Canine leishmaniosis global prevalence over the last three decades: a meta-analysis and systematic review.

Leishmaniosis by Leishmania infantum is a zoonotic vector-borne disease transmitted to humans and dogs by the bite of female sand-flies. The domestic dog is the main reservoir and infected dogs may show or not clinical symptoms. The prevalence of infection in dogs varies according to the population studied, the geographic area, and the diagnostics employed. This study aims to estimate the global prevalence, subgrouping per continent, country, diagnostic test and selected risk factors. Cross-sectional studies (n=150; from 1990 to 2020) estimating the prevalence of the infection by Leishmania infantum were extracted from four electronic databases. The pooled global prevalence obtained by random-effects meta-analysis was 15.2 % (95 %CI 13.6-16.9), mostly in rural (19.5 %) and owned dogs (16.5 %). Prevalence varied if the diagnosis was made by western blot (WB, 32.9 %), cellular immunity tests (27.5 %), ELISA (17 %), PCR (16.9 %), IFAT (15.9 %), rapid tests and direct agglutination test (DAT, 11.5 %), cytology/immunohistochemistry (13.1 %), culture (8.6 %). A small studies bias (P<0.005) in the overall prevalence meta-analysis, due to the impact of small-size studies on the overall results was found. Moreover, a continent-related bias was found regarding rapid test, DAT (P=0.021), and WB (P<0.001), as these assays are mainly used in South American studies. A study period bias (P=0.033) and a publication year bias (P=0.002) were detected for PCR, as the test was not employed before the year 2000. In conclusion, a high prevalence of canine leishmaniosis worldwide and high heterogeneity among studies were found.

Efficacy of polygenic risk scores and digital technologies for INNOvative personalized cardiovascular disease PREVention in high-risk adults: protocol of a randomized controlled trial.

Background: Cardiovascular diseases (CVDs) pose a significant global health challenge, necessitating innovative approaches for primary prevention. Personalized prevention, based on genetic risk scores (PRS) and digital technologies, holds promise in revolutionizing CVD preventive strategies. However, the clinical efficacy of these interventions requires further investigation. This study presents the protocol of the INNOPREV randomized controlled trial, aiming to evaluate the clinical efficacy of PRS and digital technologies in personalized cardiovascular disease prevention. Methods: The INNOPREV trial is a four-arm RCT conducted in Italy. A total of 1,020 participants, aged 40-69 with high 10-year CVD risk based on SCORE 2 charts, will be randomly assigned to traditional CVD risk assessment, genetic testing (CVD PRS), digital intervention (app and smart band), or a combination of genetic testing and digital intervention. The primary objective is to evaluate the efficacy of providing CVD PRS information, measured at baseline, either alone or in combination with the use of an app and a smart band, on two endpoints: changes in lifestyle patterns, and modification in CVD risk profiles. Participants will undergo a comprehensive assessment and cardiovascular evaluation at baseline, with follow-up visits at one, five, and 12 months. Lifestyle changes and CVD risk profiles will be assessed at different time points beyond the initial assessment, using the Life's Essential 8 and SCORE 2, respectively. Blood samples will be collected at baseline and at study completion to evaluate changes in lipid profiles. The analysis will employ adjusted mixed-effect models for repeated measures to assess significant differences in the data collected over time. Additionally, potential moderators and mediators will be examined to understand the underlying mechanisms of behavior change. Discussion: As the largest trial in this context, the INNOPREV trial will contribute to the advancement of personalized cardiovascular disease prevention, with the potential to positively impact public health and reduce the burden of CVDs on healthcare systems. By systematically examining the clinical efficacy of PRS and digital interventions, this trial aims to provide valuable evidence to guide future preventive strategies and enhance population health outcomes.

Guiding Principles for Evaluating Vaccines in Joint Health Technology Assessment in the European Union: Preparing for the EU's Regulation on HTA for Vaccines.

OBJECTIVES: The appraisal of vaccines in the European Union (EU) currently involves many different decision-making bodies and processes. The objective of this study was to help inform the development of standardized methodology and vaccine-specific processes for use in the EU Regulation on health technology assessment (HTA). METHODS: Literature reviews and expert consultation were conducted to identify current practices and gaps related to vaccine appraisals and to develop guiding principles for the joint clinical assessment of vaccines. RESULTS: We found that significant variation exists across the EU Member States in the decision-making processes when clinically evaluating vaccines. Three guiding principles consisting of 13 recommendations were developed to help inform the development of decision-making frameworks for the joint clinical assessment of vaccines in the EU: (1) Support the creation of appropriate terminology and measurements for clinical appraisals of vaccines; (2) Develop inclusive, timely, and transparent vaccine appraisal processes to support stronger evidence generation for vaccine decision-making and appraisal; and (3) Improve the collection and interoperability of real-world data, including robust surveillance, to foster evidence generation and support the standardization of vaccine clinical appraisals. CONCLUSIONS: Given the significance of vaccines for public health, there is an urgency to develop standardized and vaccine-specific methodologies and processes for use in the EU joint HTA framework. The proposed guiding principles could support the effective implementation of the EU Regulation on HTA for vaccines and have the potential to ensure consistent, transparent, and timely access to new vaccines in the EU.

The role of citizenship in the acceptance and completion of COVID-19 vaccine cycle in the resident population with foreign citizenship registered with the Umbrian Health Care System - An analysis of regional data.

Introduction: Non-italian citizens experienced less access to anti-COVID-19 vaccination, compared to the native population. Literature has found differences in adherence to anti-COVID-19 vaccination among these groups; however, there are apparently no studies that investigated the role of citizenship. Our objective was to investigate the role of citizenship in vaccine hesitancy toward anti-COVID-19 vaccination and the completion of vaccine cycle, in the non-Italian citizens resident in the Umbria Region. Study design: This is a population study, performed on resident population in Umbria. Methods: Population data were obtained thanks to a record linkage between the Regional Health Information System and the regional DBCOVID Umbria database. On this dataset, a descriptive and logistic regression analyses were performed. Results: The 19.2% of non-Italian citizens did not take even one dose, 2.1% did not complete it and 40.6% did not take the additional dose. The range of values of which these results are an average, however, is very wide, suggesting important differences in COVID-19 vaccine up taking, among different citizenships. The logistic regression shows that citizenships with the highest probability of non-adherence to vaccination, compared to Philippine, was Romanian (OR=7.8), followed by Macedonian (OR=7.3) and Polish (OR=5.9). Conclusions: The study provides evidence of differences among citizenships that pinpoint the importance of understanding the reasons behind these behaviours, to support decisions around health policies tailored to each citizenship.

Mapping and ranking outcomes for the evaluation of seasonal influenza vaccine efficacy and effectiveness: a delphi study.

BACKGROUND: Protection provided by seasonal influenza vaccination (SIV) may be measured against numerous outcomes, and their heterogeneity may hamper decision-making. The aim of this study was to explore outcomes used for estimation of SIV efficacy/effectiveness (VE) and obtain expert consensus on their importance. RESEARCH DESIGN AND METHODS: An umbrella review was first conducted to collect and map outcomes considered in systematic reviews of SIV VE. A Delphi study was then performed to reach expert convergence on the importance of single outcomes, measured on a 9-point Likert scale, in principal target groups, namely children, working-age adults, older adults, subjects with co-morbidities and pregnant women. RESULTS: The literature review identified 489 outcomes. Following data reduction, 20 outcomes were selected for the Delphi process. After two Delphi rounds and a final consensus meeting, convergence was reached. All 20 outcomes were judged to be important or critically important. More severe outcomes, such as influenza-related hospital encounters and mortality with or without laboratory confirmation, were generally top-ranked across all target groups (median scores ≥8 out of 9). CONCLUSIONS: Rather than focusing on laboratory-confirmed infection per se, experimental and observational VE studies should include more severe influenza-related outcomes because they are expected to exercise a greater impact on decision-making.

The role of a mindful movement-based program (Movimento Biologico) in health promotion: results of a pre-post intervention study.

Introduction: Mindful movement is a comprehensive approach that integrates various bodily, emotional and cognitive aspects into physical activity, promoting overall well-being. This study assessed the impact of a mindful movement program, known as Movimento Biologico (MB), on participants psychological well-being (PWB), positive mental health (PMH), sense of coherence (SOC), and interoceptive awareness. Methods: MB program was conducted for students attending the bachelor's degree in Kinesiology and Sport Sciences of University of Perugia over 8 weeks (from October 16 to November 27, 2022). Participants were requested to fill in four questionnaires before and after the MB program: (1) 18-item PWB scale; (2) 9-item PMH scale; (3) 13-item SOC scale; (4) 32-item scale for Multidimensional Assessment of Interoceptive Awareness (MAIA). Wilcoxon signed-rank tests were used to assess changes, with significance set at p < 0.05. Results: Thirty-eight students (mean age 21.2, 60.5% male) participated. Several MAIA subscales, including noticing (p = 0.003), attention management (p = 0.002), emotional awareness (p = 0.007), self-regulation (p < 0.001), body listening (p = 0.001), and trusting (p = 0.001), showed significant improvements. PMH increased significantly (p = 0.015), and there was a significant enhancement in the autonomy subscale of PWB (p = 0.036). SOC and overall PWB also improved, though not significantly. Conclusion: The MB program significantly improved participants' positive mental health and interoceptive awareness. This likely resulted from better recognition and management of positive physiological sensations, a stronger link between physical sensations and emotions, enhanced confidence in one's body, and increased autonomy.

Promoting Vaccinations in Pregnancy: Results of a Systematic Literature Review of Italian Initiatives.

Pregnant women and infants inherently face heightened susceptibility to complications resulting from infectious diseases. Within these populations, vaccinations offer numerous advantages. This systematic review endeavors to comprehensively analyze the existing literature concerning interventions designed to promote vaccinations among pregnant women and newborns in Italy. We searched PubMed, Scopus, and Web of Science for primary studies published until 3 August 2023 which assessed the impact of vaccination education interventions targeting pregnant Italian women. Data extraction, pooling, and a quality appraisal of the included studies were conducted according to PRISMA guidelines. Among the 528 articles identified, 3 met the inclusion criteria and focused on pregnant women aged 25 to 40 attending pre-delivery courses. In these studies, the effectiveness of the interventions was assessed using pre- and post-intervention questionnaires that investigated knowledge, attitudes, and behaviors regarding recommended vaccinations. The results reveal significant increases in intention and adherence to vaccination among participants after these interventions. The results underscore the positive influence of health professionals' educational initiatives on pregnant Italian women's vaccination knowledge and attitudes. However, longitudinal studies with larger representative samples are needed to validate these findings and identify potential avenues for improving maternal educational interventions.

Real world evidence for public health decision-making on vaccination policies: perspectives from an expert roundtable.

INTRODUCTION: Influenza causes significant morbidity and mortality, but influenza vaccine uptake remains below most countries' targets. Vaccine policy recommendations vary, as do procedures for reviewing and appraising the evidence. AREAS COVERED: During a series of roundtable discussions, we reviewed procedures and methodologies used by health ministries in four European countries to inform vaccine recommendations. We review the type of evidence currently recommended by each health ministry and the range of approaches toward considering randomized controlled trials (RCTs) and real-world evidence (RWE) studies when setting influenza vaccine recommendations. EXPERT OPINION: Influenza vaccine recommendations should be based on data from both RCTs and RWE studies of efficacy, effectiveness, and safety. Such data should be considered alongside health-economic, cost-effectiveness, and budgetary factors. Although RCT data are more robust and less prone to bias, well-designed RWE studies permit timely evaluation of vaccine benefits, effectiveness comparisons over multiple seasons in large populations, and detection of rare adverse events, under real-world conditions. Given the variability of vaccine effectiveness due to influenza virus mutations and increasing diversification of influenza vaccines, we argue that consideration of both RWE and RCT evidence is the best approach to more nuanced and timely updates of influenza vaccine recommendations.

A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region

This review focuses on existing immunization policies and practices for migrants and refugees and provides an overview of barriers and facilitators for access to and utilization of immunization services. Evidence was obtained by a scoping review of academic and grey literature in English and a further 11 languages and included official documents available from the websites of ministries of health and national health institutes of the WHO European Region Member States. The review highlights that vaccination policies tailored to migrants and refugees are very heterogeneous among WHO European Region Member States. By comparison, common barriers for the implementation and utilization of immunization services can be identified across countries. Outlined policy options are intended to strengthen information about immunization for migrants and refugees, support future evidence-informed policy-making, enable the achievement of national vaccination coverage goals and improve the eligibility of migrants and refugees to access culturally competent immunization services.

Обзор фактических данных: соблюдение принципов справедливости при организации, обеспечении доступности и оказании услуг по иммунизации мигрантов и беженцев в Европейском регионе ВОЗ

В данном отчете рассматриваются действующие в настоящее время меры политики и практические подходы к обеспечению услуг иммунизации для мигрантов и беженцев и приводится обзор препятствий и возможностей для получения доступа к таким услугам. Фактические данные по этому вопросу были получены в рамках аналитического обзора научной и внеиздательской литературы на английском и 11 других языках, с особым вниманием к официальным документам, найденным на веб-сайтах министерств здравоохранения и национальных институтов здравоохранения государств-членов в Европейском регионе ВОЗ. Авторы обзора подчеркивают огромные различия в мерах политики в области вакцинации для мигрантов и беженцев между государствами-членами в Европейском регионе ВОЗ. Вместе с тем, эти страны сталкиваются приблизительно с одними и теми же препятствиями для внедрения таких услуг и обеспечения доступа к ним. Представленные в обзоре варианты политики позволят расширить информационную базу в поддержку иммунизации для мигрантов и беженцев и дальнейшей выработки в этой сфере политики на доказательной основе, поспособствуют выполнению странами задач в отношении охвата вакцинацией и сделают возможным получение мигрантами и беженцами доступа к услугам иммунизации с учетом соответствующей культурной специфики.

Public health aspects of migrant health: a review of the evidence on health status for undocumented migrants in the European Region

Undocumented migrants are people within a country without the necessary documents and permits. They are considered at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. A systematic review found 122 documents that suggested policies and interventions to improve health care access and delivery for undocumented migrants. Undocumented migrants mostly have only access to emergency care across Europe, and even in the countries where they are fully entitled to health care, formal and informal barriers hinder their access. This raises concerns for both public health and migrant care. On the basis of findings, policy options are suggested regarding data collection, research, entitlement to health care, information and communication, training and intersectoral approaches.

Связанные с миграцией аспекты общественного здравоохранения: обзор фактических данных о состоянии здоровья недокументированных мигрантов в Европейском регионе

Мигранты, не состоящие на официальном учете, – это лица, пребывающие в стране без необходимых документов и разрешений. Считается, что они подвергаются большему риску развития проблем со здоровьем в связи с их незаконным статусом и последствиями экономической и социальной маргинализации. В результате проведения систематического обзора были обнаружены 122 документа, в которых предлагаются стратегии и мероприятия по повышению доступности и качества оказания медицинской помощи мигрантам, не состоящим на официальном учете. В странах Европы недокументированные мигранты в основном имеют доступ только к услугам неотложной помощи, и даже в тех странах, где они обладают полным правом на получение медицинской помощи, имеющиеся формальные и неформальные барьеры мешают им этим правом воспользоваться. Это вызывает обеспокоенность как в отношении охраны общественного здоровья, так и в отношении оказания помощи мигрантам. На основании полученных результатов предлагаются варианты стратегий в сфере сбора данных, проведения исследований, обеспечения права на получение медицинской помощи, информирования и коммуникации, обучения и использования межсекторальных подходов.