Cost-consequence analysis of influenza vaccination among the staff of a large teaching hospital in Rome, Italy: A pilot study.

Flu vaccination, as well as being effective to prevent seasonal influenza, decreases staff illness and absenteeism and reduces costs resulting from loss of productivity. Despite the effectiveness of flu vaccination, the seasonal coverage among healthcare workers is usually low. The aim of this retrospective observational study was to analyze the vaccination coverage rate among all employees (healthcare workers and administrative staff) of a large teaching hospital in Rome during the 2017-2018 influenza season, to perform a cost-consequence analysis of influenza vaccination (by evaluating the absenteeism due to illness in the epidemic period), and to assess the impact of vaccination in terms of both costs and sick days. The flu vaccination coverage rate was 9.8% among 4631 healthcare workers and 852 administrative employees. The human capital approach estimated a loss of productivity equal to 297.06 € for each vaccinated worker and 517.22 € for each unvaccinated worker (cost-outcome ratio: 120.07 €/sick day). Applying the friction cost method, a loss of productivity equal to 237.65 € for each vaccinated worker and 413.78 € for each unvaccinated worker (cost-outcome ratio: 104.19 €/sick day) was found. These results confirm the benefits of the flu vaccination for the society and the company. This allowed the management to grant one hour of permission to the flu-vaccinated workers in the following annual vaccination campaign (2018-2019).

[Effectiveness of a postnatal psychological treatment for women who had screened positive for depression]. / Efficacia di un intervento psicologico rivolto a donne positive allo screening per depressione post partum.

AIM: This study evaluates the effectiveness of a psychological intervention based on a brief cognitive behavioural and psycho-educational treatment for women suffering from post partum depression. METHOD: The sample was recruited within a programme of screening and early intervention for post partum depression risk. 1558 women were screened between the 6th and 12th week after birth. 110 (7.1%) of them resulted positive to the Edinburgh Postnatal Depression Scale (score ≥12) and 81 accepted a thorough clinical diagnostic examination through the administration of the Mini International Neuropsychiatric Interview and the self-assessment instruments Beck Depression Inventory, State-Trait Anxiety Inventory, Psychological Well-being Scales, Short-Form Health Survey and Positivity Scale. Women who had been confirmed with the diagnosis of major depression episode (N=65; 80.2%) were offered to follow the treatment (10 weekly sessions) and to fill in again the instruments at the end of the treatment and after six months. Out of the 81, 63 women accepted and begun the treatment. RESULTS: 56 (88.9%) women completed treatment and filled in the instruments. Most of them (N=43) completed the instruments even after 6 months. At the end of treatment and after 6 months significant improvements were found in all scores of the instruments used. Furthermore, up to 70% of women who had been treated showed a clinically significant improvement in one or more evaluated outcomes. Such improvements were persistent in women evaluated 6 months after the treatment. CONCLUSION: The results of the study are consistent with studies that in other Countries evaluated, even experimentally, the same intervention or similar interventions with postnatal women and based on cognitive behavioural techniques. Such brief and structured interventions are most likely effective and easily accepted by women who suffer from post partum depression even in the routine practice of Italian health care services.

[Positive screening and risk factors of postpartum depression in women who attended antenatal courses]. / Positività allo screening e fattori di rischio della depressione post partum in donne che hanno partecipato a corsi preparto.

AIM: This study was designed to evaluate the prevalence of women screened positive for postpartum depression (PPD) and to investigate the main risk factors for PPD, in a large sample of Italian women. METHOD: The sample (N=567) was recruited as part of 91 antenatal courses. Women were screened between the 6th and 12th week after birth, by filling the EPDS (Edinburg Postnatal Depression Scale). The validated cut-off score of ≥12 was used. Socio-demographic and clinical variables were investigated. RESULTS: Out of the 567 screened women, 42 (7.4%) were positive. A higher risk was found in women who, during pregnancy, had a depressed mood (OR=3.2) or suffered from anxiety (OR=6.3), had little (OR=4.8) or no (OR=6.5) psychological support from friends or family, or their partner (OR=4.4), had a baby given to crying (OR=7.8), had a low self-esteem (OR=4.8), or had had, as children, a mother that was often (OR=4.6) or always (OR=12.5) critical of them. DISCUSSIONS AND CONCLUSIONS: The results of the study are in agreement with the literature considering social and family support and the presence of anxiety and/or depression during pregnancy as main risk factors for PPD. In disagreement with previous studies on risk factors for depressive disorders, we found that the economic status was not associated to PPD.

[Effectiveness of a manualized cognitive-behavioural intervention for postnatal depression]. / Efficacia di un intervento cognitivo-comportamentale manualizzato nella depressione post-partum.

AIM: Important guidelines recommend cognitive-behavioural interventions for postnatal depression but in the clinical practice they are not really diffused. This study describes the results and effectiveness of a structured cognitive-behavioural intervention implemented in a public mental health department. METHODS: The study involved 54 depressed women drawn from a community screening programme for postnatal depression in Bergamo province. Intervention was conducted on group and individual basis following a cognitive-behavioural programme of 10-15 weeks duration, including at least one partner session and adhered to a structured manual. Baseline and post intervention measures of depression and health were collected through validated rating scales. RESULTS: Following treatment, a significant improvement was demostrated on Edinburgh Post Natal Depression Scale, Beck Depression Inventory, Patient Health Questionnaire-9, Short Form-12. The improvements were manteined after a 12 mounths follow up. CONCLUSIONS: These results are encouraging and suggest that brief and structured cognitive behavioral interventions can be effective as a treatment for depression in postnatal period and routinely implemented in the clinical practice.

[Prevalence and risk factors of postnatal depression among women attending antenatal courses]. / Prevalenza e fattori di rischio della depressione post parto tra le donne che partecipano ai corsi pre parto.

AIMS: Postnatal depression, the most frequent complication occurring after pregnancy, is often not recognized. The prevalence of postnatal depression is currently considered to be 10-15% in western countries. A wide range of risk factors related to postnatal depression were researched in international studies. Our aim was to evaluate the risk factors and their frequency in a women population of Bergamo Province and compare the results with findings of international literature. METHODS: 595 women taking part to antenatal courses in three hospitals in Bergamo Province were screened for Postnatal Depression using EPDS and clinical interview. Prevalence and possible psychosocial risk factors data were collected and subsequently analysed and compared with literature findings. RESULTS: Thirty six (7.1%) women of our sample had postnatal depression. Depressed mood and depression during pregnancy, anxiety during pregnancy, poor social support, recent life events, a history of depression or other psychiatric history, presence of maternity blues were the strongest predictors of postnatal depression in our sample. CONCLUSIONS: The Psychosocial risk factors emerged from our study are substantially the same indicated by international studies, on the contrary prevalence is a little lower. This result may be explained considering that our women sample wasn't completely representative of general population.

[Effectiveness of cognitive-behavioral treatment in social phobia: a description of the results obtained in a public mental health service]. / Efficacia nella pratica clinica di un servizio pubblico del trattamento cognitivo-comportamentale della Fobia Sociale: descrizione dei risultati ottenuti.

OBJECTIVE: Cognitive Behavioural Therapy for the treatment of Social Phobia has proved effective through several controlled trials and meta-analyses. In spite of this the CBT has not spread in clinical field yet. Therefore our aim was to verify the effectiveness of the CBT in a public mental health service and to compare our results with those described by experimental research. DESIGN AND SETTING: Participants were 11 public mental health center clients, with a primary diagnosis of Social Phobia (according to DSM-IV criteria). The transportability of CBT to a common clinical setting was examined comparing treatment outcome data, at the end of the treatment and at a six months follow up, with results described in controlled efficacy studies. We employed self completion rating scales relating to both general health conditions and life satisfaction (SF36) and trend of symptoms (LSPS). Moreover we recorded the Clinical Global Impression (CGI) and Patient's Global Impression (PGI). RESULTS: Despite differences in setting, clients and treatment providers, both the magnitude of change from pre-treatment and maintenance of change at a six months follow up were comparable with the parallel findings in the efficacy studies. CONCLUSIONS: The results attest the effectiveness of CBT even in a public mental health center setting so, in consideration of the fact that social phobia is a very common disease and involve high degree of severity, chronicity and disability, we hope that this effectual and relatively cheap therapy will be routinely applied in public mental health services.