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1.
BMC Public Health ; 22(1): 143, 2022 01 20.
Article in English | MEDLINE | ID: mdl-35057781

ABSTRACT

BACKGROUND: Migrants and ethnic minorities have suffered a disproportionate impact of the COVID-19 pandemic compared to the general population from different perspectives. Our aim was to assess specifically their risk of infection in the 53 countries belonging to the World Health Organization European Region, during the first year of the pandemic. METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42021247326). We searched multiple databases for peer-reviewed literature, published on Medline, Embase, Scisearch, Biosis and Esbiobase in 2020 and preprints from PubMed up to 29/03/2021. We included cross-sectional, case-control, cohort, intervention, case-series, prevalence or ecological studies, reporting the risk of SARS-CoV-2 infection among migrants, refugees, and ethnic minorities. RESULTS: Among the 1905 records screened, 25 met our inclusion criteria and were included in the final analysis. We found that migrants and ethnic minorities during the first wave of the pandemic were at increased exposure and risk of infection and were disproportionately represented among COVID-19 cases. However, the impact of COVID-19 on minorities does not seem homogeneous, since some ethnic groups seem to be more at risk than others. Risk factors include high-risk occupations, overcrowded accommodations, geographic distribution, social deprivation, barriers to access to information concerning preventive measures (due to the language barrier or to their marginality), together with biological and genetic susceptibilities. CONCLUSIONS: Although mixed methods studies will be required to fully understand the complex interplay between the various biological, social, and cultural factors underlying these findings, the impact of structural determinants of health is evident. Our findings corroborate the need to collect migration and ethnicity-disaggregated data and contribute to advocacy for inclusive policies and programmatic actions tailored to reach migrants and ethnic minorities.


Subject(s)
COVID-19 , Transients and Migrants , Cross-Sectional Studies , Ethnic and Racial Minorities , Humans , Pandemics , SARS-CoV-2 , Social Deprivation , World Health Organization
2.
Eur Arch Otorhinolaryngol ; 274(5): 2307-2317, 2017 May.
Article in English | MEDLINE | ID: mdl-28213776

ABSTRACT

Drug-Induced Sedation Endoscopy (DISE) consists of the direct observation of the upper airways during sedative-induced sleep, allowing the identification of the sites of pharyngeal collapse, which is the main pathological event in Obstructive Sleep Apnea (OSA). The Authors have compared Target Controlled Infusion (TCI) sedation endoscopy (TCI-DISE) technique to conventional DISE (CDISE), performed by a manual bolus injection of sedative agent, to recreate accurately and safely snoring and apnea patterns comparable to natural sleep. The authors conducted a prospective, randomized, long-term study and a retrospective analysis of surgical outcomes. The apnea-event observation and its correlation with pharyngeal collapse patterns is the primary endpoint; secondary endpoints are defined as stability and safety of sedation plan of DISE-TCI technique. From January 2009 to January 2011, OSA patients were included in the study and randomly allocated into two groups: the bolus injection conventional DISE group and the TCI-DISE group. Third endpoint is to compare the surgical outcomes enrolling OSA patients from January 2009 to June 2015. We recorded the complete apnea-event at oropharynx and hypopharynx levels in 15/50 pts in conventional DISE group (30%) and in 99/123 pts in TCI-DISE group (81%) (p < 0.0001). Four pts needed oxygen in conventional DISE group because a severe desaturation occurred during the first bolus of propofol (1 mg/kg) (p = 0.4872 ns). We recorded instability of the sedation plan in 13 patients of conventional DISE group (65%) and 1 patient of the TCI-DISE group (5%) (p = 0.0001). In 37 TCI-DISE group surgical patients we reported a significant reduction of postoperative AHI (from 42.7 ± 20.2 to 11.4 ± 10.3) in comparison with postoperative AHI in 15 C-DISE group surgical patients (from 41.3 ± 23.4 to 20.4 ± 15.5) (p = 0.05). Our results suggest the DISE-TCI technique as first choice in performing sleep-endoscopy because of its increased accuracy, stability and safety. However, it is mandatory an accurate assessment of PSG/PM, which allows us to differentiate OSA patients in whom UA anatomical abnormalities are predominant in comparison with not-anatomical pathophysiologic factors, achieving good surgical patient's selection and outcomes as a consequence.


Subject(s)
Anesthesia/methods , Endoscopy/methods , Propofol/administration & dosage , Sleep Apnea, Obstructive/diagnosis , Adult , Clinical Decision-Making , Drug Administration Schedule , Drug Monitoring/methods , Female , Humans , Hypnotics and Sedatives/administration & dosage , Male , Middle Aged , Monitoring, Intraoperative/methods , Patient Selection , Sleep Apnea, Obstructive/physiopathology , Treatment Outcome
3.
Int J Public Health ; 68: 1605580, 2023.
Article in English | MEDLINE | ID: mdl-37609078

ABSTRACT

Objectives: Access to vaccination for newly arrived migrants (NAMs) is a relevant concern that requires urgent attention in EU/EEA countries. This study aimed to develop a General Conceptual Framework (GCF) for understanding how to improve vaccination coverage for NAMs, by characterizing and critically analyzing system barriers and possible strategies to increase vaccination. Methods: A theoretical conceptualization of the GCF was hypothesized based on conceptual hubs in the immunization process. Barriers and solutions were identified through a non-systematic desktop literature review and qualitative research. The GCF guided the activities and facilitated the integration of results, thereby enriching the GCF with content. Results: The study explores the vaccination of NAMs and proposes strategies to overcome barriers in their vaccination process. It introduces a framework called GCF, which consists of five interconnected steps: entitlement, reachability, adherence, achievement, and evaluation of vaccination. The study also presents barriers and solutions identified through literature review and qualitative research, along with strategies to enhance professionals' knowledge, improve reachability, promote adherence, achieve vaccination coverage, and evaluate interventions. The study concludes by recommending strategies such as proximity, provider training, a migrant-sensitive approach, and data collection to improve vaccination outcomes for NAMs. Conclusion: Ensuring equitable access to healthcare services, including vaccination, is crucial not only from a humanitarian perspective but also for the overall public health of these countries.


Subject(s)
Transients and Migrants , Vaccination Coverage , Humans , Vaccination , Data Collection , Europe
4.
J Int Migr Integr ; : 1-31, 2023 Jan 11.
Article in English | MEDLINE | ID: mdl-36647529

ABSTRACT

The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans. Supplementary Information: The online version contains supplementary material available at 10.1007/s12134-023-01007-x.

5.
Microorganisms ; 10(4)2022 Mar 28.
Article in English | MEDLINE | ID: mdl-35456774

ABSTRACT

Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78-9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented.

6.
J Clin Med ; 11(5)2022 Mar 07.
Article in English | MEDLINE | ID: mdl-35268538

ABSTRACT

The COVID-19 pandemic has increased the healthcare-associated infection (HAI) risk in intensive care unit (ICU) patients. However, a comparison between patients with and without COVID-19 in terms of HAI incidence has been rarely explored. In this study, we characterized the occurrence of HAI among patients with and without COVID-19 admitted to the ICU of the Umberto I hospital of Rome during the first 16 months of the pandemic and also identified risk factors for HAI acquisition. Patients were divided into four groups according to their ICU admission date. A multivariable conditional risk set regression model for multiple events was constructed for each admission period. Adjusted hazard ratios and 95% confidence intervals were calculated. Overall, 352 COVID-19 and 130 non-COVID-19 patients were included, and a total of 361 HAIs were recorded. We found small differences between patients with and without COVID-19 in the occurrence and type of HAI, but the infections in the two cohorts mostly involved different microorganisms. The results indicate that patient management was likely an important factor influencing the HAI occurrence during the pandemic. Effective prevention and control strategies to reduce HAI rates should be implemented.

7.
Naturwissenschaften ; 96(10): 1203-12, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19621211

ABSTRACT

The chukar (Alectoris chukar, Galliformes) is a species hunted throughout its native range from the East Mediterranean to Manchuria and in the USA, which hosts the world's largest introduced population. This study aims to investigate the genetic structure of Mediterranean chukar populations to aid management decisions. We genotyped 143 specimens at two regions of the mitochondrial DNA (mtDNA: cytochrome b, control region) and eight loci of the microsatellite DNA. Samples were collected in northern (Limnos, Lesvos, Chios) and southern (Crete) Aegean islands (Greece) and Cyprus. We also carried out mtDNA-based comparison with chukars (n = 124) from Asia (16 countries) and the USA (five states). We propose six management units for Mediterranean populations. Given their genetic integrity, Limnos and Cyprus, which host different subspecies, proved to be of primary conservation interest. We found exotic A. chukar mtDNA lineages in Lesvos, Chios and Crete and produced definitive genetic evidence for the Asian origin of the US chukars.


Subject(s)
Conservation of Natural Resources , Galliformes/genetics , Animals , Asia , Cytochromes b/genetics , DNA/blood , DNA/genetics , DNA/isolation & purification , DNA, Mitochondrial/genetics , DNA, Satellite/genetics , Ecosystem , Feathers , Galliformes/classification , Genetic Markers , Genotype , Liver/physiology , Mediterranean Region , Phylogeny , Polymerase Chain Reaction , Sample Size , United States
8.
Ig Sanita Pubbl ; 64(2): 193-212, 2008.
Article in Italian | MEDLINE | ID: mdl-18523495

ABSTRACT

A global and local discussion on Public Health relevance is taking place, including the future role and organization of its services. Noteworthy becomes the role played by Public Health Specialists. This work presents the results of a workshop, carried out following the Guilbert methodology, whose aim was to define Public Health Doctors functions and their related activities. The programme involved 30 professionals from Triveneto area (North Eastern Italy), working in Prevention Departments at National Health Service and Universities. The key-functions identified were: 1) Health status assessment and identification of community risk factors, 2) Health Promotion, 3) Prevention, 4) Protection, 5) Planning, 6) Communication, 7) Professional Training, 8) Alliances and resources for complex Public Health programs, 9) Crisis management in Public Health, 10) Research. For each function activities were identified, meaning concerning areas and contents that must be warranted by professionals. This experience allowed to share existing attitudes and experiences present in Triveneto area, and it can stand as a feasible instrument for different settings. Nevertheless, it appears mandatory explaining at each level in the society role and functions of Prevention Departments.


Subject(s)
Food Service, Hospital/trends , Hospital Departments/trends , Hygiene , Nutritional Status , Preventive Health Services/trends , Public Health , Food Service, Hospital/organization & administration , Forecasting , Health Promotion , Hospital Departments/organization & administration , Humans , Italy , Preventive Health Services/organization & administration , Professional Role , Research Design
10.
J Laryngol Otol ; 117(11): 889-91, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14670152

ABSTRACT

Solitary fibrous tumours are rare neoplasms, which occur most frequently during adulthood at the level of the pleura. Recently, these tumours have been demonstrated in extraserosal sites such as the nasal cavity. A case of a solitary fibrous tumour arising at the level of the ethmoid and presenting in a 54-year-old woman, is reported. The tumour was removed using an endonasal endoscopic approach that permitted the monobloc excision of the lesion. The patient is without evidence of disease 18 months after surgery.


Subject(s)
Endoscopy/methods , Ethmoid Sinus , Paranasal Sinus Neoplasms/surgery , Female , Humans , Middle Aged , Paranasal Sinus Neoplasms/pathology , Tomography, X-Ray Computed
11.
PLoS One ; 8(6): e66208, 2013.
Article in English | MEDLINE | ID: mdl-23776633

ABSTRACT

Several arthropods are known to be highly beneficial to agricultural production. Consequently it is of great relevance to study the importance of land management and land composition for the conservation of beneficial aphid-predator arthropod species in agricultural areas. Therefore our study focusing on the beneficial arthropod Bembidion lampros had two main purposes: I) identifying the physical barriers to the species' dispersal in the agricultural landscape, and II) assessing the effect of different land management strategies (i.e. use of pesticides and intensiveness) on the dispersal patterns. The study was conducted using genetic analysis (microsatellite markers) applied to samples from two agricultural areas (in Denmark) with different agricultural intensity. Land management effects on dispersal patterns were investigated with particular focus on: physical barriers, use of pesticide and intensity of cultivation. The results showed that Bembidion lampros disperse preferably through hedges rather than fields, which act as physical barriers to gene flow. Moreover the results support the hypothesis that organic fields act as reservoirs for the re-colonization of conventional fields, but only when cultivation intensity is low. These results show the importance of non-cultivated areas and of low intensity organic managed areas within the agricultural landscape as corridors for dispersal (also for a species typically found within fields). Hence, the hypothesis that pesticide use cannot be used as the sole predictor of agriculture's effect on wild species is supported as land structure and agricultural intensity can be just as important.


Subject(s)
Arthropods/physiology , Agriculture , Animals , Ecosystem , Pesticides
12.
Eur J Pediatr ; 166(9): 949-55, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17131164

ABSTRACT

Childhood injuries are a major public health problem in Italy. From a study conducted in 1984, injury rates were found to be higher in Trieste, in the north-east of the country, than in other Italian areas. We conducted a new study to evaluate whether injury rates and patterns have changed in Trieste. There are three emergency rooms (ER) in Trieste. We collected and analyzed information on all injured children 0-16 years of age attending these ER in 2003 (child population 0-16 years of age was 28,000). We calculated the annual injury risk overall and by age. We described characteristics of the children (age, sex) and injuries (place, cause, type, affected body part, severity). 5,928 injured children attended the ER, and the annual injury risk was 21.5%. The home was the most frequent place where injuries occurred, especially among the youngest children. The most commonly injured body parts were the limbs and, among the youngest children, the head and face. Approximately 20% of children had moderate to severe injuries (AIS>1), and less then 3% were admitted to the hospital. In comparison to the previous study, there have been no significant changes in the annual risk of childhood injury and in the injury patterns. On the contrary, we observed a dramatic reduction in the frequency of hospitalization, which is probably attributable to the recent implementation of short observation and to the improvement of diagnostic/therapeutic paths in the ER. In conclusion, childhood injuries are still a relevant public health problem in this Italian area and new efforts are needed to prevent them.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Wounds and Injuries/epidemiology , Adolescent , Child , Child, Preschool , Female , Hospitalization , Humans , Infant , Infant, Newborn , Italy/epidemiology , Male , Risk Assessment
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