Walter Ricciardi

Background: Antimicrobial resistance (AMR) remains a major public health threat in Italy, where high incidence and mortality persist. In this study we aimed to describe national and regional trends in AMR rates from 2015 to 2024. Methods: We conducted an ecological time-series analysis using publicly available data from the Italian AMR surveillance system (AR-ISS). We included six priority pathogens: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE-faecium), third-generation cephalosporin-resistant Escherichia coli (3GCREC), carbapenem-resistant Klebsiella pneumoniae (CRKP), Pseudomonas aeruginosa (CRPA), and Acinetobacter spp. (CRAS). We analyzed annual resistance rates at national and regional level. Temporal trends were estimated using linear regression models, with calendar year as the independent variable. Regression coefficients, 95% CIs, and p-values were used to assess direction and significance. Relative percentage changes were calculated for 2015–2024 and, when relevant, for 2023–2024. Results: Resistance declined over time for four of six pathogens, but increased markedly for VRE-faecium, from 11.1% to 34.9%. Significant downward trends were observed for MRSA (β = −0.91, 95% CI: −1.35; −0.48, p = 0.0013), 3GCREC (β = −0.53, 95% CI: −0.99; −0.06, p = 0.0304), CRKP (β = −0.94, 95% CI: −1.35; −0.53, p = 0.0008), and CRPA (β = −0.86, 95% CI: −1.44; −0.27, p = 0.0095); VRE-faecium showed a strong upward trend (β = +2.76, 95% CI: 2.58; 2.94, p < 0.0001). CRAS remained consistently high throughout the study period. Considerable regional heterogeneity was observed across pathogens and geographical areas. Conclusions: Despite progress for several pathogens, AMR remains a critical challenge in Italy. The persistent increase in VRE-faecium and the high burden of CRAS support the need for strengthened surveillance, stewardship, and region-specific infection prevention interventions.

The Catholic Church has developed a rich body of social teaching addressing the dignity of work and the protection of workers’ health since the late nineteenth century. This article examines the trajectory of Catholic Social Teaching (CST) from Pope Leo XIII’s encyclical Rerum Novarum (1891) to Pope Leo XIV’s recent magisterium, including the apostolic exhortation Dilexi Te (2025) and the encyclical Magnifica Humanitas (2026) on safeguarding the human person in the time of artificial intelligence, with a particular focus on the concept of decent work as articulated by the International Labour Organization (ILO) and its intersection with Occupational Medicine (OM). The analysis highlights that Catholic social thought has consistently advocated for working conditions that safeguard the physical, mental, and social well‑being of workers, anticipating many principles later codified in international labor standards. It further contends that Magnifica Humanitas extends this tradition to the challenges posed by digital technology and artificial intelligence to the dignity of work. The article argues that the convergence between CST and modern occupational health frameworks provides a compelling ethical foundation for advancing decent work and Occupational Health Services (OHS) worldwide.

Background/Objectives: Contemporary healthcare systems face compound challenges (including technological acceleration, demographic aging, rising chronic disease burden, and growing patient expectations) that demand models that are simultaneously efficient, high-quality, and person-centered. Despite a substantial body of research addressing organizational design, human capital management, and clinical competencies, these dimensions have largely been theorized in isolation. This study aims to construct and justify an integrated theoretical framework explaining how organizational models, human capital, and transversal competencies may jointly shape care quality, patient safety, and institutional sustainability in healthcare organizations. Methods: A narrative literature review was conducted, integrating contributions from business economics, healthcare management, organizational psychology, and nursing sciences. This design was selected for its suitability in synthesizing heterogeneous, multidisciplinary knowledge into a coherent conceptual framework, a purpose for which systematic meta-analytic approaches are not appropriate. Sources encompassed 79 references: peer-reviewed journals (PubMed, JSTOR, Google Scholar), institutional reports (WHO, OECD, European Commission, Joint Commission), normative standards (ISO 30414:2018), and Italian regulatory frameworks, spanning foundational twentieth-century contributions through the most recent literature (2025). Results: Four principal findings emerged: (1) healthcare organizations are evolving from rigid hierarchical structures toward flexible, value-based configurations, with the Value-Based Healthcare (VBHC) paradigm redirecting institutional attention from service volume to patient-meaningful outcomes per unit of cost; (2) transversal competencies (communication, empathy, emotional intelligence, teamwork, and transformational leadership) are closely associated with care quality and patient safety, with 70–80% of sentinel events associated with communication failures; (3) human capital, encompassing technical expertise and relational capacity, constitutes the primary lever of competitive advantage in healthcare institutions; and (4) the trajectory from pyramidal toward participatory and self-managed models is supported by international evidence, including the Buurtzorg experience in the Netherlands. Conclusions: The integrated three-pillar framework (combining resource-based theory and dynamic capabilities, Value-Based Healthcare, and evolutionary organizational theory) provides a theoretically grounded basis for understanding how organizational structure, human capital, and transversal competencies are jointly associated with clinical performance. Healthcare institutions should systematically integrate soft-skills training into professional education and invest in participatory organizational structures. Health policy should revise financing mechanisms to incentivize patient-meaningful outcomes over service volumes and support the broader transition toward Value-Based Healthcare models. The Italian SSN is discussed as an illustrative national context rather than as the primary empirical focus of the review.

Background: Smoking remains a major public health issue in Italy, despite decades of tobacco control measures. This study aimed to describe trends in smoking prevalence and in consumption of other tobacco-derived products, in Italy from 1993 to 2024 stratified by gender and age group. Methods: This is an observational ecological time-series analysis. Smoking prevalence data were obtained from the Italian Institute of Statistics. Joinpoint regression model was applied to estimate the Annual Percentage Change (APC) and the Average Annual Percentage Change (AAPC). Data on tobacco-derived products were analyzed descriptively using data from the Italian National Health Institute (2013–2023). Results: Overall smoking prevalence declined significantly over the study period (AAPC = −0.78%; P < .0001), with a greater reduction among men (AAPC = −1.31%; P < .0001). However, an increase is observed from 2020 to 2024 (APC +1.53; P = .009). Long-term reductions were observed among midlife women, while smoking increased among younger and older women. E-cigarette use declined (−40%), while heated tobacco products and hand rolled cigarettes use rose steadily (+236% and +181%, respectively). Conclusions: The recent rise in smoking and the growing use of alternative nicotine products demand renewed prevention and cessation efforts, with targeted education and stronger regulation.

Objective: To map and synthesize the published literature on the epidemiological burden of urinary tract infections (UTIs) in adults with spinal cord injury (SCI) or multiple sclerosis (MS) using intermittent catheterization (IC). Methods: We conducted a comprehensive literature review following PRISMA guidelines, searching PubMed, Scopus, and Web of Science for studies published since 2014. A total of 30 studies met the inclusion criteria. Results: Reported UTI incidence varied widely from 24% to 93.1%, highlighting significant heterogeneity across the evidence base. Annually, 15–17% of patients experienced 4–6 UTIs, and up to 16.4% required hospitalization for UTI-related complications. A critical evidence gap was exposed, with only one study focusing specifically on the MS population. Conclusions: Despite its clinical benefits, IC remains underutilized and inconsistently supported. Addressing systemic delivery gaps is essential. UTIs in neurogenic bladder care should be recognized as a modifiable public health issue requiring equity-driven interventions and strengthened implementation frameworks. This review underscores the urgent need for methodologically rigorous research to establish clear best practices.