256 research outputs found
Comparative effectiveness of adjuvanted versus high-dose seasonal influenza vaccines for older adults: a systematic review and meta-analysis
No full textObjectives: MF59-adjuvanted standard-dose and nonadjuvanted high-dose seasonal influenza vaccines have been developed to protect the elderly at high risk of severe complications. This study aimed to summarize the available evidence on the comparative efficacy/effectiveness of these two vaccines. Methods: A systematic literature review of experimental and observational studies were conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. When possible, the extracted effect sizes were pooled in random-effects meta-analyses. Results: Ten studies were identified. Of these, no head-to-head randomized controlled trials were identified. All available studies had retrospective cohort design and large sample sizes, were conducted in the United States between the 2016-2017 and 2019-2020 seasons, and were at moderate risk of bias. Relative effectiveness estimates were limited to nonlaboratory-confirmed clinical end points, such as medical encounters including hospitalizations. Although most pooled relative effectiveness estimates were close to null, few statistically significant pooled effect sizes were small in magnitude, moved in opposite directions, and depended on the study sponsor and specificity of influenza-related outcomes. Conclusion: At present, MF59-adjuvanted standard-dose and nonadjuvanted high-dose vaccines appear to have similar effectiveness in preventing seasonal influenza in the elderly, and no conclusive recommendations on the preference of one vaccine over another could be drawn
Health in All Policies
No full textchapter 16: Health in All Policies A Lazzari, C de Waure, N Azzopardi-Muscat - A Systematic Review of Key Issues in …, 2015 ... of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malt
The promising application of health technology assessment in public health: a review of background information and considerations for future development
No full textIntroduction
Health technology assessment (HTA) is a multidisciplinary approach to the evaluation of health-care technologies, which aims to support the decision-making process by driving medical, technical and economic knowledge. It is characterised by the contextual examination of epidemiological, clinical, economic, social, ethical and organisational implications.
Main part
Even if it was born in fields other than medicine, HTA has progressively spread as an innovative tool to assess health-care technologies such as drugs, medical devices and surgical procedures. Through a scientific literature review the purpose of applying HTA to public health was explained and discussed. Tackling interventions to control health determinants has great potential for reducing the burden of disease and for promoting health in the general population. Anyway health expenditure for public health is low: this could threaten interventions and damage the role of public health itself. HTA could represent a guide to best invest in this field and to gain in efficacy and effectiveness in line with current strategies to implement health services in all sectors.
Conclusion
HTA could represent a good tool to address all topics and problems pertaining to choices in public health and could allow decision-makers to best invest scarce available resources
Reduction in Neisseria meningitidis infection in Italy after Meningococcal C conjugate vaccine introduction: A time trend analysis of 1994-2012 series
No full textThe incidence of invasive meningococcal disease (IMD) In Italy is among the lowest in Europe. Meningococcal C conjugate vaccine (MCC) was introduced in 2005 for 12 onths old infants. The aim of this study was to describe the epidemiology of IMD in Italy from 1994 to 2012 and to evaluate the impact of MCC introduction. Data about Neisseria meningitidis (N. meningitidis) cases were drawn from the National Surveillance of Invasive Bacterial Diseases. The average incidence of IMD during 1994-2012 in Italy was 0.36 per 100,000 (95%CI 0.30-0.40). N. meningitidis B was the most frequent serogroup and infants less than 12 onths old were the most affected. Joinpoint analysis showed a statistically significant reduction in the incidence of N. meningitidis C related IMD after MCC introduction: the Annual Percentage Change declined from 21.8 (95%CI 15.1; 28.9) in 1994-2005 to -19.9 (95%CI -28.2; -10.7) afterwards. No changes were observed with respect to N. meningitidis B related IMD. Poisson regression showed a statistically significant reduction in the incidence of IMD both associated to N. meningitidis C (Incidence Rate Ratio 0.33; 95%CI 0.29-0.37) and due to all serogroups (Incidence Rate Ratio 0.70; 95%CI 0.65-0.75) in the post-vaccination period compared to the pre-vaccination one. On the other hand, the incidence of N. meningitidis B related IMD did not decrease. Our results suggest that MCC had an impact in decreasing the incidence of N. meningitidis C related IMD. However, data on typing are incomplete and efforts are needed to make them available for studying the need and the impact of other meningococcal vaccines
Health Technology Assessment: strumento della Clinical Governance in ambito di Sanità Pubblica
No full textDoes the use of dietary supplements enhance athletes’ sport performances? A systematic review and a meta-analysis
No full textBACKGROUND: The consumption of dietary supplements has increased in recent years. Despite their widespread use, there is confusion about effects on sport performances. The aim of this study was to investigate association between use of supplements and enhance of athletes’ sports performance. METHODS: A review and a meta-analysis of studies conducted on Dietary Supplements and Sports between 2003 and 2013 were performed. Enhancement on sport performances was considered as outcome. The following aspects related to enhancement were considered: ergogenic effect (EE), time to exhaustion (TTE), muscular endurance (ME), post-exercise recovery (PER) and body mass (BM). With respect to meta-analysis, data on level of post Exercise Glucose (GpE [mg/dL]) and level of post exercise Lactate (LpE [mmol/L]) were considered as indicators of TTE, PER and EE. Similarly, Change in Body Mass (CBM) [kg] was used as indicator of BM. RESULTS: The most investigated dietary supplements were: Creatine, Carbohydrates, Beta-alanine, Proteins. The qualitative analysis evaluating the effect of supplements on sports listed by the International Olympic Committee has achieved interesting results: supplements didn’t show statistically significant effects when compared to placebo in more than 48% of papers. For the quantitative analysis, 15 studies were considered. The meta-analysis showed that there was no significant effect of Beta-alanine, Creatine and Carbohydrates on LpE and GpE. Furthermore, a nonsignificant increase in BM was observed in athletes undergoing Creatine compared to placebo. CONCLUSION: Considering the increasing attention to this topic, it would be interesting to investigate the existing awareness about effectiveness and possible risks of supplements
Capturing the chance for pneumococcal vaccination in the hospital setting
No full textIntroduction. Because of the relevant burden of pneumococcal diseases, newborns, people at risk and elderly are recommended vaccination but coverage is still low for problems in catching them. This study evaluates the proportion of eligible patients seen at hospital level in the view of assessing its potential role in vaccination campaigns. Methods. This is a retrospective analysis of discharge data of all patients over 49 years of age admitted between 2011 and 2013 to "A. Gemelli" teaching hospital. Eligibility for pneumococcal vaccination was evaluated based on ICD-9 codes. Results. Among 65 047 unique patients, 53.2% were eligible for pneumococcal vaccination. Most common eligibility criteria were chronic heart diseases, cancer and diabetes. Considering also age = 65 as an indication to vaccination, the proportion of eligible patients reached 76.8%. The highest number of eligible patients was seen in medical sciences, general surgery, cardiovascular medicine and neurosciences departments. Conclusions. Hospital might play an important role in catching patients eligible for pneumococcal vaccination because their proportion in the hospital setting is high
COVID-19 Vaccination Actual Uptake and Potential Inequalities Due to Socio-Demographic Characteristics: A Population-Based Study in the Umbria Region, Italy
No full textSocio-demographic factors are responsible for health inequalities also in vaccination. The aim of this study was to evaluate their role at the population level through a population-based study performed on the whole population entitled to receive COVID-19 vaccines in the Umbria Region, Italy, and registered to the Regional Healthcare Service as of 28 February 2021. Socio-demographic characteristics and vaccination status in terms of uptake of at least one dose of any available vaccine, completion of the primary vaccination cycle and uptake of the booster doses as of 28 February 2022 were collected from the Umbria regional database. The percentage of eligible population who did not initiate the COVID-19 vaccination, complete the full vaccination cycle and get the booster dose was 11.8%, 1.2% and 21.5%, respectively. A younger age, being a non-Italian citizen, and not holding an exemption for chronic disease/disability and a GP/FP were associated with all the endpoints. Females, as compared to males, were more likely to not initiate the vaccination but less likely to not receive the booster dose. On the contrary, the findings did not show a significant association between the deprivation index and the vaccine uptake. The findings, beyond confirming current knowledge at the population level, provide new inputs for better tailoring vaccination campaigns
The Health Technology Assessment of bivalent HPV vaccine Cervarix in Italy
No full textINTRODUCTION: Health Technology Assessment (HTA) approach was applied to Human Papilloma Virus (HPV) vaccine in the Italian context.
METHODS: Epidemiology and costs of HPV infection and related diseases, vaccine efficacy, clinical and economic impact of the HPV vaccination and women's knowledge and attitudes towards vaccination were assessed.
RESULTS: HPV infections pooled prevalence in Italy was 19% (95%CI: 10-30%) and cervical cancer incidence was 9.8/100,000 per year. The mean costs for in situ and invasive carcinoma hospitalisation were estimated respectively in euro1745.87 and euro2616.16. HPV vaccines have demonstrated high efficacy and good safety profile. The meta-analysis on efficacy results in preventing persistent cervical infections by HPV16 and 18 for both HPV vaccines resulted in 87% (95%CI: 80-91%) and 78% (95%CI: 62-87%). Modelling the impact of vaccination with bivalent vaccine, it would reduce cancer cases by 67% and be cost-effective, with a cost per Quality Adjusted Life Years (QALYs) gained of euro22,055.
CONCLUSION: The thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. The HTA report on the HPV vaccine demonstrated to be a comprehensive tool for an informed decision making proces
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