1,720,991 research outputs found
How public health professionals view mandatory vaccination in italy-a cross-sectional survey
Full text linkIn response to the decline in child vaccination coverage and the subsequent occurrence of large vaccine-preventable disease outbreaks, in 2017 Italy introduced a new law that made ten vaccines mandatory for children aged 0–16 years. The policy change initiated an ongoing debate among the general public, as well as in the political arena and the scientific community, over this major public health concern. Hence, we conducted a survey aimed at assessing Italian public health professionals’ attitudes towards and opinions on mandatory vaccination. A validated online questionnaire was administered to 1350 members of the Italian Society of Hygiene, Preventive Medicine and Public Health. Among the 1044 responders (response rate 77%), a large majority were in favour of the Italian mandatory vaccination law (91%) and against its repeal (74%). Nevertheless, according to our sample, maintaining a high level of vaccination coverage without the need to mandate would be preferable, and thus efforts to promote vaccine confidence and proactive vaccine uptake are still needed
Cost-effectiveness of RAS testing in colorectal cancer. A systematic review of economic evaluations
No full textBackground:
Epidermal growth factor receptor (EGFR) inhibitors have shown benefit in the treatment of metastatic colorectal cancer (mCRC), particularly when combined with predictive biomarkers of response. The most important is RAS mutational status: international guidelines recommend to reserve anti-EGFR treatment only to RAS wild-type tumors, as they are likely to benefit from it. We aimed to review the cost-effectiveness of RAS testing in selecting mCRC patients for anti-EGFR treatment.
Methods:
We performed a systematic review of full economic evaluations comparing testing for RAS mutational status in mCRC patients prior to anti-EGFR treatment with no-testing. We searched Medline, the Health Technology Assessment Database, the National Health Service Economic Evaluation Database, Scopus, and ISI Web of Science for English papers published since 2000. The quality of the included studies was assessed using the Quality of Health Economic Studies scale.
Results:
We included 7 economic evaluations (2 cost-effectiveness analyses; 3 cost-utility analyses; 2 cost-effectiveness and cost utility analyses) conducted between 2000 and 2017 in various Countries (Switzerland; Germany; USA; Canada; Japan; China). All studies showed good quality and adopted the perspective of the healthcare system/payer, thus only direct medical costs were analyzed. All studies except one presented at least one strategy with a favorable ICER for RAS testing prior to anti-EGFR therapy.
Conclusions:
Even if testing for RAS mutational status prior to anti-EGFR therapy increases costs, still it is a cost-effective strategy compared to anti-EGFR therapy without testing. Nevertheless, existing economic evaluations showed some limitations that should be addressed with future research, such as the impact of anti-EGFR toxicity and the introduction of comprehensive molecular profiling. The treatment of mCRC is shifting to a more personalized approach which is essential for avoiding unnecessary toxicity and costs
Determinants of the intention to vaccinate with MMR among pregnant women from the City of Rome
No full textBackground
Further to the increase in measles cases reported in Italy since 2016, MMR vaccination became mandatory in 2017, leading to an increase in vaccination coverage in the Country. To guarantee sustained coverage, factors influencing the intention to vaccinate in the population should be better understood.
Methods
We conducted a cross-sectional survey to assess knowledge and attitudes on pediatric vaccinations and intention to vaccinate among pregnant women attending Antenatal Classes in Rome, through distribution of a self-administered questionnaire, which included a specific section on MMR vaccination. Multiple logistic regression analysis was performed to analyze the determinants of the intention to vaccinate with MMR.
Results
A total of 458 pregnant women attending CANs in 36 family health centers and two hospitals answered the survey. Intention to vaccinate with MMR was associated with having received information from a healthcare professional (OR 1.92, 95%CI 1.01-3.63), the perceived importance of vaccines to protect against measles (OR 4.68, 95%CI 2.48- 9.54) and rubella (OR 5.97, 95%CI 2.98-11.95), not believing in news about the risks of MMR vaccine (OR 2.75, 95%CI 1.38-5.50), and the sense of guilt in case the child should contract the disease (OR 2.56, 95%CI 1.16-5.62). Factors negatively associated with the intention to vaccinate were the use of alternative medicine (OR 0.34, 95%CI 0.16- 0.76), believing that MMR vaccine can have serious side effects (OR 0.37, 95%CI 0.00-0.29) and guilt in case of serious side effects (OR 0.40, 95%CI 0.21-0.76).
Conclusions
Fear of MMR side effects is a relevant driver of the intention to vaccinate, coupled with the perceived importance to vaccinate to protect against measles and rubella. Also the source of information plays an important role in shaping ideas on vaccines. Information and communication strategies should be promoted to increase trust in vaccines, with a direct involvement of healthcare workers.
Key messages
Fear of MMR side effects and perceived benefits of the vaccine influence the intention to vaccinate.
Information and communication strategies to increase vaccination appectance involving healthcare workers are needed
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Public health genomics research in Italy. An overview of ongoing projects
Full text linkPublic health genomics (PHG) aims to integrate advances in genomic sciences into healthcare for the benefit of the general population. As in many countries, there are various research initiatives in this field in Italy, but a clear picture of the national research portfolio has never been sketched. Thus, we aimed to provide an overview of current PHG research projects at the national or international level by consultation with Italian institutional and academic experts. We included 68 PHG projects: the majority were international projects in which Italian researchers participated (n = 43), mainly funded by the European Commission, while the remainder were national initiatives (N = 25), mainly funded by central government. Funding varied considerably, from euro 50,000 to euro 80,803,177. Three main research themes were identified: governance (N = 20); precision medicine (PM; N = 46); and precision public health (N = 2). We found that research activities are preferentially aimed at the clinical application of PM, while other efforts deal with the governance of the complex translation of genomic innovation into clinical and public health practice. To align such activities with national and international priorities, the development of an updated research agenda for PHG is needed
An italian survey on the attitudes and beliefs of public health professionals towards mandatory vaccination: A pilot study
No full textBackground: This pilot study aimed to test a questionnaire developed to assess the attitudes and beliefs of Italian public health professionals towards mandatory vaccination for school-aged children. Methods: The online questionnaire was administered to members of the Italian Society of Hygiene, Preventive Medicine and Public Health. Internal consistency was measured using Cronbach’s alpha. Results: Fifty-two people answered the questionnaire: 90.4% were in favour of mandatory vaccination. Overall, the alpha score was above the cut-off value of 0.70. Conclusion: The questionnaire has proved a valid tool for assessing the attitudes and beliefs of Italian public health professionals towards mandatory vaccination
From bench to bedside. A health technology assessment of BRCA genetic testing programs
Full text linkBackground:
The evidence generated on the incremental benefit of the appropriate use of BRCA genetic testing for preventing breast and ovarian cancers suggested that delivery programs for this testing must be systematically implemented in all developed countries. However, it is still unclear which are the programs that could be a best fit for the European health care systems.
Methods:
To answer this issue, we performed a comprehensive evaluation of all BRCA testing programs potentially ready for implementation using a Health Technology Assessment approach.
Results:
Published information on the analytic validity of BRCA testing estimated analytic sensitivity, specificity and accuracy at 99%. Clinical validity results, stratified by prevalence and penetrance, showed high and consistent positive and negative predictive values. In clinical utility, the most effective procedure was the prophylactic surgery. Bilateral mastectomy and salpingo-oophorectomy could reduce breast, ovarian cancers and mortality up to 100%. Evidence of personal utility were also provided. The main BRCA programs identified and evaluated were: (i) population-based genetic screening of individuals without cancer; (ii) family history (FH)-based genetic screening, on women without cancer but with a suggestive FH; (iii) familial mutation-based genetic screening, on women without cancer but with carriers in the family; and (iv) cancer-based genetic screening, on women with BRCA-related cancers.
Conclusions:
Population-based screening is a good investment among specific ethnicities only. FH-based screening is potentially the best fit for most European countries, however further studies on the identification of unaffected high-risk women are needed. More evidence should be provided for the screening of all newly diagnosed cases of breast/ovarian cancers, followed by cascade testing, but programs that include tools for identifying affected women at higher risk for inherited forms are promising
Current genetic service delivery models for the provision of genetic testing in Europe. A systematic review of the literature
Full text linkBackground: The provision of genetic services, along with research in the fields of genomics and genetics, has evolved in recent years to meet the increasing demand of consumers interested in prediction of genetic diseases and various inherited traits. The aim of this study is to evaluate genetic services in order to identify and classify delivery models for the provision of genetic testing in European and in extra-European countries. Methods: A systematic review of the literature was conducted using five electronic resources. Inclusion criteria were that studies be published in English or Italian during the period 2000-2015 and carried out in European or extra-European countries (Canada, USA, Australia, or New Zealand). Results: 148 genetic programs were identified in 117 articles and were delivered mostly in the UK (59, 40%), USA (35, 24%) or Australia (16, 11%). The programs were available nationally (66; 45%), regionally (49; 33%) or in urban areas (21, 14%). Ninety-six (64%) of the programs were integrated into healthcare systems, 48 (32.21%) were pilot programs and five (3%) were direct-to-consumer genetic services. The genetic tests offered were mainly for BRCA1/2 (59, 40%), Lynch syndrome (23, 16%), and newborn screening (18, 12%). Healthcare professionals with different backgrounds are increasingly engaged in the provision of genetic services. Based on which healthcare professionals have prominent roles in the respective patient care pathways, genetic programs were classified into five models: (i) the geneticists model; (ii) the primary care model; (iii) the medical specialist model; (iv) the population screening programs model; and (v) the direct-to-consumer model. Conclusions: New models of genetic service delivery are currently under development worldwide to address the increasing demand for accessible and affordable services. These models require the integration of genetics into all medical specialties, collaboration among different healthcare professionals, and the redistribution of professional roles. An appropriate model for genetic service provision in a specific setting should ideally be defined according to the type of healthcare system, the genetic test provided within a genetic program, and the cost-effectiveness of the intervention. Only applications with proven efficacy and cost-effectiveness should be implemented in healthcare systems and made available to all citizens
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