Communication skills in HPV prevention: an audit among Italian healthcare workers

This study aims to investigate the knowledge, the attitudes and practices on HPV vaccination of health professionals of Mother and Child Service of Puglia Region (Italy). The study was conducted through a standardized questionnaire. Of 455 respondents, 74.2% judged HPV vaccine very important for immunization calendar. 88.9% did not believe that the administration of HPV vaccine implies consent to the initiation of sexual activity but 34.2% sustained that vaccine can give a false sense of protection against sexually transmitted diseases. 62.2% believed that boys should also be vaccinated. Skills necessary in the implementation of strategies in the promotion of health are partially inadequate and appropriate ongoing education should be carried out for health care workers.

A nosocomial outbreak of 2009 pandemic influenza A(H1N1) in a paediatric oncology ward in Italy, October-November 2009

A nosocomial outbreak of 2009 pandemic influenza A(H1N1), with eight confirmed cases, occurred in a paediatric oncology ward in Italy, in October/November 2009. The fact that one case was infected despite being isolated and without contact to a symptomatic patient, hints towards potential transmission through a health care worker (HCW) and underlines the importance of vaccination of HCW who are involved in the care of critically ill patients.

Malignant cancer mortality in Province of Taranto (Italy). Geographic analysis in an area of high environmental risk

BACKGROUND

A geographic analysis of the causes of death is an important tool for assessing the effectiveness of Public Health initiatives. The aim of this study is to analyse the causes of death between 2000 and 2004, to discover any excess mortality from cancer in Province of Taranto, an area at high environmental risk.

METHODS

Mortality data from cancer were selected from the Puglia Regional Nominative Causes of Death Registry. Crude and standardized rates and Standardized Mortality Ratios (SMR) were calculated for the five Provinces of the Puglia Region, their capital cities and in four concentric rings around the industrial area located in Province of Taranto.

RESULTS

. Even if the highest death rate for all tumours resulted in the Province of Lecce (24.9 x 10,000), in the cities of Lecce and Bari (29 x 10,000), the distribution of the SMRs in Province of Taranto showed an excess of mortality (+10%) in the ring next to industrial area. For lung cancer the highest rate was reported in city of Taranto (6 x 10,000) and the highest risk (+24%) in the ring next to industrial area. Moreover, in this area 9 (70%) of the 13 considered malignant tumours types presented an excess of mortality.

CONCLUSION

The results uphold the data reported in the published literature. It is fundamental to intensify research into other risk factors (exposure at work and aberrant lifestyles). Moreover, there is an increasing need for a Regional Cancer Register.

An audit of TB prevention on Italian health care workers

Tuberculosis (TB) is considered an occupational disease in health care workers. The aim of this study is to asses the state of tuberculosis prevention among the personnel of the Vaccination Services of the Puglia Region (Italy), who were given an interview-based standardised questionnaire. Of the 302 replies, TB screening had been undergone by 80.5%, whom 78.6% took advice by the occupational health physician. Of those who were negative to the PPD skin test, 60.6% had received BCG, whom 78% took vaccination advice by the occupational health physician. In Italy, the procedures for the monitoring and prevention of tuberculosis are a consolidated practice for occupational health physicians.

[Centralized immunization schedules and regional equity of access: an audit among Apulian healthcare workers]

The reform of the Vth Title of the Italian Constitution has given the Regions autonomous power over planning of their immunization programme and immunization calendar. This amendment has federalized Italy's vaccination system and, is justified by epidemiological evidence however casts doubt on its provision of equal rights to health care. The objective of this current study is to gain insight into the opinion of vaccine services officers in the Apulia region on federal immunization and the regional immunization programme. Research was conducted using an anonymous standardized questionnaire to which 302 vaccines services staff responded. 67.4% of respondents believe that the current federal vaccination programme should be maintained, whilst 20.2% believe that the current system should be eradicated and 12.4% believe it should be phased out gradually. The current apulian vaccination calendar provides free and active immunizations for all newborns for the pneumococcal, meningitis C, chickenpox and hepatitis A vaccines. The interviewees believe that the vaccinations provided in the regional immunization programme are very important (average importance out of 10 = 6.1/7). The positive response to the regional vaccination plan given by the health officers explains, at least in part, the conservative attitude tewards federal vaccination plans. It cannot be excluded that sacrificing regional autonomy over vaccination programmes might be considered by the vaccination officers as being responsible for the abandonment of the Region's long established immunization practices. The success of these practices is evident in the case of the Region's Hepatitis A immunization programme where the active provision of this vaccine has drastically reduced the endemicity of the illness in Apulia. These experiences of good practice should be adequately considered in before opting to phase out the current immunisation programme.

[Epidemiology of femoral neck fractures in Puglia (Italy): an analysis of existing data]

The aim of this study was to describe the epidemiology of femoral neck fractures in Puglia (Italy) by analysing hospital discharge records from 1998 to 2005 and mortality data from 1998 to 2003. In total, 41,354 admissions for femoral neck fractures were recorded, 75% of which in females. The mean age of patients was 78 years (73 in males, 79 in females). Approximately 70% of patients below 50 years of age were male, while above age 50, only 23% of patients were male. Yearly admission rates increased from 1998 to 2005. Mortality records recorded 1,031 deaths due to femoral neck fracture with a decreasing trend in mortality rates in the years considered. Fractures in males were most commonly associated with work related accidents and motor vehicle accidents. In females most fractures were related to home accidents. These results may be used to guide prevention strategies.

Correlation of visual function impairment and OCT findings in patients with Stargardt disease and fundus flavimaculatus

PURPOSE

To investigate the relationship between morphologic lesions of the retina and functional abnormalities in patients with Stargardt disease (STGD) and fundus flavimaculatus (FFM). DESIGN. Case-controlled, prospective, comparative observational study.

METHODS

A complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and optical coherence tomography (OCT), was performed in 61 eyes of 32 consecutive patients with STGD/FFM and in 60 eyes of 30 matched healthy control subjects. Furthermore, fundus-related perimetry was performed in 12 of the affected eyes.

RESULTS

The age ranged from 21 to 71 years in STGD/FFM patients and from 21 to 72 years in controls. BCVA ranged from 20/20 to 20/400 and from 20/20 to 20/32, respectively, in STGD/FFM patients and in controls. A foveal thinning was found by OCT Stratus in almost all cases (average 160 microm) compared with controls (average 210 microm) (p<0.001). BCVA impairment significantly correlated to the degree of foveal thinning (r2=0.16; p=0.0014). Moreover, in STGD/FFM patients the authors observed two types of hyperreflective deposits which were not correlated with BCVA impairment or foveal thinning. In addition, fundus-related perimetry revealed a stable fixation in 8/12 eyes, that was predominantly central in only 4 of these eyes. A smaller degree of foveal thinning correlated to a more stable fixation (p=0.0108), even if not predominantly central (p=0.0218).

CONCLUSIONS

In this series, lower visual acuity and unstable fixation correlated with a greater transverse foveal thinning. OCT and fundus-related perimetry may be useful tools in STGD/FFM patients.

An outbreak of measles including nosocomial transmission in Apulia, south-east Italy, January-March 2008 - a preliminary report

Between 7 January and 16 March 2008, 16 cases of measles were reported in the region of Apulia in south-eastern Italy (about four millions inhabitants). This outbreak is currently ongoing: we present here a preliminary report.

[Epidemiology of HPV infections and cervical cancer in Apulia: a survey study and current data analysis]

HPV infection is common in sexually active women and is an important risk factor for cervical cancer. The aim of this article is to describe the prevalence of HPV infection, the incidence and the mortality rates for cervical cancer and adherence to screening programs in Apulia in the light of recent introduction of anti-HPV vaccines. The prevalence of HPV was evaluated testing biological samples from 1082 women. The 33% resulted positive for HPV (80% for high-risk genotypes and 20% for low-risk genotypes). The 59% of positive samples showed only a single viral type while 37% multiple genotypes. In Apulia, from 1998 to 2005, a total of 1849 women were hospitalized for cervical cancer with a decreasing trend; the 46% had exo cervical cancer; the 22% endocervical cancer, 29% cancer of cervix without specification and 3% infiltrating cervical cancer. The mortality rate was 1,5 x 100.000. Data from PASSI study regarding cervical cancer screening showed that 62% of Apulian women 25-64 years aged had a Pap smear and 54.7% get it every three years. The viral genotypes circulating in Apulia region are present in anti-HPV vaccines; this item could give information on their introduction together with actions to implement the adherence to screening program that results lower than international standard.

Large outbreak of viral gastroenteritis caused by contaminated drinking water in Apulia, Italy, May-October 2006

At the end of July 2006, an unusually high number of patients with acute diarrhoea were reported by the accident and emergency departments in Taranto, Apulia. Subsequently, a field investigation was conducted jointly by the Apulia Regional Epidemiological Observatory and the Regional Reference Laboratory in Bari, and the Epidemiological Department of Taranto Local Health Unit.

An outbreak of measles in Apulia, Italy, November 2006-January 2007

Between 19 November 2006 and 9 January 2007, an outbreak of measles with 18 cases was reported in the region of Apulia in south-eastern Italy.

[Obesity and lifestyles among teenagers in Apulia. Survey run by a team of general practitioners]

Obesity represents one of the most worrying public health concern of the last decades. The objective of the present work was to find out more about the real risky habits of teenagers, in order to think of specific educational programs. The research sample was composed of 721 respondents (aged 11-13 years old) attending the primary schools located in Martina Franca (TA). More than 70% of the sample was formed by normal weight individuals, 24.5% was composed of overweight individuals, 5.5% were obese. The relevant differences existing between normal weight and overweight individuals are basically due to the different daily meals organization and to the specific vegetable consumption habits. More than 83% of normal weight individuals have breakfast in the morning, while among the overweight only 75% do it (OR = 0.6; 95% IC: 0.4-0.9; p < 0.01); more than 94% of normal weight kids have snack breaks between the main meals, while only 82% of overweight respondents are used to do it (OR = 0.2; 95% IC: 0.15-0.43; p < 0.01). 36% of the overweight eat vegetables everyday, among the normal weight 45% eat them (chi2 = 12.5, p < 0.05). No relevant differences in the extra school time management. The main outcome of the present study is that kids basically follow a common eating behavior: high carbohydrates and proteins consumption, low fruit and vegetables consumption, few time spent in physical activities. This is why it is strongly recommended to develop educational programs targeted to individuals in this age range.

Cryoglobulinemia in subjects with HCV infection alone, HIV infection and HCV/HIV coinfection

OBJECTIVES

To assess the prevalence of cryoglobulinemia in three groups of patients: HCV-positive/HIV-negative, HCV/HIV co-infected and HIV mono-infected.

METHODS

From September 2002 to December 2003, 58 patients with documented HCV infection, 70 subjects with HIV/HCV co-infection, and 48 subjects with HIV infection alone were enrolled. Serum samples were tested for detectable cryoglobulins, liver enzymes, HCV viral load and HCV genotypes. Plasma HIV-RNA levels and CD4+ cell count were also evaluated in HIV-positive subjects.

RESULTS

Cryoglobulinemia was detected in 24.1% HCV mono-infected, 14.2% HCV/HIV co-infected and 6% HIV mono-infected patients. A significant statistical correlation was found between the presence of cryoglobulins and HCV infection (P = 0.03), while cryoglobulins were unrelated to HIV mono-infection (P = 0.16) and HCV/HIV co-infection (P=0.7). No significant correlation was observed between the presence of cryoglobulinemia and alanine transaminase (ALT) levels, HCV viremia and duration of HCV infection. Circulating cryoglobulins in HIV patients were not correlated with plasma HIV viral load, CD4+ cell count or duration of HIV infection. Only two HCV mono-infected patients complained of arthralgia.

CONCLUSION

A similar rate of cryoglobulinemia prevalence was detected in the patient groups with an HCV-related infection. HIV infection does not appear to play a significant role in cryoglobulin production.

Access to HAART in HIV-infected immigrants: a retrospective multicenter Italian study

Since 1996, AIDS has declined in the Italian population, but cases in foreign patients, including both recent immigrants and long-term residents, have increased from 3.9% in 1995-1996 to 15.4% in 2001-2002. This increase can only be partly explained by a higher migratory flow and might reflect a delayed access to health facilities and to antiretroviral therapy in migrants. We performed a survey for the year 2003 of HIV-infected immigrants to Italy from countries outside the European Union to verify which factors might influence a lack of access to highly active antiretroviral therapy (HAART). Italian centers of infectious diseases were requested to send sociodemographic and clinical data of HIV-infected immigrant patients. A total of 553 HIV-infected immigrants (49.9% women) were evaluated, representing 6.5% of all HIV-infected patients from these centers. The mean duration of residency in Italy was 6.6 +/- 5.0 years. The country of origin was Africa (64.5%), North and South America (24.2%), Eastern Europe (7.0%), and Asia (3.8%). A total of 407 of 553 patients (73.6%) were taking antiretroviral drugs at the time of screening. Females presented a younger age (p = 0.001), a lower frequency of Centers for Disease Control (CDC) stage B/C (p = 0.008) and a more frequent heterosexual exposure to HIV (p < 0.001), while no differences were observed for time of first positive serology (p = 0.7). CD4 cell count (p = 0.9) and log plasma HIV-RNA (p = 0.1). Characteristics of HAART patients were compared to those of nontreated patients, despite a CD4 cell count less than 350 cells/mm(3). No significant difference was found for gender, country of origin, risk factor, and years of Italian residence, while legal immigrants (p = 0.018) and registered in the National Health Service (p = 0.014) were significantly more likely to receive HAART compared to illegal immigrants.

Determinants of acquiring hepatitis A virus disease in a large Italian region in endemic and epidemic periods

Viral hepatitis A is endemic in Puglia region (southeast Italy). Over the last 13 years, annual incidence rates have ranged from 4 to 138 per 100,000 inhabitants and periodical regional epidemics have been described. Between 1 January 1996 and 31 December 1997 over 11,000 cases of hepatitis A were reported accounting for an annual incidence rate over 130/100,000. To identify exposures during the epidemics, a case-control study was performed in two different rounds and since 1997, an enhanced surveillance system has permitted the monitoring of exposures of subsequent cases. Raw seafood consumption was identified as the major risk factor for hepatitis A. Adjusted odds ratio and 95% confidence intervals for this exposure from the first round of the case-control study was 38.6 (12.2-122.4) and for the second round for consumption of raw mussels it was 30.7 (16.0-52.0). Hepatitis A epidemiology in Puglia is consistent with an endemic situation sustained by locally contaminated seafood consumed raw and by the recurrence of large epidemics, where size is influenced by the accumulation of susceptible subjects in the population.

Surveillance of influenza in Apulia, Italy, 1999-2000, 2000-2001, 2001-2002, and 2002-2003 seasons

BACKGROUND

The objective of this study was to evaluate, within the Italian National Influenza Epidemiological and Virological Surveillance, the rate of vaccination coverage, the incidence of Influenza Like-Illness (ILI), the incidence of Acute Respiratory Illness (ARI), and to identify the virus strains circulating in Apulia from 1999 to 2003.

METHODS

Vaccination coverage rates were calculated based on the number of doses administered to individuals > 65 years of age. Every week, sentinel physicians reported ILI and ARI cases having occurred among their patients. Voluntary general practitioners (GPs) and paediatricians (Ps) collected oropharyngeal swab samples from patients suspected with ILI. Influenza viruses were isolated and identified by cell culture (MDCK cells) and RT-PCR. Virological surveillance was carried out by the ISS, in collaboration with a network of peripheral laboratories.

RESULTS

In Apulia, vaccination coverage progressively increased to 68.6% during the 2002-2003 season. The analysis of ILI cases showed higher incidence rates during the 1999-2000 and 2002-2003 seasons. ARI rates appeared to have a more constant trend. ILI and ARI incidence rates were higher in the 0-14 year age group.

CONCLUSION

The increase in vaccination coverage rates and implementation of the network of clinical, and epidemiological and virological surveillance are fundamental for the control and prevention of influenza.

[Opinions of women regarding a planned home birth project in Apulia (Southern Italy)]

A growing desire among women to move away from interventions and hospitals to more "natural" childbirth has emerged over several years. The role and autonomy of midwives, a favourable opinion among women about home childbirth and better cooperation between hospitals and district health facilities are all fundamental in order to implement a home birth project. The opinion of women about "planned" home birth was investigated in the Puglia region through a survey conducted among a sample of women who had just delivered in hospital and a representative sample of the general female population. From 20 to 30% of women in the Puglia region would be basically in favour of home birth project. The main difference between the two groups of women concern the higher proportion of caesarean deliveries among mothers who had just delivered and their demand for more specific training of involved health personnel. Both samples are agreed on the specific training of women during pregnancy and on the presence of a specialist during home delivery. The results of the investigation seem to be in favour of planning a home birth project in the Puglia region.

[General practitioners and mandatory surveillance of communicable diseases: a descriptive study in Puglia (South Italy)]

Public health passive surveillance systems are often affected by low sensitivity level. Enhancement of the reporting by general practitioners is important to improve the sensitivity of notification system. The aim of this work was to evaluate the mandatory notification activities of communicable diseases by general practitioners (GPs) and family pediatricians (FPs) in the Local Health Unit Bari/4, during the years 1999-2000. This study shows that GPs and FPs notified only 39% and 28% of notifiable diseases respectively in 1999 and 2000, although some of these diseases have a very low hospitalization rate. The majority of doctors never notified any case of infectious disease during the period. The study shows also that the doctors who was older and who had larger list of patients had a greater compliance regarding notification. Therefore, a specific training of family doctors and a better facility in the notification procedures (for example, by phone or e-mail) should be very important to improve the sensitivity of surveillance system.

Safety of cisplatin after severe hypersensitivity reactions to carboplatin in patients with recurrent ovarian carcinoma

BACKGROUND

Carboplatin is a milestone drug against ovarian carcinoma; it is used both in front-line and second-line chemotherapy. Hypersensitivity reactions to carboplatin may occur during the treatment as salvage therapy. The purpose of this study was to describe the feasibility of the replacing of carboplatin with cisplatin in patients presenting with severe hypersensitivity reactions to carboplatin.

PATIENTS AND METHODS

Ten consecutive patients with platinum-sensitive, recurrent ovarian carcinoma, presenting with moderate/severe hypersensitivity reactions to carboplatin were treated with cisplatin 60 mg/m2 from January 2000 to December 2002. Hypersensitivity reactions consisted of respiratory distress (chest tightness, wheezing, dyspnea), urticaria/erythema with tachycardia, facial swelling and hypotension.

RESULTS

The total number of cisplatin cycles given was 44 (range 2-5). The treatment with cisplatin was generally well tolerated. No serious allergic reactions occurred. A mild allergic reaction was recorded (urticaria) in only one case, after one cycle of cisplatin, and the patient was not rechallenged because of progressive disease. No reductions of chemotherapy doses were needed.

CONCLUSION

To date, platinum-based regimens remain the most effective treatment in recurrent platinum-sensitive ovarian cancer with a high rate of objective responses. Although our experience is limited, we suggest that, under anesthesiologic surveillance and providing immunologic blockade, the replacement of carboplatin salvage therapy with cisplatin can be considered a safe therapeutic strategy in patients who cannot continue carboplatin due to allergic reactions.

[Evaluation of the Surveillance System of Acute Flaccid Paralysis in Puglia: 5 years of work]

Surveillance of acute flaccid paralysis (AFP) is the milestone to monitor the progress toward poliomyelitis eradication aim, fixed by WHA in 1988. Active AFP surveillance started in Apulia in 1997; this work evaluates five-year period activities. In this period, the total number of cases notified was 48, 7 of which were resident out of Apulia. Twenty-five were males and 23 females; the age ranged between 1 month and 15 years. Any collected serum specimens showed protective antibody levels against polioviruses. Polioviruses type 1 and type 2 Sabin-like were isolated from stool samples collected from two AFP patients. AFP surveillance targets improved in the years, with only exception, in 2001, of second serum specimen collected within 14 days because of children were discharged earlier form the hospitals. Apulia experience demonstrates the achievement of good levels of AFP surveillance targets. System sensitivity has been optimal in 2001 with a number of notified cases threefold the expected value and adequate specimen sampling (80%). Additional involved hospitals and availability of increased and dedicated human resources contributed to this outcome. The effort to achieve WHO targets for AFP surveillance needs to be maintained in next years until global certification of eradication will be declared.

[Comparative evaluation of 2 epidemiologic surveillance systems of hepatitis A]

Epidemiological surveillance represents an important tool for the prevention of hepatitis A. In Italy, the surveillance of hepatitis A is based on the routine notification system of infectious diseases (from 1996 it was replaced by SIMI, Computerised System of Infectious Diseases) and on SEIEVA (Epidemiological Integrated System of Acute Viral Hepatitis). From 1997 to 2000 the two surveillance systems have been compared in Puglia region to evaluate match rate, completeness and sensitivity. A total of 7.018 records from SIMI and 4.413 from SEIEVA have been analyzed. During this period, the 37.0% of cases notified to SIMI match SEIEVA records whereas the 58.8% of cases reported to SEIEVA match cases notified to SIMI. Therefore, the match rate between the two systems was 29.0%. The sensitivity of SIMI and SEIEVA resulted 79.4% and 49.9% respectively. The comparison of the two surveillance systems allowed to recognise problems in local organisation. Therefore, a more adequate training should be supplied to workers involved in the surveillance activities.