Showing papers by "Vincenza Gianfredi published in 2019"

Countering vaccine hesitancy through immunization information systems, a narrative review

Abstract: Immunization is one of the most important public health interventions to contrast infectious disease; however, many people nowadays refuse vaccination. Vaccine hesitancy (VH) is due to several factors that influence the complex decision-making process. Information technology tools might play an important role in vaccination programs. In particular, immunization information systems (IISs) have the potential to improve performance of vaccination programs and to increase vaccine uptake. This review aimed to present IIS functionalities in order to counter VH. In detail, we analyzed the automatic reminder/recall system, the interoperability of the system, the decision support system, the web page interface and the possibility to record adverse events following immunization. IIS could concretely represent a valid instrument to increase vaccine confidence, especially trust in both health-care workers and decision makers. There are not enough trials aimed to evaluate the efficacy of IIS to counter VH. Further researches might focalize on this aspect.

Rectal Cancer: 20% Risk Reduction Thanks to Dietary Fibre Intake. Systematic Review and Meta-Analysis.

Abstract: The aim of this systematic review and meta-analysis was to evaluate the association between dietary fibre intake and rectal cancer (RC) risk. In January 2019, a structured computer search on PubMed/Medline, Excerpta Medica dataBASE (EMBASE) and Scopus was performed for studies reporting the results of primary research evaluating dietary fibre intake in women and men as well as the risk of developing RC. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Highest vs. lowest fibre concentrations was compared. The Egger test was used to estimate publication bias. Heterogeneity between studies was evaluated with I2 statistics. The search strategy identified 912 papers, 22 of which were included in our meta-analysis. Having evaluated a total of 2,876,136 subjects, the results suggest a protective effect of dietary fibre intake on RC prevention. The effect Size (ES) was [0.77 (95% CI = 0.66-0.89), p-value = 0.001)]. Moderate statistical heterogeneity (Chi2 = 51.36, df = 21, I2 = 59.11%, p-value = 0.000) was found. However, no publication bias was found, as confirmed by Egger's linear regression test (Intercept -0.21, t = -0.24, p = 0.816). The findings suggest that dietary fibre intake could be protective against RC, with a clinically relevant reduction of RC risk. Identifying preventive measures to avoid the development of RC, especially by following a healthy lifestyle including healthy diet, is pivotal.

Leadership in Public Health: Opportunities for Young Generations Within Scientific Associations and the Experience of the "Academy of Young Leaders".

Abstract: This paper outlines the characteristics of scientific leadership and the role of Scientific Associations with their specific activities. The recent activities of the Lombard Academy of Public Health are subsequently described, including the creation, in 2019, of the Academy of young leaders in public health. Comparing to other sectors, scientific leadership dynamics take into consideration different aspects. Besides awards (Nobel Prize or several other) and prestigious affiliations, eventual indicators might be academic roles, fundraising abilities, relevant positions among scientific associations, editors of prestigious journals or editorial series and, more recently, high bibliometric indicators. The peculiar topics of public health encompass interactions with institutions, authorities, politicians, involved in different levels in health policies. Recently, in Italy, the Ministry of Health has identified parameters to be accreditated as a scientific and technical association. The role of SItI (Italian Society of Hygiene), EUPHA, ASPHER, and WFPHA appears relevant in PH, in national and international contexts, with Italian praiseworthy members constantly achieving leading roles. Considering that few training opportunities aimed to improve research and leadership skills are available, Accademia Lombarda di Sanita Pubblica (ALSP) designed the AYLPH (Academy of Young Leaders in Public Health) program. AYLPH program is a 1-year training to shape leadership skills among young professionals. A set of didactic, theoretical and practical methods was offered and evaluated.

Factors predicting health science students' willingness to be vaccinated against seasonal flu during the next campaign

Abstract: Introduction. Influenza is an infectious disease with a high burden, for which a safe and efficacy vaccine is available. However, vaccination coverage is generally low, also among Health Care Workers (HCW). Health Professions students are comparable to HCW in terms of workplace exposure. Aim. The study aim was to identify predictive factors of flu vaccination acceptance among Italian students of Health Professions. Methods. A cross-sectional study was performed using a validated, on-line, anonymous questionnaire. Data were analyzed performing both univariable and multivariable logistic analysis. Results. The results showed a statistically significant association between intention to vaccinate next year and: geographical distribution, considering themselves at higher risk due to their profession, having been vaccinated last year, having recommended the vaccination last year, and being willing to recommend it next year and being favorable to mandatory vaccination. In conclusion, identifying an effective vaccination strategy and including students in flu vaccination campaigns might have positive effect on vaccination acceptance.

Geospatial analysis of the influence of family doctor on colorectal cancer screening adherence.

Abstract: Background Despite the well-recognised relevance of screening in colorectal cancer (CRC) control, adherence to screening is often suboptimal. Improving adherence represents an important public health strategy. We investigated the influence of family doctors (FDs) as determinant of CRC screening adherence by comparing each FDs practice participation probability to that of the residents in the same geographic areas using the whole population geocoded. Methods We used multilevel logistic regression model to investigate factors associated with CRC screening adherence, among 333,843 people at their first screening invitation. Standardized Adherence Rates (SAR) by age, gender, and socioeconomic status were calculated comparing FDs practices to the residents in the same geographic areas using geocoded target population. Results Screening adherence increased from 41.0% (95% CI, 40.8–41.2) in 2006–2008 to 44.7% (95% CI, 44.5–44.9) in 2011–2012. Males, the most deprived and foreign-born people showed low adherence. FD practices and the percentage of foreign-born people in a practice were significant clustering factors. SAR for 145 (21.4%) FDs practices differed significantly from people living in the same areas. Predicted probabilities of adherence were 31.7% and 49.0% for FDs with low and high adherence, respectively. Discussion FDs showed a direct and independent effect to the CRC screening adherence of the people living in their practice. FDs with significantly high adherence level could be the key to adherence improvement. Impact Most deprived individuals and foreigners represent relevant targets for interventions in public health aimed to improve CRC screening adherence.

Polio and measles: reasons of missed vaccination in Italy, 2015-2017.

Abstract: Background Also in Italy, a flourishing evidence confirms the recent spread of vaccine hesitancy movements resulting in approximately 4-7% of the paediatric population not immunised every year against polio and approximately 9-15% against measles in the last few years. The aim of this paper is to describe the reasons of polio and measles missed vaccination in Italy, in the period 2015-2017, and to analyse any potential effect of the 2017 mandatory vaccination law. Methods Number of missed vaccinations in children younger than 24 months, stratified by reason, were collected separately for measles and polio with a regional level of detail. Data were collected using an electronic form developed using Microsoft Excel®. Results The most frequent reason for missed polio vaccination was "definitive informed dissent" with a mean value 1.5%, followed by "found/contacted, but did not attend the appointment" with a mean value 1.3%. Inversely, "acquired immunity subsequent to previous disease or vaccination performed elsewhere" and "excused in a permanent way for health conditions" were the less frequent with a mean value 0.03% for both. For measles vaccination the reason "found/contacted, but did not attend the appointment" was the most frequent (mean value 3.2%), followed by "definitive informed dissent" (mean value 2.9%). Conclusions Percentage of missed vaccination showed a remarkable reduction in 2017. This decrease is likely due to the introduction of mandatory vaccination law. In point of fact, "Dissent" decreased for both polio and measles during the study period. While, "Delay" increased during the 3-years. It seems that hesitant parents prefer to postpone vaccinations instead of refusing them. Counselling, parents' empowerment and vaccine education are central to contrast vaccination postponing. Thus, for parents who refuse vaccines ("Dissent"), monitoring the trend is important as well as trying to understand their reasons.

E-Coaching: the DianaWeb study to prevent breast cancer recurrences.

Abstract: IntroductionBreast cancer is the most common cancer in women worldwide, for which the survival rate is increasing over time. Growing evidence are showing that the effect of lifestyle could have the same weight of the effect of the usual clinical-pathological risk factors on survival rate. The DianaWeb study responds to the pressing request of patients diagnosed with breast cancer to know the most advanced point of scientific research on the prevention of recurrences, to have a virtual space to meet, where to receive advice and practical information for the daily management the lifestyle change. DianaWeb is a community-based participatory research, dedicated to breast cancer patients, aimed to monitor lifestyle, provide them tips to encourage sustainable lifestyle changes, and to analyze clinical outcomes. In order to achieve these aims, DianaWeb uses a specific interactive website (http://www.dianaweb.org/). MethodsThe web architecture has been designed essential and light, with a rigorous implantation that brings the figure of the woman to the center. In order to humanized the project the acronym used to identify the study was Diana (Diet and Androgens), a classical female name, who was illustrated as a female avatar, aimed to symbolize all women. The graphical interface was developed using seven pastel tones colors, which become a fundamental elements of the layout, such as frame, navigation menu, and separation interspaces. ResultsThe project started in 2015, and in 4 days the web site was visited by more than 1000 people. A total of 2823 persons enrolled in the study, but 2182 did not send the full documentations, 61 persons abandoned the study, 641 timely answered to the questionnaires. ConclusionsThe high number of participants’ interaction within the web page, confirmed the high usability of the web page and the great interest of patients. Prevention of breast cancer recurrences with low cost technologies, easily available to everybody, is a priority for both public health and public finances

PILATES (Physical Activity and Diet Survey): An Italian Self-Administered Questionnaire Evaluating Diet Habits of Gym-Goers. Validation Process.

Abstract: PILATES study aims are to assess the main characteristics related to food habits, diet behaviors, and nutrition knowledge and how and where gym-goers get information on dietary supplementation. We ...

PRuNUS: design and validation of a questionnaire among prisoners - data of pilot study in the Penitentiary Institute of Perugia, Italy.

Abstract: The PRison NUtrition Surveillance (PRuNUS) questionnaire aimed to assess the eating behaviour, diet knowledge and lifestyle of Italian prisoners. The purpose of this paper is to present both data from the validation process and from the cross-sectional study.,In order to perform the validation process, the authors evaluated the reproducibility and the consistency of the questionnaire, using Cohen’s k and Cronbach’s α, the agreement between the two administrations was evaluated by the Landis and Koch score. The authors performed the study in the “Capanne” Prison, Perugia. A multivariable logistic regression model adjusted for age and gender was used.,Out of 300 men, 11 participated in the validation process and 68 in the survey. Among 47 women, 11 participated in the validation and 17 in the survey, with a 26.2 per cent (85/325) cumulative response rate. The questionnaire obtained a good concordance with a k-value=0.61 and 74.48 per cent of agreement and a high level of inter-correlations among items with α=0.8452. Half of the prisoners were overweight/obese and 68.6 per cent were smokers. Moreover, smoking habits were statistically associated with a low educational level, duration of conviction, body mass index and coffee consumption.,The results highlighted the need for an educational programme in prison. Detention period could be a good opportunity to promote healthy habits.

Food supplements intake among gymgoers: A cross-sectional study using thePILATES questionnaire

Abstract: The purpose of this study is to investigate food supplement intake among gym-goers.,A cross-sectional study, using a validated questionnaire, was conducted. All participants were gym-goers who voluntarily enrolled from eight selected gyms in Perugia. A multivariate regression analysis was performed.,In our sample, 44.9per cent (n = 57) of participants consumed dietary supplements, at least once a week, with no association with sex (p = 0.5) and educational level (p = 0.4). Supplements intake was statistically significant and associated with very low intake of mineral water (p = 0.01), diet specific for fitness programmes (p < 0.01), information about nutrition from personal trainers (p < 0.01), frequency of physical activity (p = 0.01), society’s attention to nutrition (p = 0.04) and marginally with frequency of weigh control (p = 0.05).,Food supplements intake seems to be extensively used among gym-goers, and it seems related to information about nutrition from personal trainers. However, specialized personnel, such as dietitian or nutritionist, should supervise supplements intake.

Identikit of the Umbrian traveller: analysis of clinical activity in a travel medicine unit, Italy.

Abstract: A travel medicine clinic is the proper medical centre aimed to provide updated recommendations before any journey. The study aim was to assess the number of accesses during 2016 at the Travel Medicine Clinic of the Local Health Unit in the Umbria Region. An electronic ad hoc database was developed. Paper-based data referring to 2016 were recorded in this electronic registry, developed on Microsoft Office Access®. In 2016, 891 subjects came in our clinic in order to get information before travelling. In our sample, 53.3% were male and the mean age was 35.33 years ± 0.58. Almost half had a higher education, and 20% were foreign. Vaccines against food- and water-borne diseases were the most frequently administered. Approximately, 74% of the attenders were suggested to do an anti-malaria prophylaxis (Mefloquine in one-half, approximately). Every traveller received a pre-travel counselling. Performance activity of our clinic and the adherence to preventive protocols in case of international travels, have been assessed.

CHAPTER 36: Use of Micronucleus Assays to Measure DNA Damage Caused by Cytostatic/Antineoplastic Drugs

Abstract: Occupational exposure to antineoplastic drugs (ANPD) raises concerns regarding possible health effects on healthcare workers. In fact, even when healthcare workers are specifically trained and ANPD handling occurs according to issued guidelines and/or safety recommendations, accidental contamination in the workplace (and a concurrent increased exposure risk to genotoxic/carcinogenic compounds, such as chlorambucil, cyclophosphamide, etoposide, etc.) is still detectable. Cytogenetic biomarkers are the most frequently used endpoints in human biomonitoring studies to assess the impact on health of environmental/occupational exposure to genotoxic xenobiotics. Among the cytogenetic assays, the lymphocyte cytokinesis-block micronucleus (L-CBMN) assay is one of the most frequently used and, to date, the best validated method for biological effect monitoring in subjects occupationally exposed to genotoxic xenobiotics. The assessment of micronuclei (MN) in uncultured, exfoliated epithelial cells from oral mucosa (B-MN assay) has provided a complementary method for cytogenetic analyses in easily accessible tissue without cell culture requirement. Using PubMed and an appropriate combination of key words, we retrieved 28 studies, published from 1988 to 2018, measuring MN in healthcare workers occupationally exposed to ANPD. The overall evaluation of the currently available studies clearly shows a significantly increased genotoxic risk for healthcare workers occupationally exposed to ANPD.