Background/Objectives: Lifestyle Modification Programs (LMPs) based on exercise and nutrition aim to prevent/manage chronic diseases and foster well-being. However, moving LMPs from research to medical practice can be challenging, as programs must be both effective and feasible. The primary goal of this study was to assess cardiorespiratory fitness (CRF) changes according to an LMP, measured through VO2max, as a key indicator of health outcomes and intervention efficacy. Methods: In this single-arm intervention study, 100 subjects were enrolled; per-protocol analysis of main parameters was performed on 85 participants (15 were excluded due to medical/technical reasons). A feasible intervention program (of low resource intensity with only two physician/patient encounters) provided personalized exercise prescription, optimized nutritional habits based on the Mediterranean diet and Healthy Eating Plate principles, and supported behaviour change. We assessed CRF through VO2max, a key indicator of health outcomes and intervention efficacy. We also analyzed, using regression analysis, the relationship between VO2max (the gold-standard measure of CRF) and METSpeak, a simpler, feasible parameter of CRF derived from Exercise Stress Testing. Body composition (BC) and AHA diet score were also measured at baseline and post-6-month intervention. Statistical analyses included paired comparisons and multivariable regression to explore factors influencing CRF changes. Results: Analysis on the primary outcome, VO2max, was performed according to the intention-to-treat principle and per-protocol. This feasible protocol resulted in a significant increase in VO2max, improvements in fat-free mass, and a reduction in fat mass. Overall, 42.4% of participants achieved an improvement of ≥1 MET, a change previously associated with reduced mortality risk. Older participants tend to experience smaller improvements in VO2max. Conclusions: Although observing an improvement in CRF and BC following an LMP is not surprising, the strength of the study is to show the feasibility of implementing an effective, feasible LMP into clinical routine, supporting the integration of such programs into clinical practice.

Background: General Practice is facing workforce shortages across Europe. In Italy, the estimated shortage was 5575 General Practitioners in 2024, with high retirement rates and persistent difficulties in attracting new physicians to the profession. This study investigated postgraduate career intentions among medical students and factors associated with interest in General Practice. Methods: A cross-sectional survey using an anonymous 39-item questionnaire was conducted among fifth- and sixth-year medical students at the University of Milan. Associations were assessed using ordinal and multinomial logistic regression. Results: Among 359 respondents (response rate: 46.8%), only 2.2% identified General Practice as their preferred postgraduate career. Students considering General Practice attributed greater importance to community-based work (OR = 18.49, 95% CI 3.35–102.02) and professional autonomy (OR = 4.47, 95% CI 1.03–19.44). Previous community-based primary care experience was associated with choosing General Practice (OR = 32.43, 95% CI 3.85–273.50). Most students perceived theoretical and practical General Practice training as less adequate than that of other specialties, and only 25.1% considered their preparation sufficient to support career decision-making. Conclusions: Strengthening the academic integration of General Practice and meaningful community-based learning opportunities may contribute to more informed career choices while better preparing future physicians for healthcare systems increasingly centred on Primary Health Care.

BACKGROUND:The health sector is characterized by dual aspects in relation to climate change and its impact on human health. To consider firstly the treatment of resulting health problems; and secondly the representation of environmental impact as a primary cause. Consequently, a number of certification bodies have indicated their intention to incorporate sustainability criteria into their certification processes. The objective of this study is to analyze the present sustainability practices of JCI-accredited hospitals in Italy. METHODS:The cross-sectional study was conducted using a 15-question questionnaire that was disseminated to all Italian JCI-accredited facilities. The 15 questions were structured according to the five domains outlined in the Global Green and Healthy Hospitals. These questions were both open questions regarding organizational challenges, achievements, and future strategies related to sustainability. In addition, there were closed questions for data on specific practices with multiple-choice formats. RESULTS:A response rate of 95.2% was obtained, with a geographical distribution showing a prevalence of facilities in northern Italy (55%). Statistically significant differences were not observed between Northern, Central and Southern Italy with regard to years of accreditation, number of beds, presence of sustainability committees or presence of environmental risk assessments in the risk plan. The analysis of the GHI's five domains reveals an average of approximately 60% of the responses indicating the presence of figures responsible for environmental sustainability, as well as for the analysis of environmental risks within the different company risk plans. With regard to the presence of a sustainability committee, 75% of the facilities indicated that they had one. In addition, the findings reveal that a significant proportion, close to (55%) of facilities have adopted strategies to mitigate waste generation within the supply chain, with 85% of facilities that adopt strategies reporting the implementation of specific measures to reduce waste. CONCLUSION:The issue of sustainability is becoming increasingly central to healthcare organizations, especially those accredited by the JCI. This is being addressed through the establishment of intra-company committees and the incorporation of environmental considerations into company procedures and regulations. This development signifies a preliminary step towards a paradigm shift within the Italian healthcare system, with the intention of incorporating environmental impact considerations into its accreditation requirements.

Background/Objectives: Human papillomavirus (HPV) represents a major public health challenge due to its high prevalence and the complications arising from infection. The aim of the study was to investigate the reasons for adherence to the HPV vaccination campaign offered by the University of Milan to its students. Methods: A questionnaire, distributed via QR code, was utilized to investigate the motivations behind participation in the vaccination campaign, as well as the characteristics of the population participating in the vaccination campaign carried out at the University of Milan. Concurrently, a comprehensive analysis of the characteristics of students was also carried out at the vaccination sites where it was conducted, categorizing them into university hospitals and university campuses. Results: A comparison of vaccination sites revealed a significant disparity between hospitals and universities with regard to gender, age, and faculty. A higher average age (25 versus 24 years) and a higher prevalence of females (53.9% versus 51.1%) were observed in hospitals. The findings of the regression model demonstrate that demographic factors exert an influence on only two reasons for participation, with male gender proving a predictive factor for the response option entitled “It is a responsibility towards one’s partner(s)”. Furthermore, enrolment in a course of study has been found to correlate positively with the response option entitled “I have been convinced by advertising campaigns/friends/acquaintances”. Conclusions: A vaccination campaign implemented within educational institutions is a fundamental strategy for enhancing vaccination uptake rates among young population. Conversely, the utilization of health promotion interventions, such as pre-vaccination promotional campaigns, does not seem to be a pivotal factor in enhancing uptake.

Adolescents and young adults with congenital heart disease (CHD) face significant challenges when transitioning from pediatric to adult care. Despite growing recognition of its importance, transitional care remains inconsistently implemented across healthcare systems, and a summary of published literature in this regard is still missing. This scoping review aims to systematically map the literature on CHD transitional care and identify key topics and trends. Following Joanna Briggs Institute guidelines, we conducted a comprehensive search across seven electronic databases using the Population, Concept, and Context framework. A total of 73 studies were included. Data were extracted and analyzed using Latent Dirichlet Allocation to identify core topics, and Multiple Correspondence Analysis was applied to explore thematic relationships and validate topic structure. Lexicometric analysis assessed the linguistic complexity and specificity of the literature. Three major themes emerged: (1) Education, Self-Management, and Structured Support, (2) Timing, Knowledge Transfer, and Developmental Needs, and (3) Transition Program Implementation and Coordination. These themes reflect an increasing focus on structured educational strategies, developmentally tailored care, and system-level program delivery. Education-focused interventions were more frequently found in recent, high-quality experimental studies. In contrast, studies addressing timing and developmental needs and those focused on implementation were more common in earlier-phase or heterogeneous research contexts. Transitional care for individuals with CHD requires more standardized, evidence-based approaches. Improved documentation when reporting transitional care is essential to enhance fidelity, scalability, and long-term impact. This review provides a foundation for developing outcome-focused research and supports designing individualized, high-quality transition programs.

Background/Objectives: Human papillomavirus (HPV) infection is a major concern in public health, given its role as a persistent sexually transmitted infection and a causative agent of non-cancerous and cancerous lesions (neoplasms). The increasing infection rates observed in recent years underscore the need for effective public health measures to address this issue. The objective of this study is to describe the challenges and the results of conducting vaccination campaigns within a university setting and its impact on the HPV vaccination rate. Methods: A multifaceted approach was adopted, entailing the implementation of two distinct interventions. Following the promotional and educational online campaign (described elsewhere), vaccination delivery took place from November 2024 to July 2025 in the university campus and in three university hospitals in Milan. Overall and covariate-specific drop-out rate is calculated; significance is tested through a chi-square test of homogeneity between the population that completed less than three doses vs. those who completed the full cycle. Overall and vaccine-specific vaccination proportion is reported. Results: The vaccination rate for first doses reached 92% of available appointments, with a slight female majority (50.9%) and the 23–26 age as the most represented group (47%). The most represented nationality was Italian (58.4%), followed by Iranian (26.5%). Regarding the vaccination sites, the university venue recorded the highest rates in terms of both vaccines booked (56.4%) and vaccines administered (64.7%). With a net loss in follow up, consistent with WHO data, the three-dose HPV vaccination campaign was completed by 82.5% of participants. A chi-squared test of homogeneity revealed significant differences in age distribution between vaccination groups, χ2 (3) = 347.78, p < 0.001, Cramér’s V = 0.457. Participants who received only one dose were predominantly younger (17–22 years: 71.1% vs. 19.0%, difference = 52.1 percentage points, 95% CI [46.6, 57.7]). Meanwhile, a catch-up strategy raised interest on other crucial vaccinations. Conclusions: The findings pertaining to the vaccination rate underscore the heightened awareness among young adults concerning the HPV vaccine. They further substantiate the efficacy of the integrated strategy encompassing advisory and educational site-based campaigns as an initial measure to attain the WHO-endorsed vaccination rates.

Prior studies have examined decision regret and vaccine hesitancy using variable-centered approaches. However, little is known about the diversity of profiles within oncology settings where immunocompromised patients are at high risk. This study aimed to identify distinct clusters of vaccine-related attitudes among Italian nurses working in comprehensive cancer centers. A cross-sectional survey was conducted from June to September 2024, using validated instruments to assess decision regret and vaccine hesitancy (i.e., trust in vaccine efficacy, concerns about vaccine safety, and trust in health authorities and compliance). Data were collected from 241 RNs affiliated with the Italian Association of Cancer Nurses. A t-distributed Stochastic Neighbor Embedding (t-SNE) was used for dimensionality reduction before hierarchical clustering. Seven distinct profiles emerged, ranging from Confident Adherent (low regret, high trust, high compliance) to Resigned Skeptic (low trust, moderate concern, low compliance). Educational status and age significantly influenced cluster membership. Specific profiles displayed unexpected patterns (e.g., high trust with high regret, as in the Regretful Believer group), highlighting the complexity of vaccination attitudes. These findings underscore the importance of person-centered strategies for vaccine communication. Differentiated educational and institutional approaches may enhance trust and adherence among oncology nurses.

Background:Over the past 15 years, Italy's National Health Service has been the object of increased governmental attention, due to the need to control public spending, reduce waste, and maintain acceptable levels of quality, accessibility and appropriateness of healthcare services. Methods:One of the key mechanisms to achieve this has been the implementation of performance assessment systems. Among these is the New Guarantee System, introduced in 2019, which utilizes 88 indicators across three key macro-areas - public health and prevention, primary health care, and hospital care - to assess the quality and equity of essential healthcare services. Results:This paper critically analyzes the 2025 New Guarantee System report, identifying strengths, limitations, and potential improvements for a more effective monitoring system. The findings reveal significant gaps in the current healthcare performance evaluation system. The reliance on descriptive statistics limits the ability to interpret healthcare outcomes accurately. The absence of indicators addressing chronic diseases, health inequalities, new technologies and qualitative patient experiences suggests the urgent need of a more comprehensive evaluation approach. Conclusions:To improve the healthcare performance evaluation system, it is recommended to incorporate more comprehensive indicators that address the identified gaps. Enhanced data integration, qualitative assessments, and an increased focus on chronic diseases and health disparities are essential to provide a more accurate evaluation of healthcare services.

The demand for medical services and its burden on the healthcare system is worldwide increasing. Factors influencing service requests are still partially unknown. Extended shifts may impair decision-making, potentially affecting the request for ancillary diagnostic procedures. This study aimed to investigate the association between the time-of-shift and the rate of diagnostic service requests in pediatric emergency settings. This single-center observational study was conducted at the pediatric emergency department of the Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy. The study included patient visits on weekends and public holidays. Data on blood tests, specialist consultations, and imaging requests were extracted. The shift was divided into the first 8 h and the last 4 h, and diagnostic service requests were analyzed using mixed-effects logistic regression models, adjusting for patient urgency and number of patients per shift. A total of 5370 visits were analyzed. At least one ancillary diagnostic procedure was requested in 31% of the visits. There was a 14% higher probability ( p = 0.04) of requiring ancillary diagnostic procedures during the last 4 h of shifts compared to the first 8 h. This probability increased to 20% ( p = 0.02) considering exclusively the dayshift. These findings suggest a potential role of shift duration on diagnostic service requests, warranting further multicenter studies to explore this association across various healthcare settings.

Background:Breast cancer represents the most common form of neoplasm in women, with an estimated 685,000 deaths annually. In this regard, screening programmes represent one of the most effective intervention tools in the field of cancer prevention. The aim of this study is to analyse and describe the key performance indicators of the screening programmes in Lombardy from 2016 to 2022. Study design:Descriptive temporal analysis study. Methods:The data pertaining to the screening campaign were subjected to analysis, with the results broken down according to the following criteria: individual province, age group eligible for screening, and campaign year. For each campaign, the data pertaining to the population subjected to screening, as well as the data concerning the rate of cancers identified during the campaign, were subjected to analysis. Results:For the three age groups, a substantial overlap in call and campaign adherence rates can be observed, with stable values between 2016 and 2019, followed by a significant decline in the 2020 campaign associated with the impact of the pandemic on prevention activities, including cancer screening campaigns. The data for 2021 and 2022 indicate a reversal of the decline in adherence and call rates, particularly in the 45-49 age group, which exhibited an increase of approximately 300% in the call rate between 2021 and 2020. Moreover, the categorization of the provinces into urban, mountainous and rural provinces demonstrates an overlap in the admission rates between the three areas in the different years. Conclusions:Despite the existence of mammography screening campaigns for more than 20 years, adherence rates in the Lombardy region remain below the targets set out in Europe's Beating Cancer Plan. In this regard, the observed variations, particularly during the period of the pandemic and in the subsequent post-pandemic period, provide an opportunity to rethink the organization of screening campaigns in order to increase adherence and effectiveness.

BACKGROUND:Healthcare-related procedural misadventures remain underreported despite decades of investment in patient safety. International Classification of Diseases, 10th Revision (ICD-10) codes Y62-Y69 capture defined preventable adverse events during medical and surgical care. This study aimed to examine temporal patterns in Y62-Y69-coded events using aggregated, precomputed data from the TriNetX Global Collaborative Network. METHODS:We conducted a retrospective observational study using deidentified electronic health records from the TriNetX platform, encompassing over 135 million patients aged 0-89 (years: 2016-2024). Incidence rates for Y62-Y69-coded events were analysed globally and across four regional networks, USA, Europe-Middle East-Africa (EMEA), Asia-Pacific (APAC) and Latin America (LATAM), with additional sensitivity analyses in cardiovascular (ICD-10: I00-I99) and oncological (ICD-10: C00-D49) cohorts. Temporal trends were explored descriptively using polynomial regression (for visual pattern illustration) and the Mann-Kendall trend test. FINDINGS:Globally, Y62-Y69 incidence rates increased from 0.04 to 0.09 per 100 000 patients between 2016 and 2024 (125% increase), with inflection in the early postpandemic phase. EMEA exhibited the steepest rise (414%), followed by APAC (225%). The USA showed a non-linear pattern detectable only through polynomial modelling. LATAM and APAC trends lacked statistical significance, likely due to high year-to-year variability. Sensitivity analyses in the disease-specific cohorts reflected similar patterns, reinforcing the consistency of findings. INTERPRETATION:This is the first global, real-world analysis of ICD-10 Y62-Y69-coded adverse events. The findings reveal a notable postpandemic escalation in procedural harm, underscoring the fragility of safety systems under operational stress. Regional heterogeneity and non-linear trajectories highlight the importance of locally tailored interventions and the need to reinvigorate global patient safety efforts. DATA AVAILABILITY STATEMENT:All data were extracted from the TriNetX Global Collaborative Network. Aggregated incidence rates and the R code used for statistical analysis are provided in online supplemental file 2.

Chronic pain is a prevalent and costly condition that significantly impairs functional and emotional status as well as quality of life, representing a major cause of incapacity worldwide that requires long-term management strategies.eHealth interventions, including telemedicine, mobile health applications, and internet-based programs, have emerged as promising approaches to improve pain management by enhancing access to education, psychological support, and self-monitoring tools. However, the efficacy of these interventions remains unclear due to variability in study designs or intervention components, differences in pain conditions (e.g., somatic or neuropathic pain), and outcome measures. This systematic review and meta-analysis aims to synthesize the evidence on the efficacy of eHealth interventions for chronic non-cancer pain in adults, assessing their impact on pain severity, functional outcomes, quality of life, mental health, medication adherence, patient satisfaction, and cost-effectiveness. A network meta-analysis (NMA) will be conducted to compare different eHealth modalities and identify which features contribute most to positive outcomes. Statistical analyses will follow Cochrane guidelines, with the risk of bias and evidence certainty evaluated using the Cochrane RoB 2.0 tool and GRADE framework, respectively. The findings will provide valuable insights for clinicians, policymakers, and researchers, informing best practices for integrating digital health solutions into chronic pain management.•This systematic review and meta-analysis will assess the efficacy of eHealth interventions for chronic pain management.•A network meta-analysis will compare different digital health modalities to identify the most effective intervention components.•The study will evaluate clinical, functional, psychological, adherence, and cost-related outcomes, informing evidence-based practice and policy.

The measurement of sense of coherence (SOC) has received attention for more than three decades. Despite the extensive use of SOC-13, there is still a long debate regarding its dimensionality structure. Recently, there has been an increasing use of network modeling as a valid alternative to latent-variable modeling. This study proposes an exploratory approach to the structure of SOC-13 by adopting a network perspective. The network structure was estimated with a Gaussian Graphical Model, and Exploratory Graph Analysis (EGA) was used to inspect network dimensionality. We fit and compared the unidimensional, first- and second-order confirmatory factor analysis (CFA), bifactor-CFA, and structure derived from EGA. Our results showed unacceptable fit values for the CFA models, suggesting that SOC-13 is not unidimensional. Inspection of the estimated network suggested that the SOC-13 items emerged as a dynamic system of mutually interacting nodes that formed three distinct clusters of items (communities) that are not those defined in the literature. EGA identified three communities of items: the first community was characterized by comprehensibility and manageability items, the second community was characterized by comprehensibility and manageability items, and the third dimension was characterized by all meaningfulness items and one comprehensibility item. Our study presented a novel perspective in investigating the structure of SOC-13 that strengthens the assumption that SOC should be conceptualized as a complex system of cognitive (comprehensibility), behavioral (manageability), and motivational dimensions (meaningfulness) that are deeply linked and not necessarily distinct.

Background: Antimicrobial resistance represents one of the most significant future health challenges in terms of both clinical and economic impacts on healthcare systems. The reason behind this issue is the misuse of antibiotics for the treatment of non-bacterial pathologies. The objective of this study is to investigate the factors underlying antibiotic prescription in pediatricians in the Lombardy region. Methods: The study was conducted by means of a 32-item questionnaire that investigated both pediatricians’ knowledge of antimicrobial resistance and the factors determining the choice to prescribe antibiotic therapy. Results: A total of 253 pediatricians participated in the survey. Most participants (71.6%) reported as highly relevant the need for a national plan against AMR. However, approximately half of the respondents declared the phenomenon of AMR as uncommon in pediatric settings. Among the identified associated factors, diagnostic uncertainty was associated with a stronger fear of legal repercussions and the influence of parental pressure when prescribing antibiotics. Conclusions: The inability to diagnose the bacterial origin of an infection might be the primary driver of prescribing choices, rather than other non-clinical factors, such as parental demands or a fear of lawsuits.

Objective:The COVID-19 pandemic has disrupted educational systems worldwide, raising concerns about its impact on academic performance, particularly among developmental age students. Methods:A systematic review with meta-analysis aimed to evaluate the association between the COVID-19 pandemic and the academic performance in this population was performed according to PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus and Embase were searched on December 2023 to identify relevant studies. Both fixed and random effect models were performed. The Effect size was reported as Cohen's d with a 95% Confidence Interval. Studies' quality was assessed using the Newcastle-Ottawa scale. The protocol was registered in PROSPERO. Results:A total of 30 studies met the inclusion criteria, but only 13 could be combined in the meta-analysis. Based on a sample size of 4,893,499 students, pooled Cohen's d was -0.07 [(95% CI = -0.10; -0.03); p-value <0.001]. Subgroup analyses by subject suggested that performance in math was affected the most, Cohen's d= -0.14 [(-0.18; -0.10); p-value <0.001]. Conclusion:The findings revealed a significant negative association between the COVID-19 pandemic and academic performance among developmental age students. Interventions to mitigate the adverse effects of the pandemic on educational outcomes in this population are needed.

Background: COVID-19 vaccination is the most significant step toward the long-term mitigation of SARS-CoV-2-related complication, avoiding disease and death and decreasing virus spread. This study aimed to evaluate, in a real-world setting, booster dose effectiveness to reduce COVID-19 risk considering the amount of time after the end of the two-dose vaccination cycle. A sub-analysis was conducted to adjust the booster dose effect for occupational and demographic factors. Methods: About 16,000 COVID-19-vaccinated HCWs of three University Hospital Networks in Milan (HN1/HN2/HN3) were included in the study. Data were collected by Occupational Health Physicians of the HNs within specific computerized databases. Results: In univariable analysis, booster dose administration displayed a slightly higher risk of infection with respect to not receiving it, OR = 1.18, with 95% confidence interval (C.I) [0.99, 1.41]. When the model was adjusted with the modulating effect of time from the completion of the vaccination cycle on booster dose administration, the latter resulted in strong protective effect against infection, OR = 0.43, 95% CI [0.26, 0.74]. However, considering the modifying influence of time from the vaccination cycle’s completion, the administration of booster doses appeared to have a protective effect against infection. In HN1, students and resident physicians displayed lower odds of infection with respect to physicians. Lastly, a non-linear effect of age was reported. Conclusions: Our findings suggest that the correct timing in vaccine scheduling and administration is critical to vaccine effectiveness. These findings, applicable to all vaccinations, should help in setting up more effective vaccination strategies.

Background: Vaccination is a highly effective tool for controlling infectious diseases, particularly in populations at high risk of contagion due to clinical conditions or occupational exposure, such as healthcare workers. The purpose of this study is to present the open day event that marked the beginning of the influenza and anti-COVID-19 vaccination campaign in the Lombardy region and to describe the experience of an Istituto di Ricovero e Cura a Carattere Scientifico in Milan. Methods: During the vaccination open day, eligible individuals received free vaccinations for influenza, COVID-19, pneumococcal disease, and shingles, as provided by the Lombardy Agenzia per la Tutela della Salute. In celebration of the centenary of the Università degli Studi di Milano, the Fondazione Ca’Granda Ospedale Policlinico, a contracted hospital of the university, created a special electronic diary for a total of 150 individuals, equally divided between children aged 2–6, pregnant women, and university staff. Results: At the regional level, a total of 6634 influenza vaccines, 2055 anti-COVID-19 vaccines, 108 anti-pneumococcal vaccines, and 37 anti-zoster vaccines were administered. A total of 3134 (47.3%) influenza vaccines, 1151 (56%) anti-COVID-19 vaccines, and 77 (62%) anti-pneumococcal vaccines, were given to individuals aged 60–79. No differences were observed between the total number of male and female vaccinees (1017 and 1038, respectively), who received the anti-COVID-19 vaccine. At the Policlinico Foundation, out of 150 available booking slots, 154 vaccines were administered, including 117 influenza vaccines. Conclusions: The establishment of vaccine open days is a beneficial way to increase vaccine compliance. Co-administration of little-known vaccinations outside of healthcare settings could also be a useful tool.

Abstract Background Every year in Italy, influenza affects about 4 million people. Almost 5% of them are hospitalised. During peak illness, enormous pressure is placed on healthcare and economic systems. This study aims to quantify the clinical and economic burden of severe influenza during 5 epidemic seasons (2014–2019) from administrative claims data. Methods Patients hospitalized with a diagnosis of influenza between October 2014, and April 2019, were analyzed. Clinical characteristics and administrative information were retrieved from health-related Administrative Databases (ADs) of 4 Italian Local Health Units (LHUs). The date of first admission was set as the Index Date (ID). A follow-up period of six months after ID was considered to account for complications and re-hospitalizations, while a lookback period (2 years before ID) was set to assess the prevalence of underlying comorbidities. Results Out of 2,333 patients with severe influenza, 44.1% were adults ≥ 65, and 25.6% young individuals aged 0–17. 46.8% had comorbidities (i.e., were at risk), mainly cardiovascular and metabolic diseases (45.3%), and chronic conditions (24.7%). The highest hospitalization rates were among the elderly (≥ 75) and the young individuals (0–17), and were 37.6 and 19.5/100,000 inhabitants/year, respectively. The average hospital stay was 8 days (IQR: 14 − 4). It was higher for older individuals (≥ 65 years, 11 days, [17 − 6]) and for those with comorbidities (9 days, [16 − 6]), p-value < 0.001. Similarly, mortality was higher in elderly and those at risk (p-value < 0.001). Respiratory complications occurred in 12.7% of patients, and cardiovascular disorders in 5.9%. Total influenza-related costs were €9.7 million with hospitalization accounting for 95% of them. 47.3% of hospitalization costs were associated with individuals ≥ 65 and 52.9% with patients at risk. The average hospitalisation cost per patient was € 4,007. Conclusions This retrospective study showed that during the 2014–2019 influenza seasons in Italy, individuals of extreme ages and those with pre-existing medical conditions, were more likely to be hospitalized with severe influenza. Together with complications and ageing, they worsen patient’s outcome and may lead to a prolonged hospitalization, thus increasing healthcare utilization and costs. Our data generate real-world evidence on the burden of influenza, useful to inform public health decision-making.

IntroductionHuman induced pluripotent stem cells (hiPSCs), derived from reprogrammed adult somatic cells, hold significant promise for disease modelling, personalized medicine, drug discovery, and regenerative therapies. Public awareness and understanding of hiPSCs are crucial for advancing research in this field. However, limited data exists on the general population’s knowledge and attitudes toward their use.MethodsThis study aimed to assess the awareness and perceptions of hiPSCs among Italian adults through a web-based survey conducted via the EUSurvey platform, using a snowball sampling approach. The survey included demographic information and mandatory questions on knowledge, awareness, and concerns regarding hiPSC technology, with responses collected on a 3-point scale. Statistical analysis was performed using chi-squared tests, with significance set at p ≤ 0.05.ResultsOut of 1874 respondents, the majority were aged 18–35 years (40.5%), female (63.4%), and university-educated (67.2%). Among those familiar with hiPSCs (54.1%, n = 1,201), 95.3% expressed willingness to donate blood samples for hiPSC generation to treat individuals with incurable diseases. Concerns about current research and therapeutic applications were low (less than 20%), but nearly half of the respondents were hesitant or opposed to the use of hiPSCs in animal experiments and their commercialization by pharmaceutical companies. Increased skepticism was observed in older, less educated, religious individuals, and those who were not blood donors. Overall, the Italian public shows strong support for hiPSC-based therapies, though reservations exist around specific ethical and economic issues.DiscussionThese findings underscore the importance of addressing public concerns through targeted educational campaigns, not only in Italy but globally, to foster a more informed and supportive environment for advancing stem cell research and its clinical applications worldwide. Similar studies have been conducted in Japan, the United States, and Sweden, but there remains a need for all countries to engage with their citizens to better understand how stem cell research is perceived locally. Such engagement is crucial for guiding international strategies in personalized medicine and regenerative therapies, ensuring that emerging technologies are met with both ethical integrity and public trust.

Abstract Background The gut microbiota is a key determinant of long-term health. Promoting maternal health literacy may enhance children well-being. Aim of the present study was to assess gut microbiota-related health literacy of Italian women and identify potential gaps in awareness. Methods A cross-sectional survey study was conducted using an online questionnaire (17 questions) on determinants and long-term impact of infant gut microbiota. The survey targeted Italian pregnant women and mothers of children under 2 years old, and was distributed through various social media channels between September 28th and November 15th, 2022. A total score was calculated as the sum of positive answers. Data on demographics, pregnancy status, and pre-existing knowledge of the infant gut microbiota were also collected. Descriptive and inferential statistics were applied. Results The questionnaire was completed by 1076 women. Median total score was 9 [7–11]. The 81.7% of respondents declared prior knowledge of the gut microbiota. The internet was among the most commonly cited primary sources of information. Independent predictors of total score were having a university degree (B = 0.656, p = 0.002) and prior knowledge (B = 2.246, p < 0.001). Conversely, older age was associated with lower total scores (B = -0.092, p < 0.001). The least known determinants of infant gut microbiota were gestational BMI, prematurity, mode of delivery and NICU stay. Pregnant women failed to recognize the role of breastfeeding in the development of infant gut microbiota more frequently than non-pregnant women. The 97.5% of participants reported increased interest in the gut microbiota, with heightened interest associated with prior knowledge. Conclusions Our study revealed a moderate level of knowledge about infant gut microbiota among respondents, emphasizing the positive impact of prior knowledge on understanding and interest. Targeted educational interventions are needed to address awareness gaps, especially concerning the influence of breastfeeding on infant gut microbiota. Healthcare providers have the potential to enhance women's knowledge and awareness of this topic.