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

Introduction: The COVID-19 pandemic presented unprecedented challenges to European healthcare systems. The study aimed to review the available evidence on the impact of the pandemic on the timely diagnosis of cancer across European countries. The primary objective was to examine changes in diagnostic pathways and stage at diagnosis during the pandemic, compared to the pre-pandemic period, across European countries, taking healthcare system characteristics and COVID-19 policies into account.

Methods: We conducted a review of the impact of the pandemic on cancer diagnosis in Europe, analyzing primary studies from 2018 to 2023 using both quantitative and qualitative methods through searches in PubMed and Scopus databases. Study quality was assessed using the Mixed Methods Appraisal Tool. The main explanatory factors analyzed were grouped into two categories: Covid-policies (government responses, using the Oxford COVID-19 Government Response Tracker and its stringency index as key metrics) and healthcare characteristics (healthcare system models, expenditure and resources, including hospital beds and the ratio of medical doctors).

Study design: Scoping review.

Results: Overall, 127 papers were screened, 80 retrieved for full-text evaluation and 50 articles were included in the review. The studies encompassed a total of 509,753 patients from 17 European countries. The pandemic period was characterised by worse process and outcome measures for all examined cancers, except for lung cancer, compared to the pre-pandemic period. Group-ing countries based on government actions and policy responses (stringency index) did not show any differences in timely cancer diagnosis. Countries with lower healthcare expenditure (per capita expenditure <2,000 euros) or lower investments in prevention reported more cancer diagnostic delays during the pandemic. Countries with >20% of General Practitioners over the total number of physicians and with more hospital beds per population experienced fewer diagnostic delays during the pandemic.

Conclusions: Overall, the review suggests that diagnostic pathways and cancer stage at diagnosis during the COVID-19 pandemic varied across Europe, with countries' healthcare expenditure, investments in prevention, the proportion of General Practitioners and the number of hospital beds per population possibly playing a role. This analysis can inform healthcare policies aimed at addressing post-pandemic challenges and formulating resilience plans for future emergencies.

Introduction: In Lombardy, the first European region hit by the COVID-19 pandemic, for decades the regional public healthcare service has followed a mixed delivery model with extensive involvement of private accredited providers. The study aimed at examining the role of the private sector in delivering healthcare services (diagnosis, hospitalization, and vaccination) during the pandemic.

Study design: Healthcare system study.

Methods: We analysed regional healthcare data referring to the period from March 2020 onwards to assess the availability of acute care and intensive care hospital beds, SARS-CoV-2 tests, and COVID-19 vaccinations. We specifically examined healthcare offered by private accredited providers within the region.

Results: Of the 12,306 converted beds for COVID-19 treatment, 4,975 (40%) were in accredited private hospitals. Intensive care beds increased by 95%, reaching 1,755, with 484 (28%) in accredited private hospitals. Since the pandemic onset, 28.9 million (62%) of SARS-CoV-2 tests were conducted by private accredited facilities including pharmacies. Private sector actively contributed to the COVID-19 vaccination campaign administering over 2.6 million doses in 2021, enhancing vaccination capacity to its peak.

Conclusions: The longstanding relationship between the public and private sectors within the Lombardy regional healthcare service facilitated a rapid increase in hospital bed capacity, the upscaling of SARS-CoV-2 testing capacity, and the achievement of vaccination goals to address the COVID-19 emergency. Therefore, alongside a robust and adequately funded public healthcare service, the private sector serves as an asset to enhance the resilience of healthcare systems, in line with WHO indications.

Background: Childhood overweight and obesity represent serious public health concerns in several countries worldwide, including Italy, where the highest prevalence in Europe of overweight and obesity among primary school children was recorded. Among others, primary schools represent suitable social environments for health education projects. In this perspective, to optimize resources and plan successful activities, it is necessary, first of all, to analyze the context of the intervention.

Study design: A pilot survey involving children and teachers was conducted in a primary school in Jesi (Le Marche Region, Italy).

Methods: A questionnaire was submitted by teachers between May and June 2023 to 104 pupils (aged 6-11) from the five different primary school system classes. A qualitative questionnaire was also filled out by the same teachers (n = 5) who were present while the children were filling the eating/lifestyle questionnaire.

Results: Most of the children (96.1%) had breakfast before school, with milk and cereal (51.5%) representing the preferred com-bination. During recess, 59.2% of pupils usually have a sandwich, 23.3% usually have sweet snacks, whereas only 2.9% have a fruit. Over 55% of the sample preferred drinking high-sugar beverages to water, and 15.5% declared going to a fast-food restaurant more than once a week. Over 17% of children did sport only once a week or less often. Over 64% of children habitually played videogames, and 77.6% normally watched TV or played with a tablet/smartphone while eating. Finally, the teachers' interview highlighted that there were no active health-related projects addressed to the pupils, and the school did not normally organize me-etings with health professionals to increase children's and their parents' knowledge and awareness about healthy eating habits.

Conclusions: This preliminary investigation analyzed the context for a future health and nutrition education project and will assist researchers in planning successful activities and increasing the efficiency of the intervention.

Background: Healthcare-Associated-Infections are a critical concern in healthcare settings, posing serious threats to patient safety and causing significant morbidity, mortality, and financial strain. This study aims to calculate healthcare-associated-infections trends in the hospital setting through an automatic reporting system.

Study design: The study is a descriptive analysis of automatically generated trends of an innovative digital tool based on existing hospital information flows.

Methods: An algorithm was developed within a Clinical Information System to create a suite of quality indicators for monitoring healthcare-associated-infections trends. The algorithm used criteria related to admission, laboratory tests and antimicrobial administrations. A descriptive analysis was conducted for patients aged 18 or older, admitted to a neurological or to a neuro-rehabilitation department of a neurologic hospital from 2019 to 2022.

Results: The results showed fluctuations in healthcare-associated-infections prevalence from 2.9% to 5.6% and hospital infec-tions prevalence from 4.5% to 10.9%, with notable increases in 2020 and 2021. The majority (70.3%) of healthcare associated infections identified by the tool were confirmed to be potentially hospital-acquired, according to the European Centre of Disease Prevention and Control's definition.

Discussion and conclusions: The study posits the algorithm as a vital tool for automatically monitoring hospital infections, providing valuable preliminary results for improving care quality and guiding the infections' prevention and control strategies, with plans to benchmark the algorithm against a gold standard in the future.

Background: The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic experience. Although the new emerged needs of user-centeredness, comfort and wellbeing within specific functional areas, there is still a lack of measurable indications for addressing these challenges in-patient wards.

Study design: The objective of this study is therefore to provide specific guidelines for the design of the in-patient ward, through measurable criteria and indicators based on evidence from the scientific literature, and to develop an assessment tool for its evaluation.

Methods: A five-step process has been followed: (i) performing a literature review about hospital wards and wellbeing strategies, (ii) conducting a best practice analysis and comparison of a selection of international contemporary healthcare facilities, (iii) defining some dimensional requirements from the comparison, (iv) developing an assessment tool based on extracted criteria, (v) testing the tool on an existing project.

Results: Amongst the criteria, several aspects have been highlighted ranging from qualitative indicators, as the clarity of wayfinding or the level of privacy, to quantitative values, as the percentage of single inpatient rooms or the distance between rooms and nursing stations. The assessment tool is composed by 20 indicators, associated to thematic areas and referred to three environmental units of the inpatient ward. Two types of scoring system are proposed.

Conclusions: Starting from those considerations and tool wider applications, the future design of hospital wards could follow guidelines addressing user-centeredness, comfort and wellbeing.

Background: Universities are critical in educating tomorrow's citizens and achieving the Sustainable Development Goals of the United Nations Organization. The aim of this study was to investigate the integration of these goals in the curricula of an Italian university.

Study design: Cross-sectional study.

Methods: In February 2021, as part of the annual Syllabus preparation for each course, the teaching staffs at the University of Udine (Italy) were asked to complete an additional section in which they could indicate up to three Sustainable Development Goals for their courses. Descriptive statistics, Chi-square test and logistic regression were performed to determine whether the professors' sex, age, or department affected the likelihood of mentioning Sustainable Development Goals.

Results: In 723 courses, 360/1040 professors 59% male, mean age 53 years (range 30-73), mentioned one (29%), two (23%), or three (31%) Sustainable Development Goals. No Sustainable Development Goals were mentioned in 16% of courses, the majority of which were from the Mathematical, Computer and Physical Sciences Department (58%). The top six Sustainable Development Goals quoted were: Good health and well-being (35%), Responsible consumption and production (22%), Quality education (17%), Industry, innovation and infrastructure (13%), Gender equality (13%), Decent work and economic growth (13%). The least frequently mentioned Goal was Life below water (1%). Women (p<0.0001) and senior professors (p=0.0148) were more likely to consider at least one of the Sustainable Development Goals, while Mathematical, Computer and Physical Sciences Department showed a negative correlation (p<0.0001).

Conclusions: Gaps were identified with respect to specific Sustainable Development Goals, but discrepancies between departments may indicate deficits in respondent awareness. A transparent description of the Sustainable Development Goals in courses is recommended, to increase students' and university's engagement in sustainability.

Background: Missed appointments is a significant challenge to efficient running of physiotherapy departments and it has cost implications. In this study, wait time, and pattern, predictors and impact of Missed appointments (MAs) on cost, efficiency and recovery time was assessed among Nigerian patients receiving physiotherapy.

Method: In this retrospective study a total of 3,243 physiotherapy appointments were booked between 2009 and 2019 at an Outpatient Physiotherapy Clinic in Nigeria. Data were collected on Missed appointments, on costs of of treatment and on socio-demographic characteristics. The total revenue loss due to missed appointments was calculated as a product of the total of Missed appointments and cost per treatment; recovery time was also estimated.

Results: Missed appointments were 1,701 out of 3,243 booked (52.5%) and the average wait time for the first appointment was 9.6 ± 23.2 days. The proportion of Missed appointments was higher among females (50.2%), patients who were not resident of the same location as the clinic (45.3%), patients with orthopaedic conditions (56.2%) and patients referred from an orthopaedic surgeon (32.8%). Females, those who live within the city, and those with neurological/medical conditions were 1.68, 1.24, and 1.52 times more likely to have Missed appointments compared to males (OR = 1.68, Confidence intervals = 1.44 - 1.96, p = < 0.001), those who live outside the city (OR = 1.24, CI = 1.05 - 1.46, p = 0.01), and to those who have orthopaedic conditions (OR = 1.52, CI = 1.20 - 1.93, p = < 0.001), respectively. Using per treatment schedule cost of N1000 (an equivalent of $ 2.31), a 52.5% Missed appointments rate resulted in lower efficiency of 76.6% with an efficiency ratio of 0.23. Further, a 52.5% Missed appointments rate could potentially impact patient recovery time by 3402 days if Missed appointments slow a patient recovery process by 2 days.

Conclusions: Missed appointments for physiotherapy treatment pose a significant challenge in terms of costs, efficiency, and patient recovery time. Thus, an innovative reminder system may help reduce patients' non-attendance to physiotherapy and its consequences.

Background: Acute Respiratory Infections are caused by pathogens that spread rapidly. Acute Respiratory Infections include upper respiratory tract infections and lower respiratory tract infections. According to the World Health Organization (2019), Acute Respiratory Infections rank fourth among diseases that affect children with high morbidity. Indonesia's under-five mortality rate due to Acute Respiratory Infections rank first among the Association of Southeast Asian Nations. Under-five mortality due to Acute Respiratory Infections in Indonesia accounts for 22.30% of the total under-five mortality cases.

Study design and methods: This cross-sectional study was conducted with a total of 100 mother and child pairs selected by simple random sampling. Internal and external factors, including nutritional status, maternal age, maternal education level, presence of a smoker in the house, house ownership, household size, temperature, humidity, lighting, ceilings, floors, walls, and ventilation were investigated as the risk factors of Acute Respiratory Infections among under-five children in this study.

Results: Our cross-sectional study found that 68 out of 100 under-five children in this study were infected with Acute Respiratory Infections during the study period. Among the risk factors, our multivariate analysis suggests that presence of smokers, maternal age, and inadequate ceiling conditions were the potential determinants of Acute Respiratory Infections among under-five children in Depok City.

Conclusions: Despite the limitations of this study, we believe our results could give a comprehensive overview of the risk factors of Acute Respiratory Infections in under-five children.

Introduction: In the last few years, shortcomings in caring for patient needs have promoted a growing interest in the Fundamentals of Care (FoC) to promote the quality of nursing care. However, which strategies nurse managers should implement to facilitate a FoC-based nursing care approach have not been mapped to date; therefore, the intent of this study was to map those strategies related to the nurse manager role that have been documented as being capable of promoting (or hindering), a FoC-based approach among nurses.

Methods: A scoping review following the Preferred Reporting Items for Systematic Review and Meta-Analysis - Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed, CINAHL, Cochrane Library, Scopus and Web of Science databases and the conference proceedings of the International Learning Collaborative 2022 Annual International Conference were consulted. Studies exploring the relationship between FoC and nurse managers using any methodology, published from 2008 (year of birth of the FoC movement) to September 2022, in Italian or English, were eligible for inclusion. Findings were categorized narratively, according to their similarities and differences.

Results: Four qualitative studies, four discussion papers, two reviews and one mixed-method study, published from 2017 to 2021, predominantly in Australia, were included. Several strategies have emerged as promoting a FoC-based care approach by nurse managers. At the macro level, there is a need to disseminate a culture of attention towards patients that should be incorporated in the strategy of the entire system; moreover, synergies and effective leadership styles should be promoted by also providing education both in the undergraduate and continuing education settings. At the micro levels, among others, the required resources should be available, and the quality of the environment promoted.

Conclusion: Nurse managers may facilitate a FoC-based approach among nurses through a set of strategies that should be included and considered in their educational pathways.

Background: Despite the end of the health emergency, healthcare professionals are at risk of developing long-term mental health problems. The aim of this study was to observe Burnout symptoms and work motivation among Intensive Care Nurses, one year after admission to the Intensive Care Unit of the last positive SARS-CoV-2 swab patients.

Study design: A multicenter cross-sectional study design was carried out and a national web-based survey was conducted between April, 2023 and May, 2023 among 21 Italian Intensive Care Units.

Methods: The survey consisted of single- and multiple-choice questions structured into 3 sections: demographic sample data, Maslach Burnout Inventory Scale for the assessment of Burnout-symptoms and Multidimensional Work Motivation Scale for the assessment of work motivation.

Results: Four hundred-nine surveyed and questionnaires were included in the study. Of these 272 were male (66.5%). Burnout-related symptoms were identified in at least 79% of ICU nurses. Symptoms of severe Burnout was observed in 169 nurses analysed (41.3%) and they are significantly among nurses who had COVID-19 or positive SARS-COV-2 swab during the pandemic (RR= 1.55; CI= 1.24-1.95, p= .0004) and among nurses with at least one child (RR= 1.37; CI= 1.07-1.76; p= .011). Motivated nurses for the intrinsic motivation's level have been 281 (68.7%). The risk of being intrinsically demotivated is significantly greater among nurses with 5-10 years of work experience (RR= 2.44; CI= 1.48-4.02; p= .0002). Emotional exhaustion was associated in increase in demotivation and introjected estrinsic motivation. Depersonalization was associated with demotivation. Personal accomplishment was associated with increase in external estrinsic motivation and amotivation.

Conclusions: High level of Burnout has been observed among Italian ICU nurses associated with low work motivation after COVID-19 emergency. Interventions and strategies should be adopted to prevent burnout and improve work motivation.