Subclinical Tuberculosis Disease-A Review and Analysis of Prevalence Surveys to Inform Definitions, Burden, Associations, and Screening Methodology

While it is known that a substantial proportion of individuals with tuberculosis disease (TB) present subclinically, usually defined as bacteriologically-confirmed but negative on symptom screening, considerable knowledge gaps remain. Our aim was to review data from TB prevalence population surveys and generate a consistent definition and framework for subclinical TB, enabling us to estimate the proportion of TB that is subclinical, explore associations with overall burden and program indicators, and evaluate the performance of screening strategies. We extracted data from all publicly available prevalence surveys conducted since 1990. Between 36.1% and 79.7% (median, 50.4%) of prevalent bacteriologically confirmed TB was subclinical. No association was found between prevalence of subclinical and all bacteriologically confirmed TB, patient diagnostic rate, or country-level HIV prevalence (P values, .32, .4, and .34, respectively). Chest Xray detected 89% (range, 73%-98%) of bacteriologically confirmed TB, highlighting the potential of optimizing current TB case-finding policies.

The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis

Stages of tuberculosis disease can be delineated by radiology, microbiology, and symptoms, but transitions between these stages remain unclear. In a systematic review and meta-analysis of studies of individuals with untreated tuberculosis who underwent follow-up (34 cohorts from 24 studies, with a combined sample of 139 063), we aimed to quantify progression and regression across the tuberculosis disease spectrum by extracting summary estimates to align with disease transitions in a conceptual framework of the natural history of tuberculosis. Progression from microbiologically negative to positive disease (based on smear or culture tests) in participants with baseline radiographic evidence of tuberculosis occurred at an annualised rate of 10% (95% CI 6·2-13·3) in those with chest x-rays suggestive of active tuberculosis, and at a rate of 1% (0·3-1·8) in those with chest x-ray changes suggestive of inactive tuberculosis. Reversion from microbiologically positive to undetectable disease in prospective cohorts occurred at an annualised rate of 12% (6·8-18·0). A better understanding of the natural history of pulmonary tuberculosis, including the risk of progression in relation to radiological findings, could improve estimates of the global disease burden and inform the development of clinical guidelines and policies for treatment and prevention.

The spread of COVID-19 in six western metropolitan regions: a false myth on the excess of mortality in Lombardy and the defense of the city of Milan

We analyzed the spread of the COVID-19 epidemic in 6 metropolitan regions with similar demographic characteristics, daytime commuting population and business activities: the New York metropolitan area, the Île-de-France region, the Greater London county, Bruxelles-Capital, the Community of Madrid and the Lombardy region. The highest mortality rates 30-days after the onset of the epidemic were recorded in New York (81.2 x 100,000) and Madrid (77.1 x 100,000). Lombardy mortality rate is below average (41.4 per 100,000), and it is the only situation in which the capital of the region (Milan) has not been heavily impacted by the epidemic wave. Our study analyzed the role played by containment measures and the positive contribution offered by the hospital care system. (www.actabiomedica.it).

Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study

BACKGROUND

Prevalence surveys show a substantial burden of subclinical (asymptomatic but infectious) tuberculosis, from which individuals can progress, regress, or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of tuberculosis disease.

METHODS

We created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95% uncertainty intervals (UIs).

FINDINGS

We included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40% (95% UI 31·3-48·0) of individuals with prevalent subclinical disease at baseline recover and 18% (13·3-24·0) die from tuberculosis, with 14% (9·9-19·2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50% (40·0-59·1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46% (38·3-52·2) die and 20% (15·2-25·8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37% (30·5-45·4).

INTERPRETATION

For people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected.

FUNDING

TB Modelling and Analysis Consortium and European Research Council.

Does the use of personal electronic health records increase vaccine uptake? A systematic review

BACKGROUND

Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on the impact of their use is scant. With PEHRs being more and more marketed as easily implementable and cost-effective instruments to provide people with direct control on their health, the question on whether their use might be associated with the priority to improve vaccine coverage arises.

METHODS

We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on PEHR effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention (standard care, no access to PEHR), ii) PEHR access only vs access to PEHR with additional features (e.g. health education materials, active reminders).

RESULTS

Of 3114 identified citations, 8 studies were included, the majority published in the US and before 2015; 62% were randomized trials, the rest having an observational study design. Evidence suggests a moderate positive impact of PEHR access in increasing vaccine uptake, with data available for influenza and pneumococcal vaccines, diabetic patients and childhood immunization. Pooled data report the addition of digital communication features, i.e. the delivery of educational messages, reminders and availability of scheduling features might increase vaccine uptake, as compared to PEHR access alone. However, evidence is not conclusive.

CONCLUSION

While immunization programs are struggling to achieve optimal coverage targets, it seems the potential of PEHRSs supporting informed adherence to vaccines recommendations is neither fully exploited nor explored. Which factors mediate the association between PEHRs access and vaccine uptake? Which PEHRs' design and functional components can maximize their impact? On which target populations? Which PEHR models works better for high-risk populations? Our findings can only partially answer those questions and further experimental research is needed.

The efficacy of ultraviolet light-emitting technology against coronaviruses: a systematic review

The ongoing pandemic of COVID-19 has underlined the importance of adopting effective infection prevention and control (IPC) measures in hospital and community settings. Ultraviolet (UV)-based technologies represent promising IPC tools: their effective application for sanitation has been extensively evaluated in the past but scant, heterogeneous and inconclusive evidence is available on their effect on SARS-CoV-2 transmission. With the aim of pooling the available evidence on the efficacy of UV technologies against coronaviruses, we conducted a systematic review following PRISMA guidelines, searching Medline, Embase and the Cochrane Library, and the main clinical trials' registries (WHO ICTRP, ClinicalTrials.gov, Cochrane and EU Clinical Trial Register). Quantitative data on studies' interventions were summarized in tables, pooled by different coronavirus species and strain, UV source, characteristics of UV light exposure and outcomes. Eighteen papers met our inclusion criteria, published between 1972 and 2020. Six focused on SARS-CoV-2, four on SARS-CoV-1, one on MERS-CoV, three on seasonal coronaviruses, and four on animal coronaviruses. All were experimental studies. Overall, despite wide heterogenicity within included studies, complete inactivation of coronaviruses on surfaces or aerosolized, including SARS-CoV-2, was reported to take a maximum exposure time of 15 min and to need a maximum distance from the UV emitter of up to 1 m. Advances in UV-based technologies in the field of sanitation and their proved high virucidal potential against SARS-CoV-2 support their use for IPC in hospital and community settings and their contribution towards ending the COVID-19 pandemic. National and international guidelines are to be updated and parameters and conditions of use need to be identified to ensure both efficacy and safety of UV technology application for effective infection prevention and control in both healthcare and non-healthcare settings.

The Use of Digital Technologies to Support Vaccination Programmes in Europe: State of the Art and Best Practices from Experts' Interviews

Digitalisation offers great potential to improve vaccine uptake, supporting the need for effective life-course immunisation services. We conducted semi-structured in-depth interviews with public health experts from 10 Western European countries (Germany, Greece, Italy, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, and the United Kingdom) to assess the current level of digitalisation in immunisation programmes and retrieve data on interventions and best practices. Interviews were performed using an ad hoc questionnaire, piloted on a sample of national experts. We report a mixed level of digital technologies deployment within vaccination services across Europe: Some countries are currently developing eHealth strategies, while others have already put in place robust programmes. Institutional websites, educational videos, and electronic immunisation records are the most frequently adopted digital tools. Webinars and dashboards represent valuable resources to train and support healthcare professionals in immunisation services organisation. Text messages, email-based communication, and smartphone apps use is scattered across Europe. The main reported barrier to the implementation of digital-based programmes is the lack of resources and shared standards. Our study offers a comprehensive picture of the European context and shows the need for robust collaboration between states and international institutions to share best practices and inform the planning of digital intervention models with the aim of countering vaccine hesitancy and increasing vaccine uptake.

COVID-19 mortality rate in nine high-income metropolitan regions

We analyzed the spread of the COVID-19 epidemic in 9 metropolitan regions of the world with similar socio-demographic characteristics, daytime commuting population and business activities: the New York State, Bruxelles-Capital, the Community of Madrid, Catalonia, the Île-de-France Region, the Greater London county, Stockholms län, Hovedstaden (Copenhagen) and the Lombardy Region. The Lombardy region reported the highest COVID-19 crude mortality rate (141.0 x 100,000) 70-days after the onset of the epidemic, followed by the Community of Madrid (132.8 x 100,000) New York State (120.7 x 100,000). The large variation in COVID-19 mortality and case-fatality rates for COVID-19 in different age strata suggested a more accurate analysis and interpretation of the epidemic dynamics after standardization of the rates by age. The share of elder populations (>70 years) over total population varies widely in the considered study settings, ranging from 6.9% in Catalonia to 17.0% in Lombardy. When taking age distribution into consideration the highest standardized mortality rate was observed in the State of New York (257.9 x 100,000); with figures in most of the European regions concentrated between 123.3 x 100,000 in Greater London and 177.7 x 100,000 in Bruxelles-Capital, lower in French and Danish regions. We also report and critical appraise, when available, COVID-19 mortality figures in capital cities, nursing homes, as well as excess mortality at country level. Our data raise awareness on the need for a more in-depth epidemiological analysis of the current COVID-19 public health emergency that further explores COVID-19 mortality determinants associated with health services delivery, community-level healthcare, testing approaches and characteristics of surveillance systems, including classification of COVID-19 deaths. (www.actabiomedica.it)

Estimating the contribution of subclinical tuberculosis disease to transmission: An individual patient data analysis from prevalence surveys

Background

Individuals with bacteriologically confirmed pulmonary tuberculosis (TB) disease who do not report symptoms (subclinical TB) represent around half of all prevalent cases of TB, yet their contribution to Mycobacterium tuberculosis (Mtb) transmission is unknown, especially compared to individuals who report symptoms at the time of diagnosis (clinical TB). Relative infectiousness can be approximated by cumulative infections in household contacts, but such data are rare.

Methods

We reviewed the literature to identify studies where surveys of Mtb infection were linked to population surveys of TB disease. We collated individual-level data on representative populations for analysis and used literature on the relative durations of subclinical and clinical TB to estimate relative infectiousness through a cumulative hazard model, accounting for sputum-smear status. Relative prevalence of subclinical and clinical disease in high-burden settings was used to estimate the contribution of subclinical TB to global Mtb transmission.

Results

We collated data on 414 index cases and 789 household contacts from three prevalence surveys (Bangladesh, the Philippines, and Viet Nam) and one case-finding trial in Viet Nam. The odds ratio for infection in a household with a clinical versus subclinical index case (irrespective of sputum smear status) was 1.2 (0.6-2.3, 95% confidence interval). Adjusting for duration of disease, we found a per-unit-time infectiousness of subclinical TB relative to clinical TB of 1.93 (0.62-6.18, 95% prediction interval [PrI]). Fourteen countries across Asia and Africa provided data on relative prevalence of subclinical and clinical TB, suggesting an estimated 68% (27-92%, 95% PrI) of global transmission is from subclinical TB.

Conclusions

Our results suggest that subclinical TB contributes substantially to transmission and needs to be diagnosed and treated for effective progress towards TB elimination.

Funding

JCE, KCH, ASR, NS, and RH have received funding from the European Research Council (ERC) under the Horizon 2020 research and innovation programme (ERC Starting Grant No. 757699) KCH is also supported by UK FCDO (Leaving no-one behind: transforming gendered pathways to health for TB). This research has been partially funded by UK aid from the UK government (to KCH); however, the views expressed do not necessarily reflect the UK government's official policies. PJD was supported by a fellowship from the UK Medical Research Council (MR/P022081/1); this UK-funded award is part of the EDCTP2 programme supported by the European Union. RGW is funded by the Wellcome Trust (218261/Z/19/Z), NIH (1R01AI147321-01), EDTCP (RIA208D-2505B), UK MRC (CCF17-7779 via SET Bloomsbury), ESRC (ES/P008011/1), BMGF (OPP1084276, OPP1135288 and INV-001754), and the WHO (2020/985800-0).

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.

Transition to retirement impact on health and lifestyle habits: analysis from a nationwide Italian cohort

Background

Retirement is a life-course transition likely to affect, through different mechanisms, behavioural risk factors’ patterns and, ultimately, health outcomes. We assessed the impact of transitioning to retirement on lifestyle habits and perceived health status in a nationwide cohort of Italian adults.

Methods

We analysed data from a large cohort of Italian adults aged 55–70, derived from linking six waves of the Participation, Labour, Unemployment Survey (PLUS), a national survey representative of the Italian workforce population, conducted between 2010 and 2018. We estimated relative-risk ratios (RRR) of transition to retirement and their corresponding 95% confidence intervals (CIs) for selected behavioural risk factors and health outcomes using multivariable logistic regression models. We used propensity score matching (PSM) to account for potential confounders.

Results

We included 5169 subjects in the study population, of which 1653 retired between 2010 and 2018 (exposed, 32%). Transition to retirement was associated with a 36% increased probability of practising sports (RRR 1.36, 95% CI 1.12–1.64). No statistically significant changes were reported for smoking habit (current smoker RRR: 1.18, 95% CI 0.94–1.46) and BMI (overweight/obese RRR: 0.96, 95% CI 0.81–1.15). Overall, retiring was associated with improved self-rated health status (RRR 1.26, 95% CI 1.02–1.58).

Conclusion

Individual data-linkage of multiple waves of the PLUS can offer great insight to inform healthy ageing policies in Italy and Europe. Transition to retirement has an independent effect on perceived health status, physical activity and selected behavioural risk factors. It should be identified as a target moment for preventive interventions, with particular reference to primary prevention so as to promote health and wellbeing in older ages.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11670-3.

A systematic review of email-based reminder interventions to increase vaccine uptake

Introduction

Reminder and recall interventions have been proven to be effective in increasing vaccination coverage. Emails are a popular mean of communication, and their use as a reminder method has many potential benefits: low costs, timely delivery and no restriction of content. Nevertheless, there is limited evidence that compares the advantages of using emails for vaccination reminders to other methods, on which extensive literature is already present.

Methods

We conducted a systematic review following the PRISMA guidelines to analyze evidence from peer-reviewed studies on the application of email-based interventions to immunization programs. We included any measure of vaccine uptake or immunization coverage, in any target population and settings.

Results

We included 11 studies in the final analysis, of which 9 were RCTs, 1 was a controlled trial and 1 a before and after study. Most studies were conducted in the US. Six studies had data on the uptake of influenza vaccination, three on HPV series completion, 1 on PPSV23, and 1 on vaccines recommended for adolescents. In 4 studies email reminders proved to be more effective in increasing vaccination uptake than no reminders. Five studies didn’t show advantages of using email reminders when compared to traditional methods (phone call, mail, paper card) and digital reminders (SMS, automated phone calls). In 1 study a significantly higher increase in uptake was achieved when combining emails with Interactive Voice Response phone calls. Finally, 2 studies compared different email models.

Conclusions

In conclusion, this review outlined that not enough evidence is available regarding the use of email reminders to increase vaccination uptake. Our findings suggest that the choice of reminder method should depend on the population, and future studies should analyze its cost-effectiveness and convenience in respect to other methods, and aim at improving the content of emails to increase their efficacy as a reminder method.

Key messages

Based on our review of available studies, not enough evidence is available to prove the efficacy of email reminders to increase vaccine uptake. Additional evidence is needed to analyze cost-effectiveness of email reminders, convenience in respect to other methods, and to improve their content to increase their efficacy as a reminder method.

The use of ICT to increase vaccination uptake: state of the evidence from experimental studies

Background

Information and communication technology has a great potential to improve vaccine uptake by increasing the demand of vaccines and the supply of life-course immunization services. The EUVIS (EUrope Vaccines ICT Strategies) project aims at assessing the current use of ICT in European countries’ immunization programs to inform the planning and implementation of ICT-based intervention models to increase vaccine uptake. Here we present the output of Part I of the EUVIS Project, the state of the evidence from experimental studies at the global and regional level.

Methods

We conducted a systematic review following the PRISMA guidelines to analyze the available evidence from experimental studies on the impact of ICT-based interventions to improve: i) vaccine uptake (primary outcome), and other associated outcomes, including knowledge and attitudes towards immunization in infants, adolescents, adults, elder populations and at risk groups.

Results

We included 68 RCTs. Informative websites significantly increased vaccination uptake among adolescents. Among young adults, none of the assessed interventions was successful in increasing vaccination uptake. The tools targeting parents that increased uptake were SMS, automated phone calls or messages, websites and online decision aid platforms. For pregnant women, combinations of more types of ICT were more effective in increasing uptake. In the adult population, both SMS and videos proved to be successful, while in elder populations and at-risk groups, the use of more traditional methods as short phone calls proved to be more efficient than ICTs.

Conclusions

Technological innovations have made significant contributions to healthcare, but our results shows that the interventions must be tailored to target populations’ specific characteristics and needs. These data are of crucial importance to identify which ICT-based interventions are more effective in each target group, to plan and implement immunization programs.

Key messages

Information and Communication Technology-based interventions to increase vaccine uptake are more successful when planned tailoring target populations’ specific characteristics and needs. ICT can significantly improve healthcare delivery but its role to increase vaccine uptake is controversial. Results from this systematic review are fundamental to plan tailored ICT-based interventions.

Digitalization of immunization programmes in Europe: results from the EUVIS project

The second and final phase of the EUVIS (EUrope Vaccines ICT Strategies) project, coordinated by the School of Public Health of the University Vita-Salute San Raffaele in Milan (Italy), aims at collecting best practices on the use and impact of Information and Communication Technologies (ICT) and digital tools to increase vaccine uptake and ultimately vaccination coverage in Europe. The field of ICT has flourished in recent years revolutionizing the processes of gathering, spreading and utilizing health information among healthcare providers, citizens and mass media. In particular, we are interested in any digital technology that can improve vaccine uptake supporting actions aimed at both increasing the demand of vaccines (i.e provide access to information through telecommunications, networks, the Internet, wireless, mobile devices), and the supply of effective and efficient life-course immunization services (i.e ICT-based interventions to support immunization programmes delivery and their monitoring). Within EUVIS we have previously conducted a series of systematic reviews to pool available evidence from experimental studies on the impact of selected ICT-based intervention (i.e. e-mail reminders, personal health records, among others) to improve vaccine uptake and other associated outcomes. In the current study, second and final phase of the EUVIS project, we are conducting a survey at the European level to gather original data on the use and impact of ICT and digital tools within immunization programmes in selected countries. The survey tool was developed on the basis of findings from EUVIS phase one and experts' consultation; it consisted on a 55-item questionnaire, distributed to public health professionals working in health agencies, institutions and the academia to build “ICT and immunization” countries' profile, as well as to gather, pool and critically appraise data on perceived potential and challenges of immunization programmes' digitalization in Europe.

Effectiveness of PEHRs use to increase vaccine uptake: a systematic review

Background

The digital transformation provides tools to empower individuals and enable feedback and interaction between users and healthcare providers. Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on their impact is scant.

Methods

We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention, ii) PEHR access vs access with additional features.

Results

Of identified 3125 citations, 8 studies were included, the majority published in the US before 2015. Four studies assessed differences between subjects with and without access to PEHR. Access to PEHR was reported to be an effective tool to increase vaccine uptake: when accessing PEHR, study participants were 6.7% more likely to receive influenza vaccine, parents to have children vaccinated, lifetime pneumococcal vaccination was reported to be higher in diabetic patients, a positive impact on preventive behaviors was reported. Four included studies reported on the effect of access to PEHR with or without additional communication features. In one study, the effect of electronic messages delivered through PEHRs wasn't differentially distributed in the arm receiving tailored messages on influenza, and in the arm receiving educational messages on other diseases. In other studies, active PEHR users were more likely to be vaccinated against influenza and Herpes Zoster, subjects who in addition received reminders had higher rates of influenza vaccination.

Conclusions

While immunization programs are struggling to achieve optimal coverage targets, our findings can partially outline the association between PEHR access and vaccine uptake and further experimental research is needed.

Key messages

PEHRs offer great potential to support population health and in particular immunization programs, helping to put people and patients at the center of care delivery, supporting patient empowerment. Although our findings suggest immunization coverage might benefit from people accessing PEHR, there is an urgent need to produce solid experimental evidence to quantify such effect.

The campaign "This Is Public Health" in Italy, set up by a team of Public Health Schools in Northern Italy

Despite the great effort to raise awareness among health promotion, nowadays Public Health policies are not often recognized as important tools. For this reason, the Health in All Policies (HiAP) approach is instrumental in tackling this information gap. In 2018, the US Association of Schools & Programs of Public Health (ASPPH) launched an international campaign called “This is Public Health” (TIPH), whose aim was “to brand public health and raise awareness of how it affects individuals, communities and populations”. The Association of Schools of Public Health in the European Region (ASPHER), in coordination with ASPPH, decided to create a European campaign to support and to reproduce the American one, by opening a challenge among the European Public Health Schools. The Schools and Programs of PH of Vita-Salute “San Raffaele” University, Milan, University of Parma, University of Pavia and Politecnico of Milan won this bid. In this “briefing on” we present a report on the Italian project for raising awareness of Public Health among general population and health care personell.

The impact of retirement on physical, mental health and wellbeing

Population ageing presents both challenges and opportunities for societies around the world. Increasing statutory retirement age and limiting exits to early retirement are frequent policy responses to population ageing, but this is unlikely to have the desired impact if the complex relationships that link work, retirement and health remains unknown. In this context, we designed and are currently conducting the multi-partner project on pension reforms and spatial-temporal patterns in healthy ageing, funded by Fondazione Cariplo. The project involves a multi-disciplinary research team from University Vita-Salute San Raffaele, Bocconi University and the Unit of Epidemiology of the Regional Health Service of ASL TO3.

In this first presentation we will first describe the project design, its general aim and specific objectives, then we will present a proposed conceptual framework on the association between retirement and health and its determinants. The framework is the first deliverable of the project and is the results of a comprehensive review of the available evidence and consultation with experts in the field. In particular we conducted a scoping review to retrieve, pool and critically appraise the relevant evidence on the impact of retirement and transition to retirement on physical and mental health and their determinants. We summarized the evidence collected in a conceptual framework that attempt to quantify how health and retirement are bi-directionally linked, how health is central to the timing of retirement, how labor-associated determinants condition employment cessation, how and retirement have varying effects on risk factors for physical and mental health and the role of confounding factors and mediators. Towards the end of the presentation we will outline an extensive stakeholder mapping carried out for the purposes of the project at the national and European level

Information and communication technology-based interventions to support healthcare in migrants

Background

Advances in the field of Information and Communication Technology (ICT) are revolutionizing healthcare, while massive migration flows and cross-border populations’ transit impose the planning, implementation, and evaluation of new integrated healthcare services and programmes. Nevertheless, no conclusive evidence exists on the vast potential offered by ICT to promote healthcare in migrant populations.

Methods

We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool and critically appraise all the available evidence on the effectiveness of ICT-based interventions to support the healthcare provision to migrant and in-transit populations in Europe. We searched the electronic databases Medline and Embase, relevant grey literature and consulted with experts in the field. We restricted the area of interest to EU/EEA countries and included studies providing original quantitative data.

Results

Out of 127 retrieved records, 53 (42%) met the inclusion criteria. Included studies were classified in the following four interventions: implementation of healthcare services (47%), patients’ education (26%), healthcare services’ monitoring (17%), and interventions on providers (10%). The most relevant data refer to telemedicine, prevention interventions, and healthcare data sharing and the most represented specific health-topic is that of mental health (26%). We present available data qualitatively and quantitatively pooled by country, type of ICT, target population and health topic.

Conclusions

Selected ICT-based interventions have been implemented in Europe to promote healthcare in migrant populations; however, in most cases, no monitoring and evaluation exist on their impact, effectiveness, and cost-effectiveness. Strengthened efforts are needed to identify, plan, implement and evaluate effective interventions and share best practices to protect in-transit populations’ health.

Key messages

Information and Communication Technology (ICT) offer great potential to promote health-care in migrant populations. Effective ICT interventions and best practices should be shared across Europe.