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Sartorello A, Paiola E, Moretti F, Accordini L, Postiglione C, Tardivo S, Benoni R. Inequality in access to COVID-19 vaccines: an annual experience in Verona (Italy). Eur J Public Health 2022. [PMCID: PMC9594382 DOI: 10.1093/eurpub/ckac131.115] [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
COVID-19 vaccination campaigns involved massive resources worldwide. However, the disparity in vaccine accessibility is a global issue. The study evaluated whether birthplace is a barrier to healthcare access in a high-income country (HIC). The retrospective cohort study included fully vaccinated adults in the Verona district between 27/12/2020 and 31/12/2021. In Italy, the vaccination was opened at different times according to the risk category. Two multiple linear regression models explored the relationship between (1) days before getting the first shot (IV) and (2) the distance between the municipality of residence and the vaccination point, and age, sex, and Income Group (IG, as defined by the World Bank). Distance (km) was estimated with Q-GIS. Results are reported as Marginal Effect at the Mean (MEM) with a confidence interval of 0.95. 500,001 first doses were included, with a mean age of 47 years (SD = 21) and a mean IV of 47.5 days. 6% of the sample was UpperMiddle (UMIC), 6% Lower-Middle (LMIC), and 0.3% Low-Income Countries (LIC). The mean age was higher for HIC (p < 0.05). Male outnumbered females in LMIC (61%) and LIC (69%), but not in HIC and UMIC (p < 0.001). LMIC and LIC were vaccinated at local facilities (5.8%) and pharmacies (4.2%) more than other groups (3%) and at hub centers less (p < 0.05). The IV was lower for subjects from HIC (p < 0.05) with a MEM of 24 [22; 26] for LIC, 21 [21; 22] for LMIC and 27 [26; 27] for UMIC. Men from UMIC (9 [4; 14]), LMIC (7 [6; 8]) and LIC (4 [3; 5]) had a higher IV than women. All variables being equal, IV decreased with age (MEM -0.48 [-0.49; -0.47]). Distance was shorter for LMIC and LIC than for HIC (p < 0.05). The MEM on the distance of the Income group was -2.8 [-3.5; -2.2] for LIC and -2.0 [-2.1; -1.8] for LMIC (p < 0.05). The Income Group of one’s birth country is a barrier to vaccine accessibility in Italy, a HIC. Hence, we address public health workers to improve access to vaccination in community settings to narrow this gap. Key messages • Birthplace Income Group could be linked to vaccine accessibility in High Income Countries. • Public Health stakeholders should consider community and social barriers to healthcare access when planning health interventions.
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Affiliation(s)
- A Sartorello
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - E Paiola
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - F Moretti
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - L Accordini
- Prevention Department and Public Health , AULSS 9 Scaligera, Verona, Italy
| | - C Postiglione
- Prevention Department and Public Health , AULSS 9 Scaligera, Verona, Italy
| | - S Tardivo
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - R Benoni
- Department of Diagnostics and Public Health, University of Verona , Verona, Italy
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Tocco-Tussardi I, Fila A, Tralli V, Bordin P, Gazzani D, Majori S, Postiglione C, Tardivo S, Moretti F. Screening for hepatitis B virus infection among refugees diagnosed with latent tuberculosis in an Italian community. Ann Ig 2021; 33:602-614. [PMID: 34213522 DOI: 10.7416/ai.2021.2452] [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
Background Refugees are a growing population in the EU-27 area with specific health needs that are to be addressed in the most rapid and effective way at their arrival in the host country. Screening for Hepatitis B Virus infection is offered to specific categories and it could be useful and effective to extend its indications. The aim of this study was to define the epidemiological profile regarding Hepatitis B Virus infection in re-fugees hosted in the Asylum Seekers Centers of Verona (Italy), diagnosed with latent tuberculosis infection and eligible for chemoprophylaxis. Methods We conducted a retrospective study in 715 refugees diagnosed with latent tuberculosis infection from January 1st, 2015 to December 31st, 2017. Screening for Hepatitis B Virus infection was offered to la-tent tuberculosis infection patients who were due to commence treatment. Subjects were tested for Hepatitis B surface Antigen and Hepatitis B core antigen total antibodies. None of the screened patients reported previous vaccination for hepatitis B. Results Among the 715 refugees diagnosed with latent tuberculosis infection, 593 were eligible for treatment for latent tuberculosis infection. Of these, 211 (35.6%) accepted to be screened for Hepatitis B Virus infection. One hundred and ninety-five of the 211 (92.4%) came from African countries, and 16 (7.6%) from Asia; the majority (80.9%) were males. Median age was 23 years (95% CI 22-24). Of the 211, 58 individuals (27.5%) were Hepatitis B surface Antigen and Hepatitis B core antigen total antibodies positive; 74 (35.1%) were Hepatitis B surface Antigen negative and Hepatitis B core antigen total antibodies positive; and 79 (37.4%) were Hepatitis B surface Antigen and Hepatitis B core antigen total antibodies negative. Male gender and African origin were associated with a lower probability of being Hepatitis B surface Antigen- and Hepatitis B core antigen total antibodies-negative. Conclusions Screening for Hepatitis B Virus is of paramount importance not only for the control and prevention of infection, but also in terms of long-term healthcare issues. Making screening more systematic can have an important impact on public health, while always considering cost-effectiveness and promotion of awareness among ethnic groups in order to gain their compliance to treatment/vaccination.
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Affiliation(s)
- I Tocco-Tussardi
- Department of Diagnostics and Public Health, University of Verona and Integrated University Hospital of Verona, Verona, Italy
| | - A Fila
- Department of Diagnostics and Public Health, University of Verona and Integrated University Hospital of Verona, Verona, Italy
| | - V Tralli
- Department of Diagnostics and Public Health, University of Verona and Integrated University Hospital of Verona, Verona, Italy
| | - P Bordin
- Department of Diagnostics and Public Health, University of Verona and Integrated University Hospital of Verona, Verona, Italy
| | - D Gazzani
- Service of Hygiene and Public Health, Territorial Department of Prevention of Verona, Verona, Italy
| | - S Majori
- Department of Diagnostics and Public Health, University of Verona and Integrated University Hospital of Verona, Verona, Italy
| | - C Postiglione
- Service of Hygiene and Public Health, Territorial Department of Prevention of Verona, Verona, Italy
| | - S Tardivo
- Department of Diagnostics and Public Health, University of Verona and Integrated University Hospital of Verona, Verona, Italy
| | - F Moretti
- Department of Diagnostics and Public Health, University of Verona and Integrated University Hospital of Verona, Verona, Italy
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Tralli V, Bertoni C, Colucci L, Postiglione C, Valsecchi M, Tocco-Tussardi I, Tardivo S, Majori S, Moretti F. Active TB screening among homeless people attending soup kitchens in Verona (Italy). Ann Ig 2021; 33:332-336. [PMID: 33565570 DOI: 10.7416/ai.2021.2416] [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
Background The hard-to-reach populations, including the homeless, are particularly vulnerable to the development of active tuberculosis. According to the World Health Organization, tuberculosis rates among the homeless in industrialized Countries are up to 20 times higher if compared with the general popula-tion, representing a relevant public health problem. The aim of our study was to describe the results of an active tuberculosis screening applied in order to find out suspected active TB cases among the homeless in Verona. Methods As part of a partnership between the non-profit association Medici per la Pace and one of the Local Health Units of Veneto Region (ULSS 9 Scaligera) in 2018, a tuberculosis screening, based on thoracic radiographs, was offered to the homeless guests of two Verona's soup kitchens. Results The studied population included 139 people, and three cases of suspected active tuberculosis, all in males, were observed. Among these, two received a diagnostic confirmation of active tuberculosis (a prevalence of 1.44% - CI: 0,17 - 5,1). Moreover, radiographic patterns of tuberculosis aftermaths were found in six additional subjects. Conclusions Interventions specifically dedicated to hard-to-reach populations, can be useful in identifying tuberculosis active cases and controlling the disease in low tuberculosis burden countries. In particular, the active research of subjects, the screening carried out with mobile X-ray, and also the constant caring of the patients with active disease, could be the right method to keep under control this relevant public health problem.
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Affiliation(s)
- V Tralli
- Postgraduate Specialization in "Hygiene and Preventive Medicine". University of Verona, Italy
| | - C Bertoni
- Postgraduate Specialization in "Hygiene and Preventive Medicine". University of Verona, Italy
| | - L Colucci
- Prevention Department, Hygiene and Public Health Service, AULSS 9 Scaligera, Verona, Italy
| | - C Postiglione
- Prevention Department, Hygiene and Public Health Service, AULSS 9 Scaligera, Verona, Italy
| | - M Valsecchi
- Onlus "Medici per la Pace" Volunteer Doctor, Verona, Italy
| | - I Tocco-Tussardi
- Postgraduate Specialization in "Hygiene and Preventive Medicine". University of Verona, Italy
| | - S Tardivo
- Department of Public Health and Community Medicine & Hygiene and Environmental Occupational Preventive Medicine Division, University of Verona, Italy
| | - S Majori
- Department of Public Health and Community Medicine & Hygiene and Environmental Occupational Preventive Medicine Division, University of Verona, Italy
| | - F Moretti
- Department of Public Health and Community Medicine & Hygiene and Environmental Occupational Preventive Medicine Division, University of Verona, Italy
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Piloni V, Pieri L, Pomerri F, Pittarello F, Salvetti M, Leo E, Brusori S, Bassi F, Rottoli ML, Pucciani F, Lazzini S, Minotto R, Postiglione C, Sacco P, Bernini A, Menchinelli S, Pescatori M, Marmorale C, Frascio M, Pitto G, Grassi R, Genovesi N, Basile M, Anselmetti G, Amadio L. [The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)]. Radiol Med 1996; 91:66-72. [PMID: 8614735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).
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Lazzini S, Minotto R, Postiglione C, Pozzi A, Fardin E, Sessa V, Paolucci M, Sarvello D. [Diseases detected with defecographic examination in 300 patients]. Radiol Med 1991; 82:465-9. [PMID: 1767054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Defecography is a radiological examination providing morphological details of the anorectal tract. Over almost 3 years, 300 patients were examined. The authors report on the method and the pathologic conditions they observed. The patients were seated in latero-lateral position on a radiolucent water-filled commode: lead marks were taped to define perianal skin. 150 ml of high-density barium paste were introduced into the rectum and radiographs were then acquired, at rest and during squeezing and straining. All examination phases, especially the study of dynamic evacuation, were recorded on a videotape connected to a brilliance intensifier. From their experience, the authors conclude that defecography is a valuable tool in the diagnosis and evaluation of: rectocele, occult rectal prolapse, and elevator ani tone. The technique proved less useful in the evaluation of fecal incontinence. The authors strongly suggest that the patient be previously examined by a coloproctologist. Defecography is thought to help the surgeon in the choice of therapy, together with other diagnostic procedures and with clinical history.
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Affiliation(s)
- S Lazzini
- Servizio di Radiologia, Ospedale, F. Del Ponte, Varese
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Gorreta L, Sessa V, Minonzio G, Postiglione C, Tragni C, Vanoli C, Lazzini S, Cattaneo R. [A tubo-ovarian abscess of large size]. Radiol Med 1990; 79:249-51. [PMID: 2336483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- L Gorreta
- Servizio di Radiologia, Ospedale Multizonale, Varese
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Bernasconi S, Postiglione C, Gatta L, Paganini E, Dozio F, Battaglia A. [Leiomyosarcoma of the ileum. Presentation of a clinical case (author's transl)]. Chir Ital 1980; 32:1254-8. [PMID: 7249185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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