Enhancing routine immunization efforts for older adults and frail individuals: Good practices during the SARS-CoV-2 pandemic in Italy

Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers' performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices.

Histologic Disease Persists beyond Mucosal Healing and Could Predict Reactivation in Ulcerative Colitis

Mucosal healing (MH) is the main target in ulcerative colitis (UC) treatment. Even if MH lowers the risk of disease reactivation, some patients still relapse. Histologic activity (HA) beyond MH could explain these cases. This study aims to assess how many patients with MH have HA and which lesions are associated with relapse. We retrospectively enrolled UC patients showing MH, expressed as a Mayo Endoscopic Subscore (MES) of 0 and 1 upon colonoscopy. We reviewed the histological reports of biopsies evaluating the presence of typical lesions of UC and assessed the number of clinical relapses after 12 months. Among 100 enrolled patients, 2 showed no histological lesions. According to univariate analysis, patients with a higher number of histological lesions at the baseline had a higher risk of relapse (OR 1.25, p = 0.012), as well as patients with basal plasmacytosis (OR 4.33, p = 0.005), lamina propria eosinophils (OR 2.99, p = 0.047), and surface irregularity (OR 4.70, p = 0.010). However, in the multivariate analysis, only basal plasmacytosis (OR 2.98, p = 0.050) and surface irregularity (OR 4.50, p = 0.024) were confirmed as risk factors for disease reactivation. HA persists in a significant percentage of patients with MH. Despite the presence of MH, patients with basal plasmacytosis and surface irregularity have a higher risk of relapse.

Transition from intravenous to subcutaneous biological therapies in inflammatory bowel disease: An online survey of patients

BACKGROUND

The transition from in-hospital intravenous administration to subcutaneous therapies to treat inflammatory bowel disease (IBD) can raise some concerns among patients due to the self-administration concerns, the management of potential side effects and the overall worries related to a change of treatment. This study aimed at evaluating patients' opinion about the switch from intravenous to subcutaneous formulations and their knowledge on new available therapeutic options.

METHODS

We conducted a survey using a questionnaire prepared by a team of gastroenterologists and nurses working at the IBD unit. It consists of 31 items and has been divided into four sections: descriptive, commitment, knowledge and passage mode opinion. The questions were formulated in Italian and conceived according to daily consultations with patients in everyday practice, without any previous piloting or specific medical literature reference. The survey was administered to consecutive IBD patients in intravenous biological treatment; patients currently or previously treated with subcutaneous therapy were excluded.

RESULTS

Four hundred questionnaires were distributed to participants. As many as 311 patients (77.7%) completed the survey, while the remaining were excluded from the analysis; 155 (49.8%) patients were favorable to switch from intravenous to subcutaneous therapy, while only 78 (25.1%) disagreed. In univariate and multi-variate analysis, the approval rate for home therapy was significantly associated with the distance from the IBD center and work/family/personal commitments. Surprisingly, only a quarter of the IBD patients knew that almost all available therapeutic agents have a subcutaneous administration route. Regarding patients' opinion on the efficacy of subcutaneous administration of biological agents compared to intravenous drugs, 194 (63%) had no definite idea, while 44 (14%) believed that the effectiveness could be reduced.

CONCLUSION

The transition from in-hospital to subcutaneous therapeutic management of biological therapy at home was generally viewed favorably by patients, especially if they have commitments or were residents far from the IBD center.

Serial Fecal Microbiota Infusions via Colonoscopy for Active Ulcerative Colitis: A Feasibility, Safety, and Translational Monocentric Italian Study

The effectiveness of fecal microbiota transplantation (FMT) in ulcerative colitis (UC) remains unclear. This study aimed to investigate the feasibility and effectiveness of serial fecal infusions via colonoscopy in patients with active UC. Subjects with mild-to-moderate UC received three consecutive fecal infusions via colonoscopy. A control population with the same baseline features receiving Infliximab treatment was enrolled. Adverse events and clinical, endoscopic, and microbial outcomes were investigated. Nineteen patients with mildly-to-moderately active UC were enrolled. Clinical response was obtained in six patients at week 2, in eight at week 6, and in nine at week 12. Clinical response was maintained in eight patients at week 24. Endoscopic remission at week 12 was reached in six patients. In the control population, 13/19 patients achieved clinical response at week 6, and 10/19 patients maintained clinical response after 6 months. Microbiota richness was higher in responders compared with the non-responders. Peptostreptococcus, Lactobacillus, and Veillonella were higher in non-responders, while Parabacteroides, Bacteroides, Faecalibacterium, and Akkermansia were higher in responders at all timepoints. Serial FMT infusions appear to be feasible, safe, and effective in UC patients, with a potential role in inducing and maintaining clinical response. Specific bacteria predict the response to FMT.

Italian immunization calendar implementation: Time to optimize number of vaccination appointments?

In the Italian vaccination schedule, at least six vaccination appointments are scheduled in the first year of life. This implies more discomfort for both the patient and the parents. This was particularly evident during the COVID-19 pandemic, during which several appointments were missed. A UK experience with three injectable vaccines and an oral one co-administered at the same appointment (4-in-1) at 2 and 4 months of age showed interesting results. The vaccination coverage was high, consistent with previous practice, and no relevant increase in adverse events was reported. Translating the UK experience into the Italian context would not be immediate, due to several organizational and social issues. Nevertheless, this option warrants some further considerations, which are discussed in this manuscript.

Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries

Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries.

We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff.

We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.

Changes in admissions, and hospitalization outcomes of IBD patients in an Italian tertiary referral center over a 13-year period

OBJECTIVE

The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center.

PATIENTS AND METHODS

Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed.

RESULTS

Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions.

CONCLUSIONS

Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

Fostering healthy aging: The interdependency of infections, immunity and frailty

Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.

Bowel contrast-enhanced ultrasound perfusion imaging in the evaluation of Crohn's disease patients undergoing anti-TNFα therapy

AIM

To evaluate whether changes in bowel perfusion parameters measured by dynamic-CEUS (D-CEUS) can be used for monitoring response to therapy in active Crohn disease (CD).

METHODS

Fifty-four CD patients were evaluated with d-CEUS before (T0) and after 2 (T1), 6 (T2) and 12 weeks (T3) of anti-TNFα therapy. Variations from baseline were calculated for: peak intensity, PI; area under the curve, AUC; slope of wash in, P_w; time to peak, TP; mean transit time, MTT (median percentage values) and were correlated with combined endoscopic/clinical response after 12 weeks and clinical relapse within 6 months.

RESULTS

70% of patients achieved combined endoscopic/clinical response (responders). The reduction in PI, AUC, P_w and MTT between T1 and T0 was higher in responders. Relapsers (21%) showed significantly lower reduction in delta PI and P_w at T1 and T2. At T3 they showed a new increase in PI and lower reduction in delta P_w. In relapsers, AUC showed a significantly lower decrease at T2 and T3, TP showed a significant reduction at T3 and MTT showed a progressive increase at the different time-points, reaching the statistical significance at T3.

CONCLUSIONS

d-CEUS might become a reliable predictor of combined endoscopic/clinical response and clinical relapse in CD.

Health Communication in COVID-19 Era: Experiences from the Italian VaccinarSì Network Websites

In 2013, in a bid to combat Vaccine Hesitancy (VH) and provide information on vaccines by communicating with the general public and the health community (e.g., healthcare workers and public health operators), the Italian Society of Hygiene and Preventive Medicine (S.It.I.) published the national website "VaccinarSì". The project was subsequently extended to ten Italian Regions. This led to the creation of the VaccinarSì Network, whose websites are publicly owned. The aim of this work was to present the framework of the websites of the VaccinarSì Network and to analyse user behaviour in the pre-COVID-19-era (dating from each website's publication until 31 January 2020) and in the COVID-19-era (from 1 February 2020 to 31 January 2021). Some metrics such as the number of visits to the site (sessions, number of users and average session duration), user behaviour (pages viewed, bounce rate and organic search) and the session acquisition path (direct traffic, referrals and social traffic) were searched, extrapolated and processed with Google Analytics. Qualitative and normally distributed quantitative variables were summarised with their absolute (relative) frequencies and means. Statistical differences between the means of the two periods were evaluated through paired t-test. A two-tailed p-value less than 0.05 was considered to be statistically significant. When the total values recorded over the period were compared, an overall increase in metrics was observed-the number of individual users, visits and individual pageviews rose in a statistically significant way. Our study aimed to highlight how combining disciplines such as health education and digital communication via Information and Communication Technologies (ICT) represents the best strategy to support citizens. This approach gives them the tools to become independent and responsible players that are capable of voluntarily and consciously choosing to adhere to vaccination programs. The VaccinarSì Network's goal for the future is to reach an even wider audience. By building each user's critical knowledge, this network enables users to be active components of a wider, more empowered community.

Perceived knowledge, coping and diagnostic-therapeutic pathways of infertile couples trying to conceive: an Italian survey

BACKGROUND

The last decades' increasing infertility risk factors have brought to a growing number of infertile couples. Knowledge regarding infertility and possible treatments ishowever-poor, leading to difficulty in coping and understanding. Knowing infertile couples' perceptions and needs may help clinicians develop services that better address these needs.

METHODS

This study aimed at assessing perceived knowledge, coping mechanisms and diagnostic-therapeutic pathways concerning infertility and Assisted Reproductive Technology (ART) in a sample of Italian infertile couples trying to conceive. In this cross-sectional study, 199 subjects aged 25-55 years old who had difficulties conceiving were asked to fill a questionnaire regarding infertility and ART perceived knowledge, coping and diagnostic-therapeutic pathways they had been through.

RESULTS

The perceived knowledge score was 42.5%. Couples had difficulties understanding ART's success rate and the potential risks for the woman and foetus. Subjects from North of Italy, who were previously engaged in an ART procedure, those who had signed a written informed consent and were offered a specific counselling session had significantly higher mean score of perceived knowledge. Couples were handling the situation in a satisfactory way, supported also by their family, but the procedures, clinical examinations, therapies, medications, were considered complex and stressful by 66.5% of the respondents.

CONCLUSIONS

Healthcare providers should consider the couples' previous experience with infertility, the important role of informed consent and personalized counselling sessions. Counselling for infertile couples should have a broader, comprehensive approach, integrating psychological, social, ethical support, as well as health literacy, taking into consideration the infertile couples' preferences and needs.

Intrafamilial communication of hereditary breast and ovarian cancer genetic information in Italian women: towards a personalised approach

Genomic testing expansion is accompanied by an increasing need for genetic counselling and intrafamilial communication. Genetic counselling can play an important role in facilitating intrafamilial communication and relationships. We conducted a cross-sectional, multicenter study including 252 Italian women, using a questionnaire divided in two sections, the first one to be filled after the pre-test counselling and the second after receiving BRCA test results. We assessed the factors influencing intrafamilial disclosure of genetic information for hereditary breast and ovarian cancer, family members with whom probands are more prone to share genetic information, and the perceived understanding of information received by counselees during genetic counselling. Women were accompanied to the counselling more often by their husband/partner. Among those with a positive BRCA test result, 49% intended to communicate it to their offspring and 27% to their husband/partner. Younger women, those living with their husband/partner, and those who described family communication as open/profound and spontaneous/sincere had a higher probability of being accompanied during genetic counselling and discuss about it with relatives. Spontaneous/sincere or open/profound family communication and joyful/happy familial relationships were associated with the decision to undergo genetic testing as a responsibility towards relatives. Women had a good understanding of counselling contents (mean score 9.27 in a scale 1-10). Genetic counselling providers should consider that genetic information disclosure does not depend only on the clarity of the information provided, but also on pre-existing intrafamilial communication and relationships, family structure and marital status, indicating the need for a personalised approach accounting for these factors.

Microbiological ascertainment in patients with pneumonia: the experience of a teaching hospital in Rome

OBJECTIVES

Pneumonia still remains a problem from the clinical and public health viewpoint because of the relevant epidemiological burden. The etiological diagnosis is important in the light of avoiding unnecessary antibiotic treatment and choosing the most appropriate therapeutical approach. This study is aimed at providing evidence on the proportion of microbiological ascertainment in pneumonia-related hospitalizations in one of the most important teaching hospitals in Rome.

METHODS

The study relied on the record linkage of two administrative databases of the same hospital: the electronic hospital discharge register and the microbiology laboratory surveillance database.

RESULTS

2819 records were identified, where 46% had a microbiological ascertainment, significantly higher in males than in females (51% vs 40%) and in cases of pneumonia reported in secondary diagnosis instead of primary diagnosis (52% vs 42%). Medical patients had significantly lower proportion of ascertainment compared to surgical patients (43% vs 67%) whereas there were not differences between patients with emergency and elective admission. The overall mortality was 17%. Mortality was significantly higher: in surgical compared to medical patients (27% vs 15%), in ventilated compared to not ventilated patients (41% vs 11%), in cases with secondary diagnosis of pneumonia compared to a primary diagnosis (23% vs 11% ) and in hospitalized in intensive care unit-ICU- rather than in non-ICU (71% vs 12%).

CONCLUSION

The proportion of microbiological ascertaiment in pneumonia remains less than 50%. Albeit in line with other evidence, this result should call the attention on the impact of unknown etiological diagnosis on antibiotic treatment and resistance.

A transition clinic model for inflammatory bowel disease between two tertiary care centers: outcomes and predictive factors

OBJECTIVE

Few models of transition have been proposed for inflammatory bowel disease (IBD). The aim of the present study is to evaluate the feasibility of a transition model and the predictive factors for success/failure.

PATIENTS AND METHODS

Patients with low activity or remission IBD were enrolled. Proposed model: three meetings every four-six weeks: the first one in the pediatric center (Bambino Gesù Children's Hospital); the second one, in the adult center (Foundation Polyclinic University A. Gemelli), with pediatric gastroenterologists; the last one, in the adult center, with adult gastroenterologists only. Questionnaires included anxiety and depression clinical scale, self-efficacy, quality of life, visual-analogic scale (VAS). Transition was considered successful if the three steps were completed.

RESULTS

Twenty patients were enrolled (range 18-25 years; M/F: 12/8; Ulcerative Colitis/Crohn's Disease 10/10); eight accepted the transition program, four delayed the process and eight refused. Patients who completed transition generated higher scores on the resilience scale, better scores on well-being perception, and had lower anxiety scores. Patients who failed transition were mostly women. The perceived utility of the transition program was scored 7.3 on a VAS scale.

CONCLUSIONS

The proposed transition program seems to be feasible. Psychological scores may help in selecting patients and predicting outcomes.

Streptococcus pneumoniae in hospitalized patients with pneumonia: epidemiology and implications

Background

Streptococcus pneumoniae (SP) is a major cause of pneumonia worldwide representing a significant problem from the public health viewpoint. The aim of our study was to assess the frequency of SP in hospitalized patients with pneumonia and investigate its relationship with patients' characteristics.

Methods

A deterministic record linkage of hospital discharge and microbiology laboratory surveillance databases of a teaching hospital in Rome was used to identify all patients over 15 years old (y) with a diagnosis of pneumonia and a microbiological ascertainment between November 2010 and March 2013. Pneumonia ICD-9-CM codes were used to identify the study population. The frequency of SP was assessed with respect to patients' characteristics.

Results

1216 (64% males) of a mean age 65 (SD = 18) y patients with pneumonia were identified. Of them, 707 (58%) had a positive microbiological result. Among the latter, mixed bacterial co-infections were detected in 552 (74%) cases. The most frequently isolated organism was SP in 288 (41%) cases. Nevertheless, SP was the sole isolated agent in only 6 (0.8%) cases. There were no significant differences between men and women with respect to the frequency of SP. Eventually, the frequency of SP among patients with a positive microbiological result was higher in the age group 15-64 y than in 65+ y (45% vs 37%, p = 0.038). When considering only subjects with at least one comorbidity the frequency of SP was higher among the 15-64 y age group (53% vs 44% in 15-64 y and 65+ y respectively, p = 0.040).

Conclusions

Our study revealed that SP was the most frequent isolated pathogen in hospitalized patients with pneumonia. However, the SP coexistence with other pathogens was present in the vast majority of cases. Interestingly, SP was highly frequent among people with comorbidities, in particular in the age group 15-64 y. This emphasizes the importance of vaccination in this group of patients.

Key messages

This study shows that more than 40% of pneumonia with a positive microbiological result are caused by Streptococcus pneumoniae. Preventive strategies to limit Streptococcus pneumoniae infections among adults and individuals affected by comorbidities are needed.

Intra-familial communication of hereditary breast and ovarian cancer information in Italian women

Background

Genomic testing expansion for hereditary breast and ovarian cancer (HBOC) comes with an increased need for genetic counseling and intra-familial communication. Genetic counseling can play an important role in facilitating intra-familial communication and relationships, thus avoiding misunderstandings within the family.

Methods

We conducted a cross-sectional, multicenter study including 252 Italian women, using a questionnaire divided in two sections; the first to be filled after the pre-test counseling and the second after receiving the genetic test results. This aimed at assessing the factors influencing the disclosure of genetic information for HBOC, family members that probands share genetic information with, and the degree of understanding of the information received by the counselees during genetic counseling.

Results

Women were accompanied to the counseling more by their husbands/partners. Among those with a positive test result, 49% shared it with their offspring and 27 % with their husband/partner. Younger women, those living with their husbands/partners and those who described family communication as open/deep had a higher probability of being accompanied at the genetic counseling and discuss about it with relatives. Being alone at the genetic counseling was significantly associated to non-existing familial relationship (p = 0.003) and problematic intra-familial communication (p = 0.005). Sincere or joyful familial relations were associated with the decision to undergo genetic testing as a responsibility towards relatives. Women had a good understanding of the counseling (mean score 9.2 in a scale1-10).

Discussion

Genetic counseling providers should consider that the disclosure of genetic information does not depend only on the clarity of the information provided, but also on pre-existing intra-familial communication and relationship, family structure and marital status, indicating the need of a personalized approach based on these factors.

Key messages

The disclosure of genetic information from women to their relatives in the case of HBOC is a complex relational process, which poses practical and ethical problems for individuals and families. Genetic counseling providers should be able to advice their patients on the importance of genetic information disclosure, considering, also, the pre-existing intra-familial communication dynamics.

Improving pertussis vaccination in pregnant woman. A new pathway in an Italian Local Health Authority

Pertussis is quite common in adolescents and adults, but it is especially dangerous in new-borns. The national immunization plan (NIP) 2017-2019 recommended a Tdap booster for every pregnancy at 28-36 weeks, but adherence is still far from the optimal level. This work aims to evaluate the effectiveness of a dedicated pathway organized by the department of prevention to improve the Tdap coverage among pregnant woman attending antenatal class.

The women attending from November 2019 to October 2019 the public antenatal class organized by the local health authority have been evaluated for their Tdap coverage in pregnancy. From May 2019, public health experts have been involved for 30 minutes during the first lesson to explain the NIP with a focus on vaccination in pregnancy. Then the eligible women (28-36 weeks not yet vaccinated) who voluntarily agree were accompanied to the ambulatory to be vaccinated. Pre-post Tdap vaccination coverage and pregnancy weeks at vaccination have been evaluated respectively by chi2 and t-test.

90 pregnant women have been included in the study. Their mean age was 32.3 (SD 5.2) and the overall Tdap coverage was 44.4%. The Pre-post Tdap coverage was 26.7%(12/45) before May 2019 and 62.2% (28/45) after the introduction of the new pathway (p = 0.001). 50% of the vaccinated women decided to receive the booster the same day of the antenatal lesson, while the remaining 50% delayed the vaccination till a maximum of 30 days. We observed a clinical, but not statistically, significant anticipation in the pregnancy week in which they received Tdap booster (32.4 weeks before and 31.3 after May 2019; p = 0.150).

The introduction of a short intervention on vaccination in the antenatal class followed by the opportunity to receive the booster in a dedicated time and without waiting list significantly improved the Tdap coverage in pregnancy. This study encourages the cooperation among the different public health actors involved in the field of antenatal care.

Key messages

Antenatal class represents a great opportunity to improve vaccine confidence in pregnant women. Intervention aimed to ameliorate vaccine convenience could improve Tdap coverage in pregnancy.

The Impact of School and After-School Friendship Networks on Adolescent Vaccination Behavior

Psychological and social characteristics of individuals are important determinants of their health choices and behaviors. Social networks represent "pipes" through which information and opinions circulate and spread out in the social circle surrounding individuals, influencing their propensity toward important health care interventions. This paper aims to explore the relationship between students' vaccination health choices and their social networks. We administered a questionnaire to students to collect data on individual students' demographics, knowledge, and attitudes about vaccinations, as well as their social networks. Forty-nine pupils belonging to 4 classrooms in an Italian secondary school were enrolled in the study. We applied a logistic regression quadratic assignment procedure (LR-QAP) by regressing students' positive responsive behavior similarity as a dependent variable. LRQAP findings indicate that students' vaccination behavior similarity is significantly associated with after-school social ties and related social mechanisms, suggesting that pupils are more likely to share information and knowledge about health behaviors through social relationships maintained after school hours rather than through those established during the school day. Moreover, we found that vaccination behaviors are more similar for those students having the same ethnicity as well as for those belonging to the same class. Our findings may help policymakers in implementing effective vaccination strategies.

Crohn's disease activity before and after medical therapy evaluated by MaRIA score and others parameters in MR Enterography

AIM

Aim of this retrospective study is to evaluate the response to therapy in Crohn's disease (CD) patients studied by MR Enterography (MRE) in comparison with Harvey Bradshaw Index (HBI).

METHODS

One hundred and sixty patients with histological proved CD have undergone MRE in the last years. Forty-six patients who repeated MRE after medical therapy within six months were selected for the study. Magnetic Resonance Index of Activity (MaRIA) was evaluated for each patient and used to define the MR judgment. In MRE we also evaluated wall thickening, longitudinal extension of wall thickening, presence of stratified mural hyperenhancement and extraintestinal signs. The clinical response to therapy was judged based on HBI and classified as improved, worsened or stable disease. Clinical judgment was correlated with MRE findings and the agreement was analysed using the Cohen Kappa test.

RESULTS

Among 46 enrolled patients, 18 (39%) improved clinically, 4 (10%) worsened, 24 (51%) remained stable. MR judgment was in agreement with clinical assessment in 33 patients (72%), showing moderate significant concordance (Kappa = 0.49; p < 0.01). No agreement was observed in 13 (28%) patients. Moreover, clinical improvement was significantly correlated to reduction of wall thickening, reduction of longitudinal extension of the disease and reduction of engorged vasa recta (p < 0.05). Worsening conditions were significantly correlated to increased wall thickening (p = 0.05).

CONCLUSIONS

MRE is useful in evaluating the response to therapy in CD patients.

The impact of a school-based multicomponent intervention for promoting vaccine uptake in Italian adolescents: a retrospective cohort study

BACKGROUND

In Italy, the National Immunization Prevention Plan recommends for adolescents between ages 11 and 18 several vaccines, however their adherence is below the expected coverage. School-based delivery strategies might represent an alternative to primary care settings. This study aims to evaluate the impact of a school-based intervention aimed to increase the vaccination uptake among Italian secondary class students.

METHODS

One of the four schools in which a school-based multicomponent intervention was previously carried out has been matched with a control school in the same geographical area. Students' coverage for mandatory and recommended vaccinations was assessed before and after an 8 months period using the Local Health Authority Immunization Register.

RESULTS

Seven hundred and fifty-five resident students in the RM Local Health Authority were included: 265 from the intervention school, 490 from the control school. At baseline, the two schools were comparable for grades and sex distribution; the intervention school had significant higher immunization rates for Meningococcal B, but lower ones for the 4th dose of dTap. After eight months, higher percentage of students received the HPV (30.5% vs 13.8% of females; p = 0.003) Meningococcal C (6.0% vs 2.0%; p = 0.005) and Meningococcal B (14.7% vs 0.3%; p <0.001) vaccines in the intervention school compared with control. The pre-post differences between the two schools in the immunization rates were significantly higher in the intervention school for the HPV, Meningococcal C and B vaccines.

CONCLUSIONS

This study demonstrates that a school-based health promotion project was effective in improving the recommended vaccines uptake among adolescents with potential interesting implication for the national target attainment. Considering the importance of informing and educating, innovative school-based health promotion programs could represent an excellent opportunity for the Local Health Authorities to get in touch with a hard-to-reach target. Performance in offering the vaccination in school facilities should be evaluated.

Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: Trifocal versus extended range of vision

PURPOSE

To compare the visual outcomes and quality of vision of 2 new diffractive multifocal intraocular lenses (IOLs) with those of a monofocal IOL.

SETTING

Fatebenefratelli e Oftalmico Hospital, Milan, Italy.

DESIGN

Prospective case series.

METHODS

Patients had bilateral cataract surgery with implantation of a trifocal IOL (Panoptix), an extended-range-of-vision IOL (Symfony), or a monofocal IOL (SN60WF). Postoperative examinations included assessing distance, intermediate, and near visual acuity; binocular defocus; intraocular and total aberrations; point-spread function (PSF); modulation transfer function (MTF); retinal straylight; and quality-of-vision (QoV) and spectacle-dependence questionnaires.

RESULTS

Seventy-six patients (152 eyes) were assessed for study eligibility. Twenty patients (40 eyes) in each arm of the study (60 patients, 120 eyes) completed the outcome assessment. At the 4-month follow-up, the trifocal group had significantly better near visual acuity than the extended-range-of-vision group (P = .005). The defocus curve showed the trifocal IOL had better intermediate/near performance than the extended-range-of-vision IOL and both multifocal IOLs performed better than the monofocal IOL. Intragroup comparison of the total higher-order aberrations, PSF, MTF, and retinal straylight were not statistically different. The QoV questionnaire results showed no differences in dysphotopsia between the multifocal IOL groups; however, the results were significantly higher than in the monofocal IOL group.

CONCLUSIONS

Both multifocal IOLs seemed to be good options for patients with intermediate-vision requirements, whereas the trifocal IOL might be better for patients with near-vision requirements. The significant perception of visual side effects indicates that patients still must be counseled about these effects before a multifocal IOL is implanted.

Adjuvanted influenza vaccine for the Italian elderly in the 2018/19 season: an updated health technology assessment

BACKGROUND

The elderly, defined here as subjects aged ≥ 65 years, are among at-risk subjects for whom annual influenza vaccination is recommended. For the 2018/19 season, three vaccine types are available for the elderly in Italy: trivalent inactivated vaccine (TIV), adjuvanted TIV (aTIV) and quadrivalent inactivated vaccines (QIV). No health technology assessment (HTA) of seasonal influenza vaccination in the elderly has previously been conducted in Italy.

METHODS

An HTA was conducted in 2017 to analyze the burden of influenza illness, the characteristics, efficacy, safety and cost-effectiveness of available vaccines and the related organizational and ethical implications. This was then contextualized to the 2018/19 influenza season. Comprehensive literature reviews/analyses were performed and a static mathematical model developed in order to address the above issues.

RESULTS

In Italy, influenza is usually less common in the elderly than in other age-classes, but the burden of disease is the highest; >10% of infected elderly subjects develop complications, and about 90% of all influenza-related deaths occur in this age-class. All available vaccines are effective, safe and acceptable from an ethical standpoint. However, aTIV has proved more immunogenic and effective in the elderly. Furthermore, from the third payer's perspective, aTIV is highly cost-effective and cost-saving in comparison with TIV and QIV, respectively. Nevertheless, vaccination coverage needs to be improved.

CONCLUSIONS

According to this HTA, aTIV appeared the vaccine of choice in the elderly. HTA should be reapplied whenever new relevant data become available.

Characterization of Sarcopenia in an IBD Population Attending an Italian Gastroenterology Tertiary Center

(1) Background: There is growing interest in the assessment of muscular mass in inflammatory bowel disease (IBD) as sarcopenia is associated with important outcomes. The aim of the study was to evaluate the percentage of sarcopenia in IBD patients, characterizing methods for assessment and clinical symptoms associated to it. (2) Methods: Consecutive IBD patients accessing the Fondazione Policlinico Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) were enrolled. Healthy patients, elderly or elderly sarcopenic patients, were enrolled as controls. Skeletal muscle mass was evaluated by Dual Energy X-ray Absorptiometry (DEXA) or Bio-Impedensometric Analysis (BIA). Asthenia degree was assessed by subjective visual analogue scales (VAS). Quality of life was measured by the EQ-5D questionnaire. (3) Results: Patients with IBD showed a significant reduction in skeletal muscle mass than healthy controls with lower DEXA and BIA parameters. Moreover, IBD patients presented a lower perception of muscle strength with a higher incidence of asthenia and reduction in quality of life when compared with healthy controls. A significant association between loss in skeletal muscle mass and high asthenia degree was found, configuring a condition of sarcopenia in about one third of patients with IBD. (4) Conclusions: Sarcopenia is common in IBD patients and it is associated with fatigue perception as well as a reduction in quality of life. Therefore, routine assessment of nutritional status and body composition should be a cornerstone in clinical practice, bringing gastroenterologists and nutritionists closer together for a compact, defined picture.

The unpredictability of seasonal variations in serum vitamin D levels in children with asthma and/or rhinitis

BACKGROUND

Some studies have showed that seasonality is an important determinant of vitamin D (vitD) status.

OBJECTIVE

We evaluated whether there are differences in individual trends of serum vitD level over one year in asthmatic and rhinitic children.

MATERIALS AND METHODS

Ninety-two asthmatic and rhinitic paediatric patients were followed up for one year and their serum vitD level was detected at three-month intervals, once in each season.

RESULTS

We observed higher vitD levels at the end of summer and lower at the end of winter. However, the individual seasonal trend was very variable and unpredictable. If it is true that in a given season the majority of patients followed one direction (increase or decrease of serum vitD levels), nevertheless a substantial percentage behaved differently and unpredictably. For example, at the end of spring, 70% of patients showed an increase in serum vitD levels, but 30% showed a decrease. In addition, five individuals had a value ≥50ng/ml in September and showed serum vitD levels ≥30ng/ml throughout the year; 16 patients presented vitD value ≥40ng/ml in September and always had ≥20ng/ml in the other months.

CONCLUSIONS

The wide and unpredictable variability of the individual trend of serum vitD levels should be taken into account before deciding whether or not a drug supplementation is appropriate.

[Vaccination among healthcare workers in Italy: a narrative review]

Vaccination of healthcare workers (HCWs) is a public health tool of the utmost importance and the Italian National Vaccine Prevention Plan (PNPV) 2017-2019 recommends several vaccinations in this population group. Nevertheless, vaccine hesitancy is influencing HCWs' attitude towards vaccination. Moreover, a large number of measles cases have been reported in Italy among HCWs in 2017 and 2018. In Italy there is no national registry for vaccinations, so data on vaccine coverage among HCWs are not readily accessible. The aim of this literature review is to describe the most recent data about vaccination coverage among HCWs in Italy. We also report studies that evaluated the effectiveness of strategies to increase influenza vaccine uptake. We included all studies conducted in Italy and published between 2008 and 2018, regarding vaccines recommended by the PNPV 2017-2019 (hepatitis B, influenza, pertussis, measles, mumps, rubella, varicella, and tuberculosis). Our findings confirm that low vaccination coverage levels among HCWs exist in several Italian regions and cities, highlighting a relevant gap towards targets set by the PNPV. Studies that evaluated the effectiveness of multicomponent interventions to increase vaccination coverage found only minimal to moderate increases in uptake levels. It is therefore crucial to tackle vaccine hesitancy in HCWs, by identifying effective strategies able to significantly increase vaccine coverage, in order to decrease the risk of nosocomial infections, prevent transmission of preventable diseases to patients, and reduce indirect costs related to HCW absenteeism due to illness.

Effectiveness of nutritional interventions addressed to elderly persons: umbrella systematic review with meta-analysis

Background

The number of Europeans aged over 65 will double between 2010 and 2060, reaching 30% of the European population. Nutrition is emerging as a key element of healthy life since both obesity and malnutrition are established risk factors for morbidity and disability. The aim of this umbrella review (UR) is to summarize the findings of all current systematic reviews (SRs) and meta-analyzes (MAs) on the effectiveness of nutritional intervention designed to promote healthy aging in older individuals.

Methods

Eligible articles published in English or Italian between January 2000 and May 2016 were identified in six databases. Only studies that analyzed nutritional interventions in the population of 65 years and over, or papers specifically targeting older adults were deemed eligible.

Results

Twenty-eight papers, out of which twenty-five SRs and three MAs, met the inclusion criteria and were included in this umbrella SR. Supplementation with vitamin D and other kind of products was highly effective in preventing falls and fractures. Furthermore, several interventions, ranging from the prescription of supplements to environmental and organizational programs, resulted in an improvement in energy and protein intake, as well as positive weight outcomes. Positive findings were also found for the elderly at risk of malnutrition and for older patients with dementia.

Conclusions

The findings of this UR indicate that the use of a wide range of supplements and environmental and organizational intervention improve a number of anthropometric, nutritional and functional indices in the elderly.

Detecting persons at risk for diabetes mellitus type 2 using FINDRISC: results from a community pharmacy-based study

Background

This cross-sectional study has been developed within the framework of the Italian project 'We love your heart' ('Ci sta a cuore il tuo cuore') and reports the results of the initial type 2 diabetes mellitus (T2DM) risk assessment carried out in a big network of community pharmacies in Italy and Spain.

Methods

In total 4002 pharmacists from 854pharmacies were specifically trained to collect data and perform the evaluation of the probability of developing T2DM among pharmacy customers. The risk of developing T2DM within 10 years was evaluated using the FINDRISC.

Results

Overall, 7234 (22.1%) subjects were at low risk to develop the disease, whereas 43.3% were at slightly elevated risk (scores 7-11), 19.3% were at moderate (scores 12-14), 13.9% were at high (scores 15-20), and 1.4% were at very high risk (scores > 20). Spanish participants showed higher levels of risk than Italian (16.7 vs. 14.7%) taking the cut-off FINDRISC ≥ 15.

Conclusion

This study shows that considerable percentage of persons is likely to develop diabetes in the next 10 years. Analyses of the risk factors indicate that men were more susceptible to develop this disease, as well as the Spanish participants respect to Italian.

Does Clinical Governance influence the quality of medical records?

BACKGROUND

Clinical Governance (CG) is a validated framework for continuous quality improvement in health care settings. Quality medical records may reflect the quality of care delivered and are a viable tool to implement CG skills.

AIM

Aim of this study is to investigate the correlation between the level of implementation of CG dimensions and the quality of medical records.

MATERIAL AND METHODS

A cross-sectional study was carried out in an Italian Teaching Hospital. CG implementation levels were quantified through a systematic methodology (OPTIGOV©). The overall quality of medical records was measured through a revised version of a National-validated scale. A multiple linear regression model was used to test the likely influence of all the variables constituting the OPTIGOV evaluation on the quality of medical records. 47 hospital wards and 1458 medical records were assessed.

RESULTS

A significant and positive association between the quality of medical records and the accountability score (β = 0.15; p < 0.01) and the clinical audit score (b = 0.11; p = 0.02), was found. Conversely, the risk management score shown a negative and significant correlation (b = -0.17; p < 0.01). This study confirms that CG plays a central role in driving quality improvement and advocates a systematic implementation of such an approach within healthcare organizations.

Health promotion for the aging workforce in Poland

OBJECTIVES

The aging of the workforce is an issue that calls for concrete measures to promote the health of older workers. This study reports on the results of the European "ProHealth65+" research project interventions conducted in Poland in relation to workplace health promotion for older workers (WHPOW) and the institutions involved in these programs.

MATERIAL AND METHODS

A three-stage search of peer-reviewed and grey literature on the WHPOW in Poland.

RESULTS

A total of 59 WHPOW programs were retrieved in Poland in the observation period (2000-2015). Most of these aimed at improving the Qualification and Training or at the Work Climate and attitudes toward older workers. The promotion, organization, and funding of these activities were carried out mainly by supra-national and governmental bodies, enterprises and employers, and educational and trainee institutions.

CONCLUSIONS

Although there is great commitment to the medical surveillance of workers on the part of the Polish occupational health service, our search detected a relatively low number of the WHPOW initiatives. Greater efforts should be made to introduce strategies for addressing aging of the workforce. Int J Occup Med Environ Health 2018;31(6):753-761.

[Unhealthy dietary habits among toddlers in Rome (Italy): a cross sectional study]

OBJECTIVE

To explore the nutrition and food habits of toddlers, in order to develop interventions to promote healthy eating starting from the early years of life.

METHODS

We conducted a cross-sectional study among 204 children aged from 3 months to 3 years, registered in 10 nursery schools in Rome, Italy. Children's diet-related behaviors and parent's food attitudes were evaluated using a 10-item questionnaire for parents. After administering the questionnaire, pediatricians of the local health authority conducted motivational interviews with parents to encourage them to make their children adopt healthy behaviors at home. Descriptive and analytical statistical methods were used to evaluate dietary habits in children, after stratifying by nursery school grade attended.

RESULTS

The data showed that unhealthy dietary habits occur even in nursery schoolaged children. In particular, over 50% of children were reported to watch TV while eating meals at home every day and to drink fruit juices at least 1-2 times per week. Unhealthy dietary habits were found to be more common among older children: there were significant differences in the proportions of older and younger children who consumed fruit juices or snacks more than twice per week (35.7% and 8.9% respectively of older children vs 3.3% and 3.3% respectively of younger children), who watched TV during meals (26.8% of older children versus 16.9% of younger children) and whose parents attribute a moral value to food as a reward more than twice a week (almost 14.3% of older children's parents vs 0.0% of small children's parents). On the contrary, older children were found to eat fruit significantly more frequently compared to younger children (51.8% vs 24.6% of young children ate fruit &gt;2 times a week). Parents of children with at least one unhealthy behavior had low awareness of healthy dietary choices: 86.7% believed that their children's diets were healthy.

CONCLUSION

This study showed that unhealthy dietary habits occur among Italian toddlers. These should be prevented by promoting specific interventions. Parents should be made aware of the possible consequences of their own behavior, considering that home food habits influence the development of dietary attitudes in children. Preventive interventions aimed at preschoolers may also be beneficial for parents themselves and for other family members.

Eating episode frequency and fruit and vegetable consumption among Italian university students

OBJECTIVE

To analyze breakfast consumption, regularity of meals, fruit and vegetable consumption in the Italian university student population on a national level.

DESIGN

Descriptive analysis evaluating data taken from the Sportello Salute Giovani (SSG) questionnaire.

PARTICIPANTS

12 000 university students who self-administered a confidential survey. 8292 questionnaires were analyzed.

VARIABLES MEASURED

Age; sex; self-reported economic status; BMI; number of breakfast and portions of vegetables and portions of fruit usually consumed per week; number of eating episodes per day; intended weight loss.

ANALYSIS

Descriptive and logistic regression analyses were conducted. Gender and age differences were tested by c2 and Mann-Whitney tests.

RESULTS

15.8% of males and 26.3% of females declared to consume at least one portion of fruit every day. Similar results were found for vegetable consumption. Age does not influence fruit or vegetables consumption, frequency of eating episodes or breakfast habit. Both a regular breakfast and a higher number of eating episodes are significantly associated both with a higher frequency of fruit and vegetables intake.

CONCLUSIONS AND IMPLICATIONS

This study underlines the need to promote nutritional education campaigns to increase adherence to nutritional guidelines.

Influenza and pneumococcal vaccination in older adults living in nursing home: a survival analysis on the shelter study

Background

Influenza and pneumococcal vaccines have been proved to be effective and safe in preventing and controlling infection among elderly, reducing morbidity and mortality. However, some evidences raised health concerns related to these vaccinations. This study aims to identify prevalence and outcomes related to influenza and pneumococcal vaccinations in a large European population of frail old people living in nursing homes (NHs).

Methods

We conducted a survival analysis of NH residents participating to the Services and Health for Elderly in Long-TERm project, a prospective cohort study collecting information on residents admitted to 57 NH in eight countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands and Israel). Clinical and demographical data were collected using the international resident assessement instrument for long-term care facilities. Incident mortality was recorded during 1-year follow-up. A shared-frailty Cox regression model was used to assess the impact of vaccination status on mortality.

Results

Mean age of 3510 participants was 84.6 years (SD = 7.7). In total, 81.7 and 27.0% received influenza and pneumococcal vaccination, respectively. Overall, 727 (20.7%) residents died during the follow-up period. After adjusting for potential confounders, which included age, sex, number of diseases, depression, cognitive and functional status, influenza (HR = 0.80; 95% CI 0.66-0.97) and the combination of influenza and pneumococcal vaccination (HR = 0.72; 95% CI 0.57-0.91), but not pneumococcal vaccination alone (HR = 0.52; 95% CI 0.25-1.06), were associated with a statistically significant reduction in mortality in respect of no vaccinations.

Conclusion

In a population of older adult living in NH influenza and the combination of influenza and pneumococcal vaccination were associated with a reduction in all-cause mortality respect to no vaccination.

Vaccine hesitancy: parental, professional and public responsibility

The opposition to vaccinations is a well-known phenomenon that dates back to the Victorian age when it was self-limited by the awareness of the importance to be protected against fearsome infectious diseases. In the XX century, the mass use of vaccination has - instead - consented to eradicate or drastically reduce the burden of diseases such as smallpox and polio. These positive effects of the vaccination campaigns have blurred out, if not erased, the memory of the tragic consequences of the past's widespread diseases, leading people to underestimate the severity of the harm that vaccinations prevent. In recent years, a complex mixture of contextual factors have promoted an amplification of that paradoxical situation, leading experts to study causes and consequences of the so called "vaccine hesitancy". Several studies have shown the impact for children and for the community of the refusal or hesitation towards vaccinations from different points of view, including epidemiological, clinical, social and economic evaluation. This article provides an analysis of vaccine hesitancy from an ethical perspective: parental, professional and public responsibilities are analysed and described according to the "responsibility of the fathers towards the children", as articulated by Hans Jonas in 1979.

Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn's Disease

AIM

To evaluate if a single and/or combined (clinical, endoscopic and radiological) assessment could predict clinical outcomes in Crohn's disease (CD).

METHODS

We prospectively evaluated 57 CD cases who underwent both a colonoscopy and a CT-enterography (CTE). Harvey-Bradshaw Index (HBi), SES-CD (and/or Rutgeerts score) and the radiological disease activity were defined to stratify patients according to clinical, endoscopic and radiological disease activity respectively. Hospitalizations, surgery, therapeutic changes and deaths were evaluated up to 36 months (time 1) for 53 patients.

RESULTS

CTE and endoscopy agreed in stratifying disease activity in 47% of cases (k = -0.05; p = 0.694), CTE and HBi in 35% (k = 0.09; p = 0.08), endoscopy and HBi in 39% (k = 0.13; p = 0.03). Taken together, CTE, endoscopy and HBi agreed only in 18% of cases (k = 0.01; p = 0.41). Among the 11 cases with mucosal healing, only 3 (27%) showed transmural healing. Patients with endoscopic activity needed significantly more changes of therapy compared to patients with endoscopic remission (p = 0.02). Patients with higher transmural or clinical activity at baseline required significantly more hospitalizations (p < 0.01). Hospitalization rate decreases with an increase in the number of parameters indicating remissions at baseline (p = 0.04).

CONCLUSIONS

Clinical, endoscopic and radiological assessments offer complementary information and could predict different mid-term outcomes in CD.

Capturing the chance for pneumococcal vaccination in the hospital setting

INTRODUCTION

Because of the relevant burden of pneumococcal diseases, newborns, people at risk and elderly are recommended vaccination but coverage is still low for problems in catching them. This study evaluates the proportion of eligible patients seen at hospital level in the view of assessing its potential role in vaccination campaigns.

METHODS

This is a retrospective analysis of discharge data of all patients over 49 years of age admitted between 2011 and 2013 to "A. Gemelli" teaching hospital. Eligibility for pneumococcal vaccination was evaluated based on ICD-9 codes.

RESULTS

Among 65 047 unique patients, 53.2% were eligible for pneumococcal vaccination. Most common eligibility criteria were chronic heart diseases, cancer and diabetes. Considering also age ≥ 65 as an indication to vaccination, the proportion of eligible patients reached 76.8%. The highest number of eligible patients was seen in medical sciences, general surgery, cardiovascular medicine and neurosciences departments.

CONCLUSIONS

Hospital might play an important role in catching patients eligible for pneumococcal vaccination because their proportion in the hospital setting is high.

Interventions targeting loneliness and social isolation among the older people: An update systematic review

This systematic review aims to summarize and update the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among older persons. A search of PubMed, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases was performed. The terminology combined all possible alternatives of the following keywords: social isolation, loneliness, old people, intervention and effectiveness. Eligible studies were published between January 2011 and February 2016 in English or Italian language and regarded the implementation of loneliness/social isolation interventions among the older generations. Outcome measures in terms of the intervention effects needed to be reported. In total, 15 quantitative and five qualitative studies were ultimately included in this review. Eighteen interventions were reported across the quantitative studies. Six out of 11 group interventions (55%), one out of four mixed interventions (25%) and all three individual interventions reported at least one significant finding related to loneliness or social isolation. Our review suggested that new technologies and community engaged arts might be seen as a promising tool for tackling social isolation and loneliness among the older individuals. Future studies need to work on methodological quality and take into consideration the suggestions of the present literature in order to provide firm evidence.

Workplace health promotion programs for older workers in Italy

BACKGROUND

Italy is the European country with the highest number of citizens over the age of sixty. In recent years, the unsustainability of the social security system has forced the Italian government to raise the retirement age and reduce the chances of early exit, thus sharply increasing the age of the workforce. Consequently, a significant proportion of older workers are currently obliged to do jobs that were designed for young people. Systematic health promotion intervention for older workers is therefore essential.

OBJECTIVES

The European Pro Health 65+ project aims at selecting and validating best practices for successful/active aging. In this context we set out to review workplace health promotion projects carried out in Italy.

METHODS

To ascertain examples of workplace health promotion for older workers (WHPOW), we carried out a review of the scientific and grey literature together with a survey of companies.

RESULTS

We detected 102 WHPOW research studies conducted in conjunction with supranational organizations, public institutions, companies, social partners, NGOs and educational institutions. The main objectives of the WHPOW were to improve the work environment, the qualifications of older workers and attitudes towards the elderly, and, in many cases, also to improve work organization.

CONCLUSIONS

The best way to promote effective WHPOW interventions is by disseminating awareness of best practices and correct methods of analysis. Our study suggests ways of enhancing WHPOW at both a national and European level.