Utilization of big data to improve management of the emergency departments. Results of a systematic review

Background. The emphasis on using big data is growing exponentially in several sectors including biomedicine, life sciences and scientific research, mainly due to advances in information technologies and data analysis techniques. Actually, medical sciences can rely on a large amount of biomedical information and Big Data can aggregate information around multiple scales, from the DNA to the ecosystems. Given these premises, we wondered if big data could be useful to analyze complex systems such as the Emergency Departments (EDs) to improve their management and eventually patient outcomes. Methods. We performed a systematic review of the literature to identify the studies that implemented the application of big data in EDs and to describe what have already been done and what are the expectations, issues and challenges in this field. Results. Globally, eight studies met our inclusion criteria concerning three main activities: the management of ED visits, the ED process and activities and, finally, the prediction of the outcome of ED patients. Although the results of the studies show good perspectives regarding the use of big data in the management of emergency departments, there are still some issues that make their use still difficult. Most of the predictive models and algorithms have been applied only in retrospective studies, not considering the challenge and the costs of a real-time use of big data. Only few studies highlight the possible usefulness of the large volume of clinical data stored into electronic health records to generate evidence in real time. Conclusion. The proper use of big data in this field still requires a better management information flow to allow real-time application

Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal

Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014±2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system

ER access by foreign citizens between 1999 and 2014 in five large hospital of Rome, Italy

...Lack of information about the health services and the status of illegal immigrant can make difficult for foreign population to access primary care, leading to misuse of emergency rooms (ER). This study investigated the accesses between January 1999 and December 2014 to the ERs of five large hospital of Rome, Italy

Childhood vaccinations: A pilot study on knowledge, attitudes and vaccine hesitancy in pregnant women

Background. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women. Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome. Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent. Conclusion. The questionnaire proved reliable and is suitable for further studies

Increasing subnational commitment for measles and rubella elimination: the role of regional reports

Issue/problem To assess the progress towards measles and rubella elimination in the WHO European Region, the National Verification Committee of each Member State is requested to submit an annual status report (ASR) to the WHO Verification Commission for review and evaluation. Documentation required for Italian ASR are provided by the Ministry of Health, the National Institute of Health, and the 21 Regions. However, these ASR do not allow Regions to understand deeply their situation in the elimination process. Description of the problem The aim of this project is to produce regional synthetic annual reports, using the same data sources of the national ASR, that are sent to Regions to give them feedback about their progress towards elimination. A set of indicators has been identified within the framework of the national ASR. A green or red flag has been assigned to each indicator when regional data are better or worse than the national average, respectively. Where available, international targets were provided. Results In 2014 the incidence of measles and rubella in Italy was respectively 27 and 0.4 per million population. For all Regions coverage for both 1st and 2nd doses of routine measles and rubella vaccines was below the target of 95%. Analyzing those Regions with a percentage of red flags higher than the average percentage of red flags of the country, it emerged that 6/8 Regions were in the South of Italy (75%), 4/9 in the North (44.4%) and 1/4 in the Centre (25%). Lessons Regional reports are a valid tool to enhance the verification process at the sub-national level and may encourage regional and local authorities to implement appropriate strategies to remove barriers to the elimination goals. Southern Regions of Italy need to increase their efforts compared to other Regions. Key messages: In line with WHO recommendations to reinforce the commitment of the 21 Italian Regions, regional reports are able to provide Regions with detailed information about their progress and critical issues Regions of South Italy should mobilize better their financial, technical and human resources to achieve the elimination goals

Childhood vaccinations. Validation of a tool for measuring knowledge, attitudes and vaccine hesitancy in pregnant women

Background. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women. Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome. Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent. Conclusion. The questionnaire proved reliable and is suitable for further studies

[The elimination of measles and rubella in Italy]

Despite the WHO target for measles and rubella elimination in 2015, outbreaks still occur in all WHO Regions. After a description of the epidemiological situation of measles and rubella worldwide and especially in Europe, this paper aims to provide a detailed analysis of the current epidemiological context of Italy. The surge in the number of measles cases since the beginning of 2017, together with vaccination coverage still far from the 95% target, requires priority actions to be taken to achieve the elimination goals. Alongside the recently approved decree reintroducing compulsory vaccinations for school admissions, further measures are needed and should include the increase in the commitment of the 21 Regions; the implementation of supplemental immunization activities; improving the communication skills of health care workers; ensuring an effective communication with citizens; the enhancement of the surveillance network

Prevalence of non-adequate health literacy in Europe: a systematic review and meta-analysis

Background: Many studies show that a low level of health literacy (HL) is associated with several adverse outcomes. The aim of this systematic review was to estimate the prevalence of nonadequate HL (NAHL) in European countries and outline the main needs for interventions. Methods: The systematic search was performed in April 2019 and updated in June 2019. PubMed, Embase and Scopus were searched. Articles were considered eligible if they were cross-sectional studies published in English after 2000 and estimating the NAHL prevalence in European countries. Globally, 15490 articles were retrieved. Adapted Newcastle-Ottawa Scale was applied for the quality assessment. Several stratified metaanalyses were carried out. We also performed a metaregression analysis to test the association between variables and NAHL. Results: In total, 59 articles of heterogeneous quality were included, providing data for 98 studies to include in the proportion meta-analysis. Overall, quantitative analysis yielded a pooled NAHL prevalence of 40% (95%CI, 36%-43%). Despite the prevalence varied considerably by country, it seemed to follow a geographic gradient, with the northern countries clearly having a lower prevalence than the other European counterparts. The pooled prevalence estimates (PEs) varied significantly according to the different type of HL assessment method applied. Also, high study quality was found to be significantly associated with a reduction of NAHL in the PEs. Grouping the sample in general population, oncology patients, chronic disease patients and refugees, the meta-regression analysis showed a significantly lower prevalence of NAHL in oncology patients. Conclusions: Although the PEs varied in relation to several factors (e.g. either among population groups, or depending on the HL assessment method), this study shows that more than one in every three surveyed participants had NAHL. Targeted strategies and coordinated policies aiming at improving HL in the Region are needed

Emergency Department as an epidemiological observatory of Human Mobility. The case of Rome Metropolitan Area (EMAHM). A descriptive analysis of the visits to the ED of the Northern African population

This study focuses on the analysis of Big Data obtained from the Emergency Departments (EDs) of five hospitals located in the metropolitan area of Rome, Italy. The analysis of ICD9-CM discharge diagnoses shows clear differences between the Italian population and the North African population and confirms that many of the dynamics and health conditions regarding migrants are due to the inappropriate use of health services and, eventually, of the EDs. Our results afford indication about how we could identify shortcomings and critical issues within the primary care system and, more generally, in the management of psycho-social and socio-economic support for immigrant populations

Emergency Department as an epidemiological observatory of Human Mobility. The case of Rome Metropolitan Area (EMAHM). A descriptive analysis of the visits to the ED of the Northern African population

This study focuses on the analysis of Big Data obtained from the Emergency Departments (EDs) of five hospitals located in the metropolitan area of Rome, Italy. The analysis of ICD9-CM discharge diagnoses shows clear differences between the Italian population and the North African population and confirms that many of the dynamics and health conditions regarding migrants are due to the inappropriate use of health services and, eventually, of the EDs. Our results afford indication about how we could identify shortcomings and critical issues within the primary care system and, more generally, in the management of psycho-social and socio-economic support for immigrant populations