bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of hybrid immunity after the administration of the first booster dose
Authors: Pascucci D , Nurchis M C , Lontano A , Marziali E , Grossi A , Capelli G , Vetrugno G , Damiani G , Laurenti P 
Published: October 2023

Abstract

COVID-19 vaccines have been shown to be safe, effective and life-saving. However, the advent of the Omicron variant has greatly impacted the effectiveness of vaccination and the transmissibility of the virus requiring the analysis of the different factors leading to breakthrough infections. The aim of this study is to investigate, in a cohort of healthcare workers (HCWs), the role of hybrid immunity on the incidence of breakthrough infection after the administration of the first booster dose. This retrospective study was conducted in an Italian hospital from September 2021 to September 2022. Only HCWs who had received BNT162b2 vaccine and the first booster dose were included. Participants were assigned in the cohort of hybrid immunity if were infected prior to the administration of the first dose and completing the primary course, with a single inoculation, while in the other cohort individuals had received three doses of the vaccine. The risk of infection was estimated by means of the Nelson-Aalen cumulative risk function. Cox regression was applied to detect potentially interacting covariates. Out of 5.650 HCWs observed, 402 got infected before primary schedule (hybrid immunity). Comparing the two cohorts, individuals with a hybrid immunisation had a lower risk of becoming infected after the booster dose. At 30 weeks the cumulative risk was 50% in those with three vaccine doses against 30% in those with hybrid immunity, showing an increasing trend over time. The difference between the two curves in the log-rank test appears to be statistically significant (p &lt; 0.001). Cox regression analysis confirmed the results (HR = 0.40; 95% CI, 0.35-0.57). These findings contribute robustly to the scientific debate on the comparison of protection conferred by the full vaccine cycle or by COVID-19 vaccines plus infection. The pandemic has highlighted the importance of rapidly generating clinical evidence that can allow regulatory agencies and HCWs to make informed decisions.

Key messages
• Hybrid immunity from previous infection and recent booster vaccination conferred the strongest protection against infection.
• The data collected confirm the need for continuous monitoring of vaccine-induced immunogenicity and for establishing the exact timing of vaccination with more effective vaccination schedules.
Years Lived with Disability due to COVID-19 in the capital of Serbia in 2020 and 2021
Authors: Šantrić Milićević M , Rosić N , Pavlović N , Stevanović A , Jovanović V , Vujetić M , Devleesschauwer B , Anton A , Von der Lippe E , Rommel A 
Published: October 2023

Abstract

Background
Valid estimates of the national disease burden often lack during crises. They need to be improved to help assess the effectiveness and efficiency of the national public health system. To determine the magnitude of acute COVID-19 in Belgrade in 2020 and 2021, we estimated the total, age and sex-disaggregated Years Lived with Disability (YLD).

Methods
YLD and YLD/100,000 population due to acute COVID-19 were calculated for Belgrade (Serbia) in 2020 (March 6 - December 31) and 2021 (January 1 - December 31) within the EU COST Action 18218 and the BoCO-19 study. The City Institute of Public Health Belgrade provided surveillance numbers of cases of ICD-X: U07.1 and U07.2 (unknown age cases were proportionally redistributed) and population estimates. Severity weights and length of the disease were taken from the German National Burden of Disease study.

Results
In 2020, 33,842 acute COVID-19 cases (50.04% were men) had 73.0 YLD (men: 40.6 YLD or 5.1 YLD /100,000; women: 32.4 YLD or 3.6 YLD/100,000). In 2021, 65,020 COVID-19 cases (54.5% were women) had 130.3 YLD (men: 65.1 YLD or 8.2 YLD /100,000; women: 65.2 YLD or 7.3 YLD/100,000). Mild cases were more often among men 10-19 years and women 35-44 years. Moderate cases were more often among persons 35-44 years. Critical cases were more often among the men. More YLD were estimated for severe cases among women in 2021 than in 2020.

Conclusions
In Belgrade, the YLD burden of acute COVID-19 in 2021 was almost double that of 2020. Women had more often severe forms of acute COVID-19 and more YLD in 2021 than in 2020. Men often had moderate and critical cases of acute COVID-19 and higher YLD rates than women. The COVID-19 pandemic demonstrates the importance of having disease burden metrics to help contextually assess the health system's response to crises. Belgrade-level estimates can also be used for national estimates because of the same case definitions, treatment protocols, and data collection methods.

Key messages
• The YLD burden of the COVID-19 pandemic in 2021 was almost double that of 2020 for population of Belgrade.
• In 2020, higher YLD had men due to critical cases, in 2020, women due to severe cases in 2021 indicating greater exposure of men and greater vulnerability of women.
The impact of rotavirus vaccination in Italy: an eleven-year (2009-2019) nationwide analysis
Authors: Isonne C , Petrone D , Del Manso M , Iera J , Baccolini V , Costantino C , Pezzotti P , D'Ancona F 
Published: October 2023

Abstract

Although the positive effects of the introduction of rotavirus (RV) vaccination in Italy, a national updated analysis of its effect in still lacking to date. This study aims to analyze the implementation of rotavirus vaccination in Italy, evaluating its impact on discharges for acute pediatric gastroenteritis. A retrospective analysis including hospital discharge records and data on vaccination coverage for children aged 0-71 months from 2009 to 2019 was conducted. We examined trend in hospital discharge standardized incidence before and after vaccine introduction using a negative binomial mixture model with fixed effects to evaluate the impact of universal vaccination. The percentage of vaccination coverage increased over the years, from &lt; 5% between 2009 and 2013 to 26% in 2017. After the inclusion to the National Im-munization Plan, in 2019 over 70% of children received the vaccine. In the first phase (2009-2013), the standardized incidence of discharges was 16.6/100,000 inhabitants; it decreased in the second phase (2014-2017) reaching 14.1/100,000 inhabitants. During the third phase (2018-2019) it significantly decreased to 9.9/100,000 inhabitants. In this phase, about 15% of the estimated hospital discharges were avoided compared with those estimated using the first phase data. The implementation of rotavirus vaccination reduced acute pediatric gastroenteritis incidence discharges in children aged 0-71 months. Further efforts are needed to continue monitoring the vaccination effect over time and to increase vaccination coverage.

Key messages
• The implementation of Rotavirus vaccination in Italy resulted in a reduction of acute pediatric gastroenteritis.
• Further efforts are needed to maintain high vaccination coverages, thus reducing the negative impact of rotavirus disease.
Managing uncertainty - leaders’ perspectives on health system resilience during COVID-19 in Finland
Authors: Karreinen S , Paananen H , Kihlström L , Janhonen K , Huhtakangas M , Viita-aho M , Satokangas M , Tynkkynen L K 
Published: October 2023

Abstract

Background
The role of leadership in resilience is commonly acknowledged but empirical studies in the context of healthcare are less frequent. One key to public health preparedness is to understand how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks. Finland offers an opportunity to investigate resilience in a public sector setting where the health system is decentralized and local health systems, including primary healthcare, are responsible for most public health actions. In this study we examined how leaders responsible for local health systems interpreted changes in their operational environment in Finland during the first year of COVID-19, and to how these views reflect aspects of resilience in healthcare.

Methods
We identified 14 leaders in four regions in Finland from a larger data set of 53 interviews. Leaders had responsibilities for local health and social care during the COVID-19 pandemic. Semi-structured interviews were conducted in March-June 2021. The audio recorded data were transcribed and analysed with abductive thematic analysis using Atlas.TI.

Results
From the data we identified three core issues of leadership in building primary healthcare resilience. Firstly, living with constant uncertainty was seen as an integral part of leadership not only during crises but also at normal times. Secondly, health systems’ adaptability was considered important. This was maintained through decisions on workforce, information, and collaboration. Thirdly, the leaders responsible for local health systems emphasized holistic approach to crisis governance and service needs of the public.

Conclusions
Leaders in local health systems have to consider uncertainties and various entwined aspects of resilience during public health crises. This should be emphasised in decision-making and policy recommendations. Qualitative research designs are needed to obtain a broad understanding of the entity.

Key messages
• Holistic approach and adaptability were key factors of local health system resilience in Finland.
• Resilience should be studied more in the context of local health systems and primary healthcare where complexities are processed continuously.
Accessing health and health behaviour interventions by people with severe and multiple disadvantage
Authors: Jain N , Adams E A , Joyes E C , Burrows M , Paisi M , McGowan L J , Watt R , Bambra C , Kaner E , Ramsay S E 
Published: October 2023

Abstract

Populations facing severe and multiple disadvantage (SMD) - co-occurring homelessness, substance misuse and offending, have high level of physical and mental ill-health. Poor oral health is one of the three common physical health problems among this population, and is closely linked with use of drugs, alcohol and smoking. However, little is known about pathways that improve access to health interventions for people living with SMD. This study examines organizational and individual factors that restrict access to health interventions and provides actionable suggestions for improving engagement of health services by people living with SMD. Between August 2021 and March 2022, interviews/focus group discussions were conducted with people experiencing SMD in Newcastle and with frontline staff, policy makers, and commissioners from London, Plymouth and Newcastle upon Tyne. Data were analysed iteratively using thematic analysis and were organized and coded using NVivo 1.6.1. 19 people with lived experience of SMD (age range: 27-65 years; 79% male) and 78 service providers (age range: 28-72 years; 37% male) were interviewed. The access to health interventions was reported to be affected by location, integration between services, use of technology, knowledge of services and inter-personal relationships. Furthermore, individual factors such as fear of seeking treatment, health behaviours and socio-economic disadvantage of the service user, and past experiences of treatment were common themes identified. People with SMD have complex health needs with co-occurring and linked conditions making usual pathway of care difficult to access. Reducing the number of appointments, sign posting services and coordinating with support workers may help alleviate the individual factors. Improving their health may require action across multiple domains to integrate care. Findings from our study could also be extrapolated to the planning and delivery of other health services for people with SMD.

Key messages
• Pathway of care for people with SMD can be improved through interventions that addresses organizational limitations and accounts for individual situations.
• Integrated services and engagement of people with lived experiences may improve the engagement of health services by people with SMD.
The elderly health profile and health services access during 2020-2021: results from Passi d’Argento
Authors: Contoli B , Casigliani V , Pettinicchio V , Minardi V , Asta F , Possenti V , Gallo R , Masocco M 
Published: October 2023

Abstract

Background
The COVID-19 pandemic has affected the community in multiple health, economic, social and cultural aspects and the impact was stronger among the over-65s. PASSI d'Argento (PdA) surveillance system monitors the effects on physical activity, partecipation in social life and healthcare renunciation due to fear of Covid contagion or services interruption.

Methods
Since 2016, PdA has been continuously collecting information on health, behavioural risk factors, quality of life and the care and assistance needs of eldely people. Data is collected through an anonymous and standardised questionnaire. Physical activity is assessed with the Physical Activity Scale for Elderly, an internationally validated instrument that considers all types of activities commonly performed by elderly. High PASE values correspond to high levels of physical activity.

Results
The percentage of physically active elderly decreased significantly during the pandemic, from 39% (CI95% 38.3-39.8) in 2016-2019 to 35% (CI95% 33.7-36.4) in 2020-2021. The decline is greater among people with economic difficulties (44.4% to 37.5), women (from 36.7% to 33.5%), among those with chronic deseases (from 37% to 31%) or sensory impairment (from 31.3% to 27.5%). Participation in social life declines significantly from 23.1% (95% CI 22.5.1-23.8) in the pre-covid period to 142 (95% CI 13.2-15.1) in 2020-2021. The pandemic develops in a context where inequalities in prevention and care already exist; 32% of elderly declared difficulties in accessing health services in 2016-2019. During pandemic period 28% of the over-65s gave up at least one medical or diagnostic examination with a risk of delayed in diagnosis and treatment.

Conclusions
PdA shows the importance of monitoring the strong impact of emergency on several aspects of elderly population to riorganize the local health system organization, implement targeted interventions and improve the health services’ offers to reduce inequalities.

Key messages
• Riorganize the local health system is crucial to improve targeted interventions and reduce inequalities in care and prevention for elderly population.
• Early diagnosis and adequate therapy are crucial in old age.
Roadmap for implementation of genomics in healthcare: towards equity in access to genomics
Authors: Lopes F , Costa A , Cardoso M L , Custers I , Merchant A , Konopko M , Scollen S , Vicente A 
Published: October 2023

Abstract

Issue
Implementing genomic medicine in healthcare can bring us closer to making personalised medicine a reality, with notable socioeconomic benefits.

Description of the problem
The 1+Million Genomes Initiative is promoting a reflection in European countries regarding their national strategies for genomic medicine, and how these contribute to research and improve clinical practice. Implementation of genomic medicine is complex and requires investment and adjustments in the organisation and practices of healthcare services, including technical infrastructure for genomic data generation and management, a trained healthcare workforce, and appropriate ethical and legal frameworks.

Methods
To promote the implementation of genomic medicine in healthcare systems, and improve its societal impact, the Beyond 1+MG (B1MG) project organised three country exchange visits for capacity building, developed and validated in real world settings a comprehensive Maturity Level Model (B1MG MLM) for genomic medicine, and organized workshops on health economics models for genomics.

Results
The products resulting from these activities provide policy recommendations for adoption of genomic medicine, an innovative MLM Toolkit for health systems to self-assess their current maturity status regarding genomic medicine implementation, and plan the path for improvement, as well as several brief papers highlighting main challenges and key indicators for health economic evaluation of genomic tests. Overall, this set of B1MG products provide a Playbook to support the development of national or regional roadmaps for the implementation of genomic medicine in healthcare systems.

Lessons
Country healthcare systems have specific practices, barriers and constraints, so the actions needed for progress in genomic medicine implementation towards optimization are specific to the context of each healthcare system.

Key messages
• The B1MG Roadmap will support the definition of strategies for adoption of genomics in healthcare systems, towards equity in the access to genomic medicine for all European citizens.
• Country healthcare systems actions needed for progress in genomic medicine implementation towards optimization are specific to the context of each healthcare system.
Carbapenemase-producing organisms under the covid 19 pandemic
Authors: Castilla-Heredia J P , Martín-Pérez F J , González-Martínez A , Fernández-Sierra A , Gutiérrez-Fernández J 
Published: October 2023

Abstract

Background
Antibiotic resistance is a widely recognised public health problem. Probably the factor most clearly associated with the emergence of carbapenemase-producing organisms (CPOs) is the use of antimicrobials. During the covid-19 pandemic, most patients with covid-19 received antibiotics. In addition, it is possible that the extra burden of work affected antimicrobial stewardship and infection prevention and control (IPC). The aim of the present study was to investigate the association between the frequency of carbapenemase-producing organisms (CPO) isolates and the excess of workload experienced during the covid-19 pandemic in a regional hospital in south-eastern Spain.

Methods
Descriptive study. Isolates producing one or more carbapenemases were collected from January 2015 to March 2022. Isolates of the same microorganism were grouped by individual, assuming that they correspond to the same episode of infection or colonisation. To estimate the workload, the rate of admissions of covid-19 cases in intensive care (ICU) and the total number of beds in covid-19 ICU each month were collected.

Results
The frequency of episodes shows an upward trend since 2018. From the 4th quarter of 2020 there is a clear acceleration until the 2nd quarter of 2021 (20 episodes per month), when a decrease to less than pre-pandemic frequencies is observed (10 episodes per month). The increase in episodes is parallel to the beginning of c ovid-19 admissions observed from the 4th quarter onwards. The decrease of episodes coincides with the increase of bed capacity, even with a maintained rate of admissions. CPO with two carbapenamases occur regularly from the 2nd quarter of 2020.

Conclusions
The occurrence of CPO may be related to the burden of work in healthcare systems. Disruption of antimicrobial stewardship and IPC could mediate this relationship. The decrease of episodes with a maintained rate of admissions may indicate that antibiotic use is not directly associated with CPO emergence.

Key messages
• Maintaining healthcare capacities related to antimicrobial stewardship and IPC may be critical in limiting the emergence of CPO.
• Antibiotic use may not be directly related to the increase of CPO.
Multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients
Authors: Martinelli S , Regazzi L , Rizzo F , Pascucci D , Tamburrini E , Salvo P F , Landi F , Bosello S L , Spadea A , Laurenti P 
Published: October 2023

Abstract

Background
Target populations eligible for vaccinations are not comprehensively reached by out-of-hospital health services, particularly frail people with immunization deficits. The aim of this study was to evaluate the effectiveness of a model of shared management between hospital - IRCCS Fondazione Policlinico Universitario A.Gemelli (FPG) - and out-of-hospital health services -ASL Roma1- of fragile patients with an indication for herpes zoster (HZ) vaccination, based on counseling carried out by a multidisciplinary team in the hospital setting.

Methods
From June 2022 to April 2023, patients with congenital and/or acquired immunodepression, who were treated at the IRCCS FPG in the Units of Hematology, Geriatrics, Infectious Diseases, Rheumatology were offered vaccination with the recombinant Zoster vaccine. At the time of enrollment, all patients completed the Vaccination Attitudes Examination (VAX-I) scale, for the purpose of assessing vaccine hesitancy. Patients received multidisciplinary counseling focusing on HZ and contrasting vaccine hesitancy. Multiple linear regression was used to analyze the impact of demographic and clinical characteristics on the VAX-I items.

Results
Sixty fragile patients were included. Mean vaccine hesitancy score was 2.1 ± 0.9. A significant correlation between vaccine hesitancy and the age group 45-64 years, female sex and patient with HIV was demonstrated. These patients had significantly higher score of “mistrust of vaccine benefits”, “worries about unforeseen future effects”, “concerns about commercial profiteering” and “preference for natural immunity”. After counseling, all patients adhered to the vaccination with two doses of a recombinant zoster vaccine. No serious adverse events or breakthrough HZ infections were observed during a median follow-up of 65.5 days.

Conclusions
Although vaccine hesitancy in some age groups is high, hospital-based multidisciplinary counseling achieved full HZ vaccination compliance.

Key messages
• herpes zoster vaccination coverage of frail patients is not fully achieved in the community health setting.
• The adoption of a multidisciplinary model for administration of recombinant Zoster vaccine in fragile patients based on a Hospital-Territory Vaccination Center may help overcome vaccine hesitancy.