Annali dell'Istituto Superiore di Sanità
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Redesigning diabetes care delivery in Serbia, using JA CHRODIS Recommendations and criteria
Get PDFIntroduction. Managing non-communicable diseases (NCDs) requires redesigning health care delivery to achieve better coordination of services at all levels of health care. The aim of this study was improving prevention and strengthening high quality of care for NCDs by using type 2 diabetes as a model disease.
Methods. The mix method approach served to analyse the impact of the intervention processes. Source of information were routine health statistics, interviews and observation. Key Performance Indicators in defined Improvement Areas assisted in the quality of diabetes care assessment.
Results and discussion. During the study the National Diabetes Centre (NDC) was established. The NDC experts organized numerous educational events, 316 physicians and nurses have participated. New electronic data base was implemented in 20 pilot Primary Health Care Centres (PHCCs) with 38,833 electronic diabetes records.
Conclusions. The intervention led to establishment of the NDC, strengthening competences of health care professionals and to the renewal of the Diabetes Care Units in PHCCs included in the study
Legionella pneumophila and SARS-COV-2 co-infection: the importance of laboratory diagnosis
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Challenges on the achievement of the World Health Organization goals for HCV elimination in Italy: Need for a Regional programmatic approach on screening and linkage to care
Get PDFItaly has been one of the countries with the greatest burden of HCV in Western Europe and with the highest number of HCV liver-related deaths. In order to achieve HCV elimination by 2030 Italy, like many other countries, will need to succeed in tackling the undiagnosed individuals with active HCV infection. To this aim beginning in 2021, a nationwide action has been implemented, consisting of the performance of screening tests among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The realization of the proactive screening during the first two years will define the tracks for the whole optimized screening strategy including also the 1948-1968 birth cohorts reported to be cost-effective in Italy in achieving the HCV elimination targets by 2030. Each Italian region needs to define the present and future steps to reach HCV elimination goal by 2030 guaranteeing the equity of care.
 
The first SARS-CoV-2 wave among pregnant women in Italy: results from a prospective population-based study
Get PDFIntroduction. This study aimed to estimate the incidence of SARS-CoV-2 infection among pregnant women during the first pandemic wave in Italy, and to describe COVID-19 disease characteristics and maternal and perinatal outcomes.Materials and methods. National population-based prospective cohort study collecting information on women with SARS-CoV-2 diagnosis, confirmed within 7 days from hospital admission.Results. The national SARS-CoV-2 rate was 6.04 per 1,000 births (95% CI 5.62-6.49) among pregnant women and 7.54 (95% CI 7.47-7.61) among women in reproductive age. 72.1% of the cohort developed mild COVID-19 disease without pneumonia nor need for ventilatory support. Severe disease was significantly associated with women’s previouscomorbidities (OR 2.55; 95% CI 0.98-6.90), obesity (OR 4.76; 95% CI 1.79-12.66) and citizenship from High Migration Pressure Countries (OR 3.43; 95% CI 1.27-9.25).
Conclusions. During the first pandemic wave in Italy, the SARS-CoV-2 rate among pregnant women was lower compared to that detected among women of reproductive age, and risks of severe COVID-19 disease and adverse maternal and perinatal outcomes were rare
Intangible benefits of clinical trials: a survey on a hospital research community
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The pandemic is showing the strategic role of clinical trials. They are an essential step for biomedical research and have potential life-saving impact on public health. Several studies focused on economic impact assessment models of clinical trials. Robust methods allow reliable assessment of trials impact on population health in terms of new drugs development. The present study shows the results of a survey submitted to the research community of the IRCCS Ospedale Pediatrico Bambino Gesù. Survey goal is an assessment of the partecipation to clinical trials in term of research capacity development, career improvement, health benefits, knowledge production. Results show that clinical trials promote a significant research capacity improvement in term of scientific know how development, new research network creation, diagnosys and clinical decision capability improvement, openess to new terapeuthic approches, recruitment and data management capabilities. The study points out that clinical trials enable better cures because they contribute to create better physicians, not only because they allow access to new drugs or disposals. Economic valorization, patient recruitment, internal reputation of researchers have beed highlighted as critical issues.
Health Belief Model efficacy in explaining and predicting intention or uptake pertussis vaccination during pregnancy
Get PDFIntroduction. Pertussis is a highly contagious respiratory disease and vaccination of pregnant women seems to be the most effective strategy to prevent pertussis in infants. The aim of this study is to assess the acceptance by women of pertussis vaccination during pregnancy based on Health Belief Model (HBM) constructs. Methods. A multicentre observational study was carried out with a convenience sample of 300 respondents. Results. Most women were worried to contract or to transmit pertussis during the first months of the infant’s life and perceived pertussis contracted in the first months of life as very serious. Parity appears to be a factor predicting this health behaviour, as nulliparous women tend to get more vaccinated or have a higher intention to get vaccinated (ORa 2.8 CI 95% 1.5-5.2 p<0.01). Discussion and conclusions. HBM is an effective tool for identifying facilitators and barriers to health behaviours. Strategies to promote vaccination during pregnancy are needed, including educational interventions and communication campaigns
The evaluation of capacity in dementia: ethical constraints and best practice. A systematic review: Evaluation of capacity in dementia
No full textThe progressive ageing of a population leads to an increase in the number of people sufferingfrom cognitive deterioration. This requires particular attention in terms of the necessityto assess these people’s cognitive functions and their capacity to make decisions.The present systematic review analyses the clinical and ethical aspects of any assessmentof capacity, with a specific focus on the capacity of the individual to give informedconsent for medical treatment and also with regard to their testamentary capacity. Theresults indicate that the concepts of capacity, competence and decision-making need tobe better clarified, ad-hoc devised tools are required and a multidisciplinary, clinical andlegal approach to assessments of capacity needs to be adopted. This is crucial to guaranteethat the two ethical principles of capacity assessment are adhered to: respect for anindividual’s autonomy and the protection of fragile individuals
Feasibility and effectiveness of the Australian perinatal mental health approach in the Italian health services: progress and challenges
Get PDFThe perinatal depression is one of the leading pathologies in the world causing disabilities and represents an important public health problem. Since 2003, the Center for Behavioral Sciences and Mental Health (Istituto Superiore di Sanità - ISS) has promoted studies and research on the mental health of women, children, partners and family in the perinatal period, leading to the realization of a structured program adopted in many Italian services. In this article, we describe the feasibility and effectiveness of the perinatal mental health approach in Italian health services and discuss the progress and new challenges
A structured program for perinatal depression and anxiety to be adopted in the emergencies
Get PDFQuarantine, loss of routine and social support can negatively impact mothers who have just given birth and their babies, generating concerns and reactions of intense fear. Following the COVID-19 emergency, we described a structured program for screening and treatment of perinatal depression and anxiety as a medium for constant monitoring of perinatal risk factors and early screening, which can also be implemented in emergencies with remote intervention methods, to offer women an appropriate, timely and effective treatment. In this scenario, it is desirable that the monitoring of the psychological wellbeing of women in postpartum is maintained over time, with the participation of all the professional figures with whom the woman comes into contact, to intercept any forms of psychological distress related to the epidemic and that could occur even after some time