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

Economic analysis of remote monitoring in patients with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators in the Trento area, Italy

IntroductionRemote monitoring (RM) technologies have the potential to improve patient care by increasing compliance, providing early indications of heart failure (HF), and potentially allowing for therapy optimization to prevent HF admissions. The aim of this retrospective study was to assess the clinical and economic consequences of RM vs. standard monitoring (SM) through in-office cardiology visits, in patients carrying a cardiac implantable electronic device (CIED).MethodsClinical and resource consumption data were extracted from the Electrophysiology Registry of the Trento Cardiology Unit, which has been systemically collecting patient information from January 2011 to February 2022. From a clinical standpoint, survival analysis was conducted, and incidence of cardiovascular (CV) related hospitalizations was measured. From an economic standpoint, direct costs of RM and SM were collected to compare the cost per treated patient over a 2-year time horizon. Propensity score matching (PSM) was used to reduce the effect of confounding biases and the unbalance of patient characteristics at baseline.ResultsIn the enrollment period, N = 402 CIED patients met the inclusion criteria and were included in the analysis (N = 189 patients followed through SM; N = 213 patients followed through RM). After PSM, comparison was limited to N = 191 patients in each arm. After 2-years follow-up since CIED implantation, mortality rate for any cause was 1.6% in the RM group and 19.9% in the SM group (log-rank test, p < 0.0001). Also, a lower proportion of patients in the RM group (25.1%) were hospitalized for CV-related reasons, compared to the SM group (51.3%; p < 0.0001, two-sample test for proportions). Overall, the implementation of the RM program in the Trento territory was cost-saving in both payer and hospital perspectives. The investment required to fund RM (a fee for service in the payer perspective, and staffing costs for hospitals), was more than offset by the lower rate of hospitalizations for CV-related disease. RM adoption generated savings of −€4,771 and −€6,752 per patient in 2 years, in the payer and hospital perspective, respectively.ConclusionRM of patients carrying CIED improves short-term (2-years) morbidity and mortality risks, compared to SM and reduces direct management costs for both hospitals and healthcare services

The initiative on hip fractures of the Veneto Region

Objective: to assess the prevalence of the most relevant environmental and individual risk factors in subjects with a recent hip fracture was the aim of this observational study promoted by the Health Authorities of the Regione Veneto (Italy). Methods: patients aged > 60 years of both genders with a recent hip fracture not associated with malignancies, were administered questionnaires on dietary habits, sun exposure, disability score. A complete family, pharmacological and pathology history was collected together with previous falls, details of the fracture index, anthropometric data. In a subgroup of patients blood was taken for the measurements of serum 25 hydroxy-vitamin D (25OHD). Results: the study includes 704 patients (573 women and 131 men). Mean age was 81±8 years (range 60-102). Severe prefracture disability was a common feature (58%) associated with multiple co-morbidities (84%), more frequently cardiovascular and neurological diseases, and specific medications. In a large proportion (86%) of the patients environmental or individual risk factors for falling were found. Vitamin D insufficiency was quite common, particularly in the regional Health Districts were strategies for preventing vitamin D deficiency were not implemented. Only a small proportion (17%) of the study population had been evaluate and treated for osteoporosi

Risk of Symptomatic Infection During a Second Coronavirus Disease 2019 Wave in Severe Acute Respiratory Syndrome Coronavirus 2–Seropositive Individuals

We analyzed 221 COVID-19 cases identified between June 2020 and January 2021 in 6,074 individuals screened for IgG antibodies in May 2020, representing 77% of residents of five Italian municipalities. The adjusted relative risk of developing symptomatic infection in SARS-COV-2 seropositive participants was 0.055 (95%CI: 0.014 - 0.220)

Validazione di un punteggio di gravosità assistenziale infermieristica per i pazienti delle cure domiciliari

Identificare una misura del carico di lavoro infermieristico domiciliare è molto complesso per la difficoltà di catturare e standardizzare la tipologia dell’assistenza domiciliare nei diversi contesti. Obiettivo. L’obiettivo di questo studio è validare un punteggio di gravosità assistenziale per i pazienti in assistenza domiciliare. Metodi. I pazienti dei distretti sanitari del Veneto, con almeno due accessi domiciliari al mese sono stati valutati multidimensionalmente e multiprofessionalmente con un adattamento degli strumenti usati di routine, (la scala SVAMA, che comprende la valutazione di funzioni cognitive, supporto sociale, mobilità, stato funzionale, necessità di assistenza sanitaria); elenco dei bisogni assistenziali. In 5/9 distretti è stato volontariamente registrato anche il tempo necessario per le visite domiciliari (escluso il tempo di spostamento). È stata fatta un’analisi uni e multivariata con un modello di regressione lineare sulla media sia un modello di regressione robusta (package Stata 9) per trattare i valori estremi della distribuzione. È stata inoltre utilizzata la regressione ad albero con il modello CART (package R), per evidenziare i nodi concettuali della classificazione proposta. Risultati. Sono stati valutati 1.298 pazienti in assistenza domiciliare; in 639 pazienti è stato anche registrato il tempo effettivo dell’accesso a domicilio. In questo sottogruppo, la capacità predittiva rispetto al numero degli accessi domiciliari effettuati nei 3 mesi successivi è risultata del 44%, mentre rispetto al tempo mensile di assistenza infermieristica domiciliare (numero degli accessi infermieristici moltiplicati per la rispettiva dura effettiva) è risultata del 59%. Commento. Un punteggio di gravosità assistenziale consente di allocare le risorse infermieristiche. Il punteggio di gravosità dovrebbe tener conto anche del ruolo della famiglia e del contesto. I pazienti vanno regolarmente rivalutati per identificare i cambiamenti nella loro situazione

Correction: Cazzoletti et al. Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study. Int. J. Environ. Res. Public Health 2021, 18, 8434

The authors would like to make the following corrections to this paper [...]

Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study

Background: The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on nursing homes/long-term care facilities. This study examined the relationship between geography, size, design, organizational characteristics, and implementation of infection prevention and control (IPC) measures and the extent of COVID-19 outbreaks in nursing homes in the Autonomous Province of Trento (Italy) during the time frame of March-May 2020. Methods: The analysis included 57 nursing homes (5145 beds). The association between median cumulative incidence of COVID-19 cases among residents and characteristics of nursing homes was assessed by Mann-Whitney U test, Kruskal-Wallis test or Spearman rho. To evaluate the potential confounding of geographical area, a 2-level random intercept logistic model was fitted, with level 1 units (patients in nursing homes) nested into level 2 units (nursing homes), and "being a COVID-19 case" as the dependent variable. Results: Median cumulative incidence was not significantly associated with any of the variables, except for geographical region (p = 0.002). COVID-19 cases clustered in the part of the province bordering the Italian region most affected by the pandemic (Lombardy) (45% median cumulative incidence). Conclusions: Structural/organizational factors and standard IPC measures may not predict the epidemiology of COVID-19 outbreaks and be sufficient alone to protect nursing homes against them

Implementation of tele visit healthcare services triggered by the COVID-19 emergency: the Trentino Province experience

Aim In response to the SARS-CoV-2 emergency, the Competence Centre on digital health ‘TrentinoSalute4.0’ has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how ‘TreC_Televisita’ was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning