Local Health Unit Research Articles

Technology-aided community engagement for exercise promotion: a mixed-methods systematic review

Abstract Background This review aims to provide an overview of evidence on feasibility and effectiveness in diverse populations of eHealth physical activity (PA) community engagement (CE) interventions. Increasing global PA levels would have a substantial positive impact on population health. Given their diffusion, eHealth technologies may address certain barriers to PA and reach wide audiences. The most recent Italian guidelines on PA highlight inequalities in health, which can be addressed using CE models. The potential scalability of successful eHealth CE interventions and the scarcity of previous reviews on the topic are reasons which convinced us to work on this paper. Methods This mixed-methods systematic review utilized the Joanna Briggs Institute methodologies. Primary quantitative outcome measures were minutes of PA per week. Qualitative outcome measures included self-efficacy and user engagement. Data were processed using a segregated convergent design. A narrative summary and a meta-aggregation were performed for synthesizing quantitative and qualitative data respectively. Only the interventions where CE principles were fulfilled were analyzed. Results Quantitative evidence supported effectiveness and feasibility of interventions to improve PA outcomes and related proxy indicators across studied populations. Qualitative findings suggest the utility of peer-support and that from other health care providers. Conclusions Implementing CE in future PA interventions will be critical for producing an effective digital application with the potential for considerable impact in the real world. If supported by central governments and the European Union, entities such as primary care hubs and local health units with their professionals and CE capabilities may play the key role in implementing evidence. Key messages • eHealth PA CE interventions work better when peer support takes place. • Health systems could pursue these prevention strategies for population health gains.

7.D. Workshop: Older adults’ resilience and vulnerability to COVID-19: 2-years results of multicentric LOST project

Abstract COVID-19 pandemic and consequent mitigation and containment measures greatly impacted people's daily life. Older adults, especially those with chronic conditions, have paid the highest price for the emergency. Indeed, they are the most at-risk of severe and deadly forms of COVID-19; they deal with unmet healthcare needs because of considerable pressure on healthcare systems; they are at higher risk of worsening lifestyles, mental and socioeconomic status. In this context, we designed and are currently conducting the multi-partner project LOckdown and lifeSTyles in Lombardia (LOST in Lombardia), funded by AXA and Lombardy region. We will present the design and outputs of a telephone-based cross-sectional study conducted in the fall of 2020 on a representative sample of adults aged more than 65 years living in Lombardy. Researchers from the University of Pavia, Mario Negri Institute of Pharmacological Research, Vita-Salute San Raffaele University, Insubria University, University of Genoa, Bocconi University, Health Protection Agency of Bergamo and Brianza are involved. This project aims to evaluate the COVID-19 pandemic impact and nationwide stay-at-home order on a wide range of behavioural and health-related outcomes among the older population and provide useful evidence to plan, implement, and evaluate targeted prevention programmes and welfare policies facing pandemic consequences. The workshop will be structured as follows: We will first set the scene by focusing on the determinants of SARS-CoV-2 infection in the older adult population. The second panellist will discuss changes in healthcare services use and delivery during the pandemic. Sociodemographic, physical and mental health-related determinants’ roles will be thoroughly analysed. Data on the access to hospital in older adults with chronic conditions from two local health Units from the Lombardy region, Italy during the first wave of the pandemic wee also presented. We will then provide two original contributions about lifestyle changes. In the first one, we will present data exploring how Mediterranean diet adherence has changed. A Mediterranean COVID-19 Pandemic Score was computing by scoring modifications in the consumption of nine food groups and five diet-related behaviours, and predictors of favourable changes will be debated. The fifth panellist will open up about the mental health burden. The prevalence of depression, anxiety, insomnia and hopelessness before and during the COVID-19 lockdown will be assessed, identifying subgroups at higher risk of mental distress due to pandemic-associated restrictions. In the end, we will engage in a fruitful discussion with the audience on the data presented and practical public health implications, exploring how they can inform critical policy debates addressing health system resilience and health inequalities at the European and global levels. Key messages • Public health management of older people and chronic patients represents a major challenge within and beyond pandemic times, as they have been disproportionally impacted by COVID-19. • Evidence-based recommendations are needed for the post-pandemic phase, and the results on successes and failures from one of the worst-affected regions provide guidance for the rest of Europe.

Multisectoral approach to address Female Genital Mutilation: a case study from Portugal

Abstract Issue Female genital mutilation (FGM) comprises all procedures that injury female genital organs for non-medical reasons, with several health impacts. Due to global migration, FGM has been increasingly recognised as a healthcare issue in Europe, affecting nearly 1 million women. In Portugal it is estimated that 5483 migrant women have undergone FGM in the Lisbon region. Intervention is required to tackle this issue. Description Portugal launched the “Healthy Practices: End of FGM”, a multiagency project targeting Lisbon and Tagus Valley region. Project implementation started in Nov 2018 at 5 local public health units (PHU) and was scaled-up to 5 more in Feb 2020. Project comprises 3 main axes: 1) inclusion in public policy instruments; 2) professionals’ education and awareness; and 3) community intervention. We describe inclusion of FGM in public policy, professionals training and changes in FGM recording before and after intervention. Results Between 2018-2022, inclusion of FGM in municipalities’ migration policies doubled. Between 2019-2021, 110 training sessions (n = 1722 professionals) were promoted. During pandemic years, only 344 (2020) and 202 (2021) were trained. Raising awareness and empowerment to risk communities happened mainly through local/online open sessions, workshops, flyer distribution, video projections. These occurred in all 10 PHU, mostly through partnerships with Non-Governmental Organizations and municipalities. According to the Portuguese Health Records, until 2018 there were only 300 women registered with FGM. Between 2019-2021, 363 more were added. Lessons The multisectoral approach allowed PHU professionals to collaborate directly with external organizations from different society sectors. COVID-19 pandemic posed a challenge to implementation, especially in the community intervention axis. Notification numbers increased after interventions, though causality could not be established and impact evaluation is yet to be performed. Key messages • Multisectoral projects for FGM intervention have specific implementation challenges, including how to justify and evaluate them, that must be considered in each setting. • Training health professionals might increase identification and notification of FGM, but the impact in preventing FGM in the Portuguese reality is still largely unknown.

Women of childbearing age: What antiseizure medications are they taking?

Women of childbearing age: What antiseizure medications are they taking?

The Impact of Quality of Work Organization on Distress and Absenteeism among Healthcare Workers.

The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems (p < 0.001). Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders (OR = 0.984, CI95% 0.972–0.996) and for other health problems (OR = 0.977, CI95% 0.967–0.988). A continuous improvement of work organization must consider not only the clients’ or production needs but also the well-being of workers.

Infection Rates and Impact of Glucose Lowering Medications on the Clinical Course of COVID-19 in People with Type 2 Diabetes: A Retrospective Observational Study.

PurposeDiabetes is a risk factor for COVID-19 severity, but the role played by glucose lowering medications (GLM) is still unclear. The aim of this study was to assess infection rates and outcomes of COVID-19 (hospitalization and mortality) in adults with diabetes assisted by the Local Health Unit of Padua (North-East Italy) according to the ongoing GLM.Patients and MethodsPeople with diabetes were identified using administrative claims, while those with SARS-CoV-2 infection were detected by cross referencing with the local COVID-19 surveillance registry. A multivariate logistic regression model was used to verify the association between GLM classes and the outcome.ResultsSARS-CoV-2 infection rates were marginally but significantly higher in individuals with diabetes as compared to those without diabetes (RR 1.04, p = 0.043), though such relative 4% increase may be irrelevant from a clinical and epidemiological perspective. 1923 individuals with GLM-treated diabetes were diagnosed with COVID-19; 456 patients were hospitalized and 167 died. Those treated with insulin had a significantly higher risk of hospitalizations for COVID-19 (OR 1.48 p < 0.01) as were those treated with sulphonylureas/glinides (OR 1.34, p = 0.02). Insulin use was also significantly associated with higher mortality (OR 1.90, p < 0.01). Use of metformin was significantly associated with lower death rates (OR 0.62, p = 0.02). The association of other GLM classes with the outcome was not significant.ConclusionDiabetes does not appear to modify the risk of SARS-CoV-2 infection in a clinically meaningful way, but strongly increases the rates of hospitalization and death. Insulin use was associated with worse outcomes, whereas metformin use was associated with lower mortality.

Early Detection of SARS-CoV-2 Epidemic Waves: Lessons from the Syndromic Surveillance in Lombardy, Italy.

We evaluated the performance of the exponentially weighted moving average (EWMA) model for comparing two families of predictors (i.e., structured and unstructured data from visits to the emergency department (ED)) for the early detection of SARS-CoV-2 epidemic waves. The study included data from 1,282,100 ED visits between 1 January 2011 and 9 December 2021 to a local health unit in Lombardy, Italy. A regression model with an autoregressive integrated moving average (ARIMA) error term was fitted. EWMA residual charts were then plotted to detect outliers in the frequency of the daily ED visits made due to the presence of a respiratory syndrome (based on coded diagnoses) or respiratory symptoms (based on free text data). Alarm signals were compared with the number of confirmed SARS-CoV-2 infections. Overall, 150,300 ED visits were encoded as relating to respiratory syndromes and 87,696 to respiratory symptoms. Four strong alarm signals were detected in March and November 2020 and 2021, coinciding with the onset of the pandemic waves. Alarm signals generated for the respiratory symptoms preceded the occurrence of the first and last pandemic waves. We concluded that the EWMA model is a promising tool for predicting pandemic wave onset.

Early identification of a COVID-19 outbreak detected by wastewater surveillance at a large homeless shelter in Toronto, Ontario

SettingToronto (Ontario, Canada) is a large urban centre with a significant population of underhoused residents and several dozen shelters for this population with known medical and social vulnerabilities. A sizeable men’s homeless shelter piloted a facility-level SARS-CoV-2 wastewater surveillance program.InterventionWastewater surveillance was initiated at the shelter in January 2021. One-hour composite wastewater samples were collected twice weekly from a terminal sanitary clean-out pipe. The genetic material of the SARS-CoV-2 virus was extracted from the solid phase of each sample and analyzed using real-time qPCR to estimate the viral level. Wastewater results were reported to facility managers and Toronto Public Health within 4 days.OutcomesThere were 169 clients on-site at the time of the investigation. Wastewater surveillance alerted to the presence of COVID-19 activity at the site, prior to clinical detection. This notification acted as an early warning signal, which allowed for timely symptom screening and case finding for shelter managers and the local health unit, in preparation for the declaration of an outbreak.ImplicationsWastewater surveillance acted as an advanced notification leading to the timely deployment of enhanced testing prior to clinical presentation in a population with known vulnerabilities. Wastewater surveillance at the facility level is beneficial, particularly in high-risk congregate living settings such as shelters that house transient populations where clinical testing and vaccination can be challenging. Open communication, established individual facility response plans, and a balanced threshold for action are essential to an effective wastewater surveillance program.

Development and testing of diagnostic algorithms to identify patients with acromegaly in Southern Italian claims databases

Acromegaly is a rare disease characterized by an excessive production of growth-hormone and insulin-like growth factor 1, typically resulting from a GH-secreting pituitary adenoma. This study was aimed at comparing and measuring accuracy of newly and previously developed coding algorithms for the identification of acromegaly using Italian claims databases. This study was conducted between January 2015 and December 2018, using data from the claims databases of Caserta Local Health Unit (LHU) and Sicily Region in Southern Italy. To detect acromegaly cases from the general target population, four algorithms were developed using combinations of diagnostic, surgical procedure and co-payment exemption codes, pharmacy claims and specialist’s visits. Algorithm accuracy was assessed by measuring the Youden Index, sensitivity, specificity, positive and negative predictive values. The percentage of positive cases for each algorithm ranged from 7.9 (95% CI 6.4–9.8) to 13.8 (95% CI 11.7–16.2) per 100,000 inhabitants in Caserta LHU and from 7.8 (95% CI 7.1–8.6) to 16.4 (95% CI 15.3–17.5) in Sicily Region. Sensitivity of the different algorithms ranged from 71.1% (95% CI 54.1–84.6%) to 84.2% (95% CI 68.8–94.0%), while specificity was always higher than 99.9%. The algorithm based on the presence of claims suggestive of acromegaly in ≥ 2 different databases (i.e., hospital discharge records, copayment exemptions registry, pharmacy claims and specialist visits registry) achieved the highest Youden Index (84.2) and the highest positive predictive value (34.8; 95% CI 28.6–41.6). We tested four algorithms to identify acromegaly cases using claims databases with high sensitivity and Youden Index. Despite identifying rare diseases using real-world data is challenging, this study showed that robust validity testing may yield the identification of accurate coding algorithms.

EPI-ASTHMA study protocol: a population-based multicentre stepwise study on the prevalence and characterisation of patients with asthma according to disease severity in Portugal

IntroductionIn Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of disease severity, control...

Abstract A1: Sglt2 Inhibition Via Empagliflozin Improves Endothelial Function And Reduces Mitochondrial Oxidative Stress: Insights From Hypertensive And Diabetic Frail Elders

Background: Frailty is a multidimensional condition very common in older adults that leads to physical impairment. Frail older adults have an increased risk of adverse outcomes such as disability, hospitalization, and mortality. Hypertension and diabetes are prevailing comorbidities in frail elders. Methods: We studied consecutive frail older patients presenting at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to January 2021. Exclusion criteria were: absence of frailty, hypertension, and diabetes; age &lt;65 years; left ventricular ejection fraction &lt;50%; previous myocardial infarction. In all patients we assessed blood samples for glycemia, HbA1c and creatinine; a physical frailty evaluation was performed following the Fried Criteria. Results: We evaluated 407 patients; 325 frail elders with diabetes and hypertension successfully completed the study. We propensity-score matched 75 patients treated with empagliflozin and 75 with no empagliflozin. We observed a strong correlation between glycemia and Montreal Cognitive Assessment (MoCA) Score (r 2 : 0.91; p&lt;0.001) and between glycemia and 5 meters gait speed (5mGS) (r 2 : 0.79; p&lt;0.001). We tested the differences in MoCA Score at baseline and at 3-month follow-up in empagliflozin treated and non-treated groups (20.32 vs. 22.41, p&lt;0.01; 20.34 vs . 20.71). Moreover, we measured the differences in 5mGS (0.60 vs . 0.64, p&lt;0.05; 0.58 vs . 0.59). We evaluated how many patients had frailty; the empagliflozin-treated group, at 3-month follow-up, only showed 25.3% of patients with frailty (n: 19), while the non-treated group had 73.3% of patients with frailty (n: 55) (p&lt;0.001). Our results were confirmed by regression analyses with basal MoCA Score or 5mGS as the dependent variables, after adjusting for several covariates. Mechanistically, we found that Empagliflozin significantly reduced mitochondrial ROS production and leakage triggered by high glucose conditions in human endothelial cells. Conclusions: Taken together, our data indicate that empagliflozin treatment reduced frailty in diabetic and hypertensive patients, by reducing mitochondrial oxidative stress in endothelial cells.

P06-08 Socio-demographic profile of physically inactive adults living in Italy according to the PASSI data

BackgroundInsufficient physical activity (PA) or physical inactivity (PI) is one of the ten leading risk factors for global mortality. PI leads to 20-30% increased risk of all-cause mortality and monitoring its current levels and trends in general population is essential to track progress towards health targets, identify at-risk groups, assess policies' effectiveness, guide future planning.MethodsPASSI (Progressi delle Aziende Sanitarie per la Salute in Italia - Progresses in ASSessing adult population health in Italy) is an ongoing cross-sectional Behavioral Risk Factor Surveillance System (BRFSS) that monitors prevalence and temporal trends for the major modifiable health-related risk factors in the adults (18-69 years) residing in Italy. Data are collected in the Local Health Units (LHU) by trained personnel who administer a standardized questionnaire telephonically to sampled people. In the period 2015-2018, 132,717 people were interviewed in more of 90% LHUs (89 out of 101 in 2018), achieving a response rate above 80%. Concerning PA/PI, respondents are classified as per the WHO indicators in: (i) Active - basing on levels achieved in leisure time and/or heavy work; (ii) Partially active - in leisure time and/or moderate work or in spare time and without regular work; (iii) Inactive - in leisure time with sedentary work or in spare time and without regular work. PASSI calculates prevalence of PA/PI overall and by socio-demographic characteristics, including 95% confidence intervals (CI), and a logistic regression model estimates adjusted prevalence ratios (APR).ResultsIn Italy, 28.8% (CI95%:28.5-29.1%) of adult population is featured by a sedentary lifestyle: PI is greater among women (32.4% vs. 25.1%; APR: 1.26), grows with age (34% in over50 vs. 24.7% among 18-34 year-old; APR: 1.34), is higher among deprived people both per economic difficulties (41.7% if many vs. 22.4% if none; APR: 1.39) and for education level (23.7% university vs. 47.2% primary/any; APR: 1.33). We observed a highly evident geographic gradient: PI amounts to 18.3% in the North, 25.2% in the Centre and 40.6% in the South. A multivariate analysis confirms these values are statistically significant.ConclusionsPASSI data provide strong evidence to support community prevention interventions on territorial planning or advice by health professionals.

Adherence, persistence and switching rates of apixaban, dabigatran and rivaroxaban in non-valvular atrial fibrillation: a multicentre real-life analysis at 3 years

IntroductionAdherence to and persistence with long-term treatment with oral anticoagulants play a significant role in preventing adverse events and mortality in patients with cardiac conditions. The aim of this study...

The Impact of the Introduction of the Breast Unit Model in a Northwestern Italian Region.

Breast cancer is the most common tumor in middle-aged and older women. In 2003, the European Parliament recommended to Member States that all women with breast cancer should be treated by a multidisciplinary team and that a network of certified breast centers be organized (the centers have been called Breast Units (BUs)). With the present study, we aim to explore the impact of the introduction of the BU organizational model in the Liguria region, Italy, through different outcome indicators. An explorative retrospective analysis was conducted through the period from 2013 to 2019 to assess the impact of the introduction of the BU model in our region. We identified two periods: before (2014–2015) and after (2017–2018) the introduction of this organizational model to assess its value impact through the definition of six measurable outcome indicators. Length of hospitalization, repeated specialist outpatient diagnostic procedures and the rate of subjects who started radiotherapy treatment within 60 days improved after the introduction of BUs. The passive health migration rate only improved significantly for one local health unit (LHU), while reintervention and diagnosis–surgery time did not show any enhancement after the introduction of the BU model. The BU model seems to provide an increase in several aspects of the healthcare offered to breast cancer patients in Liguria, specifically in those areas where a shared guideline could assist healthcare workers. Future research, such as pilot studies, are needed to assess the impact of the introduction of the BU model in our reality.

SGLT2 Inhibition via Empagliflozin Improves Endothelial Function and Reduces Mitochondrial Oxidative Stress: Insights From Frail Hypertensive and Diabetic Patients.

Frailty is a multidimensional condition often diagnosed in older adults with hypertension and diabetes, and both these conditions are associated with endothelial dysfunction and oxidative stress. We investigated the functional role of the SGLT2 (sodium glucose cotransporter 2) inhibitor empagliflozin in frail diabetic and hypertensive older adults. We studied the effects of empagliflozin in consecutive hypertensive and diabetic older patients with frailty presenting at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to January 2022. Moreover, we performed in vitro experiments in human endothelial cells to measure cell viability, permeability, mitochondrial Ca2+, and oxidative stress. We evaluated 407 patients; 325 frail elders with diabetes successfully completed the study. We propensity-score matched 75 patients treated with empagliflozin and 75 with no empagliflozin. We observed a correlation between glycemia and Montreal Cognitive Assessment (MoCA) score and between glycemia and 5-meter gait speed (5mGS). At 3-month follow-up, we detected a significant improvement in the MoCA score and in the 5mGS in patients receiving empagliflozin compared with non-treated subjects. Mechanistically, we demonstrate that empagliflozin significantly reduces mitochondrial Ca2+ overload and reactive oxygen species production triggered by high glucose in human endothelial cells, attenuates cellular permeability, and improves cell viability in response to oxidative stress. Taken together, our data indicate that empagliflozin reduces frailty in diabetic and hypertensive patients, most likely by decreasing the mitochondrial generation of reactive oxygen species in endothelial cells.

Exploring Contemporary Data on Lipid-Lowering Therapy Prescribing in Patients Following Discharge for Atherosclerotic Cardiovascular Disease in the South of Italy.

Current international guidelines strongly recommend the use of high-intensity lipid-lowering therapy (LLT) after hospitalization for atherosclerotic cardiovascular disease (ASCVD) events. With this study, our aim was to evaluate LLT prescribing in a large Italian cohort of patients after discharge for an ASCVD event, exploring factors associated with a lower likelihood of receiving any LLT and high-intensity LLT. Individuals aged 18 years and older discharged for an ASCVD event in 2019–2020 were identified using hospital discharge abstracts from two local health units of the Campania region. LLT treatment patterns were analyzed in the 6 months after the index event. Logistic regression models were developed for estimating patient predictors of any LLT prescription and to compare high-intensity and low-to-moderate-intensity LLT. Results: A total of 8705 subjects were identified. In the 6 months post-discharge, 56.7% of patients were prescribed LLT and, of those, 48.7% were high-intensity LLT. Female sex, older age, and stroke/TIA or PAD conditions were associated with a higher likelihood of not receiving high-intensity LLT. Similar predictors were found for LLT prescriptions. LLT utilization and the specific use of high-intensity LLT remain low in patients with ASCVD, suggesting a substantial unmet need among these patients in the contemporary real-world setting.

The Effects of the COVID-19 Pandemic in Oncology Patient Management

The COVID-19 pandemic has changed the way cancer patients should be managed. Using published literature on best practices on oncology patient management, we developed checklists to establish which recommendations were followed and differences between healthcare staff and institutions in a local health unit (overseeing two regional hospitals and 14 primary Healthcare Centers) in an interior region in Portugal. Checklists were delivered and completed by 15 physicians, 18 nurses and 5 pharmacists working at the Hospitals, and 29 physicians and 46 nurses from primary healthcare centers. Hospital staff do not show statistically significant differences regarding most proposed recommendations for the oncology clinical pathway, human resources, treatments, patient management and service management. Primary healthcare centers seem to follow a similar trend. As a local health unit, general recommendations for Oncology Patient Management show statistically significantly different values on education of suspected cases, identification, isolation procedures and samples collection; extension of work schedules; and education on cancer patient and COVID-19 positive referral procedures. All the checklists indicated good-to-high internal consistency. Our analysis showed cohesive work between groups regarding control and prevention of sources of infection; therefore, it is considered the highest priority to ensure that all other services, including oncology, continue functioning. Patient management measures such as adjustments in treatments, analysis, patient care, referrals and emergencies were not ranked higher by responders.

Anti-SARS-CoV-2 Vaccination Campaign: Risk Perception, Emotional States, and Vaccine Hesitancy in a Sample of Adolescents' Vaccinated Parents in Southern Italy.

Background: The international strategic plan for COVID-19 vaccines remains the practical option for the protection of health. However, vaccine hesitancy remains an obstacle to full population vaccination, with rapid developments in COVID-19 vaccines and concerns about efficacy acting as influencing factors. Aim: The present study investigated the perception of vaccine hesitancy among parents of adolescents in order to explore the reasons and related emotional states. Methods: In January–March 2022, an online questionnaire was administered to a sample of parents who brought their children to the vaccine center of a local health unit, ASL Salerno (Campania, Italy). Results: The participants were 1105 parents (F = 64.6%; mean age = 47.37 years, SD = 7.52) of adolescents (F = 47.6%; mean age = 14.83 years, SD = 1.72). All parents had received the COVID-19 vaccine. Regarding the vaccination schedule, 46.8% believed that children receive more vaccinations than they should; 25.1% believed that it is better to develop immunity rather than get vaccinated; 41.2% believed that their child could have side effects; 29.6% were very concerned that vaccines were unsafe, while 35.3% believed vaccines do not prevent disease; 21.5% were very reluctant about pediatric vaccines; and 23.8% did not trust the information received. Conclusions: In order to increase vaccination and reduce the prevalence of vaccine hesitancy, it is essential to support the value of vaccination among all parents and make information more accessible and usable through competent pediatricians.

A Scientific and Integrated Coaching Training Pathway to Accelerate HCV Eradication and Use of Telemedicine for Covid-19 Patients in 5 Local Health Units in Italy

A Scientific and Integrated Coaching Training Pathway to Accelerate HCV Eradication and Use of Telemedicine for Covid-19 Patients in 5 Local Health Units in Italy

Adherence to the Admission Policy in a Local Old Age Psychiatric Unit in Wrexham: A Clinical Audit

AimsElderly patients are more vulnerable due to the higher prevalence of underlying physical health problems. Hence, it is prudent to have a baseline and regular update on the physical health assessment for all old age mental health inpatients. This paper is aimed to discuss the clinical audit findings on the physical health assessment are done in accordance to the trust policy.MethodsThe clinical audit was conducted in a local elderly inpatient mental health unit over a period of a week. The standard used was based on the local Health Board Policy on acute inpatient admission, which includes an admission clerking with details on physical health need and physical examination should be done within 12 hours of admission, blood investigations and medication chart should be completed within two hours of admission, and an ECG (electrocardiography) should be done at the point of admission.ResultsA total of 21 elderly inpatients admission clerking were analysed. It is noted that over 95 cases admission did not adhere to the prescribed standard. Only 67% of the admission clerking was completed within 12 hours, while only 52% of the admission had physical examination done. Only 24% of the admission completed their blood investigations within two hours and 14% of them had ECG done at the point of admission. Although 90% of medication chart was completed within two hours of admission, there is still room for improvement. Feedback from the junior doctors revealed a multifactorial contribution to the failure of meeting the standards: patient being agitated during admission, lack of communication among different teams, lacking an online documentation system on handover, and the heavy workload on junior doctors on venepuncture and ECG.ConclusionThe clinical audit has shown a huge area of improvement is needed in terms of the physical health assessment and documentation for elderly inpatient psychiatry unit.We recommend having a good handover system, training more nurses and HCWs in phlebotomy and ECGs, having ward based doctor cover to improve the adherence for future.We will be presenting this audit in post grad teaching and junior doctor forum with a plan to conduct a regional audit to compare the adherence on the three different hospital under the same health board.