A co-design approach for the development of a mHealth solution to support the first 1000 days of life

To support the first 1000 days of life, it is essential to develop tools that meet the needs of expectant and new parents, as well as the expectations of health professionals and healthcare institutions. To incorporate the perspectives of all stakeholders, we used a participatory design approach by 1) identifying and analyzing the needs of primary (expectant and new parents), secondary (health professionals), and tertiary (healthcare institutions) users; 2) brainstorming and prototyping telehealth tools; 3) testing and refining the prototypes; and 4) evaluating their implementation. Exploring the IRCSS Burlo Garofolo’s perspective allowed us to highlight the urgent need to better inform and empower patients and families. We studied the views of health professionals and expectant and new parents while developing a digital ecosystem in parallel. We found that both primary and secondary users generally agreed with the proposed solution. A randomized controlled trial is currently underway to test the effectiveness of the digital ecosystem in supporting the first 1000 days of life. Implementing such a co-design approach was essential for the development of an appropriate and tailored mHealth solution for maternal and child health. The close synergy between the expertise of public health institutions and their professionals with technology developers and innovation accelerators and promoters is crucial for the development of a mHealth tool that can effectively support all stakeholders during the crucial time of the first 1000 days of life and ultimately ensure better and more equal outcomes for both mother and child.To support the first 1000 days of life, it is essential to develop tools that meet the needs of expectant and new parents, as well as the expectations of health professionals and healthcare institutions. To incorporate the perspectives of all stakeholders, we used a participatory design approach by 1) identifying and analyzing the needs of primary (expectant and new parents), secondary (health professionals), and tertiary (healthcare institutions) users; 2) brainstorming and prototyping telehealth tools; 3) testing and refining the prototypes; and 4) evaluating their implementation. Exploring the IRCSS Burlo Garofolo’s perspective allowed us to highlight the urgent need to better inform and empower patients and families. We studied the views of health professionals and expectant and new parents while developing a digital ecosystem in parallel. We found that both primary and secondary users generally agreed with the proposed solution. A randomized controlled trial is currently underway to test the effectiveness of the digital ecosystem in supporting the first 1000 days of life. Implementing such a co-design approach was essential for the development of an appropriate and tailored mHealth solution for maternal and child health. The close synergy between the expertise of public health institutions and their professionals with technology developers and innovation accelerators and promoters is crucial for the development of a mHealth tool that can effectively support all stakeholders during the crucial time of the first 1000 days of life and ultimately ensure better and more equal outcomes for both mother and child

Management of severe epistaxis during pregnancy: a case report and review of the literature

Epistaxis is a common problem during pregnancy. Few cases of severe epistaxis, not associated with nasal lesions or clotting disorders, were described in the literature. We reported a case of severe epistaxis in a pregnant patient, exploring all the different possible management options

Sexually transmitted infections and the HPV-related burden: evolution of Italian epidemiology and policy

Sexually transmitted infections (STIs) are a major public health problem worldwide, with a high prevalence between the ages of 15 and 25 in most Western countries. High notification rates of chlamydia, gonorrhea, and syphilis are reported in the WHO European Region, with differences between countries. In Italy, the total number of STIs alerts increased by 18% from 2020 to 2021. HPV is the most common sexually transmitted infection; globally one in seven women is infected by this virus, and certain sexual behaviors are important risk factors for HPV-related cancers, particularly cervical cancer (CC), anogenital cancers and cancers of the head and neck. The burden of CC is relevant worldwide, in particular in Europe CC is the third leading cause of cancer-related deaths in women aged 15–44. This HPV-related tumor is preventable through a combined strategy of vaccination and screening for precursor lesions. In Italy, the coverage of organized screening varies from region to region and the average HPV vaccination rate is still far from the expected optimal threshold of 95% at the age of 12. To address the challenges of health promotion and HPV prevention, priority actions are needed such as: promoting education and information at every level, from schools to healthcare professionals. In Italy, education of adolescents on sexual and reproductive health, still remains critical, regionally inhomogeneous and much lower than in other European countries. Equitable measures need to be taken, and schools are an important place for health promotion activities

Overdentures on implants placed in bone augmented with fresh frozen bone

Introduction In the last decade several studies have been performed to evaluate the clinical outcome of one or two stage loaded implants supporting overdentures. Aim Since fresh frozen bone (FFB) has an ever-increasing number of clinical applications and few reports are available on implants inserted into FFB, we performed a retrospective study on fixtures inserted in FFB and bearing overdentures. Methods In the period between December 2003 and December 2006, 17 patients (14 females and 3 males with a median age of about 56 years) were grafted and 60 implants inserted thereafter. A total of 17 overdentures were delivered: 8 in the mandible and 9 in the maxilla. Multiple implant systems were used: 22 Double etched, 7 SLA, 9 Anodic oxidized, and 22 CaPo4 ceramic-blasted. Implant diameter ranged from 3.25 to 4.3 mm and length from 11.5 to 16.0 mm. Implants were inserted to replace 23 incisors, 9 cuspids, 20 premolars and 8 molars. Results No implants were lost (i.e. survival rate = 100%) and no differences were detected among the studied variables. Kaplan Meier algorithm and Cox regression did not reveal any statistical differences among the studied variables also as regards the success rate. Conclusion Implants inserted FFB and bearing overdentures have a high survival rate and success rates, which are comparable to those of implants inserted in non-grafted bone. FFB bone is a reliable material for alveolar ridge augmentation. No difference was detected among removable prostheses supported by 2 or more implants

Safety Evaluation of New Polymer Materials Proposed for Relining Drinking Water Pipes in the City of Milano

Relining is a trenchless technology of recoating the inside walls of damaged water pipes using composite materials. In the Safe Pipe project, co-financed by Regione Lombardia, alternative polymeric materials for relining the drinking water distribution system of the city of Milan have been developed. Relining polymers have been evaluated for their toxicity. The identification of product impurities was performed by HPLC/HRMS and GC/MS analysis and safety evaluation was conducted applying toxicity data, when available, or applying QSAR models. Results showed low level of toxic substances in polymerized resins and in water samples in a migration/leaching test performed in a field experiment

Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial☆

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Parental trust and beliefs after the discovery of a six-year-long failure to vaccinate

Background: In Italy vaccine hesitancy worsened after a failure to vaccinate episode that took place in Friuli Venezia-Giulia Region until early 2017 which undermined herd immunity by leaving unprotected more than 5,444 children. Methods: Between May and June 2017, 2,557 parents were surveyed at the local vaccination clinic where they were invited within the subsequent extraordinary vaccination campaign. The aim of the survey was to evaluate whether the multi-channel extraordinary vaccination campaign had reached the target population and to know parental beliefs and trusted sources of information after the failure to vaccinate event. Results: While 279 parents were non-hesitant (10.9%) and 1,491 hesitant acceptors (58.3%), just 38 (1.5%) refused to have their children revaccinated. Overall, the most consulted sources of information were print media (18.8%), physicians (16.0%), relatives and friends (12.1%). The majority of parents considered vaccination as a fundamental practice (73.9%), but many were worried about potential side effects (38.8%) or doubtful about the effectiveness of some vaccines (11.0%). According to parents, 19.7% of them (57) changed their opinion about vaccines after the Codroipo case. Conclusions: After the Codroipo case, most parents chose to have their children re-vaccinated and just a little proportion refused the re-administration of vaccines. More studies are needed to confirm the importance of a coherent multi-channel communication strategy using both traditional and new media in order to counteract vaccine hesitancy

CARE 1000: randomized controlled trial for the evaluation of the effectiveness of a mHealth app for supporting the first 1000 days of life

Background Recent developments in eHealth and mobile health (mHealth), as well as the introduction of information and communication technology innovations in clinical practice, such as telemedicine, telemonitoring, and remote examinations, are already changing the current scenario and will continue to generate innovations in the coming decades. The widespread use of mobile devices, with an estimated nearly 30 billion devices and more than 325,000 apps worldwide, will provide various opportunities for people to take control of their own health. Already in 2017, most of the apps available were focused on pregnancy support, more than any other medical field. There have been some reported experiences with social media and mHealth that could benefit the promotion of maternal physical and mental health during pregnancy. However, many apps targeting the first 1000 days of a child's life do not consider the continuity between the prenatal and postnatal periods and their joint impact on maternal and child health. The aim of this study is to evaluate the effectiveness of this mHealth app to support women during the first 1000 days (from conception to 24 months of age) and to improve health prevention behaviours such as immunizations during pregnancy, weight gain during pregnancy, abstinence from smoking and alcohol consumption, and adherence to the routine childhood immunization schedule. In addition, the study aims to understand the level of appreciation of this mHealth app as a tool to overcome information and communication gaps between patients and institutions. MethodsConduction of a randomized controlled trial. DiscussionOur results will be relevant for improving this mHealth app to promote health and prevention and to support the first 1000 days of life for both mother and child. Our results will be relevant to the future expansion of such an mHealth app to promote positive health-related outcomes in patients and co-user satisfaction and to support the organization of health services

Health professionals who have worked in COVID-19 immunization centers suffer the effects of violence

BackgroundThe phenomenon violence against health professionals has received increasing attention in recent years because of its frequency and significant impact on victims’ mental health and disruption of health services. Despite this attention, little is known about the incidence of workplace violence in the highly politicized immunization services. Therefore, we decided to examine the prevalence of workplace violence in the COVID-19 immunization campaign, the risk and protective factors, and the impact on victims’ mental health.MethodsBetween March and April 2022, we conducted an anonymous online survey among health professionals working in COVID-19 vaccination centers in the Friuli-Venezia Giulia Region (Italy). We used the Questionnaire for Workplace Violence in Healthcare Settings and the Impact of Event Scale–Revised.ResultsOf the 200 participants, 93 (46.5%) reported being victims of an act of violence during the vaccination campaign, 60 of them verbally and 7 physically. In 35.5% of cases, the IES score indicated a possible post-traumatic stress reaction in the victim. Opinions on measures to prevent violence and support workers in the workplace differed according to the sex of the health professional, with women emphasizing the need for self-defense training and improvement of security arrangements (p < 0.001).ConclusionOne-third of health professionals involved in the COVID-19 immunization campaign reported that their mental health was affected by workplace violence. Public health professionals dealing with politicized and debated issues such as immunization should receive more attention, as should the implementation of a more structured and multidisciplinary approach to the problem within healthcare organizations