31 research outputs found

    Incidence of healthcare-associated infections in a neonatal intensive care unit before and during the COVID-19 pandemic. A four-year retrospective cohort study

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    The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All infants admitted from 1 March 2018 to 28 February 2022 were included and were divided into four groups according to their admission date: two groups before the pandemic (periods I and II) and two during the pandemic (periods III and IV). The association between risk factors and time-to-first event was analyzed using a multivariable Cox regression model. Over the four-year period, a total of 503 infants were included, and 36 infections were recorded. After adjusting for mechanical ventilation, birth weight, sex, type of delivery, respiratory distress syndrome, and previous use of netilmicin and fluconazole, the multivariable analysis confirmed that being hospitalized during the pandemic periods (III and IV) was the main risk factor for HAI acquisition. Furthermore, a change in the etiology of these infections was observed across the study periods. Together, these findings suggest that patient management during the pandemic was suboptimal and that HAI surveillance protocols should be implemented in the NICU setting promptly

    Towards elimination of measles and rubella in Italy. Progress and challenges

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    Introduction In the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country’s National Verification Committee (NVC) through an annual status update (ASU). Objective By analysing data used to produce the ASUs, we aimed to describe the advances made by Italy towards elimination of measles and rubella. Moreover, we propose a set of major interventions that could facilitate the elimination process. Methods A total of 28 indicators were identified within the six core sections of the ASU form and these were evaluated for the period 2013–2018. These indicators relate to the incidence of measles/rubella; epidemiological investigation of cases; investigation of outbreaks; performance of the surveillance system; population immunity levels; and implementation of supplemental immunization activities (SIAs). Results From 2013 to 2018, epidemiological and laboratory analyses of measles cases in Italy improved substantially, allowing timely investigation in 2017 and 2018 of most outbreak and sporadic cases and identification of the majority of genotypic variants. Moreover, since 2017, vaccination coverage has increased significantly. Despite these improvements, several areas of concern emerged, prompting the following recommendations: i) improve outbreak monitoring; ii) strengthen the MoRoNet network; iii) increase the number of SIAs; iv) reinforce vaccination services; v) maintain regional monitoring; vi) design effective communication strategies; vii) foster the role of general practitioners and family paediatricians. Conclusions The review of national ASUs is a crucial step to provide the NVC with useful insights into the elimination process and to guide the development of targeted interventions. Against this background, the seven recommendations proposed by the NVC have been shared with the Italian Ministry of Health and the Technical Advisory Group on measles and rubella elimination and have been incorporated into the new Italian Elimination Plan 2019–2023 as a technical aid to facilitate the achievement of disease elimination goals

    The association between adherence to cancer screening programs and health literacy. A systematic review and meta-analysis

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    The effectiveness of a cancer screening program relies on its adherence rate. Health literacy (HL) has been investigated among the factors that could influence such participation, but the findings are not always consistent. The aim of this meta-analysis was to summarize the evidence between having an adequate level of HL (AHL) and adherence to cancer screening programs. PubMed, Scopus, and Web of Science were searched. Cross-sectional studies, conducted in any country, that provided raw data, unadjusted or adjusted odds ratio (OR) on the associations of interest were included. The quality of the studies was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled ORs and their associated confidence interval (CI) stratified by time interval (e.g., undergoing screening in the last period, or at least once during lifetime) for each cancer type, considering unadjusted and adjusted estimates separately. A sensitivity analysis was performed for those studies providing more estimates. Overall, 15 articles of average-to-good quality were pooled. We found a significant association between AHL and higher screening participation for breast, cervical and colorectal cancer, independently of other factors, both overall (N = 7, aOR = 1.73; 95% CI: 1.27–2.36; N = 3, aOR = 1.64; 95% CI: 1.30–2.09; and N = 5, aOR = 1.25, 95% CI: 1.12–1.39, respectively) and in most time-stratified analyses. The sensitivity analyses confirmed these results. Health literacy seems to be critical for an effective cancer prevention. Given the high prevalence of illiterate people across the world, a long-term action plan is needed

    The association of health literacy with intention to vaccinate and vaccination status. A systematic review

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    Despite health literacy (HL) being recognized as a driver of health-promoting behavior, its influence on the vaccination decision-making process remains unclear. This study summarized current evidence on the association between HL and both intention to vaccinate and vaccination status. We searched PubMed, Scopus, and Web of Science, retrieving observational studies published until January 2022 that used HL-validated tools to investigate the above associations for any vaccine. Quality was assessed using the Newcastle–Ottawa scale. Twenty-one articles were included; of these, six investigated the intention to vaccinate and the remainder vaccination status. Articles on intention looked at SARS-CoV-2 vaccination using heterogeneous HL tools and were of high/fair quality. Vaccination status, mainly for influenza or pneumococcal vaccines, was explored using various HL tools; the quality was generally high. We found inconsistent results across and within vaccine types, with no clear conclusion for either vaccination intention or status. A weak but positive association was reported between a high HL level and influenza vaccination uptake for individuals aged more than 65 years. HL did not seem to significantly influence behavior towards vaccination. Differences in the methods used might explain these results. Further research is needed to investigate the role of HL in the vaccination decision-making process

    What is the prevalence of low health literacy in European Union member states? A systematic review and meta-analysis

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    Background: Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe. Methods: PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies. Results: The pooled prevalence of low HL ranged from of 27% (95% CI: 18–38%) to 48% (95% CI: 41–55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40–1.35; β: 0.59, 95% CI: 0.25–0.93; and β: 0.72, 95% CI: 0.06–1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15–1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24–1.31), or a mixed method (β: 0.66, 95% CI: 0.01–1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26–2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06–1.07). Discussion: We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies

    Early Warning Systems for Emerging Profiles of Antimicrobial Resistance in Italy: A National Survey

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    Antimicrobial resistance (AMR) national surveillance systems in Italy lack alert systems for timely detection of emerging profiles of AMR with potential relevance to public health. Furthermore, the existence of early warning systems (EWS) at subnational level is unclear. This study aims at mapping and characterizing EWS for microbiological threats available at regional level in Italy, focusing on emerging AMR, and at outlining potential barriers and facilitators to their development/implementation. To this end, a three-section, web-based survey was developed and administered to all Italian regional AMR representatives from June to August 2022. Twenty out of twenty-one regions and autonomous provinces (95.2%) responded to the survey. Among these, nine (45%) reported the implementation of EWS for microbiological threats at regional level, three (15%) reported that EWS are in the process of being developed, and eight (40%) reported that EWS are not currently available. EWS characteristics varied widely among the identified systems concerning both AMR profiles reported and data flow: the microorganisms most frequently included were extensively drug-resistant (XDR) Enterobacterales, with the lack of a dedicated regional IT platform reported in most cases. The results of this study depict a highly heterogeneous scenario and suggest that more efforts aimed at strengthening national AMR surveillance systems are needed

    Reactivity to dietary gluten: new insights into differential diagnosis among gluten-related gastrointestinal disorders

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    The ingestion of dietary gluten sometimes may trigger allergic, autoimmune or nonallergic and nonautoimmune response. The typical gluten-related allergic disorder is the wheat allergy (WA). Celiac disease (CD) is a well-known gluten-related autoimmune condition. The clinical expression of a gluten-related nonallergic and nonautoimmune response is nonceliac gluten sensitivity (NCGS), an emerging condition whose framework is yet unclear and whose diagnosis is suggested only by demonstration of gluten-dependency in patient' symptoms after exclusion of WA and CD. This review discusses the current tools to identify patients suffering from WA, CD, and NCGS, as well as the most recent insights in the differential diagnosis among these gluten-related gastrointestinal disorders

    Mutatis mutandis: are we diagnosing too many people with non-celiac gluten sensitivity? Multiple case report

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    We report three patients presenting with gluten-related signs and symptoms. Since villous height/crypt depth ratio, intraepithelial lymphocyte count, and serum antibody tests were not diagnostic for celiac disease (CD), a diagnosis of non-celiac gluten sensitivity (NCGS) was suggested. On the other hand, antibodies suggestive for CD surprisingly showed positive results in the duodenal biopsy organ culture of all three cases. The reported cases suggest the precious potential role that organ culture systems may play in differentiating CD from NCGS. This method should be recommended when gluten-related disorders are suspected in order to reduce the inappropriate diagnosis of NCGS

    Covid-19 vaccine hesitancy among italian university students: A cross-sectional survey during the first months of the vaccination campaign

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    Achieving high levels of vaccination coverage against COVID-19 may be hindered by vaccine hesitancy. We quantified over time the prevalence of COVID-19 vaccine hesitancy among university students, investigated its determinants, and analyzed student attitudes, risk perceptions and compliance with preventive measures. The survey was administered online from 1 March to 30 June 2021. A multivariable logistic regression model was built to identify predictors of hesitancy. Overall, we collected 5369 questionnaires that were grouped into three survey periods (March, April– May, and May–June). The response rate ranged from 81.2% to 76.4%, whereas vaccine hesitancy ranged from 22% to 29%. Multivariable analysis showed that April–May participants had higher odds of hesitancy than March respondents. Other positive predictors were being male, not being a healthcare student, having a lower academic level, and not disclosing a political position. Conversely, higher levels of perceived COVID-19 severity, concern for the emergency, confidence in vaccine safety and effectiveness, and self-reported adherence to mask wearing indoors and outdoors were negatively associated with hesitancy. We found that vaccine hesitancy changed over time and in relation to several factors. Strategies aimed at increasing the students’ awareness and engagement, restoring confidence in health authorities, and limiting disinformation around the vaccines should be devised
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