Addressing health inequalities in Europe: key messages from the Joint Action Health Equity Europe (JAHEE).

Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country's adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.

Evaluating the Effectiveness of Internet-Based Communication for Public Health: Systematic Review.

BACKGROUND: Communicating strategically is a key issue for health organizations. Over the past decade, health care communication via social media and websites has generated a great deal of studies examining different realities of communication strategies. However, when it comes to systematic reviews, there is fragmentary evidence on this type of communication. OBJECTIVE: The aim of this systematic review was to summarize the evidence on web institutional health communication for public health authorities to evaluate possible aim-specific key points based on these existing studies. METHODS: Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we conducted a comprehensive review across 2 electronic databases (PubMed and Web of Science) from January 1, 2011, to October 7, 2021, searching for studies investigating institutional health communication. In total, 2 independent researchers (AN and SS) reviewed the articles for inclusion, and the assessment of methodological quality was based on the Kmet appraisal checklist. RESULTS: A total of 78 articles were selected. Most studies (35/78, 45%) targeted health promotion and disease prevention, followed by crisis communication (24/78, 31%), general health (13/78, 17%), and misinformation correction and health promotion (6/78, 8%). Engagement and message framing were the most analyzed aspects. Few studies (14/78, 18%) focused on campaign effectiveness. Only 23% (18/78) of the studies had an experimental design. The Kmet evaluation was used to distinguish studies presenting a solid structure from lacking studies. In particular, considering the 0.75-point threshold, 36% (28/78) of the studies were excluded. Studies above this threshold were used to identify a series of aim-specific and medium-specific suggestions as the communication strategies used differed greatly. CONCLUSIONS: Overall, the findings suggest that no single strategy works best in the case of web-based health care communication. The extreme variability of outcomes and the lack of a unitary measure for assessing the end points of a specific campaign or study lead us to reconsider the tools we use to evaluate the efficacy of web-based health communication.

The Determinants of Vaccine Literacy in the Italian Population: Results from the Health Literacy Survey 2019.

Vaccines are among the most important public health achievements of the last century; however, vaccine awareness and uptake still face significant challenges and the COVID-19 pandemic has only exacerbated this phenomenon. Vaccine Literacy (VL) is the ability to find, understand and judge immunisation-related information to make appropriate immunisation decisions. A cross-sectional study on a sample of 3500 participants, representative of the Italian adult population aged 18+ years, was conducted in Italy in 2021. A validated questionnaire, including sections on health literacy (HL), sociodemographic characteristics, risk factors, and lifestyles of respondents, was used. VL was measured by four items (item 19, 22, 26 and 29) of the HL section. While 67.6% of the respondents had a "good" (47.5%) or "sufficient" (20.1%) level of VL, 32.4% had "limited" VL levels. Although the overall VL level was quite high, many participants reported difficulties in dealing with vaccination information, particularly those with a lower educational level, those living in southern and insular regions of Italy, those with greater financial deprivation and those with a migration background. Improving VL in Italy should be a top priority in the political agenda, with special regard to socially and geographically disadvantaged communities.

Autoaplicação de insulina em adultos com diabetes mellitus no contexto domiciliar: revisão integrativa / Insulin self-application in adults with diabetes mellitus in the home context: integr ative review / Autouso de insulina en adultos con diabetes mellitus en el contexto domiciliario: revisión integrativa

Objetivo: sintetizar a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar Método: revisão integrativa realizada entre dezembro de 2019 e janeiro de 2020, a partir da busca de publicações em periódicos indexados no PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS e BDENF utilizando-se os termos controlados diabetes Mellitus, self care, insulin, health education, disposable equipment, medical wastedisposal e self administration e seus correspondentes em português, combinados com o operador booleano AND. Foram incluídos artigos originais publicados entre 2009 e 2019, nos idiomas inglês, português e espanhol e que responderam à questão norteadora: qual a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar nos últimos 10 anos? Resultados: compuseram a amostra final oito artigos. Predominaram estudos realizados no Brasil, por enfermeiros no contexto da atenção primária à saúde. Em relação à técnica de autoaplicação de insulina, os resultados foram agrupados em quatro eixos: pré-aplicação, técnica de preparo da insulina, aplicação e pós-aplicação. Observaram-se ações inadequadas em todos os eixos tais como: transporte, armazenamento, autoaplicação, reutilização de agulhas e descarte incorreto. Tais inadequações podem resultar em procedimentos dolorosos, prejuízos no controle glicêmico e complicações para a saúde da pessoa com diabetes Mellitus. Conclusão: os resultados evidenciaram que a realidade da autoaplicação de insulina em adultos com diabetes Mellitus no domicílio pode ser modificada a partir da educação em saúde pelo enfermeiro, bem como colaborar para o planejamento das ações estratégicas para diminuir tais problemas.(AU)

Objective: to synthesize the scientific production on the technique of self-administration of insulin in adults with diabetes Mellitus in the home context. Method: integrative review carried out between December 2019 and January 2020, based on the search for publications in journals indexed in PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS and BDENF using the controlled terms diabetes Mellitus, self-care, insulin, health education, disposable equipment, medical waste disposal and self-administration and their corresponding words in Portuguese, combined with the Boolean operator AND. Original articles published between 2009 and 2019, in English, Portuguese and Spanish, were included, which answered the guiding question: what is the scientific production on the technique of self-administration of insulin in adults with diabetes Mellitus in the home context in the last 10 years? Results: the final sample comprised eight articles. Studies carried out in Brazil by nurses in the context of primary health care predominated. Regarding the insulin self-administration technique, the results were grouped into four axes: pre-administration, insulin preparation technique, administration, and post-administration. Inadequate actions were observed in all axes such as: transport, storage, self-application, reuse of needles and incorrect disposal. Such inadequacies can result in painful procedures, impaired glycemic control, and health complications for the person with diabetes Mellitus. Conclusion: the results showed that the reality of self-administration of insulin in adults with diabetes Mellitus at home can be modified based on health education by nurses, as well as collaborating in the planning of strategic actions to reduce such problems.(AU)

Objetivo: sintetizar la producción científica sobre la técnica de autoadministración de insulina en adultos con diabetes Mellitus en el contexto domiciliario. Método: revisión integradora realizada entre diciembre de 2019 y enero de 2020, a partir de la búsqueda de publicaciones en revistas indexadas en PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS y BDENF utilizando los términos controlados diabetes Mellitus, self care, insulin, health education, disposable equipment, medical wastedisposal y self administration y sus equivalentes en portugués, combinados con el operador booleano AND. Se incluyeron artículos originales publicados entre 2009 y 2019, en inglés, portugués y español, que respondieron a la pregunta orientadora: ¿cuál es la producción científica sobre la técnica de autoadministración de insulina en adultos con diabetes Mellitus en el contexto domiciliario en los últimos 10 años? Resultados: la muestra final estuvo formada por ocho artículos. Predominaron los estudios realizados en Brasil por enfermeros en el contexto de la atención primaria de salud. En cuanto a la técnica de auto aplicación de insulina, los resultados se agruparon en cuatro ejes: antes de la aplicación, técnica de preparación de insulina, aplicación y post aplicación. Se observaron acciones inadecuadas en todos los ejes, tales como: transporte, almacenamiento, auto aplicación, reutilización de agujas y disposición incorrecta. Tales deficiencias pueden resultar en procedimientos dolorosos, deterioro del control glucémico y complicaciones de salud para las personas con diabetes Mellitus. Conclusión: los resultados mostraron que la realidad de la insulina autoadministrada en adultos con diabetes Mellitus en el hogar puede modificarse a partir de la educación en salud brindada por enfermeros, además de ayudar a planificar acciones estratégicas para reducir dichos problemas.(AU)

Comunicação em saúde sobre COVID-19 e Diabetes Mellitus em mídias sociais: verdadeiro e falso / Comunicación de salud sobre COVID-19 y Diabetes Mellitus en las redes sociales: verdadero y falso / Health communication about COVID-19 and Diabetes Mellitus in social media: true and false

Resumo Objetivos Identificar em canais de veiculação midiática, os assuntos verdadeiros e falsos relacionados à COVID-19 e às pessoas com diabetes mellitus. Método Pesquisa documental realizada em postagens no Twitter e nos sites da Sociedade Brasileira de Diabetes e do Ministério da Saúde e submetidas à análise temática e discutidas à luz das evidências científicas sobre o tema. Resultados Das 110 postagens, 71 eram do Twitter, 31 do Ministério da Saúde e 8 da Sociedade Brasileira de Diabetes. As fake news correspondiam a 88 postagens; sete divulgavam informações sobre estudos não concluídos; seis eram notícias equivocadas; e nove verdadeiras. Os assuntos foram agrupados em alimentos e substâncias, condições de vida (socioeconômica e hábitos), medicações, COVID-19 e diabetes mellitus, gravidade e fatores de risco. Há excesso de desinformação com a finalidade de enganar e negar a realidade, dadas as disputas de saberes e poderes políticos, econômicos e ideológicos. Conclusão e implicações para a prática A maior parte das postagens eram fake news. Em sendo as mídias sociais um lugar para a fácil disseminação de informações verdadeiras ou falsas, os cientistas e profissionais de saúde precisam se aproximar das comunidades virtuais dessas mídias e usá-las como ferramentas aliadas da comunicação em saúde.

Resumen Objetivos Identificar cuestiones verdaderas y falsas relacionadas con el COVID-19 y personas con diabetes mellitus en los canales de comunicación. Método Investigación documental realizada en publicaciones en Twitter y en los sitios web de la Sociedad Brasileña de Diabetes y el Ministerio de Salud, sometida a análisis temático y discutida a la luz de la evidencia científica sobre el tema. Resultados De las 110 publicaciones, 71 fueron de Twitter, 31 del Ministerio de Salud y 8 de la Sociedad Brasileña de Diabetes. Las noticias falsas correspondieron a 88 publicaciones; siete revelaron información sobre estudios inconclusos; seis fueron noticias equivocadas; y nueve verdaderas. Los temas se agruparon en alimentos y sustancias, condiciones de vida (socioeconómicas y de hábitos), medicamentos, COVID-19 y diabetes mellitus, gravedad y factores de riesgo. Existe un exceso de desinformación con el propósito de engañar y negar la realidad, dadas las disputas sobre conocimientos y poderes políticos, económicos e ideológicos. Conclusión e implicaciones para la práctica La mayoría de las publicaciones eran noticias falsas. Dado que las redes sociales son un lugar para la fácil difusión de información verdadera o falsa, los científicos y los profesionales de la salud deben acercarse a las comunidades virtuales de estos medios y utilizarlos como herramientas aliadas para la comunicación en salud.

Abstract Objectives To identify true and false issues related to COVID-19 and to people with diabetes mellitus in media channels. Method A documentary research study carried out in posts on Twitter and on the websites of the Brazilian Society of Diabetes and Ministry of Health, submitted to thematic analysis and discussed in the light of the scientific evidence on the topic. Results Of the 110 posts, 71 were from Twitter, 31 by the Ministry of Health and 8 by the Brazilian Society of Diabetes. Fake news corresponded to 88 posts; seven disclosed information about unfinished studies; six were wrong news items; and nine were true. The topics were grouped into food products and substances, living conditions (socioeconomic and habits), medications, COVID-19 and diabetes mellitus, severity and risk factors. There is an excess of disinformation with the purpose of deceiving and denying reality, given the disputes over political, economic and ideological knowledge and powers. Conclusion and implications for the practice Most of the posts were fake news. As the social media are a place for the easy dissemination of true or false information, scientists and health professionals need to approach the virtual communities of these media and use them as allied tools for communication in health.

Information specialists and researchers working together for health promotion: Benefits from school-work educational programmes at the National Institute of Health in Italy.

In 2015, the Italian Ministry of Education in Italy launched innovative upper school educational programmes envisaging school-work initiatives. In this framework, the National Institute of Health (Istituto Superiore di Sanità, ISS) was among the first scientific institutions to develop educational programmes with school. Involving school students in health research activities allowed health literacy improvement, acquisition of scientific communication skills and fostered student interest in science careers. This article focuses on how health literacy and health promotion can be taught to school students through taking part in this programme. It is a multi-disciplinary collaboration among different stakeholders-ISS tutors (researchers, information and communication experts), teachers and students. This collaborative initiative is a good example of 'teaching and learning' in action since all stakeholders could benefit from cross-fertilisation in an informal educational context.

How can we manage the COVID-19 infodemics? A case study targeted to health workers in Italy.

INTRODUCTION: The Istituto Superiore di Sanità (ISS) has been asked for rapid technical and scientific advice to the State and Regions during Sars-CoV-2 pandemic preparedness. METHODS: An ad hoc Working Group on Scientific Literature updates (WG SL) was set up at ISS (March-May 2020) to screen pre-prints and peer reviewed papers from arXiv, medRxiv, bioRxiv, and Pubmed to provide a real time knowledge and empirical evidence addressed to health-workers. RESULTS: The WG SL screened a total of 4,568 pre-prints and 15,590 peer reviewed papers, delivered as daily summary report of pre-print selection for ISS President activity in the National Scientific Technical Committee framework and a weekly open access publication (COVID Contents) on peer-reviewed papers of interest for health professionals, monitored by a satisfaction questionnaire. CONCLUSIONS: Promoting heath literacy, with a cross-cutting approach is a powerful heritage of Public Health Institutes and a proven effective non pharmacological intervention.

Patient Safety and Satisfaction in Home Chemotherapy.

Chemotherapy is increasingly being administered in patients' homes, improving quality of life and patient comfort as well as reducing use of inpatient facilities and costs. This article describes outcomes of home chemotherapy administered by trained nurses to adult patients with solid tumors or hematological diseases. This descriptive study was conducted between February 2018 and May 2020. Variables examined included age, sex, diagnosis, routes of administration, adverse effects, tolerance, and patient satisfaction. One hundred forty-seven patients (57.14% male) with an average age of 67.8 years agreed to participate. A total of 1018 chemotherapy sessions were examined. The most common diagnoses were prostate cancer, colon cancer, and high-risk myelodysplastic syndromes. Thirty-five percent (n = 356) of the sessions were conducted with: Azacytidine, 5-Fluoruracil, Oxaliplatin + Docetaxel + Leucovorin + Fluorouracil, and Leuprolide Acetate. The routes of administration included: intravenous (69.25%), intramuscular (13.75%), subcutaneous (15.32%), and intravesical (1.66%). Very good tolerance was reported after 87.81% of sessions and good after 8.45%. Adverse events during administration occurred in 7 sessions (0.7%); all were considered minor events. In the 24 hours following administration, 62 adverse events (6.1%) were reported, again all considered minor. All patients reported feeling just as safe as in the hospital. Our results contribute to the feasibility and safety of home chemotherapy.

Coping strategies for violence against children, adolescents and women in the contet of social isolation due to COVID-19: scoping review / Estrategias para hacer frente a la violencia contra niños, adolescentes y mujeres en el contexto del aislamiento social debido al COVID-19: revisión de alcance / Estratégias de enfrentamento à violência contra crianças, adolescentes e mulheres no contexto do isolamento social devido à COVID-19: scoping review

ABSTRACT Objective: to map the recommendations of the coping strategies for violence against children, adolescents and women in the context of social isolation due to Covid-19. Method: a scoping review according to the Joanna Briggs Institute, through a research strategy carried out in the gray literature by the CAPES Portal and in the following databases: SCIELO, LILACS, PubMed, CINAHL, Web of Science, and Institutional Repository for Information Exchange of the Pan American Health Organization. The analysis of the identified material was carried out by three independent reviewers. The extracted data were analyzed and synthesized in narrative form. Results: of the 526 studies found, 59 were kept for review and their content was summarized in six categories: 1) prevention; 2) identification and intervention; 3) continued care; 4) care for the safety and mental health of the professionals; 5) intersectoriality/interdisciplinarity; and 6) special care for vulnerable populations. Conclusion: the services must guarantee continuous, intersectoral and safe care, especially in the context of mental health, as well as community awareness must be promoted. Health professionals must be sensitive and alert to signs of violence, intervening immediately and connected to the safety network.

RESUMEN Objetivo: mapear las recomendaciones de las estrategias para hacer frente a la violencia contra niños, adolescentes y mujeres en el contexto del aislamiento social debido al Covid-19. Método: revisión de alcance de conformidad con el Joanna Briggs Institute, por medio de una estrategia de investigación realizada en la literatura gris en el Portal CAPES y en las siguientes bases de datos: SCIELO, LILACS, PubMed, CINAHL, Web of Science, Repositorio Institucional para Intercambio de Información de la Organización Panamericana de la Salud. El análisis del material identificado estuvo a cargo de tres revisores independientes. Los datos extraídos fueron analizados y sintetizados de forma narrativa. Resultados: de los 526 estudios encontrados, 59 se mantuvieron para la revisión y su contenido se sintetizó en seis categorías: 1) prevención; 2) identificación e intervención; 3) atención continua; 4) atención a la seguridad y la salud mental de los profesionales; 5) intersectorialidad/interdisciplinaridad; y 6) atención especial a poblaciones vulnerables. Conclusión: los servicios de salud deben garantizar atención continua, intersectorial y segura, en especial en el ámbito de la salud mental, al igual que debe promoverse la concientización comunitaria. Los profesionales de la salud deben permanecer sensibles y alerta a señales de violencia, interviniendo de forma inmediata y conectados a la red de protección.

RESUMO Objetivo: mapear as recomendações das estratégias de enfrentamento à violência contra crianças, adolescentes e mulheres no contexto do isolamento social devido à Covid-19. Método: revisão de escopo conforme Instituto Joanna Briggs, por meio de uma estratégia de pesquisa realizada na literatura cinzenta pelo Portal CAPES e nos bancos de dados SCIELO, LILACS, PubMed, CINAHL, Web of Science, Repositório Institucional para Intercambio de Información da Organização Pan-Americana da Saúde. A análise do material identificado foi realizada por três revisores independentes. Os dados extraídos foram analisados e sintetizados de forma narrativa. Resultados: dos 526 estudos encontrados, 59 foram mantidos para revisão e seu conteúdo foi resumido em seis categorias: 1) prevenção; 2) identificação e intervenção; 3) cuidado continuado; 4) cuidado à segurança e saúde mental dos profissionais; 5) intersetorialidade/interdisciplinaridade; e 6) cuidado especial a populações vulneráveis. Conclusão: os serviços devem garantir um cuidado contínuo, intersetorial e seguro, em especial, no âmbito da saúde mental, bem como, deve-se promover a conscientização comunitária. Os profissionais da saúde devem estar sensíveis e alertas a sinais de violência, intervindo de forma imediata e conectada à rede de proteção.

International promotion of e-Bug, an infection prevention and control educational intervention: survey of partners across 14 countries.

BACKGROUND: Antimicrobial resistance (AMR) is a global threat to public health. e-Bug is an educational resource developed and promoted by a network of international partners. e-Bug seeks to reduce the spread of infection and use of antimicrobials in young people and the community, so helping to control AMR. This study aimed to explore how e-Bug is promoted by international partners and observe barriers to promotion, including the extent of education about antibiotics in schools. METHODS: A total of 29 e-Bug partners were invited to complete online questionnaires on (i) methods they use to promote e-Bug; and (ii) antibiotic topics covered in the national curriculum in their countries. RESULTS: Fourteen and 15 of 29 e-Bug partners across Europe and Palestine completed the promotional activities and curriculum questionnaires respectively. The most frequently reported methods of promotion included endorsement and collaboration with government and non-government sectors and involvement in national and global health awareness campaigns. Barriers to promotion included a lack of time and funding. The curriculum survey data showed variation in antibiotic education across Europe and Palestine, lack of antibiotic education for children under 11 years of age and little change in antibiotic topics included in the curriculum since 2006. CONCLUSIONS: Future and existing e-Bug partners should be encouraged to follow promotional activities reported in this paper, including ministry endorsement, educator training, international campaigns and youth programmes. We encourage all countries to increase antibiotic topics in the school curriculum across all ages.

Symptomatology and quality of life between two populations of climacteric women.

PURPOSE: The aim of this study is to compare climacteric symptomatology and sociodemographic conditions and their effect on quality of life in two populations: Monterrey (Mexico) and Madrid (Spain). METHODS: 469 women from Monterrey (mean age 50.5 + 4.3 years) and 452 (mean age 51.7 + 3.7 years) from Madrid participated in the study. Descriptive analyses of sociodemographic and clinics characteristics of the sample were performed. A cross-sectional design and a regression analysis were performed to establish the sociodemographic and clinical variables that would be used as predictors of quality of life. Data was collected using the Menopause-Specific Quality of Life, MENQOL, the Menopause Rating Scale (MRS), the Hospital Anxiety and Depression Scale (HADS), the Quality of Life Scale for Women Aged From 45 to 64 (QLS), and a sociodemographic and clinical interview designed ad hoc. RESULTS: Approximately 60% of both Spanish and Mexican women present symptoms during climacteric that impairs their quality of life. Spanish women suffer more intense symptoms and for a longer period of time than Mexican women, with the exception of anxiety. Mexican women report better quality of life than Spanish women and it is moderated by educational, socioeconomical, and marital status. Women's knowledge about menopause is also related to a better quality of life. CONCLUSIONS: Our study confirms the differences in climacteric symptomatology between populations and the impact of educational level and knowledge about menopause as predictors of a better quality of life in climacteric women.

Health and Climate Change: science calls for global action.

Climate changes affect social and environmental health determinants such as clean air, ecosystems health, safe drinking water and safe sufficient food. Globally, people at greatest risk of adverse health effects associated with climate change include children, the elderly and other vulnerable groups. Temperature-related death and illness, extreme events, polluted or stressed ecosystems represent relevant issues raising concern for both health and economic consequences. The aim of the Symposium "Health and Climate Change" (Istituto Superiore di Sanità, Rome 3-5 December 2018) was to promote an inter-sectoral and multidisciplinary approach to estimate and prevent climate change-related events as well as to call the authorities to put in place measures to reduce adverse health effects. At the end of the Symposium the Rome International Charter on Health and Climate Change was presented. It includes a series of actions and recommendations, discussed and shared by all the participants, intended to inform policy makers and all the stakeholders involved in the management of climate changes.

Health inequalities: a Research Positioning Exercise at the National Institute of Health, Italy.

BACKGROUND: The Italian National Institute of Health (Istituto Superiore di Sanità, ISS) considers health inequalities (HI) an important area of activity. As the scientific and technical body of the Ministry of Health and the National Health Service, ISS may play a key role to reduce HI. In order to enable ISS in addressing the new and crucial HI challenge, a Research Positioning Exercise was designed and implemented. METHODS: The Exercise included: (i) workshop to strengthen the institutional interest in the field of HI; (ii) review and analysis of ISS publications (years 2000-2017) to identify HI research topics; (iii) survey among ISS researchers regarding main research challenges to address HI in the coming years; and (iv) analysis of input on research challenges from HI international experts. RESULTS: The results of this Exercise suggest that the following points should be included in the future ISS agenda planning: (i) themes which ISS should continue working on (e.g. migrants/vulnerable groups); (ii) themes to be improved: (a) relationship between social determinants and mechanism of HI generation and (b) relationship between risk factors exposure and social determinants; and (iii) new themes to be addressed: (a) mechanisms underlying the resilience observed in Italy; (b) new socioeconomic indicators for HI monitoring; and (c) evidence-based policies aimed at reducing HI. CONCLUSION: Findings of this Exercise show that ISS researchers identified relevant areas, addressing inequalities in addressing the health. Because of ISS structural peculiarity that includes multidisciplinary expertise, the ISS could provide a significant contribution to HI research challenges and knowledge gaps.

Equidad según sexo y de género en la investigación: justificación de las guías SAGER y recomendaciones para su uso / Sex and gender equity in research: rationale for the SAGER guidelines and recommended use

Introducción: Este artículo describe la justificación de un conjunto internacional de directrices para apoyar la presentación sistemática del sexo y del género en investigación, en todas las disciplinas. Métodos: Un panel de 13 expertas/os representantes de nueve países desarrollaron las directrices mediante una serie de teleconferencias, presentaciones en conferencias y un taller de 2 días. Se realizó una encuesta en Internet a 716 editoras/es de revistas, científicas/os y miembros de la comunidad editorial internacional, así como una búsqueda bibliográfica sobre políticas de sexo-género en publicaciones científicas. Resultados: Las directrices para la incorporación equitativa del sexo y del género en la investigación (Sex and Gender Equity in Research − SAGER) son un procedimiento integral para informar sobre el sexo y el género en el diseño de estudios, análisis de datos, resultados e interpretación de los hallazgos. Conclusiones: Las guías SAGER están diseñadas principalmente para ayudar a las/los autoras/es en la elaboración de sus manuscritos, pero también son útiles para las/los editoras/es, como guardianes de la ciencia, para incorporar la evaluación de la existencia de hombres y mujeres y la perspectiva de género en todos los manuscritos como parte integral del proceso editorial

Background: Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. Methods: A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literatura search on sex and gender policies in scientific publishing. Results: The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. Conclusions: The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process

[Sex and gender equity in research: rationale for the SAGER guidelines and recommended use]. / Equidad según sexo y de género en la investigación: justificación de las guías SAGER y recomendaciones para su uso.

BACKGROUND: Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. METHODS: A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literatura search on sex and gender policies in scientific publishing. RESULTS: The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. CONCLUSIONS: The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

Assessment of health literacy skills in family doctors' patients by two brief, self-administered Italian measures.

Health Literacy (HL) is an important health determinant: low HL skills result in less healthy choices, riskier behavior, poorer health, less self-management and more hospitalization. An observational study was conducted in a selected population, attending the waiting rooms of family general practitioners, with the aim of assessing HL capabilities through the administration of two HL screeners (IMETER and SILS-IT), and comparing the two measures. An anonymous questionnaire was administered, consisting of the Italian versions of the two tests on a single sheet. Demographic data, as well as concomitant chronic diseases and vaccines received, were also collected. HL skills were measured by the scores observed at both tests, and by the frequency of subjects with low HL levels according to the respective cut-off values. Overall, 305 questionnaires were collected and analyzed. Regarding IMETER, the observed frequency of subjects with low HL skills was 25.2% and the mean score and mean adjusted-score (26.3 ± 8.8 and 23.2 ± 9.4, respectively) were lower than those observed in previous studies. Similarly, at SILS-IT the percentage of subjects with low skills (49.9%) was higher than observed previously. IMETER showed high internal consistency (Cronbach's alpha > 0.9). The two measures were significantly correlated, although with a low Spearman's coefficient, and IMETER did not provide significant information about the probability to predict low HL according to SILS-IT. These results are explainable by the differences in assessment and domains between the two tests, both reliable and suitable to screen patients with low functional HL.

Los medicamentos y la información: implicaciones para la imputación de la responsabilidad civil por riesgo de desarrollo en Colombia / Medications and information: implications concerning the allocation of civil responsibility for the development risk in Colombia / As medicinas e a informação: implicações para o imputação da responsabilidade civil pelo risco do desenvolvimento em Colômbia

Resumen Al utilizar como diseño metodológico el uso de un examen dogmático de las instituciones de la responsabilidad civil y del derecho del consumidor, se planteó el objetivo de verificar que el surgimiento del supuesto especial de la responsabilidad del productor contribuye a reforzar la protección de los pacientes, si se observa la posibilidad de que los medicamentos, en cuanto productos inherentemente riesgosos, pueden generar daños a quienes los consumen. El problema resalta respecto a aquellos medicamentos cuyos efectos adversos se revelan con posterioridad a su introducción en el mercado, lo que da lugar al dilema de si es dable imputar la responsabilidad al productor del medicamento defectuoso, entendida como la pregunta de investigación. Como resultado, se encontró que sí es posible articular una interpretación en ese sentido, a la luz de una lectura del régimen vigente de protección del consumidor en Colombia, bajo el cual cabe una imputación de responsabilidad por daños derivados de la defectuosidad que incluye la ausencia de información.

Abstract With the use of a dogmatic test as the methodological design of civil liability and the Consumer Right, the objective was aimed at verifying that the emergence of the special assumption of producer's responsibility helps strengthen patients' protection if the proposed possibility of medications, as inherently risky products, can contribute to harm those expected to consume them. The problem stands out with respect to drugs the adverse effects of which are revealed subsequently to their introduction in the market, which gives rise to the dilemma of deciding whether their adverse effects are revealed after their introduction in the market, which gives rise to the dilemma of whether the liability can be imputed to the faulty medication producer, understood as the research or investigation question. As a result, it was found that, indeed, articulating an interpretation in that sense is viable under the consumer's protection right in Colombia, where there is an imputation of liability for damages deriving from the defectiveness including the absence of information.

Resumo Ao utilizar como o projeto metodológico o uso de um exame dogmático das instituições da responsabilidade civil e do Direito do Consumidor, propôs-se o objetivo de verificar que o surgimento do pressuposto especial da responsabilidade do produtor contribui para reforçar a proteção dos pacientes, se a possibilidade que as medicinas estão observadas, assim que produtos inerentemente de risco, podem gerar os danos àqueles que os consomem. O problema enfatiza aqueles medicamentos cujos efeitos adversos revelam com posterioridade a sua introdução no mercado, que é a causa do dilema se for possível imputar a responsabilidade ao produtor do medicamento defeituoso, compreendida como a pergunta da pesquisa. Como o resultado, achou-se que sim é possível articular uma interpretação nesse sentido, à luz de uma leitura do regime eficaz da proteção do consumidor em Colômbia, sob o qual aplica uma imputação da responsabilidade pelos danos derivados dos ajustes da defeituosidade que inclui a ausência da informação.

Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia.

INTRODUCTION: Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed. METHODS: We used data from the 'Cohort of African people Starting Antiretroviral therapy' (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan-Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition. RESULTS: A total of 1198 patients were included in the study. Kaplan-Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition. CONCLUSIONS: The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

[Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use]. / Equidade de sexo e gênero na pesquisa: fundamentação das diretrizes SAGER e uso recomendado.

BACKGROUND: Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. METHODS: A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literature search on sex and gender policies in scientific publishing. RESULTS: The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. CONCLUSIONS: The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

CONTEXTO: Diferenças de sexo e gênero são muitas vezes negligenciadas no desenho da pesquisa, na implementação do estudo e no relato científico, bem como na comunicação científica em geral. Este descuido limita a capacidade de generalização dos achados das pesquisas e a sua aplicabilidade à prática clínica, em particular para as mulheres, mas também para os homens. Este artigo descreve a fundamentação lógica para um conjunto internacional de diretrizes, com o intuito de encorajar uma abordagem mais sistemática para o relato de sexo e gênero na pesquisa entre disciplinas. MÉTODOS: Um painel de 13 peritos, representando nove países, desenvolveu as diretrizes por meio de uma série de teleconferências, apresentações em conferências e uma oficina de dois dias. Realizou-se uma pesquisa na internet com 716 editores de revistas, cientistas e outros membros da comunidade editorial internacional, bem como uma busca bibliográfica sobre políticas de gênero e sexo na publicação científica. RESULTADOS: As diretrizes sobre Equidade de Sexo e Gênero em Pesquisa (Sex and Gender Equity in Research - SAGER) são um procedimento abrangente para relatar informações sobre sexo e gênero no desenho do estudo, na análise de dados, nos resultados e na interpretação dos achados. CONCLUSÕES: As diretrizes da SAGER destinam-se principalmente a orientar os autores na preparação de seus manuscritos, mas também são úteis para os editores, como guardiões da ciência, para integrar a avaliação de sexo e gênero em todos os manuscritos como parte integrante do processo editorial.