How strong is the evidence supporting the WHO guidelines on physical activity, sedentary behaviour and sleep in early childhood?

BACKGROUND: The WHO issued recommendations about the ideal amount of physical activity, sedentary behaviour and sleep in infants, toddlers and preschool children. To facilitate their interpretation and translation into public health policies, we analysed the quantity and quality of the evidence that supported the development of each WHO recommendation. METHODS: All data for each exposure-outcome pair analysed in the studies informing WHO guidelines were extracted, and predefined criteria, based upon GRADE methodology, were used to classify each outcome and study result. RESULTS: Among the 237 studies that could be included, 37 were experimental and 200 were observational, yielding 920 analyses of exposure-outcome associations. Sixty-two analyses used a relevant outcome, with or without significant results. Five of the 10 WHO recommendations were based upon zero analyses with significant results on relevant health outcomes. The remaining recommendations were mostly based upon analyses evaluating obesity-related outcomes. Eight of the 10 GLs thresholds were not supported by any significant analysis on clinically relevant outcomes. CONCLUSION: While these findings should not be interpreted as an attempt to disprove the benefits of healthy lifestyle habits in early childhood, neither to minimize the work of the experts in this complex research field, very limited evidence currently supports the adoption of recommended thresholds as behavioural surveillance and public health interventions targets. Therefore, until further data are available, public health interventions should be developed balancing whether to focus on the achievement of specific targets that are still not supported by high-quality evidence or on the general promotion of healthy behaviours.

Vaccination hesitancy: agreement between WHO and ChatGPT-4.0 or Gemini Advanced.

Background: An increasing number of individuals use online Artificial Intelligence (AI) - based chatbots to retrieve information on health-related topics. This study aims to evaluate the accuracy in answering vaccine-related answers of the currently most commonly used, advanced chatbots - ChatGPT-4.0 and Google Gemini Advanced. Methods: We compared the answers provided by the World Health Organization (WHO) to 38 open questions on vaccination myths and misconception, with the answers created by ChatGPT-4.0 and Gemini Advanced. Responses were considered as "appropriate", if the information provided was coherent and not in contrast to current WHO recommendations or to drug regulatory indications. Results and Conclusions: The rate of agreement between WHO answers and Chat-GPT-4.0 or Gemini Advanced was very high, as both provided 36 (94.7%) appropriate responses. The few discrepancies between WHO and AI-chatbots answers could not be considered "harmful", and both chatbots often invited the user to check reliable sources, such as CDC or the WHO websites, or to contact a local healthcare professional. In their current versions, both AI-chatbots may already be powerful instrument to support the traditional communication tools in primary prevention, with the potential to improve health literacy, medication adherence, and vaccine hesitancy and concerns. Given the rapid evolution of AI-based systems, further studies are strongly needed to monitor their accuracy and reliability over time.

Language barriers during vaccination practice, the point of view of healthcare providers.

Background: Language barriers are one of the main obstacles faced by migrants in accessing healthcare services. A compromised communication between migrants and Healthcare Providers in vaccination setting can result in increased vaccine hesitancy and decreased vaccine uptake. The objective of the current study is to investigate Healthcare Providers' perceptions about linguistic barriers faced during both routinary vaccination practice and the extraordinary vaccination program for Ukrainian refugees in the Local Health Authorities of Bologna and Romagna (Italy). Methods: A cross-sectional study was conducted through the administration of a questionnaire examining Healthcare Providers' perceptions. A descriptive analysis and a multiple logistic regression model were adopted to analyze the collected data. Results: Language barriers resulted as an obstacle to informed consent and to doctor-patient relationship. The strategies adopted were perceived as helpful in increasing vaccination adherence, despite communication difficulties were still experienced during refugees' vaccinations. Results suggest that the implementation of translated material and the use of professional interpreters may represent important strategies to overcome linguistic barriers, along with Healthcare Providers' training. Healthcare Providers' opinions could assist the implementation of new tools capable of countering language barriers. Conclusions: The current study represents an example of providers' involvement in understanding the complexities behind the issue of language barriers in vaccination practice.

Impact of the Italian Healthcare Outcomes Program (PNE) on the Care Quality of the Poorest Performing Hospitals.

One of the main aims of the Italian National Healthcare Outcomes Program (Programma Nazionale Esiti, PNE) is the identification of the hospitals with the lowest performance, leading them to improve their quality. In order to evaluate PNE impact for a subset of outcome indicators, we evaluated whether the performance of the hospitals with the lowest scores in 2016 had significantly improved after five years. The eight indicators measured the risk-adjusted likelihood of the death of each patient (adjusted relative risk-RR) 30 days after the admission for acute myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease, chronic kidney disease, femur fracture or lung and colon cancer. In 2016, the PNE identified 288 hospitals with a very low performance in at least one of the selected indicators. Overall, 51.0% (n = 147) of these hospitals showed some degree of improvement in 2021, and 27.4% of them improved so much that the death risk of their patients fell below the national mean value. In 34.7% of the hospitals, however, the patients still carried a mean risk of death >30% higher than the average Italian patient with the same disease. Only 38.5% of the hospitals in Southern Italy improved the scores of the selected indicators, versus 68.0% in Northern and Central Italy. Multivariate analyses, adjusting for the baseline performance in 2016, confirmed univariate results and showed a significantly lower likelihood of improvement with increasing hospital volume. Despite the overall methodological validity of the PNE system, current Italian policies and actions aimed at translating hospital quality scores into effective organizational changes need to be reinforced with a special focus on larger southern regions.

Immunogenicity and Safety of Chikungunya Vaccines: A Systematic Review and Meta-Analysis.

Several vaccines against chikungunya fever have been developed and tested, and one has been recently licensed. We performed a meta-analysis to estimate the immunogenicity and safety of all chikungunya vaccines that have been progressed to clinical trial evaluation (VLA1553; mRNA-1388/VAL-181388; PXVX0317/VRC-CHKVLP059-00-VP; ChAdOx1 Chik; MV-CHIK). We included trials retrieved from MedLine, Scopus, and ClinicalTrials.gov. The outcomes were the rates of seroconversion/seroresponse and serious adverse events (SAEs) after the primary immunization course. We retrieved a total of 14 datasets, including >4000 participants. All candidate chikungunya vaccines were able to elicit an immunogenic response in ≥96% of vaccinated subjects, regardless of the vaccination schedule and platform used, and the seroconversion/seroresponse rates remained high 6 to 12 months after vaccination for most vaccines. Four of the five candidate vaccines showed a good overall safety profile (no data were available for ChAdOx1 Chik), with no significant increase in the risk of SAEs among the vaccinated, and a low absolute risk of product-related SAEs. Overall, the present findings support the potential use of the candidate vaccines for the prevention of chikungunya and the current indication for use in adult travelers to endemic regions of the licensed VLA 1553 vaccine. In order to extend chikungunya vaccination to a wider audience, further studies are needed on individuals from endemic countries and frail populations.

Immunogenicity, Safety and Efficacy of the Dengue Vaccine TAK-003: A Meta-Analysis.

The TAK-003 dengue vaccine was licensed in Europe in December 2022, and the official recommendations from most EU countries are still under formulation. To support policymakers, we performed a meta-analysis to quantify TAK-003's immunogenicity, efficacy and safety among seronegative and seropositive populations after the administration of one or two vaccine doses. We included trials retrieved from MEDLINE, Scopus and ClinicalTrials.gov. The outcomes were the rates of seroconversion, virologically confirmed dengue fever and serious adverse events after each vaccine dose. Data were combined using random-effect proportion or head-to-head meta-analyses. We retrieved a total of 19 datasets, including >20,000 participants. TAK-003 showed an excellent safety profile, and the immunogenicity after two doses against the four DENV serotypes was ≥90% among both adults and children/adolescents who were either seronegative or seropositive at baseline. A single dose was able to elicit a high immunogenic response among adults (≥70%) and children/adolescents (≥90%). The primary two-dose immunization course halved the risk of all types of virologically confirmed dengue fever among seropositive children/adolescents, but seronegative minors were only protected against the diseases caused by DENV-1 and DENV-2. Overall, the results support the use of TAK-003 for the prevention of dengue fever in the pediatric population of endemic countries. Uncertainties remain on the use of a single vaccine dose in non-endemic countries.

Impacts of Urban Green on Cardiovascular and Cerebrovascular Diseases-A Systematic Review and Meta-Analysis.

Cardiovascular diseases (CVDs) are a leading cause of mortality globally. In particular, ischemic heart diseases (IHDs) and cerebrovascular diseases (CBVDs) represent the main drivers of CVD-related deaths. Many literature examples have assessed the association between CVD risk factors and urban greenness. Urban green (UG) may positively affect physical activity, reduce air and noise pollution, and mitigate the heat island effect, which are known risk factors for CVD morbidity. This systematic review aims to assess the effects of urban green spaces on CVD morbidity and mortality. Peer-reviewed research articles with a quantitative association between urban green exposure variables and cardiovascular and cerebrovascular outcomes were included. Meta-analyses were conducted for each outcome evaluated in at least three comparable studies. Most of the included studies' results highlighted an inverse correlation between exposure to UG and CVD outcomes. Gender differences were found in four studies, with a protective effect of UG only statistically significant in men. Three meta-analyses were performed, showing an overall protective effect of UG on CVD mortality (HR (95% CI) = 0.94 (0.91, 0.97)), IHD mortality (HR (95% CI) = 0.96 (0.93, 0.99)), and CBVD mortality (HR (95% CI) = 0.96 (0.94, 0.97)). The results of this systematic review suggest that exposure to UG may represent a protective factor for CVDs.

Participants Characteristics of a Park-Based Physical Activity Intervention in an Urban Context-A Cross-Sectional Study in Bologna, Italy.

Physical inactivity, a leading risk factor for chronic diseases and premature death, is prevalent worldwide. This study focuses on participant profiles and factors influencing continued participation and physical activity (PA) levels in the "Moving Parks" PA intervention in Bologna, Italy. This intervention offers free group activities in city parks during the summer. A questionnaire was administered to participants in 2022, gathering data on socio-demographic information, chronic diseases, participation in previous iterations, and PA levels. Out of 596 respondents, 85% were women, and the average age was 50. About 56% held a university degree, and 73% exercised regularly in the winter. Continuous participation was linked to older age, higher education, and chronic conditions. Prior participation predicted higher winter PA levels. Notably, the majority of participants were educated, physically active women. While the project continually engages individuals with higher education and chronic conditions, it needs further tailoring to reach less represented populations.

The Role of Needle Fear in Pediatric Flu Vaccine Hesitancy: A Cross-Sectional Study in Bologna Metropolitan Area.

(1) Background: vaccination is the most effective way to prevent influenza and reduce its complications. The main aim of the study is to assess a possible increase of parents'/caregivers' pediatric flu vaccination adherence due to a nasal administration as an alternative to injection in Bologna. (2) Methods: 169 parents/guardians of children who were joining the COVID-19 pediatric vaccination session in Bologna were interviewed. The results were summarized using descriptive statistics. A multiple logistic regression model was used to assess the determinants of the change in flu vaccine uptake if offered without injection administration. All analyses were conducted using STATA and R-Studio software. (3) Results: Only 29.0% of parents were informed about pediatric flu vaccination by pediatricians, and 32.5% heard about pediatric flu vaccination. Almost 72.2% of parents declared that they would not have their children vaccinated against influenza. Thus, 40.2% of them changed their opinion after being informed about the existence of a non-injective vaccine. Needle fear in children turned out to be a determinant of this opinion change (OR = 3.79; 95% CI = 1.63-9.43; p = 0.003). (4) Conclusions: the study has confirmed that needle fear is a determinant of vaccine hesitancy and that a different method of administration may increase parents'/guardians' adherence.