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BackgroundSevere acute respiratory syndrome coronavirus 2 has caused over 95 million confirmed cases of COVID-19 and over 2 million deaths worldwide. According to current literature data, older adults have higher risk of severe disease and mortality due to COVID-19. It is also known that older adults often do not present typical symptoms of diseases. The aim of the study was to assess if the prevalence of typical COVID-19-related symptoms varies by age group.MethodsMedical charts of a random sample of COVID-19 patients dying in-hospital were retrieved through an integrated national surveillance system and reviewed by a group of researchers at the Italian National Institute of Health. Detailed information on COVID-19-related symptoms were extracted and analyzed.Results3241 confirmed cases of COVID-19-related deaths were identified from 4391 reviewed medical charts. The mean number of COVID-19-related symptoms progressively declined with age, from 2.1 in patients aged < 60 years to 1.7 in those aged 90 years or older (p < 0.001). Moreover, fever, cough, and diarrhea significantly declined with increasing age.ConclusionsOlder adults have atypical presentation of symptoms and may be paucisymptomatic. This may lead to a diagnostic and therapeutic delay which aggravates the prognosis of COVID-19.Special attention should be posed when assessing individuals aged 65 years and older with suspected COVID-19.

Our study aimed to report on variables associated with communicative health literacy (COM-HL) in European adults. The HLS 19 survey was conducted in 2019–2021 including nine countries which measured COM-HL by using a validated questionnaire (HLS 19 -COM-P-Q6 with a score ranging from 0 to 100). Linear regression models were used to study variables associated with COM-HL globally (multilevel model with random intercepts and slopes and at country level) and in each country. Additional models studied each of the HLS 19 -COM-P-Q6 items separately. The mean COM-HL score ranged between 62.5 and 76.6 across countries. Among the 18,137 pooled participants, COM-HL was positively associated with age, a higher self-perceived social status, previous training in healthcare, an increasing number of general practitioner visits; and negatively associated with female sex, reported financial difficulties, having a chronic condition and an increasing number of specialist visits. These effects were heterogeneous from one country to another, and from one item to another when analysing the different COM-HL items separately. However, there was a consistent statistically significant association between COM-HL (score and each item) and financial difficulties as well as self-perceived social status in all countries. Interventions to improve communication between patients and physicians should be a high priority to limit communication disparities.

Regulatory frameworks for artificial intelligence (AI) are needed to mitigate risks while ensuring the ethical, secure, and effective implementation of AI technology in healthcare and population health. In this article, we present a synthesis of 141 binding policies applicable to AI in healthcare and population health in the EU and 10 European countries. The EU AI Act sets the overall regulatory framework for AI, while other legislations set social, health, and human rights standards, address the safety of technologies and the implementation of innovation, and ensure the protection and safe use of data. Regulation specifically pertaining to AI is still nascent and scarce, though a combination of data, technology, innovation, and health and human rights policy has already formed a baseline regulatory framework for AI in health. Future work should explore specific regulatory challenges, especially with respect to AI medical devices, data protection, and data enablement.

OBJECTIVE To provide an overview of the economic aspects of needlestick and sharps injury (NSI) management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate the impact of safety-engineered devices on health care METHODS A systematic review of economic analyses related to NSIs was performed in accordance with the PRISMA statement and by searching PubMed and Scopus databases (January 1997-February 2015). Mean costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int$). RESULTS A total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11 studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means for aggregate (direct + indirect) costs was Int$747 (range, Int$199-Int$1,691). The medians of the means for disaggregated costs were Int$425 (range, Int$48-Int$1,516) for direct costs (9 studies) and Int$322 (range, Int$152-Int$413) for indirect costs (6 studies). When compared with data-driven studies, modeling studies had higher disaggregated and aggregated costs, but data-driven studies showed greater variability. Indirect costs were consistent between studies, mostly referring to lost productivity, while direct costs varied widely within and between studies according to source infectivity, HCP susceptibility, and post-exposure diagnostic and prophylactic protocols. Costs of treating infections were not included, and intangible costs could equal those associated with NSI medical evaluations. CONCLUSIONS NSIs generate significant direct, indirect, potential, and intangible costs, possibly increasing over time. Economic efforts directed at preventing occupational exposures and infections, including provision of safety-engineered devices, may be offset by the savings from a lower incidence of NSIs. Infect Control Hosp Epidemiol 2016;37:635-646.

Background Initiatives aiming to assess the impact of rare diseases on population health might be hampered due to the complexity of disability-adjusted life years (DALYs) estimation. This study aimed to give insight into the epidemiological data sources and methodological approaches used in studies that estimated DALYs for chronic non-communicable rare diseases (CNCRD), and compare its results. Methods A literature strategy was developed for peer-review search in Embase and Medline, and also performed on grey literature databases and population health and/or rare disease-focused websites. We included studies that determined the burden of CNCRD listed on the Orphanet’s and/or the Genetic and Rare Diseases information center (GARD) websites. We excluded communicable and occupational diseases, rare cancers, and cost-effectiveness/benefit studies. Two researchers independently screened the identified records and extracted data from the final included studies. We used the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) statement to assess the quality of reporting of the included studies. The data synthesis depicted the studies’ characteristics, their distribution by geographic coverage and the group of disease(s) they focused on, the methods and data input sources used and estimated DALY per case. Results In total, 533 titles were screened, and 18 studies were included. These studies covered 19 different CNCRDs, of which most fell in the disease category “Diseases of the nervous system”. Diverse methodological approaches and data input sources were observed among burden of CNCRD studies. A wide range of DALY per case was observed across the different studies and diseases included. Conclusions A low number of burden of CNCRD studies was observed and most estimates resulted from multi-country studies, underlining the importance of international cooperation to further CNCRD research. This study revealed a lack of epidemiological data and harmonization of methods which hampers comparisons across burden of CNCRD studies.

Background Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest. Methods DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries. Results Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases – representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period – however, overall levels of inequality were low. Conclusions The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.

The existing frameworks for the evaluation of genetic and genomic applications clearly address the technical and clinical value of a test, but are less concerned with the way genetic services are delivered and organized. We therefore aimed to develop a comprehensive new framework that includes an assessment of service delivery. A new framework was built on the evaluation dimensions identified through a systematic review of the existing frameworks and a Delphi survey of Italian experts in public health genomics. Our framework has four sections. The first two sections, respectively, guide the evidence collection process for the genetic test (analytic validity; clinical validity; clinical utility; personal utility) and its delivery models (organizational aspects; economic evaluation; ethical, legal and social implications; patient perspective). The third section guides the formulation of the research priorities to be addressed in future research. Finally, the fourth section suggests three criteria to summarize the collected evidence (net benefit, cost-effectiveness, feasibility). We have successfully developed an evaluation framework for the evaluation of genetic tests that includes an assessment of service delivery. It also introduces some neglected evaluation dimensions such as personal utility and patient perspective.

BackgroundEpidemiological data obtained during the initial wave of the COVID-19 epidemic showed that persons dying with COVID-19 were typically older men with multiple chronic conditions. No studies have assessed if the characteristics of patients dying with COVID-19 have changed in the second phase of the epidemic, when the initial wave subsided. The aim of the present study was to compare characteristics of patients dying with COVID-19 in Italy in the first ‘peak’ phase of the epidemic and in its second phase.MethodsMedical charts of patients with COVID-19 who died while in hospital in Italy were reviewed to extract information on pre-existing comorbidities, in-hospital complications, and disease trajectories. The course of the epidemic was classified in two 3-month periods: March–May 2020 and June–August 2020.FindingsOverall, in the Italian population, 34,191 COVID-19 deaths occurred in March–May 2020 and 1,404 in June–August 2020. Patients dying in March–May were significantly younger (80.1 ± 10.6 vs. 82.8 ± 11.1 years, p < 0.001) and less frequently female (41.9% vs. 61.8%, p < 0.001) than those dying in June–August. The medical charts of 3533 patients who died with PCR-confirmed SARS-CoV-2 infection in March–May 2020 (10.3% of all deaths occurring in this period) and 203 patients who died in June–August 2020 (14.5% of all deaths occurring in this period) were analysed. Patients who died in March–May 2020, compared to those who died in June–August 2020, had significantly lower rates of multiple comorbidities (3 or more comorbidities: 61.8% vs 74.5%, p = 0.001) and superinfections (15.2% vs. 52.5%, p < 0.001). Treatment patterns also substantially differed in the two study periods, with patients dying in March–May 2020 being less likely to be treated with steroids (41.7% vs. 69.3%, p < 0.001) and more likely to receive antivirals (59.3% vs. 41.4%, p < 0.001). Survival time also largely differed, with patients dying in March–May 2020 showing a shorter time from symptoms onset to death (mean interval: 15.0 vs. 46.6 days, p < 0.001). The differences observed between the two periods remained significant in a multivariate analysis.InterpretationThe clinical characteristics of patients dying with COVID-19 in Italy, their treatment and symptom-to-death survival time have significantly changed overtime. This is probably due to an improved organization and delivery of care and to a better knowledge of disease treatment.

The international public health (PH) community is debating the opportunity to incorporate genomic technologies into PH practice. A survey was conducted to assess attitudes of the European Public Health Association (EUPHA) members towards their role in the implementation of public health genomics (PHG), and their knowledge and attitudes towards genetic testing and the delivery of genetic services. EUPHA members were invited via monthly newsletter and e-mail to take part in an online survey from February 2017 to January 2018. A descriptive analysis of knowledge and attitudes was conducted, along with a univariate and multivariate analysis of their determinants. Five hundred and two people completed the questionnaire, 17.9% were involved in PHG activities. Only 28.9% correctly identified all medical conditions for which there is (or not) evidence for implementing genetic testing; over 60% thought that investing in genomics may divert economic resources from social and environmental determinants of health. The majority agreed that PH professionals may play different roles in incorporating genomics into their activities. Better knowledge was associated with positive attitudes towards the use of genetic testing and the delivery of genetic services in PH (OR = 1.48; 95% CI 1.01-2.18). Our study revealed quite positive attitudes, but also a need to increase awareness on genomics among European PH professionals. Those directly involved in PHG activities tend to have a more positive attitude and better knowledge; however, gaps are also evident in this group, suggesting the need to harmonize practice and encourage greater exchange of knowledge among professionals.

Background Hospitals can gain valuable insights into their current level of organizational health literacy (OHL) by using self-assessment tools. OHL self-assessment tools can serve as useful instruments for supporting the planning and implementation of OHL interventions aimed at promoting health equity and improving patient outcomes. This explorative study aimed to pilot the International Self-Assessment Tool for Organizational Health Literacy (Responsiveness) of Hospitals (OHL-Hos) among hospitals across six countries. Methods The OHL-Hos, grounded in a comprehensive theoretical framework consisting of eight standards, 21 sub-standards and 141 indicators, was piloted in seven hospitals: one in Austria, Germany, the Czech Republic, Norway and Serbia, and two in Italy. In each hospital, the feasibility of using the OHL-Hos was investigated regarding acceptability, implementation, practicality, and integration, identifying strengths and areas for improvement using descriptive analyses. The self-assessment process included individual rating of an interdisciplinary and inter-hierarchical assessment team regarding OHL-Hos indicators from their personal perspectives, followed by a joint assessment to reach a consensus on different ratings. The process and experiences were documented in semi-structured forms, while the ratings on the indicators were documented numerically. Results All hospitals successfully self-assessed their OHL, identifying strengths and areas for improvement. The self-assessment process varied slightly among countries. While the tool was considered important but lengthy and complex, introductory workshops facilitated successful implementation. The self-assessment process raised awareness and stimulated discussions on improving OHL, highlighting the tool’s potential for organizational development. Conclusions The OHL-Hos can serve as a useful tool to identify strengths and areas for improvement in OHL in hospitals. The overall experience with the tool was positive and the joint assessment with the tool was found to foster consensus and enable reflection on OHL, but its comprehensive nature poses challenges to its implementation, leading to recommendations for developing a shortened version of the tool with simple language. Certain indicators require specific knowledge, suggesting different professional groups should address relevant parts.