Impact of the environment on the health: From theory to practice

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

Core competencies for public health medicine: protocol for an Italian inter-society Delphi consensus

Background

Developing core competencies is crucial for the quality of educational curricula in Public Health Medicine (PHM). The postgraduate medical School of Public Health of the University of Pisa developed a core curriculum for PHM specialists (CCV0), adapted from the list of core competencies promoted by the Association of Schools in Public Health of the European Region (ASPHER).

Objectives

We will apply the Garavalia method, a three-round step-wise Delphi consensus, for adapting the CCV0 to the Italian context. Participants will be enrolled through purposive sampling among the members of the Italian Society of Hygiene, Public Health and Preventive Medicine, aiming at the best possible balance between geographical distribution and professional profiles (PHM residents, academics, and Public Health operators). A sample of representatives of other PHM-related Italian Societies will also be included.

Results

We will invite 139 participants through e-mail invitations. During round zero, we will collect additional suggested competencies through an open-ended question. We will analyze data qualitatively and integrate the most relevant suggestions with the CCV0, resulting in the CCV1. A subgroup of 64 experts (among PHM residents, academics, and representatives of the included Societies) will participate in the following rounds. The first round will use Likert scales to measure agreement on the appropriateness of the CCV1 competencies. Consensus and agreement will be computed using the RAND/UCLA criteria. The final round will reach out for consensus repeating the same ratings for competencies classified as uncertain, with the help of quali-quantitave summaries of the answers of the first round. The final document (CC2) will report competencies classified as consensus or uncertain, with the corresponding level of consent.

Conclusions

The CC2 will enable current courses to be assessed and inform the design of future educational programs for Italian PHM residents.

Key messages

The Delphi method ensures anonymity and a balanced involvement of all stakeholders –including medical residents- in the development of a core curriculum for Public Health Medicine specialists. A consensus on core competencies in Public Health Medicine will enable the evaluation of current training curricula and the development of future educational programs.

Vaccine-preventable diseases screening and vaccination programs for healthcare professions students

Background

Students in Healthcare Professions (SHPs) present an increased risk of contracting and transmitting Vaccine-Preventable Diseases (VPDs). Our study aimed to investigate the organizational strategies (screening and immunization for VPDs and vaccination promotion among SHPs) implemented by the healthcare facilities accredited with the University of Milan.

Methods

we sent an e-survey by e-mail to medical residents and first- and last-year students in nursing, midwifery and healthcare assistance.

Results

among 3397 invited SHPs, 645 participated. We included in the analysis 522 SHPs, distributed in 24 facilities across the Lombardy region (mean age 27,4 years; 69,5% female; 69% medical residents, 28% nursing, 2% healthcare assistance, and 1% midwifery students). Although most participants underwent occupational health visit before the traineeship start (47,5%) or within 6 months (29,5%), others hadn't undergone yet (15,1%). The visits included the collection of vaccination history (72,6%; 64,6% from written documentation), serological tests for VPDs (hepatitis B 76,1%, measles and rubella 58,4%, varicella 54,4%), and screening for latent TB (69,7%). Vaccinations were recommended to 226 participants, but only 173 fully (76,5%) or partially (8%) complied. Full compliance was associated with nudges like in-hospital (Chisq. 18,7; p = 0.00) and free vaccinations (Chisq. 31; p = 0.00). Reported facility vaccination policies included campaigns (posters 37,4%, intranet 39,5%, social media 11,5%, general/personalized letters 30,3%/11,5%), time-off incentives (7,7%), on-site (30,5%) and opinion leaders' vaccinations (9,8%). However, SHPs were often unaware of those strategies (mean 48,6%), and intra-facility answers were sometimes discordant (agreement <70% for facilities with >30 respondents).

Conclusions

SHPs are often unaware or discordant regarding vaccination policies carried out by traineeship facilities, suggesting the need of inclusive communication strategies.

Key messages

About half of students in healthcare professions are screened for VPDs after the start of the traineeship. Students in healthcare professions are often unaware of vaccination promotion strategies.

A reasoned action approach to understand vaccination intention among healthcare professions students

Background

Understanding the predictors of vaccination intention among healthcare workers, including students in healthcare professions (SHPs), is crucial for policy making and for the development of evidence-driven training programs. The reasoned action approach (RAA) model includes three components to predict intention: attitude (experiential/instrumental), perceived norm (injunctive/descriptive), and perceived behavioral control (capacity/autonomy). We aimed to investigate the predictors of seasonal Flu vaccination intention among SHPs of the University of Milan.

Methods

We spread an e-survey to all medical residents and first- and last-year SHPs (medicine, nursery, midwifery, healthcare assistance and prevention techniques). The strength of association between measures of RAA components (as well as sociodemographic data, past vaccination behavior, vaccination knowledge, and perceived vaccination facilitation strategies), and vaccination intention was estimated using uni- and multivariate logistic regression models.

Results

Among 5743 invited SHPs, 884 participated in the survey and were included in the descriptive analyses (52,3% medical residents, 19,9% medicine, 21,1% nursing, 3,6% healthcare assistance, 2,7% prevention techniques and 0,5% midwifery students). Twenty-nine psycho-attitudinal items with an overall Cronbach alpha >0.7 were included in the analyses. The regression analyses were performed on 751 subjects who filled in completely the survey. Past vaccination behavior, vaccination knowledge, experiential attitudes, and perceived vaccination facilitation strategies were positive predictors of Flu vaccination intention (OR 8.16, 2.42, 1.96 and 1.15 respectively, p < 0.05).

Conclusions

Our results indicated knowledge, experiential attitudes and facilitation strategies as modifiable predictors of vaccination intention among SHPs. Targeted and lasting interventions are needed in order to pursue a change in the strongest predictor, past vaccination behavior.

Key messages

Past vaccination is the strongest predictor of vaccination intention among students in healthcare professions. Knowledge, attitudes and perceived facilitators predict vaccine propensity among students in healthcare professions.

Vaccination and immunization status among healthcare students: results from the SAVES survey

Background

Adequate vaccination coverage among healthcare workers, including students in healthcare professions (SHPs), is crucial in order to prevent spreading of infections within healthcare facilities. However, vaccination coverage among SHPs is often inadequate. We aimed to describe the vaccination/immunization status of SHPs of the University of Milan.

Methods

We spread an e-survey to the academic e-mail addresses of postgraduate medical residents and to first- and last-year undergraduate SHPs. The questionnaire covered sociodemographic data (age, sex, education, municipality of residence, internship in high-risk wards) and the reported vaccination/immunization status for Influenza (previous flu season), Varicella, MPR and DTaP vaccines.

Results

Among 5743 invited SHPs, 884 participated in the survey. The study sample comprised 462 medical residents and 422 undergraduate SHPs (medicine 176, nursery 186, midwifery 4, healthcare assistance 32, prevention techniques 24). Median age was 27 years (IQR 7); 68.4% participants were female; 91.3% had attended high school in a lyceum, while others in a professional (2.9%) or technical (5.8%) institute; 36.7% lived in municipalities of < 20.000 inhabitants, while 26.1% of > 250.000. Traineeships took place in high-risk wards for 46% of participants. Reported vaccination coverage for Influenza was 33,7% (with higher coverage for pediatric nursing and midwifery students, medicine students and medical residents). Participants reported immunity (either vaccine or natural immunity) to Varicella in 93,3% cases. Declared vaccination coverage for Hepatitis B was 94,1%; 91,7% participants reportedly completed the MPR schedule, 76,2% the recommended DTaP booster.

Conclusions

Influenza vaccination coverage was suboptimal in our sample of SHPs, suggesting the need of specific educational programs and targeted vaccination campaigns, which may help shaping a positive vaccination attitude for future healthcare professionals.

Key messages

Immunization status for VPDs is suboptimal among Italian students in healthcare professions. The monitoring of the immunization status should include healthcare students actively involved in healthcare activities.