A comparative analysis of non-pharmaceutical interventions for preventing the respiratory syncytial virus in 30 European countries

AIM

Respiratory syncytial virus (RSV) is a leading cause of childhood respiratory infections. Non-pharmaceutical interventions (NPIs) can help to reduce RSV transmission and our aim was to provide an overview of recommended NPIs across Europe during the 2022-2023 epidemic season.

METHODS

The webpages of national European public health agencies and ministries were reviewed and the information they provided on RSV prevention was compared with the December 2022 guidelines from the European Centre for Disease Prevention and Control.

RESULTS

We examined 30 countries, leading to 21 issued recommendations for RSV prevention through institutional channels, including six that were specific for the 2022-2023 season. The top five recommendations were: hand and respiratory hygiene (95%), avoiding crowded spaces (67%), staying at home when ill (62%), cleaning household items (57%) and limiting contact with sick people (57%). They also included: face masks (33%), ventilating indoor spaces (29%), properly disposing of contaminated material (13%) and keeping siblings home from preschool if there was a newborn infant in the family (10%).

CONCLUSION

There was significant heterogeneity in the NPIs recommended by different countries during RSV epidemics. Ongoing evaluation is essential to optimise the effectiveness of NPIs and adapt to changing RSV patterns.

Can youtube be trusted as a source of quality and reliable information on COVID-19 vaccination in Italy?

Background and aim: Social media platforms are common sources of information, even more so during the COVID-19 pandemic. YouTube is the second most popular social media platform both in Italy and globally. Following criticisms regarding quality control during the pandemic, banners that would direct viewers to official health information sources were incorporated into Youtube videos related to COVID-19. The aim of this study is to assess the reliability and information quality of YouTube videos related to COVID-19 vaccination in Italy.

METHODS

On March 2022, six different search queries were used to retrieve COVID-19 vaccination-related videos, resulting in the identification of 329 videos, and their characteristics were described. Two validated instruments, namely HoNCode and DISCERN, were used to assess the reliability and quality of the videos' content.

RESULTS

Of the total number of videos, 72.0% were from non-medical or generalist channels. The most represented category was internet media (32.5%) while the less frequent was educational medical channel (7.0%). Videos from medical channels had higher reliability (p=0.002) and quality (p<0.001) than not medical channels, despite receiving fewer visualizations (p=0.004), likes (p=0.018) and comments (p<0.001). Media and news agencies sources consistently delivered lower quality content.

CONCLUSIONS

These findings suggest that public health professionals and institutions should consider investing in social media representation to fill the gap with non-medical sources in terms of popularity, to provide reliable and interesting videos, and ultimately deliver health education to the general public.

Promoting societal resilience during the COVID-19 pandemic: a multi-country analysis of public health strategies

BACKGROUND AND AIM

Enhancing public health communication during a global crisis is crucial to promote resilience. This study examines the influence of health communication in ten countries, analysing its positive and negative impact on society's behavior regarding the origin, symptoms, and prevention of SARS-CoV-2.

METHODS

A comprehensive narrative analysis of available data was conducted to evaluate societal and resilience responses during the COVID-19 pandemic. The study consulted academic and grey literature, from February 1, 2020, to March 1, 2022, focusing on ten countries that exhibited heterogenous responses to pandemic, including EU (Italy, Denmark, Sweden, Spain, Portugal, Romania, France, and Germany) and non-EU (United Kingdom and Israel) countries.

RESULTS

The stringency of policy responses varied between countries and over time, with some countries implementing strict lockdowns while others only issued recommendations. Vaccination campaign and the spread of less virulent variants of the virus has led most countries to lift most restrictions by April 2022. However, vaccine uptake and refusal remain complex issues influenced by social norms, cultural beliefs, access to information, and trust in government authorities. Social media played a significant role during the pandemic, but healthcare professionals' active participation in addressing misinformation was lacking.

CONCLUSIONS

The COVID-19 pandemic highlighted the importance of Public Health in developing proper strategies and utilizing digitals tools to counteract infodemic and spread relevant information. Healthcare workers should improve their communication skills to face future epidemics and be trusted by the population. Social media and digital platforms should be studied and used effectively in times of emergency.

The efficacy of digital media tools to promote a healthy diet in children: A systematic review of intervention studies

BACKGROUND AND AIM

Proper nutrition during childhood and puberty is essential to ensure healthy growth of children and good health in adulthood. Different types of interventions have been suggested to promote nutritional health in children. This systematic review aims to summarize the available evidence from experimental studies on the efficacy of digital media tools for the promotion of a healthy diet in school-aged children.

METHODS

According to PRISMA guidelines, a literature search was conducted in the three main electronic databases (PubMed/Medline, Embase e Scopus) until April 2022. We included all experimental studies assessing the effectiveness of digital media tools for nutritional health promotion in children from 5 to 12 years of age.

RESULTS

Four studies were included in our analysis, all carried out in school settings. Three of them investigated the use of a videogame, while one study involved watching a cartoon. Each intervention tested was effective in promoting a healthy diet in school-aged children in the short term, regardless of the type of intervention and age of the children involved. A statistically significant increase was observed post-intervention in all studies, both in knowledge of food groups and food frequencies, and in practices (i.e. the amount of fruit and vegetables servings consumed per meal), although the effect faded over time (when follow-up was available).

CONCLUSIONS

Digital media tools can be used to effectively implement health promotion interventions to improve knowledge and adherence to healthy diets in school-aged children. Further studies are needed to assess the long-term effectiveness of these interventions.

Past and Future Influenza Vaccine Uptake Motivation: A Cross-Sectional Analysis among Italian Health Sciences Students

Despite its effectiveness in the prevention of seasonal flu, influenza vaccination uptake remains low, even among healthcare workers (HCWs), despite their occupational risk. The aim of this study was to explore the association between main reasons for accepting or refusing influenza vaccination and the decision to receive the vaccination during both previous and following year among health sciences students. A multi-center, cross-sectional study was performed using a validated online questionnaire. Data were analyzed by performing univariable and multivariable logistic analysis. Data from over 3000 participants showed that avoiding the spread of infection to family members and the general population (aOR: 43.55), as well as to patients (aOR: 16.56) were the main reasons associated with the highest probability of taking the influenza vaccination the following year. On the contrary, not considering influenza as a severe disease was the reason associated with the lowest probability for past (aOR: 0.17) and future vaccination (aOR: 0.01). Therefore, the importance of vaccination to protect others should always be the core of vaccination campaigns for health sciences students, together with tools to increase their awareness of the severity of this disease.

Vaccine Mandates in the COVID-19 Era: Changing Paradigm or Public Health Opportunity? Comment on "Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates"

The debate around vaccine mandates has flourished over the last decade, with several countries introducing or extending mandatory childhood vaccinations. In a recent study, Attwell and Hannah explore how functional and political pressures added to public health threats in selected countries, motivating governments to increase the coerciveness of their childhood vaccine regimes. In this commentary, we reflect on whether such model applies to the coronavirus disease 2019 (COVID-19) case and how the pandemic has re-shuffled the deck around vaccine mandates. We identify COVID-19 immunisation policies' distinctive aspects as we make the case of countries implementing mass immunisation programmes while relying on digital COVID-19 certificates as an indirect form of mandate to increase vaccine uptake. We conclude by acknowledging that different forms of mandatory vaccination might serve as a shortcut to protect population health in times of emergency, underlining, however, that the ultimate public health goal is to promote voluntary, informed, and responsible adherence to preventive behaviours.

Prevention, diagnosis and treatment of cervical cancer: A systematic review of the impact of COVID-19 on patient care

Worldwide, the COVID-19 pandemic disrupted healthcare services, including cervical cancer management, and an increased burden for this condition is expected. This systematic review synthetizes the available evidence on the impact of the pandemic on prevention, diagnosis and treatment of cervical cancer. Searches were performed on PubMed, Embase, and Scopus for relevant studies on these topics with the purpose of comparing service access and care delivery before and during COVID-19 pandemic. Due to the methodological heterogeneity among the studies, findings were narratively discussed. Of the 715 screened titles and abstracts, 33 articles were included, corresponding to 42 reports that covered the outcomes of interest: vaccination against human papillomavirus (HPV) (6 reports), cancer screening (19), diagnosis (8), and treatment (8). Seven studies observed reductions in HPV vaccination uptake and coverage during COVID-19. Reports on cervical screening and cancer diagnosis activities showed a substantial impact of the pandemic on access to screening services and diagnostic procedures. All but one study that investigated cervical cancer treatment reported changes in the number of women with cervical lesions who received treatments, as well as treatment delay and interruption. With a major impact during the first wave in 2020, COVID-19 and restriction measures resulted in a substantial disruption in cervical cancer prevention and management, with declines in screening and delays in treatment. Taken together, findings from this systematic review calls for urgent policy interventions for recovering cervical cancer prevention and care.

Digital Information Approach through Social Media among Gen Z and Millennials: The Global Scenario during the COVID-19 Pandemic

An infodemic represents a concern for public health, influencing the general population's perceptions of key health issues. Misinformation is rapidly spread by social media, particularly among young generations. We used data from the WHO "Social Media and COVID-19" study, which was conducted in 24 countries worldwide on over 23,000 subjects aged 18-40 years, to explore Generation Z and Millennials' models for health-information-seeking behaviors on social media. We summarized data on the most used sources of information, content of interest, and content sharing, as well as the sentiment toward the infodemic, through descriptive statistics and Chi-square test to verify the differences between groups. Among the survey respondents, 9475 (40.3%) were from high-income countries (HIC), 8000 (34.1%) from upper-middle-income countries (UMIC), and 6007 (25.6%) from lower-middle-income countries (LMIC). Social media were the most used sources of information to retrieve news on COVID-19 disease (about 79% in HIC, 87% in UMIC, and 90% in LIC) and the COVID-19 vaccine (about 78% in HIC and about 88% in UMIC and LIC). More than a half of the young respondents declared that they pay attention to scientific contents (about 51% in HIC, 59% in UMIC, and 55% in LMIC). Finally, most young participants reported feeling overwhelmed by the infodemic. However, this sentiment did not stop them from seeking information about COVID-19. Our findings highlight the importance of shaping public health interventions and campaigns on social media platforms and leveraging scientific contents. Public health authorities should work also on strategies to improve the digital literacy of the population as a driving force to empower them and achieve better health outcomes.

The use of digital tools to promote health in children: A systematic review of intervention studies

Background

Early childhood health interventions and educational programs are key to keeping children healthy and preventing disease during adulthood. Since several preventive strategies and campaigns targeting children have been proposed, the aim of this systematic review is to evaluate the effectiveness of digital-based interventions (e.g., cartoons, videos, video games, mobile apps, etc.) in promoting healthy behaviours in primary school-aged children.

Methods

Following PRISMA guidelines, we searched three electronic databases (Medline, Embase, and Scopus) up to April 11, 2022. We included randomized and non-randomized experimental studies quantifying the effectiveness of digital or audio-visual-based health promotion interventions in childhood (up to 12 years of age).

Results

The search strategy yielded a total of 1640 articles. Retrieved studies covered a wide range of health interventions - including a healthy diet, physical activity promotion, oral hygiene, skin cancer prevention, and different educational approaches (such as cartoons, interactive video games, etc.), mainly implemented in a school setting and comparing digital interventions to teacher-led interventions or no intervention at all. Data pooling suggests that digital and audio-visual-based health promotion interventions targeting children are effective in improving health literacy and healthy behaviours.

Conclusions

This systematic review adds to the body of knowledge on health promotion in children and provides actionable measures to implement straightforward educational approaches in this specific population, empowering them to adopt preventive behaviours, and ultimately promoting health at the household and societal level.

Key messages

Do Degree Programs Affect Health Profession Students' Attitudes and Opinions Toward Vaccinations? An Italian Multicenter Study

Background

Healthcare workers' attitudes toward vaccination have been widely described in the literature, but a restricted amount of studies assessed healthcare students' knowledge, attitudes, and opinions on this issue. This study aimed to estimate the influence of a degree course on knowledge and immunization behavior among healthcare students and to compare medical students with students from other health profession degree programs to identify possible differences.

Methods

A multicenter, cross-sectional study was performed in 2018 in 14 Italian Universities (3,131 students were interviewed). A validated questionnaire was used to assess knowledge, attitudes, and opinions toward vaccinations, with a specific focus on influenza vaccine and attitudes toward mandatory vaccination policies. Statistical software STATA® 14 was used.

Results

Significant differences were recorded between medical students and other healthcare students. The intention to get vaccinated against influenza during the next season and having been vaccinated in the previous season was higher in the medical group (p < 0.001). In the group of students of other health professions, we registered a lower probability of identifying themselves as a high-risk group for contracting infectious diseases as a consequence of their profession and health status (aOR 0.49; CI95%: 0.40–0.60) and an increased likelihood of defining their level of knowledge on vaccine-preventable diseases and related vaccinations as “insufficient/sufficient/fair” (aOR 1.31; CI95%: 1.11–1.56).

Conclusions

Results show several differences between medical students and students of other health professions when it comes to vaccination knowledge, attitudes, and perceptions, as well as a general low tendency to be vaccinated against influenza.

Is there an association between self-reported vaccination knowledge and the immunization behaviour of Health Sciences students

INTRODUCTION

The role of vaccinations is widely acknowledged. However, over the last decades, an alarming reduction in immunization coverage and a rising number of reported cases of vaccine-preventable diseases have been recorded. This multicentre cross-sectional study aimed at examining whether there is an association between self-reported vaccination knowledge and the immunization behaviour of Health Sciences students.

METHODS

A cross-sectional study was performed, using a validated questionnaire. A multivariate logistic regression with stepwise backward selection process with a univariate p-value <0.25 as the main criterion was used. The level of significance chosen for statistical analysis was 0.05.

RESULTS

The sample consisted of 3,131 students (68.1% females). 38.9% of them are medicine and surgery students and 33.1% are nursing students. The multivariate logistic regression analysis shows that, regarding the "suboptimal level of knowledge about vaccine-preventable diseases ", the main and statistically significant independent variables associated are: older age (OR 1.56), having developed a vaccine-preventable disease in the last 5 years (OR 1.38), having been vaccinated against seasonal influenza last year (OR 0.70), having recommended the vaccination to patients or family members during the last influenza season based on clinical evaluation (OR 0.53) and according to the ministerial indications (OR 0.48), planning of recommending the influenza vaccination during the next season based on clinical evaluation (OR 0.67) and according to the ministerial indications (OR 0.69).

DISCUSSION

The study highlighted the importance of academic education on vaccinations in order to build a future generation of health care workers that are aware not only of the usefulness of immunization, but particularly of the major role played by health professionals in promoting a vaccination culture among the general population.

Current understandings of the impact of mandatory vaccination laws in Europe

Vaccinations are among the most successful preventive tools to protect collective health. In response to alarming vaccines preventable diseases (VPDs) outbreaks resurgence, decreased vaccination coverage and vaccine refusal, several European countries have recently revised their vaccination policies introducing or extending mandatory vaccinations. This review examines the health, political and ethical aspects of mandatory vaccination.The authors first clarify terms and definitions and propose a conceptual framework of mandatory policies. Second, they describe the current status of mandatory childhood immunization programmes in Europe, assessing selected mandatory laws. Third, as the authors conduct a systematic review of the literature (retrieving from Medline 17 relevant records between 2010 and 2020), they take an analytical approach to measure the impact of mandatory vaccination policies on both VPDs control and immunization coverage, but also on population attitudes toward vaccines. 40% of European countries currently have mandatory vaccination policies; however, policies vary widely and, although there is evidence of increased vaccine uptake, their impact on informed adherence to preventive behaviors is scant.Although mandatory vaccination policies might be needed to protect collective health in times of emergency, public health goals of VPD prevention and health promotion should primarily be pursued through health education and population empowerment.

Type 1 Diabetes Patients' Practice, Knowledge and Attitudes towards Influenza Immunization

Diabetic patients are at higher risk of developing infectious diseases and severe complications, compared to the general population. Almost no data is available in the literature on influenza immunization in people with type 1 diabetes mellitus (T1DM). As part of a broader project on immunization in diabetic patients, we conducted a cross-sectional study to: (i) report on seasonal influenza coverage rates in T1DM patients, (ii) explore knowledge, attitudes, and practices (KAPs) towards seasonal influenza in this population, and (iii) identify factors associated with vaccine uptake, including the role of family doctors and diabetologists. A survey was administered to 251 T1DM patients attending the Diabetes Clinic at San Raffaele Research Hospital in Milan, Italy and individual-level coverage data were retrieved from immunization registries. Self-reported seasonal influenza immunization coverage was 36%, which decreased to 21.7% when considering regional immunization registries, far below coverage target of 75%. More than a third (36.2%) of T1DM patients were classified as pro-vaccine, 30.7% as hesitant, 17.9% as uninformed, and 15.1% as anti-vaccine. Diabetologists resulted to be the most trusted source of information on vaccines’ benefits and risks (85.3%) and should be more actively involved in preventive interventions. Our study highlights the importance of developing tailored vaccination campaigns for people with diabetes, including hospital-based programs involving diabetes specialists.

AB0752 CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS: A SINGLE-CENTER CASE SERIES

Background:

Chronic recurrent multifocal osteomyelitis (CRMO) is a chronic autoinflammatory disease that primarily affects the skeleton of children and adolescents in the absence of an infectious etiology[1]. CRMO lesions presentation varies widely ranging from episodic bone pain to growth disturbance; lytic and sclerotic bone lesions can be found on X-ray, however magnetic resonance imaging is very useful for evaluating the extent of disease and follow-up [2].

Objectives:

To report demographic, clinical and laboratory characteristics and response to therapy in a single center Italian cohort of CRMO patients.

Methods:

We reviewed retrospectively the clinical records of seven patients affected by CRMO diagnosed between 2008 and 2019 at rheumatologic service of South Tyrol region in Italy.

Results:

We identified 7 patients with CRMO, 4 were female patients, median age of onset of symptoms was seven years. Median delay in diagnosis was seven months; all patients had bone pain as initial symptom and 6 patients presented joint swelling. Median number of lesions was two; all patients had a recurrent pattern, 4 patient had multifocal distribution and 5 had appendicular skeleton involvement. None of our patients had antinuclear antibodies or HLA-B27 positivity. Mean erythrocyte sedimentation rate was 52 mm/h and C-reactive protein 1,96 mg/dL. Regarding other organs involvement one patient presented palmoplantar pustulosis, one psoriatic arthritis and one psoriasis guttata; three patient referred familiarity for psoriasis. Histopathological diagnosis was confirmed in 3 patients. NSAIDs were used in six patients, methotrexate in two patients and bisphosphonates in 6 patients. Among biological DMARDs Adalimumab was used in two patients, one patient was treated subsequently with Secukinumab and Ustekinumab. 3 patients achieved remission (Table 1).

Table 1.

Demographic, clinical and laboratory characteristics of patients with chronic recurrent multifocal osteomyelitis.

Total (n=7)Demographics Female (%)4 (57) Age at disease onset, years, median (range)7 (6-24) Delay in diagnosis, months, median (range)7 (2-14) Follow-up, months, median (range)69 (11-151)Initial symptoms Bone pain, n (%)7 (100) Swelling, n (%)5 (71) Limp, n (%)3 (43) Fever, n (%)1 (14)Clinical features Number of lesions, median (range)2 (1-10) Axial skeleton involvement, n (%)2 (29) Appendicular skeleton involvement, n (%)5 (71)Distribution of involvement Femur, n (%)3 (43) Radius/ulna, n (%)2 (29) Humerus, n (%)1 (14) Tibia/fibula, n (%)5 (5) Tarsal bones, n (%)1 (14) Others, n (%)3 (43)Laboratory tests Hemoglobin, g/dL, mean ± SD13.1±0.6 Leukocytes × 103/mm3, mean ± SD8.48 ±1.7 Platelets × 103/mm3, mean ± SD384±130 Erythrocyte sedimentation rate mm/h, mean ± SD52±37 C-reactive protein, mg/dL, mean ± SD1.96±2.35 Positive antinuclear antibodies, n (%)0 (100) HLA-B27 positive, n (%)0 (100)Comorbidities Any type of autoimmunity, n (%)2 (29) Others, n (%)3 (43) Histological confirmation, n (%)3 (43)Treatment NSAIDs, n (%)6 (86) Glucocorticoids, n (%)0 (0) Bisphosphonates, n (%)6 (86) TNF blocking agents, n (%)2 (29) Biological DMARDs, n (%)1 (4) Methotrexate, n (%)2 (29) Antibiotics, n (%)3 (43) Reached remission, n (%) 3 (43)

Conclusion:

CRMO remains a rare diagnosis. From our experience most of the patients had delay in diagnosis, laboratory tests showed mild elevation of inflammatory parameters, was found association with psoriatic arthritis and psoriasis, remission was achieved with combination of bisphosphonate and immunosuppressive therapy in less than half of the cohort

References:

[1]A. Taddio, F. Zennaro, S. Pastore, e R. Cimaz, «An Update on the Pathogenesis and Treatment of Chronic Recurrent Multifocal Osteomyelitis in Children», Pediatr. Drugs, vol. 19, n. 3, pagg. 165–172, giu. 2017.

[2]S. J. Menashe et al., «The Many Faces of Pediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Practical Location- and Case-Based Approach to Differentiate CRMO From Its Mimics», J. Magn. Reson. Imaging JMRI, pag. e27299, ago.2020

Disclosure of Interests:

None declared

Reasons behind flu vaccine acceptance and suggested interventions to promote flu vaccination acceptance among healthcare workers

The flu vaccination rate is still too low, both among healthcare providers (HCPs) and among health sciences university students. This study aims to assess the reasons of past and future flu vaccination acceptance among health sciences university students, and second, to identify what interventions would be helpful to foster acceptance of the flu vaccination among HCPs. A multicentre cross-sectional study was performed, using a validated questionnaire administered to health sciences students enrolled in 14 Italian universities. A multivariable logistic regression model was used. A total of 3131 questionnaires were collected. The statement that mandatory vaccination is required to increase adhesions to vaccinations (adjusted odds ratio [aOR] = 1.57; 95% confidence interval [CI] = 1.25-1.97), being in favour of this obligation (aOR = 7.91; 95% CI = 2.50-25.02) and considering themselves as people at risk of infection (aOR = 1.96; 95% CI = 1.46-2.64), are associated with having received the vaccination in the past flu season; on the other hand, planning to be vaccinated for the next season to avoid infecting patients is protective (aOR = 0.51; 95% CI = 0.38-0.70). This study shows which beliefs are associated with having joined the previous vaccination campaign in a large sample of HCPs. The acceptance of vaccination is an outcome behaviour resulting from a complex decision-making process. In order to implement coverage of the influenza vaccination in HCPs, it is necessary to implement awareness campaigns and provide specific information for this category of workers.

Are the Italian Children Exposed to Advertisements of Nutritionally Appropriate Foods?

Unhealthy eating habits are one of the main risk factors for overweight/obesity, and food marketing plays a major role in their development. The aim of this study was to monitor the amount and the characteristics of food marketing directed to Italian children broadcasted on television (TV). The WHO tool to assess food and beverage multimedia marketing aimed at children was used to analyze TV recordings. Type of product branded, viewing time, channel’s target, and broadcasting company were the exposure variables analyzed. The power of persuasive techniques was also assessed. Food products were categorized as either core or non-core products on the basis of their nutritional profile. A total of 320 h of TV broadcasting was analyzed, including 51.7 h of commercials. Food and beverages were the second most frequently advertised products, with an average of 6 food advertisements per hour during peak viewing time. A total of 23.8% of food advertisements were recorded during the time slot of 3:00 p.m. Considering food and beverage commercials, “humor” was the most frequently used primary persuasive technique, while the “image of the product/packaging” was the most commonly used secondary persuasive technique. Products specifically targeted to children were 94.3% non-core. Our findings indicate that core foods are highly underrepresented in TV commercials, especially during children TV programs and peak viewing time.

Television marketing of food and beverage targeted to children, Italy

Aim

According to the World Health Organization (WHO), 40 million children aged &lt; 5 and 131 million of children aged 5-9 are overweight or obese. Growing evidence is focusing on the association between number of hours spent watching television (TV) and children's food behaviour. Our aim was to assess the amount of TV food marketing targeted to Italian children, and to qualitatively analyse the ads.

Methods

The 5 most viewed TV channels were selected and recorded for 20 days (non-consecutive, both week and week-end days) and analysed through the WHO's tool to asses food -beverage multimedia marketing targeted to children. The analysed exposure variables were: type of product, viewing time, channel's target and broadcasting company (for all types of ads), duration of each food ad, type of programme, and target of the advertised product (only for food and beverage). Power of persuasion variables were assessed only for food marketing. Lastly, for each food product showed, the food category and if it was a core vs non-core product was assessed. Differences between groups were assessed using the chi-square test and t-test.

Results

During 320 hours of broadcasting TV, a total of 9,069 ads were identified, (51.7 hours). Food products were the second most frequently advertised (19.4%). On average, 5.4 food ads were displayed during non-peak viewing time/hour (6 during peak). The time slot of 3 pm had the highest rate of food ads (23.8%). Channels targeted to the general public had a higher rate of food ads compared to channels targeted to children (p = 0.000). Private channels transmitted a higher number of food ads compared to public channels (p = 0.000). Humour was the most frequently persuasive technique used in food ads and in ads targeted to whole population (14.3%).

Conclusions

Children usually watch TV programs that have a high rate of food ads, mainly promoting unhealthy products with captivating techniques. Legislators should advocate for a healthier food marketing.

Key messages

Children are exposed to a high amount of TV food commercials daily. Food marketing should be strictly regulated in accordance with the WHO Nutrient Profile model.

A systematic review: characteristics, complications and treatment of spondylodiscitis

OBJECTIVE

This systematic review focuses on 5 key elements that may improve the decision-making process in spondylodiscitis: the infective agent, segmental instability, abscess development, neurological compromise and focus of infection.

MATERIALS AND METHODS

We included 64 studies published between May 2012 and May 2017, that reported both a description of the discitis and comparative data regarding the disease and its complications.

RESULTS

The majority of cases were caused by Staphylococcus spp (40.3%) and involved the lumbosacral region (52.3%). 27.8% of cases were associated to neurological compromise, 30.4% developed an abscess, 6.6% were associated to instability, and 54.7% underwent surgery. The abscesses mostly involved the lumbosacral region (60.4%) with paravertebral localization; 32.6% of cases involved the thoracic region, showing mostly epidural localization; a small number of cases (7%) involved the cervical region, mostly with epidural localization. 95% of paravertebral abscesses were treated percutaneously, while 85.7% of epidural cases underwent "open" surgery. Spinal cord compression mainly occurred in the cervical region (55.9%), neurological deficit was observed in over half of cases (65%), and surgery was required in most of the cases (83.9%). The majority of cases of instability involved the lumbosacral region (53.3%) and underwent surgery (87%). The focus of infection was mostly lumbosacral (61%) and almost all cases (95%) were treated surgically.

CONCLUSIONS

Spondylodiscitis is a complex and multifactorial disease, whose diagnosis and management are still challenging. Due to its potential morbidity, it is extremely important to investigate the 5 key elements discussed in this paper in order to provide an early diagnosis and initiate the most effective treatment.

OP0300 A CROSS-SECTIONAL, MATCHED-PAIR ANALYSIS OF ACPA POSITIVE AND ACPA NEGATIVE RHEUMATOID ARTHRITIS PATIENTS COMPARING THE PREVALENCE OF OSTEOPOROSIS, FRAGILITY FRACTURES AND UNDERLYING RISK FACTORS

Background:

Rheumatoid arthritis (RA) is associated with increased systemic bone loss, leading to a high risk for fragility fractures. Especially anti-citrullinated protein antibody (ACPA) positivity is considered a risk factor for local bone erosions and systemic bone loss1.

Objectives:

The purpose of this study was to compare ACPA positive versus ACPA negative RA patients in terms of the prevalence of osteoporosis and fragility fractures and to identify differences in underlying risk factors that influence bone health.

Methods:

Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic rheumatic diseases or psoriasis treated with glucocorticoids (GC). In this cross-sectional analysis, we performed a matched-pair analysis, matching 114 ACPA positive to 114 ACPA negative RA patients according to age (5-year-steps), sex, and body mass index (BMI, 2-unit-steps). Descriptive analyses were performed, with values displayed as mean ± standard deviation for continuous variables. Non-parametric tests were used at a two-sided significance level of 5% to compare differences in underlying and potential risk factors without adjustment for multiple testing.

Results:

At same mean age (63.9 ±10.2 years) and BMI (27.9 ±5.6kg/m2), the matched groups had a female proportion of 82.5%. APCA positive patients had a significantly longer mean disease duration (13.9 vs 9.9 years, p<0.001), a higher mean cumulative GC-dose (22.3 vs 13.2g, p<0.01) and mean duration of GC therapy (10.1 vs 6.6 years, p<0.01). There was no significant difference in the prevalence of osteoporosis as defined by dual-energy X-ray absorptiometry (DXA) (18.4 vs 20.2%), nor in the prevalence of vertebral (7.0 vs 5.3%) or non-vertebral fractures (31.6 vs 29.8%). C-reactive protein levels as a marker of disease activity were significantly higher in ACPA positive patients (mean: 8.8 vs 4.3mg/l, p= 0.02), while mean disease activity score (DAS)28 levels were slightly lower in ACPA positive patients (2.4 vs 2.7, p= 0.05). No difference in health assessment questionnaire (HAQ) score was found. RA-specific treatments were similar, especially concerning current mean daily GC-dose (6.7 vs 4.9mg/day), except for Rituximab and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) which were more commonly used in ACPA positive patients (9.6 vs 2.6%, p=0.05) and (5.3 vs 0%, p=0.029), respectively. ACPA positive patients did not differ significantly from ACPA negative patients in specific anti-osteoporotic treatment, nor in the prevalence of comorbidities or concomitant medication. There were no significant differences in bone-specific laboratory parameters.

Conclusion:

In a cross-sectional analysis of our cohort, the prevalence of osteoporosis and fragility fractures was similar between ACPA positive and ACPA negative RA patients, despite longer disease duration and GC-treatment in ACPA positive patients. This is remarkable since it implies that ACPA negative patients are at a similar risk for osteoporosis and associated fractures. Optimal management of disease activity with or without GCs may represent a mainstay in preventing disease-related comorbidities such as osteoporosis.

References:

[1]Steffen, U., Schett, G., & Bozec, A. (2019). How Autoantibodies Regulate Osteoclast Induced Bone Loss in Rheumatoid Arthritis. Frontiers in immunology, 10, 1483. doi:10.3389/fimmu.2019.01483

Disclosure of Interests:

Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, gloria dallagiacoma: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

Healthcare Students' Flu Vaccine Uptake in the Last 5 Years and Future Vaccination Acceptance: Is There a Possible Association?

Background: Despite the free-of-charge offer of influenza vaccines to at-risk subgroups, vaccine coverage remains low and far from the target, probably due to the false myths and misperceptions. We aimed to explore the healthcare students’ vaccination behavior and beliefs to find any association between vaccination uptake during the last 5 years and future vaccination acceptance.

Study design: A multicentre cross-sectional study.

Methods: From Oct 2017 to Nov 2018, the Italian healthcare students from 14 different universities in 2017/2018 were enrolled, through an online and anonymous questionnaire previously validated. Absolute and relative frequencies were calculated and Pearson's Chi-square test was used. A multinomial logistic regression model was performed. Results are expressed as relative Risk Ratio (RR) with 95% Confidence Intervals (95% CI). The level of significance chosen was P-value <0.05.

Results: A total of 3137 students were enrolled and 3131 questionnaires were analysed. 82.7% of the sample declared they had not received any flu vaccination during the last 5 years. Students who received flu vaccination 4 times or more during the last 5 years were more likely to do it again next year as well (95.1% vs 4.9%). The regression model showed that having received flu vaccination over the last 5 years was statistically associated with the intention of getting vaccinated during next season.

Conclusions: Frequency of flu vaccination is predictive for future acceptance among healthcare students. This association could have both implications for the organization of vaccination campaigns and improve educational strategies for this category of students.

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

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.