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Background In an ageing society, retirement impacts on behavioural risk factors and health outcomes should be carefully assessed. Scant evidence exists from longitudinal studies on the short- and long-term consequences of the transition to retirement on smoking habit. Methods We conducted a longitudinal study based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 27 European countries plus Israel collected in 2004–2020. To estimate relative risks (RR) and corresponding 95% confidence intervals (CI) for smoking status and intensity at seven time periods before and after retirement, we fitted adjusted generalised estimating equation (GEE) models for repeated measures. Results We selected a cohort of 8998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). As compared to the year of retirement, the RR of smoking was 1.59 (95% CI 1.44–1.76) at 10 years or more before retirement, 1.35 (95% CI 1.25–1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10–1.27) from 1 to 4 years before retirement. Smoking steadily decreased after retirement, being 0.94 (95% CI 0.87–1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69–0.84) from 5 to 9 years, and 0.58 (95% CI 0.46–0.74) 10 years or more after retirement. In smokers, the estimated number of cigarettes smoked/day decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p trend Conclusion Longitudinal data suggest that lifestyles might favourably change with retirement. Further studies are needed to direct healthy ageing promotion policies better.

The debate around vaccine mandates has flourished over the last decade, with several countries introducing or extending mandatory childhood vaccinations. In a recent study, Attwell and Hannah explore how functional and political pressures added to public health threats in selected countries, motivating governments to increase the coerciveness of their childhood vaccine regimes. In this commentary, we reflect on whether such model applies to the COVID-19 case and how the pandemic has re-shuffled the deck around vaccine mandates. We identify COVID-19 immunisation policies’ distinctive aspects as we make the case of countries implementing mass immunisation programmes while relying on digital COVID certificates as an indirect form of mandate to increase vaccine uptake. We conclude by acknowledging that different forms of mandatory vaccination might serve as a shortcut to protect population health in times of emergency, underlining, however, that the ultimate public health goal is to promote voluntary, informed, and responsible adherence to preventive behaviours.

Restrictions imposed to prevent SARS-CoV-2 transmission should be weighed against consequences on vulnerable groups' health. Lifestyles and disease management of older people with diabetes might have been differentially impacted compared to non-chronic individuals.A cross-sectional study (LOST in Lombardia) was conducted on a representative full sample of 4 400 older adults (17supth/sup-30supth/supNovember 2020), collecting data on lifestyles, mental health and access to care before and during the pandemic.We compared 947 (51.9%) people with diabetes and 879 (48.1%) healthy subjects reporting no chronic conditions. People with diabetes reported more frequently increased physical activity (odds ratio, OR 2.65, 95% confidence internals, CI 1.69-4.13), drinks/week reduction (OR 6.27, 95%CI 3.59-10.95), increased consumption of fruit (OR 2.06, 95%CI 1.62-2.63), vegetables (OR 1.41, 95%CI 1.10-1.82), fish (OR 2.51, 95%CI 1.74-3.64) and olive oil (OR 3.54, 95%CI 2.30-5.46). People with diabetes increased telephone contacts with general practitioners (OR 3.70, 95%CI 2.83-4.83), hospitalisations (OR 9.01, 95%CI 3.96-20.51), visits and surgeries cancellations (OR 3.37, 95%CI 2.58-4.42) and treatment interruptions (OR 1.95, 95%CI 1.33-2.86).Pandemic adverse effects occurred but are heterogenous in a population with chronic diseases, who seized the opportunity to improve health behaviours, despite health system difficulties guaranteeing routine care, within and beyond COVID-19.

Purpose Benefits of national-level stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be carefully weighed against its impact on citizens’ health. In a country with a strong familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have resulted in mental health worsening. Methods A web-based cross-sectional study (LOST in Italy) was conducted on a representative sample of Italian adults during lockdown (27th of April–3rd of May 2020). We asked 3156 subjects to report on reduced help in housework and childcare from retired parents to assess the impact of confinement on mental health, through validated scales before and during lockdown. Results Overall, 1484 (47.0%) subjects reported reduced housework help from parents, and 769 (64.0%, of the 1202 subjects with children) diminished babysitting support. Subjects reporting reduced housework help had worsened sleep quality (multivariate odds ratio, OR = 1.74, 95% confidence interval, CI 1.49–2.03) and quantity (OR = 1.50, 95% CI 1.28–1.76), depressive (OR = 1.32, 95% CI 1.14–1.53) and anxiety symptoms (OR = 1.53, 95% CI 1.32–1.78), compared to those reporting unreduced help. Worsening in sleep quality (OR = 2.32, 95% CI 1.76–3.05), and quantity (OR = 1.80, 95% CI 1.36–2.37), depressive (OR = 1.79, 95% CI 1.39–2.31) and anxiety symptoms (OR = 1.90, 95% CI 1.48–2.46) was also associated with reduced babysitting help. Mental health outcomes were worse in subjects with poorer housing and teleworking during lockdown. Conclusion Confinement came along with reduced familial support from parents, negatively impacting household members’ mental health. Our findings might inform evidence-based family and welfare policies to promote population health within and beyond pandemic times.

Comirnaty® was the first COVID-19 vaccine available for the vaccination campaign of healthcare workers in Italy. With the aim of assessing vaccine safety, we conducted a cross-sectional survey administrating a voluntary-based questionnaire on adverse events following immunisation (AEFIs) in San Raffaele Hospital, Milano, Italy.From 4th January 2021 to 27th April 2021, we collected 2,659 questionnaires (response rate: 24,5%). We analyzed data, reporting AEFIs by gender, age, self-reported severity, type, time of insurgence and duration, and estimating relative-risk ratios (RRR) and corresponding 95% confidence intervals (CI).The most reported symptoms were injection site pain, fatigue, headache, myalgia, chills, fever, and arthralgia. Severe systemic reactions were more frequent after receiving the second dose (RRR 6.25, 95% CI 4.57-8.55), in women (RRR 3.33, 95% CI 2.30-4.82), and less frequent in individuals aged 60 or more (RRR 0.26, 95% CI 0.14-0.49). In addition, we noted a wide range of adverse events of special interest (AESIs).Consistently with clinical trials and pharmacovigilance surveillance, AEFIs were frequent, but severe ones were uncommon, supporting the massive implementation of the COVID-19 vaccination campaign and providing valuable data for a risk profiling of vaccinees. (www.actabiomedica.it).

Although influenza is a major public health concern, little is known about the use of spray live attenuated influenza vaccine (LAIV) among adults. For this reason, we conducted a systematic review and meta-analysis to investigate the efficacy and safety of LAIV, especially in adults with/without clinical conditions and children

Background The ongoing pandemic of COVID-19 has underlined the importance of adopting effective infection prevention and control (IPC) measures in hospital and community settings. UV-based technologies represent promising IPC tools: their effective application for sanitation has been extensively evaluated in the past but scant, heterogeneous and not conclusive evidence is available on their effect on SARS-CoV-2 transmission. Methods With the aim of pooling the available evidence on the efficacy of UV technologies against coronaviruses, we conducted a systematic review following PRISMA guidelines, searching Medline, Embase and Cochrane Library, and the main clinical trials’ registries (WHO ICTRP, ClinicalTrials.gov, Cochrane and EU Clinical Trial Register). Quantitative data on studies’ interventionS were summarized in tables, pooled by different coronavirus species and strain, UV source, characteristics of UV light exposure and outcomes. Findings Eighteen papers met our inclusion criteria, published between 1972 and 2020. Six focused on SARS-CoV-2, four on SARS-CoV-1, one on MERS-CoV, three on seasonal coronaviruses, and four on animal coronaviruses. All were experimental studies. Overall, despite wide heterocenicity within included studies, complete inactivation of coronaviruses on surfaces or aerosolized, including SARS-CoV-2, was reported to take a maximum exposure time of 15 minutes and to need a maximum distance from the UV emitter up to 1 meter. Conclusion Advances in UV-based technologies in the field of sanitation and their proved high virucidal potential against SARS-CoV-2 support their use for IPC in hospital and community settings and their contribution towards ending the COVID-19 pandemic. National and international guidelines are to be updated and identify parameters and conditions of use to ensure both efficacy and safety of UV technology application for effective infection prevention and control in both healthcare and non-healthcare settings.

Background Multidrug-resistant organisms (MDRO) are one of the most critical public health concerns, particularly in hospital settings. Nearly 8% of hospitalized patients develop healthcare-associated infections (HAI), 20% of which is caused by MDRO. Aim of the study was to estimate nosocomial infection-associated in-hospital mortality, by different MDRO, in a large Italian teaching hospital. Methods We conducted a retrospective cohort study on patients hospitalized at San Raffaele Hospital, Milan, from 2016 to 2018. Two existing datasets were merged: hospital discharge records and MDRO surveillance data. Exposure was defined as any HAI caused by MDRO, and main outcome variable was in-hospital mortality from all causes. Results A total of 78,795 patients were studied (mean age 59.3 y, age range 18-105 y). 1,345 patients with at least one MDRO had mean age of 68 y, mean length of stay (LOS) of 32.8 days and mean DRG weight of 3.8. 77,450 patients without MDRO isolation had mean age of 59 y, mean LOS of 7.2 days and mean DRG weight of 1.6. Risk of in-hospital mortality is 3.4 times higher in patients with at least one MDRO isolation (OR 3.4; 95% CI 2.8-4.2). Enterococci (OR 2.6; 95% CI 1.1-6.3), A. baumannii (OR 3.5; 95% CI 1.4-8.6), P. aeruginosa (OR 1.8; 95% CI 0.8-4.2), MRSA (OR 3.4; 95% CI 2.1-5.4), ESBL-producing (OR 1.9; 95% CI 1.4-2.7) and carbapenem-resistant bacteria (OR 3.8; 95% CI 2.5-5.7), and carbapenem-resistant K. pneumoniae (OR 5.5; 95% CI 3.2-9.2) isolations were risk factors for nosocomial mortality. Conclusions Patients with MDRO isolations were older, more complex and had 5 times longer LOS than ones without MDRO. Deceased patients were 18% among MDRO cohort against only 2% among others. Bacteria included in WHO list of priority pathogens with antibiotic resistance were associated with a significantly higher risk of death. These results prove the urgency of controlling MDROs' spread that threatens global public health and available treatments of infections. Key messages Nosocomial MDRO isolation is a significant risk factor for in-hospital mortality from all causes. Infection prevention and control measures, and antibiotic stewardship are key strategies in order to prevent MDRO transmission and HAI, AR spreading and their burden of related deaths.

Issue Filling out medical records properly in Emergency Departments (ED) can be challenging, due to the high number of daily admissions and the variety of involved health care professionals (HCP). Description of the Problem The ED of IRCCS San Raffaele Hospital (OSR), with a mean of 198 admissions per day in 2019, suffers of frequent overcrowding; patients are managed by multiple HCPs, based on specific care needs; coordination and handover between them are crucial to guarantee quality care. The OSR Healthcare Directorate, the ED's Staff and the School of Public Health of Vita-Salute San Raffaele University developed and validated a model of internal audit to identify ED medical records' quality issues and to implement corrective actions. The workflow included: developing a structured checklist, mapping critical processes and highlighting each figure's tasks. A group of auditors, made up by medical residents in Public Health, tested n = 300 medical charts, filled out during the first semester of 2019, picked up in order to provide a representative sample of the triage priority codes assigned to patients in this period. Results To assess completeness and quality of ED's medical records, a new checklist was developed, comprising 4 major sections, furtherly divided in 14 items, scored from 1 (poor adherence/completeness) to 5 (excellent), providing a total score for each record, ranging from 14 to 70. Specific comments to items could be added and an ultimate judgement was written by each auditor. This approach made medical records measurable and comparable. Lessons The new checklist and the audit process are useful instruments for the evaluation of medical records and the identification of corrective measures in the ED of our hospital. Next steps will be the extension of the sample, the implementation of corrective actions, and the institution of a stable working group for a regular evaluation. Key messages ED's medical records must be clear, understandable and complete. The developed checklist is a tool for preventing and correcting wrong behaviours in a continuous improvement perspective.

Aim Due to the improving of life conditions, life expectancy is steadily increasing, especially in developed countries. In this perspective, Governments have to face important challenges as guaranteeing the welfare state, providing pensions and long-term healthcare for an increasing number of people. To maintain the sustainability of the pension system, many developed countries are rising the proportion of elderly persons in paid employment by both extending working life through a higher official retirement age and preventing premature exit from paid employment. However, postponing the exit from work exposes workers to potential stressors for a longer period. Stress is one of the risk factors for depression, that represent one of the leading causes of burden of disease. Our aim is to retrieve evidence in order to understand the association between retirement and risk of depression. Methods This is a systematic literature review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In January 2020, the following databases PubMed/Medline, Embase, Psycoinfo, and Cochrane were used to perform the search, using a combination of three components of keywords: depression, aging and retirement. Results A total of 2,203 studies were retrieved of which 782 were excluded because duplicates. Screening of 1,421 retrieved studies is in progress and data will be showed in tables and summarized in narrative form. Results are preliminary. Conclusions The present research intends to bridge the lack of knowledge on the association between retirement and depression, to tackle these methodological limitations of the evidence, and to contribute to the advancement of scientific knowledge on the link between work life extension and mental health. Poor mental health is a major source of disability. Improving mental health of workers remains a critical goal if future populations need to reach older age in good health and continue to work. Key messages Work life has been extended but low information are available regarding its impact on depression. Depression is a leading cause of burden of disease and studies aimed to reduce its incidence are extremely needed.

Background During infectious disease emergencies, fully aware healthcare workers (HCWs) and public services staff are unique resources to keep health systems active and tackle epidemics. Aim of the study was to assess concern, general and health-related knowledge (case management and Infection Prevention and Control [IPC] measures) among hospital staff on SARS-CoV-2 in Lombardy region (Italy). Methods One week after WHO declared COVID-19 a public health emergency we developed and online administered a 7-item questionnaire to all staff of San Raffaele Hospital, a referral and teaching hospital in Milan, exploring knowledge and attitudes on COVID-19. The survey remained accessible online for 72 hours. Results A total of 2,046, including HCWs and other staff, answered the survey (response rate 25%). Among the 2,027 responders included in the analysis, 1,102 were HCWs (54%), also in training, and 924 non-HCWs (46%). 60% of responders reported being worried or extremely worried about the epidemic. Concerning knowledge, the survey asked about modes of transmission, clinical forms, preventive measures in everyday life in Italy and cough etiquette. There were uniform trends in the two groups: HCWs were more aware and answered more properly (mean of correct answers 71,6%) than non-HCWs (mean 61,2%). HCWs were asked about IPC precautions, with only 41% providing correct answers, while over 74% knew only supportive therapy is currently available against COVID-19. Conclusions We were among the first to explore hospital staff knowledge on COVID-19 reporting data from a large study population. HCWs were slightly less concerned but more knowledgeable than general staff. Last questions showed that among HCWs there is generally good knowledge on the topic. However, most of the responders missed the recommendations to adopt simultaneously standard, contact and airborne precautions plus eye protection managing suspected and confirmed cases, as proposed by national and international authorities. Key messages During the ongoing emergency, it is of utmost importance that hospital staff is adequately trained to implement the best IPC measures and limit the spread of the infection. Our data can inform planning of these preventive measures.

Population ageing presents both challenges and opportunities for societies around the world. Increasing statutory retirement age and limiting exits to early retirement are frequent policy responses to population ageing, but this is unlikely to have the desired impact if the complex relationships that link work, retirement and health remains unknown. In this context, we designed and are currently conducting the multi-partner project on pension reforms and spatial-temporal patterns in healthy ageing, funded by Fondazione Cariplo. The project involves a multi-disciplinary research team from University Vita-Salute San Raffaele, Bocconi University and the Unit of Epidemiology of the Regional Health Service of ASL TO3. In this first presentation we will first describe the project design, its general aim and specific objectives, then we will present a proposed conceptual framework on the association between retirement and health and its determinants. The framework is the first deliverable of the project and is the results of a comprehensive review of the available evidence and consultation with experts in the field. In particular we conducted a scoping review to retrieve, pool and critically appraise the relevant evidence on the impact of retirement and transition to retirement on physical and mental health and their determinants. We summarized the evidence collected in a conceptual framework that attempt to quantify how health and retirement are bi-directionally linked, how health is central to the timing of retirement, how labor-associated determinants condition employment cessation, how and retirement have varying effects on risk factors for physical and mental health and the role of confounding factors and mediators. Towards the end of the presentation we will outline an extensive stakeholder mapping carried out for the purposes of the project at the national and European level

Digitalisation offers great potential to improve vaccine uptake, supporting the need for effective life-course immunisation services. We conducted semi-structured in-depth interviews with public health experts from 10 Western European countries (Germany, Greece, Italy, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, and the United Kingdom) to assess the current level of digitalisation in immunisation programmes and retrieve data on interventions and best practices. Interviews were performed using an ad hoc questionnaire, piloted on a sample of national experts. We report a mixed level of digital technologies deployment within vaccination services across Europe: Some countries are currently developing eHealth strategies, while others have already put in place robust programmes. Institutional websites, educational videos, and electronic immunisation records are the most frequently adopted digital tools. Webinars and dashboards represent valuable resources to train and support healthcare professionals in immunisation services organisation. Text messages, email-based communication, and smartphone apps use is scattered across Europe. The main reported barrier to the implementation of digital-based programmes is the lack of resources and shared standards. Our study offers a comprehensive picture of the European context and shows the need for robust collaboration between states and international institutions to share best practices and inform the planning of digital intervention models with the aim of countering vaccine hesitancy and increasing vaccine uptake.

Background Advances in the field of Information and Communication Technology (ICT) are revolutionizing healthcare, while massive migration flows and cross-border populations’ transit impose the planning, implementation, and evaluation of new integrated healthcare services and programmes. Nevertheless, no conclusive evidence exists on the vast potential offered by ICT to promote healthcare in migrant populations. Methods We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to retrieve, pool and critically appraise all the available evidence on the effectiveness of ICT-based interventions to support the healthcare provision to migrant and in-transit populations in Europe. We searched the electronic databases Medline and Embase, relevant grey literature and consulted with experts in the field. We restricted the area of interest to EU/EEA countries and included studies providing original quantitative data. Results Out of 127 retrieved records, 53 (42%) met the inclusion criteria. Included studies were classified in the following four interventions: implementation of healthcare services (47%), patients’ education (26%), healthcare services’ monitoring (17%), and interventions on providers (10%). The most relevant data refer to telemedicine, prevention interventions, and healthcare data sharing and the most represented specific health-topic is that of mental health (26%). We present available data qualitatively and quantitatively pooled by country, type of ICT, target population and health topic. Conclusions Selected ICT-based interventions have been implemented in Europe to promote healthcare in migrant populations; however, in most cases, no monitoring and evaluation exist on their impact, effectiveness, and cost-effectiveness. Strengthened efforts are needed to identify, plan, implement and evaluate effective interventions and share best practices to protect in-transit populations’ health. Key messages Information and Communication Technology (ICT) offer great potential to promote health-care in migrant populations. Effective ICT interventions and best practices should be shared across Europe.