Adherence to SARS-CoV-2 Vaccination Recommendations among Patients with Substance Use Disorders: A Cross-Sectional Study in Rome, Italy.

Adherence to vaccination recommendations is a challenge for national immunization programs. We quantified adherence to COVID-19 vaccination recommendations in people with substance use disorders (SUDs) attending an outpatient addiction center in Rome, Italy; we investigated the determinants of adherence, and also analyzed patient risk perception and compliance with preventive measures. A multivariable logistic regression model identified predictors of adherence to vaccination recommendations, with statistical validity tested by estimating adjusted odds ratios (aORs) and 95% confidence intervals (CIs). From December 2021 to January 2022, 200 SUD patients completed a questionnaire, 80% of whom reported being vaccinated against SARS-CoV-2 (minimum one dose). Negative predictors of vaccine uptake included being non-Italian (aOR: 0.36, 95% CI: 0.13-0.97), having coexisting comorbidities (aOR: 0.35, 95% CI: 0.13-0.95), and previous use of heroin (aOR: 0.24, 95% CI: 0.08-0.71). No difference was found for cocaine use, demographic characteristics, previous COVID-19 infection, methadone therapy, or compliance with preventive measures. Major reasons for non-adherence to vaccination recommendations were fear of side effects, insufficient recognition of the importance of vaccination, bureaucratic issues, and lack of trust in the authorities. Given their vulnerability, additional efforts are needed to facilitate access to vaccination for people with SUDs, and to limit disinformation around vaccines..

Risk of Covid-19 Severe Outcomes and Mortality in Migrants and Ethnic Minorities Compared to the General Population in the European WHO Region: a Systematic Review.

The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans. Supplementary Information: The online version contains supplementary material available at 10.1007/s12134-023-01007-x.

Ensuring Equitable Access to the COVID-19 Vaccine: The Experience of A Local Health Unit in Rome, Italy.

Growing evidence is emerging on the higher risk of infection and adverse outcomes for the most disadvantaged groups of the population, and COVID-19 vaccination campaigns worldwide are struggling to ensure equitable access to immunization for all. From 21 June 2021 to 15 October 2021, the Local Health Unit ASL Roma 1 adopted a tailored immunization strategy to reach socially vulnerable groups of the population with the primary vaccination course. This strategy was developed with a step-by-step, participatory approach. Through engagement with internal and external stakeholders, target groups were identified, potential barriers analyzed, solutions discussed, and tailored interventions designed. Over nine thousand individuals from among irregular migrants, homeless people and hard-to-reach communities were contacted and vaccinated.

Managing the introduction of genomic applications into the National Health Service: A special challenge for health technology assessment in Italy.

In recent years, the rapid proliferation of genomic tests for use in clinical practice has prompted healthcare systems to use a health technology assessment (HTA) approach to distinguish valuable from unwarranted applications. In this study, we narratively review the Italian HTA mechanisms for medical devices (MDs), both at the national and regional levels, and discuss the opportunity and benefits of extending them to genomic technologies, for which a dedicated assessment path was advocated by the National Plan for Public Health Genomics in 2017. We found that the National Health Technology Assessment Program for MDs, completed in 2019, had developed a structured pathway for the HTA of MDs; it established a hub-and-spoke structure, run by a governmental institution, and put in place transparent methodological procedures to cover all four HTA phases (i.e., proposal and prioritization, assessment, appraisal, and dissemination). However, several factors have hindered its adoption, and the regions are at different stages of its implementation. For these reasons, efforts should be made to ensure its effective deployment, both at national and regional levels. In addition, we argue that to harmonize the institutional roles and methodological procedures adopted, the time has come to concentrate resources on a single pathway for the assessment of all technologies that include both MDs and genomic applications.

Gender Gap in Scientific Publications on COVID-19 in Italy During the First Wave of the Pandemic: An Observational Study.

Background: Worldwide, concerns rise on how COVID-19 pandemic impacted heavily on women, even on those belonging to the scientific community. The Italian scientific production regarding the COVID-19 throughout the first months of the health emergency could help to understand the heft of female researchers in this unique period. Objectives: This study aims to investigate the gender gap in the scientific production on COVID-19 in Italy during the first months of the pandemic. Methods: A systematic search of the literature was conducted and, for each included study, first and last author's gender, type of study, number of co-authors, type of affiliation, journal's Impact Factor (IF) and specialization were extracted. Descriptive and univariate analyses were performed. Results: 22.2% of the articles were signed by a woman as first author, 18.1% as last authors. Female authorship was less frequent than male authorship regardless of the type of study, number of co-authors, type of affiliation and field of specialization. Conclusion: This analysis reveal a low prevalence of studies with a female first or last author and suggests that the low share of female authors publishing on COVID-19 during the considered timespan is a transversal issue throughout the Italian medical field.

What Went Wrong with the IMMUNI Contact-Tracing App in Italy? A Cross-Sectional Survey on the Attitudes and Experiences among Healthcare University Students.

The adoption of digital contact-tracing apps to limit the spread of SARS-CoV-2 has been sup-optimal, but studies that clearly identify factors associated with the app uptake are still limited. In April 2021, we administered a questionnaire to healthcare university students to investigate their attitudes towards and experiences of the IMMUNI app. A multivariable logistic regression model was built to identify app download predictors. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. We surveyed 247 students. Most respondents (65.6%) had not downloaded IMMUNI, reporting as the main reason the perceived app uselessness (32.7%). In the multivariable analysis, being advised to use the app (aOR: 3.21, 95%CI: 1.80-5.73), greater fear of infecting others (aOR: 1.50, 95%CI: 1.01-2.23), and greater trust in the institutional response to the emergency (aOR: 1.33, 95%CI: 1.00-1.76) were positively associated with the outcome, whereas greater belief in the "lab-leak theory" of COVID-19 was a negative predictor (aOR: 0.75, 95%CI: 0.60-0.93). Major technical issues were reported by app users. Targeted strategies aimed at improving awareness of digital health applications should be devised. Furthermore, institutions should invest in the development of these technologies, to minimize technical issues and make them accessible to the entire population.

Risk of SARS-CoV-2 infection in migrants and ethnic minorities compared with the general population in the European WHO region during the first year of the pandemic: a systematic review.

BACKGROUND: Migrants and ethnic minorities have suffered a disproportionate impact of the COVID-19 pandemic compared to the general population from different perspectives. Our aim was to assess specifically their risk of infection in the 53 countries belonging to the World Health Organization European Region, during the first year of the pandemic. METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42021247326). We searched multiple databases for peer-reviewed literature, published on Medline, Embase, Scisearch, Biosis and Esbiobase in 2020 and preprints from PubMed up to 29/03/2021. We included cross-sectional, case-control, cohort, intervention, case-series, prevalence or ecological studies, reporting the risk of SARS-CoV-2 infection among migrants, refugees, and ethnic minorities. RESULTS: Among the 1905 records screened, 25 met our inclusion criteria and were included in the final analysis. We found that migrants and ethnic minorities during the first wave of the pandemic were at increased exposure and risk of infection and were disproportionately represented among COVID-19 cases. However, the impact of COVID-19 on minorities does not seem homogeneous, since some ethnic groups seem to be more at risk than others. Risk factors include high-risk occupations, overcrowded accommodations, geographic distribution, social deprivation, barriers to access to information concerning preventive measures (due to the language barrier or to their marginality), together with biological and genetic susceptibilities. CONCLUSIONS: Although mixed methods studies will be required to fully understand the complex interplay between the various biological, social, and cultural factors underlying these findings, the impact of structural determinants of health is evident. Our findings corroborate the need to collect migration and ethnicity-disaggregated data and contribute to advocacy for inclusive policies and programmatic actions tailored to reach migrants and ethnic minorities.

The association between adherence to cancer screening programs and health literacy: A systematic review and meta-analysis.

The effectiveness of a cancer screening program relies on its adherence rate. Health literacy (HL) has been investigated among the factors that could influence such participation, but the findings are not always consistent. The aim of this meta-analysis was to summarize the evidence between having an adequate level of HL (AHL) and adherence to cancer screening programs. PubMed, Scopus, and Web of Science were searched. Cross-sectional studies, conducted in any country, that provided raw data, unadjusted or adjusted odds ratio (OR) on the associations of interest were included. The quality of the studies was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled ORs and their associated confidence interval (CI) stratified by time interval (e.g., undergoing screening in the last period, or at least once during lifetime) for each cancer type, considering unadjusted and adjusted estimates separately. A sensitivity analysis was performed for those studies providing more estimates. Overall, 15 articles of average-to-good quality were pooled. We found a significant association between AHL and higher screening participation for breast, cervical and colorectal cancer, independently of other factors, both overall (N = 7, aOR = 1.73; 95% CI: 1.27-2.36; N = 3, aOR = 1.64; 95% CI: 1.30-2.09; and N = 5, aOR = 1.25, 95% CI: 1.12-1.39, respectively) and in most time-stratified analyses. The sensitivity analyses confirmed these results. Health literacy seems to be critical for an effective cancer prevention. Given the high prevalence of illiterate people across the world, a long-term action plan is needed.

Time to Align: A Call for Consensus on the Assessment of Genetic Testing.

In this paper, we updated our 2018 systematic review aimed to identify and compare ad hoc designed frameworks for genetic testing evaluation. Overall, we identified 30 frameworks (29 in the first systematic review and one in the update): they were mainly based on the ACCE model, whereas a minority were adjustments of the more traditional Health Technology Assessment (HTA) approach. After discussing the strengths and weaknesses of the retrieved frameworks, this perspective calls for consensus on the assessment of genetic testing. In line with the recent European recommendations that encouraged the generation of comparable evidence across Member States, we believe that the time has come to align all the ideas that have emerged over the last few decades and find a sustainable and sharable tool for the evaluation of genetic and genomic applications. Therefore, we suggest stopping the evaluation of such technologies using ad hoc strategies-affected by validation, implementation, and adoption issues-and we propose to use a general HTA approach, particularly the European reference tool for the assessment of health technologies, the EUnetHTA HTA core model, that is built on solid theoretical and methodological principles and provides a comprehensive assessment of the technologies value.

Urban Health and Social Marginality: Perceived Health Status and Interaction with Healthcare Professionals of a Hard-to-Reach Community Living in a Suburban Area of Rome (Italy).

The study reports an urban health investigation conducted in Bastogi, an outskirt of Rome (Italy) characterised by social marginalization and deprivation. Our aim was to analyse the health perception, health-related behaviours, and interaction with healthcare professionals of the inhabitants of Bastogi compared to the population living in the area of the same local health unit (ASL). The Progresses of Health Authorities for Health in Italy questionnaire (PASSI) was administered to a sample of 210 inhabitants of Bastogi. Data were analysed and compared to those of the ASL collected in 2017-2018. The socio-economic indicators showed an overall worse condition for the inhabitants of Bastogi, with a significantly higher proportion of foreign and unemployed residents and a lower educational level compared to the ASL. Significant differences in the prevalence of non-communicable diseases, mental health complaints, and participation in prevention strategies, including cancer screening, were found. The questionnaire showed a lower help-seeking behaviour and a lack of reliance on health professionals in Bastogi inhabitants. Our findings highlight how social determinants produce health inequities and barriers to accessing healthcare. The difficulties of conducting quantitative research in complex and hard-to-reach contexts, characterized by high social vulnerability, are outlined.

A Systematic Review and Bibliometric Analysis of the Scientific Literature on the Early Phase of COVID-19 in Italy.

Background: Studying the scientific literature about COVID-19 and Italy, one of the first countries to be hit by the pandemic, allows an investigation into how knowledge develops during a public health emergency. Methods: A systematic review of the literature was conducted to identify articles published on the topic between January and April 2020. Articles were classified according to type of study. Co-occurrence of terms, and geographic and temporal trends were analyzed. Results: Of the 238 articles included in the systematic review, the majority (37%) focused on hospital and clinical management of COVID-19, while 23.9% were commentaries. Epidemiological studies constituted 45.5% of the articles published by authors with non-Italian affiliations. Conclusion: The scientific articles on COVID-19 in Italy were varied in type of study, though with limited international impact. The lockdown and the pressure placed on hospitals during the first wave of the pandemic mainly resulted in publications on disease management and commentaries.

Social return on investment: accounting for value in the context of implementing Health 2020 and the 2030 Agenda for Sustainable Development (Investment for Health and Development Discussion Paper)

Social return on investment (SROI) is a concept to account for social value when evaluating investments. It goes beyond traditional economic evaluation tools, by considering value produced for multiple stakeholders in all three dimensions of development: economic, social and environmental. This discussion paper reviews the main features of SROI (stakeholder engagement, the theory of change and accounting for social value) and finds that they are coherent with the key features of the Health 2020 policy framework and the 2030 Agenda for Sustainable Development. It concludes that SROI represents an interesting opportunity to evaluate cross-sectoral investments which aim to promote health and development, in the WHO European Region and beyond. This publication was tabled as a background document during the Sixty-seventh session of the Regional Committee for Europe, Budapest, 11–14 September 2017.