The impact of the COVID-19 pandemic on the use of Emergency Departments in Italy.

Background: During 2020, COVID-19 had a diversified distribution in Italy, the first nation in Europe to experience the outbreak of the epidemic. This was linked to geographical differences in population density and distribution of healthcare facilities, including Emergency Departments (EDs). This study aims to assess the impact of the pandemic on ED utilization in 2020 across different subpopulations and geographical locations in Italy. Methods: We used anonymized data from a survey conducted by the Italian National Institute of Statistics on 25,000 families to analyze the yearly rate of people who used EDs from 2015 to 2020. The rate of persons who accessed ED services in 2020 per 1,000 population was compared with those of the previous non-pandemic years. Results: The number of people accessing EDs in 2020 was 32.3% lower, although this reduction was not uniform across the 21 regions / autonomous provinces. People aged 0-14 years experienced the highest reduction in ED visits. In 2020, low educational level people exhibited a steeper reduction in the use of EDs. Conclusions: This study shows a significant drop in EDs use especially by children; the population section mostly affected by the effects of the pandemic. This study also confirms that education and socio-economic status are important determinants of ED use. The heterogeneous reduction in ED use across the regions of Italy highlights the need to further investigate the impact of this pattern on the health of the population, as well as to define adequate preparedness strategies to face future emergencies.

Innovative Health Technologies to Improve Emergency Department Performance : Dario Tedesco

Background Emergency Departments (EDs) are increasingly pivotal, with a constant increment in their use, despite stable or declining fundings. Crowding can lead to disruptions and the COVID-19 epidemic has further burdened ED services. However, the pandemic has seen an increased use of telemedicine and digital health tools, which may be notably beneficial for EDs. This study offers a review of the latest available digital health technologies and their effectiveness to improve ED performance. Methods We performed a narrative review to identify digital and technological innovations in EDs. The themes of interest were defined in 4 areas: Patient Assessment, Patient Experience, Resource Allocation, and Discharge. Data was analyzed by 5 independent reviewers who focused on different macro-areas. Disagreement on data was discussed with 2 independent tiebreakers. Results Our search yielded 25 articles addressing 4 topics: Patient Assessment, Resource Allocation, Patient Experience, Discharge. We found that digital tools and Artificial Intelligence are powerful tools to detect, collect, and process data from patients, to improve healthcare delivery in EDs. The Resource Allocation category showed to be key in optimizing services already in place. New technologies showed effective to improve Patient Experience by curbing pain and anxiety. Innovative technologies demonstrated efficacy after Discharge when patients need guidance from clinicians for follow-up care. Conclusions Our review shows evidence of increasing effectiveness of innovative tools in reducing wait time and improving performance and patient experience in EDs. Technology applied to resource allocation appeared to be the most effective category. Prediction algorithms could be used to improve workforce allocation and bed management. Critical care systems must meet the challenge of innovative technologies which can lead to a new era in healthcare delivery with improvements for patients and healthcare professionals. Key messages • Digital innovation will have a significant impact on several dimensions of healthcare in the near future. • Healthcare systems and EDs must meet the challenge of innovative technologies which can lead to a new era in healthcare delivery with improvements for both patients and healthcare professionals.

COVID-19 Vaccine Hesitancy and Early Adverse Events Reported in a Cohort of 7,881 Italian Physicians.

Background: The COVID-19 vaccination campaign began in Italy at the end of December 2020, with the primary aim of immunizing healthcare professionals, using the EMA approved mRNA vaccines (Comirnaty® by Pfizer/BioNTech; mRNA-1273 by Moderna) and recombinant adenoviral vaccine (Vaxzevria® by AstraZeneca). The study aimed at evaluating the prevalence and motivations underlying Vaccine Hesitancy, as well as the incidence and type of adverse events associated with COVID-19 vaccination. Methods: Cross-sectional study. Data were collected January 1st to 28th 2021 using a purposely created online self-administered questionnaire from a selected cohort of Italian physicians. Results: Overall, 7,881 questionnaires were analyzed: 6,612 physicians had received one dose, and 1,670 two doses of Comirnaty®; 30 had received one dose of mRNA-1273. Vaccine Hesitancy rate was 3.6%; it correlated with prior SARS-CoV-2 infection, diabetes, Adverse Eventss at previous vaccinations and refusal of 2020 flu vaccine, and was mainly motivated by concerns about vaccine Adverse Events. Typical Adverse Events were pain/itching/paresthesia at the inoculation site, followed by headache, fever, fatigue and myalgia/arthralgia occurring more frequently after the second dose (77.8 vs 66.9%; p<0.001), and in subjects with a prior SARS-CoV-2 infection. Conclusion: Adherence to COVID-19 vaccination is high among physicians. Adverse Events are typically mild and more frequent in people with a prior SARS-CoV-2 infection.

“Missed a vaccine?” Survey on vaccine hesitancy of high-risk categories in Bologna

Background Vaccine Hesitancy (VH) is considered by the WHO to be one of the ten threats of the 21st century. The Italian National Plan for Vaccine Prevention, as well as the European Action Plan, have among their objectives that of increasing the adherence to vaccinations both in general population and in categories at higher risk. It is precisely to these latter groups that the action of the Bologna Local Health Authority (LHA) has addressed targeted vaccination campaigns in recent years (e.g., DTP, HepB, PCV/PPV, RZV). Aim of our study was to investigate adherence to the proposed vaccination campaigns. Methods An anonymous QR-code scanned survey was administered to adults during the COVID-19 vaccine campaign in February in Bologna, a city in Northern Italy. Results A total of 2,321 participants were enrolled, 59% of whom were female. Among healthcare workers (n = 1,417), VH was 45.6% for Hib in 2020, 60.3% in 2019, and 68.3% in 2018;and 14.9% for HepB. Among people with chronic conditions (n = 149), 36.6% did not get the PCV/PPV vaccine. Among RZV vaccine recipients (n = 406), only 11.1% reported having been vaccinated. Women who were at least once pregnant in the last 5 years (n = 124), did not get the anti-pertussis vaccine in 41.9% of cases, and 71.8% of them refused the Hib vaccine. In general, the reasons most often given for missed vaccinations were ‘I did not inform myself enough about this specific vaccine' (ranging from 16.0% for Hib for healthcare workers to 44.8% for RZV), ‘I am not informed about the vaccinations I am entitled to' (27.3% for RZV, 31.8% for PCV/PPV), and ‘I do not find it useful' (46.2% for Hib in healthcare workers). Conclusions Our findings show that even in those who accept the COVID-19 vaccine, VH is high for other vaccinations campaigns run by the Bologna LHA. Targeted awareness and designed catch-up actions are needed, especially regarding this group that does not totally stand in the ranks of the so-called ‘no vax'. Key messages Vaccine Hesitancy toward other vaccines remains high among those who accept the anti-COVID-19 vaccination. A large number of hesitant respondents report either not being aware of the possibility of vaccination or not being adequately informed about the specific vaccine.

Preliminary data on physical well-being of children and adolescents during the SARS-CoV-2 pandemic

Background The COVID-19 outbreak has forcibly overshadowed the physical well-being of children and adolescents, of which we will see the consequences in near future. The programs to contain the spread of Sars-CoV-2 resulted in prolonged lockdown periods, discontinuity of educational services and a possible decrease in physical activities (PA) among the youngest. In the local reality of the Metropolitan City of Bologna children and adolescents underwent a radical change in habits and lifestyle, overall predisposing sedentariness and unhealthy behaviors. Our project, “Come te la passi?”, aims to acknowledge lifestyle variations (concerning diet, PA, sleep behavior/quality) to design, in second-phase interventions, individualized school-based educational programs. Methods This ongoing study is being conducted using an on-line anonymous questionnaire targeting parents/guardian of children and adolescents aged 6-17 recruited from 26th to 28th of April in Bologna, a city in Northern Italy. Results Preliminary data suggested that among adolescents (n = 124) 91.2% used to do PA 2 or more times a week before lockdown, while during lockdown this percentage decreased, reaching 41.1%. In children (n = 38) we observed an even more pronounced difference, with PA decreasing from 89.5% to 26.3%. In children 29% of the participants also reported a weight gain, while 65.8% did not report any variation and only 5.2% reported a weight loss. For the majority of both children's and adolescents' parents (n = 162), the strategies to address the reduction in PA were predominantly having school time dedicated only to PA (53.1%) and being more educated about simple physical exercises (14.5%). Conclusions Our preliminary findings suggest that the current pandemic had a strong impact on the well-being of children and adolescents;“Come te la passi?” second-phase interventions could be crucial in addressing the youngest' needs, to educate and promote healthier lifestyles through school-based programs. Key messages Children’s and adolescents’ lifestyle behaviors were strongly affected by the current pandemic, with physical activity frequency more than halved. “Come te la passi?” objectives are to frame the major critical issues detected and to shape educational school programs based on identified needs.

Trust of Italian healthcare professionals in COVID-19 (anti-SARS-COV-2) vaccination.

ABSTRACT: Background. Vaccination is one of the most effective tools available to Public Health. Its potential usefulness is threatened by the rise of vaccine hesitancy among the general population, which has grown as much as to prompt the World Health Organization to express its concerns on the matter. The risk posed by vaccine hesitancy is even more concerning in the light of the efforts to curb the ongoing COVID-19 pandemic, which focus mainly on mass vaccination campaigns. This holds especially true when applied to healthcare professionals, among whom vaccine hesitancy can be particularly detrimental. For these reasons, our study focuses on potential determinants of vaccine hesitancy among healthcare professionals. Study design. The study is a cross-sectional study. Methods. Data were collected from January 1st to February 16th, by means of a self-administered online questionnaire in a cohort of Italian healthcare professionals. Results. Overall, 10,898 questionnaires were collected. Among the respondents, 1.1% expressed vaccine hesitancy. Hesitancy was less frequent in professionals involved in Primary Care and in the Clinical Scien-ces/Public Health group. Among clinicians, paediatricians, oncologists, and geriatrists showed especially accepting attitudes towards vaccination. Lower hesitancy rates were also registered among the respondents who already had received influenza vaccination and who never had any adverse effects following vaccination. Higher hesitancy rates were observed among individuals who had family members aged >65 years and with a history of severe adverse reactions to vaccination. Conclusion. Vaccine hesitancy rates were extremely low among participants in our study. Some medical specialties shown were particularly accepting towards vaccination. The potential predictors and protective factors pointed out by our analysis might allow more refined targets.

Willingness to receive covid-19 vaccination in costumers accessing community pharmacies in the province of Palermo, Italy

In Italy, vaccination against COVID-19 began on December 27, 2020. To date, 13,713,224 people in Italy are fully vaccinated, which accounts for 25.3 % of the general population, and 44.8% received at least one vaccination dose. The present study aim to investigate willingness to receive COVID-19 vaccination in costumers accessing a sample of community pharmacies in the Province of Palermo, Italy. A self-administered and anonymous questionnaire was carried out among costumers older than 18 years old between December 2020 and March 2021. Three hundred and sixty-three subjects were enrolled in the study, 259 (71.3%) expressed their willingness to receive COVID-19 vaccination. The main determinants associated with vaccination acceptance resulted “trust in safety and effectiveness of vaccinations” and the absence of any previous negative vaccination experience. Unfavourable information on COVID-19 vaccination obtained through internet/media/social media and lack of confidence in COVID-19 vaccines and in the Italian national healthcare system are the main determinants associated with vaccine refusal. Male gender, younger age classes and influenza vaccination acceptance due to the impact of COVID pandemic were significantly associated with willingness to be vaccinated against COVID-19. In order to promote COVID-19 vaccination campaign accurate, informative and communicative campaign dedicated to subjects that are more hesitant regarding COVID-19 vaccination (e.g. female sex, adults, people that usually do not adhere to influenza vaccination campaign) should be implemented. © EuroMediterranean Biomedical Journal 2021.

Would Parents Get Their Children Vaccinated Against SARS-CoV-2? Rate and Predictors of Vaccine Hesitancy According to a Survey over 5000 Families from Bologna, Italy

In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination. The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening. Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity. The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents. An online survey was performed in parents/guardians of children aged <18 years old, living in Bologna. Overall, 5054 questionnaires were collected. A vast majority (60.4%) of the parents/guardians were inclined to vaccinate, while 29.6% were still considering the opportunity, and 9.9% were hesitant. Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6-10 years, <=29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies. Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information.

Enhancing COVID-19 Vaccines Acceptance: Results from a Survey on Vaccine Hesitancy in Northern Italy

In March 2021, the coronavirus disease 2019 (COVID-19) pandemic still poses a threat to the global population, and is a public health challenge that needs to be overcome. Now more than ever, action is needed to tackle vaccine hesitancy, especially in light of the availability of effective and safe vaccines. A cross-sectional online survey was carried out on a representative random sample of 1011 citizens from the Emilia-Romagna region, in Italy, in January 2021. The questionnaire collected information on socio-demographics, comorbidities, past vaccination refusal, COVID-19-related experiences, risk perception of infection, and likelihood to accept COVID-19 vaccination. Multiple logistic regression analyses and classification tree analyses were performed to identify significant predictors of vaccine hesitancy and to distinguish groups with different levels of hesitancy. Overall, 31.1% of the sample reported hesitancy. Past vaccination refusal was the key discriminating variable followed by perceived risk of infection. Other significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%). Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance-a key path to ensure a rapid way out of the current pandemic emergency.