Epidemiologia & Prevenzione最新文献

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.

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 "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.

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.