Elvira D'Andrea

The need to improve implementation and use of lifestyle surveillance systems for planning prevention activities: an analysis of the Italian Regions.

OBJECTIVES To describe the level of use of lifestyle surveillance systems in Italy and to identify predictors of their use by the Italian Regions for planning and monitoring purposes. STUDY DESIGN Data were extracted from the 19 Regional Prevention Plans (RPPs) and the health promotion and prevention projects included in them developed by the Italian Regions within the National Prevention Plan 2010-2013. METHODS The 19 RPPs and the 702 projects were appraised using a tool specifically developed for the purpose. Multiple logistic regression was performed to identify predictors of use of surveillance systems in the 359 projects that could use them. RESULTS The analysis of regional epidemiological contexts does not always rely upon surveillance system data and there were too few projects aimed at the maintenance and the development of these systems. Moreover, fewer than half of projects that could have used surveillance systems for planning and evaluation procedures actually did so, despite the potential value of these data. There was a statistically significant association between Regional Health Care Expenditure (RHCE) and the use of surveillance system data for planning and/or evaluation of the projects (OR 7.81, 95% CI 2.86-21.29). CONCLUSIONS Use of surveillance systems for regional prevention planning in Italy is not optimal due to late implementation, presence of different data collecting systems and RGDP inequalities. There is a pressing need for full implementation of surveillance systems to allow better definition of the priorities and objectives of public health interventions.

HTA of genetic testing for susceptibility to venous thromboembolism in Italiy

Venous thromboembolism (VTE) is a condition in which a thrombus (a solid mass of blood constituents) forms in a vein. VTE represents an extremely common medical problem manifested as either deep venous thrombosis (DVT) or pulmonary embolism (PE) affecting apparently healthy as well as hospitalized patients. Often PE is the physiopathological consequence of the DVT of low extremities vessels, in particular of the calve......

Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

PurposeLynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the “real world.”MethodsWe performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.ResultsOverall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)–based, endometrial cancer–based, general population–based, LS family registry–based, cascade testing–based, and genetics clinic–based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with age-targeted programs with lower age thresholds.ConclusionUniversal or <70 years–age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the “real world.”

Emerging and re-emerging infectious diseases: tackling the challenge on a global level

After the Second World War the general feeling was to have solved almost all the most important problems of dealing with infectious diseases. This feeling appeared to be appropriate and supported by the identification of new allies such as new antibiotics and vaccines. However, in 1991 the Institute of Medicine of the National Research Council in the US appointed a 19-member multidisciplinary expert committee to study the old and new microbial threats to health. Their final report was entitled ‘Emerging Infections – Microbial Threats to Health in the United States’, but the concepts they treated can be applied worldwide [1]. They concluded that six main categories of factors could explain the emergence (outbreaks of previously unknown diseases, or significant increase of incidence in humans of known diseases in the past years) or re-emergence (reappearance of diseases after a significant decline in incidence) of infectious diseases: human demographics and behaviour; technology and industry; economic development and land use; international travel and commerce; microbial adaptation and change; and breakdown of health measures. These events can expose humans to animal or arthropod carriers of disease increasing the possibility for pathogens to be transferred from animal reservoirs to humans. Recently, the emergence of diseases with high case fatality rates - such as AIDS, severe acute respiratory syndrome (SARS), H5N1 avian influenza and pandemic influenza A (H1N1) 2009 virus, that brought to the declaration by WHO of pandemic phase 6 - have catapulted emerging and re-emerging infectious diseases to the top of the medical and political agendas, simultaneously highlighting the importance of wildlife as reservoirs or vectors for disease. Pathogens originating from an animal or animal-derived product caused approximately 75% of new diseases affecting humans over the past ten years. Threats of outbreaks of diseases such as avian flu, SARS and H1N1/A influenza further highlight the need for integration and remind us that human and animal health are intimately connected. A broader understanding of health and diseases demands a unity of approach achievable only through a consilience of human, domestic animal and wildlife health – One World, One Health [2]. In Italy the epidemiological revolution of the 20 th century was well described by De Flora et al. in an article published in 2005, in which the trend of the main pathologies and accidents was reconstructed by the 1901 through recalculation of yearly mortality rates [3]. At the beginning of the 20 th century, the main causes of death were represented by diseases of the respiratory and digestive systems and by other infectious and parasitic diseases. Thereafter, the trend in mortality of these diseases decreased progressively until the mid-century, when appeared well marked a crossover of mortality curves, with cardiovascular diseases, cerebrovascular diseases and tumors accounting for more than 70% of the deaths. In the last decades of the century also deaths from chronic diseases started to decline, especially in males. Globally, it has been calculated that more than 1 million lives are

Are knowledge and skills acquired during the Master Degree in Nursing actually put into practice? A pilot study in Italy

Background. Literature on the evaluation of the Master’s Degree in Nursing is scarce. The objective of this pilot study was to test a questionnaire aimed at monitoring the activities of nurses after receiving the Master’s degree. Methods. An electronic questionnaire was administered to 36 graduates who obtained the Master’s degree during the academic year 2010/2011. Results. Almost 80% of the participants judged their level of improvement in knowledge and skills during the course to have been satisfactory, but the level of implementation of these competencies at work was quite low. Conclusion. Competencies acquired during the Master’s degree course are not always put into practice.

Quality and relevance of master degree education for the professional development of nurses and midwives

BACKGROUND Advanced education in nursing is essential to provide safe, high quality and efficient health services in line with population needs. However, there is an almost complete lack of studies on how nurses view the usefulness of post-graduate education for their current employment and for professional advancement. OBJECTIVES To evaluate how nurse graduates view the quality, relevance and applicability of the knowledge and skills acquired during the Master of Science in Nursing (MSN) degree. DESIGN Multicentre cross-sectional study. METHODS A multicenter cross-sectional study was carried out through an online questionnaire mailed (July 2014-June 2015) to 560 nurses who obtained the MSN degree from 23 Italian universities in the academic year 2010-2011. DISCUSSION A total of 426 nurses completed the survey (response rate 76.1%), 80% of whom believed they had acquired knowledge and skills useful in their professional life after graduation. A multiple logistic regression model highlighted the characteristics of nurse graduates who judged the masters course relevant for their present role. In brief, they are expert nurses (OR=3.41, 95% CI=1.54-7.54) who achieved professional growth after the course (OR=5.25, 95% CI=2.67-10.33) and who judged the course very good or excellent (OR=2.16, 95% CI=1.04-4.52). Only 8% of the respondents achieved a full professional growth after the course. CONCLUSION In Italy, MSN courses are able to provide a high level of skills and competencies. However, given the low rate of professional growth after the course, specific policies should increase the employment rates of new masters graduate nurses.

EUROPEAN SURVEY ON KNOWLEDGE AND ATTITUDES OF PUBLIC HEALTH PROFESSIONALS ON PUBLIC HEALTH GENOMICS: PILOT STUDY

EUROPEAN SURVEY ON KNOWLEDGE AND ATTITUDES OF PUBLIC HEALTH PROFESSIONALS ON PUBLIC HEALTH GENOMICS: PILOT STUDY Background: During the past decade a debate has arisen on the possible utility of genomic science for public health purposes. Within this context, a survey is being conducted to assess attitudes of European public health (PH) professionals belonging to EUPHA network regarding their role in the implementation of public health genomics (PHG), and their knowledge and attitudes regarding genetic testing and the delivery of genetic services. Methods: A pilot on-line survey was conducted on professionals from Sapienza University of Rome and the Vrije University of Amsterdam. The survey tool is composed of 5 sections: Personal details, Professional activity, Knowledge on genetic testing and delivery of genetic services, Attitudes on genetic testing and delivery of genetic services, Attitudes on the role of PH professionals in PHG. Results: 34 people responded to the questionnaire, mostly medical doctors (61,8%). No respondents correctly identified all evidence-based applications of genetic testing. More than one third of respondents agreed that it would be more important to invest resources in the social and environmental causes of ill health than in genetic testing. Nearly 70% thought that PHG needs to be grounded on evidence of effectiveness, a lower rate agreed ii should be grounded on cost-effectiveness. The rate of agreement with the proposed roles of PH professionals in PHG was very high. Conclusions: This pilot study showed a positive attitude but the need to improve knowledge of PH professionals on PHG. It provided useful input for the implementation of the survey to all members of the EUPHA network.