Influenza Vaccination Uptake and Prognostic Factors among Health Professionals in Italy: Results from the Nationwide Surveillance PASSI 2015-2018.

(1) Influenza causes a significant health and socio-economic burden every year, and health personnel (HP) are at higher risk of exposure to respiratory pathogens than the general population. (2) The study's purpose was to describe and compare influenza vaccine uptake and its prognostic factors among Medical Doctors (MDs) and Non-Medical Health Personnel (NMHP) vs. Non-HP (NHP). We analyzed 2014-2018 data (n = 105,608) from the Italian Behavioral Risk Factor Surveillance System PASSI that, since 2008, has been collecting health-related information continuously in sampled adults. (3) MDs and NMHP represented, respectively, 1.1% and 4.6% of the sample. Among HP, 22.8% (CI 19.8-26.1%) of MDs and 8.5% (CI 7.5-9.5%) of NMHP reported to have been vaccinated vs. 6.3% (CI 6.1-6.5%) in NHP. This difference is confirmed in the three categories (MDs, NMHP, NHP), even more across age groups: in 18-34 yy, respectively, 9.9%, 4.4%, 3.4% vs. 28.4%, 13.9%, 10.6% in 50-64 yy. PASSI surveillance shows an increasing influenza vaccination uptake over time, especially among MDs (22.2% in 2014 vs. 30.5% in 2018). (4) Despite such an increase, especially among younger HP, influenza vaccination uptake is low. Even more under pandemic scenarios, these figures represent key information to address effective strategies for disease prevention and health promotion.

Data from the PASSI d'Argento Surveillance System on Difficulties Met by Older Adults in Accessing Health Services in Italy as Major Risk Factor to Health Outcomes.

(1) Age-friendly health systems ensure access to quality healthcare services to all people, especially older adults. (2) We used data on elderly population collected from 2016 to 2019 by the Italian ongoing surveillance system PASSI d'Argento to analyze the prevalence and associations between accessing health services and modifiable risk factors included in the 25 × 25 strategy for the burden of noncommunicable diseases with health outcomes. (3) Chronic diseases and hospitalization as descriptors of health status showed that the elderly perceived as having poor access to care and prevention incurred a higher risk of hospitalization. The association between difficulties in accessing health services and hospitalization was always the highest in terms of the adjusted prevalence ratio (aPR), regardless of the other behavioral risk factors considered, controlling each model with sociodemographic conditions. Elderly hospitalized at least once for two days or more in the last 12 months had greater risk to have problems in accessing health services, whereas the model included health conditions such as obesity (aPR = 1.95 95% CI 1.75-2.17), smoking (aPR = 1.95 95% CI 1.76-2.16), alcohol use (aPR = 1.93 95% CI 1.73-2.14), hypertension (aPR = 1.92 95% CI 1.73-2.13) and diabetes (aPR = 1.91 95% CI 1.73-2.12). (4) Health policies should encompass socio-economic and living environment barriers which prevent access to care among older adults.

Monitoring cardiovascular diseases and associated risk factors in the adult population to better orient prevention strategies in Italy.

INTRODUCTION: Cardiovascular disease (CVD) is the first cause of death in Europe and over the world. This study analyses health-related behaviours in adults referring doctor-diagnosed CVDs. MATERIALS AND METHODS: We used data from the Italian cross-sectional Behavioural Risk Factor Surveillance System PASSI gathered in 2015-2018. Complex survey design analyses included the Taylor series method for variance estimation and Poisson regression for associations between socio-demographic characteristics and CVD. RESULTS: Among 132,598 respondents, the prevalence of doctor-diagnosed CVD was 5%. Higher percentages are observed among: men, older individuals, socioeconomically disadvantaged people. Compared to the general population, people with CVD have greater risk and aggravating factors, and a worse health status overall. All protective behaviors and lifestyles shall be improved. DISCUSSION AND CONCLUSIONS: In Italy, adults with CVD are more likely to be exposed to aggravating modifiable risk factors: it represents a valuable information for increased preventive interventions, even more in the light of the COVID-19 pandemic scenario.

Smoking prevalence among healthcare workers in Italy, PASSI surveillance system data, 2014-2018.

INTRODUCTION: Data on smoking among Italian Health Personnel (HP) from PASSI surveillance system from 2014-2018 were analysed. MATERIALS AND METHODS: Among 169,678 working-age respondents, smoking prevalence was estimated among 1,253 Medical Doctors (MDs), 4,840 Non-Medical HP (NMHP), 87,749 Non-HP (NHP) and multivariate analysis was conducted. RESULTS: Current smokers were 23.0% among HP. Smoking prevalence in MDs (16.0%) was significantly lower than those observed in NMHP (25.3%) and NHP (28.6%). A declining trend was detected in all three groups and was more evident among MDs: from 20.8% in 2014 to 11.5% in 2018. Amongst MDs, smoking was significantly associated with male gender (Adjusted Odds Ratio, AdjOR=1.61), younger age (AdjOR=2.00), residing in South (AdjOR=1.71). Among NMHP, smoking prevalence was associated with low economic condition (AdjOR=1.54) and non-university education. DISCUSSION AND CONCLUSIONS: To further reduce smoking in HP, it is necessary to develop specific training courses in educational curricula.

The two behavioural risk factor surveillances on the adult and elderly populations as information systems for leveraging data on health-related sustainable development goals in Italy.

INTRODUCTION: Current lengthening of average life and constant increase of population ageing associated to forces that include rapid unplanned urbanisation and globalisation of unhealthy behaviours have determined the huge relevance of noncommunicable diseases (NCDs). Monitoring key modifiable behavioural risk factors has resulted to be crucial both in spatial terms and as per temporal trends in order to allow comparisons between different geographic areas or levels and over time. MATERIALS AND METHODS: In Italy, PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) and Passi d'Argento are the ongoing Behavioural Risk Factor Surveillance Systems (BRFSSs), respectively, on adults (people aged 18-69) and elderly (65 and older). RESULTS: The two Italian surveillances are information systems providing data not only on the third Sustainable Development Goal (SDG) that explicitly addresses ensuring healthy lives and promoting well-being for all, but on a total of nine health-related SDGs (HRSDGs) and 19 HRSDG targets/indicators. We describe these pairs more in detail specifying where in case of BRFSS core indicators (N = 14 HRSDG targets/indicators) concerning six HRSDGs or, on the other hand, as per BRFSS further in-depth analysis (N = five HRSDG targets/indicators) in regard of four different HRSDGs. About the HRSDG 3, HRSDG target 3.4, HRSDG indicator 3.4.1, from the PASSI and Passi d'Argento data it is possible not only to detect the prevalence of NCDs in adults and elderly living in Italy, but also to evaluate the social determinants of health, such as gender, age group, educational level, economic difficulties, as well as the associations with modifiable lifestyle risk factors. CONCLUSIONS: The two Italian BRFSSs generate accurate data, which are highly relevant to design, implement, monitor, and evaluate programs and policies at different levels (local, regional, national) for NCD prevention and health promotion. They provide numbers which can also serve as propaedeutic or, in some cases, complementary ground to address a robust measurement of several HRSDG patterns.

[A critical analysis of the degree of care humanization in the Hospitals of the Provincia Romana San Giovanni di Dio Fatebenefratelli (FBF)]. / Valutazione del grado di Umanizzazione: una indagine critica condotta negli Ospedali della Provincia Romana Fatebenefratelli.

In the Hospitals of the Ordine della Provincia Romana San Giovanni di Dio Fatebenefratelli (FBF) (consisting of four hospitals located in three Italian regions) Patient Centeredness has always been considered a central point. In 2015, the Central Hospitals' Health Direction decided to use a check-list for the evaluation of the degree of Patient Centered Care Facilities, drawn up by the National Agency for Regional Health Services (Age.Na.S) during the 2010 Research Project "Experimentation and transfer of organizational empowerment models for evaluating and improving the quality of health services." The aim of the work was to measure the "Patient Centered Care degree" of the FBF structures by means of the Age.Na.S. check-list in order to identify effective and sustainable improvement measures, and to evaluate the applicability and the critical points of the questionnaire. The check-list was divided into four areas: care systems oriented at citizen's respect and centrality; physical accessibility, liveability and comfort of the places of care; access to information, simplification and transparency; care of the relationship with the patient and the citizen. The four areas were divided into 12 sub-areas, 29 criteria and 144 items with sub-items (248 questions), defined as quantitative or qualitative variables allowing for an evaluation of observed reality. Some items from different areas have been grouped into Focus and Operational Units (UU.OO./Facilities). The results of the Age.Na.S. study were used to compare the results obtained in the Roman Province FBF structures with the national ones. The Medical Directors and the responsible of FBF Quality Systems completed the cheek-list. A working group within the Central Hospitals' Health Direction analysed the data and processed the results, using the same scores provided by Age.Na.S.. The analysis of the results was divided into three levels. Focus and UU.OO./Facilities scores were calculated based on Age.Na.S. INDICATIONS: The distinction into three levels of analysis allowed for a thorough study of results, from the evaluation of the areas to the items. By comparing the results, the overall final value (range 6-6.5) and single area scores are close to the national average for beds number category in all the FBF hospitals. The most critical criteria, recurring in different levels are: 1.1.2 (Activities/projects to promote sociability and continuity with the outside world); 3.2.3 (Content and accessibility of the website); 4.1.2 (Training and support to the staff for the care of the relationship with the patient) and 4.2.3 (Training of the front-office staff), which had a < 4 score in at least three hospitals and generally achieve a value below the national average (level II and III of analysis). The analysis was extremely useful for detecting positive and negative aspects in the structures under examination. It also permitted to plan improvement measures based on set priorities and objective criteria, aimed at enforcing organizational empowerment models for improving the quality of patient-focused health services. However, during the compilation we found difficulties related to the applicability of the questionnaire. Indeed some questions, while having the same impact on the overall score, are less relevant, considering the patient centrality as main aim. It would be desirable that Age.Na.S. considers in a future survey the observations from hospitals joining previous investigations, in order to facilitate the use of the questionnaire and to improve this tool, which proved to be highly effective.

[The Italian Immunization Plan 2017: analysis and starting point for the Regional Plans]. / Il nuovo Piano Nazionale Prevenzione Vaccinale 2017-2019: analisi e punto di partenza per i piani regionali.

The National Immunization Plan 2017-2019 has been approved on January 2017. This official document contains the new Italian guidelines to improve vaccination coverage in the country. We conducted an accurate and critical analysis of the document, highlighting its key points and critical issues, in order to offer an practical tool for writing the Regional Plans. The new immunization schedule and the establishment of a restricted panel for the vaccine vigilance are the most significant innovations of the Plan. The Plan addresses also the issues of mandatory vaccination and of penalties for physicians who advise against vaccinations. Together with the presence of qualifying aspects as information about the ethical value and the benefits of vaccination, the Plan contains other interesting proposals, such as the introduction of a computerized vaccination register and the targeted use of new technologies to reach the population extensively. The Plan is set up as a conceptually rich tool, suitable for the development of regional operational plans.