Probable airborne transmission in a nosocomial Sars-CoV-2 outbreak with an high attack rate.

Throughout the current COVID-19 pandemic, preventing nosocomial COVID-19 outbreaks has been a significant challenge for hospitals. It is essential to understand the ways in which SARS-CoV-2 spreads in healthcare settings to apply proper infection prevention and control (IPC) measures. The objectives of this study are to report on the hospital's response to a COVID-19 cluster and the transmission dynamics in a hospital ward of Geriatrics, Rehabilitation and Long term care. The study will focus specifically on how insufficient air replacement and directional airflow in indoor settings may have contributed to the transmission of the virus.

Use of healthcare services at the end of life in decedents compared to their surviving counterparts: A case-control study among adults born before 1946 in Friuli Venezia Giulia.

BACKGROUND: There is a heterogeneous literature on healthcare utilization patterns at the end of life. The objective of this study is to examine the impact of closeness to death on the utilization of acute hospital-based healthcare services and some primary healthcare services and compare differences in gender, age groups and major causes of death disease specific mortality. METHODS: A matched case-control study, nested in a cohort of 411,812 subjects, linked to administrative databases was conducted. All subjects were residents in the Friuli Venezia Giulia Region (Italy), born before 1946, alive in January 2000 and were followed up to December 2014. Overall, 158,571 decedents/cases were matched by gender and year of birth to one control, alive at least one year after their matched case's death (index-date). Hospital admissions, emergency department visits, drug prescriptions, specialist visits and laboratory tests that occurred 365 days before death/index-date, have been evaluated. Odds Ratios (ORs) for healthcare utilization were estimated through conditional regression models, further adjusted for Charlson Comorbidity Index and stratified by gender, age groups and major causes of death. RESULTS: Decedents were significantly more likely of having at least one hospital admission (OR 7.0, 6.9-7.1), emergency department visit (OR 5.2, 5.1-5.3), drug prescription (OR 2.8, 2.7-2.9), specialist visit (OR 1.4, 1.4-1.4) and laboratory test (OR 2.7, 2.6-2.7) than their matched surviving counterparts. The ORs were generally lower in the oldest age group (95+) than in the youngest (55-74). Healthcare utilization did not vary by sex, but was higher in subjects who died of cancer. CONCLUSION: Closeness to death appeared to be strongly associated with healthcare utilization in adult/elderly subjects. The risk seems to be greater among younger age groups than older ones, especially for acute based services. Reducing acute healthcare at the EOL represents an important issue to improve the quality of life in proximity to death.

Socioeconomic factors influencing childhood vaccination in two northern Italian regions.

BACKGROUND: Infant vaccination rates have been declining in Italy over the past 5-7years. The aims of this study were to assess the trend in the proportions of children unvaccinated at 24months old, to identify sociodemographic factors associated with non-vaccination; and to examine changes in parental attitudes to vaccination over time. METHODS: We conducted a population-based birth cohort study by combining existing electronic data sets. The study population consisted of children born from 1995 to 2010 in the Friuli-Venezia Giulia (FVG) region, and from 2007 to 2011 in part of the Emilia Romagna (ER) region, in north-eastern Italy. The immunization registers were linked with the medical birth registers, which contain sociodemographic data on both parents and the newborn. Unconditional logistic regressions were used to identify associations between vaccine uptake at 24months and maternal sociodemographic variables. RESULTS: Of 145,571 babies born in FVG and 75,308 in ER, there were 4222 (1.9%) who had not been vaccinated at all, and 23,948 (11.0%) without the optional measles, mumps and rubella (MMR) vaccination. The number of unvaccinated infants increased over time. Mothers who were over 35 or under 25years old, unmarried, with a higher formal education, and citizens of highly-developed countries were less compliant with vaccination recommendations in both the regions. A cohort effect was observed in FVG, for both educational level and citizenship: babies born between 1995 and 2000 to mothers without an Italian citizenship and with a lower formal education were more likely to refuse vaccination for their offspring, while this association was reversed between 2006 and 2010. CONCLUSIONS: Mothers who are Italian citizens and have a good formal education have begun to refuse vaccination for their children in recent years. Future public health action in this setting should target highly educated parents.

Do I need training in public health ethics? A survey on Italian residents' beliefs, knowledge and curricula.

INTRODUCTION: Ethics is needed to support the decision-making process in public health and to face moral issues during practice. However, professionals are often not adequately trained. OBJECTIVES: In 2015, the National Conference of Public Health Medical Residents of the Italian Society of Public Health started the "Public Health Ethics" workgroup to evaluate how the Italian Schools of Public Health train their residents in ethics, and which are residents' beliefs, knowledge and attitudes about public health ethics. METHODS: A survey was built and emailed to the Italian public health residents. RESULTS: Residents are interested in ethics/bioethics (83.2%) and are aware of its importance for professional practice (97.2%). However, few of them (19.6%) evaluated their competence above a satisfactory level. They believe that a training in ethics should be offered during residency (92.1%). Nonetheless, in Italy only two schools required a course on bioethics, and one a course in public health ethics. According to residents, a public health ethics trainer should be a public health professional (23.2%) or a social scientist (22.8%). CONCLUSIONS: In Italy, Schools of Public Health do not train future professionals in ethics or public health ethics during residency. Training should be implemented in curricula, and trainers should have a strong competence in both public health and ethics.

[Knowledge, attitudes, and training needs of residents in Preventive Medicine and Hygiene in Italy, in the context of Primary Health Care]. / Ricognizione dei bisogni formativi dei medici specializzandi di Igiene e Medicina Preventiva nell'ambito dell'Assistenza Primaria: risultati di una survey online.

In June 2015, the working group "Primary Health Care" of the Italian Society of Hygiene Representatives of Hygiene and Preventive Medicine Residents, performed an online questionnaire survey among residents of this specialty in Italy, to analyze their training needs regarding primary health care. In total, 730 residents in 32 schools were invited to participate by email, of whom 40.7% (297/730) completed the questionnaire. Most of the respondents were female (66.7%) and 40.1% were enrolled in a school in northern Italy. Almost half of participating residents were enrolled in the second or third year of the five-year program. Over 65% reported interest in deepening their knowledge in each of the proposed thematic areas of primary healthcare. For each area, less than one quarter of respondents (range 5-22%) considered satisfactory the skillsets acquired in that area. Eighty-seven percent reported that the option to do electives in primary health care during the residency was available to them.

[Investigation on the health effects of traffic-related air pollution from Mestre motorway (Veneto Region, Northern Italy)]. / Studio degli effetti sulla salute da esposizione all'inquinamento della tangenziale di Mestre.

OBJECTIVES: to evaluate whether living near motorway A57 (Mestre motorway, Veneto Region, Northern Italy) might have affected the residents' health status. DESIGN: longitudinal cohort study. SETTING AND PARTICIPANTS: 148,673 residents on the mainland in the Municipality of Venice (Mestre) who never changed their residence during the follow- up period (2002-2009). MAIN OUTCOMES MEASURES: the 2001 Italian census data were linked with the data sources of the epidemiological integrated system which includes: population registry, death certificates, hospital discharges, drug prescriptions, and tax exemption. Mortality and incidence for several subgroups of causes, incidence of acute myocardial infarction and stroke, and prevalence of asthma, chronic obstructive pulmonary disease, ischemic cardiopathy and diabetes were estimated. The ADMS-Urban model was adopted to define three different exposure areas based on PM10 emissions from the motorway: A (highly exposed), B (moderately exposed) used as a comparison for the analysis, C (unexposed). Hazard ratios (HR) for incidence and mortality were estimated from Cox proportional hazard models adjusted for calendar period, age, gender, and instruction level. The relationship between the exposure area and prevalence was investigated by multiple logistic regression analysis adjusted for the same covariates. RESULTS: compared with B area (23.25%of the population under study), people living in A area (3.16% of the population under study) had an increased incidence of acute myocardial infarction (HR: 1.43; 95%CI 1.03-1.97) in females, and prevalence of ischemic cardiopathy (odds ratio - OR: 1.12; 95%CI 1.01-1.26) in both genders. Results were borderline for COPD in males (OR: 1.17; 95%CI 0.97-1.41). Positive but nonsignificant associations were found with pneumonia and respiratory recoveries. CONCLUSIONS: this study showed that residents who live near Mestre motorway had an increased prevalence of some cardiorespiratory diseases, particularly ischemic cardiopathy.

Monitoring the web to support vaccine coverage: results of two years of the portal VaccinarSì.

OBJECTIVES: The increasingly widespread use of the Internet by the population to collect information regarding health and medical treatments and the circulation of many non-scientific documents on the effectiveness and safety of vaccines has led the Italian Society of Hygiene (SItI), in 2013, to promote a portal to provide scientific information that is verified and easily understood to counteract the rampant misinformation on health treatments and combat the phenomenon of vaccine hesitancy. METHODS: The project was launched in May 2013 and provides a portal with six main sections (vaccine preventable diseases, registered vaccines, benefits and risks of vaccination, against misinformation, pros & cons and travel immunizations) and other headings that relate to scientific events, comics and news coverage concerning vaccines. The contents are validated and evaluated by a scientific committee of high profile scientists and experts in computer-mediated communication. RESULTS: In the first two years of activity, the portal has published more than 250 web pages on all aspects related to vaccinations. The number of individual users was 860,411, with a constant increase over time. Of these, about 21.7% returned to the website at least once. The total visits in 24 months were 1,099,670, with a total page count of 2,530,416. The frequency of contact was almost exclusively Italian (95.6%), with a higher proportion of males (54.1%) and younger age groups (25-34 years, 33.5%, and18-24 years, 27.5%). The data also show a significant position of the website in the major web search engines. The website has been certified by the Health On the Net Foundation. It is connected with the main social networks and it has recently opened its first regional section (Veneto). CONCLUSIONS: The strong, progressive increase in web contacts, the involvement of several institutional bodies, and the appreciation of various stakeholders give an absolutely positive assessment of the first two years of the VaccinarSì project. The success of the website suggests future developments, with updates, sections devoted to regional problems, in-depth news analysis, and international expansion. The authors conclude that initiatives like this are to be implemented and constitute an effective way to counteract vaccine hesitancy.