Marco Bo

Conscientious objection and waiting time for voluntary abortion in Italy

Abstract Objectives This study sought to determine whether a correlation exists in Italy between conscience-based refusal by physicians to perform an abortion and waiting times for elective abortion. Methods Data on the number of objectors and of elective abortions performed within different time intervals were retrieved from annual Italian ministerial reports. Spearmans correlation coefficients were calculated between an indicator of the increase in workload for non-objectors when conscientious objection is exercised by physicians refusing to provide an abortion and the proportion of women whose request for an abortion was met within 14 days, or later, in 13 regions in Italy. Results An inverse correlation emerged between the workload for non-objectors and the proportion of abortions performed within 14 days of the request in seven regions (statistically significant in Emilia-Romagna and Tuscany). There was a direct correlation between increased workload and the proportion of abortions performed later than 21 days in nine regions. The same trends were highlighted at national level. Conclusions Our results suggest that when data spanning at least more than a decade are available, a trend toward an inverse correlation can be noted between the workloads for non-objectors and timely access to elective abortion. This holds organisational and ethical implications. Chinese Abstract 摘要： 目的 本研究的目的是确定意大利因医生的良心拒绝人流与意愿性流产的等待时间之间是否存在相关性。 方法 从每年意大利内阁报告中检索了在不同时间间隔反对流产者和选择性流产数量的数据。Spearman相关系数分析，计算当医生因良心拒绝提供流产时非反对者工作量增加的数量与在意大利的13个地区，流产要求在14天内或更久时间内得到满足的比例之间的关系。 结果 在7个地区内，非反对者的工作量与流产要求在14天内满足的比例呈负相关(在Emilia-Romagna 和Tuscany有统计学意义)。9个地区非反对者工作量的增加与超过21天进行流产的比例直接相关。在全国水平上也呈现同样的趋势。 结论 根据获得的至少超过十年的数据，我们的研究结果表明非反对者工作量增加与选择性流产等待时间呈负相关的趋势。这是组织和伦理的问题。

Delivery of written and verbal information on healthcare-associated infections to patients: opinions and attitudes of a sample of healthcare workers

BackgroundPatients education is considered a valuable mean to prevent and control healthcare-associated infections (HAIs). This cross-sectional study aims to assess declared practices of healthcare workers (HCWs) regarding the delivery of information about HAIs to patients.MethodsA 14-item multiple-choice questionnaire was designed to assess the attitudes and declared practices of HCWs (physicians, nurses and nursing assistants). Between October 2012 and October 2013, we surveyed a sample of HCWs from 4 acute hospitals in Piedmont (North-western Italy). Written information was available at three hospitals (A, B and C) and verbal information at the last one (hospital D).ResultsWe surveyed 288 HCWs (79 physicians, 124 nurses and 85 healthcare assistants). At hospital A, B and C, 128 (71.6%) HCWs declared that written information was usually delivered to any patient and 145 (66.5%) that nurses usually delivered it. Only 42 (26.3%) of them – 97.6% nurses –declared that they usually delivered written information to patients. Among all surveyed HCWs, 210 (72.9%) declared that patients also receive verbal information on HAI – mainly by nurses (70.8%) and physicians (50%) – but only 88 (29,2%) – 23.8% physician and 48.8% nurses – declared that they usually informed patients. Finally, 83 (27.7%) HCWs believed that they should decide whether or not to deliver information to patient case by case.ConclusionsA formal policy requiring to deliver written information is most likely not enough to induce HCWs to better inform patients about HAIs. Health Trusts might introduce more target actions to reinforce HCWs’ practices, such as training and internal auditing.

Availability of emergency contraception: A survey of hospital emergency department gynaecologists and emergency physicians in Piedmont, Italy

ABSTRACT Objectives To compare the knowledge and the willingness of emergency physicians and gynaecologists caring for women in Italian emergency departments (EDs) to prescribe levonorgestrel-only emergency contraceptive pills (LNG-EC pills). Methods A cross-sectional survey was conducted in 2009; anonymous postal questionnaires were mailed to the medical staff working at the 30 EDs located in Piedmont (Italy). Results Emergency physicians and gynaecologists have similar knowledge of the pharmacokinetics and pharmacodynamics of LNG-EC pills, but do not feel at ease in prescribing these and consider the prescription of LNG-EC pills an inappropriate activity for ED staff. Conclusions In Italy, unlike in most other European countries, LNG-EC pills are still prescription drugs. Thus it may be useful to further investigate the reasons why Italian ED medical staff do not feel the prescription of LNG-EC pills should be within their remit and whether women can successfully obtain the prescription from physicians working in other services that can be accessed around the clock.

Access to social security benefits among multiple sclerosis patients in Italy: A cross-sectional study.

BACKGROUND Knowledge concerning the predictors of social security benefits and the proportion of Multiple Sclerosis (MS) patients receiving these benefits is very limited. OBJECTIVE To estimate the likelihood of receiving social security benefits for Italian MS patients. METHODS From September 2014 to November 2015, we interviewed MS outpatients from two Italian MS clinics to collect information regarding their personal data, clinical and working history, and access to social security benefits. We performed both univariate and multivariable analyses to evaluate the predictors for receiving social security benefits. RESULTS We interviewed 297 patients, with a mean age of 49.5 (± 10.7) years; 71.4% were females. About 73% of patients had a relapsing-remitting (RR) course and the median EDSS score was 2.5 (IQR 1.5-6). About 75% of MS patients received a full exemption from co-payments, while the proportions of people who enjoyed each of the other social security benefits were lower, ranging from 8.8% (car adaptation) to 32% (disable badge). At multivariable analysis, the probability of obtaining each of the benefits was significantly associated with the EDSS score: walking aids (OR 3.9), care allowance (OR 3.6), disabled badge (OR 2.4), exemption from co-payment (OR 1.6) and allowed off work permit (OR 1.7). Only the probability of obtaining an allowed off work permit was also influenced by comorbidities (OR 2.9) and a higher education (OR 2.2). CONCLUSION Except for full exemption from co-payments, the proportions of MS patients who enjoyed social security benefits seem to be limited in our study sample. The EDSS score is the strongest predictor of the probability of receiving all the benefits. Only a small proportion of patients received care allowance and working permits, probably because such benefits are only granted to people with a high level of disability. On the other hand, the low proportion of patients who enjoyed fiscal benefits for home and car adaptations could have been influenced by the way such benefits are granted in our country.

The no correlation argument: can the morality of conscientious objection be empirically supported? the Italian case

BackgroundThe legitimacy of conscientious objection to abortion continues to fuel heated debate in Italy. In two recent decisions, the European Committee for Social Rights underlined that conscientious objection places safe, legal, and accessible care and services out of reach for most Italian women and that the measures that Italy has adopted to guarantee free access to abortion services are inadequate. Nevertheless, the Ministry of Health states that current Italian legislation, if appropriately applied, accommodates both the right to conscientious objection and the right to voluntary abortion.Main bodyOne empirical argument used to demonstrate that conscientious objection does not create barriers to abortion is the “no correlation” argument, which the Italian Committee for Bioethics employed to demonstrate that no association exists between conscientious objection and waiting times for voluntary abortion in Italy and to support the weak form of conventional comprise adopted by the Italian legislation to balance the conflict between women’ autonomy and healthcare professionals’ moral integrity. Conversely, we showed how the “no correlation” argument fails to demonstrate the absence of a relationship between the number of conscientious objectors and waiting times for voluntary abortion, and that the limitations of the “no correlation” argument itself demonstrate how it is still difficult to describe the real effect of conscientious objection on the access to abortion services and to evaluate the suitability of conventional compromise to effectively balance conflicting moral principles.ConclusionFurther studies are needed to better describe the relationship between conscientious objection and waiting times for voluntary abortion. If new evidence would show that the increasing proportion of objectors does undermine the efficacy of the Italian law and the right of a woman to freely obtain a voluntary abortion, new ways will need to be found to address the conflict between moral principles and restrict the protection accorded to the principle of moral integrity. This would inevitably imply the need to constrain and to redefine the terms and conditions for claiming conscientious objection.

European policies on tuberculosis prevention in healthcare workers: Which role for BCG? A systematic review

ABSTRACT National recommendations regarding the immunization of healthcare workers (HCWs) against tuberculosis differ throughout Europe. We searched multiple sources to identify legal acts, guidelines or papers addressing European national policies on BCG immunization for HCWs. For each policy, we reviewed the criteria used to recommend immunization, their level of evidence, the evidence supporting them and the actions required in cases of refusal. Four legal acts, 15 policies and 6 papers from 14 European countries met the inclusion criteria. Among European national agencies, 5 only recommend the immunization of HCWs employed in high-risk sectors, highlighting the lack of evidence of Bacillus Calmette-Guerin (BCG) efficacy in HCWs; 5 recommend BCG vaccination for all previously unvaccinated Mantoux-negative HCWs, underlining that some studies provide arguments of some BCG efficacy in HCWs; and four do not recommend the vaccine. Different interpretations of existing evidence on BCG efficacy and the demographics of HCWs may have influenced national policies.

Written versus verbal information for patients' education on healthcare-associated infections: a cross-sectional study.

In 2008, Piedmont region, Italy, recommended delivering written information on healthcare-associated infection (HCAI) to every patient admitted to hospitals. We interviewed 363 patients admitted to five hospitals to evaluate whether patients who received written information were more informed about HCAI than the other patients. We found no statistically significant difference between the two groups. We did observe that knowledge of HCAI was significantly lower among women and significantly higher among patients with higher education and those admitted to a surgical ward.

Health impact assessment of major collective events: an overview of the available experiences

Background: major sporting and cultural events are a sensitive political and social issue. The aim of this study was to perform a critical review of the international literature regarding health impact assessment (HIA) studies of major events to identify all the health indicators available in the literature. Methods: we drew up a review of available literature on HIAs pertaining to major sports and cultural events. The papers obtained were read and then assessed in relation to the inclusion criteria, and the health indicators used were listed and commented upon. Results: we found three published HIA reports. One is a full report, and the other two are a screening report and a rapid HIA report. Through a detailed analysis, it has been possible to develop a set of indicators that can be used for future HIAs on major sporting and cultural events. Conclusions: reports of HIAs for major events that are available online identify several health impacts. In the pre-event phase, negative effects are predominant; in the post-event period, positive impacts prevail. The characteristics of the different stakeholders involved in the events play an important role in the evaluation process.

Emergency contraception: different bioethical perspectives

Emergency contraceptives, in this case post-morning pills, are contraceptive methods used to avoid an unwanted pregnancy after an unprotected sexual intercourse. Their use is feeding a strong ethical debate between subjects for and against their prescription and leading some health professionals to conscientious objection. Among people contrary to prescription some oppose to it because of a general refuse of all contraceptive methods, others considering post-morning pills as abortive. Among people supporting prescription, some consider emergency contraception necessary to assure fundamental women’s rights, in particular the right to sexual auto-determination, while others prescribe emergency contraception only to avoid a greater demand for abortion. It is up to the Italian National Health Service warranting a correct balance between the two opposite positions, that can protect women’s right of access to health services.