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Background The Russian invasion of Ukraine caused millions of Ukrainian refugees to flee to other nations. To provide the most appropriate assistance, host nations necessitate up-to-date information regarding Ukrainian refugee's demographic and epidemiological conditions. We aim to investigate the demographic composition, the COVID-19 vaccinations performed, specialist care provided and the prevalence of non-communicable diseases (NCDs) in refugees assisted by an Italian Local Health Authority (LHA). Methods We conducted a retrospective cross-sectional analysis from March to June 2022, analyzing the demographic and epidemiological status of Ukrainians. Statistical analyses were carried out to assess possible associations between NCDs distribution, age and gender. Results LHA Roma 1 assisted 9349 Ukrainian refugees. Of these, 2784 (29.8%) were males and 6565 (70.2%) were females, with a median age of 25 years. Two thousand four hundred and eighty-five Ukrainian refugees were vaccinated against COVID-19. Among them, 401 (16.1%) had at least one NCD. The most frequent groups of diseases were related to the circulatory system (50.6%), the endocrine system (24.9%), and mental and behavioral disorders (6.5%). Conclusion Refugees need healthcare services targeted mainly towards minors and females. It is essential to analyze and monitor the demographic and epidemiological conditions to provide evidence about patient management and the best care integrated into the health service of host countries.

BackgroundTelemedical approaches represent a valuable tool for the management of coronavirus disease 2019 patients, allowing daily clinical assessment, monitoring of vital parameters, remote visits, and prescription of treatment or hospitalization in case of clinical worsening. This cross-sectional study aims to evaluate the use, barriers and facilitators of the "Lazio ADVICE" telemedical platform, a regional system for remote assistance for coronavirus disease 2019 patients at home, according to General Practitioners and Family Pediatricians of the Local Health Authority Roma 1, during the coronavirus disease 2019 pandemic. MethodsAn interview-based survey was performed between December 2020 and January 2021. The survey investigated the demographic information of General Practitioner and Family Pediatricians, the knowledge of the platform, frequency of utilization, usefulness, strengths and weaknesses, and hypothesis of future implementation proposed. ResultsWe interviewed 214 physicians and 89 (41.6%) were classified as users and 125 (58.4%) as non-users. Older age and working in District 1, 14 and 15 (vs. District 13) significantly reduced the probability of using the platform physician. Among the 89 users, 19 (21.3%) used the platform every day or even several times a day, 40 (44.9%) several times a week but less than one access per day, 30 (33.7%) used the platform several times a month up to one entry per week. Most of them (92.3%) consider the platform useful. Barriers were poor integration with software and work routine (76.4%), and usability issues (53.9%). Among the 125 non-users, 14 (11.2%) didn't know the existence of the platform, 60 (48.0%) never tried it and 51 (40.8%) tried to use it. Reported reasons for the interruption of use were not very user-friendly (45.1%), perceived useless (37.3%), non-optimal functioning (23.5%), and lack of time (19.6%). ConclusionThe pandemic accelerated the implementation of telemedicine services around Lazio Region, st

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INTRODUZIONEVaccinarsi in Lazio è uno dei portali web regionali che ruotano intorno al sito VaccinarSì. Nato dalla collaborazione tra enti, regioni, università, aziende sanitarie locali e società scientifiche, questo sito unisce gli esperti attivi a livello regionale sul tema della protezione vaccinale. Obiettivo di questa iniziativa è fornire ai cittadini e agli operatori sanitari, in particolare della Regione Lazio, un’informazione completa, comprensibile e verificabile, tale da facilitare le decisioni e il confronto su questo tema oltre i luoghi comuni, i miti e la falsa scienza. MATERIALI E METODIIl sito Vaccinarsi in Lazio contiene cinque sezioni principali (Le Vaccinazioni nel Lazio, Scienza e Conoscenza, Info utili, In Evidenza, Contattaci). Il portale si avvale del lavoro di uno staff tecnico (composto prevalentemente da medici in formazione specialistica in Igiene e Medicina Preventiva) e un comitato tecnico-scientifico, oltre alla collaborazione di un panel di esperti di alto valore scientifico. Inoltre, sono state predisposte le pagine facebookTM e twitterTM che rilanciano sui social media i contenuti presenti sul sito.RISULTATISebbene sia in rete solo dall’aprile del 2018, il portale ha pubblicato oltre 100 pagine web su vari aspetti legati alle vaccinazioni. Sono presenti sul sito: una scheda informativa per ogni malattia prevenibile da vaccino e per ogni rispettivo vaccino, una sottosezione vantaggi e rischi reali delle vaccinazioni, una contro la disinformazione e una sui viaggi internazionali. Inoltre nella sezione “Info utili” si trova la pagina sugli ambulatori vaccinali presenti sul territorio, che è stata la pagina web più visitata dopo l’homepage. Infine, il sito aggiorna gli utenti su eventi e notizie di rilevanza nazionale e regionale sul tema vaccinale. CONCLUSIONIVaccinarsi in Lazio s’inserisce nel mondo della corretta informazione sul tema delle vaccinazioni che ha visto impegnati enti, istituzioni ed esperti in un’azione di presidio

BACKGROUND: Since overweight and obesity has become epidemic in children and adolescents, the aim of this study was to determine the role of highly-integrated programs in preventing and reducing prevalence of children and adolescent obesity and overweight, even evaluating if this approach has properly been effective in communities with different determinants as in the Pacific Area. METHODS: According to PRISMA guidelines, a systematic review of literature was conducted and a meta-analysis was performed to compare obese/overweight prevalence between the intervention and the control group. RESULTS: We identified 23 studies describing 14 programs. For 11 out of 14 programs, obese/overweight prevalence changing from baseline were definable and meta-analysis of them showed a significant change of obese/overweight prevalence (-0.03; 95% CI = -0.04 to -0.01; P < 0.0001). Secondary outcomes as dietary (such as vegetable intake, carbonated beverages, fruit juice, drinks, healthful food consumption), physical activity and TV-time-spent was analyzed in many of the studies to define community readiness and behavioral changes. Macro-interventions, based on what was observed in our systematic review have a high potential to reach the entire population. CONCLUSION: Adoption of coordinated cross-sectoral, multi-component and multi-stakeholder initiatives to oppose obesity remains a challenge, but it is also desirable as one of the possible solutions to this major public health issue.

BACKGROUND: High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. OBJECTIVES: To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). METHODS: The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). RESULTS: Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. CONCLUSIONS: Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk.

There is a growing interest regarding the attitudes of medical students towards people with mental illness, since discrimination and stigma may affect healthcare workers and education should be aimed to improve empathy and attitudes at medical school level. A cross-sectional study was conducted at medical schools in Rome and Foggia (Italy). We recruited 339 medical students who completed an anonymous self-report questionnaire including sociodemographic data, the 40-item Community Attitudes toward the Mentally Ill scale (CAMI) and the 60-item Baron Cohen’s Empathy Quotient. The questionnaires were administered before and after the yearly academic course of psychiatry. This study shows a significant improvement in some CAMI items and total score after the yearly academic course of psychiatry among medical students, especially among those who had personal experience with mentally ill people (including the training in a psychiatric ward). Female students reported higher empathy quotient and CAMI scores. Students who preferred medical disciplines to surgical ones seemed to be less stigmatizing towards mental illness. Our results confirm evidence from the scientific literature about medical students’ attitudes towards mental illness and highlight that the improvements in the attitudes increased improving students’ psychiatric knowledge, both theoretical and practical.

Social networks (SNs) were found to influence health behaviors and choices related to health. During school attendance adolescents establish and develop ties, creating their network. At the same time schools represent ideal places in which health promotion interventions could be implemented. We studied the relationship between students' SNs and the Knowledge, Attitudes and Behaviors (KAB) toward vaccinations in a school-based health promotion pilot project. ‘VacciniAmo Le Scuole’ project was performed in 4 Italian secondary schools, in collaboration with each Local Health Authorities (LHA). Students fulfilled a questionnaire before and after they attended a health promotion intervention in order to collect data on demographics, knowledge about vaccinations, their immunization status and students’ SN. Vaccination coverage was obtained by LHA. SN analysis techniques were used to explore the structural properties of pupils’ friendship during and after school time. 680 pupils fulfilled the questionnaire. The average degree (number of ties) was 8.6 within the school and 5.6 after-school networks. It was correlated (Pearson test) both with the knowledge level after intervention and responsiveness toward vaccinations both within the network during (Rho=0.17; p < 0.05; Rho=0.10; p < 0.05) and after (Rho=0.22; p < 0.05; Rho=0.11; p < 0.05) school time. Closeness was found inversely associated with post intervention knowledge and final project judgement both within school network (Rho=-0.21; p < 0.05; Rho=-0.22; p < 0.05) and after school network (Rho=-0.24; p < 0.05; Rho=-0.25; p < 0.05). Since students’ KAB toward vaccinations can be influenced by their networks, analysing SN can help to targeting better preventive strategies and health promotion interventions. School (during and after school time) could play an important role in promoting vaccination KAB. Key message: Deeper knowledge about students’ SN could improve the effectiveness of vaccination campaigns

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

OBJECTIVE: Antibiotic prophylaxis (AP) is useful to prevent antimicrobial overuse, misuse and abuse, as well against the occurrence of surgical site infections (SSIs). This study aimed to describe the implementation of a quality improvement intervention on AP for elective surgery, as informal interviews showed a lower than expected compliance with internal recommendations, and to evaluate intervention's effect in terms of main drug consumption. DESIGN: A quality improvement intervention on all elective cases within 14 main surgical departments was performed. SQUIRE 2.0 guidelines were used in designing and reporting. SETTING: The intervention was implemented in an Italian Teaching Hospital 2 years after the adoption of internal evidence-based AP recommendations. PARTICIPANTS: Professionals involved in elective surgery. INTERVENTIONS: The intervention was structured into two phases: a survey was conducted during two non-consecutive weeks period (April-May 2013) to assess the adherence to the international guidelines in AP; survey's results were presented and discussed with all the surgical teams (December 2013-April 2014). MAIN OUTCOME MEASURES: Impact on cefazolin consumption (in defined daily doses per 100 procedures). RESULTS: Data of AP for 653 surgical procedures in terms of type, timing, duration, excess and defect were analyzed. An optimal AP rate resulted in 48.1% cases. Reduction in cefazolin use (-21.5%) and cost (-22.9%) was registered. CONCLUSIONS: Though results cannot be generalized to all hospital populations, the implemented intervention is likely to improve AP consequently improving quality of care and reducing costs. Further studies are needed to evaluate specific outcomes such as rate of SSIs and antibiotic resistance.

BACKGROUND: To assess both qualitatively and quantitatively the impact of Public Reporting (PR) on clinical outcomes, we carried out a systematic review of published studies on this topic. METHODS: Pubmed, Web of Science and SCOPUS databases were searched to identify studies published from 1991 to 2014 that investigated the relationship between PR and clinical outcomes. Studies were considered eligible if they investigated the relationship between PR and clinical outcomes and comprehensively described the PR mechanism and the study design adopted. Among the clinical outcomes identified, meta-analysis was performed for overall mortality rate which quantitative data were exhaustively reported in a sufficient number of studies. Two reviewers conducted all data extraction independently and disagreements were resolved through discussion. The same reviewers evaluated also the quality of the studies using a GRADE approach. RESULTS: Twenty-seven studies were included. Mainly, the effect of PR on clinical outcomes was positive. Meta-analysis regarding overall mortality included, in a context of high heterogeneity, 10 studies with a total of 1,840,401 experimental events and 3,670,446 control events and resulted in a RR of 0.85 (95 % CI, 0.79-0.92). CONCLUSIONS: The introduction of PR programs at different levels of the healthcare sector is a challenging but rewarding public health strategy. Existing research covering different clinical outcomes supports the idea that PR could, in fact, stimulate providers to improve healthcare quality.

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