Epidemiologia & Prevenzione最新文献

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.

The Italian Association of Epidemiology's experience during the COVID-19 pandemic and its collaboration on a national project focused on contact tracing have prompted significant insights essential for the management of future pandemics in Italy and the development of new pandemic plans. In particular, the Italian Association of Epidemiology highlighted the need to collect, analyse and interpret data, and produce indicators of effectiveness and efficiency in a consistent manner across the country to support the governance of the pandemic response. During the COVID-19 pandemic in Italy, this capacity was severely hampered by structural and regulatory factors and the limited availability of specific expertise. The lack of applications developed for contact tracing purposes and the absence of interoperability between existing information systems highlighted the need to invest in integration among ICT, Epidemiology, and Public Health Services. The absence of predefined indicators made it impossible to compare different organisational solutions for contact tracing. From the regulatory point of view, there is an urgent need for clarification of the legitimacy and legal basis of the use of data already available to the National Health System collected for different purposes to be used for the performance of proactive medicine and prevention activities. Finally, investment in training for health workers and decision-makers at all levels and community awareness raising are essential to building a resilient community. The Italian National Pandemic Plan 2024-2028 is an opportunity to prepare an effective and efficient response to future health emergencies, through coordinated plans and the valorisation of the pandemic experience.

The area known as Piana di Venafro is situated between the Mainarde and Matese massifs in the extreme western Region of Molise (Southern Italy). This valley was formerly designated as Campania felix, a moniker derived from the global esteem in which its crops were held. Nowadays, the valley is traversed by numerous high-volume thoroughfares, rendering it challenging to maintain the designation of felix. The presence of significant industrial facilities along its periphery has resulted in the valley becoming a heavily polluted area. This contribution provides an overview of the significant activities undertaken by the non-profit organisation 'Mamme per la Salute e l'Ambiente ODV ETS' (Mums for Health and Environment) in their efforts to safeguard the Venafro Plain region and address the environmental concerns they have identified.

Objectives: to provide an overview of the geographical distribution of mesothelioma and asbestosis deaths in the Campania Region (Southern Italy) occurred from 2005 to 2018 and to identify areas at higher risk.

Design: for each municipality, Standardized Mortality Ratios (SMRs) for mesothelioma and asbestosis have been estimated from the mortality data provided by the Italian National Institute of Statistics (Istat). Deaths for which mesothelioma and asbestosis were identified as the underlying causes, according to the classification system ICD-10 codes (C45 and J61, respectively), were included. Expected cases were estimated applying age- and gender-specific mortality rates in Campania on resident populations of each municipality. Furthermore, the association between the municipal SMR and the local socioeconomic deprivation index based on the 2011 General Census of Population and Housing was also analysed.

Setting and participants: Campania Region.

Main outcomes measures: the study outcomes were standardized mortality ratios for mesothelioma and asbestosis and the identification of territorial subareas.

Results: a total of 998 deaths attributed to mesothelioma and 62 to asbestosis were identified. No cases of death due to mesothelioma or asbestosis were reported in the province of Benevento. A significant increase in mortality due to mesothelioma was observed across 34 municipalities. These findings show that several municipalities within the province of Naples display a high increase in mortality due to mesothelioma and asbestosis, with 506 deaths in total and 246 cases recorded in the municipality of Naples against 178,37 expected (SMR 1,38; 90%CI 1.24-1.53). In 15 municipalities, a notable increase in mortality for asbestosis was recorded; in Naples, 28 cases occurred (SMR 2,51; 90%CI 1.84-3.42). The overlap between mortality maps for mesothelioma and asbestosis confirms the existence of areas subjected to definite and prolonged asbestos exposure. Additionally, a correlation with the deprivation index was noted: the pooled SMR by quintiles increases with higher quintiles of the deprivation index, for both mesothelioma and asbestosis.

Conclusions: results highlight the crucial need for epidemiological surveillance of asbestos-related diseases in Campania. Actively searching out for new cases of mesothelioma in the entire region is a crucial task in primary prevention of occupational, environmental, and domestic exposures to asbestos.

Objectives: to describe prevalence of disability in the population of the Agency for Health Protection of Milan (ATS Milan), integrating current administrative healthcare, socio-healthcare, and social data; to classify disability with a diagnosis into a predominant structural and functional category according to the International Classification of Functioning, Disability and Health (ICF), supplementing it with additional levels of detail.

Design: retrospective observational study.

Setting and participants: subjects residing in the territory of ATS Milan in the years from 2018 to 2022.  Main outcomes measures: prevalence of disability in the population of ATS Milan from 2018 to 2022; average annual costs since disability diagnosis of the entire population and stratified by the most common ICF classifications.

Results: the prevalence of disability ranges from 5.8% in 2018 to 8.4% in 2022. In general, women have a higher prevalence than men. However, there are significant differences in the gender distribution depending on the considered age group. The main disabilities (32.2%) affect the structures of the nervous system and mental functions, followed by disabilities identified solely by major prosthetic devices (9.4%) and sensory disabilities with alterations in sensory functions with the presence of a major device (5.2%). Analysis of average total annual per capita costs shows an upward trend with increasing years since the diagnosis.

Conclusions: the definition of standardized tools, such as the selection from several available healthcare data provided by service suppliers, can be helpful in obtaining reliable data on the prevalence of disability in the population. This evidence can be useful in planning public health interventions to address the needs of this population. The work developed by ATS Milan has been carried out in alignment with the activities outlined in Mission 5 of the National Recovery and Resilience Plan (PNRR), in particular for the reform of disability legislation, which foresees the definition of standardized tools for the in-depth study of the epidemiological aspects of the phenomenon.