Emergency Department Overcrowding. A Retrospective Spatial Analysis and the Geocoding of Accesses. A Pilot Study in Rome

The overcrowding of first aid facilities creates considerable hardship and problems which have repercussions on patients’ wellbeing, the time needed for a diagnosis, and on the quality of the assistance. The basic objective of this contribution, based on the data collected by the Hospital Policlinico Umberto I in Rome (Lazio region, Italy), is to carry out a territorial screening of the municipality using GIS applications and spatial analyses aimed at reducing—in terms of triage—code white (inappropriate) attendances, after having identified the areas of greatest provenance of improperly used emergency room access. Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor (general practitioner, GP) or Local Healthcare Unit and a more efficient functioning of the emergency room. In particular, we have elaborated a “source” map from which derive all the others and it is a dot map on which all the codes white have been geolocalized on a satellite image through geocoding. We have produced three sets made up of three digital cartographic elaborations each, constructed on the census sections, the census areas and the sub-municipal areas, according to data aggregation, for absolute and relative values, and using different templates. Finally, following the same methodology and steps, we elaborated another dot map about all the codes red to provide another kind of information and input for social utility. In the near future, this system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED

Benefits and challenges of Bbg data in healthcare. An overview of the European initiatives

Healthcare systems around the world are facing incredible challenges due to the ageing population and the related disability, and the increasing use of technologies and citizen's expectations. Improving health outcomes while containing costs acts as a stumbling block. In this context, Big Data can help healthcare providers meet these goals in unprecedented ways. The potential of Big Data in healthcare relies on the ability to detect patterns and to turn high volumes of data into actionable knowledge for precision medicine and decision makers. In several contexts, the use of Big Data in healthcare is already offering solutions for the improvement of patient care and the generation of value in healthcare organizations. This approach requires, however, that all the relevant stakeholders collaborate and adapt the design and performance of their systems. They must build the technological infrastructure to house and converge the massive volume of healthcare data, and to invest in the human capital to guide citizens into this new frontier of human health and well-being. The present work reports an overview of best practice initiatives in Europe related to Big Data analytics in public health and oncology sectors, aimed to generate new knowledge, improve clinical care and streamline public health surveillance

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

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

Emergency Department as an epidemiological observatory of Human Mobility: the experience of the Moroccan population

We conducted a retrospective study of the accesses to the Emergency Department registered from January 2000 to December 2014 in 5 major hospitals in the Metropolitan Area of Rome. We extrapolated data relating to patients of Moroccan origin from about 5 million total accesses, so we compared with Italians data which, in the same period, came to ED. The Moroccan population is distinguished by a larger number of diagnoses belonging to the ICD-9 code of Infectious Diseases and, more precisely, to Respiratory Infectious Diseases. There are also no differences in the assignment of such diagnoses to Moroccans with Italian citizenship, and this led to think that this could play an important role in the use of the ED and moreover that enrollment to the National Health Service may reduce its inappropriate use. Regarding to Degenerative Disorders, the result of our analysis is quite emblematic, showing that the accesses to the ED is due to Cardiovascular Diseases: 6.33% of Italians' accesses against 1.81% of Moroccans and 2.36% of Moroccans with Italian citizenship. The main explanation for this difference is, obviously, due to the age of the population: about 60% of Moroccans who accessed to ED was less than 40 years old. It is interesting how, in the field of ​​Cardiovascular Diseases, Moroccans have a lower percentage of diagnosis compared to Italians for acute diseases and a greater percentage of diagnoses for chronic diseases, suggesting once again that accesses to ED for migrants often is due to the inability to use the general services of the National Health Service. In conclusion, from the point of view of the Emergency Department, Migration Medicine still has Infectious Diseases as the main reason for access. Degenerative Disorders remain a prerogative of the Italians, but we could certainly assume that the Moroccan population would develop at some point with the aging

Multimodal Surveillance of HAI in an Intensive Care Unit of a Large Teaching Hospital

Background: Healthcare associated Infections (HAIs) represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients in intensive care units (ICU). Surveillance systems are recommended to gather data in order to elaborate and evaluate intervention to reduce HAIs risk. Here we describe results of the multimodal surveillance system implemented in the ICU of a large teaching hospital in Rome from April 2016 to October 2018. Methods: The surveillance system integrated four different approaches: i) active surveillance focused on inpatients; ii) environmental microbiological surveillance; iii) surveillance focused on isolated microorganisms; iv) behavioral surveillance of the healthcare personnel. The system included the molecular genotyping of bacterial isolates through the pulsed field gel electrophoresis (PFGE). Moreover, an intervention to improve personnel adherence to hand hygiene (HH) guidelines was conducted. Results: Overall, 773 patients were included in the surveillance. The global incidence rate of the device related HAIs was 14.1 (95%CI: 12.2-16.3) per 1000 patient day. Monthly device related HAIs incidence rate showed a decreasing, from 26.9 per 1000 patient day in October 2016, to 4.9 in September 2018. The most common bacterial isolate was K. pneumoniae (20.7%), the 94.0% of which were multidrug-resistant. A total of 305 environmental bacterial isolates were retrieved and the most frequent was A. baumannii (27.2%), that was always multidrug-resistant. Genotyping showed a limited number of major PFGE patters in clinical and environmental isolates. Behavioral compliance to HH guidelines improved after the educational intervention. Conclusions: The data showed an overall slight decrease over time of the adjusted risk HAIs rates. Through the integration of information gathered from the four approaches, the application of this model returns a precise and detailed view of the infectious risk and of the microbial ecology of the ICU

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

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

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

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

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

Precision medicine and public health: New challenges for effective and sustainable health

The development of high-throughput omics technologies represents an unmissable opportunity for evidence-based prevention of adverse effects on human health. However, the applicability and access to multi-omics tests are limited. In Italy, this is due to the rapid increase of knowledge and the high levels of skill and economic investment initially necessary. The fields of human genetics and public health have highlighted the relevance of an implementation strategy at a national level in Italy, including integration in sanitary regulations and governance instruments. In this review, the emerging field of public health genomics is discussed, including the polygenic scores approach, epigenetic modulation, nutrigenomics, and microbiomes implications. Moreover, the Italian state of implementation is presented. The omics sciences have important implications for the prevention of both communicable and noncommunicable diseases, especially because they can be used to assess the health status during the whole course of life. An effective population health gain is possible if omics tools are implemented for each person after a preliminary assessment of effectiveness in the medium to long term

Genomica in Sanità Pubblica. Evidenze scientifiche e prospettive di integrazione nella pratica della prevenzione

I miglioramenti registrati negli ultimi anni nella qualità del sequenziamento di nuova generazione, nella riduzione dei costi associati e in una complessiva evoluzione delle scienze omiche, hanno favorito lo sviluppo della medicina personalizzata o di precisione. Ad oggi, anche a livello di popolazione si possono ottenere dei benefici rilevanti attraverso tale approccio. La Sanità Pubblica di precisione consiste nel fornire il giusto intervento, alla popolazione che ne ha necessità, nel momento e con le modalità opportune. Significa, quindi, promuovere metodologie accurate per identificare e misurare le patologie ma anche le esposizioni, i comportamenti e la suscettibilità. La Sanità Pubblica di precisione è in evoluzione e non è legata semplicemente a geni, trattamenti e malattia ma alla precisa identificazione e risposta ai bisogni di salute. È necessario, quindi, discutere dell’inclusione delle scienze omiche in Sanità Pubblica. La medicina si è evoluta da un modello di diagnosi e trattamento basato essenzialmente sui sintomi ad uno sempre più dipendente dalla definizione bioinformatica di profili di rischio e/o patologici. Tali profili sono delineati mediante la produzione di informazioni attingendo a solide banche dati biologiche con il supporto dell’intelligenza artificiale. D’altra parte l’evoluzione nella pratica sanitaria è un processo complesso che include, tra l’altro, la sostenibilità dei costi sanitari, la valutazione dell’efficienza nella pratica clinica, l'integrazione dei nuovi progressi tecnologici e la rimodulazione dell'organizzazione dei servizi. Nel Gruppo di Lavoro Genomica in Sanità Pubblica della SItI, attivo dal 2012, sono coinvolti prevalentemente docenti universitari ma anche operatori del Ministero della Salute e dei Dipartimenti di Prevenzione. In questo special issue illustriamo alcuni argomenti di ricerca trattati. Non stupirà l’eterogeneità dei temi proposti vista la trasversalità delle scienze omiche in molteplici aspetti della salute umana. In particolare sono illustrati esempi che vanno dalla prevenzione di tumori ad alta incidenza, alla prevenzione di patologie infettive, sia per gli aspetti acuti che cronici, tenendo conto di caratteristiche genetiche ed epigenetiche della popolazione. Inoltre, illustriamo le prospettive di integrazione offerte allo studio del microbiota umano nella prevenzione. Procediamo con la discussione delle modalità di valutazione dei test genetici e genomici per la loro integrazione nell’offerta del Servizio Sanitario Nazionale. Infine, è illustrato il coinvolgimento della popolazione nell’impiego delle tecnologie omiche al fine di promuovere un cambiamento culturale nei confronti delle tecnologie disponibili e nella tutela della salute individuale e collettiva