Influenza and Covid-19 Vaccination in 2023: a descriptive analysis in two Italian Research and Teaching Hospitals. Is the On-Site strategy effective?

Introduction: Vaccinations represent an extremely effective tool for the prevention of certain infectious diseases - such as influenza and COVID-19 -, particularly for those categories at risk due to both their frail condition or professional exposure, such as healthcare workers. The aim of this study is to describe the course of the anti-influenza and anti-COVID-19 vaccination campaign at two Research Hospitals in Milan, Italy. Study design: Multicentre, cross-sectional study. Methods: For the 2023-24 vaccination campaign, the two facilities opted for two different approaches. At the Hospital A, two dif-ferent strategies for vaccinating healthcare workers were implemented: a fixed-site vaccination clinic and two mobile vaccination groups run by Public Health residents of the University of Milan. At the Hospital B, on the other hand, a single fixed-site outpatient clinic run by Public Health residents of the University of Milan was used. On the occasion of the campaign, a survey was also carried out using anonymous online questionnaires to investigate healthcare workers attitudes towards vaccination. Results: A total of 1,937 healthcare workers were vaccinated: 756 were immunized against influenza only, 99 against COVID-19 only, and 1,082 against both. The results show a substantial difference in vaccination adherence among medical and nursing staff compared to other professional categories. In particular, the category with the highest vaccination adhesion turned out to be that of medical doctors with 55.7% adhesion while, on the contrary, the category with the lowest adhesion turned out to be that of auxiliary personnel characterized by 7.4% adhesion. At the same time, the comparison between the two hospital facilities showed a double adherence rate by the staff of Hospital A as regards both the flu vaccine (40.6% and 20.1%) and the anti-COVID-19 vaccine (26.4% and 12.3%). Finally, the survey showed that the attitude towards influenza vaccination is lower among auxiliary staff in terms of both knowledge and vaccination attitude. Conclusions: The results of the study show a vaccination adherence in line with that of previous years, although lower than the values recommended by the principal national and international Organizations. The analysis of the differences between the two facilities and the surveys carried out will allow for the implementation of targeted interventions to increase adherence in future campaigns.

Association between Mediterranean diet and dementia and Alzheimer disease: a systematic review with meta-analysis.

BACKGROUND: Dementia affects 5-8% of the population aged over 65 years (~50 million worldwide). Several factors are associated with increased risk, including diet. The Mediterranean diet (MedDiet) has shown potential protective effects against several chronic diseases. AIMS: This systematic review with meta-analysis aim was to assess the association between adherence to the MedDiet and the risk of dementia in the elderly. METHODS: PRISMA-2020 guidelines were followed. PubMed/MEDLINE and Scopus were searched on 17 July 2023. The Newcastle-Ottawa Scale tool was used to assess the risk of bias. The protocol was pre-registered in PROSPERO (registration number: CRD 42023444368). Heterogeneity was assessed using the I2 test. Publication bias was assessed by visual inspection of the funnel plot and by Egger's regression asymmetry test. The final effect size was reported as OR or HR, depending on the study design of the included studies. RESULTS: Out of 682 records, 21 were included in the analysis. The pooled OR was 0.89 (95% CI = 0.84-0.94) based on 65,955 participants (I2 = 69.94). When only cohort studies were included, HR was 0.84 (95% CI = 0.76-0.94) based on 55,205 participants (I2 = 89.70). When only Alzheimer Disease was considered OR was 0.73 (95% CI = 0.62-0.85) based on 38,292 participants (I2 = 63.85). DISCUSSION: Despite the relatively low risk reduction associated with higher adherence to MedDiet among elderly, it should be considered that this population is the most affected. CONCLUSIONS: Adherence to MedDiet could be an effective non-pharmacological measure to reduce the burden of dementia, even among elderly.

Climate Change Perception and Mental Health. Results from a Systematic Review of the Literature.

Climate change is one of the main global challenges and influences various aspects of human health. Numerous studies have indeed demonstrated an association between extreme climate-related events and physical and mental health outcomes, but little is still known about the association between the perception/awareness of climate change and mental health. In accordance with the PRISMA 2020 guidelines, a search was conducted on PubMed and Scopus. The protocol was registered on PROSPERO. The included studies were original observational studies published in English, reporting the association between the perception/awareness of climate change and mental health. A total of 3018 articles were identified. A total of 10 observational studies were included. The period covered in the included studies ranged between 2012 and 2022. Climate change perception is consistently associated with adverse mental health effects across different types of estimates. In particular, the studies identified an association between a higher level of perception/awareness of climate change and depression, anxiety, eco-anxiety, stress, adjustment disorder, substance use, dysphoria, and even thoughts of suicide. Qualitative data underscore the impact on daily activities, contributing to feelings of loss and suicidal ideation. Moreover, climate change perception correlates with lower well-being and resilience. The association between awareness of climate change and mental health is a complex and still poorly explored phenomenon. The main limitations are the high heterogeneity in terms of exposure assessment and data reporting, which hinders quantitative analysis. These results show that climate change perception impacts mental health. Better understanding the phenomenon represents an opportunity to inform public health interventions that promote mental well-being.

Why Treat Patients with a Major Orthopaedic Surgery Only to Send Them Back to the Vulnerable Conditions That Made Them Sick in the First Place? A Conceptual Scenario to Improve Patient's Journey.

Individuals with severe cartilage degeneration of the hip or knee or collapsed vertebrae that cause spine deformities can suffer from joint and neuropathic pain in the back, disuse of the affected limb, and restriction of movements. Surgical intervention is the most widespread and successful solution to date. There is a general belief that eating healthy and staying physically and mentally active might have a preventive role against musculoskeletal disease occurrence, while instead, we are more certain of the benefits deriving from a healthy diet and exercise therapy after major orthopaedic procedures. These aspects are in fact vital components in enhanced recovery after surgery programmes. However, they are applied in hospital settings, are often centre-dependent, and lack primary and tertiary preventive efficacy since end once the patient is discharged. There is the lack of initiatives at the territorial level that ensure a continuum in the patient's journey towards orthopaedic surgery, home transition, and a healthy and long-lasting life. The expert panel advocates the integration of an intermediate lifestyle clinic that promotes healthy eating, physical activity, and sleep hygiene. In this facility directed by professionals in enhancing recovery after surgery, patients can be referred after the surgical indication and before home discharge. Surgery is in fact a moment when individuals are more curious to do their best to heal and stay healthy, representing a timepoint and opportunity for educating patients on how lifestyle changes may optimise not only their surgical recovery but also long-term future health state.

Rolling e-learning: an educational model to support Italian healthcare professionals during the COVID-19 pandemic.

BACKGROUND AND AIM: Rolling reviews have been widely used by the scientific community during the COVID-19 pandemic to provide guidelines and identify potential treatments in such a quickly evolving emergency. Throughout the two pandemic years, we provided independent and continuously updated (rolling) e-learning courses on COVID-19 targeted to Italian healthcare professionals with the aim of increasing dissemination based on the emerging evidence. The results of this project are presented in this brief report. METHODS: We launched five main courses on COVID-19 - with focus on treatments and vaccines - from February 2020 to December 2022. For each course, we collected and analised participation data and, via questionnaires, customer-satisfaction data on relevance, quality, efficacy and sponsor perception. RESULTS: From 22 February 2020 to 31 December 2022, a total of 224,459 enrollments were registered over the five courses with 192,966 passes (86%), for which Continuing Medical Education (CME) credits were awarded. Over 94% of participants considered the contents of high quality, relevant and effective for their educational needs. The absence of sponsorship perception, 83% overall, decreased relevantly for the two courses on COVID-19 vaccines (68.3%). CONCLUSIONS: Italian healthcare professionals working during the pandemic overwhelmingly appreciated and valued the rolling e-learning offer aimed at widening the dissemination of the best practices on COVID-19. This educational model provides independent, evidence-based and tailored information with the undoubted advantages of time flexibility, remote participation and continuous update, all elements that make it a useful tool in a pandemic as well as in a post-pandemic era.

SIMED-New Doc course, a matter of reflection.

BACKGROUND AND AIM: Obtaining a degree in medicine in Italy qualifies for the medical profession; this fact has entailed a newly qualified doctor's remarkable involvement on the medical activities of the National Health Service, especially during the Covid-19 pandemic. It is important to understand the knowledge of the newly qualified doctors and to create specific courses oriented to them. The aim of the study is to evaluate the impact of a peer learning course for the students who attend the last year of medicine school, with the purpose of defining the formal requests to integrate on the course. METHODS: A pre and post qualitative research has been carried out on SIMED-NEWDOC course. The course consisted on peer teaching lectures, as lecturers were resident doctors part of SIMED board. At the end of the course it has been submitted a survey to the participants, and data has been analyzed. RESULTS: The students enrolled were 139, the average of the participants was 27% of the registered. A qualitative evaluation questionnaire was submitted, the responses were 32 (86%). Average age was 25. Participants attending the last year of medicine school were 30 (95%). 40% of them declared to have attended at least 5 lessons. Among the course participants, 96% judged the course as very useful. CONCLUSIONS: All questionnaire results are useful to reflect on future projects. It is necessary to implement further educational projects to better understand the phenomenon, considering the positive impact that participants declared.

Disentangling the Hypothesis of Host Dysosmia and SARS-CoV-2: The Bait Symptom That Hides Neglected Neurophysiological Routes.

The respiratory condition COVID-19 arises in a human host upon the infection with SARS-CoV-2, a coronavirus that was first acknowledged in Wuhan, China, at the end of December 2019 after its outbreak of viral pneumonia. The full-blown COVID-19 can lead, in susceptible individuals, to premature death because of the massive viral proliferation, hypoxia, misdirected host immunoresponse, microthrombosis, and drug toxicities. Alike other coronaviruses, SARS-CoV-2 has a neuroinvasive potential, which may be associated with early neurological symptoms. In the past, the nervous tissue of patients infected with other coronaviruses was shown to be heavily infiltrated. Patients with SARS-CoV-2 commonly report dysosmia, which has been related to the viral access in the olfactory bulb. However, this early symptom may reflect the nasal proliferation that should not be confused with the viral access in the central nervous system of the host, which can instead be allowed by means of other routes for spreading in most of the neuroanatomical districts. Axonal, trans-synaptic, perineural, blood, lymphatic, or Trojan routes can gain the virus multiples accesses from peripheral neuronal networks, thus ultimately invading the brain and brainstem. The death upon respiratory failure may be also associated with the local inflammation- and thrombi-derived damages to the respiratory reflexes in both the lung neuronal network and brainstem center. Beyond the infection-associated neurological symptoms, long-term neuropsychiatric consequences that could occur months after the host recovery are not to be excluded. While our article does not attempt to fully comprehend all accesses for host neuroinvasion, we aim at stimulating researchers and clinicians to fully consider the neuroinvasive potential of SARS-CoV-2, which is likely to affect the peripheral nervous system targets first, such as the enteric and pulmonary nervous networks. This acknowledgment may shed some light on the disease understanding further guiding public health preventive efforts and medical therapies to fight the pandemic that directly or indirectly affects healthy isolated individuals, quarantined subjects, sick hospitalized, and healthcare workers.

Individualized Breakfast Programs or Glycogen Super-Compensation: Which Is the Better Performing Strategy? Insights from an Italian Soccer Referees Cohort.

The role of soccer referees has grown in importance in the last decades, as has attention to their performance, which may be influenced and improved with specific and evolved training programs. Today, multiple specialists are working as a team in order to develop effective training programs. Moreover, for athletes, it is becoming more and more important to be attentive to nutrition. By considering such items, in this study, we aimed to investigate the nutritional habits of a group of referees belonging to the Italian Soccer Referees' Association (on behalf of AIA-FIGC). Our main aim was to spread a "culture of nutrition" in refereeing, starting with a survey on referees' breakfast attitudes and in order to disseminate such a "culture", we chose top-level elite referees who were younger subjects (despite the average 4 years' experience). Therefore, we enrolled 31 subjects (aged 22.74 ± 1.79, BMI 22.30 ± 1.53) and asked them about their breakfast habits. Then, for measuring their performance, we used the conventional fitness test named Yo-Yo (YYiR1), performed in three different sessions (test 1, test 2, test 3). Test 1 was carried out without any nutritional indications, test 2 was given after individualized breakfast suggestions by a designed dietician, and test 3 after an individualized glycogen super-compensation strategy. The Wilcoxon statistical analysis indicates that following an individualized breakfast strategy may enhance referees' performance (p < 0.0001), whereas no significant effects were observed with the glycogen super-compensation option. However, further studies will be necessary to better address this topic and clarify whether high-carbohydrates (high-CHO) intake may be useful in other sports.

Does specialty matter? A survey on 176 Italian neurosurgeons and orthopedic spine surgeons confirms similar competency for common spinal conditions and supports multidisciplinary teams in comprehensive and complex spinal care.

BACKGROUND CONTEXT: Spine surgery is a multifaceted subspeciality requiring a breadth of knowledge and skill from different branches of medicine for the treatment of pathologies varying from degenerative to deformity, oncological, and trauma. PURPOSE: The aim of the study was to investigate the self-perceived competency of spine surgeons in relation to different types of spinal procedures. STUDY DESIGN/SETTING: This is a survey study. METHODS: We conducted a survey on 176 surgeons (orthopedic surgeons and neurosurgeons). The instrument used for the assessment of the perceived ability was a survey consisting of 21 items (scenarios) developed and distributed through a professional online survey service to ensure confidentiality and anonymity. A newly proposed procedure-specific rating survey was used for the evaluation. Kruskal-Wallis non-parametric test was used to assess validity. A p-value of <.05 was considered statistically significant. A Cronbach α value of >0.8 indicated reliability. RESULTS: Between the respondents (101), 47.5% were orthopedic surgeons and 52.5% were neurosurgeons. The internal consistency of the questionnaire was satisfactory (Cronbach α=0.93). For common spinal conditions, the orthopedic surgeons and the neurosurgeons perceived a similar competency. The neurosurgeons felt more competent in some cervical conditions (upper cervical procedures, myelopathy) and in neurologic tumors of the spine. The orthopedic surgeons felt more competent in deformities of the spine and in pelvic trauma. CONCLUSIONS: Self-perceived surgical competency for common spinal conditions is similar for orthopedic and neurosurgically trained spine surgeons. For less common conditions and clinical scenarios, the combination of both specialties seems to cover better the full spectrum of surgical care for spinal conditions. Multidisciplinary teams and comprehensive, multidisciplinary spinal surgical training should be considered to provide full coverage of spinal pathology.

Genotypic diversity of Legionella pneumophila in environmental and clinical strains assessed by Sequence-Based Typing, in association with retrospective clinical surveillance in Northern Italy.

OBJECTIVE: The study aimed to evidence previous cases of legionellosis or proven or suspected pneumonia in seven hospital facilities for the mentally disabled in Northern Italy, where no clinical surveillance had been previously carried out. An additional aim was to highlight the occurrence of strains of Legionella pneumophila of clinical and environmental origin by Sequence-Based Typing (SBT), comparing them to world surveillance. MATERIALS AND METHOD: A clinical survey was perfomed from 2003-2012, analyzing 615 medical records for hospital- and community-acquired pneumonia, with particular attention to legionellosis. Clinical (n=4) and environmental (n=25) isolates of Legionella pneumophila, isolated in the same period (2003-2012), were characterized by SBT and the Sequence Types (STs) compared with the European Working Group for Legionella Infections (EWGLI) database. RESULTS: Surveillance revealed that there were seven detected cases of legionellosis; most pneumonia cases could not be confirmed by diagnostic tests because of the disabilities of the patients and their lack of cooperation. The same ST was found in two of the clinical strains and also in a corresponding environment, i.e. ST685 and ST16, and two clinical strains belonging to the same ST (ST1). The other environmental strains were isolated in department with confirmed/suspected clinical cases. Five other STs found in this study were new to the database: ST685 was isolated both from a patient and from water; ST694, ST1181, ST1370 and ST1371 have not been described previously. CONCLUSIONS: The study confirmed that the routine collection and analysis of environmental strains may be an important strategy for preventing sporadic and epidemic cases of legionellosis, in association with clinical surveillance.