Aim of the study: The purpose of this research is to outline the potential of mobile units in the prevention and management of chronic diseases, as well as wanting to investigate their possible use as a tool for public awareness of vaccination. Method: The research analyzes the results of the 2022 edition of "Il Treno della Salute," an initiative funded by the Veneto Regional Health Authority in collaboration with the non-governmental organization "Medici con l’Africa CUAMM" of Padua. On board five train wagons, the team, after collecting information on the main risk factors for NCDs (smoking, sedentary lifestyle, low fruit consumption, excess weight), carried out a free screening of the main intermediate risk factors (blood pressure, fasting blood glucose and cholesterolemia). In the case of customers older than 65 years, vaccination status related to vaccinations offered by the National Health System against influenza, herpes-zoster, pneumococcal and tetanus was also investigated. The chi-square test was used to describe the distribution of the variables considered within the sample and p-values lower than 0.05 were considered statistically significant, while a single-step logistic regression model was used to establish the association between the variables, reporting the AORs and their 95% confidence intervals. Results: The survey of the 1548 participants in the initiative found substantial percentages of new diagnoses (15.1% of subjects with hypertension, 13.0% of subjects with impaired fasting blood glucose, and 36.2% of subjects with hypercholesterolemia) as well as turning on an alarm bell about the poor control of the known alterations among subjects over 70 years of age, particularly in the case of hypertension (more than 25% of subjects had impaired values despite already known diagnosis and started therapy). New diagnoses were conspicuous among 50-year-olds (nearly 19% of 50-59-year-old subjects did not know they were hypertensive and 15.4% had unknown fasting hyperglycemia), thus providing evidence to support the usefulness of active cardiovascular screening of the population as early as this age. The prevailing age of newly diagnosed hypercholesterolemia was even 40-49 years old (49.3% of subjects with misrecognized alteration) further suggesting how searching for the presence of intermediate risk factors is reasonable to be undertaken as early as the fourth decade of life. The distribution of common risk factors for NCDs was found to be in line with data in the literature; however, the underestimation of cardiovascular risk was made evident among women, who, despite a lower presence of risk factors and lower percentages of already known diagnoses, had rates of new diagnoses very close to those of men (14.0% of new hypertensives and 10.2% of cases of unknown fasting hyperglycemia). Finally, the research has amply highlighted the crucial role of recommendation (through active call for cohorts, promotional campaigns, or personal initiative of one's general practitioner) in influencing immunization adherence rates. Recommendation by a health care provider appears to be the main factor among those investigated and increases the likelihood of vaccination up to tenfold or even more. Conclusions: The research suggests how the mobile clinics can find a breeding ground within the primary care delivery system, both by enabling effective population screening and intensification of follow-up systems and by acting at the root of chronicity and infectious diseases through prevention and health promotion campaigns. Further economic analysis would be useful for more detailed and fruitful planning of the mobile clinic's areas of focus, so as to avoid redundancy of services already offered in the area and fragmentation of the patient care and management process.
Scopo dello studio: Lo scopo di questa ricerca è quello di delineare il potenziale delle unità mobili nella prevenzione e nella gestione delle patologie croniche (MCNT), oltre a volerne indagare il possibile impiego come strumento di sensibilizzazione della popolazione nei confronti delle vaccinazioni. Metodo: La ricerca analizza i risultati dell’edizione 2022 de “Il Treno della Salute”, un’iniziativa finanziata dall’Azienda Sanitaria regionale del Veneto in collaborazione con l’organizzazione non governativa “Medici con l’Africa CUAMM” di Padova. A bordo di cinque carrozze ferroviarie il team, a seguito della raccolta delle informazioni sui principali fattori di rischio per le MCNT (fumo, sedentarietà, scarso consumo di frutta, eccesso ponderale), ha effettuato uno screening gratuito dei principali fattori di rischio intermedi (pressione sanguigna, glicemia a digiuno e colesterolemia). Nel caso di avventori ultra 65enni è stato indagato anche lo stato vaccinale relativo alle vaccinazioni offerte dal SSN contro influenza, herpes-zoster, pneumococco e tetano. Per descrivere la distribuzione delle variabili considerate all’interno del campione è stato utilizzato il test chi quadrato e sono stati considerati statisticamente significativi i p- value inferiori a 0,05 mentre per stabilire l’associazione tra le variabili si è fatto ricorso ad un modello di regressione logistica single-step e sono stati riportati gli AOR e i relativi intervalli di confidenza al 95%. Risultati: L’indagine sui 1548 partecipanti all’iniziativa ha rilevato percentuali notevoli di nuove diagnosi (15,1% di soggetti con ipertensione arteriosa, 13,0% di soggetti con glicemia alterata a digiuno e 36,2% di soggetti ipercolesterolemici) oltre ad aver acceso un campanello d’allarme sul cattivo controllo delle alterazioni note fra i soggetti con più di 70 anni, in particolare nel caso dell’ipertensione (oltre il 25% dei soggetti presentava valori alterati nonostante la diagnosi già nota e la terapia iniziata). Le nuove diagnosi sono risultate cospicue fra i 50enni (quasi il 19% dei soggetti di 50-59 anni non sapeva di essere iperteso e il 15,4% presentava iperglicemia a digiuno non nota), fornendo quindi evidenze a supporto dell’utilità di sottoporre a screening attivo cardiovascolare la popolazione già a partire da quest’età. L’età prevalente di nuova diagnosi di ipercolesterolemia è stata addirittura di 40-49 anni (49,3% di soggetti con alterazione misconosciuta) suggerendo ulteriormente come la ricerca della presenza di fattori di rischio intermedi sia ragionevole da intraprendere già a partire dalla quarta decade di vita. La distribuzione dei comuni fattori di rischio per le MCNT è risultata in linea con i dati presenti in letteratura; tuttavia, è stata resa evidente la sottostima del rischio cardiovascolare fra le donne che, a fronte di una minor presenza di fattori di rischio e percentuali inferiori di diagnosi già note, hanno ottenuto percentuali di nuove diagnosi molto vicine a quelle degli uomini (14,0% di nuove ipertese e 10,2% di casi di iperglicemia a digiuno non nota). Infine, la ricerca ha ampiamente evidenziato il ruolo cruciale della raccomandazione (tramite chiamata attiva per coorti di appartenenza, campagne di promozione o iniziativa del proprio MMG) nell’influenzare il tasso di adesione alle vaccinazioni. La raccomandazione da parte di un sanitario appare come il principale fattore tra quelli indagati e aumenta fino a decuplicarla o anche più la probabilità di effettuare la vaccinazione. Conclusioni: Le cliniche mobili possono trovare terreno fertile nell’ambito del sistema di erogazione delle cure primarie, sia consentendo un efficace screening di popolazione e l’intensificazione dei sistemi di follow up, sia agendo alla radice della cronicità e delle patologie infettive tramite campagne di prevenzione e promozione della salute.
Ruolo delle cliniche sanitarie mobili nella prevenzione e nel controllo delle malattie croniche non trasmissibili: l’esperienza veneta “Il Treno della Salute” 2022
MORO, FRANCESCA
2022/2023
Abstract
Aim of the study: The purpose of this research is to outline the potential of mobile units in the prevention and management of chronic diseases, as well as wanting to investigate their possible use as a tool for public awareness of vaccination. Method: The research analyzes the results of the 2022 edition of "Il Treno della Salute," an initiative funded by the Veneto Regional Health Authority in collaboration with the non-governmental organization "Medici con l’Africa CUAMM" of Padua. On board five train wagons, the team, after collecting information on the main risk factors for NCDs (smoking, sedentary lifestyle, low fruit consumption, excess weight), carried out a free screening of the main intermediate risk factors (blood pressure, fasting blood glucose and cholesterolemia). In the case of customers older than 65 years, vaccination status related to vaccinations offered by the National Health System against influenza, herpes-zoster, pneumococcal and tetanus was also investigated. The chi-square test was used to describe the distribution of the variables considered within the sample and p-values lower than 0.05 were considered statistically significant, while a single-step logistic regression model was used to establish the association between the variables, reporting the AORs and their 95% confidence intervals. Results: The survey of the 1548 participants in the initiative found substantial percentages of new diagnoses (15.1% of subjects with hypertension, 13.0% of subjects with impaired fasting blood glucose, and 36.2% of subjects with hypercholesterolemia) as well as turning on an alarm bell about the poor control of the known alterations among subjects over 70 years of age, particularly in the case of hypertension (more than 25% of subjects had impaired values despite already known diagnosis and started therapy). New diagnoses were conspicuous among 50-year-olds (nearly 19% of 50-59-year-old subjects did not know they were hypertensive and 15.4% had unknown fasting hyperglycemia), thus providing evidence to support the usefulness of active cardiovascular screening of the population as early as this age. The prevailing age of newly diagnosed hypercholesterolemia was even 40-49 years old (49.3% of subjects with misrecognized alteration) further suggesting how searching for the presence of intermediate risk factors is reasonable to be undertaken as early as the fourth decade of life. The distribution of common risk factors for NCDs was found to be in line with data in the literature; however, the underestimation of cardiovascular risk was made evident among women, who, despite a lower presence of risk factors and lower percentages of already known diagnoses, had rates of new diagnoses very close to those of men (14.0% of new hypertensives and 10.2% of cases of unknown fasting hyperglycemia). Finally, the research has amply highlighted the crucial role of recommendation (through active call for cohorts, promotional campaigns, or personal initiative of one's general practitioner) in influencing immunization adherence rates. Recommendation by a health care provider appears to be the main factor among those investigated and increases the likelihood of vaccination up to tenfold or even more. Conclusions: The research suggests how the mobile clinics can find a breeding ground within the primary care delivery system, both by enabling effective population screening and intensification of follow-up systems and by acting at the root of chronicity and infectious diseases through prevention and health promotion campaigns. Further economic analysis would be useful for more detailed and fruitful planning of the mobile clinic's areas of focus, so as to avoid redundancy of services already offered in the area and fragmentation of the patient care and management process.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/46664