Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review.

Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.

Empathy in vaccination counselling: a survey on the impact of a three-day residential course.

BACKGROUND: In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known. This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients' ratings of the level of empathy of physicians and nurses working in vaccination centers. METHODS: The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children. Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups. RESULTS: Analysis of the questionnaires showed an increase of "excellent" scores and statistically significant differences between the pre- and post -course median values. Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course. CONCLUSIONS: This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents' adherence to vaccination programs.

[The active offering of measles, rubella and mumps vaccine in new mothers: the experience of health facilities in one of the Local Health Unit of Rome, Lazio, Italy]. / Offerta attiva della vaccinazione Morbillo, Parotite e Rosolia nelle donne in occasione della prima vaccinazione del figlio: l'esperienza della ex ASL Roma C.

Rubella is a contagious disease that can be very serious, especially in unvaccinated pregnant women. The best way to be protected is getting vaccinated: MMR vaccine is very effective at protecting people against measles, mumps, and rubella, and preventing the complications caused by these diseases. According to PASSI 2012-2015 (the Italian behavioral risk factor surveillance system) in the territory of ex ASL Roma C only 56% of women between 18 and 49 years were immunized against rubella, thanks to vaccination (34%) or past infection detected by rubeotest (22%); 2% was susceptible and 42% of respondents did not know their immune status against rubella. The Italian National Plan for the Elimination of Measles and Congenital Rubella (PNEMoRc) 2010-15 had the aim to reduce the prevalence of rubella susceptibility in young women (<5%), to reduce the prevalence of congenital rubella and to increase MMR vaccination coverage. This plan suggested to promote actions to spread correct information about MMR vaccine in the general population and healthcare workers and to offer this vaccine to susceptible women during every appropriate contact with the Family planning clinics. In order to ensure and monitor these recommendations, a recovery procedure for MMR vaccine was activated in 2015 for women who contacted the health facilities for their first child vaccination. A form was developed in order to collect information about women's immune status against rubella and measles. According to this tool all women who stated they had never been vaccinated for rubella or MMR and/or did not remember vaccination and/or had never had a rubeotest were considered susceptible to rubella. Women susceptible to rubella were invited to undergo vaccination. Data collected during one year activity were recorded and analyzed with Epinfo 7.0 software. We collected 1801 correctly filled forms; 88.6% (1595) of women were evaluated immune to rubella and 11.4% susceptible. The prevalence of susceptibility seems to be influenced by age, from 16% in the youngest age group to 9% in the >35 years. Among 206 women susceptible to rubella: 38% were vaccinated, 31% preferred to wait, 11% refused vaccination and for 20% data is missing. The protocol of MMR vaccine recovery was effective, and allowed to reach a good number of women who had a contact with the health facilities and we hope this number to be bigger, adding a part of those women who preferred to wait. However, data of a year activity indicate that vaccine recovery initiatives should be proposed and implemented, in consideration of the proportion of rubella susceptibility in women who were recently pregnant.

[The evaluation of susceptibility to rubella in women of childbearing age; the experience of the Asl Roma C]. / La valutazione della suscettibilità alla rosolia nelle donne in età fertile: l'esperienza della ASL ROMA C.

The new Plan for Elimination of Measles and Congenital Rubella 2010-15 recommends the local health unit (ASL) to analyze the immunization coverage data available in the adult population cohorts, in order to identify susceptible people. The aim of this paper is to estimate the susceptibility to rubella in resident women of childbearing age, through integration of all ASL data sources, in order to implement the most appropriate vaccination strategy for susceptible women. In ASL Roma C, the "PASSI" surveillance system estimates a 53% prevalence of childbearing age women immune to rubella; as many as 43 % is not aware of her immune status and 4% is certainly susceptible because of reporting a negative result "rubeotest" (years 2008-10). The data extracted from the database of the ASL Roma C laboratory (year 2010) estimate a prevalence of approximately 20% of susceptibility among women who spontaneously perform a rubeotest at the hospital laboratory for any reason (control or pregnancy). Childbearing age women susceptible to rubella, residing in the territory of our ASL, are definitely more than 5%, ranging from 4% estimated by the "PASSI" surveillance system to 20% detected by hospital laboratory.

[Communicating the benefits and risks of vaccination: a focus on the PFCC (Patient and Family Centered Care) approach]. / I segreti della comunicazione in ambito vaccinale.

In recent years an important reduction in the access to vaccination was noticed in Italy. Health care workers involved in health promotion must necessarily find new strategies to overcome the mistrust of the population. The application of some instruments of counselling in the vaccination field can improve the therapeutic alliance, making users to take the best decisions for their own wellness. The approach called Patient- and Family-Centered Care includes the relational processes within the skills of the health care worker.

[Contraindications to vaccinations: no news is good news]. / Controindicazioni alle vaccinazioni: nessuna nuova, buona nuova.

Contraindications to vaccinations represent an extremely debated topic. In this paper the literature revision is presented, taking into account different vaccines and aspects related to allergies. There were no significant differences compared to the Guide to contraindications to vaccinations, edited in 2009. Therefore, only a revision including new available vaccines and an updating of the citations would be necessary. This revision should be intended as an opportunity to renovate the Guide, transferring it on an informatics platform. This should enhance the usability and facilitate a constant update of the Guide.