10 research outputs found

    ChatGPT and the rise of large language models: the new AI-driven infodemic threat in public health

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    : Large Language Models (LLMs) have recently gathered attention with the release of ChatGPT, a user-centered chatbot released by OpenAI. In this perspective article, we retrace the evolution of LLMs to understand the revolution brought by ChatGPT in the artificial intelligence (AI) field. The opportunities offered by LLMs in supporting scientific research are multiple and various models have already been tested in Natural Language Processing (NLP) tasks in this domain. The impact of ChatGPT has been huge for the general public and the research community, with many authors using the chatbot to write part of their articles and some papers even listing ChatGPT as an author. Alarming ethical and practical challenges emerge from the use of LLMs, particularly in the medical field for the potential impact on public health. Infodemic is a trending topic in public health and the ability of LLMs to rapidly produce vast amounts of text could leverage misinformation spread at an unprecedented scale, this could create an "AI-driven infodemic," a novel public health threat. Policies to contrast this phenomenon need to be rapidly elaborated, the inability to accurately detect artificial-intelligence-produced text is an unresolved issue

    Integrazione delle fonti di dati nella sanità pubblica: applicazione dell'Intelligenza Artificiale nella prevenzione delle infezioni del sito chirurgico.

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    L'Organizzazione Mondiale della Sanità considera prioritaria la lotta alle infezioni correlate all’assistenza (ICA) e alla resistenza antimicrobica. Secondo la definizione del Center of Disease and Control, un'infezione del sito chirurgico (ISC) si verifica entro 30 giorni (o 90 giorni per gli impianti protesici) dopo l'intervento chirurgico e costituisce il 20% delle ICA in Europa, interessando dall'1% al 10% dei pazienti chirurgici. Le ISC gravano globalmente sui pazienti con morbilità, mortalità e aumento dei costi. Gli attuali sistemi di sorveglianza ospedaliera spesso sottostimano le ISC a causa di programmi di sorveglianza e controllo inadeguati. Le segnalazioni cliniche, fondamentali per l'identificazione delle ISC, non sono integrate in modo coerente nella sorveglianza automatizzata. Inoltre, quasi il 50% delle ISC si verifica dopo la dimissione, il che le rende difficili da prevedere utilizzando gli indici di rischio standard. L'intelligenza artificiale, in particolare l'apprendimento automatico nel contesto della sorveglianza delle infezioni nosocomiali, può fornire un grande supporto attraverso lo sviluppo di algoritmi automatizzati. Questo progetto mira a sviluppare uno strumento di intelligenza artificiale, basato sull'elaborazione del linguaggio naturale (NLP), per aiutare a identificare i casi di infezioni del sito chirurgico (ISC) dai record sanitari elettronici (EHR) come parte di un programma di sorveglianza delle ICA in un contesto ospedaliero universitario italiano. In particolare, il nostro obiettivo è sviluppare un sistema di sorveglianza automatizzato per identificare le ISC dal testo non strutturato delle lettere di dimissione ospedaliera (LDO). Il progetto sarà suddiviso in due domini e in ulteriori fasi sequenziali per raggiungere gli obiettivi specifici: 1) Dominio 1: prevede lo sviluppo dello strumento basato sull'intelligenza artificiale per la sorveglianza delle ISC attraverso un processo in quattro fasi, una consecutiva all'altra: a) Fase 1: identificazione dei dati, etichettatura manuale, conferma dei casi di ISC e valutazione della qualità dei dati; b) Fase 2: validazione interna dello strumento; c) Fase 3: validazione esterna dello strumento; d) Fase 4: apprendimento federato. 2) Dominio 2: il progetto prevede di calcolare l'incidenza delle ISC identificate nel corso dell'anno 2021, al fine di disporre di un dato di riferimento su cui stimare in futuro gli effetti della sorveglianza e delle conseguenti azioni messe in atto per prevenire il verificarsi di ISC

    ATTITUDINE ALLE VACCINAZIONI E PERCEZIONE DEL RISCHIO IN CAMPIONE DI GENITORI TOSCANI

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    Il calo delle coperture vaccinali e la continua insorgenza di focolai di malattie infettive pongono l’attenzione su un problema sempre più attuale: l’esitazione vaccinale. Le critiche mosse al recente decreto Lorenzin che istituisce l’estensione dell’obbligo vaccinale, includendo anche l’obbligo di certificazione per la frequenza delle scuole dell’infanzia, inserisce di fatto nelle priorità degli istituti di Igiene e Sanità pubblica italiani il dovere di spiegare le cause dell’esitazione vaccinale. Il dibattito riguardante l'importanza delle vaccinazioni è di grande attualità in Italia. Le frequenti epidemie di morbillo registrate negli ultimi anni sono l’input per poter tornare a parlare di obbligo vaccinale e occasione per screditare i falsi vecchi miti legati alla sicurezza dei vaccini in primis per il trivalente anti-morbillo-parotite-rosolia (MPR). Il fenomeno della Vaccine Hesitancy è complesso e soggetto a numerose variabili: differenti contesti sociali, psicologici e culturali. Fra le argomentazioni addotte dagli esitanti, oltre ai non ben precisati rischi di gravi effetti collaterali dei vaccini, ricorrono i sospetti sulle autorità sanitarie e le industrie farmaceutiche in un quadro più ampio di sfiducia verso la classe e la scienza medica in generale, tipica del nostro paese e di tutto il mondo occidentale. Con la presente tesi abbiamo cercato, attraverso un’indagine basata su di un questionario, di evidenziare alcune criticità che spingono all’esitazione vaccinale in un campione di genitori del territorio di Livorno con almeno un figlio di età compresa tra 0 e 18 anni. Lo studio nasce come espansione di un precedente sull’Health Literacy con lo scopo di trovare una correlazione con l’esitazione vaccinale. Guida indispensabile per la creazione del questionario è stata Teoria del prospetto di Daniel Kahneman e Amos Tversky, elaborata in modo da mettere in evidenza la contraddizione delle scelte di fronte al tema vaccinale. In ultimo abbiamo cercato una correlazione tra l’errata percezione del rischio di malattie inserite nel piano vaccinale e l’esitazione vaccinale. L’esitazione vaccinale dei genitori è stata determinata mediante il VCI calcolato in base alla loro risposta a 6 quesiti sugli argomenti attualmente più dibattuti riguardo alle vaccinazioni

    Exploring the Possible Use of AI Chatbots in Public Health Education: Feasibility Study

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    BackgroundArtificial intelligence (AI) is a rapidly developing field with the potential to transform various aspects of health care and public health, including medical training. During the “Hygiene and Public Health” course for fifth-year medical students, a practical training session was conducted on vaccination using AI chatbots as an educational supportive tool. Before receiving specific training on vaccination, the students were given a web-based test extracted from the Italian National Medical Residency Test. After completing the test, a critical correction of each question was performed assisted by AI chatbots. ObjectiveThe main aim of this study was to identify whether AI chatbots can be considered educational support tools for training in public health. The secondary objective was to assess the performance of different AI chatbots on complex multiple-choice medical questions in the Italian language. MethodsA test composed of 15 multiple-choice questions on vaccination was extracted from the Italian National Medical Residency Test using targeted keywords and administered to medical students via Google Forms and to different AI chatbot models (Bing Chat, ChatGPT, Chatsonic, Google Bard, and YouChat). The correction of the test was conducted in the classroom, focusing on the critical evaluation of the explanations provided by the chatbot. A Mann-Whitney U test was conducted to compare the performances of medical students and AI chatbots. Student feedback was collected anonymously at the end of the training experience. ResultsIn total, 36 medical students and 5 AI chatbot models completed the test. The students achieved an average score of 8.22 (SD 2.65) out of 15, while the AI chatbots scored an average of 12.22 (SD 2.77). The results indicated a statistically significant difference in performance between the 2 groups (U=49.5, P<.001), with a large effect size (r=0.69). When divided by question type (direct, scenario-based, and negative), significant differences were observed in direct (P<.001) and scenario-based (P<.001) questions, but not in negative questions (P=.48). The students reported a high level of satisfaction (7.9/10) with the educational experience, expressing a strong desire to repeat the experience (7.6/10). ConclusionsThis study demonstrated the efficacy of AI chatbots in answering complex medical questions related to vaccination and providing valuable educational support. Their performance significantly surpassed that of medical students in direct and scenario-based questions. The responsible and critical use of AI chatbots can enhance medical education, making it an essential aspect to integrate into the educational system

    HCV micro-elimination in two prisons in Milan, Italy: a model of care

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    People in prison represent a high-risk population for HCV infection control. With the advent of new direct antiviral agents (DAAs) HCV micro-elimination in prison setting became a feasible strategy. We assessed the impact of an intervention for HCV testing and treatment in 2017 and 2018 in a jail (San Vittore,SV) and a prison for sentenced individuals (Opera,OP). A dedicated protocol was applied and implemented over the two years. We collected data on demographics, HCV testing and treatment on all inmates present on October 31st 2017 and 2018. In the two facilities there were 2,366 and 2,369 inmates in 2017 and 2018 respectively; the majority were men (95.6%; 96.4%) and Italians (57.0%; 61.9%) with a median age of 41 years. Prevalence of lifetime reported drug use remained high (46.5%; 44.2%). HCV screening coverage was 89% in both years, while HCV-RNA test coverage increased (90.6%; 99.0%). HCV sero-prevalence remained stable (10.1%; 9.2%). In 2017 among inmates with HCV chronic infection 90 (42.4%) individuals had started DAAs treatment and 106 (54.6%) in 2018; of whom 38 (17.9%) and 74 (38.1%) achieved the SVR. The viremic pool decreased significantly over time (SV,24.4%; 15.4%;OP, 16.1%;&lt;1%). Among inmates with HCV-positive serology in 2018, 121 (81.0%) were never linked to care before incarceration. Our study showed how a targeted and well-implemented HCV test-and-treat intervention in prison was feasible and effective in achieving micro-elimination. Viral hepatitis elimination agenda may help drawing interest onto this neglected population and bringing prison health higher up in the global public health agenda

    HCV micro‐elimination in two prisons in Milan, Italy: A model of care

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    People in prison represent a high-risk population for HCV infection control. With the advent of new direct antiviral agents (DAAs) HCV micro-elimination in prison setting became a feasible strategy. We assessed the impact of an intervention for HCV testing and treatment in 2017 and 2018 in a jail (San Vittore,SV) and a prison for sentenced individuals (Opera,OP). A dedicated protocol was applied and implemented over the two years. We collected data on demographics, HCV testing and treatment on all inmates present on October 31st 2017 and 2018. In the two facilities there were 2,366 and 2,369 inmates in 2017 and 2018 respectively; the majority were men (95.6%; 96.4%) and Italians (57.0%; 61.9%) with a median age of 41 years. Prevalence of lifetime reported drug use remained high (46.5%; 44.2%). HCV screening coverage was 89% in both years, while HCV-RNA test coverage increased (90.6%; 99.0%). HCV sero-prevalence remained stable (10.1%; 9.2%). In 2017 among inmates with HCV chronic infection 90 (42.4%) individuals had started DAAs treatment and 106 (54.6%) in 2018; of whom 38 (17.9%) and 74 (38.1%) achieved the SVR. The viremic pool decreased significantly over time (SV,24.4%; 15.4%;OP, 16.1%;&lt;1%). Among inmates with HCV-positive serology in 2018, 121 (81.0%) were never linked to care before incarceration. Our study showed how a targeted and well-implemented HCV test-and-treat intervention in prison was feasible and effective in achieving micro-elimination. Viral hepatitis elimination agenda may help drawing interest onto this neglected population and bringing prison health higher up in the global public health agenda

    Investigating Resistance to Carbapenems in Enterobacterales: A Descriptive Epidemiological Study of 2021 Screening in an Italian Teaching Hospital

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    Antimicrobial resistance (AMR) presents a growing threat to global healthcare. This descriptive epidemiological study investigates the prevalence and characteristics of Enterobacterales with AMR factors in a tertiary teaching hospital in Italy over the course of the year 2021. In 2021, the prevalence of colonisation by Enterobacterales with AMR factors in patients was 1.08%. During the observation period, a total of 8834 rectal swabs were performed, with 1453 testing positive. A total of 5639 rectal swabs were performed according to a hospital procedure for the active screening of MDRO colonisation at the time of admission. Of these, 679 were positive for microorganisms under surveillance, and 74 patients were colonised with Enterobacterales, predominantly Klebsiella pneumoniae and Escherichia coli. Antibiotic resistance factors were observed in 61 of these 74 patients (82.43%) of these patients, with NDM and KPC being the most frequent resistance factors. A statistically significant trend in positive swabs was observed across different ward categories (surgery, ICUs, and medical wards). Regarding specific trends, the rate of positive admission screening in medical and surgical wards was higher than in ICU wards. The results highlight the ease with which Enterobacterales develops resistance across different ward categories. The findings underscore the need for adjusted screening protocols and tailored infection prevention strategies in various care settings

    Increased Risk of Acquisition of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) among a Cohort of COVID-19 Patients in a Teaching Hospital in Tuscany, Italy

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    We describe the epidemiology of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) colonization/infection in a cohort of COVID-19 patients in an Italian teaching hospital. These patients had an increased risk of NDM-CRE acquisition versus the usual patients (75.9 vs. 25.3 cases/10,000 patient days). The co-infection significantly increased the duration of hospital stay (32.9 vs. 15.8 days)

    Improving the Reprocessing Quality of Flexible Thermolabile Endoscopes: How to Learn from Mistakes

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    Background: Failure in the reprocessing of thermolabile flexible endoscopes has been reported as one of the most important threats to patient health. Method: A case report and observational study was conducted, from August 2014 to December 2019, in the Digestive Endoscopy Unit of a University Hospital in Italy, where two cases of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae infections in patients undergoing endoscopic retrograde cholangio-pancreatography were observed. Following the risk/safety management practices, an epidemiological investigation was started, duodenoscopes were removed from use and the reprocessing practices reviewed. Moreover, microbiological surveillance of endoscopes was carried out according to the CDC guidelines. Results: In the first phase of sampling, 10/10 (100%) endoscopes were found to be non-compliant, of which 7 showed results for high-concern organisms (HCOs), such as KPC-K. pneumoniae, P. aeruginosa and E. coli. After implementing corrective actions, 12 out of 17 endoscopes were found to be non-compliant (70.5%), of which 8 showed results for HCOs, such as KPC-K. oxytoca and P. aeruginosa. During the last year of regular microbiological surveillance, only 23% of endoscopes (35/152) were found to be non-compliant, of which 7 showed results for HCOs, such as NDM-K. pneumoniae, P. aeruginosa and A. baumannii. The crucial issues were related to samples collected from the internal channels of duodenoscopes. Conclusion: Managing the risk associated with the reprocessing of digestive endoscopes, through risk assessment at every stage of the process, is important for the prevention of infections associated with the use of these device

    Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

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    ABSTRACTThe decline in children’s vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents’ vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach’s alpha test (α) and McDonald’s omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups
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