Trust matters: The Addressing Vaccine Hesitancy in Europe Study.

This article presents the design of a seven-country study focusing on childhood vaccines, Addressing Vaccine Hesitancy in Europe (VAX-TRUST), developed during the COVID-19 pandemic. The study consists of (a) situation analysis of vaccine hesitancy (examination of individual, socio-demographic and macro-level factors of vaccine hesitancy and analysis of media coverage on vaccines and vaccination and (b) participant observation and in-depth interviews of healthcare professionals and vaccine-hesitant parents. These analyses were used to design interventions aimed at increasing awareness on the complexity of vaccine hesitancy among healthcare professionals involved in discussing childhood vaccines with parents. We present the selection of countries and regions, the conceptual basis of the study, details of the data collection and the process of designing and evaluating the interventions, as well as the potential impact of the study. Laying out our research design serves as an example of how to translate complex public health issues into social scientific study and methods.

Countering vaccine hesitancy: a systematic review of interventions to strengthen healthcare professionals' action.

BACKGROUND: Vaccine hesitancy is relevant for healthcare professionals (HCPs) who face challenges in building trusting relationships with patients. Accordingly, the VAX-TRUST project has been developed to improve experiences of HCPs and patients dealing with vaccinations. To support VAX-TRUST, this work aimed to identify latest interventions targeted at HCPs to address hesitancy and increase vaccine uptake. METHODS: A systematic review was conducted according to PRISMA by searching PubMed, Scopus and Embase. The protocol was registered on PROSPERO. Articles were eligible if evaluated interventions directly targeted at HCPs/healthcare students. The search was run on 26 January 2022. Articles published in 2016 or after were included. RESULTS: A total of 17 492 records were identified; 139 articles were selected. Most articles were set in USA (n = 110). Over half had a pre-post design without a control group (n = 78). A total of 41 articles focused on single-component interventions, 60 on multi-component interventions involving only HCPs and/or students and 38 on multi-component interventions involving also other professionals. Main components were in-person education (n = 76), synchronous (n = 10) and asynchronous (n = 23) online learning, educational materials (n = 26), performance assessment and feedback (n = 33), electronic record changes (n = 30), role play/simulation (n = 21) and online games/apps (n = 5). Educational sessions were mainly about scientific update or communication. Outcomes of interventions were grouped in: vaccination rates (n = 69), knowledge (n = 32), attitudes (n = 26), confidence in counselling (n = 30) and acceptability (n = 16). CONCLUSIONS: Apps, gaming, role play/simulations could represent innovative interventions. This review highlighted the need of delving into communication strategies and using more robust evaluations, longer follow-up and standardized measurements.

Risk perception, knowledge about SARS-CoV-2, and perception towards preventive measures in Italy: a nationwide cross-sectional study.

Introduction: After COVID-19 outbreak, governments adopted several containment measures. Risk perception and knowledge may play a crucial role since they can affect compliance with preventive measures. This study aimed to explore the extent and the associated factors of risk perception, knowledge regarding SARS-CoV2, and perception towards preventive measures among the Italian population. Methods: A nationwide cross-sectional study involving adults was conducted in April-May 2021: an online survey was distributed through social media. The outcomes were: Knowledge Score (KS) (0 to 100%: higher scores correspond to higher COVID-19 related knowledge); Risk Perception Score (RPS) (1 to 4: higher values indicate higher concern); Preventive measures Perception Score (PPS) (1 to 4: higher values indicate higher confidence). Multivariable regression models were performed. Results: A total of 1120 participants were included. Median KS was 79.5% (IQR = 72.7%-86.4%). Lower education and poor economic conditions were negatively associated with the KS. Median RPS was 2.8 (IQR = 2.4-3.2). Female gender, sharing house with a fragile person, suffering from a chronic disease, having a family member/close friend who contracted SARS-CoV-2 infection were positively associated with the RPS. Median PPS was 3.1 (IQR = 2.8-3.4). Lower educational level was negatively associated with the PPS. Vaccine hesitancy was negatively associated with all three outcomes. The three scores were positively associated with each other. Conclusions: Fair levels of knowledge, risk perception and perception towards preventive measures were reported. Reciprocal relationships between the outcomes and a relevant relationship with vaccine hesitancy were highlighted. Further investigations should be focused on studying underlying determinants and consequences.

Exploring Knowledge and Awareness of HCV Infection and Screening Test: A Cross-Sectional Survey Among an Italian Sample.

Addressing HCV represents a public health priority, especially in Italy, which has the highest HCV prevalence in Europe. This study primarily aimed to explore knowledge about the HCV infection and awareness of the existence of the HCV screening test in Italy, before the implementation of awareness campaigns in 2022. An online cross-sectional survey was conducted (December 2021-January 2022). The primary outcomes were: Disease Knowledge Score (DKS), Prevention and Transmission Knowledge Score (PTKS) (for both: scoring from 0 to 100%, higher scores corresponded to higher knowledge), and being unaware of the existence of the HCV screening. The final sample consisted of 813 participants. The median DKS was 75% (IQR = 66.7-83.3), the median PTKS was 46.2% (IQR = 38.5-53.8), and 23.2% of participants were unaware of HCV screening. Higher education, health-related study or profession, history of accidental injuries, being affected by HCV and having actively searched for information on HCV had positive associations with DKS. LGBT males showed significantly lower DKS. Considering PTKS, participants affected by HCV the disease had a negative association with this score. Having a postgraduate education reduced the likelihood of not knowing about the HCV screening test, while having at least one family member affected by hepatitis C increased this probability. This study highlighted a concerning lack of knowledge about prevention and transmission, indicating a need for targeted education campaigns. The findings emphasized the importance of information and motivation and identified male LGBT + individuals as a vulnerable group with limited disease knowledge. Future research should concern the effectiveness of awareness campaigns.

Changes in Physical Activity Levels and Eating Behaviours during the COVID-19 Pandemic: Sociodemographic Analysis in University Students.

The COVID-19 pandemic has forced schools and universities to shift their activities online, influencing the adoption of health-related behaviours such as physical activity and healthy dietary habits. The present study investigates the changes in adherence to a healthy diet and regular physical activity in university students in Italy before and during the COVID-19 pandemic and understands the role of sociodemographic variables in creating the changes above. We conducted a repeated cross-sectional survey performing the same sampling strategy at the first data collection (T0) and second data collection (T1) with a combination of convenience and snowball sampling approaches. The sample is composed of a total of 2001 students, 60.2% women and 39.8% men, with an average age of 22.7 (±5.5 SD). At T1, 39.9% of the students reported regular physical activity. During the pandemic, however, many, especially male students, abandoned or reduced physical activity practice (T1 40%), with an increase in social media use (T0 52.1%; T1 90%). A direct association between very low frequency of physical activity and increased sedentary time (r = 0.2, p = 0.001) and between change in dietary style and increased Body Mass Index (BMI) value (r = 0.3, p = 0.002) was found. The multivariate analysis for the total sample showed that some sociodemographic variables such as gender, age, parents' level of education, area of study, household type, and perception of one's body influence eating behaviours and physical activity. Our findings suggest that universities should invest in the protection and promotion of the health of their students with specific awareness programmes, and further research should repeat the survey in the post-lockdown period to investigate the long-term effects on health-related behaviours.

Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study.

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.

Quality of Life and Psychosocial Impacts of the Different Restrictive Measures during One Year into the COVID-19 Pandemic on Patients with Cancer in Italy: An Ecological Study.

BACKGROUND: The aim of the study was to assess the perceived quality of life and the psychosocial impact of the various restrictive measures due to COVID-19 pandemic on cancer patients in Italy, as well as their perception of the relationship with doctors and caregivers. METHODS: This study compares three population-based observational studies of patients with cancer carried out in three consecutive time periods characterized by different restrictive measures using a self-administered online questionnaire. RESULTS: Among the basic needs, psychological and medical support appeared to be prevalent; so did the need for safe transportation to reach the treatment facilities. Internet was the main source of information on the coronavirus. Although 74.6% of the total number of patients did not give up hospital therapies, 34.8% complained about variations in the continuity of treatment, with different percentages in the three samples. The majority of the sample (73.8%) was worried of being infected, but 21.9% did not share their anxieties and worries with others. The multivariate regression analysis showed that a pessimistic perception of quality of life was influenced by living in extra-urban areas and alone (OR = 1.4; OR = 2.1); while a perception of a reduced physical function result affected by the state of anxiety and stress (OR = 1.9) and the difficulties in continuity of medical assistance (OR = 2.2). The scoring of the SF-12 in the Physical Component Summary and Mental Component Summary scores showed a fluctuating trend throughout the three periods investigated. CONCLUSIONS: It is important for health professionals, caregivers and social workers to identify the new needs in order to enhance home care interventions, personalize and optimize care, ensure continuity of care and guarantee a high quality of life even in a health emergency situation.

Health-related quality of life and its associated factors: results of a multi-center cross-sectional study among university students.

BACKGROUND: The decline of health among university students represents an important and growing public health concern. Health problems and unhealthy lifestyle habits are common among many students, but factors influencing students' health are not fully understood. METHODS: Italian university students from different study programs and curriculum years were asked to fill out a self-administered questionnaire, collecting data about age, gender, curriculum year, study program and health-related quality of life (QOL). Two latent factors were extracted: physical component summary score and mental component summary score. T-test, one-way ANOVA, multivariate and age and sex-stratified analyses were performed. RESULTS: Students scored relatively poor on health-related QOL, with an overall mental component summary score of 41,3% (± 10,0) and physical component summary score of 52,9% (±6,0), with significantly higher mental component summary score for male students (P = < 0,005). Studying economics, law (b = -2,513, P = 0,007) or engineering (b = -2,762; P = 0,001) was associated to negatively influence students' health. CONCLUSIONS: Factors such as study program are associated with health-related QOL. Further longitudinal studies assessing additional socio-demographic factors are needed to fully assess what influences students' health. Students' health should be at the top of the agenda of public health researchers, academic supervisors and policy-makers.

The impact of pictorial health warnings on tobacco products in smokers behaviours and knowledge: the first quasi-experimental field trial after the implementation of the tobacco law in Italy.

BACKGROUND: The aim of the study was to evaluate in the Italian smokers, the effects of implementation of the law about Pictorial Health Warnings (PHWs) on tobacco products. METHODS: A quasi-experimental longitudinal design was conducted between 2016 and 2017. The data were collected before (pre-PHW/Wave 1) and after (post-PHW/Wave 2) the implementation of the law. The adopted questionnaire included impact of advertisement (Label Impact Index, LII), quitting behavior and knowledge of tobacco related diseases. RESULTS: 455 respondents completed both the Waves. 7.7% of smokers declared to have stopped smoking in Wave 2 and 29% of these declared the PHWs as one of the reasons to quit. The knowledge of tobacco related diseases was significantly (p <0.001) increased from Wave 1 to Wave 2 (58% versus 72%), similarly the LII (mean = 26.9, SD = 16.7 and mean = 40.4, SD = 16.2). CONCLUSION: Tobacco addiction is a problem that needs to be addressed from different angles. PHWs confirm their complementary role as a support for smokers along with other strategies such as text warnings and the tobacco quit line of the Istituto Superiore di Sanità (Italian National Institute of Health) reported on the packages. Nonetheless, over the years these measures have been not enough and policy makers should consider more strategies synergistically acting in the fight against tabagism.

[The progressive patient care program as a model of field training of public health practitioners: the experience of the Roman Public Health Academy]. / L'ospedale ad Intensità di cura come modello di formazione condivisa sul campo: l'esperienza dell'Accademia Romana di Sanità Pubblica.

The management of healthcare facilities has become increasingly complex in recent years, leading to a greater demand for public health physicians in Italy. Public Health physicians are responsible for evaluating community needs, with particular attention to health determinants and, at the same time, to final user feedback. During their training, they must acquire the competencies to manage a wide range of problems. The Roman Public Health Academy (ARSP) was developed to motivate young residents in Public Health to acquire the knowhow, skills and abilities required of a public health practitioner. It therefore implemented a special training program offering different educational opportunities for residents. In particular, the program offers a team of three young residents field training opportunities, allowing them to become engaged in solving complex technical and management problems. In this paper we describe the methods through which, following a specific request by the director of a hospital in Rome, the team supported a project involving the reorganization of several hospital wards. The aim of the reorganization was to enhance the performance and efficiency of the wards, according to the Progressive Patients Care program.

Knowledge and attitudes towards the use of antibiotics in the paediatric age group: a multicenter survey in Italy.

Background: : The misuse of antibiotics is one of the leading causes of antibiotic resistance. Paediatric patients are highly involved in this issue, as they are those who receive the largest amount of prescriptions of these drugs. Therefore, this study aimed to investigate the general knowledge regarding the use of antibiotics, as well as the attitudes related to the administration of these drugs to children, amongst parents of children in the paediatric age-group. : In 2014, a multicentre cross-sectional study was conducted amongst parents of children aged 0-14. A questionnaire made up of 33 items was administered in waiting rooms of outpatient departments. Multivariable logistic regression models were performed, in order to assess the potential predictors of a better knowledge about antibiotics. : A total of 1247 parents took part to the survey. Around 33% of the samples declared that antibiotics are useful for viral infections, 20.6% that antibiotics are useful for every kind of pain and inflammation, while 14% of the parents stated that they stop giving antibiotics to their children when they start feeling better. Multivariable models showed that males, unemployed and those with lower levels of education are less prone to answer correctly to the questions about antibiotics. : The present study demonstrates that parents have a lack of knowledge regarding the use of antibiotics, which results in bad habits and inappropriate attitudes when it comes to giving antibiotics to their children. Attention should be particularly focused on disadvantaged parents.

[Training on vaccination for health care professionals]. / La formazione del personale sanitario in ambito vaccinale.

Vaccinations in Italy show a downward trend since 2013 due to an evergrowing mistrust of the population with regard to vaccination that has resulted in lesser adherence to vaccination programs. The main cause of the reduction is due to a tendency observed in recent years, even at the international level, known as 'vaccine hesitancy'. A growing number of studies on vaccine hesitancy show that causes vary by country, population, vaccine, and context influences, but in all cases emerges the importance of health care professionals in patients decision about vaccine. The new Piano Nazionale della Prevenzione Vaccinale 2017-2019 (PNPV - Italian National Plan on Vaccine Prevention) underlines the need to invest for healthcare professionals in technical and scientific training not only about vaccination and vaccination strategies, but also on communication skills. Training interventions are also considered important for achieving another PNPV goal that is to "support, at all levels, the sense of responsibility of healthcare workers […..].". The training of health care staff is therefore recognized as a key aspect for the consolidation of national vaccination policies. It is intended to improve and standardize SSN's performance, skills and quality and to provide the essential tools to be able to respond adequately the growing demand for correct and exhaustive information from patients. Therefore, it is important to invest in strategies to improve technical, scientific and communication knowledges on vaccinations, adapting them to specific political, social and cultural contexts, in order to reinforce the sense of trust with citizens and to pursue the success of public health strategies to increase vaccine coverage.

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.

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.

[What are the competencies that public health physician should have today? A proposal for a shared training program at three Hygiene and Preventive Medicine residency training schools in Rome (Italy)]. / Quali sono le competenze che al giorno d'oggi un professionista medico di sanità pubblica deve possedere? Risultati di un'analisi di formazione condivisa fra le Scuole di Specializzazione mediche in Igiene e Medicina Preventiva di Roma.

To acquire essential knowledge and skills for Public Health practice, residents in Hygiene and Preventive Medicine programs should be provided with excellent training. On behalf of the Roman Public Health Academy (ARSP), the authors, representing the three Hygiene and Preventive Medicine residency training programs in Rome (Italy) aimed to propose a training program to be shared by the above three schools. Firstly, they performed a scientific literature review to identify the core competencies that a public health specialist should have acquired at the end of training. Ten areas (macro-areas or domains) relevant to Public Health practice were defined. The authors then identified the main characteristics that the proposed training program should have, which include: enhancement of community healthcare services and optimization of local resources to create/strengthen exchange and cooperation networks; possibility to adapt the training proposal to an international setting; adoption of a training approach that can respond effectively to a changing health system; customization of training on the basis of residents' individual abilities and motivations, so that their individual strengths can be enhanced; achievement of educational excellence, in compliance with ethical requirements.

Are undocumented migrants' entitlements and barriers to healthcare a public health challenge for the European Union?

Undocumented migrants (UMs) are at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. Moreover, the emergent reality of undocumented migration in Europe calls for action in the field of management of UM's health demands as their access to health services has become a sensitive political and social issue. In this light, this paper aims to address UMs' entitlement and barriers to healthcare and related policies citing evidence from peer-reviewed and grey literature concerning people living in a country within the European Union without the legal right to be/remain in the destination country. A systematic review was performed using several databases and websites, and a total of 54 publications in English, with full text available, were taken into consideration. Between 2000 and 2015, Europe hosted the second largest number of international migrants (20 million, 1.3 million per year) after Asia. Even though there is limited evidence specifically focused on UMs' health, it is possible to state that infectious diseases, chronic illnesses, mental disorders, maternal-child conditions, dental issues, acute illnesses and injuries are the most common pathologies. In most cases across Europe, UMs have access only to emergency care. Even in countries where they are fully entitled to healthcare, formal and informal barriers hinder them from being or feeling entitled to this right. Socio-cultural barriers, such as language and communication problems, lack of formal and informal social and healthcare networks and lack of knowledge about the healthcare system and about informal networks of healthcare professionals are all common impediments. From the healthcare providers' perspective, there can be difficulties in providing appropriate care and in dealing with cultural and language barriers and false identification. Communication strategies play a central role in addressing the inequalities in access to healthcare services, and the definition and provision of specific training, focused on UMs' health needs, would be desirable. Improving access to healthcare for UMs is an urgent priority since the lack of access is proven to have serious consequences for UMs' health and wellbeing. Notwithstanding, few available examples of policies and best practices aimed at overcoming barriers in the delivery of healthcare to UMs are available.

From directive to practice: are pictorial warnings and plain packaging effective to reduce the tobacco addiction?

OBJECTIVES: Tobacco packaging represents an important form of promotion of tobacco products and for this reason plain packaging (PP) can be considered an additional tobacco control measure. In Italy the current tobacco packaging is branded with textual warnings. The study investigated the perception of PP with textual warnings (PPTWs) and pictorial warnings (PPPWs) in Italy. STUDY DESIGN: Cross-sectional. METHODS: The study was conducted on adults who were current, never and former smokers. The participants watched out three types of packages (current packaging, PPTWs and PPPWs) and eight pictorial warnings, and indicated which they considered the most effective ones to motivate smoking cessation or reduction and to prevent the onset. RESULTS: 1065 subjects were recruited. The PPPWs were considered the most effective in motivating to quit, reduce and prevent the smoking habits (ranged 83.4%-96.1%) in all tobacco users and age groups (≤40/>40 years) (P < 0.005). In general PP does not seem to be very effective in quitting for three-quarters of the smokers and 60% declared that they would have still started smoking with PP. The younger group believed less than the older one that PP gives a motivation to quit (29.4% vs 39.1%, P = 0.002). The pictures perceived as most effective in communicating the smoking effects were lung cancer and gangrene (about one-third of the sample). CONCLUSIONS: The textual warnings on tobacco products are a measure of control now outdated. Countries still using them should consider the idea of replace them with pictorial warnings that seem to be more effective. It is also desirable in the near future that these countries introduce the PPPWs.

[Quality of life and level of satisfaction of elderly persons receiving home health care: a cross-sectional study]. / Qualità della vita e grado di soddisfazione degli anziani in regime di assistenza domiciliare. Risultati di uno studio trasversale.

This study evaluated quality of life and level of satisfaction of elderly persons receiving home health care. Data was collected through a questionnaire and by examining medical records of 500 elderly patients. The mean age of study participants was 81 years. Results shows a high level of satisfaction with the quality of care received, the training of doctors and relationships with staff. Healthcare services requested by patients and supplied almost completely match; however, social services offered need to be intensified.

Knowledge, opinions and attitudes of Italian mothers towards HPV vaccination and Pap test.

AIM: This study evaluated the knowledge and attitudes of Italian mothers - whose daughters had been vaccinated in 2012 - towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues. METHODS: The survey - part of a multicenter study carried out in 4 Italian cities (Ferrara, Rome, Cassino and Palermo) - was conducted through self-administered questionnaires. The first univariate analysis evaluated differences between mothers of under-18s and over-18s relative to knowledge and attitudes on HPV vaccination and Pap test. The second univariate analysis evaluated differences between the 2 groups of mothers and possible geographical variations regarding the sources of information on HPV and Pap test. RESULTS: The sample proved knowledgeable about the correlation between HPV and cervical cancer (>85%) but less aware of other HPV-related diseases. HPV vaccination should be administered before first sexual intercourse according to mothers of over-18s, and to 14- to 17-year-olds according to mothers of under-18s. Up to 88% of mothers of under-18s and 80% of mothers of over-18s declared that the vaccine should be given free of charge. More mothers of under-18s consulted a general practitioner (GP) or gynecologist before deciding to vaccinate their daughters. Mothers of under-18s received information on HPV vaccination mainly from GPs and gynecologists, while mothers of over-18s were informed through TV and books/journals. Over 80% of the sample declared satisfaction with the information received from their gynecologist during the Pap test. CONCLUSIONS: The findings provide useful information for the development of effective public health interventions that may help improve acceptance of HPV vaccination among mothers.