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Article ; Online: New Italian immunisation plan is built on scientific evidence: Carlo Signorelli and colleagues reply to news article by Michael Day.

Signorelli, Carlo / Odone, Anna / Bonanni, Paolo / Russo, Francesca

2015 Volume 351, Page(s) h6775

MeSH term(s)	Humans ; Immunization Schedule ; Vaccination/trends
Language	English
Publishing date	2015-12-14
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.h6775
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Article ; Online: Public Health challenges in the post-pandemic era. The effects on life expectancy and health systems.

Signorelli, Carlo

Acta bio-medica : Atenei Parmensis

2023 Volume 94, Issue S3, Page(s) e2023112

Abstract: ...

Abstract	.
MeSH term(s)	Humans ; Public Health ; Pandemics ; Life Expectancy
Language	English
Publishing date	2023-08-30
Publishing country	Italy
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2114240-3
ISSN	2531-6745 ; 0392-4203
ISSN (online)	2531-6745
ISSN	0392-4203
DOI	10.23750/abm.v94iS3.14575
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Article: Primary care doctors retirements in the context of an ageing population in Italy.

Dalla Valle, Zeno / Signorelli, Carlo / Renzi, Cristina

Annali di igiene : medicina preventiva e di comunita

2024

Abstract: Background: Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policymakers. To support planning of ... ...

Abstract	Background: Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policymakers. To support planning of primary healthcare resource allocation we analyzed the geographic distribution of primary care doctors/primary care paediatricians across Italian regions, accounting for area-specific number and age of the population. Additionally, we estimated the number of primary care doctors/primary care paediatricians expected to retire over the next 25 years, with a focus on the next five years. Study design: Ecological study. Methods: We gathered the list of Italian general practitioners and primary care paediatricians and combined them with the data from the National Federation of Medical Doctors, Surgeons and Dentists. Using data from the National Institutes of Statistics, we calculated the average number of patients per doctor for each region using the number of residents above and under 14 years of age for general practitioners and primary care paediatricians respectively. We also calculated the number of residents over-65 and over-75 years of age per general practitioner, as elderly patients typically have higher healthcare needs. Results: On average the number of patients per general practitioner was 1,447 (SD: 190), while for paediatricians it was 1,139 (SD: 241), with six regions above the threshold of 1,500 patients per general practitioner and only one region under the threshold of 880 patients per paediatrician. We estimated that on average 2,228 general practitioners and 444 paediatricians are going to retire each year for the next five years, reaching more than 70% among the current workforce for some southern regions. The number of elderly patients per general practitioner varies substantially between regions, with two regions having >15% more patients aged over 65 years compared to the expected number. Conclusions: The study highlighted that some regions do not currently have the required primary care workforce, and the expected retirements and the ageing of the population will exacerbate the pressure on the already over-stretched healthcare services. A response from healthcare administrations and policymakers is urgently required to allow equitable access to quality primary care across the country.
Language	English
Publishing date	2024-01-31
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1018045-x
ISSN	1120-9135 ; 0029-6287
ISSN	1120-9135 ; 0029-6287
DOI	10.7416/ai.2024.2602
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Article ; Online: Forty years (1978-2018) of vaccination policies in Italy.

Signorelli, Carlo

Acta bio-medica : Atenei Parmensis

2019 Volume 90, Issue 1, Page(s) 127–133

Abstract: The paper traces the evolution of vaccination policies in Italy in the first 40 years of the National Health Service. Four phases have been identified: the first (1978-98) characterized by the eradication of smallpox, the hopes of further eradications ... ...

Title translation	Quarant’anni (1978-2018) di politiche vaccinali in Italia.
Abstract	The paper traces the evolution of vaccination policies in Italy in the first 40 years of the National Health Service. Four phases have been identified: the first (1978-98) characterized by the eradication of smallpox, the hopes of further eradications and the introduction of hepatitis B and acellular antipertussis vaccines; the second (1999-2008) coincided with the first national vaccination plans and with the hypothesis of a progressive transition from mandatory vaccinations to nudging initiatives with the relevant experimentation in the Veneto Region; the third phase (2009-14) was characterized by the spread of health information on the web and social networks, by anti-scientific judgments and by an increasingly vaccines hesitancy that led to incorrect perceptions, falls in coverage rates and re-ignition of some epidemics; in the last phase (2015-18) there was a strong political committment that led to the approval of the National Plan (PNPV) 2017-19, to the extension of the mandatory vaccinations and to the sanctions against the anti-vaxxers doctors. This has led to a rapid rise in coverage, but also to a heated political and media debate on the ethical and social aspects linked to the admission bans and sancions of unvaccinated children in schools.
MeSH term(s)	Child ; Humans ; Italy ; Time Factors ; Vaccination
Language	Italian
Publishing date	2019-01-09
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2114240-3
ISSN	2531-6745 ; 0392-4203
ISSN (online)	2531-6745
ISSN	0392-4203
DOI	10.23750/abm.v90i1.7900
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Article: Variations in avoidable hospital admissions and emergency visits by primary care characteristics: an ecological study in Italy.

Dalla Valle, Zeno / Ricciardi, Giovanni Emanuele / Signorelli, Carlo / Renzi, Cristina

Annali di igiene : medicina preventiva e di comunita

2024 Volume 36, Issue 2, Page(s) 227–233

Abstract: Background: Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the ... ...

Abstract	Background: Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the characteristics of primary healthcare across Italian regions and health outcomes included in the National Programs Outcomes of the National Agency for Regional Healthcare Services. Study design: Ecological study. Methods: We analysed healthcare data from the National Agency for Regional Healthcare Services, the public lists of primary care doctors and the National Federation of Surgeons and Dentists and the National Institutes of Statistics referring to the 20 Italian regions. Pearson's correlation and Spearman's correlation were used to assess the relationships between primary healthcare characteristics and health outcomes. Results: Overall, across all Italian regions each general practitioner had on average 1447 patients and was 57.5 years old. The study found positive correlations between the number of patients per general practitioner and non-urgent Emergency Department visits among adult patients (Pearson's r = 0.58, p = 0.008), the number of residents aged 65+ per general practitioner and the rate of chronic obstructive pulmonary disease admissions (Pearson's r = 0.49, p = 0.029), and the age of general practitioners and lower-extremity amputations in diabetes patients (Pearson's r = 0.56, p = 0.011). A negative correlation was observed between the age of general practitioners and urinary tract infection admissions (Pearson's r = -0.76; p < 0.001). A non-linear negative correlation was found between the age of general practitioners and chronic obstructive pulmonary disease admissions (Spearman's ρ = -0.46, p = 0.041). Conclusions: The findings emphasise the importance of guaranteeing sufficient numbers of primary healthcare physicians to meet patients' needs, and for limiting avoidable hospitalisations and emergency presentations. General practitioners' age might also influence the provision of care, but more research is needed on possible mechanisms.
MeSH term(s)	Adult ; Humans ; Middle Aged ; Hospitalization ; Pulmonary Disease, Chronic Obstructive ; Italy ; Emergency Service, Hospital ; Primary Health Care ; Hospitals
Language	English
Publishing date	2024-01-31
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1018045-x
ISSN	1120-9135 ; 0029-6287
ISSN	1120-9135 ; 0029-6287
DOI	10.7416/ai.2024.2608
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Article: Quality of hospital care and clinical outcomes: a comparison between the Lombardy Region and the Italian national data.

Signorelli, Carlo / Pennisi, Flavia / Lunetti, Carlo / Blandi, Lorenzo / Pellissero, Gabriele / Fondazione Sanità Futura, Working Group

Annali di igiene : medicina preventiva e di comunita

2024 Volume 36, Issue 2, Page(s) 234–249

Abstract: Background: Improving the quality and effectiveness of healthcare is a key priority in health policy. The emergence of the COVID-19 pandemic has exerted considerable pressure on hospital networks, requiring unprecedented reorganization and restructuring ...

Abstract	Background: Improving the quality and effectiveness of healthcare is a key priority in health policy. The emergence of the COVID-19 pandemic has exerted considerable pressure on hospital networks, requiring unprecedented reorganization and restructuring actions. This study analyzed data from the Italian National Outcomes Program to compare some volumes and outcomes of public and private accredited hospitals in the Lombardy Region with national data. Study design: Observational study. Methods: A thorough examination of hospital outcomes between 2019 and 2021 was conducted, considering 45 volume indicators and 48 process and outcome indicators, comparing Lombardy with other Italian regions and public versus private accredited hospitals. Results: In 2020, Italy and Lombardy experienced a considerable reduction in overall hospital admissions, with Lombardy showing a deeper decline (21.3% compared with 16.0% in Italy). In 2021, both experienced a partial recovery, especially marked in the Lombardy region (+7.3%, compared with national data). Focusing specifically on the private sector in Lombardy, a recovery of +9.3% in hospitalization was observed. In the analysis of clinical outcomes, Lombardy outperformed the national average for 63% of the indicators in 2020 and 83.3% in 2021. Conclusions: The study shows the continuing decline in volumes compared to 2019 (pre-COVID), the excellent performance of hospitals in Lombardy and a relevant contribution for the volumes and the quality of outcomes of private accredited hospitals.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Hospitalization/statistics & numerical data ; Hospitalization/trends ; Hospitals/statistics & numerical data ; Hospitals/trends ; Italy ; Pandemics/statistics & numerical data ; Quality of Health Care/statistics & numerical data
Language	English
Publishing date	2024-01-23
Publishing country	Italy
Document type	Comparative Study ; Journal Article ; Observational Study
ZDB-ID	1018045-x
ISSN	1120-9135 ; 0029-6287
ISSN	1120-9135 ; 0029-6287
DOI	10.7416/ai.2024.2597
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Article: Impact of the Covid pandemic on timely cancer diagnosis across European healthcare settings: a scoping review.

Pennisi, Flavia / Odelli, Stefano / Borlini, Stefania / Morani, Federica / Signorelli, Carlo / Renzi, Cristina

Annali di igiene : medicina preventiva e di comunita

2024 Volume 36, Issue 2, Page(s) 194–214

Abstract: Introduction: The COVID-19 pandemic presented unprecedented challenges to European healthcare systems. The study aimed to review the available evidence on the impact of the pandemic on the timely diagnosis of cancer across European countries. The ... ...

Abstract	Introduction: The COVID-19 pandemic presented unprecedented challenges to European healthcare systems. The study aimed to review the available evidence on the impact of the pandemic on the timely diagnosis of cancer across European countries. The primary objective was to examine changes in diagnostic pathways and stage at diagnosis during the pandemic, compared to the pre-pandemic period, across European countries, taking healthcare system characteristics and COVID-19 policies into account. Methods: We conducted a review of the impact of the pandemic on cancer diagnosis in Europe, analyzing primary studies from 2018 to 2023 using both quantitative and qualitative methods through searches in PubMed and Scopus databases. Study quality was assessed using the Mixed Methods Appraisal Tool. The main explanatory factors analyzed were grouped into two categories: Covid-policies (government responses, using the Oxford COVID-19 Government Response Tracker and its stringency index as key metrics) and healthcare characteristics (healthcare system models, expenditure and resources, including hospital beds and the ratio of medical doctors). Study design: Scoping review. Results: Overall, 127 papers were screened, 80 retrieved for full-text evaluation and 50 articles were included in the review. The studies encompassed a total of 509,753 patients from 17 European countries. The pandemic period was characterised by worse process and outcome measures for all examined cancers, except for lung cancer, compared to the pre-pandemic period. Group-ing countries based on government actions and policy responses (stringency index) did not show any differences in timely cancer diagnosis. Countries with lower healthcare expenditure (per capita expenditure <2,000 euros) or lower investments in prevention reported more cancer diagnostic delays during the pandemic. Countries with >20% of General Practitioners over the total number of physicians and with more hospital beds per population experienced fewer diagnostic delays during the pandemic. Conclusions: Overall, the review suggests that diagnostic pathways and cancer stage at diagnosis during the COVID-19 pandemic varied across Europe, with countries' healthcare expenditure, investments in prevention, the proportion of General Practitioners and the number of hospital beds per population possibly playing a role. This analysis can inform healthcare policies aimed at addressing post-pandemic challenges and formulating resilience plans for future emergencies.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Pandemics/prevention & control ; SARS-CoV-2 ; Delivery of Health Care ; Neoplasms/diagnosis ; Neoplasms/epidemiology ; COVID-19 Testing
Language	English
Publishing date	2024-01-18
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1018045-x
ISSN	1120-9135 ; 0029-6287
ISSN	1120-9135 ; 0029-6287
DOI	10.7416/ai.2024.2596
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Article ; Online: Age-specific COVID-19 case-fatality rate: no evidence of changes over time.

Signorelli, Carlo / Odone, Anna

International journal of public health

2020 Volume 65, Issue 8, Page(s) 1435–1436

Keywords	covid19
Language	English
Publishing date	2020-09-25
Publishing country	Switzerland
Document type	Letter
ZDB-ID	2274130-6
ISSN	1661-8564 ; 1661-8556
ISSN (online)	1661-8564
ISSN	1661-8556
DOI	10.1007/s00038-020-01486-0
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Article ; Online: Spring, it's time to ROSC.

Stirparo, Giuseppe / Andreassi, Aida / Sechi, Giuseppe Maria / Signorelli, Carlo

Journal of preventive medicine and hygiene

2023 Volume 64, Issue 1, Page(s) E87–E91

Abstract: Out-hospital cardiac arrest (OHCA) is a multi-factor disease. Many studies have correlated OHCA with a patient's lifestyle; unfortunately, less evidence highlights the correlation with meteorological factors. Methods: Analysis of 23959 OHCA rescue ... ...

Abstract	Out-hospital cardiac arrest (OHCA) is a multi-factor disease. Many studies have correlated OHCA with a patient's lifestyle; unfortunately, less evidence highlights the correlation with meteorological factors. Methods: Analysis of 23959 OHCA rescue performed by the emergency medical system (EMS) of Lombardy Region, the most Italian populated region, in 2018 and 2019, the pre-pandemic era through a retrospective observational cohort study. The aim of the study consists on evaluating the probability of Return Of Spontaneous Circulation (ROSC) during months to highlight potential seasonal impact in ROSC achievement. In March and April, we highlight an increase of ROSC (OR: 1.20 95% CI 1.04-1.31; p < 0.001) compared to other months. During March and April, we highlight an increase of public access defibrillation (PAD) (3.5% vs 2.5%; p < 0.001), and a reduction of overage time of first vehicle on scene (11.5 vs 11.8; p < 0.001) and age of patient (73.5 vs 74.2; p < 0.01). Finally, we highlight a slight reduction of cancer patient (1.6% vs 1.1%; p = 0.01). We didn't register significant differences in the other variables analyzed as: onset place, sex, rescue team and the patient's death before the rescue arrive. We highlight a difference in ROSC probability during the first month of spring. We register few differences in patient characteristics and EMS rescue, though just PAD use and age clinically impact OHCA patients. In this study, we are unable to fully understand the modification of the probability of ROSC in these months. Even though four variables have a statistically significant difference, they can't fully explain this modification. Different variables like meteorological and seasonal factor must be considered. We propose more research on this item.
MeSH term(s)	Humans ; Cardiopulmonary Resuscitation ; Retrospective Studies ; Return of Spontaneous Circulation ; Seasons ; Out-of-Hospital Cardiac Arrest/epidemiology ; Out-of-Hospital Cardiac Arrest/therapy
Language	English
Publishing date	2023-05-16
Publishing country	Italy
Document type	Observational Study ; Journal Article
ZDB-ID	1102926-2
ISSN	2421-4248 ; 1121-2233
ISSN (online)	2421-4248
ISSN	1121-2233
DOI	10.15167/2421-4248/jpmh2023.64.1.2782
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Article ; Online: The role of Mayors in protecting citizens' health: a brief report from Italy.

Blandi, Lorenzo / Navobi Porrello, Vincenzo / Signorelli, Carlo / Odone, Anna

Acta bio-medica : Atenei Parmensis

2023 Volume 94, Issue S3, Page(s) e2023139

Abstract: The World Health Organization has identified urbanization as one of the most important public health challenges of our century. Nowadays, about half of the world's population live in urban areas, thus municipal authorities can influence multiple ... ...

Abstract	The World Health Organization has identified urbanization as one of the most important public health challenges of our century. Nowadays, about half of the world's population live in urban areas, thus municipal authorities can influence multiple determinants of health through Urban Health strategies. However, the health policies and welfare systems are usually managed by multi-level political governments. The aim of this report is to describe the legal and operational competences attributed to mayors and municipal councils with reference to health, taking Italy as case study. Our report summarises and analyses the national, regional, and local Italian legislations. Our results identified the mayors as the highest local health authorities. Indeed, the mayor can issue specific regulations for their local area or order contingent and urgent measures for preventing or delimiting serious health hazards for the safety of their citizens. Moreover, among their duties, municipalities play a crucial role in social care. Hence, municipalities are expected to cooperate with National Health Service at the regional level, to integrate their contributions in a single welfare system. In conclusion, mayors represent the institutional figures closest to the citizens. Municipalities and regional governments should coordinate and integrate their strategies and policies to meet health and social needs of citizens, providing easy access to shared pathways. Municipalities also regulate autonomously fundamental aspects related to the urban environment and can promote and protect health and improve the quality of life for citizens.
MeSH term(s)	Humans ; Quality of Life ; State Medicine ; Italy ; Group Processes ; Health Facilities
Language	English
Publishing date	2023-08-30
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2114240-3
ISSN	2531-6745 ; 0392-4203
ISSN (online)	2531-6745
ISSN	0392-4203
DOI	10.23750/abm.v94iS3.14481
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