Showing papers by "Luca Ronfani published in 2023"
TL;DR: Info-Vax as mentioned in this paper is a medical initiative designed to inform families about COVID-19 vaccination and to answer their questions, either in small group meetings or by phone, either by email or phone.
Abstract: Even though children and adolescents usually exhibit a milder course of COVID-19, they can develop myocarditis, multisystem inflammatory syndromes in children (MIS-C), and, exceptionally, fatalities. Furthermore, they have often suffered the effects of confinement more than adults. Therefore, when mRNA vaccines against SARS-CoV-2 became available to children, health authorities recommended vaccination to reduce the infection risks and allow the easing of social distancing measures with the resumption of live school activities.1 At the same time, the public was overwhelmed by information on COVID-19 and innovative vaccines, resulting in a mix of awareness and confusion. Parents might feel more hesitant to vaccinate children rather than to vaccinate themselves, possibly due to the less clear benefit–risk balance in this age group and to their concerns about unpredictable long-term adverse effects. From August 2021 to February 2022, we hold the Info-Vax service, a medical initiative designed to inform families about COVID-19 vaccination and to answer their questions, either in small group meetings or by phone. The service was promoted by the institutional website of the Hospital and by local televisions. A dedicated working group was built, with physicians (paediatricians and child neuropsychiatrists) assigned to hold the meetings, and biologists dedicated to update on significant scientific advances on the topic and on popular controversies on social media. This model was chosen to allow participants to ask their questions and express their fears and doubts. The speakers tried to establish an empathic and direct relationship with participants, taking into consideration their emerging emotions, regardless of the individual choices, opinions, and personal beliefs, according to the Motivational Interviewing method.2 Overall, communication aimed to address the concerns of the participants, rather than influencing their choice to vaccinate by exploiting their fears. The initiative's impact on the decision to vaccinate and on the fear of the pandemic was analysed by an online survey proposed to participants in February 2022, 1–6 month after the meeting had been held. Overall, 195 subjects (all parents of one or more children) referred to the Info-Vax service, 117 in the groups and 78 by phone. The meeting had a mean size of a dozen participants (10–15) and lasted an average 70 min. Eighty-five subjects (71 female) took part in the survey, 66 out of 117 who participated in the group (56.4%), and 19 out of 78 contacted the service by phone (24.3%). Seventy-four participants stated that both parents were already vaccinated, but 8 declared that only one of them had been vaccinated and in 3 cases both parents were unvaccinated. Only six participants had a story of severe COVID-19 in their family, while 38 reported mild cases. All subjects declared that the information they received was sufficiently clear (Table 1). Based on the answers to Frequently Asked Questions during the meetings, two topics were considered of greater importance by most of the subjects involved. Firstly, the consideration that the most worrying adverse events reported after vaccination could occur with higher frequency and severity after COVID-19 infection, such as myocarditis2 (65 answers). Secondly, viruses are generally more harmful than vaccines (50 answers). Notably, most of the participants reported a reduced fear of vaccination after the Info-Vax meeting, while fear of COVID-19 infection did not change. Eventually, 77 out of 85 participants decided to vaccinate their children, and most of these (68) declared that the Info-Vax initiative had a ‘high’ impact on the decision, and in four cases one or more adults also decided to vaccinate. We further analysed the association between the main characteristics of the enrolled population and stress levels evaluated with the Perceived Stress Scale-10 (PSS-10). A mean PSS-10 score of 19.89 was consistent with a moderate level of perceived stress, which was slightly higher than recorded in the same period in the general Italian population (17.01).3 In bivariate analysis, a significantly higher PSS score was measured in females than in males (20.42 vs. 17.30), partly due to a higher score for the ‘difficulties of coping with all the things to do’ option (2.93 in females vs. 2.23 in males), which might reflect the challenge of childcare following pandemic rules. This is likely due to the fact that Italian women spend nearly twice as much time of men in family duties and childcare. A significantly higher PSS-10 score was also found in subjects who had received information from a general practitioner or other trusted doctor vs other sources (23.25 vs. 18.89). While people who were already more stressed about COVID-19 and vaccinations might have been more actively seeking information from their doctors, it should be also considered that some physicians may have had suboptimal skills in providing balanced recommendations on COVID-19 vaccination, due to the rapid development of new vaccines.4 No other significant correlation was found between the PSS-10 score and other variables in the questionnaire, including a previous story of COVID-19 in the family. This study presents several biases. First, participants in the Info-Vax events may have been more well-disposed to consider vaccination compared to the general population, since most of them were already vaccinated. Nevertheless, some parents had conflicting views on vaccination, which in most cases could be reconciled after participation. However, it must be acknowledged that some vaccine-sceptic parents could have little confidence in seeking the opinion of scientists at a hospital and might have avoided taking part in the program. Second, the subjects who decided to fill out the questionnaire (overall 46% of participants) could represent those most satisfied with the meeting experience, resulting in a rather high approval rating for the event. However, it is worth noting that the response rate is in line with what is expected for online surveys. In conclusion, our experience confirmed that physician-led initiatives, with an interactive format halfway between medical counselling and scientific information, are feasible and can result in a reduction of vaccine fear in participants, helping to fill the information gap for vaccine-hesitant parents even in a context characterised by significant perceived stress. Our experience may also be valuable for other paediatric vaccinations.5 Remarkably, informing parents about vaccine safety seemed more effective than pointing out the potential severity of the infection. In fact, leveraging severity to incentivise the vaccine in young people could generate confusion and distrust, given the mild course of the disease in young people. In contrast, emphasising the vaccine's safety made it acceptable even for preventing a mild disease, which nevertheless had a major impact on the social lives of young people. Dr. E.V. had a primary role in promoting the Info-Vax event, assuring scientific updates, discussed results and corrected the manuscript. Dr. S. N. contributed to the conduction of Info-Vax events, discussion of results and correction of the manuscript. Dr. L.R. contributed to discussion of results and data analysis. Dr. G.A. had a primary responsibility in the neuropsychiatric studies and contributed to the discussion of results. Dr A.T. had primary responsibility for protocol development and supervision of the manuscript. This work was supported by the Italian Ministry of Health, with the contribution provided to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy, RC#30/22. Open access funding provided by BIBLIOSAN. We declare no conflict of interest. The authors thank Martina Bradaschia for the English revision of the manuscript.
1 citations
TL;DR: In this article , the authors describe the setting up and initial implementation of a regional surveillance system on pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG) in pregnant women.
Abstract: In many countries, including Italy, there are few national data on pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG), despite these being important predictors of maternal and neonatal health outcomes. This dearth of information makes it difficult to develop and monitor intervention policies to reduce the burden of disease linked to inadequate BMI status and/or GWG in pregnant women. This study describes the setting up and initial implementation of a regional surveillance system on pre-pregnancy BMI and GWG.Between 1 January 2017 and 31 December 2018, anthropometric data were collected from all pregnant women accessing public health services in the Friuli Venezia Giulia region (Italy) for first ultrasound check (T1) and at delivery (T2). Anthropometric data collected at T1 (self-reported pre-pregnancy weight and measured weight and height) and T2 (measured weight and self-reported pre-pregnancy weight and height) were compared.The system was able to reach 43.8% of all the women who gave birth in the region, and provided complete data for 6400 women of the 7188 who accessed the services at T1. At the beginning of pregnancy 447 (7.0%) women were underweight, 4297 (67.1%) had normal weight, 1131 (17.7%) were overweight and 525 (8.2%) had obesity. At delivery, 2306 (36.0%) women were within the appropriate weight gain range, while for 2021 (31.6%) weight gain was insufficient and for 2073 (32.4%) excessive. Only minor differences were observed between measured and self-reported anthropometric data.The surveillance system offers an overview of the weight status of women during pregnancy. About 1/3 of women entered pregnancy with unsatisfactory BMI and 2/3 did not achieve the recommended weight gain. This surveillance system can be an effective tool to guide public health interventions.
TL;DR: In this paper , the authors evaluated the effectiveness of a mobile health application with content to support ORL patients and their caregivers in the perioperative period to reduce caregiver anxiety and child distress compared to standard care.
Abstract: Abstract Background Otorhinolaryngology (ORL) surgery is common in children, but hospitalisation, surgery, and home care after discharge are stressful experiences for young patients and their family caregivers. Findings from literature highlight a lack of time in hospitals to support ORL surgery children and their caregivers through the perioperative process, along with the risks of caregivers’ autonomous web or social media resources investigation. Therefore, this study aims to evaluate the effectiveness of a mobile health application with content to support ORL patients and their caregivers in the perioperative period to reduce caregiver anxiety and child distress compared to standard care. Methods An open-label, two-arm randomised control trial design is being adopted. The intervention consists of a mobile health application with content to support ORL patients and their caregivers during the perioperative period. One hundred eighty participants will be enrolled and randomly assigned to the experimental group using the mHealth application or the control group. The control group receives standard information and education about the ORL perioperative period from healthcare providers orally or through brochures. The primary outcome is the difference between the intervention and control groups in preoperative caregiver state anxiety. Secondary outcome measures include children’s distress before surgery and family preparation for hospitalisation. Discussion The results of this study will be critical to the implementation of a new and safe model for the management of care and education in paediatrics. This model can achieve positive organisational and health outcomes by supporting continuity of care and empowering citizens to have informed participation and satisfaction in paediatric health promotion and management. Trial registration Trial identifier: NCT05460689 registry name: ClinicalTrials.gov. Date of registration: July 15, 2022. Last update posted: February 23, 2023.
TL;DR: In this article , the authors evaluated the effectiveness of an overheated dry-saturated steam device (Polti Sani System) in decreasing the superficial microbial contamination on dental chairs' surfaces after 30 s steam disinfection.
Abstract: This study aimed to evaluate, through Adenosine triphosphate (ATP) bioluminescence analysis, the effectiveness of an overheated dry-saturated steam device (Polti Sani System) in decreasing the superficial microbial contamination on dental chairs’ surfaces after 30 s steam disinfection (T1) in comparison to baseline (T0), i.e., at the end of an aerosol-generating procedure (AGDP), and to investigate any differences in the tested surfaces’ contamination at T0 in relation to the surface’s type. Three dental chair surfaces (scialytic lamp, control button panel, spit bowl), sized 10 × 10 cm each, were swabbed and analyzed before and after steam application. The procedure was repeated 20 times for a total of 60 before–after evaluations. Non-parametric tests were used to analyze Relative Light Unit (RLU) values and categorical data on the ATP molecules’ amount detected on the tested surfaces. Statistically significant differences were found for both RLU and categorical data for all surfaces, and each type of surface evaluated at T0 and T1 (p < 0.05). Differences in RLU among the tested surfaces at T0 were not significant. By reducing the microbial contamination on the evaluated surfaces, the overheated dry-saturated steam system was an effective measure for the disinfection of the dental chair’s surfaces after AGDPs, potentially reducing the risk of cross-infections.
TL;DR: In this article , the authors used data from nine birth cohorts participating in the LifeCycle Project, including five studies with large samples of immigrants' children: Etude Longitudinale Française depuis l’Enfance, the Raine Study and the Generation R study.
Abstract: Objective Research on adults has identified an immigrant health advantage, known as the ‘immigrant health paradox’, by which migrants exhibit better health outcomes than natives. Is this health advantage transferred from parents to children in the form of higher birth weight relative to children of natives? Setting Western Europe and Australia. Participants We use data from nine birth cohorts participating in the LifeCycle Project, including five studies with large samples of immigrants’ children: Etude Longitudinale Française depuis l’Enfance—France (N=12 494), the Raine Study—Australia (N=2283), Born in Bradford—UK (N=4132), Amsterdam Born Children and their Development study—Netherlands (N=4030) and the Generation R study—Netherlands (N=4877). We include male and female babies born to immigrant and native parents. Primary and secondary outcome measures The primary outcome is birth weight measured in grams. Different specifications were tested: birth weight as a continuous variable including all births (DV1), the same variable but excluding babies born with over 4500 g (DV2), low birth weight as a 0–1 binary variable (1=birth weight below 2500 g) (DV3). Results using these three measures were similar, only results using DV1 are presented. Parental migration status is measured in four categories: both parents natives, both born abroad, only mother born abroad and only father born abroad. Results Two patterns in children’s birth weight by parental migration status emerged: higher birth weight among children of immigrants in France (+12 g, p<0.10) and Australia (+40 g, p<0.10) and lower birth weight among children of immigrants in the UK (−82 g, p<0.05) and the Netherlands (−80 g and −73 g, p<0.001) compared with natives’ children. Smoking during pregnancy emerged as a mechanism explaining some of the birth weight gaps between children of immigrants and natives. Conclusion The immigrant health advantage is not universally transferred to children in the form of higher birth weight in all host countries. Further research should investigate whether this cross-national variation is due to differences in immigrant communities, social and healthcare contexts across host countries.
01 Jul 2023
TL;DR: In this article , an online questionnaire to assess perceived, wished and actual knowledge of healthcare workers on Palliative Care (PPC) and Pain Therapy (PT) is presented.
Abstract: There is a lack of highly reliable tools evaluating healthcare professionals’ competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of healthcare workers on PPC/PT. The tool was built on the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists. Face validity, internal consistency and the underlying structure were evaluated after a field testing in a referral hospital, Friuli-Venezia Giulia, Italy. One hundred five respondents completed the questionnaire. High internal consistency for both scales of Perceived and Wished Knowledge was found (α = 0.95 and α = 0.94, respectively). Psychologists reported higher levels of self-Perceived skills on the psychosocial needs of the child and family at the end of life (p = 0.006), mourning (p = 0.003) and ethics and deontology in PT/PC (p = 0.049). Moreover, when Actual Knowledge was tested, they also provided the highest number of correct answers (p = 0.022). No differences were found by profession for Wished Knowledge. The questionnaire showed promising psychometric properties. Our findings suggest the need of continuous training in this field and identify contents to be addressed in future training programs.