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

Background: Firearm-related deaths are an issue of ongoing public interest, from a health and economic perspective. Worldwide, firearm prevalence in suicides varies widely, depending on multiple factors including the availability of weapons in each country. Although several studies have shown that national laws about gun ownership, reducing legal access to guns, decrease the risk of suicide by firearm, the current situation clashes with widely differing legislations.

Study design: Retrospective study on a forensic case series.

Methods: Autopsy reports assessed at the Section of Legal Medicine of Milan (Italy) from January 2014 to December 2023 were retrospectively documented. Only firearm suicides were considered. For each case, a close analysis of the criminal offence reports has been performed to obtain information about the gender and age of the victim, as well as the legal possession of firearms, psychiatric disorders, alcohol, and illicit drug abuse.

Results: Among all the 1,164 suicides assessed at the Section of Legal Medicine of Milan over a 10-year-period, 101 cases (8.7%) were firearm-related. The male to female ratio was therefore about 13:1. No seasonal trends were observed. Most of the individuals owned the firearm license. Of the entire dataset, 35.6% suffered from psychiatric disorders, 4% of alcohol abuse and 2% of drug addiction. Among the owners of a firearm license, 42.3% had psychiatric disorders.

Conclusions: Knowledge about firearm suicide and its relation to firearm legal possession is limited and current preventive laws should be reconsidered. Present administrative and clinical examinations required to obtain a firearm license in Italy and in some European territories are dealt with. The evaluation of the firearm-related risk of abuse is an essential but complex procedure, which requires not only clinic-anamnestic data but also in-deep psychiatric information. There is a need to develop and reinvigorate a debate that currently presents very heterogeneous solutions, but which would probably benefit from a common vision of the prevention strategies that can be implemented and enacted for the benefit of the entire community.

Background: Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policymakers. To support planning of primary healthcare resource allocation we analyzed the geographic distribution of primary care doctors/primary care paediatricians across Italian regions, accounting for area-specific number and age of the population. Additionally, we estimated the number of primary care doctors/primary care paediatricians expected to retire over the next 25 years, with a focus on the next five years.

Study design: Ecological study.

Methods: We gathered the list of Italian general practitioners and primary care paediatricians and combined them with the data from the National Federation of Medical Doctors, Surgeons and Dentists. Using data from the National Institutes of Statistics, we calculated the average number of patients per doctor for each region using the number of residents above and under 14 years of age for general practitioners and primary care paediatricians respectively. We also calculated the number of residents over-65 and over-75 years of age per general practitioner, as elderly patients typically have higher healthcare needs.

Results: On average the number of patients per general practitioner was 1,447 (SD: 190), while for paediatricians it was 1,139 (SD: 241), with six regions above the threshold of 1,500 patients per general practitioner and only one region under the threshold of 880 patients per paediatrician. We estimated that on average 2,228 general practitioners and 444 paediatricians are going to retire each year for the next five years, reaching more than 70% among the current workforce for some southern regions. The number of elderly patients per general practitioner varies substantially between regions, with two regions having >15% more patients aged over 65 years compared to the expected number.

Conclusions: over 65 years compared to the expected number. Conclusions. The study highlighted that some regions do not currently have the required primary care workforce, and the expec-ted retirements and the ageing of the population will exacerbate the pressure on the already over-stretched healthcare services. A response from healthcare administrations and policymakers is urgently required to allow equitable access to quality primary care across the country.

Introduction: Vaccinations represent an extremely effective tool for the prevention of certain infectious diseases - such as influenza and COVID-19 -, particularly for those categories at risk due to both their frail condition or professional exposure, such as healthcare workers. The aim of this study is to describe the course of the anti-influenza and anti-COVID-19 vaccination campaign at two Research Hospitals in Milan, Italy.

Study design: Multicentre, cross-sectional study.

Methods: For the 2023-24 vaccination campaign, the two facilities opted for two different approaches. At the Hospital A, two dif-ferent strategies for vaccinating healthcare workers were implemented: a fixed-site vaccination clinic and two mobile vaccination groups run by Public Health residents of the University of Milan. At the Hospital B, on the other hand, a single fixed-site outpatient clinic run by Public Health residents of the University of Milan was used. On the occasion of the campaign, a survey was also carried out using anonymous online questionnaires to investigate healthcare workers attitudes towards vaccination.

Results: A total of 1,937 healthcare workers were vaccinated: 756 were immunized against influenza only, 99 against COVID-19 only, and 1,082 against both. The results show a substantial difference in vaccination adherence among medical and nursing staff compared to other professional categories. In particular, the category with the highest vaccination adhesion turned out to be that of medical doctors with 55.7% adhesion while, on the contrary, the category with the lowest adhesion turned out to be that of auxiliary personnel characterized by 7.4% adhesion. At the same time, the comparison between the two hospital facilities showed a double adherence rate by the staff of Hospital A as regards both the flu vaccine (40.6% and 20.1%) and the anti-COVID-19 vaccine (26.4% and 12.3%). Finally, the survey showed that the attitude towards influenza vaccination is lower among auxiliary staff in terms of both knowledge and vaccination attitude.

Conclusions: The results of the study show a vaccination adherence in line with that of previous years, although lower than the values recommended by the principal national and international Organizations. The analysis of the differences between the two facilities and the surveys carried out will allow for the implementation of targeted interventions to increase adherence in future campaigns.

Background: The evaluation of the cause of death in a forensic context is often challenging especially when the corpse is in a severely altered state (decomposed, skeletonized, charred, dismembered, etc.), thus making it difficult to obtain an overview of the features and/or lesions suggestive of the dynamics leading to death.

Case report: In this case, the corpse was partly in a state of saponification and partly in a state of mummification with signs of skeletonization. The head, trunk, arms and upper legs were mummified and almost completely dehydrated.

Conclusion: The use of special techniques such as the rehydration of bodies is an ancient practice. Parts of skin in different states of decomposition with the use of rehydration solution represents a useful procedure for the study of some damaging modalities, being able to identify damaged areas characterized by compression/dehydration effects, hidden by the advanced transformative state of the corpse, highlighting very damaged, in which skin normality can no longer be restored.

Introduction: The correct method of surface disinfection in hospitals is an essential tool in the fight against the spread of healthcare-associated infections caused by multi-resistant microorganisms. Currently, there are many disinfectants on the market that can be used against different microorganisms. However, the effectiveness of different active molecules is controversial in the literature.

Study design: The aim of this study was to evaluate the effectiveness of wipes based on hydrogen peroxide (1.0 %) and highly specific plant-based surfactants, contained in H2O2TM (Hi-speed H2O2TM) products, against some hospital-associated microorganisms.

Methods: The effectiveness of the wipes was tested against nosocomial and control strains of methicillin-resistant Staphylococcus aureus, carbapenem-resistant Pseudomonas aeruginosa, Klebsiella pneumoniae carbapenemase, Aspergillus fumigatus and Candida parapsilosis. Specifically, in vitro activity was assessed using three different techniques: stainless steel surface testing, surface diffusion testing and well diffusion test.

Results: The three different methods tested confirm the wipes' good effectiveness against the most common multi-resistant bacteria and against fungi.

Conclusions: These data show that the tested wipes could be a valid adjunct to the disinfection process and could assist in the prevention of healthcare-associated infections.

Introduction: In Italy, at the beginning of the COVID19 pandemic, only emergency and life-saving elective surgical procedures were allowed with obvious limitations in terms of numbers of operable cases. The aim of our study is to evaluate the performance of surgical activities by Apulian healthcare facilities (Southern Italy) under the pandemic emergency pressure.

Methods: The surgical procedures in study were identified via the Apulian regional archive of hospital discharge forms. We used the ICD9 codes in order to define the elective and urgency surgeries in analysis, and we extended our search to all procedures performed from 2019 to 2021.

Results: The number of all procedures decreased from 2019 to 2020; the reduction was higher for elective surgery (-43.7%) than urgency surgery (-15.5%). In 2021, an increase compared to 2020 was recorded for all procedures; nevertheless, elective surgeries registered a further slightly decrease compared to 2019 (-12.4%), while a slightly increase was observed for urgency surgeries (+3.5%). No particular variation was observed considering sex and age at surgery of the patients, and days of hospitalization from 2019 to 2021.

Conclusions: The impact of COVID19 on Apulian regional health system has been extremely shocked and has required the implementation of strategies aimed at containing the infection and guaranteeing health services as far as possible. A new paradigm of hospital care for SARS-COV-2 patients in the post-emergency phase in Italy is needed, in order to optimize the resources available and to guarantee high standards of quality and efficiency for citizens.

Introduction: The COVID-19 pandemic had a profound impact on vaccines' Research and Development, on vaccines' market, and on immunization programmes and policies. The need to promptly respond to the health emergency boostered resources' al-location and innovation, while new technologies were made available. Regulatory procedures were revised and expedited, and global production and distribution capacities significantly increased. Aim of this review is to outline the trajectory of research in vaccinology and vaccines' pipeline, highlighting major challenges and opportunities, and projecting future perspectives in vaccine preventables diseases' prevention and control.

Study design: Narrative review.

Methods: We comprehensively consulted key biomedical databases including "Medline" and "Embase", preprint platforms, including"MedRxiv" and "BioRxiv", clinical trial registries, selected grey literature sources and scientific reports. Further data and insights were collected from experts in the field. We first reflect on the impact that the COVID-19 had on vaccines' Research and Development, regulatory frameworks, and market, we then present updated figures of vaccines pipeline, by different technologies, comparatively highlighting advantages and disadvantages. We conclude summarizing future perspectives in vaccines' development and immunizations strategies, outlining key challenges, knowledge gaps and opportunities for prevention strategies.

Results: COVID-19 vaccines' development has been largely supported by public funding. New technologies and expetited autho-rization and distribution processes allowed to control the pandemic, leading vaccines' market to grow exponentially. In the post-pandemic era investments in prevention are projected to decrease but advancements in technology offer great potential to future immunization strategies. As of 2023, the vaccine pipeline include almost 1,000 candidates, at different Research and Development phase, including innovative recombinant protein vaccines, nucleic acid vaccines and viral vector vaccines. Vaccines' technology platforms development varies by disease. Overall, vaccinology is progressing towards increasingly safe and effective products that are easily manufacturable and swiftly convertible.

Conclusions: Vaccine research is rapidly evolving, emerging technologies and new immunization models offer public health new tools and large potential to fight vaccines preventables diseases, with promising new platforms and broadened target populations. Real-life data analysis and operational research is needed to evaluate how such potential is exploited in public health practice to improve population health.

Background: This study explored the link between trust in conventional healthcare and consultations with complementary and alternative medicine (CAM) providers in South Tyrol, Italy's linguistically diverse region.

Methods: A representative cross-sectional survey of 1,388 South Tyrolean adults assessed trust in conventional healthcare, general practitioners, and complementary and alternative medicine consultation frequencies and their determinants using chi-square tests and Kendall-Tau-b correlations.

Results: Seventy percent trusted the traditional healthcare system, with general practitioners as the primary trusted professionals. Trust is correlated with higher education and linguistic compatibility. A 5% subgroup, mostly women and multilinguals with lower education levels, showed uncertain trust. Over 80% had seen a general practitioner in the last year, while distrust was correlated with complementary and alternative medicine consultations. German and Ladin speakers, with higher education levels, were notably inclined towards complementary and alternative medicine consultations.

Conclusions: Trust in South Tyrolean healthcare varied according to education level and language. While general practitioners remain central, there is a marked shift towards complementary and alternative medicine among specific groups.

Introduction: The COVID-19 pandemic represents the most severe health and socioeconomic crisis of our century. It began with the first reports in China, in the Wuhan region in December 2019, and quickly spread worldwide, causing a new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Among the population most at risk of infection and developing severe forms of the disease are the elderly and healthcare workers, who are more exposed to infected individuals. On December 11, 2020, the Food and Drug Administration approved the emergency use of the BNT162b2 vaccine, the first mRNA vaccine in history. Since then, the total number of vaccine doses administered has exceeded 12 billion. Italy was the first European country to be affected by the pandemic, recording the highest number of total COVID-19 cases (25,695,311) and, after the first 70 days, had the highest crude mortality rate (141.0 per 100,000). In this study, we analyze the rate of SARS-CoV-2 infection among healthcare workers at the San Raffaele Scientific Institute in Milan before and after receiving the BNT162b2 vaccine.

Study design: Retrospective observational cohort study.

Methods: The study analyzed the immunization status of 858 employees of the San Raffaele Scientific Institute in Milan, including doctors, healthcare workers, and administrative staff. The analysis is based on previous studies on the same cohort and is integrated with extrapolation and additional analysis of data from the Preventive Medicine Service's Biobank dataset of the same hospital to estimate the infection rate, duration of the disease, and antibody levels recorded in the personnel before and after receiving the double BNT162b2 vaccination.

Results: The analysis confirms the positive impact achieved by the introduction of mRNA vaccination in reducing the SARS-CoV-2 infection rate and increasing antibody levels in healthcare workers. Although the BNT162b2 vaccination may not provide complete protection against SARS-CoV-2, it appears to be able to reduce the number of infections, particularly the more severe and symptomatic forms often detected in individuals with various risk factors and comorbidities, making them more vulnerable. Healthcare workers, who have extensive contact with patients and record the greatest decrease in the infection rates, represent the population that receives the most benefit from vaccination.

Conclusions: The evidence suggests that vaccinations are essential in protecting high-risk groups, such as healthcare workers, from SARS-CoV-2 infection. Providing adequate vaccination coverage to healthcare workers limits the spread of infections and decreases the severity of disease manifestations, while also reducing their duration.

Abstract: Japanese encephalitis, caused by the JE virus transmitted by mosquitoes, is the most common type of epidemic encephalitis in Asia. It is endemic in most of South and Southeast Asia, but the number of cases can vary greatly between areas. While many infections do not lead to disease, the symptomatic cases can be very severe and life-threatening. It mainly affects children, whereas adults are generally immune to the disease due to either being infected in childhood or receiving vaccination. However, individuals who are not immune, such as travelers from non-endemic countries, are susceptible to the disease when exposed to the virus for the first time, regardless of age. Without antiviral treatment options, vaccination is the only strategy to establish effective protection against Japanese encephalitis.