Outbreaks of COVID-19 in indoor places of worship: a systematic review

AIMS

This review aimed to describe what has been published on COVID-19 outbreaks originating from indoor places of worship.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist by searching PubMed, Scopus and Embase from 1 January 2020 to 29 March 2021. Citation chasing was also performed. Studies with information about COVID-19 outbreaks originating in indoor places of worship of any religion were included.

RESULTS

A total of 9729 records were identified and 36 were selected. The articles reported 119 descriptions of outbreaks linked to churches, mosques, synagogues, and temples, referring to approximately 52-74 unique outbreaks. The outbreaks were mostly located in three major areas: East and Southeast Asia (46%), the USA (27%), Europe (22%). All the outbreaks began in 2020. Mainly, there were no restrictive measures, or such measures were not followed at the time of the outbreak. Choir practices presented the highest attack rate (up to 0.867).

CONCLUSIONS

The lack of preventive measures and the role of singing practices were highlighted. Reports were often lacking contact tracing and sometimes did not report the date of outbreak extinction. Moreover, reports came from few geographical areas. Thus, the impact of transmission in places of worship may be largely underestimated.

Analysis of a direct access testing system for the detection of SARS-CoV-2 in the paediatric population attending school

Background

During the COVID-19 pandemic, the paediatric population plays a minor role in the spread of the SARS-CoV-2 virus. However, in order to keep schools open and reduce SARS-CoV spreading, it is necessary to identify and isolate early SARS-CoV-2 positive paediatric patients even if they are asymptomatic. The aim of this study was to describe a setting for SARS-CoV 2 testing based on the spontaneous presentation of paediatric patients attending school without a medical prescription and explore its appropriateness.

Study design

Cross-sectional study.

Methods

The study performed between September 2020 and March 2021 among a sample of 13,283 paediatric patients who underwent a swab in four different hospital settings (school hot spot, emergency department, day hospital setting and hospital wards). For each patients we collected: date of swab execution, type of swab, execution setting of the swab, result of the swab, information about community spread of the virus in the 14 days prior to the swab execution, sex and age.

Results

In our sample, females accounted for 45.8%. The median age was 6.8 years (IQR 3.0-11.2) and the most frequent age category was between 6 and 11 years (27.9%). At multivariable models with a swab tested positive as outcome. The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school hot spot setting. Compared with adolescents aged between 14 and 19 years old, new-borns below 3 months (adjOR 1.83, 95% C.I. 1.14-3) and patients aged between 11 and 14 years old (adjOR 1.32, 95% C.I. 1.07-1.63) reported a higher probability of a swab tested positive. Instead, children aged between 3 months and 3 years (adjOR 0.77, 95% C.I. 0.61-0.96) and children aged between 3 years and 6 years (adjOR 0.66, 95% C.I. 0.53-0.83) were less likely to result positive. The higher was the mean of pooled Rt in the 14 days preceding the swab, the higher was the likelihood of resulting positive (adjOR 1.75, 95% C.I. 1.53-1.99).

Conclusion

In conclusion, we found a high incidence of paediatric patients positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings during the period of observation. The free access modality to the nasopharyngeal swab was effective in identifying patients with COVID-19. Public health authorities should implement these testing modality in order to help reduce the spread of SARS-CoV-2 in school settings.

Prevention of the Werther effect: compliance of the Italian newspapers to the 'reporting on suicide' recommendations

OBJECTIVES

Suicide media coverage could lead to imitation, the so-called 'Werther effect'. The World Health Organization (WHO) published specific recommendations for reporting suicide news. This study aimed to quantify the compliance of Italian newspapers with the WHO suicide reporting guidelines.

STUDY DESIGN

This was a quantitative content analysis study.

METHODS

All articles published by the three main Italian newspapers from June 2019 to May 2020 describing suicides or attempted suicides were included. The articles were analyzed using a checklist based on the WHO recommendations, which included 18 'negative' items (e.g. 'presence of the word 'suicide' in the title') and nine 'positive' items (e.g. 'the article reports the contacts of a suicide prevention hotline'). Each negative item was scored -1, and each positive item was scored +1. Multivariate linear regressions were performed to identify factors associated with lower adherence to WHO recommendations and higher social media engagement with the articles.

RESULTS

A total of 3483 articles were screened, and 110 articles were included in the final analysis. The suicidal was male in 73.6% of cases. The median checklist score was -6 (interquartile range 3). Five percent of the articles had at least one positive item. The word 'suicide' was found in 90% of the titles. Female suicides were associated with a higher checklist score (coefficient 0.81, P = 0.039). No correlation was found between the checklist score and the social media engagement of the articles.

CONCLUSIONS

Italian newspapers do not adhere completely to the WHO recommendations on reporting suicide, leading to a potential imitation effect. Public health professionals should make decision-makers and journalists aware of the importance of these recommendations.

Sexual education in the school setting: an overview of the Italian situation

Background

There is an important interaction between sexuality and many life factors. A good sexual education at school can improve knowledge and behaviour in young people giving them a healthy sexual life. Unlike most European countries, sexual education in Italy is not compulsory in the school curriculum, so this study explored the Italian regional initiatives realised over a span of 15 years.

Methods

A review of grey literature was conducted on Public Health Administrations/Regions websites of each Italian region, focusing on official documents containing training catalogues for schools. The search was conducted in December 2021, including documents produced between 2006 and 2021. We used the topics recommended by UNESCO as quality markers for the projects found.

Results

Among the 20 Italian regions, 12 had at least one programme. A total of 39 projects were found. All UNESCO topics were covered, with notable differences between north, centre and south of Italy, which had the lowest number of projects. Most of the projects (23) were carried out only once, the others were repeated at least for two years in a row. Contraception, along with love, marriage, partnerships, and family, were the main topics discussed during sexual education programs in schools (92%), followed by biological aspects, body awareness, and anatomy (83%); birth, disability, human rights, and online media were less common (33%). Regarding the target, disability, human rights, and mutual consent were deepened only for middle and high school students.

Conclusions

Considering the fundamental importance of sexual education, there is an important lack in promotion and planning in Italy. There is a large discrepancy between the northern and southern regions and it is necessary to implement and standardize the offer of sexual education programs in schools.

Key messages

• Unlike the European average, In Italy there is an important lack on sexual education, whit large discrepancies between the northern and southern regions, putting the latter at disadvantage.

• Contraception, marriage, couples, and family were the main topics discussed during sexual education programs in schools; birth, disability, human rights, and online media the least.

The Werther effect: adherence of Italian newspapers to the “reporting on suicide” recommendations

Background

Reporting a case of suicide on a newspaper could lead to an emulation effect (Werther effect). It is important to report suicide cases by following specific recommendations implemented by World Health Organization (WHO). This study aimed to analyze articles published on Italian newspapers to quantify the adherence to the WHO recommendations in suicide report.

Methods

All the articles published in the three most important Italian newspapers from June 2019 to May 2020 that described one or more cases of suicide were included. Two researchers analyzed all the articles through an ad-hoc checklist, constructed on the basis of the WHO recommendations, that included 18 “negative” items (e.g. “presence of suicide-related words in the title”) and nine “positive” items (e.g. “the article reports the contacts of a suicide-prevention hotline”). For each negative item a “-1” point, and for each positive item a + 1 point, was assigned. Multivariable linear regressions were performed to identify factors related with a lower adherence to the WHO recommendations and with higher social engagement of the articles.

Results

A total of 110 articles were analyzed. In the 73% of the cases, the individual was male. The 14.5% of the suicide cases were homicide-suicide, while 9% were femicide-suicide. The median score of the checklist was -6 (IQR 3). Only 5% of the articles had at least one positive item. The word “suicide” (or related words) were present in 90% of the titles. Multivariable analyses showed that female suicides were associated with a higher score of the checklist (coeff 0.816, p = 0.039). No correlation was retrieved between the score of the checklist and the social media engagement of the articles included.

Conclusions

Italian newspapers do not follow WHO recommendations on how to report suicide cases, leading to a potential emulation effect. Public health professionals should raise decision makers’ and journalists’ awareness about the importance of these recommendations.

Key messages

• Since Italian newspapers are not compliant with the recommendations of the World Health Organization on how to report a suicide case, there is the risk of a potential emulation effect.

• Specific training for journalists and other professionals in the field of communication should be implemented, to raise the awareness on the importance of the “reporting on suicide” recommendation.

Analysis of a test system for the detection of SARS-CoV-2 in children attending school

Background

During the COVID-19 pandemic, in order to keep schools open and reduce SARS-CoV spreading, SARS-CoV-2 positive paediatric patients (PP) need to be isolated early. The aim of this study was to describe the appropriateness of school hot spot (HS) for SARS-CoV 2 testing based on open access of PP in a paediatric hospital in Turin, Italy.

Methods

A cross-sectional study was performed between September 2020 and March 2021. The data collected included: date of swab execution, type of swab, execution setting of the swab, result of the swab, sex, age of PP and the mean value of the Rt (reproductive number) of pandemic in the Piedmont region. We collected data about PP from four different hospital settings (HS, Emergency department, day hospital and hospital wards) of Regina Margherita Children’s Hospital (Turin, Italy). We analyzed a sample of 13,283 PP (aged 0-19 years) testing for SARS-CoV-2. The main outcome was the likelihood of testing positive in different settings and in different age groups.

Results

In Our sample, females were 45.8%. The median age was 6.8 years (IQR 3.0-11.2). The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school HS setting. Newborns below 3 months (adj OR 1.85, 95%CI 1.14 - 3) and patients aged between 11 and 13 years old (adj OR 1.32, 95%CI 1.07 - 1.63) reported a higher probability of a swab tested positive compared to adolescents. Instead, children aged between 3 months and 2 years (adj OR 0.77, 95%CI 0.61 - 0.96) and aged between 3 years and 5 years (adj OR 0.66, 95%CI 0.53 - 0.83) were less likely to result positive.

Conclusions

We found a high prevalence of PP positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings. The open access modality to the nasopharyngeal swab was effective in identifying PP with COVID-19. Public health authorities should implement this testing modality in order to reduce SARS-CoV-2 infections in PP.

Key messages

• Open access testing system to detect SARS-CoV-2 is important to do as many tests as possible to identify COVID-19 patients and isolate them in the pediatric population.

• The open access testing modality to detect COVID-19 patients saves time for doctors who, instead of carrying out the patient history, can devote themselves to other clinical activities.

Impact of the pandemic on surgical oncology in Piedmont, Italy: a retrospective observational study

Background

To prevent the spread of SARS-CoV-2, containment measures were implemented leading to huge healthcare changes worldwide. This study aimed to describe the impact of COVID-19 pandemic on surgical oncology healthcare in a large Italian sample.

Methods

A retrospective observational study included 99651 patients admitted to the hospitals of Piedmont (Northern Italy) to undergo oncological surgery, provided in ordinary hospitalization. We compared data of 2020 with 2016-2019 mean values. Data were stratified by tumor site, year, month and admission way. Chi-squared tests were used to assess differences in the percentage of admission modes between 2020 and 2016-2019.

Results

An overall reduction in oncological surgery (-12.3%) was observed in 2020 (n = 17923) compared to the mean of period 2016-2019 (n = 20432). A relevant decrease began in March (-11%), continued in April (-18%) and peaked in May (-26%). There was a greater reduction in surgery of breast (-19.2%), bladder (-17.5%), colorectal (-16.5%), kidney (-14.2%), prostate (-14%). Little or no difference was observed for liver (-5.2%), body of uterus (-0.54%), ovary (-0.07%), lymphoma (+4.5%). There was a marked reduction of non-emergency admissions (-13.6%), in particular for some tumor sites: colorectal (-19.4%), breast (-19.4%), bladder (-18.7%). The overall volume of surgeries following an emergency access was unchanged (-0.3%). The proportion of hospitalizations with emergency access increased (p < 0.001).

Conclusions

Our results highlight the burden of the reduction in cancer surgery in 2020 and the risk of delays in diagnosis and treatment for time-dependent conditions. For cancers that can be diagnosed early thanks to screening, the reduction in surgery is likely to be an indirect consequence of discontinuing screening activities. Therefore, further studies are needed to assess, as soon as data are available, the trend in 2021, and to compare our results with those reported in other European countries.

Key messages

• The COVID-19 pandemic caused a significant decline in cancer surgeries in 2020 in Piedmont, Italy. It is necessary to compare our results with those reported in other European countries.

• These results show an increase in the proportion of oncological surgical admissions following emergency access in 2020 compared to the average for 2016-2019.

Knowledge, attitude and practice about the Personal Health Record among general population in Italy

Background

The Personal Health Record (PHR) is an online tool containing a person’s health-related data, which can be shared with health professionals. This tool is widely used throughout Europe but is not very popular in Italy, despite its implementation being mandatory. This study aims to investigate knowledge, attitudes and practices (KAP) associated with the PHR among the general population in Italy, to identify the main obstacles in the usage of PHR and to establish strategies that lead to their resolution.

Methods

A cross-sectional survey was designed and shared both online and on paper (in the waiting rooms of the outpatient clinics) to an opportunistic sample of people aged ≥18 years. Factors associated with a higher knowledge and willingness to activate the PHR were investigated through multivariable logistic regression analyses.

Results

Preliminary results of the on paper survey (243 answers) showed that the median age of the participants was 45, 46% were women, 9% worked in healthcare and 68% had chronic diseases. Only 31% heard about the PHR, of which 22% showed a good knowledge of it. The 66% declared the willingness to activate the PHR and 92% agreed that the PHR is a useful tool for physicians to share information. Multivariable logistic regression models showed that those who were employed and those who were visited by a doctor in the last three months had a higher likelihood of having heard about PHR (OR 2.56, 95% CI 1.12 - 5.82 and OR 2.67, 95% CI 1.20 - 5.90 respectively). The likelihood of being willing to activate the PHR is lower for those who live alone, and is higher for those who are employed (OR 0.35, 95% CI 0.14 - 0.88 and OR 2.35, 95% CI 1.06 - 5.24).

Conclusions

The results confirm the low level of knowledge and diffusion of the PHR in Italy, although a relatively high interest in this tool was highlighted, along with a favorable perception of its usefulness. Promotional interventions are needed to increase knowledge and awareness of this tool.

Key messages

• Awareness about Personal Health Record among the Italian population is low. Despite this, a high level of willingness to activate this tool and a high perception of its usefulness were registered.

• Identifying factors that lead to lower awareness on Personal Health Record may help Public Health professionals to implement targeted promotional interventions aimed to increase the usage of this tool.

Use of TikTok by nutrition healthcare professionals: analysis of the Italian context

Background

Over the past 20 years, Social Media (SM) have become fundamental tools for quickly and effectively spreading health information in Europe. One of the most popular topics in the health sector is food and nutrition. TikTok is one of the most recent-born and most popular SM. Our study aims to analyze how healthcare professionals in the nutrition sector communicate through TikTok, and to assess characteristics of their accounts and videos.

Methods

We included in the present study 53 Italian healthcare professionals who post videos on TikTok through a search on this SM using nutrition-related keywords. For each tiktoker, we described the characteristics of their last 10 videos, through an ad hoc checklist. We performed multilevel multivariable linear regression models in order to identify factors (healthcare professional or video related) that could be associated with a higher popularity of the video.

Results

The 67.7% of the tiktokers considered were female; 46% had more than 30 years, 62.3% were biologists. The median number of likes was 300 (IQR 75 - 1070). The linguistic register was “formal” in the 11.3% of the videos. In the 31.9% of them, the location was the office of the healthcare professional. In the 67.3%, the topic was “diet-related”. Multilevel multivariable linear regression models showed that “diet-related” topics were associated with more likes (coeff 1111.63, p = 0.048), and comments (coeff 13.42, p = 0.018).

Conclusions

Many Italian nutrition professionals are present on TikTok, and perform videos in their offices discussing mainly diet-related topics. There are no specific factors associated with the popularity of their videos, other than the presence of “diet-related” topics. Since the TikTok audience is very young, and wrong messages on this topic could lead to serious health-related consequences, there is the need to pay a specific attention on the contents of the videos, to avoid the spread of potentially dangerous information.

Key messages

• Italian healthcare nutrition professionals are present on TikTok and perform videos with diet-related contents in their workplaces.

• Since wrong information on diet and nutrition could lead to serious health consequences for the audience, it is important to monitor the content of the videos to avoid the spread of dangerous messages.

Knowledge, attitudes, practices on hepatitis C and HCV screening: an Italian cross-sectional study

Background

Hepatitis C has the highest burden in the Eastern Mediterranean Region and European Region. This study aimed to explore knowledge, attitudes and practices towards hepatitis C and HCV screening, which has been large-scale implemented in Italy recently.

Methods

An online nationwide cross-sectional survey was conducted (Italy, December 2021). Five outcomes were used: HCV knowledge (from 0 to 100%: 100% represents the lowest knowledge); not being aware of the screening; wrong attitudes in case of contact with positive people (from 0 to 5: 5 represents more wrong attitudes); having performed an HCV test; sharing of blood-contaminated objects. Multivariable regressions were run.

Results

Participants were 813 (74.7% females; mean age 37 years, SD 12.4). The median score of HCV knowledge was 20% (IQR 16-24). There was a positive correlation between poor knowledge and wrong attitudes (p = 0.001). People who underwent an HCV test were less likely to have poor knowledge (p = 0.040). The 23.2% was not aware of screening existence. People who had a postgraduate degree were less likely of not being aware (p = 0.004). Investigating attitude score, the median was 0 (IQR 0-1). Increasing age was associated with wrong attitudes (p = 0.020). The 43.4% underwent an HCV test. This likelihood was greater for: residence in a municipality with more than 50000 inhabitants (p = 0.032); having at least one child (p = 0.009); considering oneself at risk (p = 0.004); being informed about HCV (p < 0.001). The 31.8% shared objects. Increasing age was associated with reduced odds of sharing (p = 0.033). The 72.4% would like to receive more information on HCV, preferring brochures and short videos.

Conclusions

This study showed good knowledge and attitudes, with a substantial frequency of individuals who never underwent an HCV test or shared contaminated objects. It also suggested brochures and short videos may be the most acceptable ways to implement awareness campaigns in comparable European contexts.

Key messages

• Italian general population had good knowledge and attitudes towards hepatitis C and its screening, while it showed poor practices.

• Most of participants were willing to receive more information on HCV, especially through brochures and short videos.

Parental perception about the pandemic impact on mental health of children: a cross-sectional study

Background

The pandemic may increase mental issues among children. This study aimed to explore parental perceptions on the pandemic impact on the health status of their children, with a focus on mental health.

Methods

An online nationwide cross-sectional study has been conducted amongst Italian parents (from April 2022-ongoing). The survey included: Strength and Difficulties Questionnaire (SDQ), Kessler-6 (K6) for parent's psychological distress, and pandemic-related items. The outcomes were: child's SDQ above the clinical cut-off and perceived child's worsening of sleep, appetite, physical and mental health during the pandemic. Multivariable regressions were run (p < 0.05 as significant).

Results

Up to date, participants were 333 (88% female). Mean age was 40.7 years (SD = 6.7). Considering their children, 52.9% were female and mean age was 6.62 (SD = 4.3). A total of 12.6% of children passed the SDQ cut-off. Having parents who are healthcare workers (adjOR=4.1), having parents positive for K6 (adjOR=4.0) and having a poor economic situation (adjOR=3.9) were significantly associated with a higher probability of passing the cut-off. Considering the pandemic, 15.4% declared their child had worse sleep, 12.2% lower appetite, 6.6% more physical issues, and 22.9% more mental issues. Using electronic devices more than before the pandemic was significantly associated with worsening of sleep (adjOR=2.9) and appetite (adjOR=6.9). Having parents who are healthcare workers was significantly associated with worsening of sleep (adjOR=2.3) and mental health (adjOR=2.4). Having parents positive for K6 was significantly associated with worsening of mental health (adjOR=5.3).

Conclusions

This study suggested a perceived substantial worsening of children's health, especially considering mental health. Exploring how parents recognize their children's health and how the COVID-19 has changed daily habits should be considered as a public health priority in Europe.

Key messages

Covid-19 pandemic in north-west Italy: the potential role of meteorology, air pollution and pollens

Background

Italy was the first western country severely affected by the Covid-19 pandemic attesting more than 16 million cases since the outbreak began. Po Valley regions have been most afflicted, with Piedmont ranking sixth at 25,899 cases/100,000 inhabitants. Within this area, air dispersion is hampered making Po Valley a recognised air pollution hotspot. We aimed to explore the potential association between the environment and Covid-19 incidence.

Methods

Daily key air pollutants (NO2, NO, CO, O3, PM10, and PM2.5), meteorological parameters (temperature, %humidity, wind speed and solar radiation), pollens and Covid-19 cases were collected from 01/01 to 31/12/2021 in Turin, Italy. This ecological study preliminarily tested correlations (Spearman) between air pollutants and Covid-19 cases.

Results

The Covid-19 pandemic followed a seasonal trend with the highest number of cases (/100,000 inhabitants) in winter and spring (3.1) followed by autumn (1.3) and summer (0.5) (KW test p < 0.0001). Likewise, all air pollutants showed peaks in winter and autumn and sensibly decreased during spring and summer apart from pollens and O3. O3 follows the photochemical processes reaching its peak in the sunniest periods, while pollens undergo their natural vegetative process. Daily Covid-19 cases were positively correlated with daily-averaged NO2 (0.50, p < 0.0001), NO (0.48, p < 0.0001), CO (0.81, p < 0.0001), PM10 (0.36, p < 0.0001), PM2.5 (0.39, p < 0.0001), pollens (0.15, p = 0.073) and inversely with O3 (-0.44, p < 0.0001). We plan future analyses to test the hypothesized association by enhanced models with lagged air pollution variables, with demographic characteristics and meteorological data as potential confounders.

Conclusions

Results from ecological studies may support researchers’ preliminary understanding of the interplay between environment and Public Health issues, including pandemics. A multidisciplinary approach is mandatory to deepen the complexity of this topic across European regions

Key messages

• The Covid-19 pandemic may be associated with environmental conditions and air pollution but further research is needed.

• Atmospheric particulate matter, including aeroallergens, can favour many airborne-related diseases by acting as immune suppressor and/or carrier, but these hypotheses deserve future research.

Is the pandemic leading to a crisis of trust? Insights from an Italian nationwide study

OBJECTIVES

Along with mistrust toward politics and journalism, the pandemic is amplifying mistrust in healthcare. To explore trust in key professionals among the Italian population, we focused on perceived change in trust during the pandemic.

STUDY DESIGN

Nationwide online cross-sectional survey (called COCOS).

METHODS

COCOS was conducted in Italy in two periods: the end of the first lockdown (T1: April-May 2020) and the end of 2020 (T2: November-December 2020). Descriptive analyses and multivariable logistic regressions were performed (sample size = 2673).

RESULTS

Trust in healthcare workers (HCWs) was reduced in 1.5% of participants (T1) and 2.8% (T2). Trust in scientists/researchers was reduced in 5.8% (T1) and 7.6% (T2). Trust in politicians was reduced in 37.6% (T1) and 52.3% (T2). Trust in journalists was reduced in 41.7% (T1) and 48.3% (T2). Considering multivariable models, participants of the second period, participants who were HCWs, participants with anxiety symptoms, and those experiencing economic struggle due to the pandemic had a higher likelihood of having a reduced trust. The period had the strongest association with reduced trust.

CONCLUSIONS

We argue that a central role might be played by the pandemic fatigue. We suggest leading figures should be more aware of the relationship between communication and trust. The pandemic is a real-world experiment in reshaping mediated communication and, although social media play an important role, other approaches might be successful. As a notable part of the population is trusting politicians and media less and less, Italian key professionals should implement initiatives to reinvigorate public support.

Are 2020’s medical students still suffering from gender stereotypes? An Italian study

Background

Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students.

Methods

During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness.

Results

Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p &lt; 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p &lt; 0.05) and those who have received good example from tutors (coefB 0.14, p &lt; 0.05) were more gender-sensitive. Older age (coefB 0.04, p &lt; 0.05), a better knowledge on gender medicine (coefB 0.12, p &lt; 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p &lt; 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p &lt; 0.05), male sex (coefB 0.12, p &lt; 0.05) and older age (coefB 0.03, p &lt; 0.05) were associated with more stereotypes towards doctors.

Conclusions

Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered.

Key messages

Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.

Vaccine adhesion before and after Vaxzevria suspension in a Local Health Unit of Piedmont - Italy

Introduction

The Oxford-AstraZeneca vaccine Vaxzevria is a viral-vector vaccine developed to prevent COVID-19 infection. Two doses scored 81.3% efficacy against symptomatic infection and 100% against hospitalization. In Italy, Vaxzevria use started in February. After two deaths among the Army, Italian Medicines Agency withdrawn the vaccine batch involved. News about fatal thrombosis increased, together with population concern. On March 14th, the Piedmont Region suspended another batch following a new time-related death. The following day, several European states suspended Vaxzevria administration waiting for indication from an EMA meeting on March 18th. The aim of Authors was to study the effect of suspension on adhesion among general population.

Methods

Authors registered vaccine adhesion of vaccination centers offering Vaxzevria. To access vaccination, people was requested to express willingness through a website. Then, access was granted with a summoning SMS or e-mail. Vaxzevria target populations were members of law enforcement agencies and school personnel of any age. Data from February 25th to April 12th form a Local Healthcare Unit in Piedmont Region (Italy).

Results

Vaccine adhesion ranged from 95 to 100% from February 25th to March 12th (mean 97%). During March 13th it decreased to 73%, then 48% on March 14th, the day of local withdraw of all Vaxzevria doses in Piedmont Region. Activity restarted on March 19th with a 65% of adhesion, and a mean of 75% (69-81%) in the following days. From March 24th-31th adhesion recovered, with a mean 89%. April 1st-12th recorded a plateau: 81-100%, mean 91%. From March 13th a total of 1478 people out of 8339 (17.7%) did not receive their scheduled vaccination.

Conclusions

Both news and official statements had an impact on trust and vaccine adhesion among population and dramatically slowed the COVID-19 vaccine campaign, with a possible effect on infection spreading. Further data and analysis will be provided in the following months.

Key messages

Vaxzevria temporary suspension had an impact on vaccine adhesion. Vaccine adhesion took one month to go back to previous values.

Gender medicine: a cross-sectional survey on knowledge and curriculum among Italian medical students

Introduction

Gender and sex are important predictors of many attitudes and behaviours that have an impact on health and disease. Gender medicine is then a fundamental approach for better quality of care in Europe. Few information is available on Italian medical students and their knowledge about gender medicine. Our study aimed to investigate knowledge about gender medicine in a sample of Italian medical students in order to identify specific knowledge gaps and improve Medicine degree curricula.

Methods

In 2020, an online cross-sectional survey was conducted on 430 medical students of the University of Turin, Italy. Participants filled out a questionnaire consisting of 29 items concerning the areas of knowledge and attitudes regarding gender medicine. Multivariable logistic regression model was performed to explore potential predictors of knowledge among students.

Results

More than 60% of the students knew the correct definition of gender medicine and around 90% of them knew the difference between sex and gender. In total, 58.16% of female students had a good level of knowledge, significantly more than male students (37,5%; p &lt; 0.001); female students also showed a higher mean score compared to male students (respectively 17.96±2.75 vs 16.59±3.20, p &lt; 0.001). Using a multivariate linear regression model, with level of knowledge about gender medicine used as a continuous variable, we found that being female was the only potential predictor of high consideration of gender medicine in patient management.

Conclusions

The results indicate that students have a good knowledge and high regard for gender medicine. Female students seem more aware of the importance of gender medicine and areas of improvement can be identified. Future European physicians must consider gender medicine in order to encourage a patient-tailored approach and to reduce gender gap still existent in current practice.

Key messages

Gender medicine is a fundamental approach to improve quality of care and to reduce gender gap among European patients. Medical students should be more aware and trained about gender and sex differences during clinical practice in order to encourage a patient-tailored medicine.

Design, implementation and assessment of a drive-through flu mass-vaccination program in Italy

Problem

The SARS-CoV-2 pandemic has completely changed health systems around the world.

As part of a mass immunization campaign with COVID-19 vaccines, it was necessary to study new methods to vaccinate a large number of people in a short time and in complete safety.

Description of the problem

To ensure the requirements of speed, safety and low cost, we therefore designed an EBM model of drive-through flu-vaccination, built in the city of Rivalta di Torino (about 20,000 inhabitants), in Northern Italy, on two Saturdays in November 2020. The project was created by Public Health Residents with the collaboration of the Municipality, a team of Family Doctors and Civil Protection.

Results

We measured driving time for each vehicle from the check-in station to the parking zone designed for the 15min post-vaccination follow-up. We calculated the mean length of stay time (LOS) and the mean time per person based on the number of individual vaccinations given per vehicle. In two days, 1539 vaccines were administered. Flows were only timed on the first day (417 vehicles and 672 vaccines). The highest percentage of cars (47%) received only one vaccination per vehicle, followed by 2 (45.8%), 3 (6.2%), and 4 (1%) vaccines per vehicle. The optimal number of vaccinations per vehicle to maximize efficiency was 4: the average LOS per vaccination decreased from 2.54 minutes per person (1 vehicle=1 person) to 0.34 seconds per person (1 vehicle=4 people). The mean LOS time was 3.06min (SD1.11).

Lessons

This model appeared as a real possibility to start a rapid, effective, safe and low-cost mass-vaccination program in the Italian setting. It also seems to be appreciated by the population, not only in terms of novelty but also for the sense of security and speed of the process. For this reason, in April 2021, the same model was successfully applied in the same area for COVID-19 vaccination.

Key messages

The drive-through model appeared as a real possibility to start a rapid, effective, safe and low-cost mass-vaccination program in the Italian setting. The Pandemic has changed the needs and methods of carrying out common health practices: the drive-through model has proved to be a valuable resource for mass vaccination.

Is the hospital Safety Walkround effective to control the risk of contagion during COVID-19 pandemic?

Background

The Safety Walk Round (SWR) is a risk assessment technique designed to decrease adverse events and improve workers attitudes about safety culture through visits and interviews about safety of care. A new field of application could be the safety requirements that hospitals have to guarantee during the Covid-19 pandemic. Our study aimed to investigate the efficacy of SWR on identifying and solving the critical issues that can increase the risk of SARS-CoV-2 infection in three Italian hospitals.

Materials and Methods

The project was developed during the first wave of SARS-Cov-2 pandemic, from May to July 2020, it involved 3 hospitals in Turin: Traumatology and Orthopaedic Centre, Paediatric Hospital Regina Margherita and Sant'Anna Hospital (obstetric and gynaecological hospital). Pre-triage services and outpatient waiting rooms were identified as areas at higher risk of crowding and potential non-compliance with anti-contagion rules. The first round consisted of observations focused on hands sanitation, safety social distance, PPE correct use. Than the workers of the observed areas were interviewed. Thanks their participation, the critical issues about patient safety and the potential resolutions were identified. A second round was realized to verify the implementation of the planned actions and their effectiveness in solving the issues.

Results

A total of 4907 moments were observed and the 9,1% of them was at risk of contagion. During the interviews 23 critical issues and their possible resolutions were identified. A total of 14 critical issues were solved, 4 partially solved and 5 were build environmental problems and cannot be solved. The 77% of total were completely solved, excluding built environment issues.

Conclusions

SWR project was effective in involving health workers in safety promotion activities, sharing informations and improving trust between hospital managers and operators and spreading new skills about safety culture in Covid-19 pandemic contest.

Key messages

SWR was effective in a pandemic context. During the emergency, the front line staff were enthusiastic about the method and felt listened and guided.This has contributed to achieving the aim of safety.

The study showed that SWR is a useful tool for hospital infection control. It also showed that the SWR method can be used in a time of constant change that requires adaptability like a pandemic.

Italian flu season 2020-2021: reasons for the drop and insights for the future

Background

Having seen the trend of 2020 flu season in the Southern hemisphere, the objectives of this study were to describe the trend of 2020-21 flu season in Italy, relating it with containment measures undertaken due to COVID-19, and to provide insights for next flu seasons and prevention of airborne diseases.

Methods

We collected data on Italian influenza virological samples on FluNet. We also collected French, German and Spanish data as a comparison. Data on Italian ILI (influenza-like illness) surveillance system were assessed with InfluNet. We used the Containment and Health Index of the Oxford COVID-19 Government Response Tracker (OxCGRT) to evaluate the impact of containment measures on Italian ILI incidence (Spearman's correlation).

Results

No sample out of 6818 tested positive to influenza virus in Italy in 2020-21 flu season; 21.6% of the samples tested positive to SARS-CoV-2. France, Germany and Spain registered a maximum of 0.10% of positive samples to influenza virus. In Italy the mean of positive samples to influenza virus in seasons from 2015-16 to 2019-20 was 28.8%; the mean number of processed samples in those seasons was 14008. ILI incidence in Italy remained at interseasonal levels during all flu season (mean 1.44/1000; range 0.85-2.04). According to the Containment and Health Index, with increasing containment measures a deflection of ILI incidence in Italy was described (p = 0.015).

Conclusions

Containment measures, along with rise of seasonal flu vaccination, are the most likely factors to explain the drop in cases in Italian 2020-21 flu season. The reduction of cases in neighbouring countries lower the role of the downsizing of Italian surveillance system seen in 2020-21 compared to seasons from 2015-16 to 2019-20. Rules and conducts may perpetrate the benefit on the decreased disease activity seen in 2020-21 flu season.

Key messages

Containment measures and flu vaccinations are the most impacting factors on the drop of influenza cases in 2020-21 in Italy.

Though the Italian surveillance system was downsized in 2020-21, the experience of neighbouring countries suggests that the decreased flu activity was factual.

COVID-19 fake news, conspiracy beliefs and the role of eHealth literacy: an Italian nationwide survey

Background

The pandemic has been accompanied by an infodemic, which includes false information that can lead to harmful consequences. Additionally, conspiracy theories have been linked to lower preventive behaviors. This work mainly aims to explore the skill in identifying COVID-19 fake news and the conspiracies beliefs.

Methods

A cross-sectional study has been conducted amongst a convenience sample throughout Italy, using a Computer-Assisted Web Interview method (from 12 April 2021-ongoing). The survey included the Single-Item Literacy Screener (SILS), the eHealth Literacy Scale (eHEALS), a Fake News Score (FNS: percentage of misclassified news), a Conspiracy Score (CS: score from 1 to 5). Multivariable linear regressions were run (p &lt; 0.05 as significant).

Results

Up to date, participants were 1252. The median FNS and CS were: 25% (IQR=19-44) and 2.8 (IQR=2.2-3.4). For instance, 54% thought ibuprofen worsens COVID-19 symptoms and 50% agreed with “politicians usually do not tell us the motives for their decisions”. The 17% had low health literacy (SILS) and 41% low eHealth literacy (eHEALS). COVID-19 vaccine hesitant people were 13%. The multivariable models identified many significant relationships. Low economic status and vaccine hesitancy were positively associated with FNS and CS. Higher education had a negative association with FNS and CS. Age was positively associated with FNS. Low health and eHealth literacy were positively associated with FNS. Low eHealth literacy had a negative association with CS. FNS was positively associated with CS.

Conclusions

Associations between news misclassification, conspiracy beliefs and vaccine hesitancy might suggest shared determinants. EHealth literacy had a conflicting role. Attention should be paid to the mass media COVID-19 coverage as key information source for the general population. Public health campaigns should be planned to fight beliefs that hinder the reduction of transmission and might cause additional damages.

Key messages

The median percentage of misclassified news was 25% (IQR=19-44) and the median Conspiracy Score was 2.8 (IQR=2.2-3.4). COVID-19 vaccine hesitant people were 13% and 41% had a low eHealth literacy. News misclassification, conspiracy beliefs and vaccine hesitancy were associated. EHealth literacy had conflicting associations with fake news and conspiracy beliefs.

COVID-19 outbreaks in places of worship worldwide: a systematic review

Background

Since the beginning of the CoViD-19 pandemic, scientific community raised concerns about mass gatherings: religious ones in particular could become the perfect soil for the Sars-CoV-2 transmission due to the environmental conditions (e.g. not-ventilated worship hall, no distance between attendees, physical contact). Thus, this systematic review aimed to explore CoViD-19 outbreaks in places of worship worldwide.

Methods

A systematic search of three electronic databases (PubMed, Scopus and Embase) was performed, including years 2020 and 2021 until March, 29th. Criteria of inclusion were articles published in English, French, Italian, Spanish or Portuguese, dealing with CoViD-19 outbreaks reported in churches, mosques, synagogues and other places of worship, regardless of region or religion. Pilgrimages were excluded.

Preliminary Results

Out of 7655 articles found, 36 were included, for more than 50 outbreaks reported. The number of persons involved in each cluster varied from units to several thousands, while the geographic distribution displayed reports mainly concerned about East and Southeast Asia (65%), Europe (15%) and North America (15%), referring to gatherings carried out in the first semester of 2020, in particular in February and March. The most involved religions were the main monotheistic ones (i.e. Christianity, Islam and Judaism), although the eastern religions played an important role too.

Conclusions

In reason of religious gatherings, places of worship had had an important role in the virus transmission, becoming the first cause of contagion in several countries especially during the first wave of the pandemic, because of the absence of social distancing, masks use, danger awareness and, in some cases, poor hygiene conditions or CoViD-19 denial. Although there was a different risk associated with different religions, this systematic review highlighted how important is to evaluate worship-related outbreaks as a major public health concern.

Key messages

50+ worship-relate clusters with a variable range of persons involved were reported principally from Asia, Europe and North America. The main monotheistic religions were more implicated. Places of worship became the first cause of contagion in several countries especially during the first wave of the pandemic: these outbreaks should be considered as public health concerns.

Consequences of cyberaggression on Social Network on mental health of Italian adults

Background

Cyberaggression (CyA) comprehends a broad spectrum of hostile behaviours carried out through electronic means. Acts of CyA were studied mostly among adolescents. This cross-sectional study aims to evaluate the nature, extent and outcomes in terms of depressive and anxiety symptoms as well psychosomatic disorders in adults in Italy.

Methods

An internet-based survey comprehensive of 34 items was distributed through Social Media and targeted only adults. Descriptive analysis and correlation tests were performed in order to identify the extent of the CyA phenomenon.

Results

The survey received a response from 341 Participants (60% women), 43% of them declared to have been victim of CyA almost 1 time in their life and the most representative forms were insults (24.7%) and harassment (19.9%). Only 13% of participants were author of acts of CyA almost 1 time in their life, and 11% of them insulted someone else online. The 74.1% was bystander of CyA episodes as insults (62.7%), discrimination (62%) and defamation (47.8%). According to 95.1% of participants, these episodes were seen on Social Network, 17% on Facebook. The 39.5% of participants asserted an increased frequency of the events during the pandemic restriction. The main reasons of CyA declared were politics (70%), racism (65.8%), sexual orientation (65%) and female gender (53.1%). Chi square Test showed a significant correlation only between sexual orientation and victimization (69.4% of non-heterosexual asserted to be victim). The 33.6% of victims of CyA asserted anxiety and sadness after episodes, while the 39.8% stated to be angry.

Conclusions

CyA episodes are widespread in the European context and potentially harmful for mental health of victims. Sexual and ethnic minorities and females are more frequently the target. Pandemics enhanced this phenomenon. European public health professionals should take into careful consideration this issue for its potential negative consequences.

Key messages

Cyberaggression is a widespread phenomenon in Europe with potential negative consequences on mental health of victims, especially during the current pandemic. Sexual and ethnic minorities and females are more frequently the target of cyberbullying and European public health professionals and policy-makers should implement strategies to prevent this issue.

Mental health and access of care during Covid-19 pandemics: an italian cross-sectional study

Background

COVID-19 emergency forced nations to introduce containment measures to reduce the spread of the virus. This study assessed the possible effects of the pandemic on mental health and care access.

Methods

A cross-sectional study was conducted in Italy in two observation periods in 2020: April-May (first lockdown) and November-December (no lockdown). Categorical variables were compared with χ2 tests. Mental health outcomes (PHQ-2 ≥ 3; or GAD-2 ≥ 3) and outcomes related to care access were considered. Multivariable logistic regression models were performed.

Results

Participants were 2673 (66.8% female; mean age=44 years, SD = 15). Depressive symptoms were found in 24.7% of participants, while 24.2% showed an anxious symptomatology. A total of 12.5% said they voluntarily gave up scheduled medical service, 6.4% avoided acute treatments, and 5% changed therapy themselves. Comparing the two periods, there were no significant differences in the outcomes under study. Students were at higher risk of depressive symptoms (OR = 2.23; 95% CI 1.42-3.52; p = 0.001). Women and those who increased the time on internet presented an increased risk of developing depressive and anxious symptomatology. The scheduled medical service was mainly postponed by those who said they were afraid to go out of necessity (OR = 2.49; 95% CI 1.87-3.32; p &lt; 0.001) or to cause themselves an injury (OR = 1.78; 95% CI 1.32-2.40; p &lt; 0.001). Foreigners (OR = 4.24; 95% CI 1.70-10.55; p &lt; 0.002) are more likely to avoid acute treatment. Workers and those with anxious disorders appear to be more inclined to self-medicate (OR = 2.05; 95% CI 1.29-3.26; p = 0.003).

Conclusions

Compared to the pre-pandemic period, higher levels of anxiety and depression were observed. No differences in mental health and care access were shown between the two observation periods. Being afraid to go out of necessity and avoidance of physical activity for fear of injury is related to reduced access to care, but not to self-medication.

Key messages

The 24.7 % of the sample reported depressive symptoms, and 24.2 % anxious symptoms. Similar increases were observed in both periods: April-May (first lockdown) and November-December (no lockdown). During the pandemic, delayed access to planned and acute care, avoidance of physical activity for fear of injury, and self-medication pose a major public health challenge in the coming period.

COVID-19 lockdown and physical activity changes in Italy: a cross-sectional survey

Background

The global pandemic of COVID-19 has caused radical changes in the structure of people's daily routines in most of the countries around the world and have had a big impact on physical activity (PA) and daily movement. Previous studies reported the increase of sedentary behaviours during movement restrictions. This study investigates the impact of the first Italian lockdown measures (9 march - 3 may 2020) on PA habits and factors potentially associated with starting or ceasing PA practice during home confinement.

Methods

A web-based cross-sectional survey was carried out using an online 40-item questionnaire spread in May 2020 in Italy. Multivariable regressions were performed.

Results

A total of 1865 people were enrolled. During lockdown, PA was performed by 65.5% of the sample. Overall, the number of physically active people increased by 8%, compared to the pre-pandemic period level (56%). A change in PA habits occurred in 34.1% of the sample (37.9% of them stopped PA and 62.1% started it). Starting PA during lockdown was related to being on a diet, whereas living with children and having poor psychological well-being were inversely related with starting PA. Conversely, unhealthy factors like being overweight or obese, having poor mental well-being and the occurrence of emotional overeating were related to stopping PA during lockdown.

Conclusions

The first Covid-19 Italian lockdown had a significant impact on healthy habits of the population, leading to an increase of physically active individuals. Furthermore, a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.

Key messages

Physical activity habits changed during lockdown due to Covid-19 pandemics and a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.

Neonatal malformations: organization of information flows in the S. Anna Hospital of Torino

Background

Congenital malformations (CMs) represent a serious public health problem, both in terms of size (3% newborns/year) and severity of outcomes. The surveillance activity carried out by the Registers is an important tool for monitoring the frequency of events, to evaluate etiology, support research and public health actions. The aim is to evaluate the organization and the information network related to the diagnosis of malformation in the S. Anna presidium.

Methods

the retrospective study analyzed all newborns with one or more CM and all cases of TOPFA (Termination of Pregnancy for Fetal Anomaly) for CMs in the period 01/2020 - 01/2021. A forward-looking pilot study was then set up to assess the impact on the quality of data collection through the introduction of a MC sheet.

Results

510 cases of CMs were found in live births, 180 in TOPFA for CMs and 4 in stillbirths. The duration of hospitalizations averaged 14.5 days (σ 36.56), with a median of 4 days. In the CMs group, an average maternal age of 33.40 years (σ 9.32), a median of 33 years and a mode of 33 years were calculated, in the TOPFA group an average maternal age of 34 years (σ 6.34), a median of 34 years and a mode of 32 years. In the live births group, 701 maternal diagnoses were detected, categorized and compared with the various national reports. The MC Sheet was compiled for 60 patients, 16 (4.30%) patients before the introduction of the sheet (01/2020 - 09/2020) and 44 (30.43%) after its introduction (10/2020 - 01/2021). Regarding the assessment of the proper use of ICD9CM an adequacy of 78% was observed in the first group vs one of 100% in the second.

Conclusions

Our preliminary data assess the need for a Regional registry, for a comparison with the main national and regional sources available (also with a view to possible participation in the EUROCAT and ICBDSR registers) and for regional health planning.

Key messages

The study underlines the need for a Regional Registry of congenital malformations. The clinical file is not always a complete source for analysing data on congenital malformations.

Pre-exposure prophylaxis' knowledge, attitudes, practices amongst italian men who have sex with men

Background

Pre-exposure prophylaxis (PrEP) is suitable for human immunodeficiency virus (HIV)high-infection-risk people, foremost amongst males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use.

Methods

An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour, knowledge on HIV and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify possible associations with PrEP knowledge.

Results

A total of 196 MSM completed the survey. Overall data showed very good HIV and safe sexual behaviour knowledge (94.4% of correct answers). Nevertheless, our sample rarely used PrEP because of existing barriers: high therapy price (26.9%)and fear of side effects (23.8%). Only 10.3% of partecipants were informed on HIV and PReP by institutional channels, even less (7.5%) from specialized physicians and general practitioners. The most significant association with PrEP knowledge was having regular HIV-tests (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29);

Conclusions

PreP's Knowledge was well established, but PrEP use was not widespread. It is necessary to improve communication on PrEP and to lower existing barriers in order to grant access to PrEP access.

Key messages

Barriers to access PrEP have to be lowered. Healthcare personnel has to be involved in PrEP's benefits communication.

Depression and post-traumatic stress disorder symptoms during the COVID-19 pandemic in Italy

Introduction

Social restrictions imposed by the Italian Government during the COVID-19 emergency might have had a significant impact on mental health. The purpose of this study was to estimate the prevalence of depressive and post-traumatic stress disorder (PTDS) symptoms in a sample of Italian citizens during the first COVID-19 pandemic wave.

Materials and methods

A cross-sectional survey was carried out between April and June 2020 using a snowball sampling. Depressive symptoms were explored through the Patient Heath Questionnaire-2 (PHQ-2), while the post-traumatic stress disorder (PTDS) was investigated through the SPAN (Startle, Physical arousal, Anger, Numbness) questionnaire. Poisson regression models were used to explore the association between the outcomes under study and sociodemographic/housing characteristics.

Results

A total of 10.758 interviews were collected and 7.847 (73%), complete for a minimum set of indicators (age, sex, area of residence), were included in the final analysis. The majority of the respondents were females (71%). Sample mean age was 48.6 years. The prevalence of depressive symptoms was 21.2% and that of PTDS was 43.8%. Symptoms of depression and PTDS significantly diminished across age groups, in particular in people over 70 years compared with people aged 14-29 years (PR 0.65, 95% CI 0.49-0.86). A higher prevalence was found in students compared with retired people, both for depressive symptoms (PR 1.49, 95% CI: 1.05-2.10) and PTDS (PR 1.31, 95% CI: 1.02-1.69).

Conclusions

Prevalence of depressive and PTDS symptoms was high, in particular among younger people and students. That could potentially lead to adverse mental health outcomes in the future, with serious public health consequences. As the pandemic emergency is not solved yet, it is necessary to implement preventive strategies in order to protect the mental well-being of particularly vulnerable subgroups in the population.

Key messages

The prevalence of psychological symptoms was high in this sample during the first wave of COVID-19 pandemic.

The subgroups of the population at higher risk for adverse psychological outcomes were younger people and students.

The underestimated burden of aspiration event and pneumonia within hospitals: what happens after dysphagia

Study design

Prospective observational study.

Background

Despite dysphagia large prevalence and the growing ageing phenomenon occurring in European countries, aspiration events among inpatients are often underestimated, given their frequent spontaneous resolution or silent contribution to aspiration syndromes. Our main objective was to evaluate the incidence of aspiration events among medical inpatients and to identify risk factors influencing the outcome of the event.

Methods

Data about aspiration events - day, hour, type and outcome of the event occurred - along with underlying patient clinical conditions at the admission were collected. Between May 2015 and September 2016, data about aspiration event occurred among medical inpatients were collected in three large Italian hospitals.

Results

Patients affected by aspiration events were 135 on 102,619 cumulative days of hospitalization; they were mostly females (53%) with an average age of 82. The total incidence of aspiration events was of 1.4 every 1,000 days of hospitalization (C.I. 95%: 1.2-1.7) and the most frequent manifestation was cough (61.6%). The addition of drugs or an infection diagnosis during the 24 hours preceding the event acted as risk factors for those events that needed additional interventions during the hospitalization (OR 3.1 e OR 1.9 respectively), while the elimination of one or more prescribed drugs seemed to lead to aspiration events without impact on the hospitalization.

Conclusions

Results showed a large incidence of aspiration events within medical wards, many of them influencing patient outcomes. Healthcare professionals' attention concerning aspiration events should be fostered during the first hours and days of hospitalization.

Which is the best communication strategy, based on anti-tobacco ads, to impress teenagers? A multicenter cross-sectional study

BACKGROUND

Well-planned mass-media campaigns can increase health literacy and raise awareness about the consequences of tobacco use. This study aims to evaluate the emotions and opinions of adolescents about several anti-tobacco spots delivered by the mass media over the world.

STUDY DESIGN

Cross-sectional study.

METHODS

The study was conducted in Italy in 2016-2017 among students aged 13-17 years. Students expressed their emotions and opinions about seven anti-tobacco spots from all over the world on different topics and styles.

RESULTS

499 students attended. The video "Sponge" was found to be the most impressive (30.2%) and what they would have chosen if they had been responsible for campaign launched by the Minister of Health (40.5%). The "Icons" spot ranged second, with 19.2% and 17.4%, respectively.

CONCLUSIONS

In summary, this study showed that the communication strategies most effective, according to the students interviewed, are those that give clear messages with a scientific profile or that discover the false stereotypes, as in the video "Icons". However, further research is needed to investigate the effectiveness of TV campaigns against smoking, in terms of habits and knowledge in young people.

[Organization and management of clinical-care pathways at the Regina Margherita Hospital in Turin during Covid-19 emergency]

The Covid-19 pandemic significantly increased the workload for the Italian Health Service. There is few information in the literature on the pediatric population and on the management of pediatric hospitals. The aim of this article is to describe the management of healthcare services during Covid-19 emergency in Regina Margherita Children's Hospital. The Regina Margherita Children's Hospital is specialized in the prevention, diagnosis and treatment of pediatric diseases. About 1000 health worker work in this Hospital and 278 hospitalization places are available.

Mediterranean diet and mental health in university students: an Italian cross-sectional study

Background

Well-being is essential for positive mental health among university students, influencing their later attitudinal and career outcomes. Many factors contribute to endanger students' mental health, including academic stressors, as well as unhealthy lifestyles. Following a Mediterranean diet (MD), widespread in Europe, is proved to have a protective role for mental health. Our aim was to investigate mental well-being and adherence to the MD in university students.

Methods

In 2019, a cross-sectional study was performed in Turin, Italy. Totally, 502 university students were enrolled. A socio-demographic form, the Mediterranean Diet Adherence Screener (MEDAS) and Warwick-Edinburgh Mental Wellbeing Scale (WEMBS), were used. Mainly, multivariable linear and logistic regressions were performed to investigate potential predictors of adherence to the MD and of psychological well-being (p &lt; 0.05 considered significant).

Results

The 24% of the sample resulted at high risk of depression (WEMWBS score&lt;40) and the 22.7% at high risk of psychological distress (WEMWBS score 41-45). The median MEDAS score was 6 (IQR=2, non-normal distribution) in a possible range between 0 and 14 (the higher is the score, the higher is the adherence). Preliminary results showed that a MEDAS score ≥6 was associated to a lower risk of depression (OR = 0.78, p = 0.006). Not being on time with university exams (OR = 2.65, p = 0.002) and not having an excellent health status (OR = 1.94, p = 0.23) led to a higher depression risk instead. The main variables that had a negative association with MD adherence were WEMWBS&lt;40 (coef=-0.65, p = 0.001) and not cooking personally (coef=-0.30, p = 0.04).

Conclusions

Students who reported greater adherence to the MD were those with the lowest risk of depression. The potential protective role that MD has for mental health in young adults could be used to help developing more comprehensive intervention strategies of health promotion among European university students.

Key messages

Adherence to the Mediterranean diet and good mental health seem to be related in a sample of university students analyzed through multivariable regressions. European policies and strategies addressing unhealthy lifestyles and encouraging Mediterranean diet adherence could be useful to improve well-being and mental health of university students.

Beyond COVID-19: a cross-sectional study in Italy exploring the Covid Collateral Impacts

Background

The COVID-19 pandemic is a calamity affecting many aspects. In particular healthcare services (HCS) are facing a great stress-test worldwide. The present work aims to explore what were health needs, beyond COVID, not covered among Italian citizens, due to fear, lockdown measures and overload of HCS, also in order to understand if there are specific subgroups of populations that will need urgent access to health services in the next future.

Methods

COCOS (COvid COllateral impactS) is a cross-sectional study performed during the Italian lockdown between April and May 2020. A forty-nine items online questionnaire was filled by the respondents. Participation was voluntary and without compensation. Informed consents were obtained. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed in ORs.

Results

Totally, 1,515 questionnaires were collected. Median age was 42 years, 65.6% were females. Around 22% declared to suffer from chronic diseases. Interestingly, 32.4% of the sample faced a delay of a scheduled Medical Service (MS) by provider decision, while 25.6% reported that this issue hit a family member. More than 13% refused to access scheduled MS for the fear of contagion, and the 6.5% avoided HCS even if having an acute onset issue: this behavior was associated with scarce trust in physicians (AdjOR 0.75); alarmingly, 1.5% avoided Emergency Department when in need and 5% of the sample took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR: 2.16; 95% C.I.: 1.16-4.02).

Conclusions

COVID-19 immediate effects are just the tip of the iceberg. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. To estimate the effects of the pandemic on non-COVID-19 patients is required, leading to aimed efforts, to reduce the backlog that HCS incurred in.

Key messages

COVID-19 biggest toll on public health is still to come if not prevented, due to temporary but widespread suspensions of scheduled medical services and the avoidance of these for fear of contagion.

The most in need are the most vulnerable: older patients and those with chronic conditions are the most affected by suspension of medical services and will potentially pay the greatest cost.

Vaccination knowledge, attitudes and practices in patients with HIV: a cross-sectional survey

Background

Infectious diseases are more common and severe in patients with HIV, which show different response to vaccines and a diminished protection. It is therefore very important to assess knowledge and attitudes towards vaccination in people with HIV, since precise vaccination coverage and vaccine hesitancy are not well established in this subgroup of patients.

Methods

A sample of 119 patients with HIV completed a cross-sectional survey. Patients were recruited during their routine medical examination at the infectious diseases clinic in Turin. The survey explored these main areas: demographics and history of HIV infection, vaccination history, attitudes towards vaccination, confidence in the public health system, contagion risk and disease seriousness perception. In this preliminary phase descriptive analysis were conducted.

Results

Preliminary data show that mean age of the participants was 49.51 years, 80% were males. The median of HIV infection duration was 10 years, while the median of the lymphocyte count was 762.50 cells/mm3. The disease with the highest vaccination coverage was tetanus (88.7%), considered a serious or very serious disease by 85.6% of the participants, despite low or very low contagion risk perception (84.1%). The disease with the lowest vaccination coverage was Herpes Zoster (7.3%), despite high or very high seriousness perception (70%). Furthermore, 99.1% of the participants showed high or very high confidence toward public health system professionals, and the majority of them (59.5%) stated that vaccines are more useful for the community than for the single person.

Conclusions

Vaccination coverage is still not fully satisfactory regarding diseases considered infrequent or mild. Considering the high level of confidence toward the public health system that has emerged, it is necessary to implement informative and operative strategies about vaccination for European HIV patients, which are particularly at risk regarding infectious diseases.

Key messages

Vaccination coverage and risk perception in HIV patients is not satisfactory for many diseases and an effort to implement informative strategies in Europe is needed. The role of vaccination in preventing infectious diseases in HIV patients should be recognized and strengthened by relying on the high level of confidence toward European public health systems.

Prevalence and predictors of stress, suicidal thoughts and depression in Italian university students

Background

Depression is a major public health issue in Europe. The prevalence of depressive symptoms (DS) in university students (US) is considerably higher than in the general population.

Since few data on DS among Italian US exist, this study aimed to estimate perceived stress (PS) and DS prevalence and assess associated factors in Italian US.

Methods

A cross-sectional study was performed in the Social Sciences and Educational Sciences degree courses at University of Cassino through self-administered questionnaires including socio-demographic items, Beck Depression Inventory-II (BDI-II) scale and Perceived Stress Scale. Primary outcomes were DS presence (BDI-II score≥14), suicidal thoughts (ST) and PS. Multivariable analysis and linear logistic regressions were performed.

Results

Globally, 203 questionnaires were collected (23 BDI-II missing). DS and ST prevalence was 30.6% and 11.3 %. PS median score was 20 (IQR=11) and 87.7% reported moderate/severe PS. Family history of psychiatric disorders and not being a freshman (attending first years of courses) were significantly (p &lt; 0.05) related to DS, while not thinking that University hinders carrying out personal activities was protective. High PS and having a chronic disease were significantly associated with ST, while family cohesion appears to be protective. High PS was significantly associated with: female gender, family history of psychiatric disorders, thinking that University hinders resting and relaxing, being under psychiatric/psychological care and having chosen university for Intellectual curiosity. Having no worries about future was linked to a lower PS.

Conclusions

This study found an alarmingly high prevalence of DS and ST in Italian US. Further longitudinal studies need to define risk factors for depression and stress in US. Public health actions such as offering preventive treatment interventions could improve health in European US.

Key messages

Depressive symptoms can be widespread up to 30% of university students and European policies should afford this issue with a strong commitment in order to reduce harmful consequences. Predictors of depressive symptoms, such as university workload and family cohesion, are recognizable and can be a target for European strategies aimed to improve university students’ mental health.

Empowering seizures awareness: knowledge, attitudes and fears of school staff trained in rescue drugs

Background

The administration of rescue medication at school concerns, in all Europe, students suffering from chronic pathologies for which it may be essential, on doctor's prescription, to take therapy during school hours. About 16% of the school's emergency calls are related to a seizure crisis. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death.

Methods

Every year, the Local Health Unit “TO3”, in Northern Italy, provides training for school staff to administrate rescue medication at school. A questionnaire survey on knowledge, attitudes and fears towards seizures was conducted during the school year 2019/2020. The same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases such as diabetes, allergies and asthma completed it before the course.

Results

110 questionnaires have been completed. About 60% of the sample had been trained in seizure management at least once in their lifetime. The respondents had a mean age of 48.7±9.6 years and a mean job experience of 17.4±11.2 years. Most of them were females (83%). Median knowledge score (10 points max) in subjects with no seizures training was 6, while it was 8.5 in subjects with seizures training (p &lt; 0.001). The self-reported level of confidence in their own skills to administer rescue medication was high in 10.4% of subjects not trained for seizures and in 63.8% of those trained (p &lt; 0.001).

Conclusions

Results suggest that medical training for school staff boosts knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude towards seizures, no longer considered as a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a safer place for all students.

Key messages

School staff trained in the administration of rescue medication are fundamental to guarantee the right to education for students suffering from chronic pathologies such as seizures. Empowering seizures awareness in schools is very important to change the attitude of school staff no longer considering seizures as a problem, making school a safer place for all European students.

Exploring depressive symptoms among LGBT+ medical students: an Italian multicentre survey

Background

Sexual minorities are high-risk populations for mental issues. Recently, attention on medical students (MS) is growing as they might be at higher risk of depression, but few studies focused on mental health of LGBT+ minorities among MS. Our main aims were to investigate depressive symptoms (DS) among LGBT+ MS, compared with non-LGBT+ MS and explore DS predictors.

Methods

A multicentre cross-sectional survey was performed in 12 Medical Schools (Italy, 2018). The questionnaire included sociodemographic items and psychometric tests. The Beck Depression Inventory II was completed by 325 LGBT+ MS and by 2048 non-LGBT+. Chi-squared tests and multivariable logistic regressions were run (significance level: p &lt; 0.05).

Results

Females consisted of 61.5% of the sample, with no differences between the two groups (p = 0.075). DS were reported by 42.5% of LGBT+ MS and 27.4% of non-LGBT+ MS (p &lt; 0.001). Overall, LGBT+ MS took more stimulants (p = 0.001), psychiatric drugs (p &lt; 0.001) and were more frequently seen by psychologists/psychiatrists (p &lt; 0.001). Also, they reported worse family cohesion (p &lt; 0.001) and relationships with classmates (p = 0.018). Considering only non-depressed MS, it was confirmed that LGBT+ MS had higher frequencies of psychiatric drugs consumption (p = 0.036), psychologists/psychiatrists follow up (p = 0.003), poor family cohesion (p = 0.003), poor classmate relationships (p = 0.003). DS predictors were comparable between the two groups, except for age and female gender that were risk factors only in non-LGBT+ MS.

Conclusions

Depression is a great public health issue; it is essential to dedicate efforts targeted to youths at high concern. LGBT+ people confirmed to have an increased DS risk compared to their peers also in a high-risk population like the MS one. Results of non-depressed LGBT+ MS showed a higher necessity of care and a bad living environment, highlighting the need of specific preventive and supportive interventions to bolster sexual minorities.

Predicting difficult discharge from surgical wards: a cohort study in an Italian sample

Background

Poor discharge planning (DP) can increase costs for European hospitals and worsen patient's experience. Validated scores are used in internal medicine to identify clinical or social difficulties in discharges upon admission but there is a lack of such a tool in the surgical context. This study aims to detect early predictors of difficult discharge.

Methods

Socio-demographic and clinical data from 15,165 surgical Hospital Discharge Records (SDOs) of the Molinette hospital of Turin, including an additional pre-surgery evaluation of social vulnerabilites from a subgroup of 388 patients, were collected between 2017 and 2019. Outcomes were length of stay (LOS), discharge destination (home, Long Term Care - LTC). Descriptive analysis and multivariable regressions were performed.

Results

52.3% of patients were male and the median age was 61 (IQR 22). Median LOS was 6 days (IQR 6) but 15 (IQR 30) for patients discharged to LTC. 18.7% were admitted through the Emergency Department (ED) with a median LOS of 7 (IQR 10). 17.6% of the subsample declared living alone. Linear regression showed associations between discharge to LTC, admission through ED, diagnosis of neoplasia and a longer LOS (Bs 10.76, 5.21 and 2.57 respectively, p &lt; 0.001). Logistic regression showed associations between admission by ED, age and discharge to LTC (OR 1.77 and 1.02 respectively, p &lt; 0.001). Preliminary analysis of the subsample did not show any new association with social vulnerabilities, but 98.2% attended elective surgery and thus probably had time to prepare for discharge.

Conclusions

Surgery LOSs are extremely diversified among patients. This study identified several predictors of difficult discharge, mainly admission through ED, discharge to LTC and diagnosis of neoplasia, suggesting difficulties handling an unexpected event by patients' relatives. Further studies gathering patients' data at admission are required in order to develop a predictive tool useful for European hospitals.

Key messages

Clinical (cancer) and social (sudden event, no housing solutions) factors can determine a difficult discharge for European patients and should be investigated to anticipate discharge planning. Elective surgery patients seem less prone to social vulnerabilities (e.g. living alone), probably because relatives have time to prepare, while ED patients often need help in the discharge process.

Health literacy level among journalists and general population: a cross-sectional survey

Background

Recent studies have shown that low Health Literacy (HL) negatively influence people's health. In an era of fake news journalists are called to recognize reliable sources in order to provide trustworthy information, especially on health topics. The aim of the study was to evaluate the knowledge of health-related topics among health journalists and how it differs from general population.

Methods

A cross-sectional survey was made by administering an online 28-item questionnaire. The questionnaire was constructed by joining an introductive part assessing socio-demographic characteristics with three tests: Single Item Literacy Screener (SILS), Medical Data Interpretation Test (MDIT) and IMETER, the Italian version of Medical Term Recognition Test (METER).

Results

A total of 589 valid surveys were obtained. Regarding this sample, 130 participants were journalists, 142 were healthcare workers and 317 belonged to general population. Journalists dealing with health-related topics (p = 0.016) and writing for online newspapers (p = 0.035) were found to have a higher HL, as well as those having a postgraduate qualification compared to colleagues with lower educational qualifications (p = 0.012). Instead, low HL was found among those journalists considering insufficient their economic status (p = 0.031) and among those who had never or only occasionally written about health-related issues (p &lt; 0.001). Among general population HL level was lower for females (p &lt; 0.001), while it was higher for participants with higher educational status (p = 0.038).

Conclusions

These results suggest that education is a key factor for an adequate health literacy. Given the importance, writing about medical and healthcare topics should be prerogative of journalists specifically formed in those fields.

Key messages

An adequate education strongly influences health literacy. It is of great importance to have specialized journalists write about medical and health-related topics.

Mobile Apps for Vaccination: an in-depth scan of Apple App Store

Introduction

In a recent estimation, time spent engaging with smartphones is 3h43m in 2019 in US population, surpassing conventional media such as TV. However, smartphones are not just a distraction from everyday life, but also a powerful tool by which to search for information and interface with institutions and services providers. National Healthcare Systems are not an exception, in particular for tackling vaccine hesitancy and fake news: in this frame, we have focused our research on mobile apps for vaccination.

Methods

We scanned Apple App Store through an API (Application Programming Interface) made available from Apple Inc. itself searching single words related to vaccination (no Boolean operators available) from both Italian and English-speaking markets, then exporting and merging the results. The univocal 121 apps obtained were then classified according by category, description, target population, informative materials and n° of reviews.

Results

The majority of apps falls under the “organizer” category (49 apps, 40.5%) with almost half of them (22) with vaccination as main topic (vaccine reminders and recorders), the others as part of a health management tool, mostly designed for parents. Just 32% of these apps give information regarding vaccines or preventable diseases. The second one is medical education apps (26.4%) focused on healthcare workers with guidelines and updates, mainly in English, then games (11.6%), Local Healthcare Service booking services (9.1%) of which only 4 from Italy, and lastly travel management apps (2.5%).

Conclusions

Organizers and reminders are a recognised tool to increase vaccine adhesion, but a complete plain-language information should be provided together with the service, to answer the most frequently asked questions from parents and dispel their doubts. In the meanwhile, Italian NHS results rarely adequate in providing a fully digital experience, from planning shots to registration of vaccine status.

Key messages

Mobile vaccination organizers are a helpful tool for parents, but they are undervalued as a first-hand source of knowledge about vaccination programs. Italian NHS should develop a modern mobile interface in order to book vaccination services as a big nudge towards the increase of vaccine adherence.

Risk perception, knowledge, prevention, information sources and efficacy beliefs related to Covid-19

Background

Sars-Cov-2 is one of the latest examples of an emerging infectious disease challenging the world and it is the third case, in just two decades, of “spillover”. In light of the recent outbreak (Italy is in 2nd position), it is important to evaluate people risk perception and to support the Health Authority with effective communicative actions to avoid the spread of “infodemia”/alarmism. The aim of this study is a) to study levels of perceived threat, risk perception, severity and comparative vulnerability b) to compare risk perception with other communicable/not communicable diseases; c) provide information to increase awareness/ knowledge of the disease.

Methods

We performed an Italian multicentre study from 11 February 2020 and it is still in progress. The subjects in study (general population, HCWs and university students) were enrolled through the administration of a standardized questionnaire based on Health Belief Model through CAPI and CAWI methods. The summary and inferential statistical analyses will be carried out using the R software.

Results

We enrolled 2495 people from 11 February until 4 March 2020. All the respondents had heard of COVID19. Only 2% didn't know any symptoms and 3% answered to all the questions correctly (mean knowledge score of 13). 48% thought that he/she could acquired COVID 19 in the next 12 months and 70% stated that their concern of the disease was high(score5). Perceived capability to avoid it was rated as good/very good by 62%. The correct mask use (WHO) was reported by 64% of the sample and 47% stated all preventive actions (2% no one). Only 22% of the sample stated all actions to be taken in case of suspected acquisition of COVID19.

Conclusions

Italy is facing an epidemic that could have the potential to affect the entire national health system. It's so important to implement public health activities and surveillance systems in order to limit the spread of the disease and bad/disinformation.

Key messages

This study is the first to report on public perception of Sars-Cov-2 in all the Italy. The results indicated that the Italian population is aware of the outbreak and it is concerned about their risk. On the other hand, only half of the sample is aware about all preventive actions and not everybody knows all procedures to be taken in case of COVID 19 suspect.

Risk Management in nursing homes: an Italian experience in 2019

Background

The ageing of the European population leads to an increasing demand for Long-Term Care services. The security and well-being of the elderly population hosted in nursing homes (NHs) needs an effective Risk Management policy, officially sanctioned in Italy by the so-called “Legge Gelli” n.24 (March 8th, 2017) and the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. In order to verify the effective application of common “best practices” in terms of Risk Management in NHs, a tool useful to analyse risk management attitudes in Northern Italy was conceived and applied in a sample of NHs.

Methods

The tool, developed in collaboration with the health insurance company SHAM Italia, is composed of 124 items (with a dichotomous answer -YES/NO) on topics related to various Risk Management practices. This tool was submitted in a face-to-face interview to several Directors (Health Directors or Nursing Coordinators) of NHs in the Piedmont Region. A list of randomly-chosen NHs was contacted: 4 of them were selected for the pilot study and compiled the questionnaire. Answers were gathered and analyzed through Microsoft Excel.

Results

Only the 25% of NHs has a Risk Management plan with objectives and indicators of effectiveness and uses Risk Analysis instruments for a pre- and post-” risk detection. Only one has employees working mainly on Risk Management alone. The 75% of the reported events were “Adverse Events”, and all the NHs (100%) have a protocol for a patient voluntary departure or for fall prevention or for bedsores prevention; while 50% have a protocol for prevention of aggressions towards operators or for patients' suicide prevention.

Conclusions

This work provides a starting point to face new challenges that are looming on the European Health-care Systems: the care for the elderlies needs to be perfected to reduce inefficiencies, cut useless costs and improve safety of patients in the NHs setting.

Key messages

Despite safety of older patients in nursing homes is not only important but mandatory in Italy, risk management tools for this setting are lacking in literature. A new tool applied in Italian nursing homes showed that risk management needs to be implemented in practice and these results can be extended to European context.

Depression, suicidal ideation and stress among Italian medical students: PRIMES multicentre study

Background

Depression represents a public health priority and a major contributor to suicide worldwide. Medical students (MS) have been reported as a high-risk group and data are required to implement action plans. This study aimed to investigate depressive symptoms (DS), suicidal ideation (SI) and perceived stress (PS), and analyse factors that may impact on such conditions.

Methods

In 2018, a multicentre cross-sectional study (PRIMES) was carried out in 12 Medical Schools, reaching 2513 MS throughout Italy. Socio-demographic data and psychometric tests were collected. Main outcomes were measured by Beck Depression Inventory-II (DS and SI) and Perceived Stress Scale (PS). Mostly, multivariable logistic and linear regressions were run (p &lt; 0.05 as significant).

Results

The prevalence of DS and SI was 29.5% and 14%. The mean PS score was 18.6 (SD = 7.8), within a range to 0 from 40. Preliminary results showed that the variables associated with a higher risk of reporting all outcomes (DS, SI, PS, respectively) were: increasing age (p = 0.004, p = 0.016, p = 0.003), bisexuality (p = 0.002, p &lt; 0.001, p &lt; 0.001), poor economic status (p = 0.010, p = 0.014, p &lt; 0.001), psychiatric family history (p = 0.007, p = 0.003, p = 0.029), negative judgment about medical school choice (all p &lt; 0.001), unsatisfying classmates' friendships (p = 0.027, p &lt; 0.001, p &lt; 0.001) and classmates' climate competitive and hostile (all p &lt; 0.001). An excellent family bond reduced the odds instead (all p &lt; 0.001). Other socio-demographic and university-related items resulted associated to the outcomes in different ways.

Conclusions

PRIMES showed a high prevalence of DS and SI among MS, with alarming PS levels. Since this issue seems common worldwide, further analyses to understand the determinants are needed and a population-based approach pertaining to public health must be addressed, e.g. to increase resilience. Universities must realize interventions, offer counselling and improve modifiable factors, such as learning climate.

Key messages

Italian medical students reported a prevalence of depressive symptoms and suicidal ideation of 29.5% and 14% respectively, both higher than the prevalence among same-aged general population. Depression, suicidal ideation and stress were mainly influenced by age, sexuality, finances, psychiatric family history, judgment on medical school, family bond, classmates’ friendships and climate.

Effects of Covid-19 lockdown on mental health and sleep disturbances, results from an Italian survey

Background

The Covid-19 pandemic is affecting different aspects of our society and brand-new conditions are expected after the lockdown. Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored.

Methods

The COvid COllateral ImpactS (COCOS) project was a national cross-sectional survey performed during the last 14 days of the Italian lockdown. Questionnaires were online and included items on socio-demographics, behaviours, and healthcare access. Depression was assessed through the Patient Health Questionnaire-2, anxiety through the Generalized Anxiety Disorder-2. Participants referring sleep disturbances completed the Insomnia Severity Index. Descriptive analyses, univariable and multivariable logistic regressions were performed (p-value<0.05 significant).

Results

The sample size was 1515. Females were 65.6%, and the median age was 42 years (IQR=23). Depression and anxiety symptoms prevalence were 24.7% and 23.2%. The 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, increased time spent on internet, and avoidance of activities for peer pressure increased the likelihood of at least one of mental health outcomes. Increasing age, not experiencing work-related troubles, being married/cohabitant reduced such probability. Females and participants with chronic conditions resulted positively associated with sleep disturbances.

Conclusions

The results showed a high prevalence of mental health issues. Since the impact might be long-lasting, it is crucial to study effective interventions, specifically planning strategies for more vulnerable groups, e.g. youths, and considering the role of internet.

Key messages

A high prevalence of mental issues and sleep disturbances was recorded during the last week of the lockdown.

Age, gender, marital status and the time spent on internet affected mental health while gender and presence of chronic conditions were predictors of sleep disturbances.

The timing of the operatingroom: a 2019 Italian exsperience

Background

The lack of economic resources for health systems is a public health issue that Europe needs to address in order to guarantee quality and safety of care for patients. Any initiative aimed to reduce waste are welcomed. In this context, the City of Health and Science of Turin (Italy) performed a study aimed to analyse the timing of operating rooms to improve efficacy, efficiency and quality standards in the surgical field.

Methods

A multidisciplinary working group created in 2019 a checklist aimed to record the operating times of the first intervention of the day in 5 Hospital Departments (including 12 operating rooms). We registered the time between the moment in which the operating room is considered available for the start of activities and the surgical incision (benchmark: within 60 minutes). All the times needed for nursing, anesthetic and surgical activities were collected and evaluated for a descriptive statistical analysis.

Results

In consideration of a room opening time scheduled for 7:00 and room availability scheduled for 7:30, the goal can be considered achieved if the time of the surgical incision does not exceed 8:30 in the morning. Three out of 5 departments (Ginecology, Orthopaedic and General surgery) reached this aim in more than 80% of interventions, while neurosurgery and thoracic surgery exceeds the time by about 40 minutes. The checklist showed that in many cases is possible to reduce the time between the end of anesthesia and surgical incision.

Conclusions

To analyse the operating times allows not only to optimize the resources but also to reduce waste of time and waiting lists for surgery in election. We described, in a sample of surgical interventions, when and how is possible to improve the efficiency of the operating room. This experience and the checklist created could be useful not only for us but every European hospital.

Key messages

The efficiency of operating rooms is related to several factors. Neurosurgery and thoracic surgery needs longer time to prepare patients and start intervention. A checklist aimed to monitor the times of activities in surgical operating rooms can be useful to reduce waste of time and resources in European hospitals.

Transition of care from paediatric to adult age for rare chronic disorders: an Italian experience

Background

Transition of care represents the transfer from child to adult care. An effective transition maintains continuity of care and presents better clinical outcomes. Thanks to improved survivorship of chronic paediatric patients to adulthood, this process has assumed growing relevance. Aim of the study was to evaluate quality and effectiveness of transition of care model of one of the biggest Hospitals of Northern Italy, that has organised a common structured model, differentiated according to patients' clinical and social complexity.

Methods

The sample consisted of patients with chronic rare diseases transited within the Hospital in the years 2016-2019. To analyse the evolution of all pathologies, for each patient the medical record was consulted; questionnaires were then administered to patients to investigate their illness perception and quality of life.

Results

The average age at transition of the retrospective study patients was 19.8±4.7 years. For most disorders, 100% of patients made the first post-transition visit. More than 90% of patients who did not make further post-transition visits were patients with Neurofibromatosis 1. Only 7 out of 18 patients with NF1 continued their treatment to the indicated specialist. One-year drop-out was 13%. Regarding the perception of one's own illness, 78% of respondents consider their health status from good to excellent, but more than 30% of respondents believe not to have currently adequate psychological and social support.

Conclusions

Transition of care represents an important phase in chronic diseases management. The proposed model assures a multidisciplinary approach, involving all specialists of both paediatric and adult teams. Preliminary data were positive and showed how this model could be an example for other institutions in Europe. Anyway, the transition model might be still be improved. Our data underlined the importance of a complete taking charge, with peculiar attention to psychological and social support.

Key messages

The study shows to the European Healthcare Providers the importance of a personalized planning of transition of care, that considers the complexity of clinical situation and concomitant social issues. A successful strategy of transition of care requires a multidisciplinary approach, that guarantees a complete taking charge, with peculiar attention to psychological and social support.

Cohort study of electronic cigarette use: safety and effectiveness after 4 years of follow-up

OBJECTIVE

More than a decade after e-cigarette (e-cig) market launch, limited information are available on their safety after 24 months of use. In 2013, we started the first observational study assessing e-cig long-term effectiveness and safety, directly comparing tobacco smokers and e-cig users. Here we report the results after four years of follow-up.

PATIENTS AND METHODS

Adults (30-75 years) were included if: smokers of ≥1 tobacco cigarette/day (tobacco smokers); users of any type of e-cig inhaling ≥50 puffs weekly (e-cig users); users of both tobacco and e-cig (dual users). Data were collected by phone and/or internet, and carbon monoxide levels tested in 50% of those declaring tobacco abstinence. Main outcomes were: possibly smoking-related diseases (PSRD; validated through hospital discharge data or visit in 62.6% of the sample); 4-year tobacco abstinence; number of tobacco cigarettes/day.

RESULTS

Data were available for 228 e-cig users (all ex-smokers), 471 tobacco smokers, 216 dual users. A PSRD was observed in 73 subjects (8.0%). No differences emerged across groups in PSRD rates, with negligible variations in self-reported health. Of e-cig users, 63.6% remained tobacco abstinent; dual users and tobacco smokers showed non-significantly different rates of tobacco (33.8% vs. 26.8%) and all-product (20.2% vs. 19.4%) cessation, and a similar decrease in cigarettes/day. Almost 40% of the sample switched at least once (tobacco smokers: 17.2%; dual users: 81.9%).

CONCLUSIONS

After four years, a scarce, non-significant harm reduction was observed among e-cig or dual users. Given the long-lasting health effects of tobacco smoking, the benefits of e-cig use may start being detectable at the next follow-up (six years). The complete switch to e-cig may help tobacco quitters remain abstinent, but e-cig use in addition to tobacco did not increase the likelihood of smoking cessation or reduction.

Knowledge, attitudes and eating habits red and processed meat among gym users: a cross-sectional survey

Aims:

In 2015, the International Agency for Research on Cancer (IARC) classified red meat (RM) and processed meat (PM) intakes as ‘probably carcinogenic’ and ‘carcinogenic’ to humans, respectively. The aim of the study was to evaluate eating behaviours and knowledge on the potential risks of RM-PM consumption among gym users.

Methods:

In 2018, a cross-sectional survey was conducted in 20 gyms in Turin using a 48-item questionnaire assessing sociodemographic, sports, dietary information and knowledge about RM-PM (sample size = 298). Multivariable logistic and linear regressions were performed. The significance level was p ⩽ 0.05.

Results:

Around 75% of the sample consumed RM and PM at least once a week, with an average of 240.55 ± 435.99 g and 106.50 ± 157.88 g consumed weekly, respectively. Only 7.69% exceeded 700 g of raw RM weekly. Females, those with higher education, those who practise sport outside gyms and those who declared to practise sport to stay healthy, declared to consume less RM. Those who practise sport at a competitive level, those who are on a diet for athletic needs, those with higher body mass index (BMI) and those who consume more eggs and alcohol had a higher RM intake. The association with PM consumption was negative for females and positive for those living without a partner. The likelihood of answering incorrectly to one of the knowledge outcomes was lower for those who had a healthcare-related background and declared to practise sport to stay healthy, while it was higher for participants who stated to have a sport-related background, to be on a diet to lose weight, to read rarely/never the RM-PM nutrition labels and to consume <400 g of fruit and vegetables daily.

Conclusions:

Given the relatively low knowledge of the potential risks of RM-PM consumption, it would be advisable to implement campaigns specifically focused on male athletes and people with lower socioeconomic status, in order to raise awareness about this topic.

Which are the communication styles of anti-tobacco spots that most impress adolescents?

Objectives

To evaluate emotions and opinions of Italian adolescents aged 13-18 years old about different anti-tobacco spots delivered by the mass media campaigns over the world.

Methods

A multicenter cross-sectional study was conducted. Italian students from different regions were enrolled. A video that collected 7 anti-tobacco spots from all over the world. The spots describe the tobacco dependence, the health damages and the tobacco components using different communication styles (funny, scientific, dramatic, comedians, shocking, and sad). Information on age, gender, smoking status of family and peers were gathered. Descriptive and univariate analysis of emotional and cognitive reactions to spots were performed with respect to gender, smoking status of adolescents, their peers and parents.

Results

495 students were enrolled. 14% of them were current smokers. Two spots resulted to have most impressed the students: Sponge (29%) and Icons (18%). In the first spot the sponges represent human lungs, a pair of hands squeeze the tar from the sponge, revealing the cancer-producing tar that goes into the lungs of a pack-a-day smoker every year. The second one contrasts tobacco industry images such as a cowboy, a hip-hop DJ with a more accurate depiction of the repercussions of smoking: a dying man in a wheelchair who warns, ‘The reality is you can end up looking like this’. The reactions on these videos are disgust, reflection and sadness, respectively: Sponge 79%, 44% and 15%; Icons 60%, 3% and 20%. Univariate analysis showed differences by smoking status about video considered most impressive (p = 0.02) and by gender about the choice of spot in the role of the Minister of Health (p &lt; 0.001).

Conclusions

The spot media campaigns that gave a clear and scientific message or that changed the “icon” of the smoker were preferred by adolescents. Further research is needed to study adolescents’ responses and smoking outcomes obtained by different anti-tobacco mass media campaigns.

Key messages

The study demonstrates the preference of adolescents for spot giving clear scientific messages or using strategies that fight manipulation of the tobacco industry and aimed at changing smoker’s icon. The present study underlines that it is necessary to monitor the effect of a multimedia campaign and to examine its longitudinal impact, especially its impact on smoking behavior.

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

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

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