Francesca Sanna

Background/Objective: Part of the workload of ambulance service involves patients with low-acuity health events that do not require the specific resources provided by ambulance services or emergency departments (EDs). The problem of inappropriateness is also present in Italy. However, research is limited to the perspective of triage nurses only, excluding patients and emergency medical service (EMS) staff. This study aims to identify the presence of inappropriate ambulance use in the study context by comparing patients’ perception of emergency with appropriateness perspectives of both triage nurses and emergency service staff. Methods: A cross-sectional study involving 109 patients transported by ambulance was performed between January and March 2020. Questionnaires were distributed to patients, EMS staff, and triage nurses operating in the chief town and hinterland of a region of Italy. Results: Non-penetrating trauma was the most frequent cause for calling an ambulance. Patients referred that activation of the service was necessary, while triage nurses and EMS technicians were in line in believing the non-urgency of the call due to non-emergent health conditions. Conclusions: Although we cannot conclude that citizens use the emergency system inappropriately, the results of this study make us think about the need to implement educational interventions that increase citizens’ knowledge of how the service works and the territorial services available.

The COVID-19 pandemic has posed significant challenges for healthcare workers worldwide, potentially affecting their sense of coherence (SOC) and overall well-being. This study aimed to identify factors associated with different levels of SOC among healthcare workers, exploring demographic characteristics, work-related factors, changes in relationships and social habits, and the overall well-being. A cross-sectional study was conducted among 628 healthcare workers. SOC scores were assessed using a standardized questionnaire. Statistical analyses were performed to identify associations between these factors and SOC. Healthcare workers had a lower average SOC score (mean: 57.1) compared to the national average in Italy (mean: 60.3). Younger age and shorter length of service were associated with a higher risk of low SOC (p < 0.0001). Healthcare workers in the northwestern regions of Italy had an increased risk of low SOC compared to their counterparts in the northeastern regions (p = 0.0336). Adverse pandemic-related experiences and worsening social relationships were also associated with a higher risk of low SOC (p < 0.0001). This study highlights the unique challenges and stressors faced by healthcare workers during the COVID-19 pandemic and their impact on SOC. Age, length of service, geographic location, and social status were significant factors influencing SOC levels. Targeted interventions are needed to enhance SOC and well-being, particularly for younger and newly employed healthcare workers. Strategies promoting social connections, work-life balance, and psychological support services are crucial to support healthcare workers’ resilience and coping abilities.

The COVID-19 pandemic has led to far-reaching disruptions to health systems, including preventative and curative services for malaria. The aim of this study was to estimate the magnitude of disruptions in malaria case management in sub-Saharan Africa and their impact on malaria burden during the COVID-19 pandemic. We used survey data collected by the World Health Organization, in which individual country stakeholders reported on the extent of disruptions to malaria diagnosis and treatment. The relative disruption values were then applied to estimates of antimalarial treatment rates and used as inputs to an established spatiotemporal Bayesian geostatistical framework to generate annual malaria burden estimates with case management disruptions. This enabled an estimation of the additional malaria burden attributable to pandemic-related impacts on treatment rates in 2020 and 2021. Our analysis found that disruptions in access to antimalarial treatment in sub-Saharan Africa likely resulted in approximately 5.9 (4.4–7.2 95% CI) million more malaria cases and 76 (20–132) thousand additional deaths in the 2020–2021 period within the study region, equivalent to approximately 1.2% (0.3–2.1 95% CI) greater clinical incidence of malaria and 8.1% (2.1–14.1 95% CI) greater malaria mortality than expected in the absence of the disruptions to malaria case management. The available evidence suggests that access to antimalarials was disrupted to a significant degree and should be considered an area of focus to avoid further escalations in malaria morbidity and mortality. The results from this analysis were used to estimate cases and deaths in the World Malaria Report 2022 during the pandemic years.

Sense of coherence (SOC) is a psycho-social trait formed in childhood or adolescence, allowing individuals to be more resilient to daily life stressors, stay well, and improve their personal health. Although SOC remains stable after the age of thirty, only a few studies investigated its stability in adulthood. The aim was to investigate the development of SOC over time in 489 participants and its association with age, gender, educational level, or negative life events. The study was performed as part of the Healthy Ageing project of the Academic Collaborative Centre AGORA, a longitudinal study involving four municipalities of Eastern Netherlands. A self-administrated questionnaire was used to monitor the SOC of the elderly in 2008, 2010, and 2013, using the Orientation to Life Questionnaire (SOC-13). The analysis included repeated-measures ANOVA analysis and bivariate analysis using Pearson’s chi square test. We found no statistically significant variation in SOC over time (F (2, 282) = 2.99, p = 0.052) and no significant association with age (F (2, 282) = 2.851, p = 0.06), gender (F (2, 282) = 0.845, p = 0.43), or educational level (F (2, 282) = 0.708, p = 0.49). SOC remained stable in the elderly population, even if they experienced negative events over their lifespan.

Background: There is growing evidence that lung function in early-life predicts later lung function. Adverse events over the lifespan might influence an individual's lung function trajectory, resulting in poor respiratory health. The aim of this study is to identify early-life risk factors and their impact on lung function trajectories to prevent long-term lung impairments.Methods: Our study included participants from the Raine Study, a prospective pregnancy cohort, with at least two spirometry measurements. Lung function trajectories from the 6- to 22-year follow-ups were characterised using finite mixture modelling. Multinomial logistic regression analyses were used to evaluate the association between early-life predictors and lung function trajectories.Main results: A total of 1512 participants (768 males, 744 females), representing 53% of the whole cohort, were included in this analysis. Four lung function trajectories of forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC (z-scores) were identified. FEV₁and FVC trajectories were categorised as: “very low”, “low”, “average” and “above average”, respectively. Based on their shape, lung function trajectories of FEV₁/FVC were categorised as “very low”, “low–average”, “average–low” and “average”. Asthma and maternal smoking were identified as risk factors for low lung function trajectories in this cohort, as well as early-life exposure to PM_{2.5Absorbance}.Conclusions: Early-life risk factors may influence lung function trajectories over time. Nonetheless, identifying children with a high risk of having low lung function trajectories should be prioritised to prevent deficits in later life.

Early lung function predicts later lung function. Genetic and environmental factors can alter baseline lung function resulting in trajectories that reflect poorer lung health. The aim was to characterize lung function trajectories in the Raine cohort to identify risk factors that alter trajectories. Methods: We investigated 1516 participants with at least two spirometry measurements at 5,14 and 22 years of follow-up. Lung function trajectories for FEV1(z-scores) were identified using group-based trajectory modelling. Participants were assigned to one group based on the highest group membership probabilities. Multivariable analysis for childhood and parental risk factors was assessed using multinomial logistic regression. Results: We identified four lung function trajectories of FEV1:“very low” (n=48), “low”(n=740), “average”(n=619),“high”(n=109).We found association between the lowest trajectory and childhood asthma (RR= 3.10, p=0.02), asthma ever (RR=3.69, p=0.002) compared to the highest trajectory. Conclusion: A group demonstrated a persistently low lung function trajectory where asthma was found to be associated with a three-fold risk compared to the highest trajectory. Generation of these lung function trajectories will give us the opportunity to investigate the effects of other known early-life environmental predictors of low lung function in childhood such as maternal vitamin D deficiency and birth weight on lung function into adulthood.