Knowledge and training of Italian students in Healthcare Settings on COVID-19 vaccines and vaccination strategies, one year after the immunization campaign.

Introduction: COVID-19 vaccines represent an important opportunity for defeating the disease, as long as high vaccination acceptance rates are achieved. Healthcare workers (HCWs) have a relevant role in the promotion of immunization among the population and since students in healthcare area will be HCWs it is crucial to provide more in-depth knowledge on vaccinations. Therefore, the aim of the study is to assess the knowledge of medical and pharmaceutical area students regarding COVID-19 vaccination and the impact of a specific Elective Teaching Activity (ETA) on the increase of students' knowledge. The ETA was held one year after the immunization campaign in Italy. Methods: Students' knowledge was tested with a questionnaire before and after attending the course. Descriptive statistical methods were used to analyse the results obtained. Student's t-tests for paired data were used. Results: Overall, 387 students at the University of Florence attended the course and took the same test before and after the ETA on COVID-19 vaccines. Despite achieving satisfactory average scores in the pre-course test (26/32 ± 4.0), all students were able to significantly enhance their final score (+17.1%; p < 0.001), indicating that the ETA was highly effective in improving their knowledge of COVID-19 vaccination. Medical students demonstrated a better comprehension of the role of the medical specialist in public health in the COVID-19 vaccination campaign, while some uncertainties were revealed regarding the role of pharmacists. Conclusions: The results of this study confirm that specific training activities on vaccination are effective for implementing the knowledge of future health professionals.

Electronic Package Leaflets for Vaccines: What Are People's Perceptions in Italy?

In Italy, the paper package leaflet (PPL) is the official document that is approved by the Italian Medicines Agency (AIFA) for each medicine. PPLs of all medicines, including vaccines, are freely available online by accessing the AIFA website. To investigate people's attitudes toward possible access to the PPLs of vaccines and the acceptability of switching to an electronic package leaflet (e-leaflet) in the future, we surveyed three target groups (pregnant women, young parents, and older people) in Italy, via an online survey. We collected 321 questionnaires from the cohorts, which comprised 104 pregnant women, 105 young parents, and 112 older people. The results indicate in all target groups that health care professionals (HCPs) do not usually offer the vaccine PPL during the vaccination session: only about 10.7% of respondents receive the PPL without asking for it, with pregnant women receiving it the most frequently. The acceptance rate for switching from a PPL to an e-leaflet is fairly high in all target groups (76.9% in pregnant women, 81.9% in young parents, and 66.1% in the elderly), especially if the option exists to request a paper print, to make sure that people with a low level of digital skills can access the PPL information as well. HCPs have an important role in ensuring access to the PPLs of vaccines. HCPs should be trained to inform their patients about the different options for accessing the PPLs (as well as online access) to increase their patients' knowledge and satisfaction.

Predictors of Influenza Vaccination Uptake and the Role of Health Literacy among Health and Social Care Volunteers in the Province of Prato (Italy).

Annual influenza vaccination is recommended for volunteers involved in primary health and social services. Little is known about the volunteers' adhesion to influenza vaccination recommendations. The aim of this study was to assess influenza vaccination determinants among a group of volunteers who provided essential activities during the first SARS-CoV-2 pandemic wave in the province of Prato, Tuscany (Italy) and to evaluate the role of health literacy in influencing vaccination determinants. METHOD: In this cross-sectional study, the predictors of influenza vaccination uptake were assessed through the administration of a questionnaire. Variables significantly associated with influenza vaccination uptake were included in five multivariate logistic regression models through a backward stepwise procedure. RESULTS: Among the 502 enrolled volunteers, 24.3% reported being vaccinated in the 2019-2020 season. Vaccination uptake was 48.8% in participants aged 65 years or older and 15.7% in those aged 64 years or younger. Considering the whole sample in the final model of multivariate logistic regression analysis, the predictors of influenza vaccination uptake were age (OR = 1.05; 95% CI = 1.03-1.07), presence of heart diseases (OR = 2.98; 95% CI = 1.24-7.19), pulmonary diseases (OR = 6.18; 95% CI = 2.01-19.04) and having undergone surgery under general anesthesia in the prior year (OR = 3.14; 95% CI = 1.23-8.06). In the multivariate model considering only participants with a sufficient level of health literacy (HL), none of these predictors resulted in significant associations with vaccination uptake, except for age (OR= 1.04; 95% CI = 1.02-1.07). CONCLUSIONS: Our findings revealed a very low influenza vaccination uptake among volunteers, suggesting the need to increase awareness in this at-risk group by means of a better communication approach.

Trends in Adolescent Health Risk Behaviors and Wellbeing: A 10 Year Observation from the EDIT Surveillance of Tuscany Region, Italy.

Background: The aim of this study was to evaluate the trends of prevalence of health risk behaviors (HRBs) and health conditions over a 10 year period (2008-2018) in a representative sample of adolescents of Tuscany Region, Italy. Methods: This was a repeated cross-sectional (four survey waves) study. The prevalence of 17 HRBs and health conditions were analyzed by age, sex, and socioeconomic status (SES). Results: A total of 21,943 students were surveyed. During the study period, decreases in smoking participation, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased. Males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking, and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetable consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low-SES students than in high-SES students. Conclusions: The findings showed different tendencies in adolescent participation in HRBs over the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females' risk-taking behavior on the rise require careful monitoring.

The Role of Health Literacy in COVID-19 Preventive Behaviors and Infection Risk Perception: Evidence from a Population-Based Sample of Essential Frontline Workers during the Lockdown in the Province of Prato (Tuscany, Italy).

BACKGROUND: The effectiveness of pandemic control measures requires a broad understanding from the population. This study aimed to evaluate the role played by health literacy (HL) in influencing the adherence to COVID-19 preventive measures and risk perception of essential frontline workers during the lockdown period. METHODS: A cross-sectional survey was conducted on a population-based sample of frontline workers from Prato Province (Italy). Data on knowledge, attitudes and practices towards COVID-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Multivariate linear regression analyses were performed. RESULTS: A total of 751 people participated in this study, and 56% of the sample showed a sufficient level of HL. In the multivariate models, HL resulted in being positively correlated with both knowledge (beta 0.32 for sufficient HL, 0.11 for problematic HL) and attitudes (beta 0.33 for sufficient HL, 0.17 for problematic HL) towards the importance of COVID-19 preventive measures. The HL level was not associated with the adoption of preventive behaviors and COVID-19 risk perception. CONCLUSIONS: HL may play a key role in maintaining a high adherence to infection prevention behaviors and may be a factor to take into account in the implementation of public health interventions in pandemic times.

Biodanza as a Nonpharmacological Dance Movement-Based Treatment in Older People With Alzheimer's Disease: An Italian Pilot Study in 2 Tuscan Nursing Homes.

The aim of this pilot, feasibility study was to assess health improvements in 16 institutionalized older people with Alzheimer's disease, after the Biodanza intervention, a nonpharmacological dance movement-based treatment. Biodanza significantly decreased agitated and neuropsychiatric behaviors. Effectiveness studies will be performed in order to assess the implication of such interventions.

Health Communication in COVID-19 Era: Experiences from the Italian VaccinarSì Network Websites.

In 2013, in a bid to combat Vaccine Hesitancy (VH) and provide information on vaccines by communicating with the general public and the health community (e.g., healthcare workers and public health operators), the Italian Society of Hygiene and Preventive Medicine (S.It.I.) published the national website "VaccinarSì". The project was subsequently extended to ten Italian Regions. This led to the creation of the VaccinarSì Network, whose websites are publicly owned. The aim of this work was to present the framework of the websites of the VaccinarSì Network and to analyse user behaviour in the pre-COVID-19-era (dating from each website's publication until 31 January 2020) and in the COVID-19-era (from 1 February 2020 to 31 January 2021). Some metrics such as the number of visits to the site (sessions, number of users and average session duration), user behaviour (pages viewed, bounce rate and organic search) and the session acquisition path (direct traffic, referrals and social traffic) were searched, extrapolated and processed with Google Analytics. Qualitative and normally distributed quantitative variables were summarised with their absolute (relative) frequencies and means. Statistical differences between the means of the two periods were evaluated through paired t-test. A two-tailed p-value less than 0.05 was considered to be statistically significant. When the total values recorded over the period were compared, an overall increase in metrics was observed-the number of individual users, visits and individual pageviews rose in a statistically significant way. Our study aimed to highlight how combining disciplines such as health education and digital communication via Information and Communication Technologies (ICT) represents the best strategy to support citizens. This approach gives them the tools to become independent and responsible players that are capable of voluntarily and consciously choosing to adhere to vaccination programs. The VaccinarSì Network's goal for the future is to reach an even wider audience. By building each user's critical knowledge, this network enables users to be active components of a wider, more empowered community.

SARS-CoV-2 Seroprevalence Survey in People Involved in Different Essential Activities during the General Lock-Down Phase in the Province of Prato (Tuscany, Italy).

Serosurveys may help to assess the transmission dynamics in high-risk groups. The aim of the study was to assess the SARS-CoV-2 antibody seroprevalence in people who had performed essential activities during the lock-down period in the Province of Prato (Italy), and to evaluate the risk of exposure to SARS-CoV-2 according to the type of service. All the workers and volunteers of the Civil Protection, employees of the municipalities, and all the staff of the Health Authority of the Province of Prato were invited to be tested with a rapid serological test. A total of 4656 participants were tested. SARS-CoV-2 antibodies were found in 138 (2.96%) cases. The seroprevalence in health care workers, in participants involved in essential support services and in those who worked from home were 4.1%, 1.4% and 1.0%, respectively. Health care workers experienced higher odds of seropositivity (OR 4.38, 95%CI 2.19-10.41) than participants who were assigned to work-from-home; no significant seropositivity differences were observed between support services and work-from-home groups. A low circulation of SARS-CoV-2 was observed among participants performing different essential activities. Findings highlighted the risk of in-hospital transmission in healthcare workers and that community support services may increase the risk of seropositivity to a limited extent in low incidence areas.

The Experience of VaccinarSinToscana Website and the Role of New Media in Promoting Vaccination.

The Department of Health Sciences (University of Florence) developed a regional website "VaccinarSinToscana" in order to provide information on vaccines and communicate with the general population, as well as the healthcare community, at a regional and local level. The aim of this paper is to present the VaccinarSinToscana website framework and analyze the three-year activity of the website and the related social network account on Facebook in terms of dissemination and visibility. In the first three years since its launch, the VaccinarSinToscana portal has increased its visibility: the number of single users, visits and single web pages has grown exponentially. Our results also demonstrate how the Facebook account launch contributed enormously to the increase in the visibility of the website. The objective for the future of the VaccinarSinToscana portal is to grow further, in order to reach out to an even wider audience.

Older People Living in Nursing Homes: An Oral Health Screening Survey in Florence, Italy.

The oral health state plays an important role in the concept of 'elderly frailty', since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set-Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health.