COVID-19 Vaccine Hesitancy among Unvaccinated Adults: A Cross-Sectional Exploratory Analysis of Vaccination Intentions in Italy Related to Fear of Infection

From the initial COVID-19 outbreak, Italy was the first Western country to be seriously affected by the pandemic. Understanding vaccine hesitancy can help efforts to achieve broad vaccination coverage. The objectives of this research were to determine the extent of vaccine hesitancy in Italy and to understand the characteristics of those segments of the population with some hesitancy. Between January and February 2021, 41,473 subjects answered the second questionnaire delivered in phase II of the web-based EPICOVID19 survey. Among the included adult volunteers living in Italy, 4653 (11.2%) reported having previously received at least one dose of the COVID-19 vaccine. In the sample of 36,820 respondents, all not vaccinated (age 51.1 ± 13.5; 59.7% female; 63.6% high level of education), the comparison between hesitant and inclined participants was accompanied by percentages and odds ratios. A total of 2449 individuals were hesitant (6.7% of the unvaccinated ones). Hesitancy was higher among women (OR = 1.48; 95%CI: 1.36-1.62); it was highest in the 50-59 and 40-49 age groups and among those with a lower educational level. A higher level of education was associated with a lower proportion of hesitancy (5.54%) compared with 9.44% among respondents with a low level of education (OR = 0.56; 95%CI: 0.46-0.68). Hesitancy was most common in subjects who did not report fear of infection (12.4%, OR = 4.0; 95%CI: 3.46-4.61). The results can guide the design of tailored information and communication campaigns through considering objective and subjective characteristics.

A critical look to community wisdom: Applying the World Café method to health promotion and prevention

Patient experiences and ideas are key components for improving health promotion and prevention. Engaging patients and other stakeholders in sharing their practices and ideas is nowadays crucial to increase the legitimacy, credibility, and acceptability of the decisions in these fields, by fostering community wisdom. The World Café is a participatory method suitable to involve a large number of actors to propose creative solutions based on their different knowledge and experiences. However, the diffusion of this approach is not uniform in the various countries and health topics. This review summarises the specific topic, the study design, the number and the characteristics of participants, as well as the main findings and the purpose of the studies regarding the application of this method to health promotion and prevention. Among other results, it was found that the World Café is an appreciated, inspiring, and flexible participatory process often used in association with one or more other methods, to explore emergent themes or topics, to collect best practices or suggestions, to generate improvements or recommendations, and to define priorities for the implementation of projects or research agendas. The results highlight the potentiality of the World Café whenever an issue is not well defined and needs to be explored through deep and several insights. The method allows the exploitation of creativity and collective wisdom when qualitative and in-dept results-more than quantitative and statistically rigorous ones-are appropriate.

Risk management and communication plans from SARS to COVID-19 and beyond

Objective

Nowadays, due to globalisation, the likelihood that infectious diseases spread rapidly is extraordinarily high. SARS and COVID‐19 are two diseases of the Coronavirus family, which developed in China and then spread internationally, causing global public health emergencies. This study investigates the role that risk management and communication systems played in mitigating these emergencies, to establish how they should be improved in the future.

Methods

A narrative review was carried out to investigate different knowledge domains, such as risk management and communication, risk assessment and indicators, epidemiological and clinical data, diagnostic methods, vaccines, public health and social measures.

Results

On one side, risk management systems assess the main data, knowledge, and indicators on epidemiology, diagnostics, and vaccines (science‐based); on the other side, they apply public health and social measures (socially‐based). Decision‐makers, in fact, implement their actions by constantly balancing these two sides (policy‐based).

Conclusions

A correct crisis management approach should support the governance of pandemics, by harmonising the actual risks assessed by experts with those perceived by the general population. It should incorporate not only the biological, but even the environmental, social and economic aspects of virus emergencies, towards establishing a suitable framework to deal with possible future pandemics.

COVID‐19 and SARS enhanced rapid research on specific diagnostics and vaccines.

Public health and social measures remain the primary response to virus outbreaks.

Risk perception affects people's behaviour and public health measures' application.

Risk management and communication plans are crucial to cope with pandemics.

SARS and COVID‐19 experiences should help to deal with future virus emergencie.

Antibody Response in Healthcare Workers before and after the Third Dose of Anti-SARS-CoV-2 Vaccine: A Pilot Study

The SARS-CoV-2 pandemic led to the development of various vaccines. The BNT162b2 mRNA vaccine was the first approved due to its efficacy in eliciting a humoral immunity response after the second dose. However, a decrease in the antibody concentration was observed over time. Therefore, the administration of a third dose was scheduled, primarily for frail people and workers of essential public activities. The aim of this study was to assess the level of antibodies against the spike (S) RBD of SARS-CoV-2 in healthcare workers before and after the third dose of BNT162b2 vaccine, according to sex, age, and the time interval between vaccine doses and tests. All 37 (12 males, 25 females, 19 < 50 years old, 18 ≥ 50 years old) healthcare workers recruited showed a consistent antibody titer increase after the third dose. Data analysis showed that the antibody concentration before the third dose significantly decreased as the time interval up to the test increased, and a significantly higher level was shown in young than older people. Cluster analysis revealed that young females had a higher antibody level than older females before the third dose (p < 0.05). This study indicated the benefit of the third dose of BNT162b2 vaccine and its effect on leveling up the humoral immune response.

Health Technology Assessment for In Silico Medicine: Social, Ethical and Legal Aspects

The application of in silico medicine is constantly growing in the prevention, diagnosis, and treatment of diseases. These technologies allow us to support medical decisions and self-management and reduce, refine, and partially replace real studies of medical technologies. In silico medicine may challenge some key principles: transparency and fairness of data usage; data privacy and protection across platforms and systems; data availability and quality; data integration and interoperability; intellectual property; data sharing; equal accessibility for persons and populations. Several social, ethical, and legal issues may consequently arise from its adoption. In this work, we provide an overview of these issues along with some practical suggestions for their assessment from a health technology assessment perspective. We performed a narrative review with a search on MEDLINE/Pubmed, ISI Web of Knowledge, Scopus, and Google Scholar. The following key aspects emerge as general reflections with an impact on the operational level: cultural resistance, level of expertise of users, degree of patient involvement, infrastructural requirements, risks for health, respect of several patients’ rights, potential discriminations for access and use of the technology, and intellectual property of innovations. Our analysis shows that several challenges still need to be debated to allow in silico medicine to express all its potential in healthcare processes.

Knowledge, Information Needs and Risk Perception about HIV and Sexually Transmitted Diseases after an Education Intervention on Italian High School and University Students

Sexually transmitted diseases (STDs) among adolescents and young people represent a significant public health problem that generates a pressing requirement of effective evidence-based education to promote primary and secondary prevention. The objective of the study is to evaluate how knowledge, information needs, and risk perception about HIV and STDs can change after targeted education interventions for students. A total of 436 subjects aged 15-24 attending high school (134 biomedical and 96 non-biomedical fields) and university courses (104 scientific and 102 non-scientific disciplines) were enrolled to respond to a questionnaire before and after the intervention. An improvement in knowledge was found in all groups, with statistically significant knowledge score differences between the four groups in 60% of the items. More than 94% of the students consider it useful to promote information on these issues. Receiving this information generated awareness and safety in more than 85% of high-school students and 93% of University students. Students widely perceived a great risk being infected with HIV/STDs, although pregnancy was seen as a more hazardous consequence of unprotected sex. This study shows that educational interventions are effective in improving knowledge, apart from findings about key knowledge topics, information needs, and risk perception, which provide significant insights to design future targeted education programs.

[Inappropriateness in ionizing imaging. The central node of the informed consent: from "event" model to "process" model]

The phenomenon of inappropriateness in ionizing imaging and medical interventions is large-scale and increasing. This tendency causes noteworthy damages to health and to patient's autonomy. Moreover, this trend causes a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, insurance compensations. The actual passive signature on unreadable templates of informed consent in the Italian hospital context constitutes, by a matter of facts, a central node of inappropriateness problem. This way to manage informed consent - "event" model - mortifies the patient's right to decide freely and deliberately, being him unaware of biological consequences of clinical-therapeutical interventions on himself and his progeny's health. Physician himself can generate arbitrary clinical acts, with heavy deontological and legal consequences. Hence, informed consent in ionizing imaging necessitates a particular "process" management, useful to convey a series of other clinical and organisational processes towards a full realisation of therapeutic alliance among physician and patient. This review aims at highlighting - in a juridical and communicative key - a range of tools which are applicable to contrasting the hospital abuse of ionizing radiations, for defending both patients' health and patients' dignity, being them primarily persons and citizens of a rule-of-law State.

Quality assurance in radiotherapy. How to improve the effectiveness and completeness of an electronic patient's chart

A checking form was introduced in order to test the completeness of electronic and paper patient's charts in a radiotherapy department which had introduced record-and-verify system (RVS) and to improve tha staff performance. The chosen items for the electronic chart were 9 and 5 for paper chart. 223 patients were reviewed in two phases. The data analysis was based on a scoring method, attributing a positive score (+1) to the operator's good behaviour, a negative score (-1) to the lack of data input and a neutral score (0) to the inapplicable situation. The average global score increased from 0.4 to 0.7: in A (lowest complexity) category from 0.37 to 0.64, in B category from 0.4 to 0.89, in C category from 0.48 to 0.61.

Puglia cooperative study on biofiltration

Biofiltration (BF) was performed on 60 patients from 12 dialytic centers in Puglia. The protocol was 9-10.5 hours a week with 1.2 m2 PAN dialyzers. A dialysate with 140 Na+, 2-2.5 K+, 3.5-4 Ca++, 38 mEq/l acetate was used in 49 patients; the acetate was replaced by bicarbonate (35-40 mEq/l) in 11 patients. The same patients were treated for 1 year with standard acetate dialysis (49 patients) and standard bicarbonate dialysis (11 patients). The two protocols were compared on the basis of the clinical state, BUN and serum creatinine, acid-base balance, PTH, anemia, and nerve conduction velocity (NCV). Favourable effects were achieved in 55 patients. Four patients left the program because of progressive hyperhydration. BUN and serum creatinine levels showed a moderate, but insignificant increase. PTH, anemia and NCV did not worsen. BF gave better correction of metabolic acidosis in the patients undergoing acetate dialysis.

[Heparin tolerance in relation to age and the presence of amyloidosis]

Clotting time under basal conditions and 30', 60' and 120' after 100 I.U. heparin/kg i.v. was determined in four groups:1) 15 healthy subjects aged less than 50 yr; 2) 27 "healthy" subjects over 65 yr; 3) 20 subjects with either myeloma (7 cases), benign monoclonal gammopathy (7) or rheumatoid arthritis (6); 4) 4 subjects with amyloidosis (2 primary, 1 secondary to rheumatoid arthritis, and 1 secondary to myeloma). Rectal biopsy and a histological search for amyloid substance were carried out in all subjects from the 3rd and 4th groups. Heparin tolerance was too widely scattered to enable statistically significantly means to be deduced. Comparison between the arithmetical means of the four groups, however, showed a greater resistance in aged opposed to young subjects, and in patients with amyloidosis as opposed to those in the other three groups. This was constant and marked after 60' and 120', suggesting that this test may offer indirect evidence in support of a diagnosis of amyloidosis.