Subnational inequalities in years of life lost and associations with socioeconomic factors in pre-pandemic Europe, 2009-19: an ecological study.

BACKGROUND: Health inequalities have been associated with shorter lifespans. We aimed to investigate subnational geographical inequalities in all-cause years of life lost (YLLs) and the association between YLLs and socioeconomic factors, such as household income, risk of poverty, and educational attainment, in countries within the European Economic Area (EEA) before the COVID-19 pandemic. METHODS: In this ecological study, we extracted demographic and socioeconomic data from Eurostat for 1390 small regions and 285 basic regions for 32 countries in the EEA, which was complemented by a time-trend analysis of subnational regions within the EEA. Age-standardised YLL rates per 100 000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease study. Geographical inequalities were assessed using the Gini coefficient and slope index of inequality. Socioeconomic inequalities were assessed by investigating the association between socioeconomic factors (educational attainment, household income, and risk of poverty) and YLLs in 2019 using negative binomial mixed models. FINDINGS: Between Jan 1, 2009, and Dec 31, 2019, YLLs lowered in almost all subnational regions. The Gini coefficient of YLLs across all EEA regions was 14·2% (95% CI 13·6-14·8) for females and 17·0% (16·3 to 17·7) for males. Relative geographical inequalities in YLLs among women were highest in the UK (Gini coefficient 11·2% [95% CI 10·1-12·3]) and among men were highest in Belgium (10·8% [9·3-12·2]). The highest YLLs were observed in subnational regions with the lowest levels of educational attainment (incident rate ratio [IRR] 1·19 [1·13-1·26] for females; 1·22 [1·16-1·28] for males), household income (1·35 [95% CI 1·19-1·53]), and the highest poverty risk (1·25 [1·18-1·34]). INTERPRETATION: Differences in YLLs remain within, and between, EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing health inequities to improve overall disease burden within the EEA. FUNDING: Research Council of Norway; Development, and Innovation Fund of Hungary; Norwegian Institute of Public Medicine; and COST Action 18218 European Burden of Disease Network.

Translation and validation of the Italian version of the incivility in nursing education-revised scale.

BACKGROUND: Incivility in nursing education is present worldwide and impacts all those involved and the teacher-student relationship. The revised Incivility in Nursing Education (INE-R) is a validated and reliable instrument to measure academic incivility, but it is not available in Italian language. The aim of the study was to translate and validate the INE-R tool with an Italian sample. METHODS: The INE-R was translated from English into Italian, culturally adapted and piloted for content and linguistic clarity. The questionnaire was administered online to Nursing Faculty (NF) and Nursing Students (NS) of Sapienza University of Rome to assess uncivil behaviors and their frequency of occurrence. The psychometric properties of the Italian version were investigated. RESULTS: 79 Italians participated, of which 63.3 % were NS. Four-factor models provided the best fit for NF and NS scales. The models explained 78.2 % (NF) and 73.2 % (NS) of the variance of the scales. The Root Mean Square Error of Approximation for both models was 0.07, indicating an acceptable fit. INE-R reliability for all 48 NF and NS incivility items was 0.962 and 0.954, respectively. Measuring the degree of incivility and establishing codes of conduct were recommended. CONCLUSIONS: Incivility in nursing education negatively impacts the teaching-learning environment and could cause emotional or physical distress for those involved. Zero-tolerance policy regarding incivility, routine evaluation, and raising awareness among students and faculty could improve the quality of academic settings. The Italian INE-R is a valid and reliable tool that can be used to evaluate incivility in Italian nursing programs.

Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study.

BACKGROUND: Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest. METHODS: DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries. RESULTS: Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low. CONCLUSIONS: The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.

Management and Prevention of Pre-Eclampsia in Nigeria.

This research paper analyses the management and prevention of pre-eclampsia in Nigeria. Although efforts have been made to reduce outcomes due to pre-eclampsia, it still rears its head in the form of high maternal and perinatal morbidity and mortality. The aim of this review was to identify the main obstacles, gaps, and interventions related to the prevention and management of pre-eclampsia in order to be fully knowledgeable of the magnitude of the issue at the national level, to assess if current government policies are adequate and to recommend solutions. A search was performed on online databases and it was completed with hand searches related to the subject matter. Screening tests for early detection of pre-eclampsia are hardly available in Nigeria as many hospitals rely on the history of previous and current pregnancies, blood pressure monitoring and urinalysis-proteinuria. The administration of low-dose aspirin, antihypertensive drugs and magnesium sulphate, coupled with calcium in calcium deficit regions, was recommended. The main barriers to the wider implementation of these strategies are inadequacy of the antenatal care services in providing appropriate care, lack of resources and trained personnel, high healthcare costs, and low antennal care attendance. Improving education and awareness, use of low-cost screening modalities and low-dose aspirin can be deployed in developing countries to curb pre-eclampsia.

Rural-urban variation in willingness to donate blood in Ibadan Region, Nigeria.

BACKGROUND: Although there are ongoing blood donation campaigns in Nigeria, the prevalence of voluntary blood donation is about 10% and there is limited information about the determinants of blood donation behavior, especially across rural-urban geographic areas. This study examines the rural-urban differences in willingness to donate blood. METHOD: A cross-sectional study addressing adults from three rural and three urban communities was performed in 2021 to evaluate willingness, knowledge, attitude and practice of blood donation. RESULTS: A total of 287 individuals were surveyed. Most of the respondents across all communities have never donated blood (72%). Females aged 18-25, highly educated, and from urban communities were more incline to donate blood compared to their counterparts. The main reasons for not donating blood for rural dwellers were: never thought of it (39% vs 34.7%) and no one asked (34.4% vs 17%); fear of needles was declared mostly by urban dwellers (21.8% vs 12.5%) (p=0.02). CONCLUSIONS: Willingness to donate blood varies across rural and urban communities and is influenced by socio-demographic characteristics. The gap between willingness to donate and actual blood donation has consequences for the establishment of blood transfusion services. Targeted public health interventions are required to enhance awareness and knowledge and modify attitudes towards blood donation.

The Determinants of Vaccine Literacy in the Italian Population: Results from the Health Literacy Survey 2019.

Vaccines are among the most important public health achievements of the last century; however, vaccine awareness and uptake still face significant challenges and the COVID-19 pandemic has only exacerbated this phenomenon. Vaccine Literacy (VL) is the ability to find, understand and judge immunisation-related information to make appropriate immunisation decisions. A cross-sectional study on a sample of 3500 participants, representative of the Italian adult population aged 18+ years, was conducted in Italy in 2021. A validated questionnaire, including sections on health literacy (HL), sociodemographic characteristics, risk factors, and lifestyles of respondents, was used. VL was measured by four items (item 19, 22, 26 and 29) of the HL section. While 67.6% of the respondents had a "good" (47.5%) or "sufficient" (20.1%) level of VL, 32.4% had "limited" VL levels. Although the overall VL level was quite high, many participants reported difficulties in dealing with vaccination information, particularly those with a lower educational level, those living in southern and insular regions of Italy, those with greater financial deprivation and those with a migration background. Improving VL in Italy should be a top priority in the political agenda, with special regard to socially and geographically disadvantaged communities.

Coronavirus-Related Health Literacy: A Cross-Sectional Study during the COVID-19 Pandemic in Italy.

The COVID-19 pandemic has caused an overabundance of valid and invalid information to spread rapidly via traditional media as well as by internet and digital communication. Health literacy (HL) is the ability to access, understand, appraise, and apply health information, making it fundamental for finding, interpreting, and correctly using COVID-19 information. A cross-sectional study of a sample of 3500 participants representative of the Italian adult population aged 18+ years was conducted in Italy in 2021. A validated HL questionnaire was employed, including sections on coronavirus-related HL, general HL, sociodemographic characteristics, risk factors, and respondents' lifestyle. Of our sample, 49.3% had "excellent" levels of coronavirus-related HL and 50.7% had "sufficient" (20.7%) or "limited" (30.0%) levels. Although the overall HL-COVID level was high, many participants reported difficulties dealing with COVID-19 information; in particular, participants older than 65 years, with a low education level, living in southern regions of Italy, and with high financial deprivation. Targeted public information campaigns and the promotion of HL are required for better navigation of health information environments. The COVID-19 pandemic has highlighted the need to improve HL and to prepare the general population for future emergency and non-emergency situations, confirming that HL can be considered a social vaccine.

Health data collection methods and procedures across EU member states: findings from the InfAct Joint Action on health information.

BACKGROUND: Health-related data are collected from a variety of sources for different purposes, including secondary use for population health monitoring (HM) and health system performance assessment (HSPA). Most of these data sources are not included in databases of international organizations (e.g., WHO, OECD, Eurostat), limiting their use for research activities and policy making. This study aims at identifying and describing collection methods, quality assessment procedures, availability and accessibility of health data across EU Member States (MS) for HM and HSPA. METHODS: A structured questionnaire was developed and administered through an online platform to partners of the InfAct consortium form EU MS to investigate data collections applied in HM and HSPA projects, as well as their methods and procedures. A descriptive analysis of the questionnaire results was performed. RESULTS: Information on 91 projects from 18 EU MS was collected. In these projects, data were mainly collected through administrative sources, population health interview or health examination surveys and from electronic medical records. Tools and methods used for data collection were mostly mandatory reports, self-administered questionnaires, or record linkage of various data sources. One-third of the projects shared data with EU research networks and less than one-third performed quality assessment of their data collection procedures using international standardized criteria. Macrodata were accessible via open access and reusable in 22 projects. Microdata were accessible upon specific request and reusable in 15 projects based on data usage licenses. Metadata was available for the majority of the projects, but followed reporting standards only in 29 projects. Overall, compliance to FAIR Data principles (Findable, Accessible, Interoperable, and Reusable) was not optimal across the EU projects. CONCLUSIONS: Data collection and exchange procedures differ across EU MS and research data are not always available, accessible, comparable or reusable for further research and evidence-based policy making. There is a need for an EU-level health information infrastructure and governance to promote and facilitate sharing and dissemination of standardized and comparable health data, following FAIR Data principles, across the EU.

Mapping European research networks providing health data: results from the InfAct Joint Action on health information.

BACKGROUND: Research networks offer multidisciplinary expertise and promote information exchange between researchers across Europe. They are essential for the European Union's (EU) health information system as providers of health information and data. The aim of this mapping exercise was to identify and analyze EU research networks in terms of health data collection methods, quality assessment, availability and accessibility procedures. METHODS: A web-based search was performed to identify EU research networks that are not part of international organizations (e.g., WHO-Europe, OECD) and are involved in collection of data for health monitoring or health system performance assessment. General characteristics of the research networks (e.g., data sources, representativeness), quality assessment procedures, availability and accessibility of health data were collected through an ad hoc extraction form. RESULTS: Fifty-seven research networks, representative at national, international or regional level, were identified. In these networks, data are mainly collected through administrative sources, health surveys and cohort studies. Over 70% of networks provide information on quality assessment of their data collection procedures. Most networks share macrodata through articles and reports, while microdata are available from ten networks. A request for data access is required by 14 networks, of which three apply a financial charge. Few networks share data with other research networks (8/49) or specify the metadata-reporting standards used for data description (9/49). CONCLUSIONS: Improving health information and availability of high quality data is a priority in Europe. Research networks could play a major role in tackling health data and information inequalities by enhancing quality, availability, and accessibility of health data and data sharing across European networks.

Innovative Methods Used in Monitoring COVID-19 in Europe: A Multinational Study.

Several innovative methods have been deployed worldwide to curb the COVID-19 pandemic. The aim of the study is to investigate which innovative methods are used to monitor COVID-19 health issues in Europe and related legislative and ethical aspects. An online questionnaire was administered to European countries' representatives of the project Population Health Information Research Infrastructure. Additional information was obtained from websites and documents provided by the respondents; an overview of the literature was also performed. Respondents from 14 countries participated in the study. Digital tools are used to monitor the spread of COVID-19 (13/14 countries) and vaccination coverage (12/14); for research, diagnostics, telehealth (14/14); to fight disinformation (11/14) and forecast the pandemic spread (4/14). The level of implementation of telehealth applications was mostly low/medium. Legislative and ethical issues were encountered in many countries, leading to institutional distrust. The COVID-19 pandemic has highlighted the need for timely and accurate health data for research purposes and policy planning. However, the use of innovative methods for population health monitoring and timely data collection has posed challenges to privacy and online security globally. Adequate regulatory oversight, targeted public health interventions, and fight against disinformation could improve the uptake rate and enhance countries' emergency preparedness.

Overview of national health reporting in the EU and quality criteria for public health reports - results of the Joint Action InfAct.

BACKGROUND: Health reporting shall provide up-to-date health-related data to inform policy-makers, researchers and the public. To this end, health reporting formats should be tailored to the needs and competencies of the target groups and provide comparable and high-quality information. Within the Joint Action on Health Information 'InfAct', we aimed at gaining an overview of health reporting practices in the EU Member States and associated countries, and developed quality criteria for the preparation of public health reports. The results are intended to facilitate making health information adequately available while reducing inequalities in health reporting across the EU. METHODS: A web-based desk research was conducted among EU Member States and associated countries to generate an overview of different formats of national health reporting and their respective target groups. To identify possible quality criteria for public health reports, an exploratory literature review was performed and earlier projects were analysed. The final set of criteria was developed in exchange with experts from the InfAct consortium. RESULTS: The web-based desk research showed that public health reports are the most frequently used format across countries (94%), most often addressed to scientists and researchers (51%), politicians and decision-makers (41%). However, across all reporting formats, the general public is the most frequently addressed target group. With regards to quality criteria for public health reports, the literature review has yielded few results. Therefore, two earlier projects served as main sources: the 'Evaluation of National and Regional Public Health Reports' and the guideline 'Good Practice in Health Reporting'from Germany. In collaboration with experts, quality criteria were identified and grouped into eight categories, ranging from topic selection to presentation of results, and compiled in a checklist for easy reference. CONCLUSION: Health reporting practices in the EU are heterogeneous across Member States. The assembled quality criteria are intended to facilitate the preparation, dissemination and access to better comparable high-quality public health reports as a basis for evidence-based decision-making. A comprehensive conceptual and integrative approach that incorporates the policy perspective would be useful to investigate which dissemination strategies are the most suitable for specific requirements of the targeted groups.

Incivility among nursing faculty: A multi-country study.

BACKGROUND: In nursing programs, incivility can be a main issue affecting future registered nurses, and this may threaten patient safety. Nursing faculty play an important role in this scenario to reduce incivility. PURPOSE: The aim of this study was to assess incivility among nursing faculty in different countries. METHOD: This descriptive (cross-sectional) study was conducted to assess the extent of incivility among nursing faculty by using Incivility in Nursing Education-Revised tool and a non-probability (convenience) sampling method was used. Three hundred ninety-five nursing faculty in 10 countries distributed in four continents participated in this study. RESULTS: The results indicated that levels of incivility among participants in different countries were significantly different. Also, there was a significant difference (F = 9.313, P value = 0.000) among the nursing faculty concerning the behaviours that have been rated as disruptive. Furthermore, there was a significant difference (F = 6.392, P value = 0.000) among participants regarding uncivil behaviours that have occurred during the past 12 months. CONCLUSION: Regular assessments are needed to highlight uncivil behaviours and reduce them by making policies and rules in order to enhance academic achievement in nursing education.

Prevalence of COVID-19-related symptoms by age group.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 has caused over 95 million confirmed cases of COVID-19 and over 2 million deaths worldwide. According to current literature data, older adults have higher risk of severe disease and mortality due to COVID-19. It is also known that older adults often do not present typical symptoms of diseases. The aim of the study was to assess if the prevalence of typical COVID-19-related symptoms varies by age group. METHODS: Medical charts of a random sample of COVID-19 patients dying in-hospital were retrieved through an integrated national surveillance system and reviewed by a group of researchers at the Italian National Institute of Health. Detailed information on COVID-19-related symptoms were extracted and analyzed. RESULTS: 3241 confirmed cases of COVID-19-related deaths were identified from 4391 reviewed medical charts. The mean number of COVID-19-related symptoms progressively declined with age, from 2.1 in patients aged < 60 years to 1.7 in those aged 90 years or older (p < 0.001). Moreover, fever, cough, and diarrhea significantly declined with increasing age. CONCLUSIONS: Older adults have atypical presentation of symptoms and may be paucisymptomatic. This may lead to a diagnostic and therapeutic delay which aggravates the prognosis of COVID-19. Special attention should be posed when assessing individuals aged 65 years and older with suspected COVID-19.

Trends in hip and distal femoral fracture rates in Italy from 2007 to 2017.

Osteoporosis-related fractures are a growing public health concern worldwide due to high societal and economic burden. The study aims to assess trends in incidence rates of hip and distal femoral fractures and in the use of anti-osteoporosis drugs in Italy between 2007 and 2017. Patients with hip and distal femoral fractures (ICD-9-CM codes 820.x and 821.x) were identified in the Italian National Hospital Discharge Database while anti-osteoporosis medication data were retrieved from the National Observatory on the Use of Medicines Database. A joinpoint regression analysis was performed to identify the years where the trends in incidence rates of hip and distal femoral fractures changed significantly; the average annual percentage change for the period of observation was estimated. Hospitalizations for femoral fractures were 991,059, of which 91.4% were hip fractures and 76.5% occurred in women. Age-standardized hip fractures rate per 100,000 person-years decreased both in women (-8.7%; from 789.9 in 2007 to 721.5 in 2017) and in men (-4.3%; from 423.9 to 405.6), while the rate of distal femoral fractures increased by 23.9% in women (from 67.78 to 83.95) and 22.7% in men (from 27.76 to 34.06). These changes were associated with an increment in the use of anti-osteoporosis drugs from 2007 to 2011 (from 9.1 to 12.4 DDD/1000 inhabitants/day), followed by a plateau in the period 2012-2017. The use of bisphosphonates increased progressively from 2007 to 2010 (from 8.2 to 10.5 DDD/1000 inhabitants/day), followed by a plateau and then decreased from 2015 onwards. The decreasing trend of hip fractures could be related to a major intake of anti-osteoporosis medications while the increment of distal femoral fractures might be due to population aging and to the use of bisphosphonates and denosumab. Further research is needed to identify and implement interventions to prevent hip and distal femoral fractures.

Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy.

BACKGROUND: Among the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited sex-disaggregated data available. METHODS: A retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27-June 11, 2020). Clinical characteristics and the times from symptoms' onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex. RESULTS: Of the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39-2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29-2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13-1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55-0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25-0.63), yet both sexes had a high level of multimorbidity. The times from symptoms' onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45-5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13-1.90). CONCLUSIONS: Men and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.

Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey.

BACKGROUND: The international public health (PH) community is debating the opportunity to incorporate genomic technologies into PH practice. A survey was conducted to assess attitudes of the European Public Health Association (EUPHA) members towards their role in the implementation of public health genomics (PHG), and their knowledge and attitudes towards genetic testing and the delivery of genetic services. METHODS: EUPHA members were invited via monthly newsletter and e-mail to take part in an online survey from February 2017 to January 2018. A descriptive analysis of knowledge and attitudes was conducted, along with a univariate and multivariate analysis of their determinants. RESULTS: Five hundred and two people completed the questionnaire, 17.9% were involved in PHG activities. Only 28.9% correctly identified all medical conditions for which there is (or not) evidence for implementing genetic testing; over 60% thought that investing in genomics may divert economic resources from social and environmental determinants of health. The majority agreed that PH professionals may play different roles in incorporating genomics into their activities. Better knowledge was associated with positive attitudes towards the use of genetic testing and the delivery of genetic services in PH (OR = 1.48; 95% CI 1.01-2.18). CONCLUSIONS: Our study revealed quite positive attitudes, but also a need to increase awareness on genomics among European PH professionals. Those directly involved in PHG activities tend to have a more positive attitude and better knowledge; however, gaps are also evident in this group, suggesting the need to harmonize practice and encourage greater exchange of knowledge among professionals.

The Provision of Genetic Testing and Related Services in Quebec, Canada.

BACKGROUND: Research in the field of genomics and genetics has evolved in recent years and so has the demand of consumers who are increasingly interested in genomic prediction of diseases and various traits. The aim of this study is to identify genetic service delivery models, policies governing the use of genomics medicine, and measures to evaluate genetic services in the province of Quebec, Canada. METHODS: An ad hoc questionnaire was designed and administered online in 2017 to healthcare workers with good knowledge or experience in the provision of BReast CAncer genes 1 and 2 (BRCA1/2), Lynch syndrome, familial hypercholesterolemia, inherited thrombophilia genetic tests, engaged in policy planning or evaluation of genetic services. A quali-quantitative analysis of the survey results was performed. RESULTS: Thirty professionals participated in the study. The delivery models are classified in five categories according to the leading role of healthcare professionals in patient care pathways: i) the geneticist model; ii) the primary care model; iii) the medical specialist model; iv) the population screening program model; and v) the direct-to-consumer model. Barriers to genetic services are the coverage of genetic tests by the publicly funded healthcare system, the availability of qualified personnel, and the number of genetic centers. Regulatory oversight concerning the provision of genetic services appears to be insufficient. CONCLUSIONS: Integration between genetics and the overall healthcare system in Quebec is in an early phase. Current models of genetic services require good level of genetic knowledge by all medical specialists, collaboration among different healthcare personnel, and work redistribution. The proper implementation of genomics into healthcare can be achieved through education and training, proper regulatory oversight, genomic policies, and public awareness.