Pediatric post COVID-19 condition: an umbrella review of the most common symptoms and associated factors

BACKGROUND

Although the long-term consequences of the Coronavirus Disease-2019 (COVID-19) pandemic are yet to be fully comprehended, a syndrome symptomatically akin to the COVID-19 disease has been defined, for children and adolescents, in February 2023 by the World Health Organization (WHO) as 'post COVID-19 condition' (PCC). Potential consequences of COVID-19 that affect developmental milestones in children and adolescents should be comprehended in their magnitude and duration. The aim is to investigate the most common symptoms and predictors or risk factors for pediatric PCC.

METHODS

In this umbrella review, the population of interest was defined as children and adolescents from 0 to 19 years old presenting PCC symptoms as defined by the WHO in the International Classification of Diseases. The intervention considered was general follow-up activity to monitor the patients' recovery status. No comparator was chosen, and the outcomes were symptoms of PCC and predictors or risk factors of developing PCC. Methodological quality, risk of bias and the level of overlap between studies were assessed. A random-effects meta-analytic synthesis of respective estimates with inverse variance study weighting was carried out, for the primary studies included by the reviews retrieved, regarding predictors or risk factors reported.

RESULTS

We identified six eligible systematic reviews, five with meta-analyses, from three databases. The most common symptoms reported were fatigue and respiratory difficulties; female sex and older age were the most reported factors associated with the development of pediatric PCC.

CONCLUSIONS

A deeper understanding of pediatric PCC requires well-designed and clearly defined prospective studies, symptom differentiation, and adequate follow-up.

Cost-utility of cardiac contractility modulation in patients with heart failure with reduced ejection fraction in Italy

AIMS

Cardiac contractility modulation (CCM) is a device therapy for heart failure, based on the delivery of high-voltage biphasic impulses to the right ventricular septum during the myocardial absolute refractory period. This study evaluated the cost-effectiveness of CCM therapy plus optimal medical therapy (OMT) vs. OMT alone in patients with heart failure with reduced ejection fraction.

METHODS AND RESULTS

A Markov model with a lifespan time horizon was developed to assess the cost-utility using the FIX trials as main data sources. A deterministic sensitivity analysis and a probabilistic sensitivity analysis were run to analyse the decision uncertainty in the model through cost-effectiveness acceptability curve (CEAC) and cost-effectiveness acceptability frontier (CEAF). Value of information analysis was also conducted computing the expected value of perfect information (EVPI) and the expected value of partial perfect information. The base case results showed that the CCM plus OMT option was highly cost-effective compared with OMT alone with an incremental cost-utility ratio of €7034/quality-adjusted life year (QALY). The CEAC and CEAF illustrated that for all willingness to pay levels above €5600/QALY, tested up to €50 000/QALY, CCM plus OMT alternative had the highest probability of being cost-effective. The EVPI per patient was estimated to be €124 412 on a willingness to pay threshold of €30 000/QALY.

CONCLUSIONS

For patients with heart failure with reduced ejection fraction, CCM therapy could be cost-effective when taking a lifetime horizon. Further long-term, post-approval clinical studies are needed to verify these results in a real-world context, particularly concerning the effect of CCM therapy on mortality.

Cost-Effectiveness of Whole-Genome vs Whole-Exome Sequencing Among Children With Suspected Genetic Disorders

Importance

The diagnosis of rare diseases and other genetic conditions can be daunting due to vague or poorly defined clinical features that are not recognized even by experienced clinicians. Next-generation sequencing technologies, such as whole-genome sequencing (WGS) and whole-exome sequencing (WES), have greatly enhanced the diagnosis of genetic diseases by expanding the ability to sequence a large part of the genome, rendering a cost-effectiveness comparison between them necessary.

Objective

To assess the cost-effectiveness of WGS compared with WES and conventional testing in children with suspected genetic disorders.

Design, Setting, and Participants

In this economic evaluation, a bayesian Markov model was implemented from January 1 to June 30, 2023. The model was developed using data from a cohort of 870 pediatric patients with suspected genetic disorders who were enrolled and underwent testing in the Ospedale Pediatrico Bambino Gesù, Rome, Italy, from January 1, 2015, to December 31, 2022. The robustness of the model was assessed through probabilistic sensitivity analysis and value of information analysis.

Main Outcomes and Measures

Overall costs, number of definitive diagnoses, and incremental cost-effectiveness ratios per diagnosis were measured. The cost-effectiveness analyses involved 4 comparisons: first-tier WGS with standard of care; first-tier WGS with first-tier WES; first-tier WGS with second-tier WES; and first-tier WGS with second-tier WGS.

Results

The ages of the 870 participants ranged from 0 to 18 years (539 [62%] girls). The results of the analysis suggested that adopting WGS as a first-tier strategy would be cost-effective compared with all other explored options. For all threshold levels above €29 800 (US $32 408) per diagnosis that were tested up to €50 000 (US $54 375) per diagnosis, first-line WGS vs second-line WES strategy (ie, 54.6%) had the highest probability of being cost-effective, followed by first-line vs second-line WGS (ie, 54.3%), first-line WGS vs the standard of care alternative (ie, 53.2%), and first-line WGS vs first-line WES (ie, 51.1%). Based on sensitivity analyses, these estimates remained robust to assumptions and parameter uncertainty.

Conclusions and Relevance

The findings of this economic evaluation encourage the development of policy changes at various levels (ie, macro, meso, and micro) of international health systems to ensure an efficient adoption of WGS in clinical practice and its equitable access.

Co-administration of SARS-CoV-2 and influenza vaccines in healthcare workers: Results of two vaccination campaigns in a large teaching hospital in Rome

The concurrent administration of COVID-19 and influenza vaccines has arisen as a promising approach to bolster protection against respiratory pathogens and improve vaccination rates. However, there remains a lack of data regarding the prevalence of co-administration across several vaccination campaigns, especially among healthcare workers (HCWs). Therefore, this study aims to shed light on the acceptance of co-administration strategies among HCWs during the two campaigns following the introduction of the anti-SARS-CoV-2 vaccine. A retrospective cohort study was conducted among the HCWs of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS, a research hospital in Rome. Hospital administrative databases were accessed to gather information about vaccination for SARS-CoV-2 and influenza during the 2021/2022 and 2022/2023 vaccination campaigns. The study included 7399 HCWs. The co-administration of anti-SARS-CoV-2 and influenza vaccines presented a significant rise in 2022/2023 compared to the previous vaccination campaign (+38%): this was confirmed for every professional category, with the largest increases among resident doctors (+47%) and physicians (+44%), and also for every age category, but it was particularly evident for the youngest health professionals. The probability of co-administration uptake during the 2022/2023 campaign was significantly higher for males, and for those that received co-administration during the 2021/2022 campaign, while the probability was lower for nurses and administrative staff. This study highlights the co-administration procedure as a valuable and effective tool in annual vaccination campaigns for SARS-CoV-2 and influenza. The procedure's safety and streamlined logistics make it increasingly attractive for implementation, particularly among HCWs.

Bayesian cost-effectiveness analysis of Whole genome sequencing versus Whole exome sequencing in a pediatric population with suspected genetic disorders

Genetic diseases are medical conditions caused by sequence or structural changes in an individual's genome. Whole exome sequencing (WES) and whole genome sequencing (WGS) are increasingly used for diagnosing suspected genetic conditions in children to reduce the diagnostic delay and accelerating the implementation of appropriate treatments. While more information is becoming available on clinical efficacy and economic sustainability of WES, the broad implementation of WGS is still hindered by higher complexity and economic issues. The aim of this study is to estimate the cost-effectiveness of WGS versus WES and standard testing for pediatric patients with suspected genetic disorders. A Bayesian decision tree model was set up. Model parameters were retrieved both from hospital administrative datasets and scientific literature. The analysis considered a lifetime time frame and adopted the perspective of the Italian National Health Service (NHS). Bayesian inference was performed using the Markov Chain Monte Carlo simulation method. Uncertainty was explored through a probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI). The present analysis showed that implementing first-line WGS would be a cost-effective strategy, against the majority of the other tested alternatives at a threshold of €30,000-50,000, for diagnosing outpatient pediatric patients with suspected genetic disorders. According to the sensitivity analyses, the findings were robust to most assumption and parameter uncertainty. Lessons learnt from this modeling study reinforces the adoption of first-line WGS, as a cost-effective strategy, depending on actual difficulties for the NHS to properly allocate limited resources.

Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review

Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.

Organizational Aspects of the Implementation and Use of Whole Genome Sequencing and Whole Exome Sequencing in the Pediatric Population in Italy: Results of a Survey

This study explores the organizational aspects of whole genome sequencing (WGS) implementation for pediatric patients with suspected genetic disorders in Italy, comparing it with whole exome sequencing (WES). Health professionals' opinions were collected through an internet-based survey and analyzed using a qualitative summative content analysis methodology. Among the 16 respondents, most were clinical geneticists performing only WES, while 5 also used WGS. The key differences identified include higher needs for analyzing genome rearrangements following WES, greater data storage and security requirements for WGS, and WGS only being performed in specific research studies. No difference was detected in centralization and decentralization issues. The main cost factors included genetic consultations, library preparation and sequencing, bioinformatic analysis, interpretation and confirmation, data storage, and complementary diagnostic investigations. Both WES and WGS decreased the need for additional diagnostic analyses when not used as last-resort tests. Organizational aspects were similar for WGS and WES, but economic evidence gaps may exist for WGS in clinical settings. As sequencing costs decline, WGS will likely replace WES and traditional genetic testing. Tailored genomic policies and cost-effectiveness analyses are needed for WGS implementation in health systems. WGS shows promise for enhancing genetics knowledge and expediting diagnoses for pediatric patients with genetic disorders.

Whole genome sequencing diagnostic yield for paediatric patients with suspected genetic disorders: systematic review, meta-analysis, and GRADE assessment

BACKGROUND

About 80% of the roughly 7,000 known rare diseases are single gene disorders, about 85% of which are ultra-rare, affecting less than one in one million individuals. NGS technologies, in particular whole genome sequencing (WGS) in paediatric patients suffering from severe disorders of likely genetic origin improve the diagnostic yield allowing targeted, effective care and management. The aim of this study is to perform a systematic review and meta-analysis to assess the effectiveness of WGS, with respect to whole exome sequencing (WES) and/or usual care, for the diagnosis of suspected genetic disorders among the paediatric population.

METHODS

A systematic review of the literature was conducted querying relevant electronic databases, including MEDLINE, EMBASE, ISI Web of Science, and Scopus from January 2010 to June 2022. A random-effect meta-analysis was run to inspect the diagnostic yield of different techniques. A network meta-analysis was also performed to directly assess the comparison between WGS and WES.

RESULTS

Of the 4,927 initially retrieved articles, thirty-nine met the inclusion criteria. Overall results highlighted a significantly higher pooled diagnostic yield for WGS, 38.6% (95% CI: [32.6 - 45.0]), in respect to WES, 37.8% (95% CI: [32.9 - 42.9]) and usual care, 7.8% (95% CI: [4.4 - 13.2]). The meta-regression output suggested a higher diagnostic yield of the WGS compared to WES after controlling for the type of disease (monogenic vs non-monogenic), with a tendency to better diagnostic performances for Mendelian diseases. The network meta-analysis showed a higher diagnostic yield for WGS compared to WES (OR = 1.54, 95%CI: [1.11 - 2.12]).

CONCLUSIONS

Although whole genome sequencing for the paediatric population with suspected genetic disorders provided an accurate and early genetic diagnosis in a high proportion of cases, further research is needed for evaluating costs, effectiveness, and cost-effectiveness of WGS and achieving an informed decision-making process.

TRIAL REGISTRATION

This systematic review has not been registered.

Potentiality of algorithms and artificial intelligence adoption to improve medication management in primary care: a systematic review

OBJECTIVES

The aim of this study is to investigate the effect of artificial intelligence (AI) and/or algorithms on drug management in primary care settings comparing AI and/or algorithms with standard clinical practice. Second, we evaluated what is the most frequently reported type of medication error and the most used AI machine type.

METHODS

A systematic review of literature was conducted querying PubMed, Cochrane and ISI Web of Science until November 2021. The search strategy and the study selection were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Population, Intervention, Comparator, Outcome framework. Specifically, the Population chosen was general population of all ages (ie, including paediatric patients) in primary care settings (ie, home setting, ambulatory and nursery homes); the Intervention considered was the analysis AI and/or algorithms (ie, intelligent programs or software) application in primary care for reducing medications errors, the Comparator was the general practice and, lastly, the Outcome was the reduction of preventable medication errors (eg, overprescribing, inappropriate medication, drug interaction, risk of injury, dosing errors or in an increase in adherence to therapy). The methodological quality of included studies was appraised adopting the Quality Assessment of Controlled Intervention Studies of the National Institute of Health for randomised controlled trials.

RESULTS

Studies reported in different ways the effective reduction of medication error. Ten out of 14 included studies, corresponding to 71% of articles, reported a reduction of medication errors, supporting the hypothesis that AI is an important tool for patient safety.

CONCLUSION

This study highlights how a proper application of AI in primary care is possible, since it provides an important tool to support the physician with drug management in non-hospital environments.

Outpatient parenteral antimicrobial therapy (OPAT) from an emergency model applied during the COVID-19 pandemic to standard of care: Preliminary lessons from our experience

OBJECTIVES

We wish to report on our experience of OPAT during the first two years of the COVID19 outbreak.

PATIENTS AND METHODS

We recorded data on all patients treated in the OPAT regimen in 2020 and 2021 and compared overall trends, use of carbapenems and saved days of hospitalization.

RESULTS

The OPAT model enabled us to ensure the administration of first choice antibiotic therapy to 239 patients with an increase of 21.3% from 2020 to 2021 (108 vs 131). Applying this model, we also recorded a reduction in the use of carbapenems from 33% in 2020 to 26% in 2021 and a total of 3041 recovery days saved in 2021.The clinical cure rate reached 94%. Few adverse events occurred (35/239; 14.6%), and they did not require hospitalization.

CONCLUSION

OPAT is a safe, efficacious, and cost-effective model that functioned effectively during the COVID-19 crisis and could become the standard of care for the treatment of selected patients.

Mortality after transvenous lead extraction: A risk prediction model for sustainable care delivery

BACKGROUND AND AIMS

Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, the literature about the long-term impact of TLE on survivals is still lacking. Given these knowledge gaps, the aim of our study was to analyse very long-term mortality in patients undergoing TLE in public health perspective.

METHODS

This prospective, single-centre, observational study enrolled consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE, from January 2005 to January 2021. The main goal was to establish the independent predictors of very long-term mortality after TLE. We also aimed at assessing procedural and hospitalization-related costs.

RESULTS

We enrolled 435 patients (mean age 70 ± 12 years, with mean lead dwelling time 6.8 ± 16.7 years), with prevalent infective indication to TLE (92%). Initial success of TLE was achieved in 98% of population. After a median follow-up of 4.5 years (range: 1 month-15.5 years), 150 of the 435 enrolled patients (34%) died. At multivariate analysis, death was predicted by: age (≥77 years, OR: 2.55, CI: 1.8-3.6, p < 0.001), chronic kidney disease (CKD) defined as severe reduction of estimated glomerular filtration rate (eGFR <30 mL/min/1.73 m² , OR: 1.75, CI: 1.24-2.4, p = 0.001) and systolic dysfunction assessed before TLE defined as left ventricular ejection fraction (LVEF) <40%, OR: 1.78, CI 1.26-2.5, p = 0.001. Mean extraction cost was €5011 per patient without reimplantation and €6336 per patient with reimplantation respectively.

CONCLUSIONS

Our study identified three predictors of long-term mortality in a high-risk cohort of patients with a cardiac device infection, undergoing successful TLE. The future development of a mortality risk score before might impact on public health strategy.

Nudging Interventions on Alcohol and Tobacco Consumption in Adults: A Scoping Review of the Literature

Background: The World Health Organization identified alcohol and tobacco consumption as the risk factors with a greater attributable burden and number of deaths related to non-communicable diseases. A promising technique aimed to modify behavioral risk factors by redesigning the elements influencing the choice of people is nudging. Methodology: A scoping review of the literature was performed to map the literature evidence investigating the use of nudging for tobacco and alcohol consumption prevention and/or control in adults. Results: A total of 20 studies were included. The identified nudging categories were increasing salience of information or incentives (IS), default choices (DF), and providing feedback (PF). Almost three-quarters of the studies implementing IS and half of those implementing PF reported a success. Three-quarters of the studies using IS in conjunction with other interventions reported a success whereas more than half of the those with IS alone reported a success. The PF strategy performed better in multi-component interventions targeting alcohol consumption. Only one DF mono-component study addressing alcohol consumption reported a success. Conclusions: To achieve a higher impact, nudging should be integrated into comprehensive prevention policy frameworks, with dedicated education sessions for health professionals. In conclusion, nudge strategies for tobacco and alcohol consumption prevention in adults show promising results. Further research is needed to investigate the use of nudge strategies in socio-economically diverse groups and in young populations.

Incremental net benefit of wearable devices for home monitoring of chronically ill patients

Background

Hospital overcrowding is a growing problem worldwide. Studies demonstrated that up to 40% to 67% of hospitalizations of residents in nursing homes may be avoidable, causing health and economic damages. Furthermore, research shows that for non-critical patients there are arguably no differences between home and hospital recovery in terms of health outcomes, with a preference for home settings in most patients. During COVID-19 pandemic, telemedicine and homecare increased its range of possible intervention, allowing efficient and cost-effective processes of care. Transdermal sensors are indeed a cheap and easy to use alternative to conventional instruments, allowing a continuously operative and ready-to-use tool to care providers. This systematic review aims to map the application fields of these technologies, demonstrating their accuracy and assessing their cost-effectiveness in chronically ill home-assisted patients.

Methods

Articles were retrieved from Scopus, Web of Science, and PubMed. The dominance ranking matrix (DRM) tool was applied to allow a qualitative synthesis of the studies. Incremental net benefits (INBs) were estimated and meta-analysis was implemented to pool INBs across studies. A comparison between wearables and conventional tools accuracy was simultaneously carried out through a literature review.

Results

The database search identified 1156 publications of which six articles were considered eligible for the meta-analysis. According to DRM, 80% of evaluated studies showed the cost-effectiveness of wearable devices. The pooled INB of wearables over conventional measurement was estimated at US$1280 (95% CI US$952 - US$2849). In 85% of evaluated wearables the accuracy resulted comparable to conventional measurement tools.

Conclusions

Wearables performances resulted as accurate as conventional methods and their application cost-effective. A continuous measurement of parameters may relate to a better process of care for chronically ill outpatients.

Key messages

• Wearables are a cheap and accurate alternative to conventional life parameters measurement tools.

• Technology evolution might soon reduce the pressure on hospitals, changing the care process of chronically ill outpatients allowing continuous evaluation of their health status.

Flu shot in the era of COVID-19 vaccination: findings from a research hospital of Rome

 

Influenza represents a major burden for public health. Healthcare workers (HCWs) are a priority target group for flu vaccination. During the COVID-19 pandemic, when SARS-CoV-2 vaccines were not yet available, susceptibility to influenza vaccination especially by HCWs increased. The aim of this study is to analyze the flu vaccination coverage among HCWs and to study which factors affected their adherence given the concomitant COVID-19 vaccination. The retrospective study was conducted in an Italian research hospital from October 2021 to January 2022. A total of 7,048 individuals was included. Age class, gender and job category variables were analyzed. Statistically significant differences among groups were tested through χ2 test. Univariate and multivariate analyses (p < 0,005) were performed to assess differences towards vaccination attitude. The flu vaccination coverage rate was 24.6%. Among the selected job categories, 29.8% of physicians, 19.9% of nurses and 19.7% of other HCWs were vaccinated with a statistically significant decrease (p < 0.001) across all categories respect with the last campaign. The findings of the logistic regression depicted that the 40-59 years old age class, compared with the youngest age class (OR 1.30, 95% CI 1.12-1.43) as well as being physician (OR 2.79, 95% CI 1.87-3.41) with the respect to being nurses, had a higher adherence to vaccination. Interestingly, being male, is associated with a statistically significant reduction (OR 0.71, 95% CI 0.59-0.87) in vaccination uptake. Study findings showed a several decline in the flu vaccination coverage comparing with previous campaigns, probably due to the concomitant administration of the booster dose against SARS-CoV-2. This alarm should not be underestimated and requires timely and innovative organizational approaches (i.e., combined vaccine). Further studies are needed to analyze the reasons for this poor adhesion and the strategies to be adopted to increase the awareness of the HCWs.

Key messages

• Reaching high coverage rates and restore a positive trend for the future campaign for flu vaccination it is essential strategy to protect HCWs themselves, their patients and the hospital community.

• Decision-makers should implement consistent communication strategies to lessen vaccine hesitancy among HCWs.

COVID-19 Vaccination Campaign among the Health Workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS: A Cost–Benefit Analysis

Vaccinations generate health, economic and social benefits in both vaccinated and unvaccinated populations. The aim of this study was to conduct a cost–benefit analysis to estimate the costs and benefits associated with the COVID-19 vaccination campaign for health workers in Fondazione Policlinico Universitario Agostino Gemelli IRCCS (FPG). The analysis included 5152 healthcare workers who voluntarily received the Pfizer–BioNTech COVID-19 vaccine, divided into physicians, nurses and other health workers. Data about vaccine cost, administration and materials were derived from administrative databases of the FPG from 28 December 2020 to 31 March 2021. The costs associated with the COVID-19 vaccination campaign amounted to EUR 2,221,768, while the benefits equaled EUR 10,345,847. The benefit-to-cost ratio resulted in EUR 4.66, while the societal return on investment showed a ratio of EUR 3.66. The COVID-19 vaccination campaign for health workers in FPG has high social returns and it strengthens the need to inform and update decision-making about the economic and social benefits associated with a vaccination campaign. Health economic evaluations on vaccines should always be considered by decision-makers when considering the inclusion of a new vaccine into the national program.

Assessing the potentiality of algorithms and artificial intelligence adoption to disrupt patient primary care with a safer and faster medication management: a systematic review protocol

INTRODUCTION

In primary care, almost 75% of outpatient visits by family doctors and general practitioners involve continuation or initiation of drug therapy. Due to the enormous amount of drugs used by outpatients in unmonitored situations, the potential risk of adverse events due to an error in the use or prescription of drugs is much higher than in a hospital setting. Artificial intelligence (AI) application can help healthcare professionals to take charge of patient safety by improving error detection, patient stratification and drug management. The aim is to investigate the impact of AI algorithms on drug management in primary care settings and to compare AI or algorithms with standard clinical practice to define the medication fields where a technological support could lead to better results.

METHODS AND ANALYSIS

A systematic review and meta-analysis of literature will be conducted querying PubMed, Cochrane and ISI Web of Science from the inception to December 2021. The primary outcome will be the reduction of medication errors obtained by AI application. The search strategy and the study selection will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the population, intervention, comparator and outcome framework. Quality of included studies will be appraised adopting the quality assessment tool for observational cohort and cross-sectional studies for non-randomised controlled trials as well as the quality assessment of controlled intervention studies of National Institute of Health for randomised controlled trials.

ETHICS AND DISSEMINATION

Formal ethical approval is not required since no human beings are involved. The results will be disseminated widely through peer-reviewed publications.

500 The impact on healthcare of reimplantation and long-term mortality after transvenous lead extraction in patients with device related infection

Aims

Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, literature about long-term outcomes and the impact of a new device implantation on survival is still lacking. Given these knowledge gaps, the aim of our study was to analyse reimplantation and both early and long-term mortality in patients undergoing TLE, even in a public health perspective, specifically clarifying concerns about reimplantation.

Methods

This prospective, single-centre, observational, real-world registry consecutively enrolled patients (pts) with cardiac implantable electronic device who underwent TLE at our Hospital, from January 2005 to September 2020. The primary endpoint was to analyse major adverse cardiovascular events (MACEs) in both re-implanted (R Group) and non reimplanted (NR Group); secondary end-point was long-term (after discharge) mortality of the whole cohort, in order to investigate long-term mortality predictors.

Results

We enrolled high-risk cohort of 451 pts (mean population age 70 ± 12, with lead dwelling time 81.7 ± 201.2 months) at baseline findings: 92% of pts had an evidence of device infection, a generally impaired heart function with mean left ventricular ejection fraction (LVEF) 44 ± 13% and high rates of comorbidities (15% of pts with hypertension+ diabetes mellitus + renal failure). Three-hundred thirteen (72%) pts were reimplanted, using endocardiac leads in 86% and epicardial leads in 14%. Total MACEs rate was higher in R Group versus NR Group (64% versus 28%, P ≤ 0.001, CI 95%, respectively). In particular, rehospitalizations occurred more frequently in reimplanted population (R group 43% versus NR group 13%, P = 0.001, CI 95%). Long-term mortality rate was 34% (150 pts) at a mean follow up of 5.2 years. The leading contributor to long-term mortality was represented by multiple non-communicable chronic diseases (62%), being sepsis responsible for only 4% of long-term mortality, with a clear evidence of reduced infective burden after TLE and complete antibiotic therapy. At multivariate analysis, we found three independent predictors of long-term mortality: advanced age (&gt; 77 years, OR 1.04, CI 1.02–1.06, P &lt; 0.001), renal failure (eGFR&lt;30 mL/min, OR 1.66, CI 1.15–2.39, P = 0.007) and left ventricular dysfunction before TLE (LVEF&lt;45%, OR 1.58, CI 1.08–2.13, P = 0.017).

Conclusions

In patients undergoing TLE for infective indications, our study identified the reimplantation group as high risk group for adverse events before discharge. On the other hand, advanced age, renal failure and systolic dysfunction, as independent predictors of long-term mortality, could be evaluated as a predictive score to assess the mortality risk before the procedure of TLE.

Multiple-access versus telemedicine home-based sleep apnea testing for obstructive sleep apnea (OSA) diagnosis: a cost-minimization study

Purpose

The aim of the present study was to compare two clinical pathways: the multiple-access outpatient pathway versus the telemedicine pathway.

Methods

The multiple-access outpatient pathway and the telemedicine pathway were both performed with WatchPAT and implemented in a real-life healthcare scenario, adopting a cost-minimization approach. A cost-minimization analysis was undertaken to assess the economic impact of the two alternatives. The cost analyses were performed in euros for the year 2021 adopting the patient, the hospital, and the societal perspectives. Given the chosen perspectives, direct medical costs, direct nonmedical costs, and indirect costs were considered. In addition, a univariate sensitivity analysis was conducted.

Results

From a hospital perspective, the telemedicine approach was estimated to cost €49 more than the multiple-access alternative. Considering the patient perspective, the telemedicine approach was estimated to cost €167 less than the multiple-access pathway. Considering the societal perspective, the telemedicine approach is estimated to cost €119 less than the multiple-access pathway.

Conclusion

The adoption of telemedicine home sleep apnea testing could improve the efficiency of the healthcare processes if considering the direct and indirect costs incurred by patients and not only by healthcare providers.

Organisational Model and Coverage of At-Home COVID-19 Vaccination in an Italian Urban Context

The COVID-19 pandemic called for a reorganisation of the methods for providing health services. The aim of this paper is to describe the organisational model implemented by one of Rome’s Local Health Units (LHU), ASL Roma 1, for the “at-home COVID-19 vaccination campaign” dedicated to a target population and to outline data related to vaccination coverage stratified by health districts. A cross-sectional study was designed to describe the strategies implemented by LHU to deliver at-home vaccination programmes. People eligible for the at-home vaccination programme included patients living in the area of the LHU, being assisted by the district home care centre or not transportable or individuals with social situations that make traveling difficult. Priority for vaccination was given to (I) age > 80 years, (II) ventilated patients with no age limit, (III) very seriously disabled people with no age limit. Patients’ data were acquired from regional and LHU databases. From 5 February until the 16 May, 6127 people got at least one dose of Pfizer-Biontech Comirnaty^® vaccine, while 5278 (86.14%) completed the necessary two doses. The highest number of vaccines was administered during the first week of April, reaching 1296 doses overall. The number of vaccines administered were similar across the districts. The average number of people vaccinated at home was 6 per 1000 inhabitants in the LHU. This model proved to be extremely complex but effective, reaching satisfying results in terms of vaccination coverage.

Evaluation of the Strategies to Control COVID-19 Pandemic in Four European Countries

On March 11, 2020, the World Health Organization (WHO) has officially declared the novel coronavirus outbreak a pandemic. The national governments deployed a series of severe control measures and a set of public health policies in order to stop the spread of COVID-19 pandemic. The aim of this study is to investigate the correlation between specific interventions and incident cases during the second wave in multiple and specific countries. The observational study was based on data from the Oxford COVID-19 Government Response Tracker (OxCGRT) source retrieved from October 1st, 2020 to January 10, 2021. Thirteen specific indicators related to measures adopted were considered. Four European countries were taken into account: Italy, German, Spain and UK. A vector autoregression (VAR) model and the Granger Causality test were performed to allow for an assessment of any possible effect induced by each control measure against the overall pandemic growth. Wald test was conducted to compute p-values. No correlation between the applied measures and incident cases in the four countries was shown by the Granger causality test. Only closings of workplaces (C2) and limits on private gatherings showed (C4) a significant correlation with incident cases in UK and restrictions on internal movement between cities/regions in Germany. The Granger causality also tested that C2 and C4 forecasted the decrease of incident cases after a time lag of 6–30 days in UK and Germany, respectively. Policy makers must analyze the context in which policies are set because of effectiveness of interventions can be influenced by local context and, especially, by socio-economic and demographic characteristics, and make a proper communication to support the resilience of the population capable of guaranteeing adherence to the interventions implemented.

Evaluation of the Effectiveness and Safety of the BNT162b2 COVID-19 Vaccine in the Vaccination Campaign among the Health Workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Health workers, especially those in patient-facing roles, had a significantly increased risk of COVID-19 infection, having serious outcomes, and risking spreading the virus to patients and staff. Vaccination campaign planning suggests allocating initial supplies of BNT162b2 vaccine to health workers given the importance of early protection to safeguard the continuity of care to patients. The aim of the study is to assess the effectiveness and safety of BNT162b2 vaccine among the health workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS (FPG). The retrospective cohort study was conducted among health staff working at the FPG. Vaccination data were collected from hospital records. The primary end points were vaccine effectiveness and safety. A total of 6649 health workers were included, of whom 5162 received injections. There were 14 cases of COVID-19 with onset at least 14 days after the second dose among vaccinated health workers and 45 cases among unvaccinated ones. BNT162b2 was 91.5% effective against COVID-19 (95% credible interval, 84.7% to 95.3%). The safety profile of BNT162b2 vaccine consisted of short-term, non-serious events. The promotion and boost of the COVID-19 vaccination campaign represents a key public health measure useful to curb the spread of the pandemic especially in vulnerable contexts, such as hospitals, where health workers carry out a paramount role for the entire community, and requires further protection with a possible booster dose in view of autumn-winter 2021.

Promoting food literacy in type 2 diabetes: a systematic review

Background

Diabetes is one of the major global health threats whose burden is sharply increasing. Food literacy is proved to be relevant to optimize self-management in diabetic patients. The present review aims to map the current literature on educational interventions to promote food literacy in type 2 diabetes, with a particular focus on the concept of patient engagement.

Methods

Five databases were queried using the Population-Intervention-Context-Outcome (PICO) model. Individual study quality was assessed using the Quality Criteria Checklist for primary research provided by the American Diabetes Association. Data were summarized using descriptive statistic and a comparison between intervention carried out by a multidisciplinary team versus a single professionist was performed adopting a Chi-square test (p &lt; 0.05 was deemed as statistically significant).

Results

Of 1580 articles, 28 were finally included. Outcome categories were narratively labelled as “clinical”, “psychological”, “behavioural” and “literacy”. When the provider was a multidisciplinary team (25% of studies) improvement in self-management occurred in 86% of cases while in single-provider intervention the percentage was 71%, but the difference was not significant (p = 0.45). In the 10.7% of articles the use of technologies was reported, but generically descripted as the use of webpages, email or social media. Globally, an improvement in food literacy was reported in 75% of the interventions.

Conclusions

Nowadays, the use of a technology proxy is recognized as an efficient support in boosting patients' education, but the evidence in improving food literacy is scarce and difficult to compare. Public health programs improving food literacy are effective at different levels. These findings should encourage decision makers to allocate resources in this kind of programs.

Key messages

Engaging people in the management of their disease by increasing food literacy level may represent a first step to reach the “health in all policies” approach. When planning a public health intervention, allocating resources for improving individual’s education is essential to achieve better health outcomes.

Artificial Intelligence and Urban health: a step forward to the achievement of SDGs

The Sustainable Development Goals (SDGs) recognized the transformative power of urbanization with a dedicated goal (SDG11) focused on cities. This represents a pivotal first step to empower cities, also technologically, enabling new levels of intelligence and showing the need to become smarter. Artificial Intelligence (AI) and smart cities bring a multidisciplinary, integrated approach, examining how the digital and physical worlds are converging. The AI-based algorithms are overcoming the provision of urban services entering the realms of urban governance, planning, health, and safety. The aim of this study is to review how digital technologies and AI-based algorithms can influence and transform urban health. A scoping review of the literature was conducted using the Population, Concept, Context (PCC) framework to formulate the research question. A comprehensive search strategy will be implemented according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Major electronic databases were queried combining specific keywords. In addition, the search was completed by a snowball-search to identify missing articles. Out of a total of 1150 publications, 8 were identified as relevant to the research question. Among these articles, 43% and 35% reported findings from Europe and North America respectively. Evidence from the literature primarily focuses on the integration of smart city networks (sensor, people, business), based on AI, and urban health with different impacts on the health conditions of urban population over time. Public health plays major roles in urban planning sharing jointly common missions and perspectives. The advent of smart cities supported by AI can have an impact on public health, transforming urban life, with important consequences for physical, mental, and social well-being. AI applications in urban health could support public health activities of prevention and surveillance, and decision-making process, ushering a new era of public health.

From infections to preventive actions monitoring in health facilities: an experience on MDROs

 

Healthcare-Associated Infections (HAIs) and Antimicrobial Resistance (AMR) involve high costs both in health and economic terms for patients and health systems. Implementing Infection Prevention and Control (IPC) programs is critical to decrease infectious agents' transmission in healthcare settings. The aim of this study is to assess if the monitoring of Contact Precautions could decrease the incidence of Multi-Drug Resistant Organisms (MRDOs) infections. This pilot study was conducted in a teaching hospital in Rome. A checklist of 16 items was developed to assess the compliance to Contact Precautions in 11 hospital wards in which MRDOs were detected between November and December 2020. It was administered on-site both interviewing healthcare professionals and through direct observation. A paired t-test with α = 5% was used to compare the number of alert organisms in the first quarter of 2020 respect to the first quarter of 2021 before and after implementing the surveillance checklist. A total of 30 checklists were analyzed. The rate of compliance to Contact Precautions was high for the proper use of personal protective equipment (100%), the intensified room cleaning (100%) and the presence of isolation mark (100%), while it was low for the active screening of contacts (53%). Mean MDROs infections rate decreased from 4.94 to 4.37 for every 1000 hospitalization day, with an average decrease of 0.57. However, the paired t-test showed that there was no statistically significant difference between the mean number of MDROs infections before and after the implementation of the checklist (p > 0.05). Despite the good adherence to IPC program, the low infection rate decrease, is probably due to the impact of COVID-19 on the HAIs surveillance and prevention practices. Even if the check-list administration could be a useful tool to reduce MDROs infections, it should be associated to other prevention strategies during the COVID-19 pandemic in order to achieve a successful outcome.

Key messages

Preventing Healthcare-Associated Infections represents a priority public health challenge in order to improve patient safety and health system economic sustainability.

The COVID-19 pandemic has shown that healthcare facilities should enhance efforts in their IPC programs to reduce Healthcare-Associated Infections.

Flu vaccination during COVID-19 pandemic: a lesson from an Italian teaching hospital

 

Influenza is an acute viral respiratory infection that causes significant morbidity and mortality worldwide, with indirect costs considerably exceeding direct costs on patients and society. Flu vaccination is one of the major strategies for preventing it, especially among healthcare workers (HCWs), to avoid onward transmission to patients and colleagues. The aim of this research is to analyze the flu vaccination coverage rate among HCWs and to study which factors conditioned their adherence. The observational study was conducted in an Italian teaching hospital located in Rome (Italy) and data were collected from October to December 2020. A total of 6,568 HCWs was included considering physicians, nurses and other HCWs as job categories. Age class, gender and job category variables were analyzed. Statistically significant differences among groups were tested through χ2 test. Univariate analyses and a multivariate logistic regression (p &lt; 0.05) were performed to assess differences in flu vaccination adherence. The flu vaccination coverage rate was 60.94%. Considering the job categories, physicians reached the highest coverage (76.09%) followed by others HCWs (64.25%) and nurses (49.09%). According to the logistic regression, belonging to 20-40 age class was significantly associated with higher flu vaccination adherence, as well as being nurses (OR 0.26, 95% CI 0.22-0.31) or other HCWs (OR 0.48, 95% CI 0.40-0.58). Findings showed an encouraging vaccination coverage rate among HCWs. Deeper knowledge of the value of vaccination among younger HCWs could be probably a reason for higher adherence as well as the wrong perception of being at low risk of illness or transmitting infections may explains job categories differences. Especially when considering the disrupting impact of the SARS-CoV-2 pandemic, an improved attitude towards flu vaccination would reduce stress on hospitals and preserve scarce medical resources.

Key messages

Reaching high coverage rates for flu vaccination could save healthcare resources. It is crucial to preserve this positive trend for the future years by spreading the message to all the involved stakeholders.

Covid-19 vaccination in a teaching hospital in Rome: preliminary results from a retrospective study

 

Healthcare workers (HCWs) are on the frontline fight against the ongoing pandemic with an increased risk of infection from COVID-19. As of December 27, 2020, approximately 89,879 COVID-19 cases had been reported among HCWs in Italy. Vaccination plans recommend that initial supplies of COVID-19 vaccine be allocated to HCWs because their early protection is crucial to preserve capacity to care for patients. The aim of this study is threefold: to investigate the factors influencing the likelihood towards vaccination, to estimate the vaccine efficacy (VE) in a hospital setting and to assess the frequency of adverse reactions (AR). This retrospective study was conducted in an Italian teaching hospital from December 28, 2020 to March 31, 2021 (before the introduction of mandatory vaccination for HCWs). A total of 6,649 individuals was included. HCWs were divided into physicians, nurses and other HCWs. Univariate analyses and a multivariate logistic regression were run with an alpha of 0.05. VE was estimated as the proportionate reduction in disease attack rate between the unvaccinated and vaccinated. Out of 6,649 HCWs, 5,162 were fully vaccinated against COVID-19. Among the selected job categories, 82% of physicians, 79% of nurses and 68% of other HCWs were vaccinated. The findings of the logistic regression depicted that the 41-60 years old age class, compared with the youngest age class, was statistically significant (OR 1.17, 95% CI 1.03-1.33) in influencing vaccination, as well as being nurses (OR 0.80, 95% CI 0.69-0.92) or other HCWs (OR 0.45, 95% CI 0.39-0.52) in comparison with physicians. VE equaled 92.83% (p &lt; 0.05). The frequency of serious and not serious AR was 0.03% and 2.9%, respectively. Sustaining and boosting COVID-19 vaccination campaigns is effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination among HCWs is a critical public health measure to safeguard HCWs themselves, patients and the hospital community.

Key messages

In light of the encouraging efficacy and safety of COVID-19 vaccination, it represents an essential strategy to protect HCWs themselves, their patients and the hospital community. Despite the introduction of mandatory vaccination, policy-makers should set up tailored strategies of clear communication to reduce reluctancy to vaccination among HCWs.

Algorithms and Artificial Intelligence in Primary Care for conscious drug use: a systematic review

 

Primary care is a growing medical field willing to become a more integrated and technological asset. Although big changes already happened and more investments have been made, a limited amount of literature describes processes and technologies there applied or to be used. This paper aims to evaluate the efficacy and usability of different types of algorithms in primary care to improve drug safety by speeding up processes and achieving greater accuracy opening the path to providing better healthcare overall. The PICO model was adopted, three electronic databases (PubMed, Cochrane, Web of Science) were searched using appropriate keywords. Selected studies were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analysed using descriptive statistic, comparison of drug usage between algorithms or artificial intelligence application and usual care was performed using a χ2 test(α = 0.05). Out of 2207,19 studies were included,37% of them regarding error prevention,21% drug interactions,21% drug monitoring,16% drug prescription,5% drug administration. Results showed an easier and safer medication use in 74% of studies, a loss of safeness and accuracy in 16%; 10% of total studies did not come up with a valid esteem of results either for inadequate availability of the AI machine or because of the heterogeneity of the results in different settings. The evaluation of errors prevention, 40% of total studies, showed the most statistically significant results with 88% of positive outcomes from AI application. The results support that this technological approach to drugs management could contribute to the safety of treatment and to increase patients' and general practitioners' satisfaction. The application of AI or algorithms is significantly associated with a reduction of drug use errors (p &lt; 0.05). Future studies should work toward establishing a gold standard to measure AI performances.

Key messages

Artificial Intelligence and Algorithms in primary care have the potentiality to disrupt patient care with a safer and faster medication management. A comparison between Artificial Intelligence or algorithms and standard clinical practice may help finding the medication fields where a technological support could lead to better results.

Burden of COVID-19: Disability-Adjusted Life Years (DALYs) across 16 European countries

OBJECTIVE

The aim of this study is to measure and compare the burden of disease of COVID-19 pandemic in 16 EU/EEA countries through the estimation of Disability-Adjusted Life Years (DALYs) over a long period of time.

MATERIALS AND METHODS

The observational study was based on data from ECDC and WHO databases collected from 27 January 2020 to 15 November 2020. In addition to the absolute number of DALYs, a weekly trend of DALYs/100,000 inhabitants was computed for each country to assess the evolution of the pandemic burden over time. A cluster analysis and Kolmogorov-Smirnov (KS) test were performed to allow for a country-to-country comparison.

RESULTS

The total DALYs amount to 4,354 per 100.000 inhabitants. YLLs were accountable for 98% of total DALYs.  Italy, Czechia and Sweden had the highest values of DALYs/100,000 while Finland, Estonia and Slovakia had the lowest. The latter three countries differed significantly from the others - in terms of DALYs trend over time - as shown by KS test. The cluster analysis allowed for the identification of three clusters of countries sharing similar trends of DALYs during the assessed period of time. These results show that notable differences were observed among different countries, with most of the disease burden attributable to YLLs.

CONCLUSIONS

DALYs have proven to be an effective measure of the burden of disease. Public health and policy actions, as well as demographic, epidemiological and cultural features of each country, may be responsible for the wide variations in the health impact that were observed among the countries analyzed.

L'emergenza COVID-19 nell'ottica del finanziamento del Servizio Sanitario Nazionale: analisi e proposte

The COVID-19 pandemic crisis has strongly stressed national health systems and resulted in a global economic crisis. This paper aims to frame and evaluate the funding disbursed and the costs incurred by the National Health Service, in relation to the COVID-19 emergency. It also intends to assess current monetary policies. It aims also to suggest and provide proposals in the context of strengthening the NHS. A narrative review of the grey literature was conducted querying OpenGray, WONDER e Pro-quest's Digital Dissertations e Conference Papers Index and the major institutional websites. The ALTEMS COVID-19 Instant Reports and reports published by regional, national and European institutional bodies were used as main information sources. The discussion begins with the presentation of the economic-health and epidemiological situation, and ends with the proposal of possible initiatives aimed at economic and financial reinforcement of the NHS.

Is COVID-19 a Real Incentive for Flu Vaccination? Let the Numbers Speak for Themselves

Seasonal flu vaccination is one of the most important strategies for preventing influenza. The attitude towards flu vaccination in light of the COVID-19 pandemic has so far been studied in the literature mostly with the help of surveys and questionnaires. Whether a person chooses to be vaccinated or not during the COVID-19 pandemic, however, speaks louder than any declaration of intention. In our teaching hospital, we registered a statistically significant increase in flu vaccination coverage across all professional categories between the 2019/2020 and the 2020/2021 campaign (24.19% vs. 54.56%, p < 0.0001). A linear regression model, based on data from four previous campaigns, predicted for the 2020/2021 campaign a total flu vaccination coverage of 30.35%. A coverage of 54.46% was, instead, observed, with a statistically significant difference from the predicted value (p < 0.0001). The COVID-19 pandemic can, therefore, be considered as an incentive that significantly and dramatically increased adherence to flu vaccination among our healthcare workers.

Impact of interprofessional collaboration on chronic disease management: Findings from a systematic review of clinical trial and meta-analysis

Improvement of chronic disease management demands effective collaborative relationships between health and social-care which is achieved through teamwork. Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) are recognized as essential for the delivery of effective and efficient healthcare. Although IPC and IPE are key components of primary care, evidence of studies evaluating how an IPE intervention prior to IPC improved chronic patient outcomes remains scarce. The aim of this study was to assess the impact of IPC interventions on the management of chronic patients compared to usual care. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) on IPC interventions on chronicity management and their impact on clinical and process outcomes was conducted. Of the 11,128 papers initially retrieved, 23 met the inclusion criteria. Meta-analyses results showed the reduction of systolic blood pressure (Mean Difference (MD) -3.70; 95 % CI -7.39, -0.01), glycosylated hemoglobin (MD -0.20; 95 % CI -0.47, -0.07), LDL cholesterol (MD -5.74; 95 % CI -9.34, -2.14), diastolic blood pressure (MD -1.95; 95 % CI -3.18, -0.72), days of hospitalization (MD -2.22; 95 % CI -4.30, -0.140). A number of positive findings for outcomes related to IPC were found reflecting an improvement of quality of care and an enhancement in the delivery of patient-centered and coordinated care. Moreover, the need for a purposeful systemic approach linking interprofessional education with interprofessional collaboration and patient health and wellbeing is necessary.

Moving forward: Cost-Effectiveness of PrEP in HIV prevention for Men Who Have Sex with Men in Italy

Globally, in 2018 1.7 million people contracted Human Immunodeficiency Virus (HIV) and 770,000 people died from AIDS-related illnesses. Men Who Have Sex with Men (MSM) have one of the highest probabilities of HIV transmission.

In Italy, in 2018 2,847 new HIV cases were diagnosed, of which 39% among MSM. The MSM population accounts for 16,690 individuals whereof 50% already underwent the Highly Active Antiretroviral Therapy (HAART). The aim of this study is to evaluate the cost-effectiveness of daily Pre-Exposure Prophylaxis (PrEP) in the Italian MSM susceptible population.

A Markov transition model was calibrated to the HIV epidemic among MSM in Italy, comparing PrEP to naïve patients (NP). Model parameters were retrieved by querying scientific databases. Transition probabilities were adjusted for incidence of HIV while costs and benefits were discounted at an annual rate of 3%. The impact on results of critical parameters was explored through a Monte Carlo-based sensitivity analysis. The cost-effectiveness analysis results were reported as Incremental Cost-Effectiveness Ratio (ICER) express as € per Quality Adjusted Life Year (QALY) gained.

The introduction of such a PrEP program would result in a total cost of €822,398,199 million and lead to a gain of 70,762 discounted QALYs over an 85-year time horizon.

Assuming a 92% efficacy of PrEP therapy, the ICER for the PrEP program is €4,346.16/QALY gained. This value is definitively lower than acceptability NICE threshold (£20,000).

PrEP can reduce the infection rate up to 60% in a five-year period. The Monte Carlo simulation confirmed the robustness of the model results.

This analysis showed PrEP to be cost-effective when used in a susceptible population. Even if PrEP doesn't protect from other sex-related infectious diseases, it could prevent HIV transmission, thus breaking down HIV-infection incidence rate. Each country should reflect on the real possibility to implement a robust Public Health program pondering the adoption of PrEP.

Key messages

PrEP is very effective at reducing HIV infection when taken correctly. It is the backbone in the “combination prevention”, necessary to reach the SDG of ending the AIDS epidemic by 2030. This preliminary analysis suggests that the introduction of a daily PrEP program for MSM in Italy is cost-effective and possibly cost saving in the long term.

Epidemiology of odontogenic sinusitis: an old, underestimated disease, even today. A narrative literature review

Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses resulting from dental pathology. The aim of this study is to provide an overview of the current literature on the dimensions of the phenomenon, quality of life, economic considerations, and approaches to odontogenic sinusitis. A narrative review was conducted following the methodology proposed by Green et al. (2006). There appears to have been an increase in the incidence over the last decade. Nowadays, evidence in the literature reports that 10-12% up to 40% of all sinusitis cases are associated with odontogenic infections. The iatrogenia was by far the leading cause of odontogenic sinusitis (55.97%) while the first and second molars were the most affected teeth with an incidence of 35.6% and 22%. If not properly diagnosed and treated, these infections may lead to a rapid spread, giving rise to potentially life-threatening complications with a significant general health-related Quality of Life detriment. The proper management of patients in a pre-implant logical setting leads to substantial savings, ranging from €38 million to €152 million, for the Italian National Health Service. Odontogenic sinusitis management should involve shared decisionmaking between the otolaryngologist, dental provider, and patient, where the benefits and risks of dental treatment and endoscopic sinus surgery are discussed.

A shared battle against cancer: overcoming screening uptake differences within European countries

Cancer is the second leading cause of dead in Europe and it is responsible of more than 30% of all deaths. For this reason, European Union (EU) identified the battle against cancer as a priority for the European Research Program 2021-2027.About 40% of total deaths for cancers could be prevented with screening.Validated screening test are available for breast (BC), cervical (CC) and colorectal cancers (CRC).

In 2003 the Recommendation of the European Council indicated the right timing and the population target but, nowadays, the percentage of screening within EU is low and consistent differences persist among States.In 2020 there are still countries that don't have population-based screening programs. Last data available for all 28 EU countries are referred to 2014. Data were retrieved from “Osservasalute” reports and Global Burden of Disease database.Pearson test and a paired t test were used to describe correlation between mortality and screening coverage rates.

In 2014 the mean percentage of screening was 70.7% for CC, 68.7% for BC and 31.3% for CRC and the mean of mortality rate was of 2.1, 10.4 and 17.2 for 100,000, respectively.The rate of mortality did not change significantly in 2017 (2, 10 and 16 for 100,000 respectively).The median coverage is 67 for BC [IR: 43-91], 21.4 for CRC [IR: -3-46] and 70.6 for CC [IR: 54-87]. Pearson test resulted in a negative correlation for all three cancers equal to -0.045, -0.060 and -0.561, respectively.A higher adherence to screening programs is significantly associated to lower mortality rates in all the three types of cancer (p &lt; 0.01).

Even if many factors determine the rate of cancer mortality, screening represents the best method to early diagnosis and treatment.Up-to-date data are needed to correctly monitor progress towards the common goal of reaching the entire target population with screenings.A strong leadership at international level is necessary to improve screening programs all over EU and support screening campaigns.

Key messages

Screening is one of the most efficient and life-saving way to prevent cancer. It is needed to improve screening adherence through population-based programmes both at international and national level. Last data available for all EU countries are referred to 2014. It is necessary to update the data in order to enhance the understanding of screening efficiency.

Community Engagement: Reducing inequalities acting on environmental health. A Systematic Review

Sustainability is one of the most important challenges for Healthcare Systems all over the world. According to the Sustainable Development Agenda, one of the goals is to reduce inequalities, and environmental health is faced by several specific goals. Community Engagement can both empower vulnerable populations (so reducing inequalities) and identify the prior environmental issues to address. The aim was to search for public health programs using Community Engagement tools in healthy environment building.

A systematic review was conducted searching on Scopus, MEDLINE and Cochrane databases. The search string was created according to the Population-Intervention-Context-Outcome model. The Risk Of Bias In Non-randomized Studies-of Interventions tool was used to assess quality. Data analysis was based on descriptive statistics and a Chi-Square test was performed to compare studies in which the community carried out engagement interventions with or without the direction of public health institutions (p &lt; 0.05).

Of 182 articles, 11 were eventually included. Risk of Bias was moderate in 70% of the articles.

7 studies were conducted in rural areas, while 4 in urban contexts. Target populations were children in 20%, adults in 50% and elderly in 30% of the articles. Concerning the intervention design, 9 studies included the research of local leaderships, and in 7 there were both context study (to identify the main barriers and facilitators) and the active planning of motivational meetings by public health professionals. We found that the level of engagement reached is highly correlated with the presence of public health professionals acting as engaging coaches (p = 0.007).

Community engagement allows Public Health to carry out promotion and prevention programs by leveraging community forces. This study shows that one of the most important ingredients to make it work is the active presence of the Public Health professionals acting as community coaches.

Impact of the Burden of COVID-19 in Italy: Results of Disability-Adjusted Life Years (DALYs) and Productivity Loss

The WHO declared the novel coronavirus disease a pandemic, with severe consequences for health and global economic activity and Italy is one of the hardest hit countries. This study aims to assess the socio-economic burden of COVID-19 pandemic in Italy through the estimation of Disability-Adjusted Life Years (DALYs) and productivity loss. The observational study was based on data from official governmental sources collected since the inception of epidemic until 28 April 2020. DALYs for a disease combines the years of life lost due to premature mortality in the population and the years lost due to disability of the disease. In addition to DALYs, temporary productivity loss due to absenteeism from work and permanent productivity loss due to premature mortality were estimated using the Human Capital Approach. The total DALYs amount to 2.01 per 1000 persons. The total permanent productivity loss was around EUR 300 million while the temporary productivity loss was around EUR 100 million. This evaluation does not consider other economic aspects related to lockdown, quarantine of contacts, healthcare direct costs etc. The burden of disease methodology is functional metric for steering choices of health policy and allowing the government to be accountable for the utilization of resources.