"Early" and "definitive" taking charge of subjects positive to SARS-CoV2: the experience of an Italian Local Health Authority

Abstract

During the second covid-19 pandemic wave in November-December 2021 Prevention Departments had to face a hardly-sustainable workload of contact tracing and taking charge of the sars-cov2 positive case and of his or her close contacts. Also laboratories have been stressed in their ability to process timely the extraordinary load of swabs performed. In this context of hazardous delays, the Prevention Department of Belluno (Italy) tested its resilience: a simple and effective method of taking charge was implemented, by initially phoning to the positive case and imposing the isolation measure on him or her and later on proceeding with the conventional contact tracing.

[Evaluation and containment of cardiovascular risk in a large number of "healthy" subjects]

Cardiovascular diseases are the primary cause of death and represent a public health problem both in terms of mortality and morbidity. Since many risk factors for cardiovascular disease can be corrected with active interventions, we proposed a structured model operating in ways similar to cancer screening: active recall of healthy subjects, offers to intervene in selected subjects. In the experimental model adopted by the Local Health Unit n. 17--Este and the Local Health Unit n. 7--Pieve di Soligo, after pre-evaluation/exclusion by the general practitioner subjects aged between 45 and 59 years were recalled and evaluated by a trained health assistant using anthropometric measurements, screening blood pressure, fasting blood glucose, and evaluation of lifestyle. If their values were abnormal, the health assistant invited them to participate, and counseled them on some initiatives to make changes. The proposed model was demonstrated to be a good model both because using previously tested structured models, it revealed an elevated number of subjects with hypertension and hyperglycemia that were before undetected and because it placed up front strategic actions of the Prevention Departments. In addition, in follow-up, improvements in lifestyle were seen in subjects who had been counseled to alter them.

[The network of palliative care for persons with incurable disease in the Local Health Agency n. 7 of the Veneto region]

Only 20% of terminally ill people with cancer in Italy are assisted by a network of palliative care, whereas the majority of them die in the hospital, against their will, and with very low doses of opioids. A palliative care service, is offered by the Nucleus of Palliative care within the Operative Unit of District Primary Care in the local health agency n. 7 of Pieve di Soligo. This service takes charge of the patient from hospital discharge until his/her death, working in concert with the inpatieint hospitals and other territorial health care structures. In this way, the patient and his/her family are followed by a team of professionals working together in coordination and collaboration. In 2010 the percentage of terminally ill persons enrolled in the program was 52%, much greater than the standard of 45% required by ministerial law (DM no 43 del 2007) for the local health agencies without a hospice. The duration of time spent at home during the last phases of the illness was over 90% of time in care, with an in-home mortality of 63%. The consumption of major opioids was amongst the highest in Italy. Thanks to the opening of a hospice, already planned, we will be able to take charge within the network of palliative care thos sick people who cannot remain in the home and extend the service to ill persons without cancer in conditions of advanced incurable disease and end of life.

[Overcoming mandatory vaccination policy: first steps]

Steps toward overcoming mandatory vaccination policy follow two main tracks: scientific and administrative. Scientific course checks starting conditions of the project in Veneto Region and monitors the effects of policy. Thanks to sensibilization regional programs and partecipation to national campaigns of vaccination, Veneto Region has achieved high coverage for all actively promoted vaccinations. Specific projects has been implemented in order to improve vaccination system quality, particularly with regard to infectious diseases and vaccine adverse events surveillance, training workers and informatization. On 23rd March 2007 Veneto Region passed the regional law number 7 called "Sospensione dell'obbligo vaccinale per l'età evolutiva" becoming in force for children born since January 1st 2008. The law provides for the institution of a scientific committee having the task of monitoring both vaccination coverage and preventable infectious diseases incidence after overcoming mandatory vaccination policy.

[Results and development in cancer screening programs]

In order to contribute to the definition of good model for cancer screening programs, the paper reports an overview of Veneto Local Health Units' results according to required "gold standard" defined by the authors. The analysis was based on a standard attesting that the program is running stabely and a standard for the organisation requiring that general management is performed by a unique central unit, supplied with a unique software and a working group equipped with specific know-how. Ten of the 21 Locale Health Unit of Veneto Region chose to assign to Prevention Department (Public Health Department) all the three screening programs included in the National Prevention Plan. Among these we found the two achieving the defined gold standard (Thiene and Pieve di Soligo). Management model implemented in these units showed a framework for excellence.

Outbreak of serogroup C meningococcal disease in Veneto region, Italy

Meningococcal infections occur worldwide as endemic disease; there have also been outbreaks in Europe and in the Americas in the last 30 years but they have not reached the high incidence levels of epidemics in other parts of the world [1].

[Anti-rubella vaccine coverage in women 11-28 years of age: data on 5 local socio-health units of Veneto]

Selective rubella vaccination in the 11 years old girls, has been carried out in the Regione Veneto (Venetian Land) since 1974. The rubella immunization rate in teh women born between 1962 and 1978, in five sanitary districts, is 68.25%; the trend of increasing vaccination is continuing. Important differences in the organization of vaccination campaign were found among the five districts.

[Evaluation of the compliance to the proposal of anti-rubella vaccination]

The incidence of acquired rubella in the females who have been interested by the proposal of vaccination, according to the selective strategy adopted in Italy, allows to appraise the national adhesion to this proposal lower than 50%. The values registered in Venetia suggest an adhesion rate near 80%, which is confirmed by datas about the regional use of vaccine. The punctual verify of vaccinal covering rate in a little Sanitary District in the Province of Treviso points out values higher than 90%.