora
- Azienda Regionale Emergenza Urgenza, Regione Lombardia, Milan, Italy
| | - A Oradini-Alacreu
- School of Public Health, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - A Odone
- School of Public Health, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - C Signorelli
- School of Public Health, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - A Zoli
- Azienda Regionale Emergenza Urgenza, Regione Lombardia, Milan, Italy
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Odone A, Gianfredi V, Frascella B, Balzarini F, Oradini Alacreu A, Signorelli C. Digitalization of immunization programmes in Europe: results from the EUVIS project. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The second and final phase of the EUVIS (EUrope Vaccines ICT Strategies) project, coordinated by the School of Public Health of the University Vita-Salute San Raffaele in Milan (Italy), aims at collecting best practices on the use and impact of Information and Communication Technologies (ICT) and digital tools to increase vaccine uptake and ultimately vaccination coverage in Europe. The field of ICT has flourished in recent years revolutionizing the processes of gathering, spreading and utilizing health information among healthcare providers, citizens and mass media. In particular, we are interested in any digital technology that can improve vaccine uptake supporting actions aimed at both increasing the demand of vaccines (i.e provide access to information through telecommunications, networks, the Internet, wireless, mobile devices), and the supply of effective and efficient life-course immunization services (i.e ICT-based interventions to support immunization programmes delivery and their monitoring). Within EUVIS we have previously conducted a series of systematic reviews to pool available evidence from experimental studies on the impact of selected ICT-based intervention (i.e. e-mail reminders, personal health records, among others) to improve vaccine uptake and other associated outcomes. In the current study, second and final phase of the EUVIS project, we are conducting a survey at the European level to gather original data on the use and impact of ICT and digital tools within immunization programmes in selected countries. The survey tool was developed on the basis of findings from EUVIS phase one and experts' consultation; it consisted on a 55-item questionnaire, distributed to public health professionals working in health agencies, institutions and the academia to build “ICT and immunization” countries' profile, as well as to gather, pool and critically appraise data on perceived potential and challenges of immunization programmes' digitalization in Europe.
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Affiliation(s)
- A Odone
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - V Gianfredi
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - B Frascella
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - F Balzarini
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - A Oradini Alacreu
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - C Signorelli
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
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Moro M, Vigezzi GP, Callari E, Biancardi A, Nizzero P, Cichero P, Signorelli C, Odone A. Multidrug-resistant organism infections and mortality: estimates from a large Italian hospital. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Multidrug-resistant organisms (MDRO) are one of the most critical public health concerns, particularly in hospital settings. Nearly 8% of hospitalized patients develop healthcare-associated infections (HAI), 20% of which is caused by MDRO.
Aim of the study was to estimate nosocomial infection-associated in-hospital mortality, by different MDRO, in a large Italian teaching hospital.
Methods
We conducted a retrospective cohort study on patients hospitalized at San Raffaele Hospital, Milan, from 2016 to 2018. Two existing datasets were merged: hospital discharge records and MDRO surveillance data. Exposure was defined as any HAI caused by MDRO, and main outcome variable was in-hospital mortality from all causes.
Results
A total of 78,795 patients were studied (mean age 59.3 y, age range 18-105 y). 1,345 patients with at least one MDRO had mean age of 68 y, mean length of stay (LOS) of 32.8 days and mean DRG weight of 3.8. 77,450 patients without MDRO isolation had mean age of 59 y, mean LOS of 7.2 days and mean DRG weight of 1.6. Risk of in-hospital mortality is 3.4 times higher in patients with at least one MDRO isolation (OR 3.4; 95% CI 2.8-4.2). Enterococci (OR 2.6; 95% CI 1.1-6.3), A. baumannii (OR 3.5; 95% CI 1.4-8.6), P. aeruginosa (OR 1.8; 95% CI 0.8-4.2), MRSA (OR 3.4; 95% CI 2.1-5.4), ESBL-producing (OR 1.9; 95% CI 1.4-2.7) and carbapenem-resistant bacteria (OR 3.8; 95% CI 2.5-5.7), and carbapenem-resistant K. pneumoniae (OR 5.5; 95% CI 3.2-9.2) isolations were risk factors for nosocomial mortality.
Conclusions
Patients with MDRO isolations were older, more complex and had 5 times longer LOS than ones without MDRO. Deceased patients were 18% among MDRO cohort against only 2% among others.
Bacteria included in WHO list of priority pathogens with antibiotic resistance were associated with a significantly higher risk of death. These results prove the urgency of controlling MDROs' spread that threatens global public health and available treatments of infections.
Key messages
Nosocomial MDRO isolation is a significant risk factor for in-hospital mortality from all causes. Infection prevention and control measures, and antibiotic stewardship are key strategies in order to prevent MDRO transmission and HAI, AR spreading and their burden of related deaths.
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Affiliation(s)
- M Moro
- Infection Control Committee, IRCCS San Raffaele Hospital, Milan, Italy
| | - G P Vigezzi
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - E Callari
- School of Economics and Statistics, Milano-Bicocca University, Milan, Italy
| | - A Biancardi
- Infection Control Committee, IRCCS San Raffaele Hospital, Milan, Italy
| | - P Nizzero
- Infection Control Committee, IRCCS San Raffaele Hospital, Milan, Italy
| | - P Cichero
- Microbiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - C Signorelli
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - A Odone
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
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Odone A, Mazzuconi R, Ambrosio A, Bottinelli E. Health Technology Assessment (HTA) in a leading Research Hospital: principles and practice. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
IRCCS San Raffaele Hospital HTA Committee
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Affiliation(s)
- A Odone
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Hospital, Milan, Italy
| | | | - A Ambrosio
- IRCCS San Raffaele Hospital, Milan, Italy
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Salvati S, Croci R, Odone A, Signorelli C. HIV incidence fall in Italy: a –20% fall in 2018 to be explained. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
HIV is still a critical public health threat in Europe, especially in some at-risk populations. Stigma keeps undermining access to prevention, diagnosis, and care. Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP) have spread heterogeneously across the continent. The study aimed to compare recent HIV incidence trends in five European countries (Italy, Spain, Germany, France, UK), and to speculate about TasP and PrEP's relative contribution as preventive measures in Italy.
Methods
We collected incidence data by consulting the ECDC HIV/AIDS Surveillance Report 2019, and a preliminary Italian 2019 report issued by the National Institute of Health. We used the latest ECDC Continuum of HIV care data to appraise European trends in HIV viral suppression.
Results
All the considered European countries reported a decreasing trend in 2018, compared to 2017. In Italy, according to raw preliminary data, the number of new HIV infections dropped from 3,561 (5.9/100,000) to 2,847 (4.7/100,000), thus resulting in a -20% fall. Interestingly, Spain shows an even sharper decrease of -22%, dropping from 3,795 new cases in 2017 to 2,527 in 2018, that is from a rate of 8.2/100,000 to 6.4/100,000.
Conclusions
Since 2008, when the coordinated ECDC/WHO Regional Office for Europe HIV/AIDS surveillance system was set up, Italy has never witnessed such a sharp yearly fall in incident cases, thus representing, together with Spain, an epidemiological peculiarity in the European context. TasP could have played a major role in Italy. Indeed, Continuum of HIV care data show a positive trend in viral suppression in European countries. PrEP has been introduced in the Italian guidelines in 2016 and is nowadays adopted in a few urban areas, as a co-pay, on-demand service for high-risk populations with limited diffusion. It is thus plausible that PrEP carries a much lower epidemiologic weight in the Italian 2018 incidence reduction.
Key messages
We need to spread PrEP, TasP and screening programs, especially in at-risk populations. We must search for a causal association between preventive measures and decreasing incidence.
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Affiliation(s)
- S Salvati
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - R Croci
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - A Odone
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - C Signorelli
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
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Stirparo G, Bini M, Odone A, Signorelli C. Lifestyle change predictors in the general population. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Even thought lifestyle changes have a main role in cardiovascular disease prevention, people show a weak adherence to medical advices. Aim of our study was to identify anamnestic predictors of poor compliance for lifestyle changes in a general population.
Methods
We submitted a 26 questions questionnaire to 301 general population subjects, investigating multiple anamnestic characteristics. Afterwards, we proceeded to explain people the main line of the European society of Cardiology guidelines on Cardiovascular prevention. Finally, we asked the subjects if this prevention campaign was able to modify their lifestyle.
Results
Sixty-four percent of interviewed were prone to change their lifestyle. Females answered positively more than males (73% vs 59%, p = 0.011). In terms of cardiovascular risk factors only the presence of dyslipidemia was significantly associated with a will of change (84% vs 58%, p = 0.000). Age (49 (18) vs 46 (20) ), familiar history of cardiovascular disease (69% vs 63%,p=0.320) and the presence of a previous cardiovascular event (68% vs 66%,p=0.841), do not predict the adherence to lifestyle change.
Key messages
Cardiovascular disease dose not influence people’s decision in life style change. Male gender represents an anamnestic characteristics that predict a poor adherence to lifestyle changes while people affected by dyslipidemia more frequently are prone to modify their routine.
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Affiliation(s)
- G Stirparo
- Public Health Department, Università Vita e Salute San Raffaele, Milan, Italy
| | - M Bini
- Cardiology Department, Università di Parma, Parma, Italy
| | - A Odone
- Public Health Department, Università Vita e Salute San Raffaele, Milan, Italy
| | - C Signorelli
- Public Health Department, Università Vita e Salute San Raffaele, Milan, Italy
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Cocciolo G, Salvati S, Allora A, Molinari C, Burini A, Scavini M, Odone A. Influenza vaccination coverage in patients with diabetes mellitus afferent to an Italian hospital. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with type 1 (T1DM) and type 2 (T2DM) diabetes are at increased risk of vaccine-preventable diseases and their complications. The National Vaccinal Prevention Plan 2017-2019 includes specific recommendations for patients with diabetes, which in 2018 have been included in the standards of care of the Italian Diabetes Society (SID) and Italian Association of Clinical Diabetologists (AMD).
Methods
Adult diabetic patients attending the Diabetes clinic at the San Raffaele Hospital, a large teaching hospital in Milan, Italy, were surveyed with a questionnaire to investigate self-reported vaccinal history, knowledge, attitudes and practice on the recommended vaccinations, vaccinal hesitancy and information sources on the topic.
Results
Between May 16 and November 11, 2019 N = 222 T1DM and N = 57 T2DM patients were enrolled. 25.2% of T1DM and 26.3% of T2DM patients did get vaccinated annually against the flu in the past 3 year. 85.0% of T2DM patients were vaccinated at the General Practitioner's (GP) clinic, while 54.9% of T1DM patients were vaccinated by their GP and 24.4% from territorial vaccinal clinics. 54.5% of T1DM and 50.0% of T2DM patients chose not to be vaccinated because they didn't consider the vaccine useful, while the second most common reason was that they have not been advised by healthcare personnel.
Conclusions
We documented a low coverage and knowledge about influenza vaccination. Patients with diabetes trusted information and advice of diabetologists and GPs about vaccination and claimed that they would be more likely to vaccinate if vaccination were offered in the diabetes clinic. Implementing training programs for professionals and educational campaigns for patients with diabetes may improve vaccinal coverage.
Key messages
Vaccination coverage in T1DM and T2DM patients is low due to vaccination hesitancy. A strong action from care givers, in order to raise vaccination awareness in this at-risk population, is needed.
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Affiliation(s)
- G Cocciolo
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - S Salvati
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - A Allora
- School of Endocrinology and Metabolic Diseases, University Vita-Salute San Raffaele, Milan, Italy
| | - C Molinari
- Endocrinology, Diabetes and Metabolism Department, University Vita-Salute San Raffaele, Milan, Italy
| | - A Burini
- Diabetes Research Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - M Scavini
- Diabetes Research Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - A Odone
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
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Gianfredi V, Schaper NC, Eussen SJPM, Odone A, Signorelli C, Dukers N, Koster A, Stehouwer CDA, Wasselius A, Schram MT. Social network characteristics are associated with depressive symptoms: The Maastricht Study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies suggested that social network characteristics are associated with depression. However, most of the previous studies investigated social network characteristics in isolation. We assessed the association of both structural and functional social network characteristics with prevalent and incident depressive symptoms over 5 years of follow-up.
Methods
We used data from 2,465 participants (49.1% women, mean age 59.8± 8.1 years) of The Maastricht Study, a population-based prospective cohort study. Social network characteristics were assessed through a name generator questionnaire. Depressive symptoms (9-item Patient Health Questionnaire score ≥10) were assessed at baseline and annually over 5 years. We used multivariate logistic regression and Cox regression analyses adjusted for socio-demographic characteristics, lifestyle and cardiovascular risk factors.
Results
Less emotional (odds ratio (OR) (95% confidence interval (CI)):1.19; 1.01-1.40) and informational support (OR (95%CI): 1.20 (1.04-1.39), and every fewer 10% of family members (OR(95%CI) 1.11 (1.01-1.23) were associated with prevalent clinically relevant depressive symptoms. Less emotional support (hazard ratio: 1.13; 95%CI: 1.03-1.25) was associated with incident clinically relevant depressive symptoms.
Conclusions
This study observed associations between poor social network characteristics with higher odds of depressive symptoms. In particular, less emotional support was associated with both prevalent and incident depressive symptoms.
Key messages
Poor social network characteristics were associated prevalent depressive symptoms. Less social support was associated with a higher risk of depressive symptoms.
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Affiliation(s)
- V Gianfredi
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, Netherlands
- CAPRHI Care and Public Health Research Institute, University of Maastricht, Maastricht, Netherlands
- Public Health post graduate school, University Vita-Salute San Raffaele, Milan, Italy
| | - N C Schaper
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, Netherlands
- Department of Internal Medicine, University of Maastricht, Maastricht, Netherlands
| | - S J P M Eussen
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, Netherlands
- Department of Epidemiology, University of Maastricht, Maastricht, Netherlands
| | - A Odone
- Public Health post graduate school, University Vita-Salute San Raffaele, Milan, Italy
| | - C Signorelli
- Public Health post graduate school, University Vita-Salute San Raffaele, Milan, Italy
| | - N Dukers
- CAPRHI Care and Public Health Research Institute, University of Maastricht, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Me, University of Maastricht, Maastricht, Netherlands
| | - A Koster
- CAPRHI Care and Public Health Research Institute, University of Maastricht, Maastricht, Netherlands
- Department of Social Medicine, University of Maastricht, Maastricht, Netherlands
| | - C D A Stehouwer
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, Netherlands
- Department of Internal Medicine, University of Maastricht, Maastricht, Netherlands
| | - A Wasselius
- NUTRIM School for Nutrition and Translational Research in Me, University of Maastricht, Maastricht, Netherlands
| | - M T Schram
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, Netherlands
- Department of Internal Medicine, University of Maastricht, Maastricht, Netherlands
- School of Mental Health and Neuroscience, University of Maastricht, Maastricht, Netherlands
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Balzarini F, Oradini Alacreu A, Frascella B, Gaetti G, Signorelli C, Odone A. Effectiveness of PEHRs use to increase vaccine uptake: a systematic review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The digital transformation provides tools to empower individuals and enable feedback and interaction between users and healthcare providers. Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on their impact is scant.
Methods
We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention, ii) PEHR access vs access with additional features.
Results
Of identified 3125 citations, 8 studies were included, the majority published in the US before 2015. Four studies assessed differences between subjects with and without access to PEHR. Access to PEHR was reported to be an effective tool to increase vaccine uptake: when accessing PEHR, study participants were 6.7% more likely to receive influenza vaccine, parents to have children vaccinated, lifetime pneumococcal vaccination was reported to be higher in diabetic patients, a positive impact on preventive behaviors was reported. Four included studies reported on the effect of access to PEHR with or without additional communication features. In one study, the effect of electronic messages delivered through PEHRs wasn't differentially distributed in the arm receiving tailored messages on influenza, and in the arm receiving educational messages on other diseases. In other studies, active PEHR users were more likely to be vaccinated against influenza and Herpes Zoster, subjects who in addition received reminders had higher rates of influenza vaccination.
Conclusions
While immunization programs are struggling to achieve optimal coverage targets, our findings can partially outline the association between PEHR access and vaccine uptake and further experimental research is needed.
Key messages
PEHRs offer great potential to support population health and in particular immunization programs, helping to put people and patients at the center of care delivery, supporting patient empowerment. Although our findings suggest immunization coverage might benefit from people accessing PEHR, there is an urgent need to produce solid experimental evidence to quantify such effect.
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Affiliation(s)
- F Balzarini
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - A Oradini Alacreu
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - B Frascella
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - G Gaetti
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - C Signorelli
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - A Odone
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
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Oradini-Alacreu A, Rebecchi A, Mezzoiuso AG, Croci R, Buffoli M, Odone A, Signorelli C, Capolongo S. Measuring health outcomes of OECD countries’ urban greenspace, with a special focus on Milan (Italy). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Urban world population has raised to 4.2 billion in 2018, with 2.5 billion more forecasted by 2050. Cities are places of opportunities but, at the same time, sites of environmental and social risk factors. Scientific evidence about urban green's environmental benefits is abundant, but Public Health outcomes are seldom carefully defined. The project aims at assessing the Public, Urban and Mental Health outcomes of urban green areas in Organisation for Economic Co-operation and Development (OECD) countries, and at exploring citizen urban greenspace perception in Milan, Italy.
Methods
A systematic review of literature was conducted according to the 2015 PRISMA statement. Two online databases (Medline and Embase), were consulted, and inclusion criteria were set, ruling in all OECD countries-based, English-written studies from 2000 to December 2019. Only objectively measurable health outcomes were deemed suitable for analysis. Based on the main review findings, a community-based survey was created, targeting residents of Milan and its suburban area to understand better how they benefit from the urban green areas in their city. The study is being carried out by an interdisciplinary team of medical doctors and architects.
Results
We grouped health outcomes into five separate domains, namely cardiovascular, obesity, respiratory, neoplasia and mental health. We found negative associations between disease prevalence and urban greenspace overall quantity. Size, perceived quality and accessibility were powerfully explanatory variables. Milan community-based survey drafting is underway. Results are still preliminary and will be presented by tables, graphs and plots.
Conclusions
Cities are increasingly becoming critical points for many emerging Public Health challenges. The results of our study may help urban planners, key stakeholders, policymakers and communities to preserve and increase existing green spaces, and to improve Urban Public Health.
Key messages
Urban greenspace is paramount to OECD cities’ current and future sustainability because of its significant impact on Public, Urban and Mental Health. Milan citizens show remarkable care for urban greenspaces integrity and development.
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Affiliation(s)
| | - A Rebecchi
- ABC, Politecnico di Milano, Milan, Italy
| | - A G Mezzoiuso
- School of Public Health, Università Vita - Salute, Milan, Italy
| | - R Croci
- School of Public Health, Università Vita - Salute, Milan, Italy
| | - M Buffoli
- ABC, Politecnico di Milano, Milan, Italy
| | - A Odone
- School of Public Health, Università Vita - Salute, Milan, Italy
| | - C Signorelli
- School of Public Health, Università Vita - Salute, Milan, Italy
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Scardoni A, Sancini S, Ambrosio A, Signorelli C, Odone A. Managing transition to ValueēBased hospital care pathways. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
San Raffaele Hospital (OSR) is part of a European alliance of 9 University Hospitals (EUHA) which promotes comparison and excellence in the clinical, research and training strategies.
Description of the Problem
The development of Value-Based (VB) strategies has been active in OSR since March 2019, with multidisciplinary healthcare pathways and with the promotion of patient engagement.
Results
The prostate cancer pathway was identified as a pilot and replicable model to promote the VB culture in different areas, in particular in the field of digitalization, human resources, research, redesigning of paths and outcomes collection. The other clinical pathways progressively launched during 2019 were: breast cancer, stroke, heart failure and pancreatic cancer.
The project was realized by: • setting up a Multidisciplinary disease teams; developing a training course on VB, involving all the healthcare professionals (clinicians and managers);involving patient associations in the development of the pathway;adopting sets of clinical outcomes, Patient-Related Outcome Measures (PROMs) and Patient-Related Experience Measures (PREMs) with a specific collection platform, currently under implementation;identifying new IT support tools, activated from March to December 2019 in 11 Disease Units: HealthMeeting, a platform supporting document and data sharing, connecting different Specialists and performing advanced digital multidisciplinary meetings; DNM-Digital Narrative Medicine, a platform connecting patients with their clinical team, supporting web-based storytelling and personalized therapeutic approach.
Lessons
The introduction of a new shared and patient-centred work model, with the reorganization of spaces, resources and dedicated IT tools, has improved the diagnostic-therapeutic process.
Key messages
The main challenge of hospital transition to VB pathways is organizational and cultural. For VB implementation is needed sustainable use of available resources and IT, to achieve better outcomes.
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Affiliation(s)
- A Scardoni
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - S Sancini
- Chief Medical Officer, Humanitas Mater Domini Hospital, Castellanza, Italy
| | - A Ambrosio
- Chief Medical Officer, San Raffaele Hospital, Milan, Italy
| | - C Signorelli
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - A Odone
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
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