Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach

The PHERCC Matrix. An Ethical Framework for Planning, Governing, and Evaluating Risk and Crisis Communication in the Context of Public Health Emergencies

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix.

GLP-1 Receptor Agonists and Related Mental Health Issues; Insights from a Range of Social Media Platforms Using a Mixed-Methods Approach

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs; semaglutide and others) now promises effective, non-invasive treatment of obesity for individuals with and without diabetes. Social media platforms' users started promoting semaglutide/Ozempic as a weight-loss treatment, and the associated increase in demand has contributed to an ongoing worldwide shortage of the drug associated with levels of non-prescribed semaglutide intake. Furthermore, recent reports emphasized some GLP-1 RA-associated risks of triggering depression and suicidal thoughts. Consistent with the above, we aimed to assess the possible impact of GLP-1 RAs on mental health as being perceived and discussed in popular open platforms with the help of a mixed-methods approach. Reddit posts yielded 12,136 comments, YouTube videos 14,515, and TikTok videos 17,059, respectively. Out of these posts/entries, most represented matches related to sleep-related issues, including insomnia (n = 620 matches); anxiety (n = 353); depression (n = 204); and mental health issues in general (n = 165). After the initiation of GLP-1 RAs, losing weight was associated with either a marked improvement or, in some cases, a deterioration, in mood; increase/decrease in anxiety/insomnia; and better control of a range of addictive behaviors. The challenges of accessing these medications were a hot topic as well. To the best of our knowledge, this is the first study documenting if and how GLP-1 RAs are perceived as affecting mood, mental health, and behaviors. Establishing a clear cause-and-effect link between metabolic diseases, depression and medications is difficult because of their possible reciprocal relationship, shared underlying mechanisms and individual differences. Further research is needed to better understand the safety profile of these molecules and their putative impact on behavioral and non-behavioral addictions.

Spreading of misinformation on mass media and digital platforms regarding vaccines. A systematic scoping review on stakeholders, policymakers, and sentiments/behavior of Italian consumers

Studies on traditional and social media have found that misinformation about vaccines has been widely spread over the last decade, negatively impacting public opinion and people's willingness to get vaccinated. We reviewed the sentiments of Italian users to define the characteristic of anti-vax and pro-vax contents and defined the strategies to deal with the misinformation. Scopus, MEDLINE/PubMed, Google Scholar (up to page 10), and ISI Web of Knowledge databases were systematically searched. Research articles, brief reports, commentaries, and letters published between January 1, 2010 and March 30, 2022 were included in the search. No-vax or ambiguous contents in Italian mass media are not prevalent compared to neutral and pro-vax content; the communication of no-vax groups is significantly simplified, favoring the understanding of the topics by users. Events related to vaccinations are associated with news coverage by media, search engine consultations, and user reactions on social networks. In this context, the activity of no-vax groups is triggered, and misinformation and fake news spread even further. A multifactorial approach is necessary to manage online user sentiment and use mass and social media as health promotion tools.

Patient narratives - a still undervalued resource for healthcare improvement

In recent years, patient narratives have attracted increasing attention as a valuable source of insights into the subjective experience of healthcare. This paper outlines a best-practice approach to the collection, analysis, and use of patient narratives, based on current literature and on the experience of developing the Swiss Database of Individual Patient Experiences (DIPEx). The DIPEx project aims to provide a systematic and methodologically rigorous collection of patient narratives on various health situations and topics. This paper presents and details the DIPEx approach as a current standard in the field, offering a comprehensive overview and discussing the potential uses and benefits of patient narratives: improve healthcare practice, empower patients and caregivers, help structure better communication in healthcare, and contribute to medical teaching and learning.

Exploring the effectiveness of the Digital Green Certificate Law as Public Health instrument to increase anti-COVID-19 vaccination in a sample of working-age adult population in the Palermo Metropolitan Area

Counteracting vaccine hesitancy should be considered an absolute priority for Public Health Authorities. A correct health communication represents one of the best ways to increase adhesion to vaccination among hesitant population. In order to increase vaccination coverage rates against COVID-19, the Italian government has issued a legislative decree with a mandatory "Digital Green Certificate" (DGC) to access workplaces for some categories considered at risk.

METHODS

We conducted a cross-sectional study with the aim to highlight the factors associated with the anti-COVID-19 vaccine acceptance and to estimate the influence of the introduction by law of the Digital Green Certificate (DGC) on the adhesion to the COVID-19 vaccination campaign in a sample of individual accessing one of the main vaccination centres of the metropolitan area of Palermo, Italy. An anonymous and validated questionnaire was self-administered through the Google Documents® platform, between October 2021 and March 2022.

RESULTS

Among the 467 subjects enrolled, 43.3% were influenced on their vaccination choice by the introduction of the DGC. The multivariate analysis showed that among the respondents emerged contrasting feelings with a self-reported significantly higher sense of freedom (Adj-OR = 2.45, 95%CIs = 1.51-3.97, p-value: < 0.001) but a lower sense of safety (Adj-OR = 0.19, 95%CIs = 0.12-0.29, p-value: < 0.001) after vaccine administration.

CONCLUSIONS

Our findings, in line with the available literature, suggest that the introduction of DGC has led to a significant increase in the immunization rate and, together with an appropriate communicative approach, it could represent an effective strategy to counteract vaccine hesitancy.

Perceived Covid-19-crisis intensity and family supportive organizational perceptions as antecedents of parental burnout: A study conducted in Italy in March/April 2021 and 2022

The purpose of this study is to investigate to what extent perceived Covid-19-crisis intensity (PCCI) leads to the experience of parental burnout (PB), a syndrome characterized by exhaustion, emotional detachment from one's own children and a sense of inefficacy in the role as parent. Furthermore, the mediating role of work-family conflict (WFC) is examined. The buffering effect of family supportive organizational perceptions during the pandemic (FSOP-p) on the relationship between work-family conflict and parental burnout is also explored. Data were collected in March-April 2021 and March/April 2022. In spring 2021, 222 Italian working parents with at least one minor child living at home filled out the questionnaire. Data from 2021 showed that PCCI was positively related to the experience of parental burnout. Moreover, WFC mediated this relationship. No significant interaction effect was found for FSOP-p; however it was found that FSOP-p is negatively related to PCCI and WFC, and indirectly to parental burnout. In spring 2022, we examined whether there were changes in PCCI, WFC, and FSOP-p in a sample of 83 Italian parents. Moreover, for the second data collection we examine the tensions experienced by parents in their families about vaccination and infection precaution measures (e.g., Covid-19 vaccination passport). The results are different in 2022; the effect of PCCI on parental burnout is now completely mediated by the amount of WFC. It seems that now we go 'back to normal' and homeworking has become more optional for many, there is still an effect of PCCI on WFC, but no longer directly on parental burnout. Furthermore, the prevalence of PCCI in 2022 is lower than in 2021, while WFC and FSOP-p are not significantly different between the two timepoints. As family supportive organizational perceptions reduce the level of perceived Covid-19 intensity, organizations are urged to develop practices of support and to create a supportive environment.

Public views on the Covid-19 immunity certificate: A scoping review

INTRODUCTION

Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance.

METHODS

We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions.

RESULTS

We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure.

CONCLUSION

The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure.

PATIENT OR PUBLIC CONTRIBUTION

This does not apply to our work as it was a review paper.

A Lesson from the Green Pass Experience in Italy: A Narrative Review

The COVID-19 outbreak has raised several global challenges related to disease management while highlighting the need to embrace a multidimensional approach in dealing with events such as. Due to the singular features of SARS-CoV-2, an appropriate medical response was required to develop new vaccines able to tackle it effectively. Mass vaccination plans were thus promptly launched around the world. However, vaccine uptake has been coupled with growing concerns that have affected people’s willingness to get vaccinated. To promote compliance with vaccination campaigns, many governments introduced the use of vaccination certificates and immunization passports. Studies have discussed some benefits and cons coupled with the rollout of vaccine passports or certificates. This paper takes up and extends this discussion by showing the results of a mini- narrative review we undertook with the aim of critically summarizing the existing scholarly research on the Green Pass in Italy. In analyzing the 12 included records, we explored the scientific viability of this measure, as well as the concerns and criticisms it has raised and the recommendations that have been proposed to address them, as a starting point to consider how the lesson learned in the Italian context can contribute to informing future reflections and strategies in view ofanother pandemic event.

Addressing vaccine hesitancy and resistance for COVID-19 vaccines

The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.