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Introduction: Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. Material and methods: Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. Results: 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. Discussion and conclusions: Delayed discharge may cause a "bottleneck" in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organiz

Objectives: A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design. Background: The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients. Methods: The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents. Results: 102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds. Conclusions: Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings.

The diagnosis of rare diseases and other genetic conditions can be daunting due to vague or poorly defined clinical features that are not recognized even by experienced clinicians. Next-generation sequencing technologies, such as whole-genome sequencing (WGS) and whole-exome sequencing (WES), have greatly enhanced the diagnosis of genetic diseases by expanding the ability to sequence a large part of the genome, rendering a cost-effectiveness comparison between them necessary. Objective To assess the cost-effectiveness of WGS compared with WES and conventional testing in children with suspected genetic disorders. Design, Setting, and Participants In this economic evaluation, a bayesian Markov model was implemented from January 1 to June 30, 2023. The model was developed using data from a cohort of 870 pediatric patients with suspected genetic disorders who were enrolled and underwent testing in the Ospedale Pediatrico Bambino Gesu, Rome, Italy, from January 1, 2015, to December 31, 2022. The robustness of the model was assessed through probabilistic sensitivity analysis and value of information analysis. Main Outcomes and Measures Overall costs, number of definitive diagnoses, and incremental cost-effectiveness ratios per diagnosis were measured. The cost-effectiveness analyses involved 4 comparisons: first-tier WGS with standard of care; first-tier WGS with first-tier WES; first-tier WGS with second-tier WES; and first-tier WGS with second-tier WGS. Results The ages of the 870 participants ranged from 0 to 18 years (539 [62%] girls). The results of the analysis suggested that adopting WGS as a first-tier strategy would be cost-effective compared with all other explored options. For all threshold levels above euro29 800 (US $32 408) per diagnosis that were tested up to euro50 000 (US $54 375) per diagnosis, first-line WGS vs second-line WES strategy (ie, 54.6%) had the highest probability of being cost-effective, followed by first-line vs second-line WGS (ie, 54.3%)

Background: Although the long-term consequences of the Coronavirus Disease-2019 (COVID-19) pandemic are yet to be fully comprehended, a syndrome symptomatically akin to the COVID-19 disease has been defined, for children and adolescents, in February 2023 by the World Health Organization (WHO) as ‘post COVID-19 condition’ (PCC). Potential consequences of COVID-19 that affect developmental milestones in children and adolescents should be comprehended in their magnitude and duration. The aim is to investigate the most common symptoms and predictors or risk factors for pediatric PCC. Methods: In this umbrella review, the population of interest was defined as children and adolescents from 0 to 19 years old presenting PCC symptoms as defined by the WHO in the International Classification of Diseases. The intervention considered was general follow-up activity to monitor the patients’ recovery status. No comparator was chosen, and the outcomes were symptoms of PCC and predictors or risk factors of developing PCC. Methodological quality, risk of bias and the level of overlap between studies were assessed. A random- effects meta-analytic synthesis of respective estimates with inverse variance study weighting was carried out, for the primary studies included by the reviews retrieved, regarding predictors or risk factors reported. Results: We identified six eligible systematic reviews, five with meta-analyses, from three databases. The most common symptoms reported were fatigue and respiratory difficulties; female sex and older age were the most reported factors associated with the development of pediatric PCC. Conclusions: A deeper understanding of pediatric PCC requires well- designed and clearly defined prospective studies, symptom differentiation, and adequate follow-up.

AimsCardiac contractility modulation (CCM) is a device therapy for heart failure, based on the delivery of high-voltage biphasic impulses to the right ventricular septum during the myocardial absolute refractory period. This study evaluated the cost-effectiveness of CCM therapy plus optimal medical therapy (OMT) vs. OMT alone in patients with heart failure with reduced ejection fraction.Methods and resultsA Markov model with a lifespan time horizon was developed to assess the cost-utility using the FIX trials as main data sources. A deterministic sensitivity analysis and a probabilistic sensitivity analysis were run to analyse the decision uncertainty in the model through cost-effectiveness acceptability curve (CEAC) and cost-effectiveness acceptability frontier (CEAF). Value of information analysis was also conducted computing the expected value of perfect information (EVPI) and the expected value of partial perfect information. The base case results showed that the CCM plus OMT option was highly cost-effective compared with OMT alone with an incremental cost-utility ratio of euro7034/quality-adjusted life year (QALY). The CEAC and CEAF illustrated that for all willingness to pay levels above euro5600/QALY, tested up to euro50 000/QALY, CCM plus OMT alternative had the highest probability of being cost-effective. The EVPI per patient was estimated to be euro124 412 on a willingness to pay threshold of euro30 000/QALY.ConclusionsFor patients with heart failure with reduced ejection fraction, CCM therapy could be cost-effective when taking a lifetime horizon. Further long-term, post-approval clinical studies are needed to verify these results in a real-world context, particularly concerning the effect of CCM therapy on mortality.

Objectives: to set out a method based on the Reed Frost model to delimit over time COVID-19 epidemic waves in Italy. Design: the available national epidemic reports published by the Protezione Civile (Italian civil defence) from 24.02.2020 to 16.022022 were used to collect data on COVID-19 epidemic in Italy. Then, the Reed-Frost model was applied to develop a methodology based on the calculation of the effective contact probability, i.e., the probability of contact. Setting and participants: in Italy, a daily report related to the epidemic was immediately available, including main epidemiological data (point and periodic infection prevalence, mortality, etc), which made it possible for researchers from different institutions to perform analyses about the epidemic. Results: an iterative methodology was developed resulting in the identification of the start-of-wave, end-of-wave, and inter-wave periods and of the starting and ending days of the COVID-19 epidemic waves in Italy (first wave: from 26±2 February 2020 to 28±2 June 2020). Conclusions: this study led to the development of an accessible and reproducible method to determine the start-of-wave and end-of-wave dates of an epidemic, starting only from the number of cases and susceptible people. The main implications of the method mainly consist in allowing benchmarking and forecasting analyses of the epidemic trend to be carried out to support policy and decision-making processes.

Obiettivo: individuare proposte di inserimento del pediatra di famiglia nelle attività integrate di assistenza primaria community-oriented, promosse attraverso la costituzione delle case della comunità. Metodi: è stata condotta una revisione narrativa inclusiva di letteratura scientifica e grigia. Risultati: nel contesto della casa della comunità, il pediatra di famiglia può operare in forme aggregate – AFT e UCCP –, all’interno di équipe multidisciplinari e multiprofessionali, in rete integrata con attori sociosanitari di altri setting e stakeholder comunitari. Figura strategica nell’offerta di salute, il pediatra realizza una presa in carico del paziente in età evolutiva, intercettando e rispondendo ai suoi bisogni, attraverso interventi di promozione della salute, prevenzione, cura, riabilitazione e palliazione rivolti al singolo e alla comunità. Conclusioni: la pediatria di famiglia si candida a rappresentare il nucleo motore di un processo sinergico che, con logiche sistemiche di presa in carico, consente di perseguire obiettivi di salute di una comunità, valorizzandone tutte le risorse.

This study explores the organizational aspects of whole genome sequencing (WGS) implementation for pediatric patients with suspected genetic disorders in Italy, comparing it with whole exome sequencing (WES). Health professionals' opinions were collected through an internet-based survey and analyzed using a qualitative summative content analysis methodology. Among the 16 respondents, most were clinical geneticists performing only WES, while 5 also used WGS. The key differences identified include higher needs for analyzing genome rearrangements following WES, greater data storage and security requirements for WGS, and WGS only being performed in specific research studies. No difference was detected in centralization and decentralization issues. The main cost factors included genetic consultations, library preparation and sequencing, bioinformatic analysis, interpretation and confirmation, data storage, and complementary diagnostic investigations. Both WES and WGS decreased the need for additional diagnostic analyses when not used as last-resort tests. Organizational aspects were similar for WGS and WES, but economic evidence gaps may exist for WGS in clinical settings. As sequencing costs decline, WGS will likely replace WES and traditional genetic testing. Tailored genomic policies and cost-effectiveness analyses are needed for WGS implementation in health systems. WGS shows promise for enhancing genetics knowledge and expediting diagnoses for pediatric patients with genetic disorders.

Background The issue of reluctance towards vaccination is becoming more worrisome. Health care workers (HCWs) are the primary point of contact with individuals who make decisions about vaccination. Therefore, it is crucial that HCWs receive sufficient training and periodic updates. The main objective of this systematic review is to evaluate the HCWs' training needs in vaccination and vaccine uptake. Methods In February 2022, a search was conducted on MEDLINE, Scopus and Google Scholar databases. The search included papers written in English, Italian, Portuguese, Spanish, French and Romanian, with a publication date ranging from 1 January 2011 to 24 February 2022 and conducted in Europe. To assess the methodological quality of the papers, the Appraisal tool for Cross-Sectional Studies was utilized. Results The search of scientific literature yielded 640 outcomes on PubMed, 556 on Scopus and 15 on Google Scholar, for a total of 1211 records. After eliminating duplicates, screening titles and abstracts and evaluating the full text of the articles, only 25 of them were found suitable for inclusion. The studies' overall quality ranged from moderate to good. The majority of the research emphasized the need for improved knowledge of vaccine-preventable diseases, vaccine efficacy, immunization schedules and vaccine adverse effects. Conclusions It is vital to prioritize educational programmes on vaccinology and vaccine hesitancy for HCWs, with the objective of improving their knowledge, awareness and attitudes. Addressing the diversity of educational backgrounds, roles and training requirements of HCWs involved in vaccination across Europe is a critical issue that must be tackled for future initiatives.

SARS-CoV-2 vaccination has been the most effective tool to prevent COVID-19, significantly reducing deaths and hospitalizations worldwide. Vaccination has played a huge role in bringing the COVID-19 pandemic under control, even as the inequitable distribution of vaccines still leaves several countries vulnerable. Therefore, organizing a mass vaccination campaign on a global scale is a priority to contain the virus spread. The aim of this systematic review was to assess whether COVID-19 vaccination campaigns are cost-effective with respect to no vaccination. A systematic literature search was conducted in the WHO COVID-19 Global literature database, PubMed, Web of Science, Embase, and Scopus from 2020 to 2022. Studies assessing the COVID-19 vaccination campaign cost-effectiveness over no vaccination were deemed eligible. The "Drummond's checklist" was adopted for quality assessment. A synthesis of the studies was performed through the "dominance ranking matrix tool". Overall, 10 studies were considered. COVID-19 vaccination was deemed cost-effective in each of them, and vaccination campaigns were found to be sustainable public health approaches to fight the health emergency. Providing economic evaluation data for mass vaccination is needed to support decision makers to make value-based and evidence-based decisions to ensure equitable access to vaccination and reduce the COVID-19 burden worldwide.

The COVID-19 pandemic is considered one of the deadliest pandemics in history. Pregnant women are more susceptible to developing serious diseases during COVID-19 than their non-pregnant peers. Pregnant women often express doubt about accepting the vaccination, especially in regard to their security and safety. This study aims to investigate the appreciation of the vaccination offer, and if there are any determinants impacting vaccine hesitancy. A questionnaire was administered to a sample of pregnant women who had just received their immunization against COVID-19 at the vaccination service of a teaching hospital in Rome, from October 2021 to March 2022. A high appreciation of the vaccination services was found, both for the logistic organization and the healthcare personnel, with mean scores above 4 out of 5. The degree of pre-vaccinal doubt was low (41%) or medium (48%) for the largest part of the sample, while the degree of COVID-19 vaccine knowledge was high for 91% of the participants. Physicians were the most decisive information source for the vaccination choice. Our results highlighted that a supportive approach could increase appreciation and improve the setting of vaccinations. Healthcare professionals should aim for a more comprehensive and integrated role of all figures.

Background: Frequent users (FUs) are patients who repeatedly and inappropriately visit the emergency department (ED) for low-grade symptoms that could be treated outside the hospital setting. This study aimed to investigate the phenomenon of the FU in Rome by profiling such users and analyzing ED attendance by FUs. Methods: The analysis was carried out for attendance in 2021 at 15 EDs in the Local Health Authority Roma 1 geographical area. A digital app collected data, including information on the following variables: number of attendance, demographic characteristics, emergency medical service (EMS) usage, triage code, and appropriateness of attendance. COVID-19 diagnosis was also studied to analyze any possible influence on ED attendance. Differences between FUs and non-FUs were investigated statistically by t-test and chi-square test. Univariate analysis and multivariable logistic regression were performed to analyze the associated factors. Results: A total of 122,762 ED attendance and 89,036 users were registered. The FU category represented 2.9% of all users, comprising 11.9% of total ED attendance. There was a three times higher frequency of non-urgent codes in attendance of FU patients (FU: 9.7%; non-FU: 3.2%). FUs were slightly more likely to have used the EMS (13.6% vs. 11.4%) and had a lower frequency of appropriate ED attendance (23.8% vs. 27.0%). Multivariate logistic analysis confirmed a significant effect of triage code, gender, age, EMS usage, and COVID-19 diagnosis for the appropriateness of attendance. The results were statistically significant (p < 0.001). Conclusion: The FU profile describes mostly non-urgent and inappropriate attendance at the ED, including during the COVID-19 pandemic. This study represents an important tool for strengthening preventive policies outside the hospital setting. The Italian National Recovery and Resilience Plan represents an excellent opportunity for the development of new strategies to mitigate the phenomenon of

Background Healthcare systems are complex systems. Achieving financial, social, and environmental sustainability of these systems requires a high degree of integration and coordination at all levels, especially between acute-care settings and primary/community care services. Some authors have, therefore, suggest redirecting integrated healthcare research towards the network theory and network concepts as a useful lens. Objective The current paper proposes to investigate the existence, the institutional level of formalization and the degree of development of hospital/primary-community care Networks currently present in the main types of healthcare systems worldwide by studying an appropriate selection of representative countries for each system typology. Materials and Methods A narrative review of the scientific and gray literature following the methodology by Green et al. was, therefore, conducted to describe hospital and primary/community care networks and their integration/coordination in the main international models. To select these models, one country with the current highest life expectancy at birth for each of the B öhm's five healthcare system categories was chosen. The grade of integration of the Networks retrieved for each State was therefore qualitatively appraised (high, medium or low degree), following Valentijn's framework. Results The networks retrieved show: in Norway, Australia and Japan both at the government/ national and at the regional/lower level/other a high degree of systemic, organizational, normative and functional integration; in Switzerland both at the government/national and at the regional/lower level/other a medium degree of systemic, organizational, normative and functional integration; in the USA at the governmental/institution level a low degree of systemic, organizational and normative integration, with a medium degree of functional integration and at the regional/lower level/other integration a low degree of systemic and normat

Cardiovascular diseases (CVDs) represent a major threat to health and primary prevention outstands as the most effective instrument to face this issue, addressing multiple risk factors at a time and influencing behavioral patterns. Community nurses have been involved in many interdisciplinary prevention activities, resulting in effective control of CV risk factors. We conducted a pilot study aiming at describing the impact on the CV risk profile of an 18-month interdisciplinary intervention on lifestyle habits. From September 2018 to May 2020, four general practitioners (GPs) working in the Roman neighborhood of Torresina recruited patients having a cardiovascular risk score (CRS) equal to or higher than 3% and lower than 20%; those patients were included in a nutritional, physical, and psychological counseling program. Assessments of patients' health status were led at baseline, 6, 12, and 18 months by a nutritionist, a physiotherapist, a psychologist, their GPs, and a community nurse. The CRS was estimated at every examination, based on the Italian Progetto Cuore algorithm. A total of 76 patients were included (mean age of 54.6 years; 33 men and 43 women). Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8); both total cholesterol and systolic blood pressure (SBP) significantly decreased at 6 months of follow-up (respectively, from 211.1 to 192 and from 133.1 to 123.1). Nonetheless, the reduction was later maintained only for SBP. However, during the last 6 months of the intervention, the COVID-19 pandemic broke out, thus, it is not possible to know how much the results achieved at 18 months were influenced by the restrictive measures introduced by the Italian government. When stratifying according to the presence of hypertension/diabetes and physical activity, no differences in the CRS could be highlighted between the two groups. Our pilot study proved that an interdisciplinary counseling intervention program can improve CV ri

Background: The World Health Organization identified alcohol and tobacco consumption as the risk factors with a greater attributable burden and number of deaths related to non-communicable diseases. A promising technique aimed to modify behavioral risk factors by redesigning the elements influencing the choice of people is nudging. Methodology: A scoping review of the literature was performed to map the literature evidence investigating the use of nudging for tobacco and alcohol consumption prevention and/or control in adults. Results: A total of 20 studies were included. The identified nudging categories were increasing salience of information or incentives (IS), default choices (DF), and providing feedback (PF). Almost three-quarters of the studies implementing IS and half of those implementing PF reported a success. Three-quarters of the studies using IS in conjunction with other interventions reported a success whereas more than half of the those with IS alone reported a success. The PF strategy performed better in multi-component interventions targeting alcohol consumption. Only one DF mono-component study addressing alcohol consumption reported a success. Conclusions: To achieve a higher impact, nudging should be integrated into comprehensive prevention policy frameworks, with dedicated education sessions for health professionals. In conclusion, nudge strategies for tobacco and alcohol consumption prevention in adults show promising results. Further research is needed to investigate the use of nudge strategies in socio-economically diverse groups and in young populations.

Background and aims: Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, the literature about the long-term impact of TLE on survivals is still lacking. Given these knowledge gaps, the aim of our study was to analyse very long-term mortality in patients undergoing TLE in public health perspective. Methods: This prospective, single-centre, observational study enrolled consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE, from January 2005 to January 2021. The main goal was to establish the independent predictors of very long-term mortality after TLE. We also aimed at assessing procedural and hospitalization-related costs. Results: We enrolled 435 patients (mean age 70 ± 12 years, with mean lead dwelling time 6.8 ± 16.7 years), with prevalent infective indication to TLE (92%). Initial success of TLE was achieved in 98% of population. After a median follow-up of 4.5 years (range: 1 month-15.5 years), 150 of the 435 enrolled patients (34%) died. At multivariate analysis, death was predicted by: age (≥77 years, OR: 2.55, CI: 1.8-3.6, p < 0.001), chronic kidney disease (CKD) defined as severe reduction of estimated glomerular filtration rate (eGFR <30 mL/min/1.73 m2 , OR: 1.75, CI: 1.24-2.4, p = 0.001) and systolic dysfunction assessed before TLE defined as left ventricular ejection fraction (LVEF) <40%, OR: 1.78, CI 1.26-2.5, p = 0.001. Mean extraction cost was €5011 per patient without reimplantation and €6336 per patient with reimplantation respectively. Conclusions: Our study identified three predictors of long-term mortality in a high-risk cohort of patients with a cardiac device infection, undergoing successful TLE. The future development of a mortality risk score before might impact on public health strategy.

Obiettivi - Stimare la costo-efficacia dei pacemaker leadless (PL) rispetto ai pacemaker tradizionali (PT) nella popolazione eleggibile per l’impianto di PL e PT dalla prospettiva del Servizio Sanitario Nazionale (SSN). Metodologia - Un albero decisionale Bayesiano è stato calibrato per una coorte ipotetica di pazienti divisi equamente nel braccio PL e nel braccio PT, adottando la prospettiva del SSN. Dopo che il paziente è stato impiantato, può incorrere con probabilità prede- terminate in una complicanza. La popolazione target consisteva di pazienti eleggibili per l’impianto di PL e PT e ai quali viene impiantato uno dei due tipi di device. I parametri del modello sono stati ottenuti dalla letteratura scientifica. In particolare, i costi dei device, il costo medio delle complicanze ad essi associate e le probabilità di transizione sono stati derivati rispettivamente da un report statale statunitense [1], uno studio economico nazionale francese [2] e una revisione sistematica con meta-analisi [3]. I costi e i bene- fici sono stati scontati a un tasso annuo del 3%. Per orientare il processo decisionale su quale alternativa supportare è stato scelto il threshold dell’Eurozona, che varia da € 30.000 a € 50.000. L’impatto dell’incertezza sui parametri del modello è stato esplorato attraverso un’analisi di sensibilità probabilistica (PSA), calcolando la curva di accettabilità della costo-efficacia (CEAC) e la frontiera di accettabilità della costo-efficacia (CEAF), e un’analisi del valore dell’informazione (VOI), stimando invece il valore atteso dell’informa- zione perfetta (EVPI). L’inferenza Bayesiana è stata supportata da una serie di algoritmi noti come Markov Chain Monte Carlo (MCMC), tra cui il Gibbs sampler. È stata inoltre valutata la performance dell’algoritmo selezionato attraverso l’impiego di alcune tecni- che diagnostiche (i.e., traceplot, grafici di densità, diagnostica di Gelman-Rubin, funzioni di autocorrelazione della catena). I risultati d

Obiettivi - Lo Scompenso Cardiaco (SC) comporta un onere importante per il nostro Ser- vizio Sanitario Nazionale ed è associato ad un elevato carico di malattia legato ai costi, diretti e indiretti, che vengono generati dalla gestione della patologia stessa. La Cardiac Contractility Modulation (CCM) potrebbe rappresentare una nuova possibilità terapeutica per i pazienti con SC. Il presente progetto si propone, pertanto, mediante il coinvolgimen- to di diversi professionisti della salute (cardiologi, elettrofisiologi, professionisti di sanità pubblica) di analizzare e sistematizzare le evidenze attualmente disponibili sulla CCM, al fine di identificare gli elementi chiave per una possibile implementazione di questa tecno- logia innovativa nel contesto di cura italiano. Metodologia - È stata condotta un’analisi della letteratura scientifica sul burden epide- miologico dello SC, sulle caratteristiche del percorso di cura e sull’assorbimento delle risorse per il trattamento dello SC, nonché sulle evidenze scientifiche attualmente dispo- nibili sulla CCM. Risultati - Il burden dello SC riguarda 64,3 milioni di persone in tutto il mondo, diven- tando sempre più comune nei pazienti di età pari o superiore a 65 anni. Circa il 50% dei pazienti con SC muore entro 5 anni dalla diagnosi e si stima che questa sindrome inte- resserà più di 8 milioni di persone nel 2030. Nel corso degli ultimi anni, nuovi trattamenti, farmacologici e no, sono stati sviluppati per la gestione dello SC, come, ad esempio, terapie farmacologie (valsartan, ivabradina ecc.), la terapia di resincronizzazione cardiaca (CRT) e l’ablazione della fibrillazione atriale. Tuttavia, queste opportunità terapeutiche si sono dimostrate efficaci solo nello SC a Frazione di Eiezione (FE) ridotta. Risulta, quindi, essenziale identificare strategie farmacologiche ed elettriche alternative, soprattutto in considerazione del fatto che circa il 50% dei pazienti è affetto da SC a FE ridotta e che solo il 30% dei

This study investigates the financial consequences of perceived discrimination towards LGBTQAI+ people in Italy, focusing on psychological support and medication costs. It highlights the burden of discriminatory experiences, emphasizing the need for policies to minimize costs. A cost analysis was performed according to the NHS perspective. A purposive sample was recruited through a web-based survey spread on Italian researchers’ social networks, asking any LGBTQAI+ readers to answer about discriminatory experiences, access to psychological support, and medication use. Costs of health services use were estimated according to the Italian NHS tariffs and Italian Psychologists’ Board. The time horizon was set at one year and discounting was not necessary. Robustness was checked by a one-way sensitivity analysis. A total of 75 LGBTQAI+ people completed the survey. Most of them (aged 26-35 years, 85%; residing in big cities, 70%; unaffiliated with LGBTQAI+ associations, 88%) reported discriminative actions (60%), with 15% seeking psychological help soon after being victim of a single discriminatory act. Verbal and physical abuse were reported by 88% and 6% respectively. 40% of respondents claimed to have resorted to psychotherapy sessions because of the discomfort felt after acts perceived as discriminatory or violent, amounting to 810 total therapy hours. The total therapy cost was E72,900, of which 60% paid as out-of-pocket expenses, and 40% partially covered by regional Local Health Units. Additionally, 12% of respondents used SSRI or benzodiazepines, costing the National Health System an esteemed E3054. The sensitive analysis confirmed the robustness of results. The study demonstrates the significant economic burden of discrimination against LGBTQAI+ individuals in Italy, emphasizing the need for inclusive policies and accessible mental health support. Further research is required to explore indirect costs, for a comprehensive understanding of the total economic impac

Background: Primary care providers (PCPs) play an essential role in obesity care as they represent the first contact for patients seeking weight loss interventions. Objective: This study explored the knowledge, experiences, and perceptions of PCPs in the Lazio Region of Italy in the management of obesity. Design and subjects: We conducted an anonymous survey delivered from March to July 2022 via the newsletter of Rome Provincial Order of Physicians and Dentists and at the annual meeting of the regional section of the Italian Obesity Society. Approach: The survey consisted of 24 closed-ended questions grouped into 5 sections: sociodemographic and work information; assessment of obesity; management of obesity; connections with regional Centres for Obesity Management; attitudes towards obesity. Key results: A total of 92 PCPs accessed the survey. Of those, 2.2% were excluded because they did not see any patients with obesity. A total of 68 PCPs (75.6%) had complete questionnaires and were included in this analysis. All participants reported asking their patients about their eating habits, lifestyle, and clinical complications at the first assessment. Body weight and blood pressure were measured by 98.5% of participants and 82% calculate body mass index (BMI), while a small proportion of PCPs analysed body composition and fat distribution. Over 80% prescribed laboratory tests and ECG. Approximately 40% of PCPs did not refer patients for nutritional counselling, and most prescribed a low-calorie diet. Sixty-three percent referred patients to an endocrinologist, 48.5% to a psychotherapist, and a minority to specialists for obesity complications. Twenty-three percent prescribed anti-obesity medications and 46.5% referred patients for bariatric surgery only in severe cases. Ninety-one percent stated that obesity is "a complex and multifactorial disease" and 7.4% considered obesity to be secondary to other conditions. Conclusions: Despite most PCPs adopt a correct approach t

Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05).The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health.The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.