Parent's perception of respiratory syncytial virus and subsequent wheezing burden: A multi‐country cross‐sectional survey

Background: Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization in infants. RSV bronchiolitis is associated with an increased risk of subsequent wheezing. We aimed to document the parents' perception of the link between RSV infection and subsequent wheezing, wheezing-related healthcare and family resources use, and its impact on family daily life. Methods: This cross-sectional online survey enrolled 1200 parents with at least one child <= 6y living in the United States, United Kingdom, Spain, and Italy. Children diagnosed with RSV bronchiolitis before age of 2 years were included in the RSV group, and those never diagnosed with RSV bronchiolitis in the Reference group. Results: The odds of wheezing were 4.5-fold (95%CI 3.5-5.9) higher in the RSV than in the Reference group. The odds increased to 7.7-fold (95%CI 5.4-11.1) among children who were hospitalized, and 9-fold (95%CI 5.1-16.6) among those admitted to pediatric intensive care with RSV bronchiolitis. Similar trends were observed across all countries. In total, 57% of parents reported their child's wheezing to have moderate to severe impact on their emotional well-being, and 53% on their daily life activities and/or social life. 64% of parents reported moderate-severe impact of wheezing on child's quality of sleep and 49% and 46% reported a moderate-severe impact on their children's emotional well-being and physical activities. Conclusions: This survey suggests an association between RSV infection and subsequent wheezing in children across different countries. Wheezing, especially in association with RSV infection, was associated with increased healthcare utilization and costs, and significantly impacted parents' and children daily life

Development and Validation of the Climate Change-Related Reproductive Concerns Scale (CCRCS)

Introduction: As global concerns about climate change intensify, emerging research reveals a link between climate change anxiety and individuals' decisions regarding parenthood. More people are choosing not to have children due to worries about their carbon footprint or the future implications of climate change on their offspring. This trend emphasizes the critical necessity for a nuanced comprehension of how environmental concerns intertwine with reproductive intentions. To address this imperative, our study develops the Climate Change-Related Reproductive Concerns Scale (CCRCS) and evaluates its psychometric properties. Methods: CCRCS was developed and validated in a sample of 206 Italian adults aged 19 to 51. Ten items were created to evaluate climate change-related reproductive attitudes: 5 anti-reproductive items and 5 pro-reproductive, with their responses reversed for consistency in interpretation. Results: Exploratory factor analysis revealed a single-factor structure, explaining 63.82% of the variance, with the scale demonstrating good internal consistency (α = 0.85). The factor structure was replicated, and the scale's validity was examined through correlations with measures of eco-paralysis and climate change anxiety, with significant correlations supporting construct validity. Furthermore, the relationship between climate change-related reproductive concerns and adaptation responses was explored, assessing the impact of framing on CCRCS scores. Conclusion: the CCRCS provides a reliable and valid measure of these concerns, highlighting the psychological impact of climate change anxiety on reproductive decisionmaking and emphasizing the need for nuanced understanding in this area

recommendations to optimise reporting of epidemiological studies on antimicrobial resistance and informing improvement in antimicrobial stewardship

Objectives To explore the accuracy of application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool in epidemiological studies focused on the evaluation of the role of antibiotics in selecting resistance, and to derive and test an extension of STROBE to improve the suitability of the tool in evaluating the quality of reporting in these area. Methods A three-step study was performed. First, a systematic review of the literature analysing the association between antimicrobial exposure and acquisition of methicillin-resistant Staphylococcus aureus and/or multidrug-resistant Acinetobacter baumannii was performed. Second, articles were reviewed according to the STROBE checklist for epidemiological studies. Third, a set of potential new items focused on antimicrobial-resistance quality indicators was derived through an expert two-round RAND-modified Delphi procedure and tested on the articles selected through the literature review. Results The literature search identified 78 studies. Overall, the quality of reporting appeared to be poor in most areas. Five STROBE items, comprising statistical analysis and study objectives, were satisfactory in <25% of the studies. Informative abstract, reporting of bias, control of confounding, generalisability and description of study size were missing in more than half the articles. A set of 21 new items was developed and tested. The new items focused particularly on the study setting, antimicrobial usage indicators, and patients epidemiological and clinical characteristics. The performance of the new items in included studies was very low (<25%). Conclusions Our paper reveals that reporting in epidemiological papers analysing the association between antimicrobial usage and development of resistance is poor. The implementation of the newly developed STROBE for antimicrobial stewardship (AMS) tool should enhance appropriate study design and reporting, and therefore contribute to the improvement of evidence to be used for AMS programme development and assessment

How Does Climate Change Worry Influence the Relationship between Climate Change Anxiety and Eco-Paralysis? A Moderation Study

Climate change (CC) has a significant impact on human health, resulting in both physical and mental illnesses. Eco-anxiety-the excessive and pervasive fear about the consequences of CC-is the most studied psychoterratic state. This study presents the validation of Italian versions of Hogg's Eco-Anxiety Scale (HEAS) and the Eco-Paralysis Scale. It also investigates the effects of worry on eco-anxiety and eco-paralysis. The study was conducted on 150 Italian individuals who responded to the two scales and to other questionnaires to make comparisons with the two above. Internal consistency and factorial structure were assessed through Cronbach's alpha, Confirmatory Factor Analysis and Exploratory Factor Analysis. A median regression was used to assess the association between the EPS and the HEAS and Climate Change Worry Scale (CCWS) and their interaction. HEAS and EPS showed good psychometric properties: HEAS resulted in good internal consistency (Cronbach's alpha = 0.986), and the Eco-Paralysis scale had good test-retest reliability (r = 0.988). In both cases, a one-factor structure was suggested to be retained. The interaction terms between HEAS and CCWS (beta = -0.02; 95% CI: -0.03, -0.01; p &lt; 0.001) and between HEAS and education (beta = -0.05; 95% CI: -0.08, -0.02; p &lt; 0.001) were significant. Therefore, the feeling of worry seems to act as a moderator between climate change anxiety and eco-paralysis since it may appear to influence individuals and their ability to transform anxiety into action. Education plays a role in reducing the risk of Eco-Paralysis in subjects affected by climate change anxiety. Thus, data suggest that working on reinforcing a more cognitive concern might result in more problem-solving-focused strategies to face climate change anxiety and eco-paralysis

Development and validation of the climate change-related reproductive concerns scale (CCRCS)

Introduction: As global concerns about climate change intensify, emerging research reveals a link between climate change anxiety and individuals' decisions regarding parenthood. More people are choosing not to have children due to worries about their carbon footprint or the future implications of climate change on their offspring. This trend emphasizes the critical necessity for a nuanced comprehension of how environmental concerns intertwine with reproductive intentions. To address this imperative, our study develops the Climate Change-related Reproductive Concerns Scale (CCRCS) and evaluates its psychometric properties. Methods: CCRCS was developed and validated in a sample of 206 Italian adults aged 19 to 51. Ten items were created to evaluate climate change-related reproductive attitudes: 5 anti-reproductive items and 5 pro-reproductive, with their responses reversed for consistency in interpretation. Results: Exploratory factor analysis revealed a single-factor structure, explaining 63.82 % of the variance, with the scale demonstrating good internal consistency (α = 0.85). The factor structure was replicated, and the scale's validity was examined through correlations with measures of eco-paralysis and climate change anxiety, with significant correlations supporting construct validity. Furthermore, the relationship between climate change-related reproductive concerns and adaptation responses was explored, assessing the impact of framing on CCRCS scores. Conclusion: The CCRCS provides a reliable and valid measure of these concerns, highlighting the psychological impact of climate change anxiety on reproductive decision-making and emphasizing the need for nuanced understanding in this area.</p

Using health care audit to improve quality of clinical records: the preliminary experience of an Italian Cancer Institute

Introduction: Audit and feedback are recognized as part of a strategy for improving performance and supporting quality and safety in European health care systems. These considerations lead the Clinical Management Staff of an Italian Cancer Institute to start a project of self-assessment of the quality of clinical records and organizational appropriateness through a retrospective review. Materials and methods: The evaluation about appropriateness and congruity concerned both clinical records of 2013 and of 2015. At the end of the assessment of clinical records of each Care Unit, results were shared with medical staff in scheduled audit meetings. Results: One hundred and thirteen clinical records (19%) did not meet congruity criteria, while 74 (12,6%) resulted as inappropriate. Two surgical Care Units produced a high negative difference in terms of economic value, 7 Care Units produced about the same medium difference and 2 Care Units had a positive difference. Concerning the quality assessment of clinical records of 2015, the most critical areas were related to medical documents and Hospital Discharge Form compilation. Conclusions: Our experience showed the effectiveness of clinical audit in assessing the quality of filling in medical records and the appropriateness of hospital admissions and the acceptability of this tool by clinicians

Conspiracy beliefs, COVID-19 vaccine uptake and adherence to public health interventions during the pandemic in Europe

Background: Conspiracy beliefs can be a major hindrance causing a lack of compliance with public health measures, including vaccination. We examined the relationship between individual attitudes, socio-demographic factors, conspiracy beliefs, COVID-19 vaccine hesitancy and preferences about pandemic policies in Europe. Methods: We used data from the 10th round of the European Social Survey, conducted in 2021-22 in 17 European countries. Both a conspiracy index and a personal attitude index for each participant were built by using a Latent Class Analysis model. Then, we used a multilevel regression model to investigate the relationship between a personal attitudes index, socio-demographic factors and country of residence, and a conspiracy index. We descriptively analyse the relationship between the conspiracy index and four main items related to COVID-19. Results: We found that a higher probability of believing in conspiracy theories was associated with male gender, middle age, lower levels of education, unemployment, lower levels of trust and satisfaction and right-wing political orientation. The country of residence was a contextual factor, with eastern European countries having higher levels of conspiracy beliefs. Individuals who expressed conspiracy beliefs had lower COVID-19 vaccine uptake, were less satisfied with the way health services coped with the pandemic and less supportive of governmental restrictions. Conclusions: This study provides valuable insights into the factors associated with conspiracy beliefs and their potential impact on public health. The findings highlight the need for effective strategies to address the underlying factors driving conspiracy beliefs, reduce vaccine hesitancy and promote acceptance of public health interventions

PERSIST: a pre–post study to assess an educational methodology to enhance youth climate literacy and systems thinking ability

Background: Education has a pivotal role in preparing society to address the forthcoming health impacts of the climate crisis. Education provides the tools necessary to instil both individual and collective attitudes for mitigating climate change, fosters the development of adaptive skills and mindsets, and promotes a critical understanding of climate change. The aim of the PERSIST project was to assess the effectiveness of a school educational intervention to strengthen literacy on the climate crisis, pro-environmental behaviours, and systems thinking in high school students (aged 14-18 years). Methods: Three meetings were carried out in a scientific high school in the suburbs of Rome (Italy) between March 21, and April 12, 2023, using complex systems models, group activities, and collective discussions. Pre-intervention and post-intervention questionnaires were administered to students to record knowledge, climate-related emotions, and pro-environmental behaviours. Questionnaires that were complete were considered valid. The anonymously collected data were processed using descriptive statistics and t test. Findings: A total of 273 students in ten different classes attending between grades 1 and 4 took part in the project. 78 (36%) participants were female, 133 (62%) were male, and four (2%) did not disclose their gender. The mean age was 15 years. We received 211 pairs of valid pre-intervention and post-intervention questionnaires. The preliminary analysis showed an average increase of 19% in correct responses to knowledge questions, a 21·2% increase in pro-environmental behaviours, and no discernible differences in climate-related emotions between pre-intervention and post-intervention questionnaires. Interpretation: An interactive approach and the use of complex systems might improve students' literacy and attitudes towards the climate crisis, without increasing negative ecological emotions. This pilot project can guide similar, repeatable programmes in other schools and countries and it represents the first measure of climate-related emotions after school intervention. Funding: None

Towards planetary health systems: a manifesto for a revised quadruple aim for healthcare improvement

Healthcare systems significantly impact the environment, which in turn affects human health. To address this, we propose to revise a popular framework for healthcare improvement, by introducing the advancement of planetary health (the health of both humans and the natural systems) among the aims that health systems should pursue. This approach suggests reducing medical service needs through disease prevention, minimizing environmental impacts, and supporting global efforts to protect planetary health. Practical applications to bring about these pathways are documented in the literature.Technical summary Restoring the health of the planet, with concurrent benefits for human civilization, is paramount. Healthcare systems play a crucial role in this regard, considering the environmental impact of health services. Widely recognized approaches to designing healthcare systems for the optimization of their performance are based on the pursuit of multiple aims, such as the Triple Aim and Quadruple Aim frameworks. The objective of this work is to revise the latter by substituting 'Advance Planetary Health' for 'Improve Population Health'. The objective of advancing planetary health supports all other pre-existing objectives: lowering costs, enhancing patient experience, team wellbeing, and population health, which directly relates to planetary health. Health systems promoting planetary health reduce the need for medical services through disease prevention and health promotion, pursue the provision of appropriate care, minimize the overall environmental impact of medical services, and support planetary health initiatives across all sectors and society. Multiple interconnected pathways exist to operationalize the above components. A revised quadruple aim for healthcare improvement, aligned with social and economic goals of sustainable prosperity and wellbeing, may be a desirable step toward constructing planetary health systems capable of maximizing the health of humans and natural systems.Technical summary Restoring the health of the planet, with concurrent benefits for human civilization, is paramount. Healthcare systems play a crucial role in this regard, considering the environmental impact of health services. Widely recognized approaches to designing healthcare systems for the optimization of their performance are based on the pursuit of multiple aims, such as the Triple Aim and Quadruple Aim frameworks. The objective of this work is to revise the latter by substituting 'Advance Planetary Health' for 'Improve Population Health'. The objective of advancing planetary health supports all other pre-existing objectives: lowering costs, enhancing patient experience, team wellbeing, and population health, which directly relates to planetary health. Health systems promoting planetary health reduce the need for medical services through disease prevention and health promotion, pursue the provision of appropriate care, minimize the overall environmental impact of medical services, and support planetary health initiatives across all sectors and society. Multiple interconnected pathways exist to operationalize the above components. A revised quadruple aim for healthcare improvement, aligned with social and economic goals of sustainable prosperity and wellbeing, may be a desirable step toward constructing planetary health systems capable of maximizing the health of humans and natural systems.Technical summary Restoring the health of the planet, with concurrent benefits for human civilization, is paramount.Healthcare systems play a crucial role in this regard, considering the environmental impact of health services. Widely recognized approaches to designing healthcare systems for the optimization of their performance are based on the pursuit of multiple aims, such as the Triple Aim and Quadruple Aim frameworks. The objective of this work is to revise the latter by substituting 'Advance Planetary Health' for 'Improve Population Health'. The objective of advancing planetary health supports all other pre-existing objectives: lowering costs, enhancing patient experience, team wellbeing, and population health, which directly relates to planetary health. Health systems promoting planetary health reduce the need for medical services through disease prevention and health promotion, pursue the provision of appropriate care, minimize the overall environmental impact of medical services, and support planetary health initiatives across all sectors and society. Multiple interconnected pathways exist to operationalize the above components. A revised quadruple aim for healthcare improvement, aligned with social and economic goals of sustainable prosperity and wellbeing, may be a desirable step toward constructing planetary health systems capable of maximizing the health of humans and natural systems.Social media summary It's time for new 'planetary health systems': focusing on planetary health to enhance healthcare performance. #PlanetaryHealth #ClimateCrisis #HealthcareImprovement