Annali di igiene : medicina preventiva e di comunita最新文献

Background: Patients with psychiatric disorders face exacerbated physical health issues and reduced life expectancy, primarily due to premature cardiovascular diseases. The intricate relationship between lifestyle factors, illness, and psychotropic medications contributes to this phenomenon. The focus of this research is to evaluate weight management interventions for individuals with Severe Mental Disorders through a comprehensive scoping review, investigating the characteristics, types, modalities and topics of interventions to provide a useful tool for professionals who want to promote lifestyle interventions for people with Severe Mental Disorders.

Methods: Eligible articles were peer-reviewed studies that reported an intervention targeted to patients with Severe Mental Disorders and aimed at promoting health through nonpharmacological interventions (including but not limited to nutritional education, physical activity and exercise interventions).

Results: A total of 20 studies with a total of 3,886 participants were evaluated.The studies included patients with a weighted mean age of 44.37 (SD=4.72) and a mean Body Mass Index of 34.7 kg/m2 (SD=3.56). Varied interventions, mostly conducted in the US, showed promising weight reduction and cardiovascular risk management results among patients with psychiatric disorders. However, disparate methods used in the studies hindered the evaluation of outcomes. The studies, which yielded the most interesting results, included parallel cluster randomized controlled trials, which showed improvements in HDL cholesterol and metabolic indicators, (HR 0.085; 95% CI:0.007-0.16) using IMPACT therapy, and a pragmatic randomized controlled trial which reported that with the InShape intervention 51% of participants achieved clinically significant reduction in overall cardiovascular risk.

Conclusion: Such a synthesis of findings provides valuable insights for future research, emphasizing the need for standardized outcome measures and more extended, comprehensive interventions.

Background: Over the past 15 years, Italy's National Health Service has been the object of increased governmental attention, due to the need to control public spending, reduce waste, and maintain acceptable levels of quality, accessibility and appropriateness of healthcare services.

Methods: One of the key mechanisms to achieve this has been the implementation of performance assessment systems. Among these is the New Guarantee System, introduced in 2019, which utilizes 88 indicators across three key macro-areas - public health and prevention, primary health care, and hospital care - to assess the quality and equity of essential healthcare services.

Results: This paper critically analyzes the 2025 New Guarantee System report, identifying strengths, limitations, and potential improvements for a more effective monitoring system. The findings reveal significant gaps in the current healthcare performance evaluation system. The reliance on descriptive statistics limits the ability to interpret healthcare outcomes accurately. The absence of indicators addressing chronic diseases, health inequalities, new technologies and qualitative patient experiences suggests the urgent need of a more comprehensive evaluation approach.

Conclusions: To improve the healthcare performance evaluation system, it is recommended to incorporate more comprehensive indicators that address the identified gaps. Enhanced data integration, qualitative assessments, and an increased focus on chronic diseases and health disparities are essential to provide a more accurate evaluation of healthcare services.

Background: Glaucoma, diabetic retinopathy, and age-related macular degeneration impose substantial economic burdens on healthcare systems due to their high prevalence and chronic nature. Nevertheless, comprehensive Italian data is limited. This study aims to collect Italian evidence on the economic impact of these conditions to support more effective healthcare planning.

Study design: Systematic review.

Methods: A systematic literature search was conducted in accordance with PRISMA guidelines across PubMed, Scopus, Web of Science, and EMBASE databases. Studies reporting cost evaluations of managing glaucoma, diabetic retinopathy, and age-related macular degeneration in Italy were included. Direct, indirect and non-medical costs were considered.

Results: The review included 23 studies exhibiting considerable heterogeneity in timeframes, regions, and economic evaluation approaches. For glaucoma, annual direct costs ranged from €788.70 for early-stage cases to €8,368.51 for advanced cases requiring surgery. Annual costs associated with diabetic retinopathy ranged from €4,050 to €5,799 per patient, depending on disease severity and treatment approach. The financial burden of age-related macular degeneration varied considerably, with costs ranging from €1,399.20 for early-stage cases to €3,973.30 for advanced stages. Although non-medical and indirect costs, such as lost productivity and caregiving expenses were less frequently assessed, they represented a significant contributor to the overall financial burden.

Conclusions: This study highlights the substantial economic burden ocular diseases place on the Italian healthcare system. Early intervention and preventive strategies could reduce the long-term costs of managing diabetic retinopathy and age-related macular degeneration. Further research into indirect costs and cost-effective interventions is necessary to support more efficient healthcare resource allocation.

Background: Continuing Medical Education (CME) is essential for enhancing professional performance. Modern CME approaches should prioritize adaptability and engagement through interactive and experiential learning, fostering better knowledge retention, skill application, and innovation to meet evolving healthcare challenges. This study aims to assess knowledge and perceptions of perceived role of engagement and active learning techniques in CME in the Italian population.

Methods: We conducted a pilot study with cross-sectional design among graduate and post-graduate students from the University of Modena and Reggio Emilia in 2023, by administering a 17-item questionnaire about knowledge, and perceptions of CME.

Results: We included 43 participants (median age 25, 72% females). Role of CME was recognized by 72.1%, and 53.5% were aware of its benefits. Likert responses showed high perceived importance of CME and engagement (mean scores 3.79 and 4.40). Active approaches like simulation (68.3%) and role-playing (65.9%) were familiar, but gamification (36.6%) was far less known.

Conclusions: While methods like simulation, role-playing, case-based learning, and problem-based learning were familiar to study participants for their strong evidence of effectiveness, emerging approaches such as gamification and team-based learning were less known. Such approaches require further implementation in educational programs to show their benefits.

Background: The term 'Missed Nursing Care' (MNC) refers to any aspect of nursing care that is not delivered, partially delivered, or delayed. MNC has significant negative consequences, including adverse patient outcomes, safety risks, and decreased job satisfaction. While extensively studied in hospitals, MNC in community healthcare settings, remains under-researched, especially in Italy. This study aims to explore the phenomenon of MNC in Italian home care settings by documenting and analyzing the lived experiences of freelance nurses, focusing on the characteristics, influencing factors, and consequences of MNC as perceived by these healthcare professionals.

Study design: This is a descriptive phenomenological study.

Methods: Using snowball sampling, 12 Italian freelance nurses were recruited and interviewed from November 2022 to February 2023. Data collection was based on in-depth interviews, that have been transcribed and analyzed using Giorgi's phenomenological framework. The study report adhered to the COREQ-32 checklist for qualitative research.

Results: Thematic analysis revealed four main themes: dimensions of MNC, organizational challenges, consequences of MNC, and family-nurse collaboration. Freelance nurses frequently addressed unmet fundamental and complex nursing needs, highlighting significant clinical, psychological, and economic impacts on patients and families. Organizational issues, such as rigid public service schedules and inadequate staffing, were identified as primary contributors to MNC. Families played a crucial role in managing care and collaborating with freelance nurses to ensure continuity.

Conclusions: This study provides novel insights into MNC in Italian home care settings, emphasizing the critical role of freelance nurses in filling care gaps. The findings suggest the need for systemic changes to improve flexibility, staffing, and integration of public and private nursing services. Further research, particularly quantitative studies, is essential to validate these findings and explore broader implications for patient care and health outcomes.

Background: Preventive measures can avert up to 45% of dementia cases worldwide. The aim of the study is to analyse some selected national dementia prevention strategic plans.

Methods: A qualitative comparative analysis was performed between national dementia plans of the European countries with the best healthy life expectancy among the elderly. The national dementia plans of France, Ireland, Italy, Spain and Sweden were included. The consensus on priority actions and key elements of prevention policies was evaluated, according to the World Health Organization recommendations and to an analysis tool designed for evaluating chronic diseases policies.

Results: All the countries emphasized the importance of prevention policies within their dementia plans and established monitoring committees. However, not all countries defined timelines for policy implementation and only Spain updated its national plan so far. The integration of dementia prevention with other chronic disease preventive campaigns is still lacking, and also a clear allocation of funds for dementia plans is absent so far.

Conclusions: All countries extensively followed the World Health Organization's recommendations. However, the plans have not been updated. Thus, they do not address all the current known risk factors for dementia, preventing only a fraction of potentially preventable cases. Moreover, the need for financial support in national dementia plans are critical but inadequately addressed, with inconsistent or undefined funding sources to implement their goals.

Background: Worldwide population is ageing rapidly. Lifestyle factors are essential targets for leading to behaviour change interventions that promote healthy aging.

Study design: We performed a scoping review aimed to underline the current knowledge and experience on preventive interventions for healthy and active ageing in Italy. Secondly, it intended to study the manner in which this country will pursue the topic in this research area.

Methods: The search was conducted on different databases: PubMed, CINAHL, Embase, and Scopus on July 25th, 2023, and search results were filtered to include only articles published from 2003.

Results: A total of 951 potentially relevant records were retrieved. After duplicates removal, 810 unique records were screened. Finally, four studies fulfilling established criteria were included. All the studies were conducted in the northern and central regions of Italy. The investigated populations were older adults, and all four studies were focused mainly on primary prevention and health promotion strategies based on self-efficacy and motivation of the participants, including physical activity, diet and cognitive training. In addition, two studies used mobile health technologies to deliver the preventive intervention for healthy ageing.

Conclusion: Our scoping review underlines the limited knowledge and experience of preventive healthy aging interventions in the national setting. The new preventive pathway that promotes healthy ageing healthily should be based on tailored lifestyle interventions, managed by multidisciplinary teams with the use of digital tools, in order to improve older people's safety. The characteristics of the settings are still not clear.

Background: The demographic transition has led to an increase in the older population, resulting in a rise in individuals with comorbidities and reduced self-sufficiency. Low health literacy levels are associated with poor health outcomes especially among vulnerable groups (like older individuals). Enhancing health literacy through targeted programs is crucial for improving self-care in chronic conditions. To date, in Italy, there are no validated tools to measure health literacy in older people. Thus, the aim of this study is to validate the European Health Literacy Survey Questionnaire 6 in a Tuscan (Italy) sample of senior individuals.

Study design: Cross-sectional.

Methods: The sample was drawn from the Surveillance System of Advancements in health of the Italian Local Healthcare Units from 2017 to 2019. Item analysis, Cronbach's alpha and confirmatory factor analysis were used to validate the scale. Additionally, associations between Health Literacy levels and sociodemographic characteristics were analyzed.

Results: A total of 11,000 subjects were interviewed, with 1,080 (10%) aged 65-69. Cronbach's alpha was 0.89. In the older subgroup, the percentage of missing responses ranged from 4.54% to 11.85%, with the fourth item having the highest percentage of missing values. The confirmatory factor analysis revealed that the three-factor model showed a better fit to the data compared to the unidimensional model. Similar findings were observed in the 18-65-year-old population. In both groups, individuals with economic difficulties or lower education were at higher risk of having inadequate levels of health literacy. Moreover, in the 18-64 age group, being female reduced the probability of having an inadequate health literacy level, while being inactive/retired or a foreigner increased it.

Conclusions: The study provides preliminary evidence supporting the validity and reliability of the European Health Literacy Survey Questionnaire 6 for assessing health literacy in the Italian older population. Further research is necessary to confirm these findings, particularly in samples of individuals aged over 69 years.

Background: Breast cancer represents the most common form of neoplasm in women, with an estimated 685,000 deaths annually. In this regard, screening programmes represent one of the most effective intervention tools in the field of cancer prevention. The aim of this study is to analyse and describe the key performance indicators of the screening programmes in Lombardy from 2016 to 2022.

Study design: Descriptive temporal analysis study.

Methods: The data pertaining to the screening campaign were subjected to analysis, with the results broken down according to the following criteria: individual province, age group eligible for screening, and campaign year. For each campaign, the data pertaining to the population subjected to screening, as well as the data concerning the rate of cancers identified during the campaign, were subjected to analysis.

Results: For the three age groups, a substantial overlap in call and campaign adherence rates can be observed, with stable values between 2016 and 2019, followed by a significant decline in the 2020 campaign associated with the impact of the pandemic on prevention activities, including cancer screening campaigns. The data for 2021 and 2022 indicate a reversal of the decline in adherence and call rates, particularly in the 45-49 age group, which exhibited an increase of approximately 300% in the call rate between 2021 and 2020. Moreover, the categorization of the provinces into urban, mountainous and rural provinces demonstrates an overlap in the admission rates between the three areas in the different years.

Conclusions: Despite the existence of mammography screening campaigns for more than 20 years, adherence rates in the Lombardy region remain below the targets set out in Europe's Beating Cancer Plan. In this regard, the observed variations, particularly during the period of the pandemic and in the subsequent post-pandemic period, provide an opportunity to rethink the organization of screening campaigns in order to increase adherence and effectiveness.

Background: An increasing number of individuals use online Artificial Intelligence (AI) - based chatbots to retrieve information on health-related topics. This study aims to evaluate the accuracy in answering vaccine-related answers of the currently most commonly used, advanced chatbots - ChatGPT-4.0 and Google Gemini Advanced.

Methods: We compared the answers provided by the World Health Organization (WHO) to 38 open questions on vaccination myths and misconception, with the answers created by ChatGPT-4.0 and Gemini Advanced. Responses were considered as "appropriate", if the information provided was coherent and not in contrast to current WHO recommendations or to drug regulatory indications.

Results and conclusions: The rate of agreement between WHO answers and Chat-GPT-4.0 or Gemini Advanced was very high, as both provided 36 (94.7%) appropriate responses. The few discrepancies between WHO and AI-chatbots answers could not be considered "harmful", and both chatbots often invited the user to check reliable sources, such as CDC or the WHO websites, or to contact a local healthcare professional. In their current versions, both AI-chatbots may already be powerful instrument to support the traditional communication tools in primary prevention, with the potential to improve health literacy, medication adherence, and vaccine hesitancy and concerns. Given the rapid evolution of AI-based systems, further studies are strongly needed to monitor their accuracy and reliability over time.