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Restivo V, Minutolo G, Battaglini A, Carli A, Capraro M, Gaeta M, Odone A, Trucchi C, Favaretti C, Vitale F, Casuccio A. Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies. Int J Environ Res Public Health 2022; 19:10995. [PMID: 36078706 PMCID: PMC9518077 DOI: 10.3390/ijerph191710995] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader's decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0-18.0%) in before-after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15-0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (β = 0.56; 95%CI 0.13, 0.99), in private hospitals (β = 0.60; 95%CI 0.14, 1.06), and in medical specialty (β = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Giuseppa Minutolo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alberto Battaglini
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, Via Antonio Pastore 1, 16132 Genova, Italy
| | - Alberto Carli
- Santa Chiara Hospital, Largo Medaglie d’oro 9, 38122 Trento, Italy
| | - Michele Capraro
- School of Public Health, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Cecilia Trucchi
- Planning, Epidemiology and Prevention Unit, Liguria Health Authority (A.Li.Sa.), IRCCS San Martino Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Carlo Favaretti
- Centre on Leadership in Medicine, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, 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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Gianfredi V, Minerva M, Casu G, Capraro M, Chiecca G, Gaetti G, Mantecca Mazzocchi R, Musarò P, Berardinelli P, Basteri P, Bertini B, Ferri C, Odone A, Signorelli C, Alberti VF, Gastaldi G. Immediate adverse events following COVID-19 immunization. A cross-sectional study of 314,664 Italian subjects. Acta Biomed 2021; 92:e2021487. [PMID: 34739452 PMCID: PMC8851022 DOI: 10.23750/abm.v92is6.12365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022]
Abstract
Background and aim: The urgency of having rapidly safe and efficient COVID-19 vaccines called for the need to shorten trial phases, reduce sample sizes, and speed-up the approval process by the regulatory Agencies. In light of this, monitoring adverse effects (AEFI) (both immediate and at medium-long term) become of great importance. Aim of this cross-sectional study was to explore the associations between several factors and risk of immediate AEFI. Methods: Data come from the electronic dataset developed ad hoc to record demographic data, anamnesis and data related to immunization, set-up in the mass vaccination site in Novegro (Milan). Novegro mass vaccination site was one of the mass vaccinations sites with the highest flow in Lombardy Region, with a maximum capacity of 5,000 vaccinations/day. The center opened in April 2021 and closed the 1st of August 2021. A multivariable logistic regression model was used. Odds ratios adjusted (aOR) for age and sex are presented. Statistical significance was set at p<0.05. Analyses were conducting using STATA. Results: Among the total of 314,671 subjects vaccinated, 0.5% developed an immediate AEFI, on average 17.0 ± 0.43 minutes after the administration. The three most frequent AEFI recorded were vagal response (30%), anxiety reaction (24%) and dizziness (21%). AEFI were more frequently observed among women [aOR= 2.24 (95%CI= 2.00 - 2.50)], and those with at least one previous disease [aOR= 1.47 (95%CI= 1.22-1.76)]. Conclusions: In conclusion, AEFI were less likely to occur for increasing age and after the second dose. Results from this large, complete and representative sample population regarding enrich the interesting scientific debate on potential adverse events following COVID-19 immunization. (www.actabiomedica.it)
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Affiliation(s)
- Vincenza Gianfredi
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy; CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Massimo Minerva
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giulia Casu
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Michele Capraro
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Greta Chiecca
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giovanni Gaetti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | | | - Paola Basteri
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy.
| | | | - Camilla Ferri
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy.
| | - Anna Odone
- IRCCS Ospedale San Raffaele, Milano, Italy .
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | | | - Gilda Gastaldi
- Sovrintendenza Sanitaria del Gruppo San Donato, Milano, Italy.
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Odone A, Gianfredi V, Sorbello S, Capraro M, Frascella B, Vigezzi GP, Signorelli C. The Use of Digital Technologies to Support Vaccination Programmes in Europe: State of the Art and Best Practices from Experts' Interviews. Vaccines (Basel) 2021; 9:1126. [PMID: 34696234 PMCID: PMC8538238 DOI: 10.3390/vaccines9101126] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/01/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022] Open
Abstract
Digitalisation offers great potential to improve vaccine uptake, supporting the need for effective life-course immunisation services. We conducted semi-structured in-depth interviews with public health experts from 10 Western European countries (Germany, Greece, Italy, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, and the United Kingdom) to assess the current level of digitalisation in immunisation programmes and retrieve data on interventions and best practices. Interviews were performed using an ad hoc questionnaire, piloted on a sample of national experts. We report a mixed level of digital technologies deployment within vaccination services across Europe: Some countries are currently developing eHealth strategies, while others have already put in place robust programmes. Institutional websites, educational videos, and electronic immunisation records are the most frequently adopted digital tools. Webinars and dashboards represent valuable resources to train and support healthcare professionals in immunisation services organisation. Text messages, email-based communication, and smartphone apps use is scattered across Europe. The main reported barrier to the implementation of digital-based programmes is the lack of resources and shared standards. Our study offers a comprehensive picture of the European context and shows the need for robust collaboration between states and international institutions to share best practices and inform the planning of digital intervention models with the aim of countering vaccine hesitancy and increasing vaccine uptake.
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Affiliation(s)
- Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Vincenza Gianfredi
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Sebastiano Sorbello
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Michele Capraro
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Beatrice Frascella
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Giacomo Pietro Vigezzi
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
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Dallagiacoma G, Allora A, Salvati S, Cocciolo G, Capraro M, Lamberti A, Senatore S, Gentile L, Gianfredi V, Laurenzi A, Molinari C, Caretto A, Faccini M, Signorelli C, Scavini M, Odone A. Type 1 Diabetes Patients' Practice, Knowledge and Attitudes towards Influenza Immunization. Vaccines (Basel) 2021; 9:vaccines9070707. [PMID: 34210044 PMCID: PMC8310009 DOI: 10.3390/vaccines9070707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Diabetic patients are at higher risk of developing infectious diseases and severe complications, compared to the general population. Almost no data is available in the literature on influenza immunization in people with type 1 diabetes mellitus (T1DM). As part of a broader project on immunization in diabetic patients, we conducted a cross-sectional study to: (i) report on seasonal influenza coverage rates in T1DM patients, (ii) explore knowledge, attitudes, and practices (KAPs) towards seasonal influenza in this population, and (iii) identify factors associated with vaccine uptake, including the role of family doctors and diabetologists. A survey was administered to 251 T1DM patients attending the Diabetes Clinic at San Raffaele Research Hospital in Milan, Italy and individual-level coverage data were retrieved from immunization registries. Self-reported seasonal influenza immunization coverage was 36%, which decreased to 21.7% when considering regional immunization registries, far below coverage target of 75%. More than a third (36.2%) of T1DM patients were classified as pro-vaccine, 30.7% as hesitant, 17.9% as uninformed, and 15.1% as anti-vaccine. Diabetologists resulted to be the most trusted source of information on vaccines’ benefits and risks (85.3%) and should be more actively involved in preventive interventions. Our study highlights the importance of developing tailored vaccination campaigns for people with diabetes, including hospital-based programs involving diabetes specialists.
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Affiliation(s)
- Giulia Dallagiacoma
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.D.); (L.G.)
| | - Agnese Allora
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Stefano Salvati
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Giulia Cocciolo
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Michele Capraro
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Anna Lamberti
- Agency for Health Protection of Metropolitan Area of Milan (ATS), 20121 Milan, Italy; (A.L.); (S.S.); (M.F.)
| | - Sabrina Senatore
- Agency for Health Protection of Metropolitan Area of Milan (ATS), 20121 Milan, Italy; (A.L.); (S.S.); (M.F.)
| | - Leandro Gentile
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.D.); (L.G.)
| | - Vincenza Gianfredi
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Andrea Laurenzi
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Chiara Molinari
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Amelia Caretto
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Marino Faccini
- Agency for Health Protection of Metropolitan Area of Milan (ATS), 20121 Milan, Italy; (A.L.); (S.S.); (M.F.)
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.A.); (S.S.); (G.C.); (M.C.); (V.G.); (C.S.)
| | - Marina Scavini
- Diabetes Research Institute, San Raffaele Hospital, 20132 Milan, Italy; (A.L.); (C.M.); (A.C.); (M.S.)
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.D.); (L.G.)
- Correspondence:
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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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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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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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9
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Bellini L, Bossi E, Bucci D, Capraro M, Chiappa F, Ambrosio A. Preventive and responsive plans to COVID-19 epidemic in a leading teaching hospital in Milan, Italy. Eur J Public Health 2020. [PMCID: PMC7543431 DOI: 10.1093/eurpub/ckaa166.618] [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: 11/13/2022] Open
Abstract
Abstract
Issue
Following the SARS-Cov-2 outbreak in Wuhan, China, the first case of COVID-19 was reported in Codogno, Lombardy, Italy, on 20 February 2020. The ongoing epidemic has exposed the health care system to a severe stress. San Raffaele Hospital (OSR) in Milan, Italy - a leader in the emergency management, may provide a benchmarking experience useful for other countries.
Description of the Problem
OSR has established a task force including the health care director, the Infections Prevention and Control Committee (IPCC) and the head of ward and outpatients' facilities management area in order to assess the situation and to define a multi-step strategy. The management process has been divided in two steps. Firstly, a preventive phase was devised, in a preparedness perspective, to avoid the spread of the infection to the Healthcare Professionals (HCP). Secondly, a reorganizational phase was implemented to guarantee assistance to infected patients, especially the critical ones.
Results
Before the outbreak, the IPCC updated OSR's procedures, based on the WHO's, national and regional guidance, planned a lectures series and an online survey to train healthcare professionals and proposed to stack Personal Protective Equipment (PPE) to face the expected shortage. The Head of the facilities management area defined separate pathways in the Emergency Department in order to isolate patients with respiratory symptoms, set up a new ward, with 26 beds and dedicated personnel, as well as two Intensive Care Units, with 13 beds, Some wards were merged and more healthcare workers were moved to the COVID-19 units.
Lessons
The coordination between task force members has been crucial for translating the multi-step strategy in a quick reorganization of the whole hospital. Despite early preparations, we could not anticipate the evolution of the outbreak and its logistic impact, especially on the PPE procurement.
Key messages
A major Hospital was proved to be capable to respond to the changing healthcare requests. Organizational flexibility is crucial for proper emergency management.
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Affiliation(s)
- L Bellini
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - E Bossi
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - D Bucci
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - M Capraro
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - F Chiappa
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - A Ambrosio
- IRCCS San Raffaele Hospital, Milan, Italy
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10
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Moro M, Vigezzi GP, Capraro M, Biancardi A, Nizzero P, Signorelli C, Odone A. COVID-19: knowledge and attitudes of hospital staff of a large Italian teaching hospital. Eur J Public Health 2020. [PMCID: PMC7543399 DOI: 10.1093/eurpub/ckaa166.608] [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: 11/22/2022] Open
Abstract
Background During infectious disease emergencies, fully aware healthcare workers (HCWs) and public services staff are unique resources to keep health systems active and tackle epidemics. Aim of the study was to assess concern, general and health-related knowledge (case management and Infection Prevention and Control [IPC] measures) among hospital staff on SARS-CoV-2 in Lombardy region (Italy). Methods One week after WHO declared COVID-19 a public health emergency we developed and online administered a 7-item questionnaire to all staff of San Raffaele Hospital, a referral and teaching hospital in Milan, exploring knowledge and attitudes on COVID-19. The survey remained accessible online for 72 hours. Results A total of 2,046, including HCWs and other staff, answered the survey (response rate 25%). Among the 2,027 responders included in the analysis, 1,102 were HCWs (54%), also in training, and 924 non-HCWs (46%). 60% of responders reported being worried or extremely worried about the epidemic. Concerning knowledge, the survey asked about modes of transmission, clinical forms, preventive measures in everyday life in Italy and cough etiquette. There were uniform trends in the two groups: HCWs were more aware and answered more properly (mean of correct answers 71,6%) than non-HCWs (mean 61,2%). HCWs were asked about IPC precautions, with only 41% providing correct answers, while over 74% knew only supportive therapy is currently available against COVID-19. Conclusions We were among the first to explore hospital staff knowledge on COVID-19 reporting data from a large study population. HCWs were slightly less concerned but more knowledgeable than general staff. Last questions showed that among HCWs there is generally good knowledge on the topic. However, most of the responders missed the recommendations to adopt simultaneously standard, contact and airborne precautions plus eye protection managing suspected and confirmed cases, as proposed by national and international authorities. Key messages During the ongoing emergency, it is of utmost importance that hospital staff is adequately trained to implement the best IPC measures and limit the spread of the infection. Our data can inform planning of these preventive measures.
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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
| | - M Capraro
- School of Public Health, Vita-Salute San Raffaele 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
| | - 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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11
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Signorelli C, Odone A, Gianfredi V, Bossi E, Bucci D, Oradini-Alacreu A, Frascella B, Capraro M, Chiappa F, Blandi L, Ciceri F. COVID-19 mortality rate in nine high-income metropolitan regions. Acta Biomed 2020; 91:7-18. [PMID: 32701911 PMCID: PMC8023097 DOI: 10.23750/abm.v91i9-s.10134] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
Abstract
We analyzed the spread of the COVID-19 epidemic in 9 metropolitan regions of the world with similar socio-demographic characteristics, daytime commuting population and business activities: the New York State, Bruxelles-Capital, the Community of Madrid, Catalonia, the Île-de-France Region, the Greater London county, Stockholms län, Hovedstaden (Copenhagen) and the Lombardy Region. The Lombardy region reported the highest COVID-19 crude mortality rate (141.0 x 100,000) 70-days after the onset of the epidemic, followed by the Community of Madrid (132.8 x 100,000) New York State (120.7 x 100,000). The large variation in COVID-19 mortality and case-fatality rates for COVID-19 in different age strata suggested a more accurate analysis and interpretation of the epidemic dynamics after standardization of the rates by age. The share of elder populations (>70 years) over total population varies widely in the considered study settings, ranging from 6.9% in Catalonia to 17.0% in Lombardy. When taking age distribution into consideration the highest standardized mortality rate was observed in the State of New York (257.9 x 100,000); with figures in most of the European regions concentrated between 123.3 x 100,000 in Greater London and 177.7 x 100,000 in Bruxelles-Capital, lower in French and Danish regions. We also report and critical appraise, when available, COVID-19 mortality figures in capital cities, nursing homes, as well as excess mortality at country level. Our data raise awareness on the need for a more in-depth epidemiological analysis of the current COVID-19 public health emergency that further explores COVID-19 mortality determinants associated with health services delivery, community-level healthcare, testing approaches and characteristics of surveillance systems, including classification of COVID-19 deaths. (www.actabiomedica.it)
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Affiliation(s)
- Carlo Signorelli
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Anna Odone
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Vincenza Gianfredi
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Eleonora Bossi
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Daria Bucci
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Aurea Oradini-Alacreu
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Beatrice Frascella
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Michele Capraro
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Federica Chiappa
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università Vita-Salute San Raffaele, Milano.
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, Scuola di Specializzazione in Igiene e Medicina Preventiva, Università di Pavia.
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12
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Odone A, Salvati S, Bellini L, Bucci D, Capraro M, Gaetti G, Amerio A, Signorelli C. The runaway science: a bibliometric analysis of the COVID-19 scientific literature. Acta Biomed 2020; 91:34-39. [PMID: 32701915 PMCID: PMC8023084 DOI: 10.23750/abm.v91i9-s.10121] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: To reflect on content, trends and quality of scientific publishing on COVID-19. In particular, to report on the systematic screening, quantitative assessment and critical appraisal of the first 10,000 scientific papers published on COVID-19 and to compare how scientific outputs matched identified research priorities and public health needs. Methods: A comprehensive research strategy was developed to systematically retrieve on a daily basis all studies published on COVID-19. From included studies we extracted: bibliometric parameters, country of studies’ implementation and study design. We assigned papers to 25 a priori defined COVID-19-related topics and we described scientific outputs in relation to countries’ academic publishing ranking, as well as COVID-19 burden. Results: 10,000 scientific articles were published on COVID-19 between 20th January and 7th May 2020, accounting for 2.3% of total scientific production over the study period. One third (33%) focused on COVID-19 clinical management, with little adherence to identified research priorities. Over sixty per cent of papers were opinion pieces not reporting original data. Papers were published on 1881 different journals but with half of scientific production included in 8% of journals. The US accounted for one fourth of total scientific production, followed by China (22.2%) and Italy (9%). Conclusions: Never before in the history of academic publishing such a great volume of research focused on a single topic, this being likely to introduce major changes in the way science is produced and communicated, at the risk of bringing it far from its ultimate aim: informing clinical and public health practice and decision making. (www.actabiomedica.it)
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Affiliation(s)
- Anna Odone
- 1) School of Medicine, University Vita-Salute San Raffaele, Milan, Italy 2) Clinical Epidemiology and HTA, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Stefano Salvati
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
| | - Lorenzo Bellini
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
| | - Daria Bucci
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
| | - Michele Capraro
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
| | - Giovanni Gaetti
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
| | - Andrea Amerio
- 1) Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy 2) IRCCS Ospedale Policlinico San Martino, Genoa, Italy 3) Department of Psychiatry, Tufts University, Boston, MA, USA .
| | - Carlo Signorelli
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
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13
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Signorelli C, Odone A, Gianfredi V, Bossi E, Bucci D, Oradini-Alacreu A, Frascella B, Capraro M, Chiappa F, Blandi L, Ciceri F. The spread of COVID-19 in six western metropolitan regions: a false myth on the excess of mortality in Lombardy and the defense of the city of Milan. Acta Biomed 2020; 91:23-30. [PMID: 32420920 PMCID: PMC7569623 DOI: 10.23750/abm.v91i2.9600] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/23/2022]
Abstract
We analyzed the spread of the COVID-19 epidemic in 6 metropolitan regions with similar demographic characteristics, daytime commuting population and business activities: the New York metropolitan area, the Île-de-France region, the Greater London county, Bruxelles-Capital, the Community of Madrid and the Lombardy region. The highest mortality rates 30-days after the onset of the epidemic were recorded in New York (81.2 x 100,000) and Madrid (77.1 x 100,000). Lombardy mortality rate is below average (41.4 per 100,000), and it is the only situation in which the capital of the region (Milan) has not been heavily impacted by the epidemic wave. Our study analyzed the role played by containment measures and the positive contribution offered by the hospital care system. (www.actabiomedica.it).
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Affiliation(s)
- Carlo Signorelli
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Anna Odone
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Vincenza Gianfredi
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy; CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Eleonora Bossi
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Daria Bucci
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | | | - Beatrice Frascella
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Michele Capraro
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Federica Chiappa
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, School of Public Health, University of Pavia, Pavia, Italy.
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14
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Bucci D, Rossi D, Croci R, Bellini L, Bonaldi F, Capraro M, Frascella B, Gaetti G, Granata L, Solla D, Stirparo G, Bizzarro A, Bordin G, Odone A, Capolongo S, Pasquarella C, Pelissero G, Signorelli C. The campaign "This Is Public Health" in Italy, set up by a team of Public Health Schools in Northern Italy. Acta Biomed 2020; 91:171-174. [PMID: 32275286 PMCID: PMC7975906 DOI: 10.23750/abm.v91i3-s.9508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/05/2022]
Abstract
Despite the great effort to raise awareness among health promotion, nowadays Public Health policies are not often recognized as important tools. For this reason, the Health in All Policies (HiAP) approach is instrumental in tackling this information gap. In 2018, the US Association of Schools & Programs of Public Health (ASPPH) launched an international campaign called “This is Public Health” (TIPH), whose aim was “to brand public health and raise awareness of how it affects individuals, communities and populations”. The Association of Schools of Public Health in the European Region (ASPHER), in coordination with ASPPH, decided to create a European campaign to support and to reproduce the American one, by opening a challenge among the European Public Health Schools. The Schools and Programs of PH of Vita-Salute “San Raffaele” University, Milan, University of Parma, University of Pavia and Politecnico of Milan won this bid. In this “briefing on” we present a report on the Italian project for raising awareness of Public Health among general population and health care personell.
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15
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Moro M, Vigezzi GP, Capraro M, Biancardi A, Nizzero P, Signorelli C, Odone A. 2019-novel coronavirus survey: knowledge and attitudes of hospital staff of a large Italian teaching hospital. Acta Biomed 2020; 91:29-34. [PMID: 32275264 PMCID: PMC7975896 DOI: 10.23750/abm.v91i3-s.9419] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022]
Abstract
One week after the World Health Organization (WHO) declared the 2019 novel coronavirus (2019-nCoV) outbreak a global health emergency we conducted a survey to explore knowledge and attitudes on 2019-nCoV, recently renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in a large cohort of hospital staff. A representative sample of 2,046 hospital staff of a large university hospital in northern Italy (54% healthcare workers and 46% administrative staff, overall response rate: 25%) was administered an online questionnaire: overall there is good knowledge on 2019-nCoV control measures. The mean of correct answers for questions on general aspects of 2019-nCoV epidemic was 71.6% for HCWs and 61.2% for non-HCWs. The mean of correct answers for questions on 2019-nCoV patient management was 57.8% among HCWs. Nevertheless, on recommended precautions, also among healthcare workers there is still much to do in order to promote effective control measures and correct preventive behaviours at the individual level.
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Affiliation(s)
- Matteo Moro
- Infection Control Committee, IRCCS San Raffaele Hospital, Milan, Italy.
| | | | - Michele Capraro
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Anna Biancardi
- Infection Control Committee, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Paola Nizzero
- Infection Control Committee, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Carlo Signorelli
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
| | - Anna Odone
- School of Public Health, Vita-Salute San Raffaele University, Milan, Italy.
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16
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Capraro M, Della Valle M, Podswiadek M, De Sandre P, Sgnaolin E, Ferrari R. The role of illness perception and emotions on quality of life in fibromyalgia compared with other chronic pain conditions. Reumatismo 2012; 64:142-50. [DOI: 10.4081/reumatismo.2012.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 05/06/2012] [Accepted: 05/09/2012] [Indexed: 11/23/2022] Open
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17
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Abstract
We have examined the interactions of UvrABC endonuclease with DNA containing the monoadducts of 8-methoxypsoralen (8-MOP) and 4,5',8-trimethylpsoralen (TMP). The UvrA and UvrB proteins were found to form a stable complex on DNA that contains the psoralen monoadducts. Subsequent binding of UvrC protein to this complex activates the UvrABC endonuclease activity. As in the case of incision at pyrimidine dimers, a stable protein-DNA complex was observed after the incision events. For both 8-MOP and TMP, the UvrABC endonuclease incised the monoadduct-containing strand of DNA on the two sides of the monoadduct with 12 bases included between the two cuts. One incision was at the 8th phosphodiester bond on the 5' side of the modified base. The other incision was at the 5th phosphodiester bond 3' to the modified base. The UvrABC endonuclease incision data revealed that the reactivity of psoralens is 5'TpA greater than 5'ApT greater than 5'TpG.
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