Search

Background In the context of common surgical procedures in pediatric otorhinolaryngology (ORL) patients, providing for education to families for hospitalization, surgery, and postoperative home management has been shown to improve peri-operative outcomes. In this regard, the use of Mobile Health Applications (MHA) is increasing. However, for these tools to be needs-appropriate and effective, their development requires a user-centred approach. Methods Our study aimed to explore the informational needs and preferences - in terms of features and functionalities - of health care providers and ORL patients’ caregivers (end-users) to inform the development of an MHA supporting ORL peri-operative process effectively. The study was conducted at a 136-bed maternal and child health hospital in Trieste. A user-centred participatory study design was employed, and the methodology steps were informed by the 3 cycles of the Information System Research Framework (Schnall et al., 2016). Results The Relevance cycle was performed to better understand the environment as well as end users’ (64 participants) informational needs and desired features for the MHA. Five critical information/education moments of the ORL perioperative period were identified. In the Rigour cycle a literature review was performed to identify further key topics relevant to understanding ORL end-users’ needs and relevant features for the MHA. In the Design cycle the final contents were defined to be displayed on the MHA spread across the 5 identified moments. A randomized controlled trial will then be conducted to evaluate the effectiveness of the MHA compared to standard care. Conclusions Triangulation of data sources collected by experts, ORL patients’ caregivers, and healthcare professionals ensured the rigour of the methodology adopted in the study. Moreover, such a MHA user-centred developed MHA favours end-users positive health outcomes and organizational benefits of health services. Key messages

Background For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Methods Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7). After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission. The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Results A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol

Background Violence against healthcare workers (HCWs) has gained increasing attention in recent years, both because it is on the rise and because there is growing concern about these incidents, which are classified as sentinel events by the Italian Ministry of Health. Since little is known about the actual burden of this phenomenon, especially during the stressful COVID-19 vaccination campaign, we decided to explore the problem in our region. Methods Between January and March 2022, in the 1.2 million-inhabitant Friuli Venezia Giulia region (Italy), we conducted an anonymous online survey to collected data on episodes of violence and their consequences for HCWs. Data from validated tools assessing characteristics of violent episodes and post-trauma impact were analyzed in conjunction with socio-demographic data of respondents. Results 200 HCWs participated in the survey, most of whom were women (72%), worked as nurses (107) or doctors (71), and had a mean age of 47 years. More than half of them (59%) reported at least one episode of violence, mainly in the form of a verbal assault (64%); there were no differences between victims. In 72 cases, these incidents affected the HCW’s private life, mainly disturbing sleep or concentration (68%). Most HCWs stated that inadequate communication was a trigger for the violence (97%). Although 80% of HCWs would readily report any violent incident, to improve the situation they called for certainty of action against the perpetrator (87%), more organizational support (85%), standard procedures (75%) and self-defense courses (75%). Conclusions Violence in COVID-19 vaccination campaign appears to be common and to affect both the personal and professional lives of HCWs. Improvements at the institutional and personal level could help to address this problem that affects the health workforce. Key messages • Given the growing public debate, violence in healthcare settings is an important issue that needs to be addressed in the coming years. • Assessing workplace violence and its associated risk factors will help focus on the strategies that can be usefully employed to prevent it in the future.

Background The COVID-19 infodemic is putting pressure on public health systems to control the pandemic. With the internet and social media playing a key role in emergency communication, digital health literacy (DHL) can be considered a determinant of health. This study aims to assess the impact of infodemic on the skills of medical students, for whom low levels of DHL may affect the ability to identify the best available medical evidence. Methods A cross-sectional web-based survey was conducted at the University of Florence (Italy) in Apr-May 2019 (pre-pandemic period) and in Nov-Dec 2020 (pandemic period) to investigate DHL skills. Two different cohorts of students, both in their first year of medical school, participated in the survey. The 8-item self-assessment tool (IT-eHEALS) with a 5-point Likert scale was used to examine DHL. The change in perception of ability between the two cohorts was examined using the Wilcoxon test. Results A total of 329 students participated in the survey in 2019 (F: 58.1%; mean age 20.6±2.1) and 341 in 2020 (F:61.9%; mean age 19.8±2.0). In 2019, participants’ DHL level was moderate with a IT-eHEALS overall mean score (MS) of 28.4±5.8. Students had a good idea of how to find helpful health information (MS 3.9±0.8) and how to use the web for this purpose (MS 3.8±0.9), but they were less confident about the usefulness of the information they received (MS 2.9±1.1). In 2020, the medical students’ DHL level deteriorated as the overall MS of IT-eHEALS decreased to 23.4±7.2 (p < 0.01). The scores of the IT-eHEALS items were significantly lower and students indicated that they found it difficult to assess the information they found (MS 2.4±1.1; p < 0.01). Conclusions DHL can contrast infodemic, but the latter in turn may have a negative impact on perceived DHL skills if personal knowledge base is not well structured. Training programmes for medical students as future health care providers should be reinforces to guide their practise. Key messages

The fight against fake news, mainly spread through Internet, is a major public health issue, even among undergraduate students. This study aims to evaluate the effectiveness of a website promoted by the Italian Federation of the Provincial Orders of the Medical Doctors as a first aid communication kit for health topics.Pre-post study using a web-based survey, conducted in April-May 2019 on Medical students and October-November 2020 on Communication Sciences students at the University of Florence (Italy).Undergraduate students of both schools were exposed to the use of the "dottoremaeveroche" website. Primary and secondary outcomes measures: the Italian-electronic Health Literacy Scale self-assessment tool was used to examine subjects' electronic Health literacy, and source quality. All responses were rated on a 5-point Likert scale. Changing in perception of abilities were examined using the Wilcoxon test.The 362 participants felt moderately confident in electronic Health Literacy, with an initial Italian-electronic Health Literacy Scale overall mean score of 3.6±0.7 for medical and 3.2±0.8 for communication students. Medical students had a good idea of how to find helpful sources (3.9±0.8) and communication students felt confident in recognizing their quality (3.5±1.0). In contrast, their confidence in using Web information to make health decisions was low (medical: 2.9±1.1; communication: 2.8±1.1). All items improved significantly after "dottoremaeveroche" use (p.001), with the overall mean score of Italian-electronic Health Literacy Scale increasing to 4.3±0.6 for medical and 4.1±0.8 for communication students.Low electronic health literacy levels can affect public health efforts, as seen during the COVID- 19 pandemic. The effectiveness of "dottoremaeveroche" among students showed the usefulness of online educational interventions that, if further implemented, could help combat the spread of infodemic.

Adult acute lymphoblastic leukemia/lymphoma (ALL/LBL) is a rare and heterogeneous malignancy characterized by uncontrolled proliferation of B or T cell precursor cells. Here, we retrospectively analyzed the outcome of early autologous stem cell transplantation in standard-risk patients in first complete remission (n=24) and of allogeneic transplantation in high and highest risk, and relapsed/refractory patients (n=35). The 10-year overall survival after autologous transplantation was 45%. The 10-year overall survival after allogeneic transplantation was 58%. The cumulative incidence of relapse was 29% after allogeneic and 67% after autologous transplantation. The cumulative incidence of non-relapse mortality was 0% after autologous and 12% after allogeneic transplantation. This retrospective single center analysis in a limited number of standard-risk patients clearly demonstrates that early autologous transplantation in first complete remission leads to an acceptable long-term outcome with a short overall treatment duration of less than 6 months compared with more than 2 years with conventional chemotherapy. More sensitive and standardized methods to detect minimal residual disease (MRD) will further help to identify those patients more accurately who are most likely to benefit from such a short and intensive treatment strategy (i.e., MRD negative standard-risk patients) or those who require early targeted therapy (e.g., blinatumomab) in case of MRD positivity. Early allogeneic transplantation results in long-term survival/cure in nearly two-thirds of all high and highest risk, and relapsed/refractory patients.

Background In Italy vaccine hesitancy worsened after a failure to vaccinate episode that took place in Friuli Venezia-Giulia Region until early 2017 which undermined herd immunity by leaving unprotected more than 5,444 children. Methods Between May and June 2017, 2,557 parents were surveyed at the local vaccination clinic where they were invited within the subsequent extraordinary vaccination campaign. The aim of the survey was to evaluate whether the multi-channel extraordinary vaccination campaign had reached the target population and to know parental beliefs and trusted sources of information after the failure to vaccinate event. Results While 279 parents were non-hesitant (10.9%) and 1,491 hesitant acceptors (58.3%), just 38 (1.5%) refused to have their children revaccinated. Overall, the most consulted sources of information were print media (18.8%), physicians (16.0%), relatives and friends (12.1%). The majority of parents considered vaccination as a fundamental practice (73.9%), but many were worried about potential side effects (38.8%) or doubtful about the effectiveness of some vaccines (11.0%). According to parents, 19.7% of them (57) changed their opinion about vaccines after the Codroipo case. Conclusions After the Codroipo case, most parents chose to have their children re-vaccinated and just a little proportion refused the re-administration of vaccines. More studies are needed to confirm the importance of a coherent multi-channel communication strategy using both traditional and new media in order to counteract vaccine hesitancy.

Human papillomavirus (HPV) is one of the most frequent sexually transmitted infectious agents worldwide, and it is responsible for a significant burden of cancers. The aim of this study was to evaluate HPV knowledge and awareness in a sample of Northeastern Italian adolescents and parental support available to them, in order to highlight potential room for improvement towards optimal HPV vaccination adherence. Between April and May 2018 an observational questionnaire-based study was conducted in 1st year students of secondary upper schools in Udine (Italy). We quantitatively evaluated HPV knowledge, awareness and parental support level of male and female adolescents. The contribution of sociodemographic characteristics to HPV vaccination knowledge and uptake were explored using Chi-Square or Fisher test and multivariate logistic. Knowledge about HPV vaccine resulted to be mostly insufficient among enrolled adolescents, with a worrying proportion of them believing that HPV vaccine was expected to prevent HIV/AIDS. Awareness about their vaccination status was poor, and more than half of them were not involved in HPV vaccine uptake deliberation. Girls performed better than boys in relation to knowledge, awareness and engagement. Our results support the hypothesis that HPV vaccine knowledge and uptake can be affected by some gender bias. Improvements in adolescent health education and vaccination strategies are needed to engage and finally protect both genders from HPV.

To address vaccine hesitancy and to build public trust, many factors need to be considered in the process of planning consistent public health interventions. After uncertain vaccinations of the Codroipo case, hesitant parents were surveyed about own beliefs and trusted sources of information.A semi-structured phone survey was conducted between December 2017 and February 2018, collecting also age and educational level of respondents.The most trusted sources of information of the 258 surveyed parents were pediatricians (27.2%), general practitioners (25.4%) and institutional channels (12.1%). Highly educated parents trusted self-study of the scientific literature and expressed doubts about vaccine effectiveness more than others (p=0.0018).Despite the underlying improper vaccination issue undermined public trust, healthcare professionals and institutional channels maintained their role as trusted sources of information. Educational patterns emerged among doubtful parents should be considered by public health policies to effectively tackle vaccine hesitancy.

Introduction The current pandemic scenario may cause psychological distress among healthcare workers (HCWs). Although several studies highlighted this issue as particularly affecting frontline HCWs, no data are available regarding professionals dealing with the governance of healthcare organizations. This study aims to assess the psychological impact of COVID-19 on healthcare leaders (HeLs). Methods A cross-sectional study was carried out between October and November 2020, among HeLs working within Friuli-Venezia Giulia healthcare system (Italy). HeLs included: heads of surgical or medical department, deans of hospital, heads of doctors and nurses working at regional level or in hospital/community settings. We collected demographic data and assessed the presence of depressive (DS) and anxiety symptoms (AS), perceived stress (PS) and insomnia using internationally validated tools. Relationship between mental health outcomes and professional role was analysed using nonparametric tests. Results A total of 48 HeLs participated; their mean age was 53.4±7.9, women were 56.3%. Most (45.8%) were heads of department, 16.7% deans of hospital, 8.3% heads of doctors, 29.2% heads of nurses. The majority (60.4%) worked in hospital setting, 22.9% in the community and 16.7% at regional level. The prevalence of DS and AS was 14.6% and 12.5%, respectively. Moderate insomnia was found in 12.5% of HeLs, while severe insomnia in 6.3% of them. The 45.8% of HeLs showed moderate level of stress, whereas 4.2% high level. PS was significantly higher among deans of hospital. Moreover, lower PS correlated with lower DS, AS and insomnia (p < 0.05). Conclusions The high level of perceived stress, insomnia, depressive and anxious symptoms experienced by HeLs shows another issue of the COVID-19 pandemic psychological impact. Considered the key role of HeLs in leading healthcare organizations over the current crisis, mental health of these professionals is a major issue that needs higher attention. Key messages Psychological impact of COVID19 not only affects frontline HCWs, but also the professionals who are leading healthcare organization through the crisis. Promotion of mental well-being among HCWs should be improved at all levels of healthcare organizations, ensuring a healthier workplace for all professionals working for public health.

Background To prevent flu spread, Italian healthcare workers (HCWs) are annually recommended and given free flu vaccination. This measure of healthcare system protection resulted to be fundamental during COVID-19 pandemic to prevent staff shortage issue. Being the minimum coverage target set at 75%, we decided to evaluate vaccination adherence among HCWs at Udine University hospital. Methods The 2020 vaccination campaign started 4 weeks earlier than usual and was based on a multiple offer strategy including a daily-dedicated clinic, in-ward administrations along with wide vaccination agenda promotion within hospital. The prevalence and the characteristics of vaccinated HCWs were compared with the same 2019 data. Results During 2020, 1868 out of 3839 (48.7%) of HCWs were vaccinated, compared to 29.1% in 2019 (p < 0.0001). Doctors and residents were the most vaccinated categories in both years, being respectively 64.7% and 67.2% in 2020 vs 45.0% and 52.4% in 2019 (p < 0.0001). Midwives showed the best improvement in coverage passing from 44.4% to 20.4% (p = 0.0096). HCWs working in emergency areas and intensive care unit reached the highest adherence in 2020 (61.3%) and the best improvement compared to 2019 as well (37.9%; p < 0.0001). Conclusions Even if the target was not reached, strategies adopted for 2020 vaccination campaign significantly increased HCWs adherence. COVID-19 contribution in this achievement cannot be ruled out, possibly representing a strong reinforcing element for HCWs awareness towards infectious disease prevention. Key messages Despite the improvement in vaccination adherence, HCWs flu vaccination coverage still remains a concerning issue to be addressed. Increased flu shot adherence reached during COVID-19 pandemic should be not only a target to be maintained but even improved next year getting closer to herd immunity.

Introduction Clinical record (CR) is an appropriate source for adverse events (AEs) detection and Italian law requires its compilation. Its completeness is used as an indicator of the quality of care provided and offers guidance on system changes to improve professional practice. This study aimed at assessing the completeness of CRs, describing AEs' rate and triggers, and investigating the relationship between CR completeness and the occurrence of AEs. Methods A retrospective review of CRs was conducted, randomly selecting patients discharged from Internal Medicine (IM), General Surgery (GS) and Obstetrics (O) between June and September 2020 at the Academic Hospital of Udine (Italy). The completeness of CRs was assessed using a 65-items checklist developed by the hospital Quality Unit. Triggers and rate of AEs were detected by using Global Trigger Tool. Relationship between AEs and completeness of CR was analyzed using nonparametric tests. Results Among 93 reviewed CRs, 91.4% were from the GS, 5.4% from IM and 3.2% from O. Patient mean age was 64.6±18, women were 51.6%. The average completeness of CRs was 50.4% [30.4%-83.5%]. Identified triggers and AEs were 125 and 29 respectively, with at least one AE every 23.7% admissions, 31.2 AEs per 100 admissions and 40 AEs per 1000 patient-days. The most frequent AEs were surgical damage (51.7%; 15) and hospital-acquired infection (24.1%; 7). Hospitalization length for patients with at least one AE was 12.6 days, whereas it was 6.3 days without AEs. A significant positive correlation (R = 0.36; p < 0.001) was found between length of hospitalization and number of AEs. The increase in CR completeness is associated with the decrease of the total number of AEs (R=-0.18; p = 0.083). Conclusions These findings suggest a direct association between the number of AEs and the length of hospital stay. The correlation between CR completeness and AEs suggest that patient safety could benefit from the improvement of clinical record compilation. Key messages More studies are needed to understand if the occurrence of AEs to patients may cause a prolonged length of hospitalization. A better compilation of CRs should allow to reach a more effective communication between healthcare workers, creating a work environment less prone to errors and AEs.

Background Within the growing availability of health apps worldwide, apps for pregnancy and postnatal care still raise critical issues. The content they provide might rise some concerns in terms of quality, completeness, as well as practical implications for effective prevention and health promotion. This study aims at evaluating free pregnancy and postnatal care apps available in Italian language, shedding light on the main shortcomings and future challenges in this public health field. Methods Between July and November 2020, a multidisciplinary research group conducted a systematic review on iOS and Android stores. Data about information, functionalities and technical features of the apps were collected through a 71-items questionnaire including six domains: pregnancy and postnatal care and counselling, reminders and push notifications, notes and records, social support, and technical features. Results From 684 identified apps, 22 were deeply analyzed. Resulting apps did not include most desirable features, with just one achieving the 50% of them. The most lacking domain was postnatal care and counselling (17.3%), with particularly scarce information about immunizations that mothers or newborns need (9.1%). Information about free-of-charge and upon payment clinical exams during pregnancy is also absent in half of the apps. Moreover, most apps did not provide users social support with other mothers nor with the healthcare professionals (95.5%). Finally, just one app was CE marked as a medical device. Conclusions The identified gaps highlight large room for improvement in the use of pregnancy and postnatal care apps for prevention and health promotion. More efforts are needed to design and implement increasingly high-quality apps providing information related to preventive or diagnostic medical practices, as well as social and certified mechanism to interact with healthcare staff. Key messages Increase in use of pregnancy and postnatal care apps should be considered as an opportunity for public health in terms of prevention and health promotion. Providing appropriate information as well as social mechanism to interact with healthcare staff could help to direct mothers and mothers-to-be to the most suitable screening and therapeutic paths.

Introduction Coronavirus disease 2019 (COVID19) pandemic is the most significant public health threat of the century, a crisis that have been challenging healthcare systems around the world. Assessment of leadership skills is needed in order to identify attributes of successful leadership during public health emergencies. This study aims to highlight the critical role played by healthcare leaders during this pandemic, assessing the most challenging and demanding phases of the health crisis and the characteristics required for a healthcare leader. Methods A cross-sectional survey was carried out between October and November 2020, using online questionnaires, involving medical and nursing leaders working in the healthcare organizations of the Friuli-Venezia Giulia Region (Northeast of Italy). Professionals from hospital, community setting and regional level were asked about the two most challenging phases of the current pandemic among: crisis early recognition, peak of the emergency phase, declining epidemic, long tail. The most important healthcare leaders' skills were investigated among competence, awareness, communication, decision-making, inspiring trust and data interpretation. Results A total of 48 healthcare leaders participated. Women were 56.3%. Mean age was 53.4±7.9. According to the leaders interviewed, the two most challenging phases of such crisis were crisis early recognition (45%) and the peak phase (31%). Lesser important phases were recognized in the declining epidemic (15%) and the long tail phases (8%). Concerning healthcare leaders' skills required to manage with pandemic, the most reported were communication (35%) and decision-making (26%); while lower importance was identified in inspiring confidence (5%). Conclusions The two most challenging phases identified by this study suggested the importance of public health surveillance and monitoring systems. Communication appeared a critical success factor for leaders in public health emergencies. Key messages Early recognition of the crisis and the emergency peak management are considered the most challenging phases of the COVID19 pandemic by healthcare leaders. Ability to communicate and decision-making emerged as the two most important crisis skills, and should be included among public health leaders core competencies.

Background The struggle against fake medical news, nowadays widely spread by web sources, is a main issue in public health especially in a pandemic period. Even among medical students, there is a lack of eHealth literacy (eHL) skills to solve medical problems. The Italian Medical Doctors Federation (FNOMCeO) promoted a Web source as a first-aid communication kit for basic notions in health hot-topics named “dottoremaeveroche” (DMVEC). This study aims to evaluate its effectiveness in improving eHL. Methods Between April and November 2019, medical students from the University of Firenze (Italy) joined a cross-sectional web-based survey before and after accessing the DMVEC Web source. The 8-item self-assessment tool (IT-eHEALS) was used to examine subject's eHL, in addition to questions on source's features and its quality. All responses were rated on a 5-points Likert scale. Changing of abilities' perception was assessed using Wilcoxon test. Results A total of 329 joined the survey, 42% male, mean age of 20.6±2.1. Participants felt moderately confident in eHL, in fact the initial eHEALS overall mean score was 3.6± 0.7. Students had a good perception on how to find helpful health resources (mean score 3.9±0.8) and how to use the Internet to answer health questions (mean score 3.8±0.9), but their ability in using this information to make health decisions was low (mean score 2.9±1.1). All items improved after the use of DMVEC, with overall mean score of IT-eHEALS increasing to 4.3±0.6 (p < 0.0001). Regarding source's quality, mean score related to transparency of sources, an aspect underestimated at first, increased from 3.5±1.2 to 4.7±0.7 (p < 0.0001). Conclusions Low levels of eHL can damage public health efforts, as seen during COVID19 pandemic. DMVEC effectiveness in medical students demonstrated that the scaling up to the general population of online educational interventions, with further implementation, could help in tackling infodemic and fake news spreading. Key messages Moderate levels of eHL among medical students could reflect lower levels in general population, highlighting this as critical issue in public health. Educational programs addressed to Health professionals could be adapted and empowered considering general population as target.

Background The struggle against fake medical news, especially spread by web sources, is a main issue in public health. Even among college students, there is a lack of eHealth literacy (eHL) skills. The Italian Medical Doctors Federation (FNOMCeO) promoted a website as a first-aid communication kit for notions in health hot-topics named “dottoremaeveroche” (DMVEC). This study aims to evaluate its effectiveness in improving eHL. Methods Between April 2019 and October 2020, college students attending the first year of medical and communication theory course at the University of Florence (Italy) joined a web-based survey before and after accessing the DMVEC website. The 8-item self-assessment IT-eHEALS tool was used to examine subject’s eHL, in addition to questions on source’s features and its quality. All responses were rated on a 5-points Likert scale. Changing of abilities perception was assessed using Wilcoxon test. Results 362 students joined the survey, 329 medical and 33 communication ones. Participants felt moderately confident in eHL, with an initial IT-eHEALS overall mean score of 3.6 ± 0.7 for medical students and of 3.2 ± 0.8 for communication students. Medical students had a good perception on how to find helpful health sources (mean score of 3.9 ± 0.8) and communication students felt sure in discerning sources quality (mean score of 3.5 ± 1.0). Instead, their confidence in using web information to make health decisions was low (medical students: mean score of 2.9 ± 1.1; communication students: mean score of 2.8 ± 1.1). All items improved after the use of DMVEC, with overall mean score of IT-eHEALS increasing to 4.3 ± 0.6 (p

During 2017 an alert was raised in relation to a possible vaccination failure occurred in Friuli Venezia Giulia Region (Italy) between 2009 and 2015, exposing multiple cohorts of children and the entire community to vaccine preventable diseases outbreak risk. The Codroipo case resulted in 20,441 vaccine doses being in doubt, thus prompting the healthcare system to react in order to revaccinate 5444 children through planning and implementing network actions and multiple channels of communication.

Medical students and residents play an important role in patient care and ward activities, thus they should follow hospital procedures and ensure best practices and patient safety. A survey concerning staff on training was conducted to assess the perceived quality of healthcare from healthcare workers (HCWs), residents, medical students and patients in Udine Academic Hospital, Italy. Between December, 2018 and March, 2019, a 5-point Likert-scale questionnaire was administered in 21 units, covering four thematic areas: patients and medical staff satisfaction with the quality of care provided by residents and students, patient privacy, clinical risk management, patient perception of staff on training. Data analysis included descriptive analysis and ordered logistic regressions. A total of 596/1,863 questionnaires were collected from: HCWs (165/772), residents (110/355), students (121/389), and patients (200/347). Residents were rated high both by patients (median = 5, IQR = 4–5, OR 0.49, 95%CI 0.26–0.93) and HCWs (median = 4, IQR = 3–5, OR 0.14, 95%CI 0.08–0.26), with a lower score for medical students on the same topic, both by patients (median = 4, IQR = 3–5, OR 2.94, 95%CI 1.49–5.78) and HCWs (median = 3, IQR = 2–3, OR 0.41, 95%CI 0.25–0.67). Therefore, the role of staff on training in quality and safety of healthcare deserves integrated regular evaluation, since direct interaction with patients contributes to patients’ perception of healthcare.

The recent pandemic reminded the world of the high risk of healthcare workers (HCWs) and patient contagiousness along with the healthcare services disruption related to nosocomial outbreaks. This study aims at describing vaccination campaigns within healthcare institutions of a North-Italian Region and comparing their effectiveness in term of vaccination coverage. In December 2019, we surveyed all healthcare institutions of Friuli Venezia Giulia Region throughout an email questionnaire with 15 questions investigating strategies adopted for the vaccination of HCWs against influenza and other vaccine-preventable diseases (VPDs), along with actions put in place in case of a VPD exposure. We found a strong heterogeneity in VPDs prevention and control policy and practice for HCWs, along with responsibility attribution ranging among different stakeholders. Strategies adopted to promote vaccination included a wide range of methods, but HCWs&rsquo, influenza vaccination coverage still ranged from 17.0 to 33.3%. Contact tracing after a VPD exposure did not always include medical residents and students and visitors/caregivers/extra personnel as possible contacts. Even if knowledge and complacency gaps among HCWs could be faced with education activities, more efforts should be done in identifying and implementing effective vaccination strategies, and mandatory vaccination for HCWs could be introduced to achieve host, herd, and healthcare immunity preventing possible hospital outbreaks.

Background The excessive amount of information (infodemic) about SARS-COV2 is a global challenge for healthcare authorities in tackling misinformation. Aim of the study was to investigate SARS-COV2 global and Italian web search amount made through a reliable information source during 2019-20 SARS-COV2 epidemic. Methods From December 15th, 2019 to February 23rd, 2020, we used Google Trends to analyze global changes in the volume of searches about “Coronavirus” in relation to reliable sources: “World Health Organization”, “WHO” and the Italian equivalents of “Ministry of Health” and “National Institute of Health”. Primary searches and associated queries (AQs) were analyzed by nation and Italian Region. Results Global interest on “Coronavirus” progressively rose from mid-January, with 2 peaks on days 28th and 31st, fell on February 20th and rose again until day 23rd. “WHO” searches fluctuated with no clear pattern but increased on January 26th and February 3rd. 'WHO' term was among the most frequent “Coronavirus” AQs and viceversa. Singapore, Italy and New Zealand were the most interested nations in “Coronavirus”, while China was at first place in “Coronavirus+WHO” searches. In Italy from January 21st interest in “Coronavirus” gradually increased, with peaks on days 28th and 31st and a higher peak on February 21st. The other terms showed a fluctuating trend, with peaks on January 31st for “WHO” and “Ministry of Health” and on February 21st for all of them. “Coronavirus” was most frequently AQ to “Italy” and “China”, while AQs for the other terms were “Coronavirus” and “WHO official website”. The most interested Italian Regions for “Coronavirus” and “Coronavirus+WHO” were Lazio and Friuli Venezia-Giulia, respectively. Conclusions Interest in SARS-COV2 globally increased during the considered period, especially within most affected areas. The associations between terms thus highlighted seems to confirm that the general population relies on trustworthy information sources. Key messages Infodemic can be at the same time a danger and an opportunity during global and local health emergencies. Health systems should take advantage of current search flow in order to foster reliable information sharing.

Issue Despite low healthcare workers (HCWs) vaccination coverage being a risk for hospital outbreaks, vaccine hesitancy is not unusual among HCWs. In Italy vaccinations are strongly recommended for HCWs, but there are few occasions for a dedicated counseling. Aim of the study is to evaluate the effectiveness of a new vaccination service in the academic hospital of Udine (northern Italy) in tackling vaccine hesitancy among HCWs. Description of the problem Available data on HCWs specific antibody titers revealed that in high-risk units, 25% of HCWs were certainly unprotected for at least 1/6 of the vaccine preventable diseases (VPDs): measles, rubella, mumps, varicella, pertussis, hepatitis B; only varicella coverage reached the herd immunity target. Periodic occupational health visit was the only moment to screen for VPDs protection and suggest vaccination, but the following inconvenient procedure of HCWs contacting the vaccination office outside the hospital, often lead to delays or loss. In order to improve vaccination adherence, since June 2019 a dedicated clinic has been set up inside the hospital, making vaccination counseling and administration available every two weeks, with appointments directly given by the occupational doctor. Results From June 2019 to February 2020, a total of 362 appointments were booked for the dedicated vaccination clinic, 69.7% of which actually took place as 252 HCWs actually accessed the service. Hours dedicated to the service activity were 76 hours, distributed over 19 days. Administered vaccination were 322, including 107 MMR (measles, rubella, mumps), 4 MMRV (MMR+varicella), 20 varicella, 64 hepatitis B, 127 DTPa (diphtheria, tetanus, pertussis). Lessons Making the access to vaccination more convenient in term of service location within the hospital and giving the appointment when performing the occupational health visit seems to be helpful in filling the VPDs protection among HCWs gap. Key messages Monitoring immunological status of HCWs and promoting vaccination at occupational health visit would sustain herd immunity protection for susceptible individuals in healthcare settings. The dedicated hospital vaccination clinic and the effective procedure of giving the appointment during the occupational health visit could be helpful in improving HCWs vaccine adherence.

Issues Mycobacterium chimaera bacterium, firstly identified in 2004, is mainly present in drinking water but is generally not harmful for human health. Incubation period ranges from 3 to 72 months, with a median of 17 months. Clinical signs are fever, weakness and weight loss. The infection has a lethality rate of 50%. Invasive infections are associated to the use of Heater-Cooler-Devices (HCD) in cardiovascular surgery. Description of the Problem This work reports on an unexpected Mycobacterium chimaera infection case occurred after a time period much longer than what literature reports for both incubation and surgical infection. In January 2007, a 67-year-old man underwent cardiac surgery for an aortic dissection Stanford type A, with implantation of an ascending aorta prosthesis at Udine Academic Hospital (Italy). After a chronic heart failure relapse occurred in September 2018, he developed fever of unknown origins, sepsis, and then he underwent surgery to substitute the vascular prothesis. In January 2019 the clinical condition of the patient got worse and he died in September 2019. Results The first level bacterial culture turned out to be positive for Mycobacteria, so the second level molecular biology test was carried out with GenoType NTM-DR. This analysis revealed a specific positivity for Mycobacterium chimaera. The confirmation test on the Heater-Cooler-Device (HCD) could not be carried out as this device was scrapped since years. Lessons This case report suggests that Mycobacterium chimaera incubation period can be extremely variable. Therefore, when performing differential diagnosis, it should be considered even for those patients who underwent cardiac surgery more than 5 years prior clinical manifestation. We suggest extending the current ECDC's exposure criteria, assuming that incubation period could cover the entire patient's life. Key messages Mycobacterium chimaera can have an incubation period much longer than what is usually described in literature and ECDC guidelines. This report can be considered a starting point to improve the hospital infection control surveillance system in hospitals performing cardiac surgery.

Background Healthcare workers (HCWs) occupational exposure to vaccine-preventable diseases (VPDs) is a great challenge, especially for the risk of disease transmission to patients and general population. Our aim was to explore HCWs occupational exposure management within Friuli Venezia-Giulia (FVG) Region (Italy) in order to identify the most appropriate and equal strategies. Methods In December 2019 we collected data from the 7 acute-care hospitals of FVG. Total number of employees, methods to investigate on potential exposure to VPDs, immunity assumptions and management of occupational exposure were investigated. Results We obtained data from all FVG hospitals, for a total of 14,002 employees (average 2,000; range 551-4,336), including 12,557 HCWs (average 1,794; range 467-3,922). Four hospitals also include students, being academic centers (2) or research institutions (2). All hospitals conduct potential exposure investigation among HCWs, including patients, caregivers, visitors, non-HCW employees, but students are considered in 6/7 hospitals. Immunity of exposed subjects is assumed based on vaccination evidence or serological positivity. Exclusion from work is prescribed to exposed susceptible HCWs in 5/7 hospitals, while workers re-allocation to lower risk wards is required in 4 hospitals; in 2 cases HWCs are asked to wear a mask during their shift. When appropriate, 2 hospitals administer immunoglobulin, whereas a specific procedure for susceptible HCWs exposure was not always available. In 6 cases the exposure of non-HCWs subjects is notified to the occupational doctor or worker manager, and in 1 case serological positivity is directly tested. Conclusions There is heterogeneity in the management of VPDs occupational exposure within FVG, in particular regarding the surveyed categories and the actions required to the exposed subjects. The evaluation of potential adverse outcomes on patients would contribute in designing a more effective preventive strategy. Key messages The adoption of different strategies in the HCWs occupational exposure management could result in potential treatment inequality. Exploring occupational exposure management strategies adopted in hospitals is fundamental to standardize practices.

Background Vaccine hesitancy among general population can be even greater regarding flu than other vaccine preventable diseases, as complacency towards influenza is quite high and confidence can be reduced by the confounding effect of influenza-like-illnesses. Health professionals face hesitant people alleging many different motivations against flu vaccination, some of them being susceptible to tailored one-to-one health promotion. Methods During 2019/20 flu vaccination campaign, 44 trained pharmacists of Carnia District in Friuli Venezia Giulia Region (Italy) surveyed at-risk people accessing 25 pharmacies regarding beliefs on flu vaccination and offered one-to-one advice. As stated in the Italian national vaccination plan, subjects with comorbidities or older than 65 were considered at risk. Adherence to influenza vaccination during past flu season and reasons for that choice, as well as intention to be administered flu shots after counseling were registered. Results A total of 2,748 at-risk subjects adhered to the project with a mean age of 70±12 years, 57% of them being females; 1,702 (38%) did not adhere to flu vaccination campaign last year. Most of them confirmed a low complacency level, reporting to have refused flu vaccination because of “not getting ill” (43%) believing that vaccines are dangerous (12%) or not effective (5%); some did not know they could access flu vaccination (8%). After counseling, 2196 (80%) decided to adhere to flu vaccination, in particular 83% (1284/1555) of over 65 and 84% (684/816) of at-risk subjects. Conclusions More than one third of over 65 or at-risk surveyed subjects did not receive influenza vaccination during 2018/19 flu season. One-to-one tailored counseling conducted by pharmacists resulted to be effective in tackling vaccine hesitancy among 2019/20 flu shot target population. Key messages Motivations underlying vaccine hesitancy toward flu vaccination continue to impair health outcomes of target population. A one-to-one counseling intervention conducted by pharmacists with specific targets should be useful to improve seasonal flu vaccine coverage.

Malnutrition in Intensive Care Unit patients has been associated with worse clinical outcomes such as mortality and length of stay (LOS) in Intensive Care Unit (ICU), and nutritional status of Intensive Care Unit patients in particular seemed to be a significant predictor of mortality. Promptness of clinical nutrition administration is a key of nutritional support whenever volitional intake is unfeasible. Early enteral nutrition is associated with better clinical outcomes (reduced complications, LOS in ICU and in Hospital). The aim of this study is to investigate the nutrition therapy management in a large Academic Hospital, evaluating its effects on mortality and LOS in ICU and in the Hospital.Data were collected retrospectively from clinical records. Six physicians were trained on the data collection protocol and they reviewed every clinical record of patients included in the survey.Data of 426 patients admitted to ICUs between November 2016, 1st and April 2017, 30th were collected. A multivariate logistic adjusted regression, with backward variables selection method, was performed in order to identify predictors of enteral and parenteral nutrition conducted within 48 hours after admission to the ICU. The relation between medical nutrition therapy, mortality and LOS in ICU and in the Hospital were also evaluated.Patients were given prompt parenteral and enteral nutrition in 25.12% and 27.46% of cases, respectively. No association was found between medical nutrition therapy and ICU or hospital mortality. Predictors of early enteral nutrition were type of admission and surgery before admission; early parenteral nutrition predictors were gender, ICU (A vs B), impaired immunity status and Central Venous Catheter presence at admission.Our study stresses the need of monitoring nutrition prescribing behaviors in acute hospitals in order to better set up tailored interventions to standardize clinicians' practices and to focus on specific training targets.

Home care is managed with extreme heterogeneity among Italian regions by healthcare and social services. Standardization and self-assessment of these activities can improve their quality and outcomes. The goal of the study is to develop and validate an accreditation tool that provides minimum standards for home care. A multidisciplinary group of health and social care professionals developed a new tool according to the Deming cycle, including 26 items for a total of 144 standards grouped in 6 areas: Organization&governance (A1); Patient safety&clinical risk (A2); Job description, knowledge and skills (A3); Communication&information (A4); Integration tools in care processes (A5); Improvement&innovation (A6). Between April and November 2019, 40 experts from Italian primary care and social services of Friuli-Venezia Giulia (FVG) and Veneto Regions were asked by email to evaluate the tool using Delphi methodology. Experts were asked to score each standard according to relevance and feasibility (RF) on a 1 to 9 point scale. RF and agreement among experts were considered good respectively when mean score was >7, and 70% of responses were greater than 7. A total of 21 experts' reviews were collected, with a response rate of 53%. Most responders came from the healthcare setting (71%) and FVG Region (86%). Globally, 101 standards (70%) were rated as good. RF mean and agreement resulted to be good for: A1 (7.6; 81%); A2 (7.4; 71%); A4 (7.5; 86%); A5 (8.0; 86%). More critical results were achieved concerning A3 (7.0; 52%) and A6 (6.5; 43%). Most standards were recognized as both relevant and feasible by experts, confirming the tool developed for home care accreditation. Agreement for Job description, knowledge and skills, and Improvement&innovation areas seems harder to be achieved. The evaluation of detailed experts' comments would further improve the tool, and a pilot study will be implemented in the next future to test its reliability. Key messages The implementation of the home care accreditation could reduce inequalities among contexts, while helping quality and patient safety improvement outside healthcare facilities. The existence of a unique home care accreditation tool can foster the integration between health and social care while reducing hospitalizations.

Issue In Friuli Venezia-Giulia Region (Italy), accessibility to health services can be substantially influenced by the geographical context. In fact, during recent years, at-risk inhabitants of mountain villages were less likely to be vaccinated against flu in comparison with other areas. To tackle inequalities, local pharmacies were identified as a proximity health promotion network to be engaged in the 2019/2020 flu vaccination campaign. Description Within the mountainous Carnia District, 43 pharmacists from 25 pharmacies were trained before the campaign to promote flu shot uptake through counseling in over 65 and high-risk subjects. After counseling, subjects were directed to General Practitioners who performed vaccine administration and registration. Anti-flu counseling offered by pharmacists was traced and vaccine coverage against influenza among target categories was considered as the principal outcome. A reward was granted to pharmacies in relation to flu vaccine conversions among counseled subjects. Results Between October 2019 and January 2020, a total of 2,748 counseling sessions with people accessing pharmacies for any reason were conducted. Within Carnia District, flu vaccine was administered to 6,484 out of 10,895 (59.5%) over 65 subjects in comparison with 5,569/10,251 (54.3%) who got their flu shot during the 2018/19 flu season, achieving an improvement of + 5.2%. This result exceeded the regional global outcome reaching +2.2%, being the best among all districts. In particular, in comparison with the previous year, +10.2% over 65 and +37.8% at-risk subjects were vaccinated against flu in Carnia District. Lessons Pharmacies played an important role in promoting flu vaccination locally, and proved their potential contribution in tackling inequalities related to difficult contexts. The collaboration of health professionals, including pharmacists, should be taken into consideration to improve health promotion and health services access. Key messages Pharmacies are trustworthy healthcare system access points for people, therefore their role in health promotion should be fostered. Pharmacists can help in improving flu shot uptake in contexts where health service access is hindered.

Introduction WHO stresses the need to implement multi-component interventions to raise coverage among healthcare workers (HCWs). We investigated different HCWs influenza immunization programs within Friuli Venezia Giulia (FVG) Region hospitals (Italy) during 2019-20 flu season with the aim of identifying the most effective strategies to tackle hesitancy. Methods In December 2019 we collected from FVG hospitals: number of employed HCWs, vaccination strategies against flu and refusers management during 2019-20 flu season. We obtained data about HCWs flu vaccination coverage from the regional database; Chi-square test was used to find correlation between strategies and coverage. Results We collected data from 7/7 hospitals for a total of employed HCWs of 12,557 (average 1,794; range 467-3,922); 2 hospitals being academic centers and 2 research institutions. All hospitals promoted flu vaccination using emails, notice on hospital website and posters display; 3/7 organized training courses. Vaccination was always provided within the hospital in a dedicated easy and free access room; most hospitals (5/7) also offered ward on-site sessions, some allowing ward self-administration (3/7) or organizing on demand extra-sessions (2/7). No countermeasures were taken in case of refusal. Regional HCWs flu vaccination coverage resulted to be 24.9% (range 17-33.3). Multi-component intervention including passive and active offer, communication and education activities was confirmed to be significantly associated with higher HCWs flu coverage (OR 1.7; CI 1.6-1.9; p Conclusions Different strategies to foster HCWs vaccination were adopted in FVG Region during 2019-20 flu season. The multi-component approach producing the best results should be further analyzed in order to identify the most effective recipe to be shared both nationally and internationally. Key messages Investigating the relation between HCWs flu immunization strategies and their effect is crucial to identify best practices. A multi-component approach including passive and active offer, communication and education activities seems the most effective way to tackle influenza vaccine hesitancy among HCWs.

Background In Italy, recommended annual influenza vaccination is free to healthcare workers (HCWs) to prevent flu spread. No official data are available on HCWs' vaccination coverage (VC), which minimum target is set at 75%. Aim of this study is to compare 2019-20 and 2018-19 flu vaccination coverage in order to evaluate last year campaign effectiveness. Methods 2019-20 flu vaccination campaign efforts at Udine Hospital (Italy) were improved with the aid of public health residents to tackle HCWs convenience concerns. From October 29th to December 5th 2019, dedicated areas and days were increased, informative course about influenza vaccination (efficacy, benefits and safety) toward HCWs were conducted. Data about HCWs getting their flu shot within the hospital were traced and analyzed, grouping different categories. Results During 2019-20 flu season, vaccinated HCWs were 29.1% (1,169/4,012), while they were 22.7% (955/4,203) in 2018-19 (p Conclusions A significant improvement in vaccination coverage during 2019-20 flu season was reached by the specific vaccination campaign for all categories except midwives. Despite this, the global vaccination coverage is still far from the desired target and more must be done to fill this gap. Evidence of HCWs categories for which this intervention was more effective, could be useful in planning next flu vaccination strategies. Key messages Continuous efforts made by public health professionals in promoting flu vaccination show their effect on healthcare workers flu shot adherence. A planned vaccination agenda and educative course about influenza infection and benefits of vaccination, seem to be good strategies to improve vaccination coverage.

Background Coverage for vaccine-preventable diseases (VPDs) among healthcare workers (HCWs) in Italy remains low, and WHO strongly recommends to tailor immunization programs to tackle hesitancy. Aim of the study was to investigate HCW-specific immunization programs within Friuli Venezia Giulia (FVG) Region in order to plan new common strategies. Methods In December 2019 we collected information about FVG hospitals and HCWs immunization programs conducted within each of them, including: number of HCWs employed, monitored VPDs, immunization assumption, vaccination strategies and refusers management. Results We obtained data from 7/7 hospitals, for a total of 12,557 employed HCWs (average 1,794; range 467-3,922); 2 hospitals are academic centers, while 2 are research institutions. All hospitals have immunization programs for measles, mumps, rubella; the majority for hepatitis B (6/7); 5 for diphtheria, tetanus, pertussis, chicken pox. Presumptive evidence of immunity is established when written vaccination documentation is available or in presence of laboratory evidence. HCWs immunization programs are responsibility of the occupational doctor in most hospitals (6/7). Vaccination promotion strategies include: mail or email personal invitation, training courses, video and notice display on hospital website, reminders. Most hospitals set up a dedicated vaccination service located in a hospital common area (4) or outside the hospital (2); one hospital also offered ward on-site vaccination. For airborne or droplets transmission diseases, refusers are asked to wear a mask during shift in 2 hospitals. Conclusions HCWs immunization programs in FVG Region are heterogeneous, and their specific effectiveness has to be studied yet. This study represents the first step in the process of FVG hospitals engagement in sharing effective actions in order to plan a new regional strategy for HWCs immunization. Key messages The investigation of effective strategies conducted in different FVG hospitals is essential for their scaling-up evaluation. A common regional plan for healthcare workers immunization is needed to tackle hesitancy and reduce infectious risk within hospitals.

Background The coverage for influenza vaccination among healthcare workers (HCWs) is inadequate in many countries despite strong recommendations; is there evidence that influenza vaccination is effective in preventing absenteeism? Aim of the study is to evaluate the influenza vaccination coverage and its effects on absences from work among HCWs of an Italian academic healthcare trust during the 2017–2018 influenza season. Methods We performed a retrospective study to identify predictive characteristics for vaccination, and a retrospective cohort study to establish the effect of vaccination on absences among the vaccinated and non-vaccinated cohorts between December 2017 and May 2018. Overall absence rates over the whole observation period and sub-rates over 14-days intervals were calculated; then comparison between the two groups were conducted applying Chi-square test. Results Influenza vaccination coverage among 4419 HCWs was 14.5%. Age, university degree, medical care area and physician profile were positively associated with vaccine uptake. Globally during influenza season non-vaccinated HCWs lost 2.47/100 person-days of work compared to 1.92/100 person-days of work among vaccinated HCWs (p Conclusions Factors predicting influenza uptake among HCWs were male sex, working within medical care area and being a physician. Absenteeism among HCWs resulted to be negatively correlated with vaccination against influenza. These findings add evidence to the urgent need to implement better influenza vaccination strategies towards HCWs to tackle vaccine hesitancy among professionals.

Sustainable Development Goals (SDGs) and 2030 Agenda represent global development programs. Education can widen the acknowledgement of their relevance and their applications. This survey aims to assess awareness, knowledge and attitudes towards SDGs and sustainability among first-year students in nine Italian Universities. A Likert scale-based online questionnaire of 70 items was compiled by students from March to July 2019. It examined knowledge and expectations referred to sustainable development concepts, indicators and documents/models accounting for sociodemographic variables. Statistical analyses performed were Chi-square test, Fisher&rsquo, s Exact test, Kendall&rsquo, s W correlation coefficient, univariate and multivariate analysis. The questionnaire was completed by 1676 students. A low percentage referred a good knowledge of SDGs and 2030 Agenda, most of them had never attended related educational activities previously. Better knowledge of SDGs and 2030 Agenda was observed in case of previous specific educational activities (p &lt, 0.001). The expectation towards university guaranteeing an education on SDGs was high, both for personal wisdom and for usefulness in future professional context. A significant difference (p &lt, 0.001) in such expectations was found, as healthcare students were less interested than colleagues of other areas. The results showed low knowledge but interest towards sustainable development. A scheduled implementation of academic initiatives should be considered.

Issue Influenza vaccination of Healthcare workers (HCW) has a key role in avoiding flu transmission among patients and HCWs and is annually recommended by health authorities. Despite the 75% target identified by WHO, coverage is still inadequate in many European countries. Description of the problem The Infection Control Team and Public Health Residents of a University Hospital annually cooperate to actively offer flu shots directly in the Units, but in 2017-18 campaign only 12,1% of HCWs took advantage of the service. From July to December 2018 a composite intervention was performed to increase immunization rates. In each Unit a medical doctor and a nurse (midwife for the Obstetrics unit) were identified as Link Professionals (LPs).Two educational meetings with Infectious Diseases and Public Health experts were organized for LPs to deal with their hesitancies and to engage them for the vaccination promotion among colleagues.The calendar (2/week ambulatory + 16 in-ward appointments), tailored to maximise the HCW accessibility, was sent to medical consultants and head of departments, to all physicians, and to head nurses for dissemination. Promotional posters and videos were displayed across the hospital. Results Educational meetings were attended by 130 LPs. A total of 772/3420 HCW took advantage of the 2018-19 active campaign (22,6%), with a significant increase from the previous year (+10,4%; 95%CI 8,7-12,2; p < 0,001). The immunization rates raised in all HCWs categories: 279/660 doctors (it was 167/660 in 2017-18; +17.0%; 95%CI 11,9-21.9; p < 0,001); 303/1615 nurses (150/1615 in 2017-18; +9.5%; 95%CI 7.1-11-9; p < 0,001); 13/43 midwives (2/43 in 2017-18; +25,6%; 95%CI 9.7-40.8; p = 0,002). Lessons Despite the significant increase,further efforts are necessary to reach the WHO target rate. All HCWs categories were positively affected by the multi-modal intervention. LPs seem to play an important role in promoting vaccination among colleagues, in a peer-to-peer trust relationship. Key messages Influenza vaccination rates needs to be increased in healthcare workers for their protection and for patient safety. A well-structured multi-modal intervention programme involving prepared HCW promoters into wards is essential to increase compliance.

Background Rotavirus (RV) is the most common cause of gastroenteritis (GE) among children under 5 years. Since 2012 Friuli Venezia Giulia (FVG) Region (Italy) has offered free RV vaccination to low birthweight preterm and other at-risk babies. Starting from 2018, the offer has been extended to all newborns. Aim of the study is to investigate the effectiveness of RV vaccination offer on coverage and GE-related hospital admissions among FVG children under 1 year between 2010-2018. Methods With a retrospective analysis we identified FVG Region children Results Of 77,330 children (51% males) born in FVG during 2010-2018, 8209 (11%) were vaccinated for RV. Coverage progressively increased from 0.2% in 2010 (22/9736) to 23% in 2017 (1782/7747) and then almost tripled in 2018 reaching 67% (5006/7425). During the 9 years observed, 414 children were hospitalized for NSGE (0.5%) and 172 for RVGE (0.2%). NSGE hospitalizations started from 48 (0.5%) in 2010 and reached 58 (0.8%) in 2018. Admissions for RVGE were 27 (0.3%) in 2010 and decreased to 15 (0.2%) in 2018. Annual hospitalization rate fluctuated with no clear pattern. In the observation period, 11 RV vaccinated children were admitted to hospital for NSGE (2.6% of total NSGE admissions), 1 of them specifically with RVGE. Conclusions The offer of RV vaccination to newborns results to be effective to gain vaccine coverage among children under 5 years. The impact of this offer on GE-related hospital admission and RVGE in particular cannot be properly evaluated yet, as not enough time has passed since the implementation of free offer to all newborns. Key messages Defining and implementing an appropriate vaccination offer is essential to ensure adequate levels of coverage against Rotavirus among children under 5 years. The evaluation of the effect of Rotavirus vaccination on hospital admissions for NSGE and RVGE needs a careful and continuous assessment in next years.

Background Perioperative antimicrobial prophylaxis is a key practice to prevent surgical site infection. The Udine Healthcare and University Integrated Trust has defined its features in a specific procedure, available on the hospital Intranet. Compliance with the procedure has been monitored on a semi-annual basis. Methods Between July 2013 and December 2018 15 clinical records per semester for each one of the 16 surgical units were randomly extracted, including ordinary admissions with clean or clean/contaminated surgery. Compliance with the procedure was monitored for all the items considered: drug, dosage, timing of administration, redosing and duration of prophylaxis. A first comparison analysis both between semesters and for longer time frames was performed with the chi-square test; to evaluate the presence of a linear trend all over time (in semestres), the Pearson linear correlation coefficient was calculated; in case of correlation, a simple two-variable linear regression analysis was performed. Statistical significance was assessed for p < 0.05. Results A sample of 2775 records was evaluated. Focusing on the first and last semester of monitoring, overall compliance increased in 9 of the 16 units, although there is a drop, when extending the analysis to the whole sample (72% vs 70.8%) with no statistical significance. Otherwise a statistically significant difference is recorded between the first and the last two years of analysis (p Conclusions Compliance with hospital procedure has substantially improved over time reaching a stable performance value. However the linear regression analysis highlights the need to implement new intervention strategies in order to increase overall compliance to redosing. Key messages Overall compliance with hospital procedure has improved over time. Results highlight the need to implement new intervention strategies.

Background In 2018, 52% of the European population use the Web to seek health information and 77% consider it a useful tool to improve their knowledge about health. The Italian survey “SEI Donna” aims to investigate knowledge, perceptions and use of the web tools in women regarding health issues. Methods We used an online questionnaire to collect data including the type of online research and the degree of trust towards different sources. We also assessed health literacy (HL) and eHealth literacy scale (eHEALS) using validated tests. Results Of 7291 women who completed the questionnaire, 96% (n = 7022) seeks health information online. The 33% of women follows social media groups on health. One third of sample (31%) purchased a health product online, particularly cosmetics (75%) and supplements (41%). More than one third of sample thinks that information retrieved by web improve their health (35%) and influence their habits (34%). Half of sample (52%) searched online for a second opinion after medical examination. The reason was the need of a deepening in the 67% of cases. Overall, the HL is functional in 34% of cases, marginal in 56% and low in the rest (10%). Women with low HL trust less health information reported by institutional websites than women with functional HL, respectively 73% vs 86% (p < 0.001) and the eHEALS score of women less trusting is lower than those trusting, 23±7 vs 28±7 (p < 0.001). One third of women declares not to be able to evaluate the reliability of a website particularly women with low HL (36%) compared to those with functional HL (20%), p < 0.001. Women reporting not to be able to evaluate the reliability of a website have eHEALS score lower than women who indicated an institutional website, respectively 24±7 vs 28±7 (p < 0.001). Conclusions The results confirm the large use of the web as a tool to seek health information, have a second opinion and buy health products. A good level of HL and eHEALS seem to make women more skilled in surfing the web. Key messages The results confirm the importance to put effort on strategies aiming to improve health literacy and eHealth literacy in the population. In the public health communication perspective, the fact that one third of women thinks that information retrieved by web improve their health and influence their habits, must be considered.

Background Residents have a significant role in both patient’s care and daily ward activities; thus, they should be trained to adhere to hospital procedures and to guarantee best clinical practices and patient’s safety. A survey was carried out to assess healthcare workers’ (HCWs) opinions about residents’ role and performance. Methods Between February and March 2019, a paper-based/online survey was developed and distributed among both doctors (d) and nurses (n) in 17 (10 medical, 7 surgical) wards of Udine Academic Hospital, Italy. 22 Likert Scale questions (1-totally disagree, 5-totally agree) investigated 5 areas: respect of patient safety and privacy, healthcare quality, clinical risk management, role played within medical team, satisfaction concerning training activities planning. Profession, ward (medical/surgical), age and sex were considered as exposures. Descriptive analysis, median(M)±interquartile range, and ordered logistic regressions were performed with Stata software. Results The survey involved 153/785 HCWs’ (112/477 nurses and 41/308 doctors). All the units were represented with at least 1 HCWs; answers from both categories were collected in 82% of wards. Data analysis showed that nurses gave lower scores about residents’ respect of patient privacy than doctors: patient privacy protection: M(d)=4±0, M(n)=4±1, OR(d/n) 2.60, [95%CI, 1.04-6.52]; sensitive data management: M(d)=4±0, M(n)=3±1, OR(d/n) 2.97, [95%CI, 1.26-7.02]. The same resulted regarding clinical risk management: patient record management: M(d)=4±0, M(n)=3±2, OR(d/n) 13.64 [95%CI 5.30-35.12]; proper hand hygiene: M(d)=4±1, M(n)=3±1, OR(d/n) 5.56 [95%CI 2.35-13.17]; incident reporting: M(d)=4±1, M(n)=3±2, OR(d/n) 7.05 [95%CI 3.14-15.86]. Conclusions Nurses appeared to be more critical than doctors about residents performances in safety and privacy and clinical risk management areas. Reasons behind these different opinions should be investigated in order to improve constantly healthcare’s quality. Key messages Residents hold a key role in healthcare quality, therefore it is significant evaluate their practice regarding patient’s safety and privacy. Doctors and nurses opinions on residents adherence to hospital procedures in order to guarantee best clinical practices and patient’s safety differ significantly.

Background Human Papillomavirus (HPV) infections show an estimated prevalence of 290 millions of cases worldwide, being the most common viral infection related to the reproductive tract and the main cause of cervical cancer. Being HPV vaccination currently recommended for both genders, we assessed knowledge and attitudes regarding HPV prevention among high school students in Udine, Northern Italy. Methods Between April and May 2018, a sexual and reproductive health anonymous questionnaire was proposed to first-year students in five academic, technical and vocational upper secondary schools of Udine. In particular, students were asked about HPV related diseases, whether they were vaccinated against HPV and how that decision was taken. Data were analyzed by school type and gender using Chi Square Test with α = 0.05. Results A total of 747 questionnaires were collected from 990 students; both genders had a mean age of 14.8±0.9 years, 59% of respondents were males. Technical high school students were 42% of the sample, while 30% came from vocational and 28% from academic high schools. Genital warts and cervical cancer were identified as HPV-related by 8% and 20% of students respectively, the latter more frequently in technical institutes (p = 0.0016) and in females (43% vs 13%, p < 0.001). Almost 54% of students did not know if they were immunized against HPV; academic school students and females declared more frequently to have received at least one vaccine dose compared to others (p < 0.001). Almost two thirds of respondents reported to have undergone vaccination due to a parental decision; parents discussed this choice more frequently with academic students (p = 0.0016) and females (22% vs 14%, p < 0.001). Conclusions Girls and technical school students are more informed about HPV, while adherence to immunization schedules is higher in females and those attending academic school. Parents appear to create a supportive environment for females. Key messages The different level of knowledge by gender can be explained by past vaccination campaigns, mainly focused on girls, and by parental proactivity towards females. There is room for improvement in HPV-related knowledge and prevention among both adolescents in general and males in particular as they can play an important role to reduce the burden of HPV.

Background: The eHealth Literacy Scale (eHEALS) is a tool for the self-assessment of perceived comfort and skills in using the internet as a source for health-related information. Although evidence exists of the reliability and construct and structural validity of the scale, there is a lack of evidence in relation to what is proposed by Norman and Skinner in their theoretical lily model of eHealth literacy; in particular it is not clear whether having a higher level of health literacy can positively influence electronic health (eHealth) literacy as measured by the eHEALS. Objective: Our study aim was to assess whether real-life experiences from studying or working in the health field, as a proxy of higher functional health literacy, correlate with self-referred eHealth literacy as measured by the eHEALS. Methods: A Web-based survey was conducted among adults living in Northeast Italy using an Italian version of the eHEALS (IT-eHEALS). In order to be able to measure the effect of higher functional health literacy on eHealth literacy, we divided our sample into two groups, respectively characterized by studying or working experience in the health sector and by lack thereof. Mean differences between eHEALS were calculated using t test and effect size evaluated using Cohen d. To ensure the validity of the IT-eHEALS, we evaluated its psychometric properties (internal consistency and dimensionality) and construct validity (by evaluating its correlation with respondents age, gender, educational attainment, self-rated health, use of internet for health-related purposes, and working status). Results: A total of 868 respondents that completed the IT-eHEALS were included for analysis, of which 259 had working or studying experience in the health field. Mean (SD) eHEALS total score was 28.2 (6.2) for the whole sample, with statistically significant differences (P