Explore the vast range of titles available.

Background The first 1000 days of life -including pregnancy and the first 2 years after birth- represent a critical window for health interventions. This systematic review aimed to summarize the evidence on the relationship between traffic-related air pollutants exposure in the first 1000 days of life and the development of wheezing and asthma, with a particular focus on windows of exposure. Methods Medline and Embase were searched from January 2000 to May 2020 to retrieve population-based birth-cohort studies, including registries, providing quantitative information on the association between exposure to traffic-related air pollutants during pregnancy or early life, and the risk of developing wheezing and asthma in childhood. Screening and selection of the articles were completed independently by three reviewers. The quality of studies was assessed using the Newcastle-Ottawa scale. Results Out of 9681 records retrieved, 26 studies from 21 cohorts were included. The most common traffic-related air pollutant markers were particulate matter (PM) and nitric oxides (NOx). The variability in terms of pollutants, exposure assessment methods, and exposure levels chosen to present the results did not allow a meta-analysis. Exposure to PM and NOx in pregnancy (10 cohorts) was consistently associated with an increased risk of asthma development, while the association with wheezing development was unclear. The second trimester of pregnancy seemed to be particularly critical for asthma risk. As for exposure during early life (15 cohorts), most studies found a positive association between PM (7/10 studies) and NOx (11/13 studies) and the risk of asthma development, while the risk of wheezing development was controversial. The period of postnatal exposure, however, was less precisely defined and a partial overlap between the period of exposure measurement and that of outcome development was present in a consistent number of studies (14 out of 15) raising doubts on the associations found. Conclusions Traffic-related air pollution during pregnancy is associated with an increased risk of asthma development among children and adolescents. The relationship between exposure in the first two years of life and the development of wheezing and asthma needs to be confirmed in studies with more precise exposure assessment.

Background The COVID-19 pandemic has had repercussions in several areas. The indirect effects of the pandemic on healthy living behaviours are multiple and complex to assess. The aim is to assess the impact of the outbreak of COVID-19 pandemic in Italy on the most relevant modifiable behaviours risks for non-communicable diseases (NCDs). Methods PASSI 2008–2023 data referring to a sample of 18-69-year-olds residing in Italy was used to estimate the prevalences of smoking, alcohol, fruit and vegetable consumption, and physical inactivity lifestyle. For each of these risks was used an interrupted time series (ITS) study with Generalized Least Squares (GLS) model to assess trends before and after the pandemic’s outbreak in Italy (March 2020). The “intervention” period is postulated as March 2020, and the “post-intervention” period extends from April 2020 to December 2023. In these models, the hypothetical situation without “intervention” and with the trend remains unchanged is commonly known as the ‘counterfactual’ scenario. Through ITS model both “counterfactual data” and “factual data” were obtained. Results From 2008 to 2023, 532,115 people were interviewed. Results showed, during “post-intervention” period, significant differences between factual and counterfactual prevalences started in 2022 and strengthened during 2023 and for all of the four behavioural indicators analysed: smoking, high-risk alcohol consumption, fruit and vegetable consumption (both all three of them worsening) and physical inactivity (which appears to decrease). Current smokers exhibited similar prevalences in March 2020 (24.5% vs. 24.3%), followed by a plateau throughout the entire ‘post-intervention’ period. By December 2023, however, the counterfactual prevalence was significantly lower than the observed rate (24.5% factual vs. 22.7% counterfactual). The initial improvement observed in the prevalence of high-risk drinkers in March 2020 (13% factual vs. 17% counterfactual) was followed by a rapid worsening and in December 2023 the prevalence was significantly higher than expected (19.7% vs. 16.9%). The fruit and vegetable consumption worsened and the factual prevalence of five-a-day in December 2023 was significantly lower than counterfactual (6.6% vs. 9.0%). Physical inactivity following an initial worsening in March 2020 (albeit not statistically significant), appeared to decrease in December 2023, with the factual prevalence lower than counterfactual (26.9% vs. 32.4%). Conclusions Results found in this article showed at the end of studied period the achievement of a plateau for current smokers, a worsening in the high-risk alcohol consumption, in fruit and vegetable intakes and a reduction in physical inactivity. Understanding shifts in these lifestyle indicators is crucial for the proper design of interventions aimed at reducing the burden of NCDs.

Background Climate change is projected to increase the number and intensity of extreme weather events, for example heat waves. Heat waves have adverse health effects, especially for the elderly, since chronic diseases are more frequent in that group than in the population overall. The aim of the study was to investigate mortality during heat waves in an adult population aged 50 years or over, as well as in susceptible subgroups of that population in Rome and Stockholm during the summer periods from 2000 to 2008. Methods We collected daily number of deaths occurring between 15th May and 15th September each year for the population above 50 as well as the susceptible subgroups. Heat wave days were defined as two or more days exceeding the city specific 95th percentile of maximum apparent temperature (MAT). The relationship between heat waves and all-cause non-accidental mortality was investigated through time series modelling, adjusting for time trends. Results The percent increase in daily mortality during heat waves as compared to normal summer days was, in the 50+ population, 22% (95% Confidence Interval (CI): 18-26%) in Rome and 8% (95% CI: 3-12%) in Stockholm. Subgroup specific increase in mortality in Rome ranged from 7% (95% CI:–17-39%) among survivors of myocardial infarction to 25% in the COPD (95% CI:9-43%) and diabetes (95% CI:14-37%) subgroups. In Stockholm the range was from 10% (95% CI: 2-19%) for congestive heart failure to 33% (95% CI: 10-61%) for the psychiatric subgroup. Conclusions Mortality during heat waves increased in both Rome and Stockholm for the 50+ population as well as in the considered subgroups. It should be evaluated if protective measures should be directed towards susceptible groups, rather than the population as a whole.

Unintentional injuries such as falls, are particularly frequent in early childhood. To date, epidemiological studies in this field have been carried out using routine data sources or registries and many studies were observational studies with a cross-sectional design. The aims of the study are to describe unintentional injuries in the first two years of life in the Piccolipiù birth cohort, and to investigate the association between mother and children characteristics and the First Event of Raised surface Fall (FERF). This longitudinal observational study included 3038 children from an Italian birth cohort. Data on socio-demographic factors, socio-economic indicators, maternal health and lifestyle characteristics and child's sleeping behavior, obtained from questionnaires completed at birth, 12 and 24 months of age, were considered in the analyses as potential risk factors of FERF. Time of occurrence of FERF was analyzed using the Kaplan-Meier method. The multivariable analysis for time to event was carried out using a Cox proportional hazards model. Falls from raised surfaces are the leading cause of unintentional injuries in the cohort with 610 (21.1%) and 577 (20.0%) cases among children during the first and second year of life, respectively. An increased risk of FERF was associated with several risk factors: maternal psychological distress (HR 1.41, 95%CI 1.10-1.81), maternal alcohol intake (HR 1.26, 95%CI 1.10-1.45), and child's sleeping problems (HR 1.28, 95%CI 1.09-1.51). Children with older aged mothers (HR 0.98, 95%CI 0.96-0.99) and living in northern Italy (HR 0.64, 95%CI 0.55-0.75) had a lower risk of FERF. The results of the study suggest that a higher risk of FERF is associated with socio-demographic factors, maternal characteristics and child sleeping behavior that could hinder parent empowerment.

The increasing burden of chronic diseases associated with the ageing of the European population constitutes one of the main challenges for the welfare systems in developed western countries, especially through its impact on the use of hospital services and the cost of care. This study aims at evaluating the cost of hospital care for older adults living in the Lazio Region, Italy, according to their level of frailty. Since 2014 a longitudinal randomized cohort study has been carried out on a sample consisting of 1280 older adults aged over 64 years resident in the Lazio region (Italy), with their being evaluated for multidimensional frailty. Accesses to Hospital Services (acute care and Day Hospital care admissions and Emergency Room accesses) during the first year after enrolment, as well as the related costs have been recorded through a regional database. Costs have been stratified on the basis of the state of frailty. The analysis of hospital services and costs highlights the role played by pre-frail individuals who generated 49.3% of the hospital care cumulative costs. Hospital Admission (HA) costs arising from robust and pre-frail subjects are 70% of the total HA costs. Pre-frail individuals also showed the highest average HA cost per person/year (7062.89 Euros). The main determinant of the highest HA costs was given by the number of HAs during the follow-up (multivariate linear regression, ß coefficient = 0.319; p<0.001), which was higher among pre-frail individuals than in any other group of patients. Pre-frail individuals generated the highest cost for hospital care in a sample of representative subjects living in an Italian Region with a low rate of community care services, as is the case in the Lazio region. Assessment of the multidimensional frailty of older adults permits a better definition of the important target of the pre-frail population as the main category within which interventions to prevent or mitigate frailty should be carried out.

ObjectivesStudies on the effect of temperature on rates of work-related injuries (WRIs) are very recent, and are evolving in depth and scope. However, less is known about potential effects of air pollutants. Our objective was to analyse the association between WRI and NO2, PM10 and air temperature in three major Italian cities, and to identify groups of workers more at risk in Italy.DesignTime-stratified case-crossover study.SettingsMilan, Turin, Rome, years 2001–2010.ParticipantsA total of 468 816 WRI occurred between 2001 and 2010 in Milan, Turin and Rome were extracted from the Italian national workers’ compensation authority database.Main outcomesAssociations between WRI and temperature, PM10, NO2, separately in the warm and in the cold season (WS, May–September; CS, November–February). Effect modification was studied by economic sector, occupational activity and indoor/outdoor job activity.ResultsExposure to NO2 (lag 0–8) showed the highest effect on the risk of WRI,with ORs ranging from 1.20 (95% CI 1.16 to 1.24) in Milan to 1.30 (95% CI 1.24 to 1.37) in Turin in the WS. The effect of exposure to PM10 was milder but consistent across all cities: ORs from 1.09 (95% CI 1.05 to 1.12) in Turin to 1.15 (95% CI 1.11 to 1.18) in Rome. Temperature was associated with risk of WRI only among those working in construction (highest association in Rome 1.06; 95% CI 1.01 to 1.12), transportation (highest association in Milan 1.05; 95% CI 0.96 to 1.14) and the energy industry (highest association in Milan 1.57; 95% CI 1.03 to 2.38) in the WS in all cities. A weak effect of low temperatures was observed in the CS only in Rome.ConclusionsExposures to NO2 resulted as strongest hazard for WRIs, mainly in warm months, while the independent effect of temperature was significant only in specific subgroups of workers. These results could be considered to better plan safety prevention programmes.

(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d’Argento, in the period of August 2020–December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.

Introduction Education of the multidisciplinary burns team is essential for optimising patient outcomes but can be challenging, particularly when coordinating across multiple sites and ensuring consistent engagement. There is a recognised gap in providing comprehensive, interdisciplinary education that covers all aspects of burn care. Hybrid teaching models, combining face-to-face and online delivery, offer a practical solution to address these challenges while promoting collaboration and engagement across the team. This study aimed to evaluate the impact of a structured, cross-site hybrid teaching programme designed to provide comprehensive, interdisciplinary education for the multidisciplinary burns team. Methods A weekly hybrid teaching programme was delivered to the multidisciplinary team over 21 months in a burns centre, with topics aligned to the Intercollegiate Surgical Curriculum Programme for Plastic Surgery. Participant feedback was collected using QR code surveys at the end of each session. Over 60 sessions, with more than 500 responses were analysed, assessing session enjoyability, delivery, quality, and self-reported confidence in the topics presented. Results Mean ratings for session enjoyability, delivery, and quality exceeded 4.7 on a Likert scale out of 5. Self-reported confidence in the delivered topics increased significantly, from 2.9 to 4.2 ( p  < 0.001). The programme facilitated interprofessional collaboration, team building, and professional development while overcoming geographical barriers. Iterative improvements based on participant feedback contributed to sustained engagement and educational value. Conclusion A well-structured hybrid teaching programme can effectively enhance knowledge, confidence, and collaboration within the multidisciplinary burns team. This model is adaptable to other burns centres, with potential for long-term benefits on clinical practice.

Abstract During the COVID-19 pandemic, a noticeable decrease in medical care utilization occurred which may contribute to increased morbidity and mortality rates associated with treatable conditions. In Italy, severely impacted by the pandemic, a comprehensive data source on healthcare renunciation is essential for policy formulation and intervention strategies. This study used data from the PASSI d‘Argento (PdA) surveillance system to investigate healthcare renunciation among people aged ≥65 years in Italy from August 2020 to December 2021 and to estimate the health and sociodemographic profiles associated with barrier-renunciation (due to service disruption) and refusal-renunciation (because of fear of contagion). A total of 4364 out of 10 827 individuals needing healthcare reported foregoing at least one medical visit or diagnostic test, with the major reasons being fear of COVID-19 contagion (33%) and service disruptions (29%). Sociodemographic inequalities existed: regression analysis revealed significant associations between healthcare renunciation and being female [adjusted prevalence ratio (aPR) 1.17, 95% CI: 1.08–1.26], reporting economic difficulties (aPR 1.15, 95% CI: 1.02–1.28), having two or more chronic conditions (aPR 1.18, 95% CI: 1.04–1.34), and having at least one sensory problem (aPR 1.13, 95% CI: 1.06–1.22). Compared to 2020, healthcare renunciation decreased in 2021. The relevant healthcare renunciation among elderly in Italy during the pandemic highlights widening health gaps and barriers to care access. Long-term monitoring tools are crucial to mitigate the pandemic’s impact on public health, especially for vulnerable populations.