Promoting Universal Equitable Accessibility: An Overview on the Impact of Assistive Technology in the UN, UNICEF, and WHO Web Portals.

The number of people with disabilities and frailties who need support and assistance is increasing. Assistive technologies (ATs) are increasingly playing a central role in supporting people with disabilities and frailties. The study investigated the impact of the ATs on the websites of the UN, UNICEF, and WHO in terms of proposed activities and actions. The methodology proposed was based on two points of view: (1) A formal process to directly select elements in the institutional webs of the UN, UNICEF, and WHO. (2) A formal process for a complementary literature narrative review based on an umbrella review of Pubmed and Scopus. A standard checklist and a qualification process were applied. The outcome reported 35 documents from the direct search on the web and 19 systematic reviews for the complimentary literature overview. The direct search returned documents related to initiatives focused on the following: The tailoring of the ATs to a person based on international guidelines and specific monitoring initiatives of the AT introduction/access based on surveys both at the population and system/government level with the publication of the data/metadata in an observatory. Dissemination initiatives of both the culture of ATs (e.g., catalog, guidelines, reports, congresses) and of recommendations. The literature overview contributed more specifically to the use and effectiveness of categories of ATs. Both direct research and the literature overview have shown a consistent growth in interest in ATs. The initiatives of the UN, UNICEF, and WHO have been consistent with the institutional role and aimed at improving the diffusion of ATs through capillary monitoring, which is not free from obstacles, and a diffusion of the culture and rational use of ATs. The narrative review shows also the important role of research in monitoring the development, use, and effectiveness of devices, strategies, and support of international institutional initiatives. Important initiatives have been launched internationally on AT in terms of monitoring, dissemination, and improvement in access. However, it is necessary to consider and face the obstacles that limit these initiatives.

The Accessibility and the Digital Divide in the Apps during the COVID-19. Comment on Cao et al. The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective. Healthcare 2022, 10, 479.

We are writing to you as the corresponding author of the interesting study "The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective" [...].

Adapting the World Health Organization rapid Assistive Technology Assessment (rATA) to the Italian context: implementation of a TRAPD-based approach.

BACKGROUND: Measuring access to assistive technology (AT) has become a global priority. Recently, the World Health Organization (WHO) has developed the rapid assistive technology assessment (rATA), a population-based household survey that measures the use, need, unmet need, and barriers to accessing AT. OBJECTIVE: The aim of this paper is to report on the translation and adaptation process undertaken to implement the rATA survey in the Italian context. METHOD: The Translate, Review, Adjudicate, Pretest, and Document (TRAPD) approach was used to translate and adapt the rATA from English to Italian. Eleven independent reviewers and 23 AT users were involved to validate the Italian translation of the rATA and pilot the survey, respectively. RESULTS: The feedback provided by the first users of the rATA indicate that the data collected are reliable and well reflect the state of AT provision in Italy. CONCLUSION: This study confirmed the applicability of the rATA survey to the Italian context. The Italian version of the rATA can be used to support the government, the health system as well as the civil society to monitor the current state of AT access (and abandonment) in the country.

Ethics and Automated Systems in the Health Domain: Design and Submission of a Survey on Rehabilitation and Assistance Robotics to Collect Insiders' Opinions and Perception.

BACKGROUND: The problem of the relationship between ethics and robotics is very broad, has important implications, and has two large areas of impact: the first is conduct in research, development, and use in general. The second is the implication of the programming of machine ethics. PURPOSE: Develop and administer a survey of professionals in the health domain collection of their positions on ethics in rehabilitation and assistance robotics. METHODS: An electronic survey was designed using Microsoft Forms and submitted to 155 professionals in the health domain (age between 23 and 64 years; 78 males, mean age 43.7, minimum age 24, maximum age 64; 77 females, mean age 44.3, minimum age 23, maximum age 64) using social media. RESULTS AND DISCUSSION: The outcome returned: (a) the position on ethics training during university studies and in the world of work, (b) the organizational aspects hindered by ethics and those to be perfected in relation to ethics, (c) issues of ethical concern, (d) structured feedback on the usefulness of the methodology along with considerations of open text. CONCLUSIONS: An electronic survey methodology has allowed the structured collection of information on positions towards ethics in this sector. Encouraging feedback from the participants suggests the continuation of the study is beneficial. A continuation is expected, expanding the audience of professionals involved and perfecting the survey with the support of scientific companies.

Technologies to Support Frailty, Disability, and Rare Diseases: Towards a Monitoring Experience during the COVID-19 Pandemic Emergency.

This report illustrates the design and results of an activity of surveillance proposed by the National Centre for Innovative Technologies in Public Health and the National Centre for Rare Diseases of the Istituto Superiore di Sanità with the aim of monitoring the state-of-use of technologies by people with frailty, disabilities, and rare diseases. The results of the surveillance activity reported in this report are as follows: (a) An international Webinar; (b) A Full report published by the Istituto Superiore di Sanità (ISS); (c) an electronic survey tool, for periodic monitoring; (d) an initial summary of the survey (15 September-30 November 2020), giving an overall picture relating to the state-of-use of technologies by the interviewed; (e) an understanding of the needs that emerged, causing reflection on the current state-of-the-art and offering important stimuli for all the stakeholders involved.

Assistive Technologies and Quadriplegia: A Map Point on the Development and Spread of the Tongue Barbell Piercing.

The barbell piercing can be used as an assistive device that allows people with severe disabilities, such as tetraplegia, to control their environments using the movement of the tongue. The human tongue can move rapidly and accurately, such that the tip can touch every tooth. Lingual control systems allow people with disabilities to take advantage of their residual skills for easier communication and to improve the control of mobility and the surrounding environment. The aim of this study was to conduct a narrative review of the development and dissemination of the assistive technologies based on tongue control by means of the barbell piercing. The design of the study was based on: (I) an overview of Pubmed complemented with other databases and Web searches (also institutional); (II) an organization according to a standardized checklist for narrative reviews; (III) an arrangement with four different perspectives: the trends in the scientific literature, technological evolution and categorization, dominant approaches, issues of incorporation into the health domain-such as acceptance, safety, and regulations. The results have highlighted: (1) that the volume of scientific productions, which started in this sector before the smartphone expansion, has not increased; (2) that it is possible to make a map point of the technological evolution and categorization; (3) that these assistive technologies have a high degree of acceptance and performance, especially when integrated with aid tools with mechatronics; (4) and the complexity of the regulatory framework in this area. The study, from a general point of view, highlighted the high potential of these systems and we suggest investing the energy into agreement tools for assistive technologies (AT)s, such as health technology assessment studies, comparative assessment analysis, or consensus conferences that could allow a better diffusion and use of ATs, including these systems.

Differences in the clinical characteristics of COVID-19 patients who died in hospital during different phases of the pandemic: national data from Italy.

BACKGROUND: Epidemiological data obtained during the initial wave of the COVID-19 epidemic showed that persons dying with COVID-19 were typically older men with multiple chronic conditions. No studies have assessed if the characteristics of patients dying with COVID-19 have changed in the second phase of the epidemic, when the initial wave subsided. The aim of the present study was to compare characteristics of patients dying with COVID-19 in Italy in the first 'peak' phase of the epidemic and in its second phase. METHODS: Medical charts of patients with COVID-19 who died while in hospital in Italy were reviewed to extract information on pre-existing comorbidities, in-hospital complications, and disease trajectories. The course of the epidemic was classified in two 3-month periods: March-May 2020 and June-August 2020. FINDINGS: Overall, in the Italian population, 34,191 COVID-19 deaths occurred in March-May 2020 and 1,404 in June-August 2020. Patients dying in March-May were significantly younger (80.1 ± 10.6 vs. 82.8 ± 11.1 years, p < 0.001) and less frequently female (41.9% vs. 61.8%, p < 0.001) than those dying in June-August. The medical charts of 3533 patients who died with PCR-confirmed SARS-CoV-2 infection in March-May 2020 (10.3% of all deaths occurring in this period) and 203 patients who died in June-August 2020 (14.5% of all deaths occurring in this period) were analysed. Patients who died in March-May 2020, compared to those who died in June-August 2020, had significantly lower rates of multiple comorbidities (3 or more comorbidities: 61.8% vs 74.5%, p = 0.001) and superinfections (15.2% vs. 52.5%, p < 0.001). Treatment patterns also substantially differed in the two study periods, with patients dying in March-May 2020 being less likely to be treated with steroids (41.7% vs. 69.3%, p < 0.001) and more likely to receive antivirals (59.3% vs. 41.4%, p < 0.001). Survival time also largely differed, with patients dying in March-May 2020 showing a shorter time from symptoms onset to death (mean interval: 15.0 vs. 46.6 days, p < 0.001). The differences observed between the two periods remained significant in a multivariate analysis. INTERPRETATION: The clinical characteristics of patients dying with COVID-19 in Italy, their treatment and symptom-to-death survival time have significantly changed overtime. This is probably due to an improved organization and delivery of care and to a better knowledge of disease treatment.

Clinical characteristics of individuals with Down syndrome deceased with CoVID-19 in Italy-A case series.

BACKGROUND: Persons with Down syndrome (DS) are presumed to be at high risk of severe CoVID-19, due to immune dysregulation and often compromised cardiopulmonary function. Aim of the present study is to assess epidemiological and clinical characteristics of individuals with DS deceased in Italian hospitals with CoVID-19. METHODS: We used a nationwide database of 3,438 patients deceased with RT-PCR-confirmed SARS-CoV-2 infection in Italy (10.4% of all deaths with CoVID-19 in the country at the time of analysis). Data on demographics, pre-existing comorbidities and in-hospital complications leading to death were extracted from medical charts obtained from hospitals. Data on individuals with DS deceased with CoVID-19 were obtained from this sample. RESULTS: Sixteen cases of death in individuals with DS (0.5% of all charts analyzed) were identified. Acute respiratory distress syndrome occurred in all 16 cases. Compared with individuals without DS, those with DS deceased with CoVID-19 were younger (52.3 ± 7.3 vs. 78.1 ± 10.6 years, p < .001) and presented a higher incidence of superinfections (31.2 vs. 13.0%, p = .029). Autoimmune diseases (43.8 vs. 4%, p < .001), obesity (37.5 vs. 11%, p = .009), and dementia (37.5 vs. 16.3%, p = .012) were more prevalent in individuals with DS. ICU admissions was similar in both groups (25 vs. 18.8%, p = .129). CONCLUSIONS: Individuals with DS deceased with CoVID-19 are younger than individuals without DS. Comorbidity burden and increased risk of complications (i.e., bacterial superinfections) can influence CoVID-19 prognosis in individuals with DS. Specific strategies to prevent and mitigate the effects of CoVID-19 in the population with DS are needed.

General and specific mortality among the elderly during the 2003 heat wave in Genoa (Italy).

The effects of heat waves on health can be serious for elderly persons, especially those in urban areas. We investigated in-depth the mortality excess during the 2003 heat wave among elderly persons (>74 years) in the City of Genoa (Italy). The excess in general mortality was calculated for the period July 16-August 31, as the ratio of observed to expected deaths. To evaluate "harvesting", we compared observed and expected mortality in the period September 2003-April 2004. We also studied the relationship between mortality and climatic conditions considering daily maximum temperature and Humidex discomfort degrees, as well as "lag-time". For cause-specific mortality, we considered all pathologies reported on the death certificate. The excess in general mortality was significant and was greatest in the first half of August. During Summer 2003, in Genoa the climatic conditions (described in terms of maximum temperature and Humidex Index) were extremely hot; regarding lag-time, the greatest correlation between the number of observed deaths and the maximum temperature values was observed for the three preceding days (rho=0.568; significance level<0.01). The prominent causes of death, for which an excess was observed, were cerebrovascular diseases, severe respiratory diseases, severe renal diseases, dementia; moreover, certain pathologic conditions and symptoms, usually not lethal, were also frequent causes of death (e.g., hypovolemia, hyperpyrexia, decubitus ulcers and immobilization syndrome). The results of this study confirm the relationship between the heat waves and death among elderly, stressing that, because of their poorer physical health and the prevalence of cognitive disturbances that hinder risk perception, it is necessary to properly care for them during heat waves.

Epidemiologic study of mortality during the Summer 2003 heat wave in Italy.

INTRODUCTION: It is widely recognized that extreme climatic conditions during summer months may constitute a major public health threat. Owing to what is called the "urban heat island effect," as well as to the consequences of heat waves on health, individuals living in cities have an elevated risk of death when temperature and humidity are high compared to those living in suburban and rural areas. Studies on heat wave-related mortality have further demonstrated that the greatest increases in mortality occur in the elderly. Following the unusually hot summer of 2003 and the dramatic news from neighboring countries such as France, the Italian Minister of Health requested the Istituto Superiore di Sanita-Bureau of Statistics to undertake an epidemiologic study of mortality in Italy during Summer 2003 to investigate whether there had been an excess of deaths, with a particular focus on the elderly population. MATERIALS AND METHODS: Communal offices, which maintain vital statistics, were asked for the individual records of death of residents registered daily during the period 1 June-31 August 2003 and during the same period of 2002 for each of the 21 capitals of the Italian regions. As it was necessary to obtain mortality data quickly from many municipalities and to make the analysis as soon as possible, the method adopted was comparison of mortality counts during the heat wave with figures observed during the same period of the previous year. RESULTS: Compared with 2002, between 1 June and 31 August 2003, there was an overall increase in mortality of 3134 (from 20,564 to 23,698). The greatest increase was among the elderly; 2876 deaths (92%) occurred among people aged 75 years and older, a more than one-fifth increase (21.3%, from 13.517 to 16.393%). The highest increases were observed in the northwestern cities, which are generally characterized by cold weather, and in individuals 75 years and older: Turin (44.9%), Trento (35.2%), Milan (30.6%), and Genoa (22.2%). Of note are also the increases observed in two southern cities, L'Aquila (24.7%) and Potenza (25.4%), which are located, respectively, at 700 and 800 m above see level. For Bari and Campobasso, both in the South, with a typically hot summer climate, the increase during the last 15 days of August was 186.2 and 450%, respectively. CONCLUSIONS: The relationship between mortality and discomfort due to climatic conditions as well as the short lag time give a clear public health message: preventive, social, and health care actions must be administered to the elderly and the frail to avoid excess deaths during heat waves.

[Epidemiologic Study of Mortality during summer 2003 in Italy]. / Studio epidemiologico della mortalità durante l'estate 2003 in Italia.

Following the unusually hot summer this year and the dramatic news from neighboring countries such as France, the Italian Minister of Health requested an epidemiologic mortality study during summer 2003, to investigate whether there had been an excess of deaths in Italy, particularly for the elderly population. Communal offices, which provide vital statistics, were asked for the number of deaths among resident people, occurred from June 1 to August 31, for 2003 and 2002, for the 21 Italian regions capitals. A mortality increase of 3,134 deaths was observed for 2003; most of them (92%) were people aged 75 years and older. The highest increases were observed in the North Western cities (Turin, Milan, Genoa). The relationship between mortality and climatic indexes (T. max, Humidex) was investigated and a clear correlation was observed.