Effectiveness of a vaccine recovery plan after the COVID-19 pandemic in the Siracusa Local Health Authority, Italy. Results of one year follow-up.

Introduction: The COVID-19 pandemic has strongly impacted on the immunization services around the world, threatening the gains made in the control of vaccine-preventable diseases. Methods: A vaccination recovery plan of missed vaccinations has been put in place in the LHA of Siracusa after the pandemic. We compared 2021 and 2020 vaccination coverage by age group and vaccine type after one year of follow-up of the recovery plan. The Chi-square test was executed on proportions for the years 2021 vs 2020. Results were considered statistically significant at a two-tailed p-value ≤ 0.05. Results: 36-month coverage rates were 92.5% for polio and 93.7% for measles-containing-vaccine, representing -0.3% and -1.8% decreases, respectively, as compared to 2020. By 8 years of age (booster doses), immunisation coverage was 80.7% for polio and 80.1% for measles, representing a -5.7% and -3.7%, respectively, compared to 2020. 36-month coverage was 56.6% for Men B (-5.0% as compared to 2020), 73.2% for Men ACW135Y/C (+1.1% as compared to 2020) and 86.9% for PNC vaccine (-1.7%, as compared to 2020). Regarding HPV vaccination, in 2021, vaccine coverage was 44.2% (-4.4% compared to 2020). Compared to the previous report, the VC difference among the cohorts narrowed for all almost vaccinations, except for the anti-men B and the anti-HPV vaccination, for which we recorded an increase in VC difference, and for men ACW135Y/C, for which a significant increase has been recorded. Conclusions: Despite the efforts to organize and realize an extensive and well-designed vaccination recovery, our data show that even after the 1-year follow-up, globally deficits in coverage for these routine vaccinations persist, although there has been a substantial and significant recovery of missed vaccinations, especially among younger children and for primary cycles.

Are austerity measures really distressing? Evidence from Italy.

Since 2007 financial recovery plans have been adopted by some Italian regions to contain the costs of the healthcare sector. It is legitimate to ask whether spending cuts associated with the austerity policy have had any effect on the health of the citizens. We examine the indirect impact of financial recovery plans on a broad set of health indicators, accounting for several dimensions of both physical and psychological diseases. We use an instrumental variable fixed-effects model to control for time-varying heterogeneity and to deal with the potential endogeneity of the enrolment in the austerity programme. We find that the Italian austerity policy Piano di Rientro resulted in unintended negative effects on several dimensions of health, hurting and potentially jeopardising the health of citizens.

Pandemic urban development is leading us away from nature.

Recovery plans in Europe in the COVID-19 pandemic era have stimulated construction-led development, which has eclipsed nature-based agendas in terms of scale, size, and policy. One estimate is that only 0.3% of spending on urban infrastructure globally is directed towards various nature-based solutions and other ecosystem efforts supporting human well-being. In the future we will urgently need to employ nature-based approaches in crisis management for the power and potential of nature to be fully employed in pursuit of urban recovery. We strongly recommend that nature-based approaches be an explicit requirement to secure funding for future recovery plans.

COVID-19: yesterday, today and tomorrow. The quality of COVID-19 management and the evaluation of the "Health" chapter of the Recovery Plan.

Introduction: The COVID-19 pandemic represented an unprecedented challenge for the healthcare world and the introduction of a new stronger and believable project plays a fundamental role for the quality of work and the provision of qualitative care. Aim: The survey provided by Italian Association for the Quality of Health and Social Care (ASIQUAS) aims to examines the impact of "Health" chapter included in the Recovery Plan, through the assessment of management quality of the COVID-19 pandemic. Methods: Starting from a literature review, in September 2021, a web-based survey has been conducted and administered by e-mail. It has been taken into account measures widely used by different healthcare structures in order to analyze the projects implemented in the face of pandemic and to evaluate the new real possibility to invest funds in new healthcare structures and projects. Results: The survey consists of 19 multiple choices and respondents were from different types of structures, including regional departments and regional health agencies (1.4%), universities, research centers and scientific hospitalization and treatment institutes (IRCCS) (11%), hospitals and university polyclinics (34.2%), Local Health Authorities (39.7%), socio-health organizations and Others (13.7%). The pandemic has highlighted many vulnerabilities at both hospitals and territorial level. The major weaknesses revealed by the survey are mainly due to the lack of support from new staff units and poor availability of specific training tools for COVID-19 procedures. The Recovery Plan is still unclear with a lot of concern about the implementation and many limits of diffusion. Conclusions: It becomes essential to guarantee a new effective and interoperative model of integration. Today we can start more aware for the implementation of a system closer to everyone's needs, making shortcomings the new strength and starting point.

Demography of the black grouper, Mycteroperca bonaci (Poey, 1860) (Teleostei: Epinephelidae) from the North Brazil Shelf.

Mycteroperca bonaci (black grouper) is one of the most sought species of grouper along its entire distribution, being a prime target for demersal line fisheries because of its high commercial value. Nonetheless, because of population declines the species is considered near threatened according to the IUCN red list. The present study aimed to determine the population parameters of M. bonaci, including growth, reproduction and mortality, and thus contributes to measures towards its conservation and management in the southwestern Atlantic. The sampling area is in the North Brazil Shelf, off Maranhão State, an area of intense fisheries development and yet poorly known. The large continental shelf harbours unique coral reef formations and has been declared an ecologically or biologically significant marine area (EBSA). Sampling on landing sites was carried out monthly between May 2017 and January 2019. A total of 137 black grouper specimens were sampled from commercial landings of artisanal fisheries. The size of the specimens ranged from 44 to 157 cm, and the weight varied from 0.976 to 54 kg. The length-weight was established: log(TW) = -11.26 + 3.01log(TL). Histological analysis of the gonads confirmed only the presence of female individuals, and the occurrence of individuals in the sexual transition was not recorded. Higher GSI values and higher frequency of spawning capable staged individuals occurred during the months of June to August, indicating spawning peaks. The estimated age of sexual maturity A50 for females was 4.62 years ( x _ 93 cm-TL). The growth parameters for the Von Bertalanffy model were TL∞ (cm): 185.5, k: 0.04, t0 (year): -4.75 (t0 not fixed) and TL∞ (cm): 141, k: 0.11 (t0  = 0 fixed). The total estimated mortality rate (Z) according to catch length presented a Z value = 0.11, and the natural mortality was M = 0.04 year-1 . This is the first study on the age and growth of M. bonaci in the SWA, a region where the species is considered as endangered according to Brazil's red list regional assessment. Only females were present in the samples, results that suggest either differential capturability of sexes because of distinct patterns of behaviour or distribution or an effect of selective mortality upon larger and older individuals, as the species is described as a protogynous hermaphrodite. This indicates the need to closely manage this population to avoid collapses. Recovery plans that have been planned by the Brazilian government but not yet implemented for the species must be put into practice to avoid progressive decline as fisheries target more remote areas.

Exploring volatility of carbon price in European Union due to COVID-19 pandemic.

The European Union (EU) Emissions Trading System is the most important means for the EU to achieve carbon neutrality, but it has been severely affected by the outbreak of COVID-19 in Europe, and carbon price have fluctuated sharply. Research on the driving factors of carbon price during this period will help maintain the stability of the carbon emissions trading market and promote the realization of carbon neutrality. This study selected the EU carbon allowance futures price as the research object and applied the Bai-Perron structural break test to analyze the factors that influences carbon price fluctuations using the Johansen cointegration technique and the Newey-West regression estimation. Studies have shown that the outbreak of COVID-19 and the "€750 billion green recovery plan" both had a significant impact on EU carbon price. Carbon price has also undergone significant structural changes. Under the influence of these two factors, the relationship between the level of economic development and carbon price displayed a short-term negative correlation. At the same time, oil price and interbank dismantling rates were also important factors affecting carbon price, while the impact of the clean development mechanism on carbon price was not significant. The study confirmed the effectiveness of the EU's "green recovery plan" in stabilizing the carbon market during the COVID-19 pandemic and will provide a reference for the formulation of economic recovery policies of countries around the world.

A supply chain disruption recovery strategy considering product change under COVID-19.

A recent global outbreak of Corona Virus Disease 2019 (COVID-19) has led to massive supply chain disruption, resulting in difficulties for manufacturers on recovering their supply chains in a short term. This paper presents a supply chain disruption recovery strategy with the motivation of changing the original product type to cope with that. In order to maximize the total profit from product changes, a mixed integer linear programming (MILP) model is developed with combining emergency procurement on the supply side and product changes by the manufacturer as well as backorder price compensation on the demand side. The model uses a heuristic algorithm based on ILOG CPLEX toolbox. Experimental results show that the proposed disruption recovery strategy can effectively reduce the profit loss of manufacturer due to late delivery and order cancellation. It is observed that the impact of supply chain disruptions is reduced. The proposed model can offer a potentially useful tool to help the manufacturers decide on the optimal recovery strategy whenever the supply chain system experiences a sudden massive disruption.

Genetic diversity and structure of the narrow endemic Seseli farrenyi (Apiaceae): implications for translocation.

Seseli farrenyi (Apiaceae) is an extremely narrow endemic plant, which is considered as one of the species of most conservation concern in Catalonia (NW Mediterranean Basin). Given the accelerated fragmentation and reduction of population size (of over 90%), the environmental agency of Catalonia is currently preparing a recovery plan that includes reinforcements of the extant populations. The present study is aimed at providing the necessary knowledge to carry out genetically-informed translocations, by using microsatellites as genetic markers. Fourteen microsatellites have been specifically developed for S. farrenyi, of which nine have been used. Besides the extant natural populations, the three ex situ collections that are known to exist of this species have also been studied, as they would be the donor sources for translocation activities. Our main finding is that levels of genetic diversity in the natural populations of S. farrenyi are still high (H e = 0.605), most likely as a result of a predominantly outcrossing mating system in combination with the limited time elapsed since the population decline. However, population fragmentation is showing the first genetic signs, as the values of genetic differentiation are relatively high, and two well-differentiated genetic lineages have been found even in such a narrow geographic range. These genetic results provide important information when designing conservation management measures.

Death by austerity? The impact of cost containment on avoidable mortality in Italy.

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south-to-north patient migration. These findings suggest that-even in a high-income country with relatively low avoidable mortality like Italy-spending cuts can hurt survival.

Challenges of the Slovenian Healthcare System Exposed in Hospitals' Recovery Plans.

In recent years, Slovenian public health has been a very prominent topic, both politically and professionally. In 2017, a one-off cash transfer to hospitals from the state budget in the total amount of EUR 136.24 million cash has been ensured to pay debts to suppliers of medical materials and medicines. At the same time, emergency legislation enacted the recovery plans to ensure operational and payment stability. The in-depth analysis of the recovery plans for 15 hospitals revealed that management boards highlight the infrastructure and financial challenges as the greatest, whereas the challenges concerning the services/products and patients/users are perceived to be less important.

COVID-19 Unintended Effects on Breast Cancer in Italy After the Great Lockdown.

Italy introduced social distancing measures, which limited the spread of COVID-19; all the non-life-threatening treatments have been temporarily suspended, including screening programs. This decision leads to unintended effects on the ability to detected neoplasia in their first stages. Possible future outcomes of the ability to detect new breast cancer cases based on two alternative scenarios show that the reduction in organized screening activities will limit the ability to detect no <3.43% of the new cases; the economic crisis will reduce voluntary screening, increasing the undetected new cases up to 11.73%. Cases diagnosed with delay will show up in their advanced stage along with unknown effects on mortality and health care costs. Global health care policies should be implemented to counterbalance these adverse effects.

Security and privacy preserving approaches in the eHealth clouds with disaster recovery plan.

Cloud computing was introduced as an alternative storage and computing model in the health sector as well as other sectors to handle large amounts of data. Many healthcare companies have moved their electronic data to the cloud in order to reduce in-house storage, IT development and maintenance costs. However, storing the healthcare records in a third-party server may cause serious storage, security and privacy issues. Therefore, many approaches have been proposed to preserve security as well as privacy in cloud computing projects. Cryptographic-based approaches were presented as one of the best ways to ensure the security and privacy of healthcare data in the cloud. Nevertheless, the cryptographic-based approaches which are used to transfer health records safely remain vulnerable regarding security, privacy, or the lack of any disaster recovery strategy. In this paper, we review the related work on security and privacy preserving as well as disaster recovery in the eHealth cloud domain. Then we propose two approaches, the Security-Preserving approach and the Privacy-Preserving approach, and a disaster recovery plan. The Security-Preserving approach is a robust means of ensuring the security and integrity of Electronic Health Records, and the Privacy-Preserving approach is an efficient authentication approach which protects the privacy of Personal Health Records. Finally, we discuss how the integrated approaches and the disaster recovery plan can ensure the reliability and security of cloud projects.

Strategies for dealing with fraud in clinical trials.

Research misconduct and fraud in clinical research is an increasing problem facing the scientific community. This problem is expected to increase due to discoveries in central statistical monitoring and with the increase in first-time clinical trial investigators in the increasingly global reach of oncology clinical trials. This paper explores the most common forms of fraud in clinical trials in order to develop offensive and defensive strategies to deal with fraud. The offensive strategies are used when fraud is detected during a trial and the defensive strategies are those design strategies that seek to minimize or eliminate the effect of fraud. This leads to a proposed fraud recovery plan (FRP) that would be specified before the start of a clinical trial and would indicate actions to be taken upon detecting fraud of different types. Statistical/regulatory issues related to fraud include: dropping all patients from a site that committed fraud, or just the fraudulent data (perhaps replacing the latter through imputation); the role of intent-to-treat analysis; effect on a planned interim analysis; effect on stratified analyses and model adjustment when fraud is detected in covariates; effect on trial-wide randomization, etc. The details of a typical defensive strategy are also presented. It is concluded that it is best to follow a defensive strategy and to have an FRP in place to follow if fraud is detected during the trial.

Groundwater chemical baseline values to assess the Recovery Plan in the Matanza-Riachuelo River basin, Argentina.

The two most exploited aquifers in the Matanza-Riachuelo River basin are being monitored in the framework of the Integrated Environmental Sanitation Plan that implements the Basin Authority, Autoridad de Cuenca Matanza Riachuelo. In this context, this work identifies the groundwater chemical types and the natural processes behind them; determines spatial and temporal changes; establishes ranges of variation for chemical components, and proposes concentration values for the upper limit of the natural chemical background. A total of 1007 samples from three aquifer-layers (Upper Aquifer, top and bottom of Puelche Aquifer) have been studied. As concrete guidelines for practical determination of baseline values are not available in the region, the methodology used follows the proposals of European projects which assessed European water directives. The groundwater composition is very stable in terms of both chemical facies and mineralization degree, and the changes observed in the dry and wet periods analysed are subtle in general. Most of the groundwater is Na-HCO3 type, except a few samples that are Ca-HCO3, Na-ClSO4 and Na-Cl types. The Ca-HCO3 waters are the result of calcium carbonate dissolution, Na-HCO3 waters result from cation exchange and carbonate dissolution, while in the Na-ClSO4 and Na-Cl waters, mixing with connate and with encroached old marine water from the underlying and overlying sediments are the most relevant processes. The proposed values for the upper limit of the natural background consider the influence of geology and Holocene marine ingressions in the baseline of coastal groundwater. This study allowed to know the initial chemical conditions of the groundwater system of the Matanza-Riachuelo River basin and to establish the reference from which Basin Authority can start to evaluate trends and monitor the recovery plan. At the same time, it sets a precedent for future studies in the region.

The need to improve implementation and use of lifestyle surveillance systems for planning prevention activities: an analysis of the Italian Regions.

OBJECTIVES: To describe the level of use of lifestyle surveillance systems in Italy and to identify predictors of their use by the Italian Regions for planning and monitoring purposes. STUDY DESIGN: Data were extracted from the 19 Regional Prevention Plans (RPPs) and the health promotion and prevention projects included in them developed by the Italian Regions within the National Prevention Plan 2010-2013. METHODS: The 19 RPPs and the 702 projects were appraised using a tool specifically developed for the purpose. Multiple logistic regression was performed to identify predictors of use of surveillance systems in the 359 projects that could use them. RESULTS: The analysis of regional epidemiological contexts does not always rely upon surveillance system data and there were too few projects aimed at the maintenance and the development of these systems. Moreover, fewer than half of projects that could have used surveillance systems for planning and evaluation procedures actually did so, despite the potential value of these data. There was a statistically significant association between Regional Health Care Expenditure (RHCE) and the use of surveillance system data for planning and/or evaluation of the projects (OR 7.81, 95% CI 2.86-21.29). CONCLUSIONS: Use of surveillance systems for regional prevention planning in Italy is not optimal due to late implementation, presence of different data collecting systems and RGDP inequalities. There is a pressing need for full implementation of surveillance systems to allow better definition of the priorities and objectives of public health interventions.

Assessing the impact of the U.S. Endangered Species Act recovery planning guidelines on managing threats for listed species.

The Endangered Species Act (ESA) of the United States was enacted in 1973 to prevent the extinction of species. Recovery plans, required by 1988 amendments to the ESA, play an important role in organizing these efforts to protect and recover species. To improve the use of science in the recovery planning process, the Society for Conservation Biology (SCB) commissioned an independent review of endangered species recovery planning in 1999. From these findings, the SCB made key recommendations for how management agencies could improve the recovery planning process, after which the U.S. Fish and Wildlife Service and the National Marine Fisheries Service redrafted their recovery planning guidelines. One important recommendation called for recovery plans to make threats a primary focus, including organizing and prioritizing recovery tasks for threat abatement. We sought to determine the extent to which results from the SCB study were incorporated into these new guidelines and whether the SCB recommendations regarding threats manifested in recovery plans written under the new guidelines. Recovery planning guidelines generally incorporated the SCB recommendations, including those for managing threats. However, although recent recovery plans have improved in their treatment of threats, many fail to adequately incorporate threat monitoring. This failure suggests that developing clear guidelines for monitoring should be an important priority in improving ESA recovery planning.

Current practices in the identification of critical habitat for threatened species.

The term critical habitat is used to describe the subset of habitat that is essential to the survival and recovery of species. Some countries legally require that critical habitat of listed threatened and endangered species be identified and protected. However, there is little evidence to suggest that the identification of critical habitat has had much impact on species recovery. We hypothesized that this may be due at least partly to a mismatch between the intent of critical habitat identification, which is to protect sufficient habitat for species persistence and recovery, and its practice. We used content analysis to systematically review critical habitat documents from the United States, Canada, and Australia. In particular, we identified the major trends in type of information used to identify critical habitat and in occupancy of habitat identified as critical. Information about population viability was used to identify critical habitat for only 1% of the species reviewed, and for most species, designated critical habitat did not include unoccupied habitat. Without reference to population viability, it is difficult to determine how much of a species' occupied and unoccupied habitat will be required for persistence. We therefore conclude that the identification of critical habitat remains inconsistent with the goal of protecting sufficient habitat to support persistence and recovery of the species. Ensuring that critical habitat identification aligns more closely with its intent will improve the accuracy of the designations and may therefore help improve the benefits to species recovery when combined with adequate implementation and enforcement of legal protections.

Climate change, marine environments, and the US Endangered species act.

Climate change is expected to be a top driver of global biodiversity loss in the 21st century. It poses new challenges to conserving and managing imperiled species, particularly in marine and estuarine ecosystems. The use of climate-related science in statutorily driven species management, such as under the U.S. Endangered Species Act (ESA), is in its early stages. This article provides an overview of ESA processes, with emphasis on the mandate to the National Marine Fisheries Service (NMFS) to manage listed marine, estuarine, and anadromous species. Although the ESA is specific to the United States, its requirements are broadly relevant to conservation planning. Under the ESA, species, subspecies, and "distinct population segments" may be listed as either endangered or threatened, and taking of most listed species (harassing, harming, pursuing, wounding, killing, or capturing) is prohibited unless specifically authorized via a case-by-case permit process. Government agencies, in addition to avoiding take, must ensure that actions they fund, authorize, or conduct are not likely to jeopardize a listed species' continued existence or adversely affect designated critical habitat. Decisions for which climate change is likely to be a key factor include: determining whether a species should be listed under the ESA, designating critical habitat areas, developing species recovery plans, and predicting whether effects of proposed human activities will be compatible with ESA-listed species' survival and recovery. Scientific analyses that underlie these critical conservation decisions include risk assessment, long-term recovery planning, defining environmental baselines, predicting distribution, and defining appropriate temporal and spatial scales. Although specific guidance is still evolving, it is clear that the unprecedented changes in global ecosystems brought about by climate change necessitate new information and approaches to conservation of imperiled species. El Cambio Climático, los Ecosistemas Marinos y el Acta Estadunidense de Especies en Peligro.

An axis for risk management in classificatory systems as a contribution to efficient clinical practice.

Comprehensive clinical assessment and patient management plans have been enhanced by the development of multiaxial classificatory systems. Assessment of risk is an essential clinical task for which the conclusions are not currently reflected in the multiaxial diagnostic schemata. Developments in the understanding of risk and its management make possible consideration of its place in multiaxial systems. The structure and principles of a potentially workable axis, summarizing current knowledge of risk in the domains of suicide, self-neglect and violence to others, are described. Clinicians are more likely to use this axis than the multiple, emerging, risk assessment guidelines. Incorporating risk management would be a practical addition to presently available axes and be very widely clinically applicable.