Epidemiologia & Prevenzione最新文献

Background: reducing air emissions is the fundamental action necessary to mitigate the negative health effects caused by air pollution. However, increased public awareness has highlighted the need to identify protective measures that can mitigate the personal health risks associated with air pollution.

Objectives: examine the evidence regarding personal protection strategies capable of mitigating the health effects caused by air pollution, with a focus on healthy individuals and at-risk categories.  Design: narrative review.

Setting and participants: this study examines the most effective personal protection strategies for healthy and at-risk individuals, considering children, the elderly, and individuals with cardiovascular and respiratory diseases; the examined strategies include the use of air purifiers, respiratory masks, exposure limitation, physical activity, alternative means of transportation, and environmental monitoring systems.

Main outcomes measures: reduction of individual exposure to air pollution, respiratory and cardiovascular outcomes, total and all-cause mortality.

Results: the evidence indicates that these measures can reduce exposure and promote well-being. For at-risk individuals, it is crucial to limit exposure during periods and in locations with high pollution levels, with an emphasis on physical activity. The use of high-efficiency air purifiers can reduce the negative effect of air pollution on individuals with respiratory and cardiovascular conditions, especially those with asthma. In healthy individuals, multiple mitigation actions have been identified, with evidence suggesting that the benefits of physical activity persist even in environments with high levels of air pollution.

Conclusions: this narrative review provides an overview of personal strategies capable of reducing air pollution exposure and consequently mitigating its negative impact on health. These findings can support the development of recommendations and communication and prevention interventions, promoting risk reduction policies and increased awareness and engagement from both healthcare and non-healthcare networks at the local level. Although more robust systematic approaches are needed, this review serves as a useful tool for stakeholders and citizens, while also providing a simple instrument with significant communicative potential, applicable on a large scale.

Hearing and vision disorders in newborns are a serious social and public health problem. To improve the effectiveness and efficiency of screening protocols, it is necessary to use standardized procedures and ensure their implementation at a national level. This is the first set of Italian national practice recommendations for professionals involved in the diagnosis, treatment, and management of hearing and eye screening that will guide the development of multidisciplinary services and public health policies to prevent and/or treat hearing and vision impairment in newborns. This document refers to art. 38 of the Italian Prime Ministerial Decree of 12th January 2017 defining the essential levels of assistance. It also provides an overview - albeit not exhaustive - of the current organization of the screening system as a whole and the potential areas of implementation.

The Social Report (SR) is a form of measurement and reporting, transparency, and communication, essential for sharing decisions, activities, and the value an institution generates with stakeholders from a social responsibility perspective. It is a useful tool for screening programmes to understand their objectives and structure, assess their effectiveness, and promote informed participation by citizens and stakeholders.This contribution explores the implementation of the SR in oncological screening programmes - a project conducted in the CCM 2019 Programme 'Guidelines for Social Reporting of Screening Programmes', coordinated by the Institute for Cancer Research, Prevention and Clinical Network (ISPRO) in Tuscany Region in collaboration with the Centre for Oncological Screenings of Reggio Emilia (Emilia-Romagna Region) and the Population Screening Programmes Service of ATS Valpadana (Lombardy Region) - conducted between 2020 and 2022.The project general objective was to review the Guidelines for Social Reporting of Oncological Screening Programmes developed in 2012. This was achieved through a training and knowledge-deepening phase and an experimental phase in a co-creation logic with all stakeholders involved, particularly with Corporate Management, Regional Screening coordinators, and Associations of citizens and patients.The project had three specific objectives: to spread the culture and practice of social reporting through training courses for professionals working in screening programmes; to experiment with drafting SR in three pilot projects and subsequently update the guidelines; to disseminate the updated guidelines to regional screening coordination and promote informed and conscious involvement of stakeholders.At the end of the project, three SRs were produced for mammography, cervical, and colorectal screening programmes, structured into homogeneous sections and enriched with specific local content. This experience demonstrated the importance of the SR as an accountability tool, but also highlighted difficulties due to the pandemic and the need for earlier and more integrated stakeholder involvement. The updated Guidelines reflect the commitment towards more comprehensive, comparable, and inclusive reporting, to be systematically adopted within screening programmes.

This work is the third in a series of articles dedicated to the EASY-NET network programme. The first article described the rationale, structure, and methodologies; while the second evaluated the adherence of individual audit&feedback A&F interventions tested in EASY-NET to literature recommendations. This contribution provides a concise summary of the effectiveness results of A&ented by clinical and organizational areas: chronic disease management, emergency territorial and hospital care for acute conditions, post-acute rehabilitation, hospital oncology care, childbirth, and caesarean sections. In alignment with existing literature, the results on the effectiveness of A&F, in terms of measurable improvement, were observed across all settings, although to varying degrees and more significantly in processes than in outcomes. Key elements that proved to be fundamental to the implementation of A&F interventions include the importance of institutions in making A&F systematic, continuous, and a priority for healthcare professionals; the central role of the required and available data for preparing feedback; the involvement of A&F recipients in the whole path, from the design of the interventions to the discussion of results and improvement actions. A final consideration, in light of the activities conducted and the results achieved, suggests that integrating research into practice and practice into research is essential to ensure, on one hand, the transferability of evidence into operations and, on the other hand, the design of studies that are feasible and integrable into daily activities - a necessary aspect to optimize resources.

The project "Experimentation of new integrated hospital-territory organizational models for the prevention and control of sexually transmitted infections: facilitated diagnostic-care pathways and offer of free targeted screening" was developed as part of the CCM 2019 programme, funded by the Italian Ministry of Health, being coordinated by the Italian National Health Institute (ISS), in collaboration with Sapienza University of Rome. Three clinical units located in Turin, Milan, and Cagliari, specialized in sexually transmitted infection (STI) diagnosis and treatment, and three highly specialized microbiology laboratories located in Trieste, Florence, and Palermo were involved.The objectives were to develop an innovative network model for the treatment of STIs based on multidisciplinary centres with high quality of care for STIs (hub-IST) and territorial structures (spoke-IST), to plan and test integrated facilitated care pathways for STIs, to evaluate the priorities, feasibility, and sustainability of prevention interventions.A focus group of 12 experts, together with other members from the participating units, defined the characteristics of hub-IST and spoke-IST centres and outlined the integrated care pathway (PIC) for STIs based on the hub&spoke model.A 4-month field trial was subsequently started, applying the proposed PIC in 3 participating units. Improvements were immediately observed in care (increased access to the centre, reduced waiting times, increased number of visits), in the direct connection with intrastructure specialists, in prevention interventions, and in the information provision.The hub&spoke model applied to STIs proved to be innovative, transferable, and adaptable to different Italian regional situations, establishing itself as the currently most functional model for modern care for this type of infections. By reducing barriers to healthcare access, expanding the number of attendees, reducing costs for the community, and implementing targeted and effective prevention interventions, the epidemic chain can be interrupted and the spread of STIs reduced. Based on these results, in Italy, it is urgent to develop an STI strategic prevention plan at a national level.

The "One Health and Citizen Science" (OHCS) project aims to provide an integrated intervention model useful for characterising the state of environmental quality, assessing population exposure to pollutants, investigating the association between environmental risk factors and health outcomes, and measuring the impacts associated with contamination and remediation scenarios. In pursuing this objective, the activation of participatory pathways and the use of risk communication strategies are envisaged.Within the OHCS project, training and discussion meetings were planned on a number of issues deemed central. The first of these meetings focused on the theme of environmental justice. By embracing this theme, researchers explicitly acknowledged several essential elements: the value of a transdisciplinary approach in enriching our understanding, the non-neutrality of knowledge, and the prioritization of public health. Environmental justice, through this perspective, can represent the trait d'union of different disciplines and, in this circumstance, it was a fertile ground for exchanges between epidemiology, history, and social sciences allowing the historical and narrative reconstruction of the events affecting a place and its community as a result of personal and collective reflections.This contribution, therefore, explores the perspectives that can be developed around the topic of environmental justice. These perspectives are investigated by adopting a transdisciplinary approach, which on the one hand integrates the contributions of these different disciplines, on the other includes knowledge of other natures, with a view to peer collaboration in the production of knowledge. The theoretical reflections are complemented by the description of the training workshop experience, presented as a practical example for the construction of a useful dialogue space for local communities and technicians.

Background: after the recent reform of territorial healthcare, districts have been designated within the Lombardy Regional Health System to coordinate and deliver territorial care. This entails the need of readily available information to measure the quality of provided healthcare, identify critical areas for improvement, monitor the balance between demand and supply of healthcare services.

Objectives: to present the development of a dynamic evaluation system of processes and outcomes resulting from the integration of territorial and hospital care, based on a set of composite indicators, called 'health profiles', and their visualization and release through a dedicated web platform. These summary measures aim to capture the complexity of a specific clinical area or population and easily convey it to health managers.

Methods: the definition of a reproducible process for the construction of composite indicators, having defined a theoretical framework, maps the potential indicators of the profile of interest in a matrix made up of health needs and healthcare quality dimensions, and selects them on the basis of desirable properties and statistical metrics. Single indicators are normalized in the range [0,1], weighted according to the value of their quality dimension and to their reliability (measured as intraclass correlation coefficient), and aggregated via a geometric mean. The result is the value of the health profile, a percentage ranging from 0 to 100.

Results: the 'cancer profile', related to the domain of cancer prevention and treatment, was developed as a case study to illustrate the methods and potential application of these composite indicators at the district level. The initial set of 37 candidate indicators investigated: adherence to organized screening; timeliness of first visits; efficacy and safety of treatment; and end-of-life care. Applying the methods described, 28 indicators were selected and used to compute the cancer profile for different territorial units. Four main user-oriented infographics were developed to convey the health profile, its individual indicators, and their variation over time and across territorial units. The cancer profile was calculated and graphically visualized for the years 2015-2022.

Conclusions: a method has been defined and implemented to build synthetic territorial indicators, called health profiles, that can be applied to other clinical areas, such as chronic conditions. The release of a dedicated web platform for the effective communication of the profiles is an important tool to support evidence-based public health decisions.

Carbapenem-resistant Enterobacterales (CREs) are globally considered to be a major threat to public health. National and international guidelines emphasize the importance of routine active surveillance policies to prevent their transmission. Consequently, screening for the evaluation of the status of colonization by CREs in hospitalized patients in Italy is considered essential to contain and control the spread of these microorganisms and their evolution towards infection. The Italian Ministry of Health funding the CCM Project "Phenotypic and molecular screening methodologies for the detection of colonizations due to carbapenem-resistant enterobacterales (CRE)", carried out between February 2018 and January 2021 with the aim of evaluating phenotypic and molecular tests as methods able to detect patients colonized by CRE in Italian hospital setting. To assess the impact of the SARS-CoV-2 pandemic on CRE colonization, the observation period was divided into two periods: September 2018-September 2019 (first period) and October 2019-September 2020 (second period).As general objective of the project, the evaluation of the effectiveness of the methods has been appropriately foreseen. In addition, four specific objectives have been envisaged: 1. to standardize and to compare phenotypic and molecular methods, in terms of Turnaround Time (TAT); 2. to quantify the frequency of colonization at the admission and during hospitalization in Intensive Care Unit (ICU) and non-ICU wards; 3. to evaluate the effectiveness of screening interventions; 4. to provide activities that attest to the importance of screening.In order to evaluate the role of hospitalization in CRE-colonization, 11,063 patients were enrolled to perform rectal swabs on admission, and, if negative, weekly for three weeks during hospitalization. The data were collected in a dedicated IT platform.The molecular test demonstrated to be able to detect colonized patients and presence of resistance markers within 60 minutes from the sample arriving.The prevalence of CRE has increased during SARS-CoV-2 pandemic, especially in hospitals in South Italy. K. pneumoniae was the species most frequently associated with patients colonized by CRE.Training activities have been started for hospital staff, in order to reduce the frequency of colonization of patients. All the participating centres have defined the procedures to be applied locally for the screening of CRE colonized patients and have started screening activities.