Influenza vaccination and COVID-19 Infection Risk and Disease Severity: A systematic review and multi-level meta-analysis of prospective studies

BACKGROUND

In light of the SARS-CoV-2 pandemic, the influence of influenza vaccination on the risk and severity of COVID-19 has been a subject of debate. This systematic review and meta-analysis of prospective studies aim to elucidate the association between influenza immunization and the risk of SARS-CoV-2 infection and subsequent COVID-19 disease severity.

METHODS

A comprehensive search of PubMed and Embase databases was performed to identify prospective studies published before March 2024. We focused on evaluating the effect of influenza vaccination on SARS-CoV-2 infection risk and severe COVID-19 outcomes, such as hospitalization and mortality. The analysis employed a multi-level random effects meta-analysis approach. The risk of bias assessment was conducted using the Newcastle-Ottawa Scale (NOS).

RESULTS

From an initial pool of 5863 records, 14 studies were selected for inclusion. The aggregated data yielded a Summary Relative Risk (SRR) that showed no significant protective correlation between influenza vaccination and SARS-CoV-2 infection risk (SRR 0.95, 95%CI 0.81-1.11), COVID-19-associated hospitalization (SRR 0.90, 95%CI 0.68-1.19), or COVID-19-related mortality (SRR 0.83, 95%CI 0.56-1.23).

CONCLUSIONS

This systematic review and meta-analysis, based exclusively on prospective studies, demonstrates the lack of a proven protective effect of influenza vaccination against COVID-19 and related outcomes. Our results do not support a significant protective effect of influenza vaccination against the risk or severe outcomes of COVID-19.

Enhancing Primary Health Care through Interprofessional education: Insights from a Training Workshop

Introduction

Strengthening primary care services with a focus on comprehensive Primary Health Care principles necessitates collaborative work practices within interprofessional teams. In Italy, the Local Health District of Florence embodies a comprehensive Primary Health Care -inspired model of primary care, prominently featuring the House of Community concept. This work presents findings and insights from a multidisciplinary, interprofessional education activity tailored for healthcare professionals, researchers, and students actively participating in the primary care reorganization.

Methods

The activity was structured using a four-phase learning model (imaginative, analytical, common sense, and dynamic), aligning with four distinct activities (brainstorming, lecture, case study, and group project).

Results

Key themes that emerged encompassed the significance of nurturing relationships among team members, the aspiration for an inclusive work environment, the vital role of community engagement and collaboration across various services, disciplines, and sectors beyond healthcare.

Discussion

These themes highlight the essential attributes of successful primary care practices built on the principles of comprehensive comprehensive Primary Health Care. Throughout the innovation process of primary care services, interprofessional education training events emerged as indispensable components for bolstering implementation and ensuring sustainability. This study underscores the crucial role of interprofessional education in bridging the gap between theoretical constructs and practical application, emphasizing that comprehensive Primary Healthcare principles find tangible manifestation in real-world scenarios.

Global analysis of respiratory viral circulation and timing of epidemics in the pre-COVID-19 and COVID-19 pandemic eras, based on data from the Global Influenza Surveillance and Response System (GISRS)

INTRODUCTION

The COVID-19 pandemic significantly changed respiratory viruses' epidemiology due to non-pharmaceutical interventions and possible viral interactions. This study investigates whether the circulation patterns of respiratory viruses have returned to pre-pandemic norms by comparing their peak timing and duration during the first three SARS-CoV-2 seasons to pre-pandemic times.

METHODS

GISRS data from 194 countries (2014-2023) was analyzed for epidemic peak timing and duration, focusing on pre-pandemic and pandemic periods across both hemispheres and the intertropical belt. Analysis was restricted to countries meeting specific data thresholds to ensure robustness.

RESULTS

In 2022/23, the Northern hemisphere experienced earlier influenza and RSV peaks by 1.9 months (p<0.001). The duration of influenza epidemics increased by 2.2 weeks (p<0.001), with RSV showing a similar trend. The Southern hemisphere's influenza peak shift was not significant (p=0.437). Intertropical regions presented no substantial change in peak timing but experienced a significant reduction in duration for hMPV and adenovirus (7.2 and 6.5 weeks shorter, p<0.001).

CONCLUSIONS

The pandemic altered the typical patterns of influenza and RSV, with earlier peaks in 2022 in temperate areas. These findings highlight the importance of robust surveillance data to inform public health strategies on evolving viral dynamics in the years to come.

Perspectives in the Development of Tools to Assess Vaccine Literacy

Vaccine literacy (VL) is the ability to find, understand, and evaluate vaccination-related information to make appropriate decisions about immunization. The tools developed so far for its evaluation have produced consistent results. However, some dimensions may be underestimated due to the complexity of factors influencing VL. Moreover, the heterogeneity of methods used in studies employing these tools hinders a comprehensive understanding of its role even more. To overcome these limitations, a path has been sought to propose new instruments. This has necessitated updating earlier literature reviews on VL and related tools, exploring its relationship with vaccine hesitancy (VH), and examining associated variables like beliefs, attitudes, and behaviors towards immunization. Based on the current literature, and supported by the re-analysis of a dataset from an earlier study, we propose a theoretical framework to serve as the foundation for creating future assessment tools. These instruments should not only evaluate the psychological factors underlying the motivational aspect of VL, but also encompass knowledge and competencies. The positioning of VL in the framework at the intersection between sociodemographic antecedents and attitudes, leading to behaviors and outcomes, explains why and how VL can directly or indirectly influence vaccination decisions by countering VH and operating at personal, as well as at organizational and community levels.

How to communicate with older adults about climate change: a systematic review

Introduction

Although older adults are particularly vulnerable to the effects of climate change, they seem to be overall less concerned about it, and less inclined to support climate policies. The study aims to identify the communication strategies that have been evaluated in promoting awareness and/or climate friendly behaviors in older adults.

Methods

We searched multiple electronic databases for studies that evaluated the effects of any interventions aimed at communicating climate change to older persons (over 65 years) and assessed the results as awareness and /or behavioral changes. We selected quantitative, qualitative and mixed methods studies, and we also included systematic reviews for cross-referencing. Risk of bias of included studies was evaluated using different tools according to the study design.

Results

From a total of 5,486 articles, only 3 studies were included. One mixed-method study engaged older adults to assess the community vulnerability to climate change and to develop adaptation recommendations based on their perspectives; one qualitative study conducted focus groups to identify the more effective language, values and themes based on participants' responses to narratives; one quantitative study utilized a 360-degree audio-visual platform allowing users to engage with immersive visualizations of sea-level rise scenarios.

Discussion

Despite the paucity of literature, this review demonstrates the potential for different strategies to increase the awareness of older persons about climate change. The involvement of older adults in the communication process, the identification of their priorities, and the integration of technology in their daily lives are promising approaches but more research, including both quantitative and qualitative studies is recommended on this topic.

Systematic review registeration

For further details about the protocol, this systematic review has been registered on PROSPERO on July 1, 2023 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023438256).

Health Literacy and Self-Care in Patients with Chronic Illness: A Systematic Review and Meta-Analysis Protocol

Self-care plays a critical role in symptom recognition, management, and risk factor modification for patients with chronic illnesses. Despite its significance, self-care levels in this population are generally poor. Health literacy (HL) is pivotal for promoting effective self-care, yet the association across specific chronic illnesses remains fragmented and conflicting. Therefore, a systematic review and meta-analysis will be conducted. Inclusion criteria encompass quantitative studies involving adult patients with at least one chronic illness reporting on the association between a measure of HL and one or more elements of self-care behaviors as outcomes. Databases to be searched include PubMed, CINAHL, APA PsycINFO, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The studies will undergo risk of bias and certainty of evidence assessment using ROBINS-E and GRADE. Extracted data will include authors, publication date, aim(s), study location, design, sample characteristics, chronic illness type, study length, HL, and self-care measures. Understanding the link between HL and self-care can aid healthcare providers in implementing strategies to enhance health-promoting behaviors, contributing valuable insights to the scientific community and fostering nuanced discussions. This protocol ensures methodological transparency, stimulates discourse, and paves the way for informed interventions to improve overall health outcomes.

The Impact of Rapid On-site Evaluation on Diagnostic Performance of Computed Tomography-Guided Core Needle Biopsy in Lung Cancer

PURPOSE

Rapid on-site-evaluation (ROSE) is a technique aimed at improving the diagnostic performance of computed tomography (CT)-guided core needle biopsy (CNB) in lung cancer. The aim of this retrospective study was to investigate the impact of ROSE on the rate of nondiagnostic specimens and on accuracy computed on diagnostic specimens.

MATERIALS AND METHODS

During a 3-year period, 417 CT-guided CNBs were performed at our center. The biopsies were retrospectively classified into 2 groups: 141 procedures were assisted by ROSE and 276 were not. All of them were reviewed for clinical, procedural, and pathological data. Pathology results were classified as diagnostic (positive or negative for malignancy) or nondiagnostic. The results were compared with the final diagnosis after surgery or clinical follow-up. Nondiagnostic rate, sensitivity/specificity/negative predictive value/positive predictive value for the ROSE and non-ROSE groups were calculated. Finally, procedural complications and the adequacy of the specimens for the molecular analysis were recorded.

RESULTS

The study evaluated 417 CNBs (mean patients' age 71 years, 278 men). Nondiagnostic rates with and without ROSE were 4% (6/142) and 11% (29/276), respectively (P = 0.028). Sensitivity/specificity/negative predictive value/positive predictive value with and without ROSE did not show statistically significant differences, and no difference in major/minor complication rates was observed between the 2 groups. The adequacy of specimen for subsequent molecular analysis was 100% with (42/42) and 82% without ROSE (51/62).

CONCLUSIONS

Rapid on-site-evaluation reduced the rate of nondiagnostic specimens by 50% with no change in complication rates or accuracy and increased by 20% the chances of a successful subsequent molecular analysis.

COVID-19 vaccine literacy: A scoping review

To address vaccine hesitancy, specific self-rated tools have been developed to assess vaccine literacy (VL) related to COVID-19, including additional variables, such as beliefs, behavior, and willingness to be vaccinated. To explore the recent literature a search was performed selecting articles published between January 2020 and October 2022: 26 papers were identified using these tools in the context of COVID-19. Descriptive analysis showed that the levels of VL observed in the studies were generally in agreement, with functional VL score often lower than the interactive-critical dimension, as if the latter was stimulated by the COVID-19-related infodemic. Factors associated with VL included vaccination status, age, educational level, and, possibly, gender. Effective communication based on VL when promoting vaccination is critical to sustaining immunization against COVID-19 and other communicable diseases. The VL scales developed to date have shown good consistency. However, further research is needed to improve these tools and develop new ones.

Health literacy and breast cancer screening adherence: results from the population of Tuscany, Italy

Mammographic screening can reduce breast cancer (BC) mortality in women. In Italy, although attendance rates increased recently, they are still far from the recommended levels internationally. Inadequate health literacy (HL) may be a reason for poor awareness and/or knowledge about the importance of completing cancer screening. This study examined the relationship between HL, other sociodemographic determinants, and their influence on participation in both opportunistic and organized BC screenings among women aged 50-69 in Tuscany. The study analyzed 2017-2019 data from the Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia). HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Among the 2250 interviewees, 75.3% underwent the organized BC screening and 9.4% on voluntary basis. Although to a different extent, HL was significantly associated to compliance rates with both opportunistic and organized screenings. Among sociodemographic factors, only occupational status was associated with opportunistic screening attendance rates. As expected, being invited by letter resulted to be strongly associated with participation to organized screening programs and the medical advice predicts for participating to both opportunistic and organized screening. This study highlights the relevant role that HL plays in BC, opportunistic and organized, screening adherence in a universal healthcare system. To increase BC screening participation rates, healthcare systems would benefit by implementing interventions for improved HL at population level or within healthcare organizations.

Doubts and concerns about COVID-19 uncertainties on imaging data, clinical score, and outcomes

BACKGROUND

COVID-19 is a pandemic disease affecting predominantly the respiratory apparatus with clinical manifestations ranging from asymptomatic to respiratory failure. Chest CT is a crucial tool in diagnosing and evaluating the severity of pulmonary involvement through dedicated scoring systems. Nonetheless, many questions regarding the relationship of radiologic and clinical features of the disease have emerged in multidisciplinary meetings. The aim of this retrospective study was to explore such relationship throughout an innovative and alternative approach.

MATERIALS AND METHODS

This study included 550 patients (range 25-98 years; 354 males, mean age 66.1; 196 females, mean age 70.9) hospitalized for COVID-19 with available radiological and clinical data between 1 March 2021 and 30 April 2022. Radiological data included CO-RADS, chest CT score, dominant pattern, and typical/atypical findings detected on CT examinations. Clinical data included clinical score and outcome. The relationship between such features was investigated through the development of the main four frequently asked questions summarizing the many issues arisen in multidisciplinary meetings, as follows 1) CO-RADS, chest CT score, clinical score, and outcomes; 2) the involvement of a specific lung lobe and outcomes; 3) dominant pattern/distribution and severity score for the same chest CT score; 4) additional factors and outcomes.

RESULTS

1) If CT was suggestive for COVID, a strong correlation between CT/clinical score and prognosis was found; 2) Middle lobe CT involvement was an unfavorable prognostic criterion; 3) If CT score < 50%, the pattern was not influential, whereas if CT score > 50%, crazy paving as dominant pattern leaded to a 15% increased death rate, stacked up against other patterns, thus almost doubling it; 4) Additional factors usually did not matter, but lymph-nodes and pleural effusion worsened prognosis.

CONCLUSIONS

This study outlined those radiological features of COVID-19 most relevant towards disease severity and outcome with an innovative approach.

The Activity of Special Continuity Care Units in the City of Florence During the COVID-19 Pandemic

Objectives: Worldwide, countries adopted different strategies in primary care (PC) to cope with the COVID-19 pandemic. This study aims to describe and evaluate the functions and activity load of a specific PC organizational model called "Special Continuity Care Units" (SCCU) in Florence, Italy, and to investigate the characteristics of the COVID-19 patients assisted by the service. Methods: The retrospective cross-sectional design used daily updated reports by SCCU team members to evaluate the activity load. The retrospective cohort study analyzed data of the demographics, clinical characteristics, and process outcomes of patients assisted during the second pandemic wave. Results: The analysis shows how the service activity load changed along with the epidemiological trend. Regarding people assisted by the SCCU, the median follow-up duration of symptoms was 6 days; male gender and being symptomatic were predictors of hospitalization. Conclusion: Some key characteristics can be described as indispensable in PC services facing health emergencies: model flexibility, the availability of resources, networking among services to enhance coordination and resource optimization, and close collaboration with general practitioners.

Do demographic and socio-economic factors predict Sense of Coherence among university students?

INTRODUCTION

The COVID-19 pandemic and related containment measures have been threatful for psychological well-being, particularly for young people such as university students. Sense of Coherence (SoC) can help in coping with stressful and anxiety-provoking situations.

AIM

The aim of this study is to describe the levels of SoC and to investigate the socio-economic, and demographic predictors in a sample of students attending Florence University, in the timespan between August, 17th and October, 3rd 2020.

METHOD AND RESULTS

The cross-sectional online survey was completed by 2,996 students. Higher levels of SoC have been found among males and for respondents reporting a better socioeconomic condition. Regarding the dimensions of SoC, lower levels were reported for comprehensibility and manageability, higher for meaningfulness.

CONCLUSIONS

These results reinforce the need to plan and implement health promotion interventions aimed to support and sustain university students in general and specifically those at higher risk of low level of SoC.

Predictors of well-being, future anxiety, and multiple recurrent health complaints among university students during the COVID-19 pandemic: the role of socioeconomic determinants, sense of coherence, and digital health literacy. An Italian cross-sectional study

The pandemic deeply changed young adults' life. Lockdown period and the social restrictions dramatically affected university students' mental health. The aim of our cross-sectional study was to describe psychological well-being, future anxiety (FA), and health complaints (HCs) in a sample of 3,001 students of the University of Florence in the middle of the first two pandemic waves. We assessed the role of subjective social status, chronic diseases, sense of coherence (SoC), and digital health literacy (DHL) as predictors of psychological well-being, FA, and HCs. Students expressed high levels of FA and reported being disturbed by not being able to achieve their desired future goals. About 40% reported a low or a very low well-being and 19.1% experienced two or more subjective health complaints more than once a week. The likelihood of having a better mental health status significantly increased with increasing SoC and among males. Subjective Social Status proved to be a predictor for FA. Enhancing SoC could improve the health status of the university students during the pandemic and beyond.

Does Vaccine Confidence Mediate the Relationship between Vaccine Literacy and Influenza Vaccination? Exploring Determinants of Vaccination among Staff Members of Nursing Homes in Tuscany, Italy, during the COVID-19 Pandemic

BACKGROUND

Low coverage of influenza vaccination in nursing home (NH) staff may be attributed to factors such as vaccine confidence (VC) and vaccine literacy (VL). Our study aimed to evaluate the role of VL and VC in predicting the intention to get the influenza vaccine in a sample of employees of NHs in Tuscany, Italy.

METHODS

Data from staff members in Tuscany were collected using an online questionnaire that examined influenza vaccination history, intentions, demographic information, health status, and VL. Statistical analyses explored the relationships between VC, VL, and vaccination intentions.

RESULTS

The study included 1794 respondents, (86.3%) and assistants/aides (58.1%), with a median age of 46 years. The intention to get vaccinated was significantly higher among those with health risk conditions, and there was a positive association between VC and VL, specifically its interactive/critical component. The mediation analysis showed that VC completely mediated the relationship between VL and the intention to get vaccinated, with significant effects observed in different subgroups.

CONCLUSIONS

VC is a key factor that mediates the effect of VL on vaccine intention. These results suggest that interventions aimed at improving VL alone may not be sufficient to increase vaccine uptake unless VC is also addressed.

Vaccination as a social practice: towards a definition of personal, community, population, and organizational vaccine literacy

BACKGROUND

A comprehensive and agreed-upon definition of vaccine literacy (VL) could support the understanding of vaccination and help policy-makers and individuals make informed decisions about vaccines.

METHODS

To shed some light on this debate and provide clarity, a scoping review was conducted to collect, summarize, and analyse available definitions of VL. Based on the findings of the scoping review, a new and comprehensive definition was proposed by a panel of experts.

RESULTS

Fifty-three articles were included, and two of them appeared to be the milestones around which the other definitions were grouped. The new definition proposed by the panel of experts included not only the personal perspective, but also the community, population, and organizational perspectives. Moreover, due to the increasing complexity of the social context with respect to the ability to navigate, understand, and use information and services, the definition of organizational vaccine literacy and the attributes of a vaccine literate healthcare organization have been proposed.

CONCLUSION

The new definition can contribute to the overall paradigm of health literacy and its distinct component of vaccine literacy, possibly improving the implementation of public health strategies to allow vaccination to be understood as a social practice by the entire community. This study describes the conceptual foundations, the competencies, and the civic orientation to be considered when developing measurement tools devoted to assessing VL at the different levels and in different contexts.

Dr-MUSIC: An Effective Device for Investigating Multisensory Mechanisms during Development with EEG recordings. Annu Int Conf IEEE Eng Med Biol Soc 2023;2023:1-5. [PMID: 38082766 DOI: 10.1109/embc40787.2023.10340915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

From birth, we are continuously exposed to multisensory stimuli that we learn to select and integrate during development to perceive a coherent world. To date, there are no optimal solutions to investigate how auditory, visual and tactile signals are integrated during EEG recording in infants and children. The present work aims to introduce Dr-MUSIC, a novel multisensory device with EEG-compatible timing and an attractive design for children. It is composed of audio, visual, and tactile stimulators arranged in the form of a couple of chubby dragons that can simultaneously provide selectable uni-, bi-, or tri-modal information. We first validated the system's EEG compatibility in 8 adults by implementing an audio-tactile oddball task during a high-density EEG recording. Then, we replicated the same task in a couple of toddlers to validate the device's usability for young children. The results suggest that the system can be effectively used for setting new experimental protocols to understand the neural basis of multisensory integration in the first years of life.Clinical Relevance- The amusing design and the possibility of changing the stimulation's characteristics (i.e., light, sound, and vibrotactile features) make it attractive in children with and without sensory impairments. Therefore, Dr-MUSIC could be used to investigate multisensory development and related neural correlates in typical and atypical children to design new early rehabilitation protocols.

Prevalence and Contextual Factors of Juvenile Fibromyalgia in a Population-Based Italian Sample of Children and Adolescents

Juvenile Fibromyalgia (JFM) is poorly known, leading to delay in the identification of the syndrome. On the other hand, early diagnosis in children is important to prevent the worsening of the disease. This study aims to estimate the prevalence of JFM in an Italian population-based convenience sample, using different criteria (2010 and 2016 ACR, Yunus and Masi), by involving family pediatricians. It also aims to assess the relationships between JFM and contextual factors of the children and their parents, as well as to raise awareness of JFM among pediatricians. Children's data were collected using an ad hoc electronic questionnaire. Overall, 7275 questionnaires were collected (48.5% females; mean age: 8.2 ± 3.6 years). Thirty-eight children (0.5%) met the 2010 ACR criteria, and 4 (0.1%) met the 2016 ACR criteria. The likelihood of meeting the 2010 ACR criteria was significantly higher for children older than 8 years (OR: 2.42), those who had injuries during the leisure time that caused persistent pain (OR: 6.49), whose parents (at least one) had a diagnosis of fibromyalgia (OR: 2.54) or diffuse pain (OR: 9.09). In conclusion, 2010 ACR criteria are confirmed as the more appropriate for children and adolescents and the analysis of contextual factors suggests the need for family pediatricians to pay particular attention to the most important predictors of JFM.

Impact of SARS-CoV2 infection on mortality and hospitalization in nursing home residents during the "Omicron era"

BACKGROUND

Widespread vaccination and emergence of less aggressive SARS-CoV2 variants may have blunted the unfavourable outcomes of COVID-19 in nursing home (NH) residents. We analysed the course of COVID-19 epidemic in NHs of Florence, Italy, during the "Omicron era" and investigated the independent effect of SARS-CoV2 infection on death and hospitalization risk.

METHODS

Weekly SARS-CoV2 infection rates between November 2021 and March 2022 were calculated. Detailed clinical data were collected in a sample of NHs.

RESULTS

Among 2044 residents, 667 SARS-CoV2 cases were confirmed. SARS-CoV2 incidence sharply increased during the Omicron era. Mortality rates did not differ between SARS-CoV2-positive (6.9%) and SARS-CoV2-negative residents (7.3%, p = 0.71). Chronic obstructive pulmonary disease and poor functional status, but not SARS-CoV2 infection independently predicted death and hospitalization.

CONCLUSIONS

Despite that SARS-CoV2 incidence increased during the Omicron era, SARS-CoV2 infection was not a significant predictor of hospitalization and death in the NH setting.

Impact of Built Environment and Neighborhood on Promoting Mental Health, Well-being, and Social Participation in Older People: an Umbrella Review

Background

The built environment, especially in the context of the neighborhood, affects older people's health. This umbrella review aims to summarize the associations between factors and interventions in the built environment as regards modifying or improving mental health, well-being, social inclusion and participation in the elderly.

Methods

We searched articles in the following databases: PubMed, Embase, Cochrane Library, Scopus, Avery Index, Sage, Web of Science, Health Evidence, and Google Scholar, without any time limits. The factors and interventions examined have been classified into three categories (urban infrastructure, green infrastructure, built environment), and we have assessed their relationships with each of the health outcomes.

Results

Eight reviews have been included. The results show a positive association between factors and interventions and health outcomes, even though this tends to differ with respect to some of the elements (study design, sample size, built environment and health outcome measurements, and the quality of the primary studies included in the reviews) in the selected studies.

Conclusions

In conclusion, the present study suggests and confirms that acting on the built environment has a positive impact on mental health and social inclusion.

Digital Health Literacy and Information-Seeking in the Era of COVID-19: Gender Differences Emerged from a Florentine University Experience

Gender appears to be a strong predictor of online health information-seeking behaviour (OHISB), which is related to Digital Health Literacy (DHL). Gender differences in OHISB have been studied in different countries with different results, but no studies have investigated gender-specific OHISB among University students during the COVID-19 pandemic. We sought to investigate any gender differences in OHISB in the period between the first and second waves of the pandemic in Italian university students. A questionnaire developed by the global COVID-HL network, including existing and adapted validated scales and self-developed scales, was administered to 2996 University students in Florence. Gender differences were tested using the χ² test or the Mann-Whitney U test. Male students reported a higher score in DHL than females (p < 0.001). However, female students seek COVID-19 information more often on different sources (for themselves and other people), on various topics, consider various aspects of information quality to be "very important'' (p < 0.05) and are more likely to be "often dissatisfied'' or "partly satisfied'' with information (p < 0.001). Our study confirmed gender as an important dimension to explain students' OHISB differences, which could help institutions promote gender-specific education programmes and provide gender-oriented health information.

Communicating with Patients about COVID-19 Vaccination: A Qualitative Study on Vaccinators in Tuscany Region, Italy

The rapid development of the vaccine and the infodemia have challenged communication about COVID-19 vaccines. This study aims to characterize-through the experience of vaccinators-the challenges faced during COVID-19 vaccination consultations and the communication strategies adopted. A qualitative study was conducted on COVID-19 vaccinators in Tuscany, Italy. Face-to-face interviews were conducted and examined by thematic analysis. In total, 30 vaccinators were interviewed. Four main themes emerged. The first highlighted distinct profiles of users' attitudes toward COVID-19 vaccination. Barriers and promoters of vaccine uptake emerged in the second theme: concerns over the vaccine, excessive exposure to information, and a lack of clear guidance from institutions were the main factors behind hesitancy. The third theme highlighted users' information-seeking behaviors; vaccinators observed that users ideologically opposed to the vaccine (IOV) unconsciously seek information that confirms their theories. The last theme comprised communication strategies for dealing with hesitancy. Empathy, first-hand examples, transparency, and tailored communication style appear to be effective in building vaccine trust. Lastly, the impossibility of developing a decision-making partnership with IOVs was noticed. These findings may help to better characterize public attitudes toward COVID-19 vaccination and highlight key communication principles and strategies to foster vaccine confidence.

Health literacy of informal caregivers of older adults with dementia: results from a cross-sectional study conducted in Florence (Italy)

AIM

The aim of this study was to measure the prevalence of inadequate health literacy (HL) in a sample of family caregivers of older adults with dementia, and to assess the relationship of HL with characteristics of caregiver and persons with dementia.

METHODS

The study followed a cross-sectional design. Persons with dementia and their family caregivers were enrolled in an outpatients' geriatric memory clinic. For the caregivers, the following information was collected: socio-demographic data, level of HL, cognitive impairment (using the Mini-Cog). For persons with dementia, the following data were collected: socio-demographic data, functional status (using the Basic and Instrumental Activities of Daily Living), cognitive impairment (using the Mini Mental State Evaluation, and the Global Deterioration Scale) behavioral and psychological symptoms associated with dementia (assessed using the Neuropsychiatric Inventory).

RESULTS

A total of 174 person with dementia/caregiver dyads were enrolled. About 45% of the caregivers presented a possibility or a high likelihood of inadequate HL. The percentage of caregivers with inadequate HL was higher among spousal caregivers than in offspring. Female gender, higher age and lower education were independent predictors of low HL. On multiple logistic regression analysis, persons with dementia assisted by caregivers with a high likelihood of limited HL presented higher risk of a more severe disease.

CONCLUSION

The results of this study suggest that the HL of dementia caregivers has to be included in the comprehensive geriatric assessment, to develop an appropriate individualized care plan. Moreover, public health interventions are needed to increase the HL of dementia caregivers.

Digital Health Literacy during COVID-19: gender differences from a Florentine University experience

 

Gender appears to be a strong predictor of online health information-seeking behaviour (OHISB). Gender differences in OHISB have been studied in different countries with different results, but no studies investigated gender-specific behaviour among University students during the COVID-19 pandemic, which has brought with it a consequential infodemic. We sought to investigate any gender differences in OHISB in the period between the first and the second wave of the COVID-19 pandemic. A questionnaire promoted by the COVID-HL network was administered to 2996 students of all the courses at the University of Florence. It included existing validated scales adapted to the COVID-19 pandemic and newly developed scales. Gender differences were tested using the χ2 test or the Mann-Whitney U test, where appropriate. Male students reported a higher score in DHL than females (p < 0.001). However, female students reported using more often different sources for online information seeking (p < 0.05, except for YouTube), searching more corona-related topics (p < 0.05, except for economic and social consequences) and considering ‘‘very important'’ each item in the ‘‘Importance of internet information search'’ section (p < 0.05). Furthermore, female students are more likely to be ‘‘often dissatisfied'’ or ‘‘partly satisfied'’ with information about COVID-19 (p < 0.001) and to search more often for information for themselves and other people. Our study confirmed that gender could affect the way students search for health information on the Internet. Since students, in particular females, have been affected by stress and anxiety during the pandemic, these findings could help institutions to promote gender-specific education programmes to improve students’ DHL and their mental health outcomes, as well as to provide health information that fit specific gender needs.

Key messages

• Gender influences how university students search on the Internet for health information.

• This should guide institutions to better address educational programmes to improve their Digital Health Literacy.

Health literacy and gender differences in colorectal cancer screening

Introduction

Colorectal cancer (CRC) is one of the major causes of death worldwide. Previous research reported differences in screening adherence both by gender and socioeconomic determinants. However, little is known about the extent to which Health Literacy (HL) may affect gender differences in CRC screening rates. Here, we aimed to assess HL levels in both genders and their relations with CRC screening adherence.

Methods

The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System (PASSI - Progress by local health units toward a healthier Italy) in 2017-2019. Socioeconomic status was measured by education level, occupation, financial status, and nationality, while HL by the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Multivariate analysis was performed to investigate associations between CRC screening rates, social determinants, and HL.

Results

Among 4,268 people aged 50-69 years included in PASSI, 64% undergo to CRC screening in the 2 years preceding the interview. No statistically significant differences in screening adherence were found by gender. In the multivariate analysis, the odds of adherence to CRC screening increased in both genders for being aged 60-69 years (Males: OR 1.43, 95% CI 1.12-1.82; Females: OR 1.72, 95% CI 1.37-2.14) and high education level (Males: OR 1.34, 95% CI 1.08-1.66; Females: OR 1.30, 95% CI 1.05-1.60). Males with a poor financial status and females with a low HL level were less likely to undergo CRC screening (OR 0.71, 95% CI 0.57-0.88 and OR 0.68 95% CI 0.49-0.95 respectively).

Conclusions

Our findings suggest that adherence to CRC screening is associated with HL in females only, while it depends on financial status in males. Therefore, gender specific interventions, tailored on different factors, are needed to increase the CRC screening rates.

Key messages

Environmental Health Literacy: an index to study its relations with pro-environmental behaviors

 

The citizen’ awareness about environmental health risks has been identified as an important determinant of citizens’ choices for the adoption of pro-environmental behaviors, but for its study simple measures to be applied in population studies are still lacking. The Environmental Health Literacy (EHL), is a recent sub-cathegory of health literacy, including functional, critical and interactive dimensions, that can be applied in surveys on environmental health risk perception and behaviors. The aim of our study was to elaborate and validate an EHL Index (ELHI) using data from a large multicenter survey carried out among 4778 students of different disciplines in 15 Italian Universities, with a self-administered anonymous questionnaire investigating risk perceptions, attitudes and behaviors towards environmental health risks and including a simple Functional Health Literacy test (FHL). From the original questionnaire of 56 items three sets of questions were selected to represent the three dimensions of health literacy (Functional, Critical or Interactive) and their outcomes were compared with the answers about FHL test and pro-environmental behaviors. The Principal Component Analysis was used to select the most representative questions that were then grouped in the EHLI. The index was significantly associated with both FHL test and behaviors questions. The ROC curve indicated a satisfying accuracy and was used to identify the best cut-off for ELHI. In conclusion the constructed ELHI can be considered reliable and useful for further population surveys in similar target people to plan communication interventions about environmental health risks and their prevention through individual choices.

Key messages

Smoking cessation at diagnosis and cancer survival: systematic review and meta-analysis

 

Stopping smoking can considerably cut one's risk of developing cancer compared to continued smoking (i.e. up to 50% after 5 years for esophageal cancer and after 10 years for lung cancer). Much less is known about whether quitting smoking may bring a survival advantage to people who are active smokers at the time of cancer diagnosis. We conducted a systematic review and meta-analysis of the studies that examined the prognostic effect of quitting smoking at or around diagnosis among cancer patients. We searched MEDLINE and EMBASE for articles published until 30th March 2022 that reported the impact of quitting smoking at or around diagnosis on cancer patients’ survival (any type). Separately for each cancer site, study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models, investigating sources of heterogeneity and bias. Forty-three articles were included, including 20 for lung cancer (LC), 16 for head and neck cancer (HNC), and less than 10 for bladder, breast, gastrointestinal tract, and other sites. Quitting smoking at or around diagnosis was associated with longer overall survival (SRR 0.71, 95% CI 0.64-0.80) in LC patients (consistently for non-small cell and small cell LC) as well as HNC patients (SRR 0.80, 95% CI 0.70-0.91). No significant publication bias was found. For the other body sites, the studies were limited in number, which prevented meta-analyses, but results were generally consistent with a beneficial effect of smoking cessation on survival. Quitting smoking at or around diagnosis is associated with a significantly improved overall survival of smokers diagnosed with LC and HNC and shows beneficial effects in patients with other cancers. Physicians should offer smoking cessation counselling to smokers who start diagnostic workup for suspected cancer, and smoking cessation strategies should arguably become part of standard multidisciplinary oncological care.

Key messages

• Smoking cessation at or around diagnosis is associated with a significantly improved overall survival of smokers diagnosed with different types of cancer.

• Smoking cessation strategies (and counselling) should become part of standard multidisciplinary oncological care.

Beliefs about vaccines and information about coronavirus, COVID-19 and the pandemic. Findings from Italy

Introduction

In Italy, COVID-19 vaccination campaign for school personnel started in February 2021 and began mandatory from 15th December 2021 to all the people who work within schools. Here we described Italian school principals’ beliefs about vaccines and its association with feelings about information regarding coronavirus, COVID-19 and the pandemic.

Methods

Data collection started in October 2021 and is ongoing. Beliefs about vaccines were investigated both for COVID-19 vaccination and for vaccination in general.

Results

A total of 726 questionnaires were analyzed so far. The majority feels to be well informed about the coronavirus or the pandemic (75%) and not at all nor a little confused about COVID-19 information (89%). Only 2% disagree/strongly disagree with the statement “vaccination is compatible with my attitudes or religious beliefs”. Beliefs regarding vaccines in general are correlated with those regarding COVID-19 vaccines. When different beliefs are described, we observed a trend towards considering COVID-19 vaccines less safe and effective, but more important to protect themselves and their family than other vaccines. Moreover, beliefs about vaccination in general and regarding COVID-19 are associated with how well they feel informed about the coronavirus or the pandemic, and whether they feel confused about COVID-19 information. In particular: the better they feel informed about the coronavirus and the related pandemic, the higher the perception of vaccines in general and COVID-19 vaccine as important, safe, and effective; the less they feel confused about COVID-19 information.

Conclusions

School principals showed a high level of confidence on vaccines. The association between beliefs in vaccinations and the characteristics of information about COVID-19 supported the effectiveness of Italian vaccination policy and information campaigns.

USCA service utilization in the city of Florence (Italy) during the COVID-19 pandemic

Background

In order to support primary care during the first pandemic wave (March 2020), the Italian Government instituted multiprofessional health teams called “USCA” (Special Continuity Care Units), which ensured continuity of care for COVID-19 patients who do not need hospitalization. The aim of our study was to compare the volumes of USCA service utilization in Florence (Tuscany, Italy) during the peak of home visits of three pandemic waves.

Methods

This single-center study followed a retrospective cross-sectional design. The USCA of the Heath District of Florence served a population of 366,190 people. The following data were collected: home medical visits, nursing home (NH) visits, visits in health-care hotels. The peak periods of three epidemic waves were considered in the analyses: the second wave (23 October - 20 November 2020), the third wave (25 March - 22 April 2021), and the Omicron period (27 December 2021 - 6 February 2022). The maximum 7-day moving averages of the daily number of visits during the three periods were calculated. Relative percent differences for visits comparing the considered periods were computed.

Results

Home visits during the third pandemic wave increased by 14% compared to the second wave (second wave: N = 1370, third wave: N = 1562), while a decrease was observed during the Omicron period (Omicron vs third wave: -21%; peak value: 41 vs 60). Visits in health-care hotels during the third wave doubled compared to the second wave. After the start of the COVID-19 vaccination campaign, NH visits steeply declined (third wave vs second wave: -95%; N = 323 vs 15; peak value= 14 vs 2 visits per day). During the Omicron period, NH visits increased by almost four times compared to the third wave period.

Conclusions

The USCA service utilization was significant in all the analyzed periods. In a pandemic context, it is necessary to strengthen primary care services such as USCA, which have proved to respond to rapidly changing health needs.

Key messages

• The USCA service is an innovative model of integrated home care that has proved to respond to rapidly changing health needs during all phases of the COVID-19 pandemic.

• The USCA service utilization was significant during all phases of the pandemic. The USCA service has introduced new ways of working and new relationships between services in primary care.

Trends of risk behaviors in adolescents: a 10-year study in a representative sample of Tuscany, Italy

Background

The aim of the study was to evaluate the trends of prevalence of several health risk behaviors (HRBs) and health conditions over a 10-years period in a representative sample of adolescents of Tuscany Region, Italy.

Methods

The study had a repeated cross-sectional design, data from the last four survey waves of EDIT surveillance (2008-2018) were used. EDIT surveillance investigates HRBs in a representative sample of students attending the upper secondary schools of Tuscany. Prevalence of 17 HRBs and health conditions were considered and analyzed by age, sex, and socioeconomic status (SES).

Results

A total of 21.943 students were surveyed from 2008 to 2018. Declining trends in the participation in smoking, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased during the study period. During the most recent survey males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetables consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low SES students than in high SES students.

Conclusions

In conclusion findings showed various different tendencies in adolescent participation in HRBs over the course of the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females’ risk-taking behavior on the rise require careful monitoring and intervention.

Key messages

• Distinct tendencies according to sex, socio-economic condition and specific health risk behavior were observed in adolescent participation in health risk behaviors over the course of the last decade.

• Health promotion and prevention interventions tailored on specific health risk behaviors and population groups are needed.

Health Literacy, Covid-19 and risk perception: a cross-sectional survey in Prato in the 2nd wave

 

During the Covid-19 pandemic, individual and collective public health measures were undertaken to control the spread of the virus. Their effectiveness relies on people’s abilities to understand and adopt the correct behaviors. This study aims to evaluate the role of Health Literacy (HL) in influencing the adherence to Covid-19 preventive measures and risk perception of a sample of workers employed in various activities involving close contact with the population in the province of Prato (Tuscany, Italy) in the second pandemic wave (November-December 2020). A cross-sectional survey was conducted on a sample of public workers (e.g., teachers, educators, assistants/aides, other health personnel). Data on knowledge, attitudes and practices towards (KAP) Covid-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Spearman correlation analysis was used to assess the correlation between HL and KAP and Covid-19 risk perception. Multivariate linear regression analyses were performed to evaluate the role of HL in predicting KAP and Covid-19 risk perception, adjusted for sex, age, comorbidity, educational level, country of birth. A total of 402 people participated in this study; 47.8% had a problematic HL level. The HL level was correlated with KAP and practices towards Covid-19 prevention measures; no significant associations were found with Covid-19 risk perception. In multivariate models, HL significantly and positively predicted a higher level of knowledge of Covid-19 preventive measures (B = 0.413 for problematic HL; B = 0.542 for sufficient HL). Confirming a previous study conducted in Prato in the first pandemic wave, HL did not predict adherence to Covid-19 infection control measures, probably due to fear of the disease and attention towards prevention behaviors being still higher in the second pandemic wave.

Key messages

• HL skills are linked to understanding of public health measures.

• HL skills should be improved to favor the adherence to correct behaviors.

Coronavirus-related Health Literacy in elderly and adult population during COVID pandemic in Italy

Background

The COVID-19 pandemic caused an overabundance of valid and invalid information rapidly spread via traditional media, by internet and digital communication. Health Literacy (HL), as the ability to access, understand, appraise, apply health information, is fundamental for finding, interpreting, correctly using COVID-19 information.

Methods

In 2021, in the framework of the participation to the WHO M-POHL (Measuring Population and Organizational Health Literacy) network, a survey was conducted in a representative sample of the Italian general population aged 18+ years (N = 3,500). The validated HL questionnaire included coronavirus-related HL (HL-COVID, 16-items), general HL, sociodemographic characteristics, risk factors, lifestyles sections. For the HL-items, a 4-point Likert scale was applied: very easy, easy, difficult, very difficult. HL-COVID levels were defined as Good: very easy+easy&gt;81.3% (more than 12 of 16 answers); Sufficient: 50.0%&lt;very easy+easy &lt; =81.3% (9-12 of 16 answers); Limited: very easy+easy &lt; =50.0% (fewer than 9 of 16 answers). Elderly were responders aged 65+ years, the remaining ones were defined as adults. Ordinal Logistic Regression analysis was performed to assess the association of HL-COVID with sociodemographic characteristics (sex, age-group, educational level, financial deprivation).

Results

Good HL-COVID prevalence was lower in elderly than in adults (44.8% vs. 51.0%, p-value=0.001); the opposite for both sufficient (22.8% vs. 19.9%) and limited (32.5% vs. 29.1%) levels, but not statistically significant. The odds of a low HL-COVID (sufficient/limited) increased by 31% in the elderly and by 50%, 92%, and almost triple in persons with a low, considerable, and severe financial deprivation level, respectively.

Conclusions

The COVID-19 pandemic highlighted the need to improve HL and to prepare the general population for future emergency and non-emergency situations, confirming that HL can be considered a social vaccine.

Key messages

Vaccine Literacy, Covid-19 and influenza: a cross-sectional survey in Prato in the 2nd pandemic wave

 

Covid-19 is a pandemic and an infodemic, with contrasting information regarding risk and preventive measures, including vaccination. This study aims to assess Vaccine Literacy (VL) of a sample of workers in the province of Prato (Tuscany, Italy) in the second wave of the Covid-19 pandemic (November-December 2020) and to analyze the relationship between VL and attitudes about Covid-19 and flu vaccination. A cross-sectional design was adopted. Sociodemographic characteristics, health information, vaccination behaviour for past and current flu season and intention to get vaccinated against Covid-19 were collected. A multivariate logistic regression was performed to identify predictors of getting a Covid-19/flu vaccination. The Italian Health Literacy tool on Vaccination (HLVa-IT) tool was used to measure VL. A total of 117 questionnaires were analyzed. Among them, 64.9% intended to get Covid-19 vaccine. The mean VL was 3.18 ± 0.43 (functional 2.87 ± 0.72; interactive-critical 3.36 ± 0.45) out of 4. Having more than one comorbidity was a negative predictor of intention to get Covid-19 vaccine (OR: 0.21 95%CI: 0.04 - 0.91). Regarding the flu vaccine, being vaccinated in the previous season was the only positive predictor of being vaccinated in the current season (OR = 24.25 95%CI 7.96 - 87.73). The study was conducted before the authorization of Covid-19 vaccines: little information about them may have contributed to VL not being related to the intention to get vaccination. The negative role of comorbidities could be due to fear of adverse effects on fragile health status. For flu vaccination, VL may have exerted a lower impact because of the positive experience with the flu vaccine in terms of safety and effectiveness in the previous seasons.

Key messages

• The introduction of new vaccines should be supported by effective communication.

• Better knowledge of current vaccines and not just routine administration is desirable for greater personal empowerment.

Determinants of Actual COVID-19 Vaccine Uptake in a Cohort of Essential Workers: An Area-Based Longitudinal Study in the Province of Prato, Italy

Identifying determinants of COVID-19 vaccine uptake is essential for developing effective strategies for promoting vaccination. This longitudinal study aimed to explore predictors of actual COVID-19 vaccine uptake in workers involved in essential services during the first lockdown period in the Prato Province (Italy). All essential workers were invited and surveyed before COVID-19 vaccine approval (96.5% participation rate). Participants were followed up to evaluate their actual COVID-19 vaccination uptake using the vaccination register. Multinomial models were performed to assess predictors of delayed vaccination or non-vaccination. A total of 691 participants were included, of whom 21.7% had delayed the vaccination and 4.4% were unvaccinated. Participants with a sufficient level of health literacy were 50.2% in the vaccinated-on-time group and 32.3% in the unvaccinated group. The multinomial model predictors of delayed vaccination were work type (OR = 0.51), age between 50 and 59 years (OR = 1.82), and influenza vaccination uptake in the last season (OR = 2.51). Predictors of being unvaccinated were work type (OR = 0.33) and attitudes related to attributing less importance to COVID-19 preventive measures (OR = 0.47). Findings showed distinct predictors for COVID-19 vaccination delay and for being unvaccinated. Being unvaccinated seems to be associated with a general skepticism toward prevention measures.

[Mortality study in a cohort of entertainment workers]

SUMMARY

Introduction. Malignant mesotheliomas have been observed in entertainment workers in the last decades. They have been evaluated as occupationally exposed to asbestos contained in tools used for fireproof and sound-absorbing purposes. Aim of the study. To evaluate the mortality of workers engaged in a Florentine theatre where a large quantity of asbestos was found in the '80s, put in place 20 years earlier. Methods. It is a cohort study on entertainment workers with follow-up period ranged from 1-1-1970 till 31-12-2018. Standardized Mortality Ratios (SMRs) and their 95% Confidence Intervals (95% IC) were calculated by gender and job ("manual workers" and "all other jobs"), using age and sex specific mortality rates of Tuscan population. Results. The cohort includes 826 workers (389 manual workers and 437 engaged in other jobs) engaged by the Florentine theatre between 01/01/1937 and 31/12/1990. Excesses of mortality for all causes are observed in manual workers, either males (301 cases; SMR 304,0; 95% IC 271,5-340,3) or females (86 cases; SMR 429,8; 95% IC 348,0-531,0). The group of the other workers presents deficits of mortality by all causes, cancers and cardiovascular diseases in both genders. One death for pleural cancer is observed in a manual worker. Discussion. The results are in line with previous observations in similar occupations. In the examined Florentine theatre the asbestos exposures were important only for the manual workers who worked in the technical rooms characterized by the presence of friable asbestos sprinkled and in a bad state of maintenance.

Careggi Re-Engineered Discharge (CaRED) Project: Standardize Discharge and Improve Care Coordination Between Healthcare Professionals

BACKGROUND

The hospital discharge process plays a key role for patient care. CaRED (Careggi Re-Engineered Discharge) aimed at establishing a meaningful relationship among General Practitioners (GPs) and patients, throughout the discharge process. In this paper we describe the activities and results in the period 2014 - 2017.

METHODS

CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad-hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy of effective communication. A pre-post survey was launched to assess the GPs' perceived quality, and patient and family satisfaction.

RESULTS

A total of 1,549 hospitalizations were included, respectively 717 in the pre and 832 in the post intervention period. The 30-day hospital readmission rate decreased significantly in the post intervention period (14.4% vs 19.4%, χ2(1)=8.03, P<0.05).Eighty-two and 52 GPs participated, respectively, in the pre- and post- survey. In the post-phase the percentage of GPs declaring the discharge letter facilitated the communication on the admission causes (χ2(1)=0.56, P=0.03) and on what to do if conditions change (χ2(31)=19.0 P <0.01) significantly increased, as well as the perception of an easier contact with the hospitalist (χ2(3)=19.6, P <0.01).Two-hundred-eighty and 282 patients were enrolled in the pre- and post- survey. The level of understanding of key parts of the discharge letter (reason for hospitalization, post-discharge therapy, follow-up examinations and how to contact the hospital ward) improved significantly (P <0.01).

CONCLUSIONS

CaRED significantly improved the discharge process, and became a benchmark for local improvements in communication patterns with GPs.

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services during the first pandemic wave: A system-wide study of Tuscany Region, Italy

Background

Utilization of Emergency Medical Services (EMS) declined during COVID-19 pandemic, but most of the studies analyzed components of the EMS system individually. The study aimed to evaluate the indirect impact of COVID-19 pandemic on the utilization of all the components of the EMS system of Tuscany Region (Italy) during the first pandemic wave.

Methods

Administrative data from the health care system of Tuscany were used. Changes in utilization for out-of-hospital emergency calls and emergency vehicle dispatched, emergency department (ED) visits, and patients being admitted from the ED to an inpatient hospital bed (hospitalizations from ED) during the first pandemic wave were analyzed in relation with corresponding periods of the previous two years. Percentage changes and 95%CI were calculated with Poisson models. Standardized Ratios were calculated to evaluate changes in in-hospital mortality and hospitalizations requiring ICU.

Results

Significant declines were observed in the utilization of all the EMS considered starting from the week in which the first case of COVID-19 was diagnosed in Italy till the end of the first pandemic wave. During the epidemic peak, the maximum decreases were observed: -33% for the emergency calls, -45% for the dispatch of emergency vehicles, -71% for ED admissions. Furthermore, a decline of 37% for hospitalizations from ED was recorded. Significant decreases in ED admissions for life threatening medical conditions were observed: acute cerebrovascular disease (-36%, 95% CI: -43, -29), acute myocardial infarction (-42%, 95% CI: -52, -31) and renal failure (-42%, 95% CI: -52, -31). No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the epidemic peak.

Conclusion

All the components of the EMS showed large declines in their utilization during COVID-19 pandemic; furthermore, major reductions were observed for admissions for time-dependent and life-threatening conditions. Efforts should be made to ensure access to safe and high-quality emergency care during pandemic.

Potentially inappropriate prescribing before and after nursing home admission: a retrospective observational study in a sample of Italian nursing homes

OBJECTIVES

to assess the occurrence of potentially inappropriate prescribing (PIP) in residents of Tuscany nursing homes (NHs) and its variation before and after NH entry.

DESIGN

retrospective observational study using data from the Regional Administrative Database of Tuscany.

SETTING AND PARTICIPANTS

the study involved residents of 67 Tuscan NHs identified between 2011 and 2012. To estimate PIP prevalence before and after NH, a subset of 10 indicators of the Screening Tool of Older Person's Prescriptions (STOPP) criteria were selected.

MAIN OUTCOME MEASURES

prevalence of PIP. RESULTS: considering 2,801 NH residents, the proportion of PIP ranged from 0.0% to 55.2% and from 0.0% to 33.9% before and after the NH admission, respectively. Overall, this study showed a decrease in the occurrence of PIP after the NH admission for most of the indicators, reaching statistical significance for indicator 3 (tricyclic antidepressants in combination with an opiate or calcium channel blockers), 7 (prescription of NSAIDs in heart failure patients), and 9 (warfarin in combination with NSAIDs).

CONCLUSIONS

although the reduction of PIP after NH admission may suggest greater awareness about the appropriateness of drug use, more efforts still need to be made.

COVID-19: opinions and behavior of Italian general population during the first epidemic phase

BACKGROUND AND AIM

On January 9, 2020, the World Health Organization (WHO) declared that Chinese health authorities had identified a new coronavirus strain never before isolated in humans, the 2019-nCoV later redefined SARS-CoV-2, that still today represent a public health problem. The present survey started on 10 February 2020 with the aim of a) assessing the risk perception in healthcare workers and young students, following the evolution of attitudes, perception and knowledge over time, b) provide useful information to the general population during survey.

RESULTS

A study sample consisting of 4116 Italian individuals of both sexes was enrolled. High levels of risk perception, low perception of self-efficacy and low levels of knowledge scores (24.55 ± 5.76 SD) were obtained indicating the need for continuous population monitoring as well as further communication strategies carried out at institution levels.

CONCLUSION

The results of the present study could help public health authorities in carrying out informative campaigns for general population and could be an important tool in evaluating public knowledge and misperceptions during the management of the COVID-19. (www.actabiomedica.it).

Health Literacy, Socioeconomic Status and Vaccination Uptake: A Study on Influenza Vaccination in a Population-Based Sample

Background: Health Literacy (HL) has been recently hypothesized to affect the relationship between socio-economic status (SES) and health conditions. However, to date no study has yet assessed the potential contribution of HL in the pathway through which SES affects influenza vaccination status. We aim to examine the relationships among HL, SES factors, and influenza vaccination uptake in Tuscan (Italy) residents belonging to different high-risk groups (HRGs) for influenza. Methods: The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System in 2017−2018. HL was assessed using the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Mediation analyses were conducted using SES variables as independent variables, influenza vaccination status as dependent variable and HL as mediator variable. Results: A total of 3278 people belonged to HRGs for influenza. In the whole sample, 19.4% of the participants were vaccinated against influenza. Participants who were not employed or had a poor financial status were more likely to be vaccinated against influenza (OR 1.56, 95%CI 1.26−1.94, p < 0.001, and OR 1.21, 95%CI 1.00−1.48, p = 0.047 respectively). HL did not mediate the relationship of any of the independent variables with influenza vaccination status. Conclusions: Some SES determinants resulted to influence influenza vaccination uptake, while HL did not affect the likelihood of influenza vaccination uptake among HRGs. Universal health care systems, as in the case of Italy, offering influenza vaccination free of charge to HRGs help in reducing inequalities and mitigating HL demands.

Trends in Adolescent Health Risk Behaviors and Wellbeing: A 10 Year Observation from the EDIT Surveillance of Tuscany Region, Italy

Background: The aim of this study was to evaluate the trends of prevalence of health risk behaviors (HRBs) and health conditions over a 10 year period (2008-2018) in a representative sample of adolescents of Tuscany Region, Italy. Methods: This was a repeated cross-sectional (four survey waves) study. The prevalence of 17 HRBs and health conditions were analyzed by age, sex, and socioeconomic status (SES). Results: A total of 21,943 students were surveyed. During the study period, decreases in smoking participation, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased. Males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking, and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetable consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low-SES students than in high-SES students. Conclusions: The findings showed different tendencies in adolescent participation in HRBs over the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females' risk-taking behavior on the rise require careful monitoring.

The Prevalence of Several Risky Driving Behaviors and Associated Crash Risk in Adolescent: A Population-Based Study of Tuscany Region

Objectives: To evaluate the prevalence of numerous risky driving behaviors (RDBs) and the associated risk of road traffic accidents (RTA) in a population-based sample of adolescent drivers (14–19 years) of Tuscany, Italy.

Methods: The frequency of participation -by age and sex- often RDBs were investigated: Multivariable analyses were performed to evaluate the association between RDBs and the risk of RTA and severe RTA.

Results: 2,737 adolescents were included in the study. Talking to passenger(s), listening to loud music, speeding, and texting showed the highest weekly participation rates. For all the considered RDBs, the frequency of participation significantly increased with age. Males reported a significantly higher participation in speeding, DUI of alcohol or drugs; while females reported listening to loud music and talking to passenger(s) more frequently. All the considered RDBs were significantly associated with the risk of RTA and severe RTA.

Conclusion: The prevalence of RDBs and the associated risk of RTA largely varied in adolescents. Findings provide evidence for tailoring prevention interventions and suggest the need to include common- but traditionally overlooked- RDBs in road safety campaigns.

Vaccine Literacy and Source of Information about Vaccination among Staff of Nursing Homes: A Cross-Sectional Survey Conducted in Tuscany (Italy)

Vaccine literacy (VL) mediates the transfer of information and facilitates vaccination acceptance. The aims of this study are to validate the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano—Vaccine health literacy for adults in Italian language) for the staff of nursing homes (NHs), to measure VL in such a peculiar target group, and to assess its relationship with the sources used to obtain information about vaccines and vaccinations. A survey has been conducted in a sample of Tuscan NHs using an online questionnaire. Eight-hundred and fifty-three questionnaires were analyzed. Two dimensions of the HLVa-IT appeared (functional and interactive/communicative/critical VL). The HLVa-IT interactive/communicative/critical subscale score was slightly higher than the functional subscale, although with no statistical significance. General practitioners (GPs) or other professionals have been reported as the main source of information by most of the respondents (66.1%). The HLVa-IT total score was significantly higher among those who have declared to use official vaccination campaigns (mean score: 3.25 ± 0.49; p < 0.001), GPs or other health professionals (3.26 ± 0.47; p < 0.001), and search engines (3.27 ± 0.48; p = 0.040) as the main sources of information. In conclusion, the HLVa-IT could be reliable test to investigate VL for staff of NHs, and also to highlight criticalities related to information sources.

Long‐term effects of SARS‐CoV ‐2 vaccination in the nursing home setting

Background

SARS‐CoV‐2 vaccination has significantly reduced infection, hospitalization, and lethality rates among nursing home (NH) residents, but durability of vaccine effects remains unknown.

This study investigated the long‐term impact of BNT162b2 SARS‐CoV‐2 vaccine on breakthrough infection rates in the NHs of Florence, Italy.

Methods

Participants included residents living in Florence NHs as of April 1st, 2021, who had completed the primary SARS‐CoV2 vaccination course by February 15th, 2021. Weekly rates of breakthrough infection were calculated between April 1st and October 31st 2021, with 7‐day incidence defined as the number of new confirmed SARS‐CoV‐2‐positive residents over the vaccinated resident census. Hospital admissions and deaths were recorded from local administrative and clinical sources. Patients admitted to NHs after April 1st were excluded to avoid confounding effect of different vaccination timing.

Results

Among 2271 vaccinated residents (mean age 86.6, 74% female), we recorded 105 cases of breakthrough infections. Rates of breakthrough infection remained very low in the 6 months after vaccination, but started to rise over the following months, peaking at 0.94%, and then became stable around 0.2%–0.3%. Over the study period, infection rates remained low as compared to the incidence of SARS‐CoV‐2 infection during pre‐vaccination period. Overall hospitalization and lethality rates were 8%.

Conclusions

Among vaccinated NH residents, rates of breakthrough SARS‐CoV‐2 infection, hospitalization and lethality remained low up to 9 months following primary vaccination course. A mild resurgence of SARS‐CoV‐2 infection, after 6 months from vaccination, suggests a decline of vaccine effectiveness in preventing transmission.

Coronavirus-Related Health Literacy: A Cross-Sectional Study during the COVID-19 Pandemic in Italy

The COVID-19 pandemic has caused an overabundance of valid and invalid information to spread rapidly via traditional media as well as by internet and digital communication. Health literacy (HL) is the ability to access, understand, appraise, and apply health information, making it fundamental for finding, interpreting, and correctly using COVID-19 information. A cross-sectional study of a sample of 3500 participants representative of the Italian adult population aged 18+ years was conducted in Italy in 2021. A validated HL questionnaire was employed, including sections on coronavirus-related HL, general HL, sociodemographic characteristics, risk factors, and respondents’ lifestyle. Of our sample, 49.3% had “excellent” levels of coronavirus-related HL and 50.7% had “sufficient” (20.7%) or “limited” (30.0%) levels. Although the overall HL-COVID level was high, many participants reported difficulties dealing with COVID-19 information; in particular, participants older than 65 years, with a low education level, living in southern regions of Italy, and with high financial deprivation. Targeted public information campaigns and the promotion of HL are required for better navigation of health information environments. The COVID-19 pandemic has highlighted the need to improve HL and to prepare the general population for future emergency and non-emergency situations, confirming that HL can be considered a social vaccine.

Global patterns of seasonal influenza activity, duration of activity and virus (sub)type circulation from 2010 to 2020

Background

Seasonal influenza viruses undergo unpredictable changes, which may lead to antigenic mismatch between circulating and vaccine strains and to a reduced vaccine effectiveness. A continuously updated knowledge of influenza strain circulation and seasonality is essential to optimize the effectiveness of influenza vaccination campaigns. We described the global epidemiology of influenza between the 2009 A(H1N1)p and the 2020 COVID‐19 pandemic.

Methods

Influenza virological surveillance data were obtained from the WHO‐FluNet database. We determined the median proportion of influenza cases caused by the different influenza virus types, subtypes, and lineages; the typical timing of the epidemic peak; and the median duration of influenza epidemics (applying the annual average percentage method with a 75% threshold).

Results

We included over 4.6 million influenza cases from 149 countries. The median proportion of influenza cases caused by type A viruses was 75.5%, highest in the Southern hemisphere (81.6%) and lowest in the intertropical belt (73.0%), and ranged across seasons between 60.9% in 2017 and 88.7% in 2018. Epidemic peaks typically occurred during winter months in Northern and Southern hemisphere countries, while much more variability emerged in tropical countries. Influenza epidemics lasted a median of 25 weeks (range 8–42) in countries lying between 30°N and 26°S, and a median of 9 weeks (range 5–25) in countries outside this latitude range.

Conclusions

This work will establish an important baseline to better understand factors that influence seasonal influenza dynamics and how COVID‐19 may have affected seasonal activity and influenza virus types, subtypes, and lineages circulation patterns.

Health Literacy and COVID-19 preventive behaviours in during the Lock-Down Phase in Tuscany (Italy)

 

In the first COVID-19 pandemic period, when no vaccines were available, individual behaviours were essential for controlling the spread of the virus. In this context of rapidly changing guidance, emerging new evidence, fake news and misinformation, there have been new challenges for health literacy (HL). This study explored whether guidance-compliant healthy behaviours were associated with HL in individuals who have performed essential activities (public employees and volunteers of the Civil Protection) during the lock-down period in the Province of Prato, Italy. Items on knowledge, attitudes and practices (KAP) towards COVID-19 preventive measures and COVID-19 risk perception, along with the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6), were collected using a self-administered structured questionnaire. In May 2020, 751 responses were collected; respondents were mostly males (59%), younger than 65 years old (83.5%), with sufficient HL (56%), and never smokers (54.2%). Most of the items related to the KAP towards COVID-19 preventive measures were significantly correlated with the HLS-EU-Q6 score in the total sample. In the multiple linear model, HL results to be a predictor of both a better self-reported knowledge of COVID-19 preventive measures (beta 0.32 for sufficient HL, 0.11 for problematic HL, 1.00 for inadequate HL) and a higher score of attitude towards the importance of COVID-19 preventive measures (beta 0.33 for sufficient HL, 0.17 for problematic HL, 1.00 for inadequate HL), while it has no role in predicting a higher risk perception. These findings can be useful to understand the importance of HL in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Key messages

Lower levels of Health Literacy predict poor COVID-19 related knowledge and a worse attitudes towards the importance of COVID-19 preventive measures. Health Literacy may be an important factor in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services

Background

Fear of contracting COVID-19 and the large-scale preventing measures may have influenced health service utilization. The aim of the study was to assess the indirect impact of COVID-19 pandemic on the utilization of the emergency medical services (EMS) of Tuscany Region (Italy).

Methods

The study was carried out on administrative data from the public healthcare system of Tuscany (38 general hospitals and 4 university teaching hospitals). Variations in the utilization of out-of-hospital (i.e. calls for emergency medical assistance and dispatch of mobile medical care units) and in-hospitals (emergency department(ED) visits and hospitalizations from the ED) EMS during the first pandemic wave were analyzed (February - July 2020) in relation with corresponding periods of the previous three years. Furthermore, in order to understand changes in illness severity of patients using the EMS, standardized ratios for hospitalizations requiring ICU and in-hospital mortality were analyzed.

Results

Significant decreases in the expected volumes of utilizations were observed in each of the considered EMS starting from the week in which the first case of COVID-19 was confirmed in Italy till the last week of the first wave. In particular, during the peak period of COVID-19 pandemic wave a reduction of 73,041 (-67%, 95%CI -69%; -66%) in ED admissions and of 682 (-38% 95%CI -55%; -43%) in hospitalization from ED were observed. Significant decreases in hospitalizations for life threatening medical conditions were observed. No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the COVID-19 epidemic peak period (SR 1.1 95%CI 0.72-1.90; SR 1.0 95%CI 0.83-1.23).

Conclusions

A large and generalized decrease in EMS utilization was observed during the first wave of COVID-19 pandemic. Furthermore, findings suggest that seriously ill patients avoid seeking care as less seriously ill patients did.

Key messages

The falling in the utilization of emergency medical services during pandemic could portend substantial harm to public health, and not simply the absence of real health need.

The preparedness of the healthcare delivery system should not focus solely on confronting the pandemic disease, but also on ensuring access to high quality emergency care for other diseases.