Urban mobility and health: a multicentric survey conducted in some Italian cities.

INTRODUCTION: Urban and transport planning, environmental exposures, physical activity and human health are strictly linked. The aim of this study was to analyze the determinants of sustainable and active mobility in 4 Italian provinces. MATERIALS AND METHODS: An online multiple-choice survey was administered via Google Form between October 2019 and February 2020. RESULTS: 605 people answered the questionnaire, reporting their mobility practices. The home location did not seem to influence mobility behaviours, with the exception of the greater use of public transport for those who did not live in the province capital. Working or studying in central areas was associated with less use of the car, while not working or studying in the province capital was associated with less use of the motorbike. Women use cars more, and motorcycles/bicycles less. Age and educational level did not seem to influence mobility practices, while being a student compared to a worker was related to greater use of public transport and tendency to walk to the work/study place as well as to lesser car use. DISCUSSION: It is essential that all cities adopt solutions to encourage healthy mobility. The positive relationship between BMI and car use, between good food score and bike use and between frequent light physical activity and healthy mobility indicators confirmed that risk factors are often interconnected and that improving even one single habit could have a positive effect on the others as well. CONCLUSION: An urgent paradigm shift is needed to transform urban areas from agglomerations oriented on motorized transport to ones that rely on active and sustainable mobility, in order to turn cities into places generating wellness and health.

Prevalence and factors associated with bullying phenomenon among pre-adolescents attending first-grade secondary schools of Palermo, Italy, and a comparative systematic literature review.

BACKGROUND: Bullying is recognized as one of the most significant social and health problems in the school environment for children and adolescents. In Italy, bullying involved 2 in 10 kids between 11-17 years that referred to have been bullied two or more times in a month. In Sicily, the estimated prevalence of children aged 11 to 15 that suffered at least one act of bullying in the last two months was 14% in 2011. METHODS: A questionnaire consisting of 30 items investigating physical, verbal and indirect bullying, observers of bullying, resiliency, and prosociality was administered to preadolescents of ten first-grade secondary schools within the Palermo Province in order to analyze prevalence and factors associated with bullying phenomenon. Also, a systematic literature review (SLR) analyzing manuscripts that reported prevalence of the bullying phenomenon worldwide was conducted. RESULTS: Survey: a total of 867 students, belonging to 35 s and 31 third classes of ten different schools in Palermo, Italy, were recruited in the survey. The values of physical bullying are included between the 4% of the single question method and the almost forty percent detected by the score of 7 method. Verbal bullying oscillates between 15.9% and 66.3%. Observers average values varies from 15.8% to 47.5%. SLR: the estimated prevalence showed a considerable fluctuation. The occurrence of the bullying phenomenon was low in some Northern European countries, while in Anglo-Saxon countries it affected over a quarter of the middle school student population (28% in Maryland, USA and 21% in the UK). CONCLUSIONS: The prevalence of the bullying phenomenon recorded by this survey with the three different methods used is similar to observations in international literature. In the Sicilian context, a higher prevalence of bullying phenomena was observed in pre-adolescents attending major classes and in schools with lower socio-economic index. Though it remains difficult to obtain univocal data that clarifies the prevalence of different type of bullying, the continuous investigation of prevalence and factors associated with the phenomenon is a necessary starting point to introduce interventions and preventive measures in Public Health programs.

Knowledge, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo's Province, Italy: From Influenza to COVID-19.

In Italy, following the start of the SARS-CoV-2 vaccination campaign, community pharmacies (CPs) were recruited on a voluntary basis in order to administer COVID-19 vaccines as part of their activities. The aim of the present study was to investigate the knowledge, attitudes, and practices regarding SARS-CoV-2 infection prevention, and vaccine acceptance/hesitancy towards COVID-19 and influenza vaccinations among the community pharmacists operating in the Palermo Province. A cross-sectional study was conducted, with two different questionnaires administered before and after the conduction of the vaccination campaign against SARS-CoV-2 at the COVID-19 vaccination center of the Palermo University Hospital (PUH). The baseline survey showed that 64% of community pharmacists (CPs) declared that they planned to vaccinate against SARS-CoV-2, and 58% were vaccinated against influenza during the 2020/2021 season. Factors significantly associated with willingness to receive the COVID-19 vaccination were confidence in vaccines (adjOR 1.76; CI 1.11-2.80), fear of contracting SARS-CoV-2 infection (adjOR 1.50; CI 1.06-2.11), considering COVID-19 vaccination to be the best strategy to counteract SARS-CoV-2 (adjOR 1.79; CI 1.39-2.29), and adherence to influenza vaccination during the 2020/2021 season (adjOR 3.25; CI 2.23-4.25). The adherence among CPs of the Palermo Province to COVID-19 vaccination was 96.5%. From the post-vaccination survey, the main reasons for changing opinions on vaccination adherence were the introduction of mandatory vaccinations, fear of contracting COVID-19, and limitations on work activities in the case of vaccine refusal. The achievement of very high COVID-19 vaccination coverage rates among healthcare professionals (HCPs) in the present study was mainly due to the mandatory vaccination policies; nevertheless, a willingness for COVID-19 vaccination was relatively high among pharmacists before the beginning of the vaccination campaign. HCPs and CPs should receive training on vaccination, which is recommended in the national immunization plan and is also suggested by the respondents in our study, in order to routinely re-evaluate their own vaccination profiles, as well as those of their patients.

Human Papilloma Virus Infection and Vaccination: Pre-Post Intervention Analysis on Knowledge, Attitudes and Willingness to Vaccinate Among Preadolescents Attending Secondary Schools of Palermo, Sicily.

In recent years, vaccination coverage rates against Human Papilloma Virus (HPV) in Europe have shown a decreasing trend and remain below the required standard. The present study aims to assess knowledge and attitudes regarding HPV infection and vaccination among a representative sample of preadolescents of Palermo, Italy. A survey was carried out throughout two questionnaires, before and after carrying out an educational intervention scheduled during school hours. A total of 1702 students attending first-grade secondary schools of the province of Palermo were enrolled (response rate 68.9%). Students attending third classes (adj OR = 1.18; CI 95% 1.03-1.36), being of higher socioeconomic status (adj OR = 1.35; CI 95% 1.05-1.73), who had previously received information about sexually transmitted diseases (STDs) at home (adj OR = 1.62; CI 95% 1.27-2.07) or at school (adj OR = 2.15; CI 95% 1.70-2.71) and who had ever heard in the past about HPV (adj OR = 1.80; CI 95% 1.42-2.29) showed a significantly higher baseline level of knowledge regarding HPV. Willingness to receive HPV vaccination, in a 10-point Likert scale, significantly increased between the pre- (8.51; SD ± 1.79) and post- (9.01 SD ± 1.52) intervention questionnaires (p < 0.001). A total of 188 out of 272 (69.1%) preadolescents attending five out eighteen schools involved in the project, who had not previously received the HPV vaccine, were vaccinated. During past years, education campaigns on HPV were mainly dedicated to adult women, excluding teenagers and omitting young males. It should therefore be of primary importance that school-based education and vaccination programmes be standardized.

Public health strategies adopted to manage the increase of accesses to vaccination services, as a result of the application of the law 119/2017.

BACKGROUND AND AIM OF THE WORK: In response to the alarming reduction of vaccination coverage rates, Italian Ministry of Health approved the law number 119/2017, which has extended the number of mandatory vaccinations, for school attendance, from four to ten. The present study aims to evaluate accesses to the vaccination services of the Palermo Local Health Unit (LHU) and the variation of the vaccination coverage rates for hexavalent and measles, mumps, rubella and varicella (MMRV) vaccines, after the implementation of the law 119/2017. METHODS: An extent of opening hours and an involvement of other health-care professionals in the vaccination services of the Palermo LHU have been adopted to manage the excess of accesses after the introduction of 119/2017 law and to limit the discomfort of general population. Vaccination accesses and coverage rates were calculated from the electronic immunization registers. RESULTS: An overall increase of about 15% of single vaccination accesses was observed in the three semester after the introduction of the law in the LHU of Palermo. A peak of 35,516 accesses was observed during the second semester of 2017 (+ 30% compared to the same semesters of 2016 and 2018). From 2016 to 2018, coverage rates for full hexavalent cycle and first dose of MMRV, at 24 and 36 months, and for full MMRV cycle and fourth dose of diphtheria, tetanus, pertussis, poliomyelitis (DTPa+IPV), among 6 years old children, showed considerable increases. CONCLUSIONS: Law 199/2017 demonstrated a high efficacy in increase vaccination coverage rates also in Sicily. The synergy established between the LHU and the University of Palermo allowed an excellent management of the accesses to vaccination services, making it possible to respond to the public health needs of the general population.

Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy.

BACKGROUND AND AIM OF THE WORK: Even though vaccination is easy to access in Europe, it has been facing several outbreaks caused by vaccine preventable diseases. Trying to balance the right to health of the community with individual self-determination, in Italy was mandate vaccination for ten vaccine preventable diseases in 2017. The project "Sportello Vaccinale" provided a counseling service to parents in kindergarten of Palermo. The main objective of the study was to investigate knowledge and compliance on vaccination by children's parents after the implementation of mandatory vaccination. METHODS: A cross sectional study was conducted among parents accessing to the "Sportello Vaccinale" using a questionnaire.  The questionnaire consisted of 34 items divided into three sections: socio-demographic data; knowledge and attitude on mandatory vaccination using Health Belief Model (HBM); Health Literacy (HL) level. RESULTS: A total of 95 questionnaires were garnered in the kindergartens from respondents with a mean age of 36 (±SD=6) years. The respondents who delayed hexavalent or Measles, Mumps, Rubella and Varicella (MMRV) vaccinations were 8 (8%) and the more frequent cause was fear of adverse reaction (87%). The sample had more often high level of health literacy (37%), and 55% had higher HBM score. The factor significantly associated with higher HBM score was the age of respondents (OR= 1.14, p=0.006) after controlling for other variables. CONCLUSIONS: Consent to vaccination practice was widely represented, but the results of the study highlighted the need for parents to have more information and more time devoted to the practice of vaccination counseling. Implementing counseling activities at school or at the vaccination service, could support an aware decision process of the parents on vaccination topic.

Determinants of vaccine hesitancy and effectiveness of vaccination counseling interventions among a sample of the general population in Palermo, Italy.

Counteract vaccine hesitancy is a public health priority. Main objectives of the cross-sectional study conducted were to evaluate knowledge, attitudes, and behaviors regarding vaccination issues, to estimate the prevalence of vaccine hesitancy and to estimate the effectiveness of vaccination counseling on community advocacy in a sample of general population. An anonymous validated questionnaire was administered in April 2017 at the main shopping center of Palermo and was followed by tailored vaccination counseling interventions. To estimate the effectiveness of the interventions four main connection parameters to the vaccinarsi.org website were evaluated, in the two months before and after the intervention and in the two months before the intervention compared with the same period of previous and following years. Among the 299 subject enrolled 12.7% were hesitant about vaccinations, and 4.7% declared being against vaccinations. General practitioners (GPs) and pediatricians were the most affordable source of information about vaccinations. A higher probability of vaccination hesitancy/refusal was reported among subjects who considered "alternative strategies" the best way for the prevention of infectious diseases (adj-OR = 7.01, IC95% 2.88-17.09, p-value < 0.001). A considerable increase of all the vaccinarsi.org website indicators analyzed was observed, from the area in which survey participants lived. Prevalence of vaccine hesitancy among population surveyed is consistent with the literature data. HCWs, such as GPs and pediatricians, should play a key role in modifying personal convictions and choices about vaccinations. A proper vaccination counseling could improve attitudes regarding vaccination issues, such as quality of web-based research.

Rotavirus gastroenteritis hospitalization rates and correlation with rotavirus vaccination coverage in Sicily.

Background and aim of the works: Rotavirus (RV) is considered the main cause of gastroenteritis in children from 0 to 59 months and vaccination represents the only strategy to prevent hospitalizations due to RV. In 2013 Sicilian Region introduced universal RV vaccination for all newborns. The present study aims to estimate the reduction rotavirus gastroenteritis (RVGE) hospitalization rates among Sicilian children and their relations with vaccination coverages of the nine Sicilian Local Health Units (LHUs). METHODS: Were analyzed hospital discharge records including a diagnosis of RVGE occurred from January 2009 to December 2017 in hospitalized children aged 0 to 59 months, residents in Sicily. Were reported data on complete RV vaccination cycles among Sicilian children under 12 months of age (vaccination coverage). RESULTS: A 49.2% overall reduction of RVGE hospitalization rates was reported after RV vaccination introduction. A more considerable reduction of hospitalization rates was observed among children aged 0 to 11 months (-61.4%), followed by children aged 12-23 months (-51.2%) and 24-35 months (-48.8%). In all the nine Sicilian Local Health Units (LHUs), a reduction of RVGE hospitalization rates was observed after RV vaccine implementation. CONCLUSIONS: This study demonstrated the significant impact of RV vaccination on RVGE hospitalization rates in Sicily, especially among children aged 0 to 23 months. The reduction in RVGE hospitalization rates observed in the Sicilian LHUs after universal vaccination program implementation, were generally higher or consistent with average vaccination coverage reported from 2013 to 2017.

Prevalence of the bullying phenomenon in a schools sample of Palermo, Sicily: a pre-post intervention observational study among teachers.

BACKGROUND AND AIM OF THE WORK: Bullying involves a significant percentage of school-age children. According to the latest available surveillance data, in Sicily, the estimated prevalence among 11-15 years old children is 14%. This study aimed to estimate a prevalence of the bullying phenomenon, observed by teachers, in a sample of secondary schools of Palermo, Sicily. Moreover, after the conduction of preventive interventions among teachers, aimed to evaluate any modification in bullying prevalence. METHODS: A cluster sampling selection according to socio-economic level of the school neighborhood was carried out. Two anonymous online questionnaires, pre and post-intervention, were administered to the 63 teaching staff, belonging to second and third year classes of ten secondary schools enrolled. Preventive interventions were conducted among teachers by experienced researchers. RESULTS: Prevalence of bullying reported decreased significantly from 44.4% to 19.0% (p-value 0.001), comparing pre and post-intervention questionnaires. A reduction in the prevalence of verbal and physical bullying and a concomitant slight increase of indirect bullying were also observed. All the characteristics, reported by the teaching staff, for describing bullies, victims and observers of bullying have been categorized under three different content domains (affective-relational discomfort, socio-cultural context, and character/natural disposition). CONCLUSIONS: The present study estimated the prevalence and the characteristics of bullying phenomenon in a sample of secondary schools of Palermo, evaluating the reduction of bullying episodes among students, after a preventive interventions conducted among teaching staff. Data obtained confirmed the effectiveness of this approach and suggested an extension of the project at Regional Level.