Epidemiologia & Prevenzione最新文献

Within the prevention programmes of the Italian Ministry of Health, a project aimed to containing the circulation of SARS-CoV-2 virus in the immigrant population in Italy has entrusted to the Regional Health Authority of Sicily Region (Southern Italy). New evidence has been promoted to disseminate and share public health intervention models. The project involved public health institutions across the national territory and was carried out during the COVID-19pandemic. The project reached the general aim through specific objectives, identifying information sources and health indicators, evaluating the impact of COVID-19, and promoting intervention programmes for taking charge immigrant population. Social distancing, although necessary, has further amplified the gap of inequalities in health, confirming major vulnerability for infection. Having filled some knowledge gaps and proposed prevention tools has been useful for the containment of the virus, for a possible resurgence of the phenomenon, for application in other emergency contexts, and for recalibration in new epidemic events.

Objectives: to describe indicators, data sources, and levels of geographical stratification used within the framework of the CCM project "Epidemiological Surveillance and Control of COVID-19 in Metropolitan Urban Areas and for the containment of SARS-CoV-2 circulation in the immigrant population in Italy".

Design: population-based observational study based on data from the Integrated Covid-19 Surveillance System and the archive of hospital discharge records.

Setting and participants: interregional collaborative project. Resident population in 5 Italian Regions (Piedmont, Emilia-Romagna, Tuscany, Lazio, and Sicily).

Main outcomes measures: crude and age-standardized rates of diagnostic test utilization and positivity, hospitalization (in any department and in intensive care unit), and mortality in COVID-19 cases.

Results: starting from the set of 11 indicators from the Italian National Institute for Health, Migration and Poverty (INMP) project "Epidemiology of SARS-CoV-2 Infection (COVID-19) and Use of Health Services in the Immigrant Population and Vulnerable Population Groups in Italy", the five most effective indicators for CCM purposes were identified. The INMP project highlighted higher rates of test access and positivity among Italians compared to foreigners, higher standardized hospitalization rates among foreigners, and higher standardized mortality rates among Italians, with geographical and temporal heterogeneity. The intersection between the DEGURBA (degree of urbanisation) classification and altimetric zones defined five levels of territorial stratification characterized by decreasing population density. Approximately 81% of the population involved in the CCM project resided in the first two levels; 43% of Italians lived in areas with intermediate population density in hilly or plain areas, while 48% of foreigners were concentrated in densely populated areas.

Conclusions: sharing the collaborative approach and a research methodology already tested, integrated with the analysis of disaggregated indicators by morphological, functional, and administrative characteristics of the residential territory, allowed for assessing differences in the impact of the pandemic between Italians and foreigners residing in more or less densely populated areas.

During the spread of SARS-CoV-2 virus, contact tracing proved to be a very effective public health tool. Within the local health authority of Trapani (Sicily Region, Southern Italy), contact tracing was managed by physician, prevention technicians, and administrative from the Health Prevention Department who were trained and updated during the evolution of the epidemic. Contact tracing has been extended to migrants who arrived in Trapani with the landings. Extended contact tracing had some critical factors related to language barriers, which reduced the effectiveness of the telephone contacts and psychological counseling during tracing, up to the loss of definition of high or low risk contacts among both migrants and rescuers. The team made up of workers from the Health Prevention Department, the Global Health Center, and Cultural Mediators was important in effectively managing the critical issues. The high number of cases occurred during the outbreak of COVID-19 in January 2022 has shown difficulties to support the contact tracing in this phase.

Background: the spread of SARS-CoV-2 in the population has amplified the effects of health inequalities, particularly in the most vulnerable groups such as immigrants and refugees. An assessment of the intervention to contain the COVID-19 in these population groups was essential to define new strategies for more equitable, inclusive, and effective health policies to on health.

Objectives: to provide a systematic synopsis of the impact of interventions to contain the spread of SARS-CoV-2 in immigrants.

Methods: data sources included major bibliographic databases. Using a study protocol, already shared with the international scientific community, two independent researchers reviewed the citations, selected and evaluated the interventions studies. Due to the heterogeneity of the interventions, a narrative synthesis was carried out.

Results: three eligible studies were identified. The first study modelled the incidence of the disease in a refugee camp in Greece, based on an intervention of sectorialization of people that accessed to services, the use of masks, the early identification and isolation of cases and their family members, and the limitation of movements within the camp. The second evaluated the impact of preventive pharmacological interventions such as the use of hydroxychloroquine, ivermectin, povidone-iodine, zinc, and vitamin C, in different dosages and combinations, to a group of immigrant workers in a city dormitory in Singapore. The third study evaluated an intervention to increase vaccination coverage within a Latino immigrant community in the United States, moving the location of vaccine supply throughout the most frequented contexts by the immigrant community to access the city services. The results of the first and second studies suggest impacts for some of the proposed interventions even if they have been partially overcome due to the use of mass vaccination. The third showed a reduction in vaccine hesitancy and an increase in vaccination uptake and a snowball effect.

Conclusions: the systematic review identified few heterogeneous studies, preventing any generalization of the results. Probably, the low scientific production does not reflect the successful experiences implemented. In the case of a possible resumption of the epidemic or new emergencies, it will be necessary to rely on indirect evidence and the scientific community should consider more the responsibility to evaluate and make available the experiences gained in the field. A constant monitoring activity of the evidence that will be necessary to updating the results for suggest consolidated prevention measures to for controlling the incidence of COVID-19 in immigrants during a possible resumption of the epidemic and for application in other similarly emergency contexts.

Objectives: to provide researchers and stakeholders with an overview of the statistical sources of micro data available for estimating and studying the demand for care for dependent older people in Italy.

Design: analysis of questionnaires and variable displays from statistical surveys conducted on the resident population in Italy, selecting datasets that: 1. include at least one question on non-self-sufficiency and the related demand for care; 2. allow to distinguish the population by age groups; 3. are conducted uniformly at the national level and are representative of the population residing in Italy at least at NUTS-1 (nomenclature of statistical territorial units) level of geographic detail; 4. have periodicity character at least for the last ten years (2014-2024); 5. are immediately available for micro-analysis.

Setting and participants: all statistical surveys carried out on the Italian population between 2014 and 2024 that meet the requirements of the survey design. The most recent questionnaire is taken into account.

Main outcomes measures: selected surveys and number of questions identified in the selected surveys related to 9 sets of variables useful for studying the demand for care among dependent older people, including analyses of associations and correlations.

Results: the review identified 8 statistical surveys that can provide useful information for estimating and studying the demand for care for dependent older people, consistent with the objectives and design of the study. Six of these surveys are conducted by the Italian National Institute of Statistics (Istat) (EHIS, EU-SILC, IMF-AVQ, IMF-FSS, IMF-TUS, and ISF); two surveys are carried out by private consortia (ESS and SHARE). Not all groups of variables are simultaneously available in the datasets of the surveys considered, with the exception of the EHIS and SHARE surveys, but with severe limitations. In addition, some surveys allow regional statistics (NUTS-2), but none of them allow analyses at a more detailed territorial level.

Conclusions: no survey provides all the information useful for studying the demand for care of dependent older people, but sources have been identified which already allow demand to be estimated at sub-national level (NUTS-1 or NUTS-2) and correlations and associations with certain sets of variables to be investigated.

Objectives: to identify any differences between Italian and foreign women in the access to prenatal care, including the number and appropriate scheduling of visits, the execution of diagnostic, blood, and microbiological tests and the use of specific healthcare services.

Design: retrospective cohort epidemiological study, based on the monitoring of current information flows.

Setting and participants: data extrapolated from the Birth Attendance Certificate information flow of the Autonomous Province of Trento (Northern Italy) between 2012 and 2016. A total of 23,165 women with data regarding citizenship were included in the analysis.

Main outcomes measures: outcome variables used to assess appropriateness of antenatal care were medically assisted procreation techniques, use of invasive prenatal diagnosis, gestational age at the first appointment, total number of appointments and ultrasounds during pregnancy, blood and microbiological tests taken, and participation in antenatal classes.

Results: data indicates a significant difference in the use of chorionic villus sampling, testing for Cytomegalovirus, and vaginal-rectal swab for the detection of group B streptococcus, which are lower in the foreign population. Furthermore, there is a statistically significant difference in the gestational age at which the first appointment is attended, in the total number of visits, and in the number of ultrasounds performed during pregnancy as well as in participation in antenatal classes.

Conclusions: this study reveals significant differences in access and use of pregnancy assistance between foreign and Italian women. There are also differences in terms of social determinants of health, with a concentration of unemployment and low education in the foreign population. It is therefore necessary to identify the factors that can potentially create health inequalities, considering the socioeconomic determinants and the specific needs of migrant women.

The foreign population accounts for 8.6 percent (about 5 million) of the total number of residents, so it is necessary to monitor their health status. Foreigners have standardized mortality rates of about half that of Italians. In terms of hospitalization, rates and causes of hospitalization differ substantially due to the younger average age of foreigners. In particular, a much higher burden of hospitalizations in obstetrical care is observed among foreign women. Maternal and child health is a major concern for foreigners, especially for pregnancy care, which is also reflected in worse health outcomes for newborns.Difficulties in accessing and using basic and specialized territorial services are confirmed by the higher proportion of ordinary emergency hospitalizations among foreigners, the higher risk of being hospitalized for causes that could be treated in an outpatient setting, and the higher frequency of access to emergency rooms with a white/green triage code.The pandemic exacerbated health inequalities because it affected the most disadvantaged social strata of the population, including immigrants, more severely in terms of infection and outcomes.Immigrants could become the least healthy part of the population, similar to what is observed in countries with a longer tradition of migration, even in a country like Italy, where access to care is universally guaranteed.