Journal of preventive medicine and hygiene最新文献

The present article summarises the historical and palaeopathological evidence of tetanus, an ineradicable yet vaccine-preventable infectious disease caused by Clostridium tetani. The antiquity of the disease is described thanks to historical written sources, artistic references and very recent palaeogenetic data. A recollection of now long-supplanted therapies is offered together with a focus on the introduction of an effective vaccine. Moreover, a potential identification of tetanus in the Bible is analysed and general considerations on the current health relevance of tetanus are presented.

Introduction: This retrospective analysis aims to follow the course of SARS-CoV-2 infections in pediatric population residing in Liguria, North-west Italy, from March 2020 to December 2022 and to relate it to the regional and national containment measures adopted, to assess the representativeness of the infection rate observed at the national level and to analyze the vaccination rates in different pediatric groups.

Methods: First episodes of SARS-CoV-2 infections registered in the national surveillance system were extracted and further anonymously analyzed for subjects aging ≤ 19 years. The absolute number of cases diagnosed daily during each year was compared to the number of residents in the region and graphical representations were used to visualize the trends in infection rates both annually and weekly in each year. Through narrative analysis, the relationship between changes in IR and key social events was analyzed.Applying the direct standardization method, the epidemiology of SARS-CoV-2 infection in pediatric population was compared with that observed in the same age group in Italy.All analyses were performed using Stata and Microsoft Excel.

Results: In the study period, 106,537 (17.4%) cases of SARS-CoV-2 infection were registered in subjects ≤ 19 years, out of a total of 610,404 cases reported in Liguria during that period. In the summer of 2020 the IR was close to zero, while later we observed increases and decreases in the IR in relation to activities and social restrictions adopted. Direct standardization showed an almost perfect coincidence between the expected cases in Italy, based on the Liguria incidence, and the observed cases.

Conclusions: Our results show that, in absence of effective therapies and vaccines, strict non-medical interventions (e.g. use of masks, improving indoor ventilation, physical social distancing, general lockdown) can be the only actions to counter the spread of a respiratory infection.

Introduction: Dengue is a vector-borne viral disease that causes a million of cases every year (including deaths). A tetravalent live-attenuated virus vaccine is available for this infection. The aim of our work was to study vaccine acceptance, attitudes and behaviors among travelers heading to areas with risk of dengue.

Methods: We conducted a cross-sectional study in February-April 2024 at the Travel Medicine Clinic of Rozzano (Italy), focusing on travelers directed to areas with risk of dengue. We collected the following information anonymously: travel destination, reason for travel, date/month of departure, length of stay, and accepted/refused vaccinations.

Results: 58 travelers were included in our study and they chose 23 countries for their travel with a mean length of stay of 16.98 days. Five (8.62%) refused dengue vaccination because they considered the vaccination not necessary (80%), or for its cost (20%). There was no statistically significant difference between men and women in vaccination acceptance. Age and length of stay did not influence the percentage of refusals.

Conclusions: Although the results are limited by the small number of travelers, they highlighted the problem of vaccine hesitancy among travelers, and further efforts are needed to address this phenomenon.

Background: There is evidence supporting the efficacy of Sacubitril /Valsartan for improving left heart failure, but few studies have examined its effects on right ventricular (RV) dysfunction. The current study aimed to investigate the effects of Sacubitril /Valsartan on RV dysfunction in patients with right heart failure.

Methods: The current study was a randomized and parallel clinical trial study. Patients over 18 years with any degree of right heart failure regardless of Left ventricular ejection fraction (LVEF) were included. The included patients were assigned randomly to three study arms using simple random allocation, i.e. the intervention group (Sacubitril Valsartan recipients) and the control groups (Losartan and Captopril recipients). The SPSS software version 19 was used for data analysis.

Results: The changes in LVEF, RV FAC, RV diameter, DOE grade, and TAPSE in the Sacubitril/Valsartan group were significantly higher than the other two groups. The severity of RV dysfunction, as well as TR (Tricuspid Regurgitation) severity, decreased significantly three months after the intervention compared to the beginning of the intervention in all groups especially in the Sacubitril/Valsartan group (p: 0.006). The mortality rate in the Sacubitril/Valsartan, Losartan, and Captopril groups, were 2 (6.7%), 2 (11.2%), and 1 (7.7%) respectively (p: 0.83). Also, 27.6, 62.5, and 7.7% of cases in the Sacubitril/Valsartan, Losartan, and Captopril reached to optimum dose (p: 0.006).

Conclusions: Considering the results, it seems that Sacubitril/Valsartan has a positive effect on improving RV dysfunction in patients with right heart disorders.

The present article reviews the major historical plague epidemics that characterised human history by combining data derived from historical sources and biomedical evidence emerged in recent years thanks to advancements of palaeogenetics and palaeopathology. Notes are offered on the Plague of Athens, the Antonine Plague, the Plague of Cyprian, the Justinian Plague, the Black Death down to more recent centuries and presenting key aspects that continued to be preserved over time and would also partly characterise the recent COVID-19 pandemic.

Introduction: The beneficial role of physical activity on the cardiovascular system has been well established and appreciated. The aim of this narrative review was to present a summary of the latest recommendations for physical activity, and to evaluate the most recent scientific evidence regarding the role of aerobic and or resistance exercise in relation to atherosclerotic cardiovascular disease (ASCVD) risk.

Methods: Narrative review; searches were performed in PubMed, Scopus and Google Scholar. The guidelines of major Organizations (i.e., European Society of Cardiology, American College of Cardiology/ American Heart Association, American College of Sports Medicine, and World Heart Federation, World Heart Organization) were also retrieved and presented here.

Results: Engagement in regular aerobic exercise is strongly recommended for all people and by all scientific organizations for reducing ASCVD mortality and morbidity. Resistance exercise should be implemented in addition to aerobic, however, its individual effects on ASCVD risk are not well established.

Conclusions: A reduction of sedentary behavior at population level reduces the healthcare costs by multiple ways. Effective approaches should be implemented that include behavior theory-based interventions, e.g., goal-setting, re-evaluation of goals, self-monitoring, and feedback. Most important is to encourage activity that individuals enjoy and/or can be included in their daily life.

Health is a precious asset, essential for both individuals and communities. The wars that have affected various parts of the world in recent years have had a detrimental impact on health, leading to malnutrition and an increased vulnerability to epidemic diseases among the population, especially the poorest. Hospitals and healthcare facilities themselves have become primary strategic targets in many war zones. The destruction of infrastructure and hospitals, along with challenges in obtaining clean water and access to medicines, has contributed to the resurgence of epidemic diseases in countries where they had been eradicated. Additionally, the difficulty in ensuring vaccination programs for children raises the risk of these diseases spreading to areas typically free from them. The authors reflect on the consequences of wars on the health of populations and the close link between health and peace, presenting the latest data on ongoing epidemics in countries affected by war.

Introduction: We examined the association of blood eosinophil counts at the time of AECOPD hospitalization with the risk of ICU admission as well as the hospital lengths of stay and mortality.

Methods: In the current retrospective study, the association between blood eosinophil counts in COPD patients at the time of AECOPD hospitalization and the risk of subsequent ICU admission as well as mortality was assessed. The chi-squared test and t-test were used to compare categorical and continuous variables. The statistical significance level was set at 0.05. Kaplan-Meier curves for mortality as well as ICU admission up to 40 days after discharge from the index hospitalization were constructed using the determined optimal eosinophil threshold derived above and for the predetermined ≥ 300 vs < 300 cells/μL threshold. All analyses were performed using SPSS version 19.

Results: Antibiotic prescription was significantly associated with increased ICU admission (OR = 1.57; confidence interval [95% CI] = 1.02-2.42. Patients with higher FEV1 had decreased ICU admission (OR = 0.98, 95% CI = 0.97-1.01, p = 0.1) as well as all-cause mortality compared (OR = 0.98, 95% CI= 0.92-1.04, p = 0.58). There were significantly greater mortality rates for patients with higher ESR (OR = 1.02, CI =1.01-1.03, p = 0.01) and CRP (OR = 1.02, 95% CI = 1.01-1.03, p = 0.01). There were significantly lower ICU admission rates for patients with higher FVC (OR = 0.97, 95% CI = 0.95-0.98, p = 0.002).

Conclusions: Blood eosinophil count could help determine the risk of ICU admission as well as mortality in COPD patients at the time of hospitalization.

Background: Equity in health service delivery ensures that resources are distributed based on need, minimizing barriers to access and reducing health disparities. Hospital beds are a critical healthcare resource, essential for providing timely and effective medical care. This study aims to evaluate the equity in the distribution of hospital beds in Lorestan Province, western Iran, using the Gini coefficient and Lorenz curve as analytical tools.

Methods: Data on the number of hospital beds and population statistics for each city in Lorestan were collected from the Lorestan University of Medical Sciences and the Statistical Center of Iran. The equity of hospital bed distribution was assessed using the Gini coefficient and Lorenz curve, with analyses conducted using R statistical software.

Results: Lorestan Province, with a population of 1,678,873, has significant disparities in hospital bed distribution. The Gini coefficient for hospital beds was 0.27, indicating moderate inequality. The Lorenz curve showed a substantial deviation from the equity line, highlighting the imbalance. Khorramabad and Aligudarz exhibited the highest inequality, while Rumeshkan, Kuhdasht, and Poldokhtar had more equitable distributions.

Conclusions: The study reveals notable inequities in hospital bed distribution in Lorestan Province, emphasizing the need for targeted policy interventions. Strategic resource allocation, infrastructure development, and policy reforms are essential to enhance healthcare equity. Continuous monitoring and consideration of additional healthcare resources and socioeconomic factors are recommended for comprehensive future assessments.

Background: Family physicians play a crucial role in healthcare delivery systems worldwide. In Iran, the family physician program has been introduced in only two provinces, with its expansion to other regions currently stalled due to various challenges. This study aims to identify the barriers and challenges hindering the effective implementation of the family physician program in urban areas of Iran.

Methods: This qualitative study utilized purposeful sampling to select health system policymakers, senior administrators, and physicians as participants. Data were collected through semi-structured interviews with 32 participants until saturation was reached. The data were analyzed using grounded theory, involving open, axial, and selective coding to identify key themes and sub-themes.

Results: The primary challenge in implementing the urban family physician program was conflicting interests among stakeholders, identified as the core category. Key contributing factors included payment mechanism complexities, stewardship, structural issues, financial constraints, and cultural elements. Specialist physicians, in particular, resisted the program's implementation, often employing reverse referral as a coping strategy. These challenges collectively hindered the nationwide rollout of the program.

Conclusions: Addressing the barriers to implementing urban family physician policies requires a comprehensive reassessment of stakeholder roles and a restructuring of the payment system. Additionally, proactive efforts to resolve the complex contextual challenges within the healthcare system are essential for the successful implementation of these policies.