RESUMO
Vaccination against SARS-CoV-2 will likely be the most promising way to combat the pandemic. Even if mass vaccination is urgent, it should still always be supported by appropriate patient safety management. The aim of this study, based on failure mode, effects and criticality analysis (FMECA), was to identify possible failures and highlight measures that can be adopted to prevent their occurrence. A team of resident doctors in public health from the University of Padua and specialists in risk analysis in public health examined the mass vaccination process. A diagram was drafted to illustrate the various phases of mass vaccination, analyze the process, and identify all failure modes. Criticalities were ascertained by rating the severity, frequency and likelihood of failure detection on a scale of 1 to 10. We identified a total of 71 possible faults distributed over the various phases of the process, and 34 of them were classified as carrying a high risk. For the potentially high-risk failure modes, we identified 63 recommended actions to contain the cause of their occurrence or improve their detection. For the purpose of detecting potential failures, FMECA can be successfully applied to mass vaccination, which should be considered a high-risk process.
RESUMO
Childhood vaccination has been a milestone in the control of infectious diseases. However, even in countries offering equal access to vaccination, a number of vaccine-preventable diseases have re-emerged. Suboptimal vaccination coverage has been called into question. The aim was to explore socioeconomic inequalities in vaccine hesitancy and outright refusal. Families with at least one child aged between 3 months and 7 years were involved through an online survey. Families were classified as provaccine, hesitant, or antivaccine. The association between socioeconomic determinants and hesitancy/refusal was investigated with a logistic-regression model. A total of 3865 questionnaires were collected: 64.0% of families were provaccine, 32.4% hesitant, and 3.6% antivaccine. Rising levels of perceived economic hardship were associated with hesitancy (adjusted odds ratio (AOR) from 1.34 to 1.59), and lower parental education was significantly associated with refusal (AOR from 1.89 to 3.39). Family economic hardship and parental education did not move in parallel. Economic hardship was a determinant of hesitancy. Lower education was a predictor of outright refusal without affecting hesitancy. These findings may serve as warnings, and further explanations of socioeconomic inequities are needed even in universal healthcare systems. Insight into these factors is necessary to improve convenience and remove potential access issues.
RESUMO
This study explores whether clinicians or a statistical model can better identify patients at risk of early readmission and investigates variables potentially associated with clinicians' risk judgment. We focus on a total of 142 patients discharged from acute psychiatric wards in the Verona Mental Health Department (Italy). Psychiatrists assessed patients' risk of readmission at 30 and 90 days postdischarge, predicted their postdischarge compliance, and assessed their Global Assessment of Functioning (GAF) score at admission and discharge. Clinicians' judgment outperformed the statistical model, with the difference reaching statistical significance for 30-day readmission. Clinicians' readmission risk judgment, both for 30 and 90 days, was found to be statistically associated with predicted compliance with community treatment and GAF score at discharge. Clinicians' superior performance might be explained by their risk judgment depending on nonmeasurable factors, such as experience and intuition. Patients with a poorer GAF score at discharge and poor assumed compliance were predicted to have a higher risk of readmission.