Annali dell'Istituto Superiore di Sanità
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The Italian National Vaccine Prevention Plans, 1999/2020-2023/2025: challenges and obstacles to vaccine coverage goals
Get PDFFive consecutive national vaccination plans (from 1999 to 2025) were revised, outlining their objectives, challenges, and results. Vaccination coverage for children consistently approached target levels, though regional differences emerged. In contrast, coverage for adolescents, the elderly, and vulnerable groups, consistently fell short of targets. While vaccination policies in Italy over the past 25 years were ambitious and well-planned, success was primarily limited to newborns immunization, thanks to effective organizational activities. Failure to achieve goals for other population groups was partly due to inconsistent implementation of Regional Vaccination Prevention Plans
Post-Acute Sequelae of COVID-19 – Checklist (PASC-C): a screening tool for long-COVID physical, psychological, and cognitive symptoms
Get PDFBackground. The management of Long COVID symptoms is necessary. This study proposes a screening tool for psycho-physical COVID-19 sequelae. Patients’ experiences after COVID-19 are also described.Method. 84 COVID-19 patients (66.2±11.0 years old; 71.4% male) underwent a phone interview 1-2 years after the disease using the ad-hoc “Post-cute Sequelae of COVID-19 Checklist (PASC-C)”. It explores 30 physical, psychological, and cognitive symptoms clustered into 10 areas, with possible clinical recommendations in case of high severity scores (>50) of a symptom or the presence of two or more ones within the same area.Results. Overall, fatigue (69%), dyspnea (52.4%), memory disturbances (44%), jointmuscle pain (41.7%), vision/hearing loss (40.5%), anxiety (40.5%) persist one-two years after COVID-19 disease. Being a survivor was primarily defined in terms of being “lucky”.Conclusions. PASC-C seems promising in monitoring psycho-physical sequelae of Long COVID and providing tailored suggestions to care for the patient over time
From COVID-19 to a “new normal”: could we support a “healthy renaissance” for our cities?
Get PDFBackground. At the beginning of 2020, worldwide public debate focused on the fight against the climate crisis. Many challenges are ahead of us, from health emergencies, with the pandemics underway, to the exhaustion of natural resources, to major climate change.Discussion. Many cities face health threats related to urban and land use planning, while infectious diseases thrive in overcrowded cities: living in unhealthy environments killed 12,6 million people in 2012 and air pollution killed 7 million people in 2016. Urbanization is one of the major global trends of the 21st century and has a significantimpact on health. Over 55% of the world’s population lives in urban areas, a percentage that is expected to increase to 68% by 2050.Conclusions. Developing new and more sustainable ways of living, moving, utilizing resources, and accessing services including healthcare and education, is crucial to preserve our future and the future of the next generations
A Screening for antenatal maternal depression: comparative performance of the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9
No full textBackground. Maternal antenatal depression affects 21-28% of expectants globally and negatively impacts both maternal and child health in the short and long term.Objective. To compare the psychometric properties and clinical utility of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in pregnant individuals.Methods. In this cross-sectional study, 953 third-trimester pregnant Italian individuals completed both the EPDS and the PHQ-9.Results. Both scales demonstrated good internal consistency (EPDS ω=0.83, PHQ-9 ω=0.80) and a moderate correlation between their scores (r=0.59). Concordance at recommended cut-off points (≥14 for both) was moderate (k=0.55). Factor analyses indicated a bifactor solution for the EPDS (dimensions: “depression” and “anxiety”) and for the PHQ-9 (dimensions: “depression”, “pregnancy symptoms”, “somatic”). Benchmarks for clinical change were also established.Conclusions. The EPDS and PHQ-9 capture distinct aspects of perinatal depressive symptomatology. Clinically, these findings recommend using both scales in obstetric and gynaecologic settings to minimize false positives and negatives
Characteristics of out-of-hospital births and perinatal outcomes: data from the Lazio Region cross-sectional study from 2019 to 2021
Get PDFIntroduction. In Italy, the primary place of birth is typically a hospital, with only a small number of women opting for an out-of-hospital setting. This study details the characteristics of midwifery care and perinatal and maternal outcomes of women who gave birth in an out-of-hospital setting in the Lazio Region, Italy, from 2019 to 2021.Methods. A cross-sectional study was carried out. The study population included 542 healthy low-risk women who completed the process of planning an out-of-hospital birth, and excluding transfers, this resulted in a total sample of 478 women who gave birth outof- hospital. Descriptive and inferential analyses and also a logistic regression model were performed.Results. The main outcomes of the out-of-hospital deliveries were: intact perineum in 38.9% of cases, two cases of 3rd degree laceration (0.4%) and in one case (0.2%) episiotomy. Intrapartum emergencies occurred in 85 out of 478 women (17.8%) but only 10 women required a transfer to hospital after delivery. The one minute Apgar score was equal to or greater than 7 in 99.2% of cases. Exclusive breastfeeding of 96% one week after birth and 94.6% one month. Furthermore, having a previous vaginal hospital birth (adjOR 9.7; CI 95% 4.33-21.68 P<0.001) and a previous out-of-hospital birth (adjOR 24.2; CI 95%3.23-181.48 P=0.002) was associated with the continuation of out-of-hospital birth.Conclusions. For low-risk pregnant women who have planned an out-of-hospital birth, it has been shown to be a safe, adequate, appropriate, and effective alternative
Regulation of gene transcription in Escherichia coli O157:H7 in response to a natural derivate peptide of Esculentin-1a used in combination with essential oils from plants of the Cymbopogon genus.
Get PDFIntroduction. We analyzed the expression of several genes implicated in the pathogenicity of Escherichia coli O157:H7, treating bacteria with Esc(1-21), a derivative of peptide esculentin-1 in combination with three essential oils obtained from plants from the Cympopogon genus.Methods. We used the checkerboard assay to determine the antimicrobial activity of the combinations. We analyzed the expression of some genes implicated in the pathogenicity and quorum sensing system of E. coli O157:H7 by real-time RT-PCR technique.Results. Treatment of the bacteria with the peptide combined with oils had an efficacious antimicrobial activity. The analysis of gene expression showed that all used combinations regulate positively the espAD and ler genes, located in the pathogenicity island, named the locus of enterocyte effacement. None of the combinations affects the quorum sensing genes: lsrABCFKR and qseBC.Conclusions. This study demonstrates that the use of essential oil/peptide combinations can be effective in fighting microbial infections
Changes in the use of nicotine-containing products during and after the COVID-19 pandemic in a representative sample of the Italian adult population
Get PDFIntroduction. To assess nicotine-containing products (NCPs; heated tobacco products and/or electronic cigarettes) use in relation to conventional smoking.Methods. “LOST IN ITALY” (“LOckdown and Lifestyles IN ITALY”) and “LOST IN TOSCANA” cross-sectional surveys estimated lifestyles changes before, during, and after the lockdown in a representative sample of the Italian population. A Poisson regression model was used to estimate prevalence ratios of NCP use according to sociodemographic, mental distress, and smoking variables.Results. The prevalence of conventional cigarette smokers did not decrease, remaining stable at 23%. Exclusive conventional cigarette smokers decreased from 21% before the lockdown in 2020 to 15% in 2023 but dual users, representing the large majority of NCP users, increased by 4 times, and exclusive NCP users decreased from 7% in 2020 to 5% in 2023.Conclusions. NCPs are mostly accompanying instead of replacing conventional cigarettes. A targeted campaign should be developed in Italy to raise awareness on that
Compassionate drug uses in Italy. Analysis at single-center level
Get PDFAims. Using a database from two pharmaceutical companies that managed several compassionate use programs in the last few years in Italy, we have previously analyzed the data by the number of patients and centers in each region and province, showing that the use of compassionate drugs is largely diffused in the country, in a manner directly related to the size of population of each region. In the present study we used the same database to expand the analysis to single-center level, aiming to test the hypothesis whether, despite a good diffusion of compassionate drug uses in each region, the majority of them concentrates within a relatively low number of centers.Methods. Data from different programs were grouped per center, and the centers were ordered per the number of compassionate uses dispensed, and per region. Two cutoff levels, at 75% and 90%, were drawn to look at the number of centers accounting for such percentages of compassionate uses in each region.Results. Out of 343 centers throughout Italy, 93 and 156 centers (i.e., 27.11% and 45.48% of the total) account for about 75% and 90% of all compassionate drugs dispensed in Italy. In 6 regions out of 20 (Valle d’Aosta, Liguria, Umbria, Lazio, Molise and Campania) the centers accounting for 75% of all compassionate drugs dispensed are located in a single town. Forty and 20 out of the 93 centers dispensing 75% of all compassionate drugs are academic hospitals and research hospitals (Istituti di Ricovero e Cura a Carattere Scientifico, IRCCS), respectively.Conclusions. In this study we have demonstrated that, in spite of widespread diffusion of compassionate drug uses in all Italian regions, their management is restricted to a relatively low number of dispensing centers in each region