Knowledge, attitudes and adherence towards influenza and other vaccinations among healthcare workers at the University Hospital of Palermo, Italy, during the first COVID-19 pandemic season (2020/2021)

Background

Increasing adherence to influenza vaccination among healthcare workers is a public health priority, stated that actually remains far below than international recommendations. During the 2020/2021 pandemic season, COVID-19 vaccines were not yet available until the end of December 2020, and influenza vaccines were the only one available to protect against seasonal respiratory diseases. The main objective of the present study was to assess knowledge, attitudes and adherence to influenza and other vaccinations recommended by the National Immunization Plan 2017-2021 for healthcare workers.

Methods

Enrollment lasted from October and December 2020 at the vaccination unit of the University Hospital of Palermo. Data were collected through an anonymous and self-administered questionnaire, divided into 5 sections and 31 items.

Results

Among 734 healthcare professionals that completed the survey, a significantly higher adherence to influenza vaccination was observed among healthcare workers that were more prone to receive COVID-19 vaccination (OR=4.02; 95% CI: 1.63-9.91). Moreover, higher influenza vaccination rates were observed among healthcare professionals that received influenza vaccination during previous 2019/2020 season (OR=15.3; 95% CI: 5.17-45.1) and that were favorable to the possible impact on increasing adherence of influenza mandatory vaccination (OR=4.88; 95% CI: 2.43-9.80).

Conclusions

Propensity of healthcare workers to undergo vaccinations recommended in the National Immunization Plan increased during the first pandemic season. At the end of the vaccination season, flu vaccination coverage reached highest rates ever at the University Hospital of Palermo (around 60%), remaining anyway below the recommended minimum value of 75%. During next seasonal flu vaccination campaigns, it becomes essential to promote communication and information strategies to increase flu vaccination among healthcare workers, also focusing on co-administration with the anti-COVID-19 booster/seasonal doses.

A cross-sectional study on smartphone uses among pregnant women attending childbirth classes in the Metropolitan Area of Palermo, Italy: The Stop-Phone study

Background

Prevalence of mobile device addiction has increased over the years; both women and men have assimilated the mobile phone as a central component of their personal existence: integrating it into their lifestyle or becoming so dependent on it that life without it has become unimaginable. Smartphones generate radio-frequency electromagnetic fields. While short-term exposure in adults was considered quite safe, effects of long-term exposure or exposure during pregnancy on fetuses or during breastfeeding on newborns are not well studied yet. The objective of the present study was to investigate the prevalence and usage characteristics of smartphones among a sample of pregnant women, and promote the correct and conscious use of the smartphone.

Methods

A cross-sectional study was conducted, with a questionnaire administered during childbirth classes and - after the questionnaire administration - an educational intervention focused on promoting the correct and conscious use of smartphones was carried out by psychologists and psychotherapists.

Results

The findings of our study suggest that a significant number of the participants suffered addiction to mobile phone usage, but were not aware of it. More than two third of the sample (67.2%) have not changed their smartphone use habits since the beginning of their pregnancy and even more significant data shows that almost all future moms (98.3%) never speak with their doctor about smartphone use during pregnancy.

Conclusions

Data collected suggest a lack of attention to the proposed topic, especially in relation to pregnancy. It seems necessary to sensitize future mothers on this topic. The promotion of a more conscious and controlled use of electronic devices can help reduce the radiation to which the unborn child may be exposed, but has a fundamental role even after birth, to ensure an adequate psychomotor and relational development of the child and do not affect, due to uncontrolled use of smartphones, the mother-child relationship.

Safety of in-neonatal intensive care unit administration of rotavirus vaccination among preterms

Background

Rotavirus is among the most common vaccine preventable illness in children under 5 years old. Despite increased severity of rotaviral illness in early infancy, most neonatal intensive care units (NICUs) do not administer rotavirus vaccination. The present project aims to evaluate the safety of in-neonatal intenive care unit administration of the monovalent live, attenuated rotavirus vaccination to preterm newborns in Sicily.

Methods

From the first of March 2018 within the six most important NICUs of Sicily (three located in Palermo, two in Catania and one in Messina), and under the scientific coordination of the University of Palermo and of the Regional Health Department, rotavirus vaccination was administered to preterm newborns with gestational age ≥28 weeks. Vaccine administrations were performed both under hospital and outpatient settings, from 6 weeks of age and in accordance with the Sicilian Vaccination Schedule.

Results

At the end of December 2019, 449 preterm newborns were fully vaccinated (two dose completion) against rotavirus in the six Sicilian NICUs participating to the project. Average gestational age was 31.4 (SD ± 2.7) weeks. First dose of rotavirus vaccination was administered at 6.3 (SD ± 0.6) weeks. Average weight at first dose were 2.890 (SD ± 0.456) grams. Only 8% and 2% of vaccinated newborns reported abdominal colic and fever >38.5 °C in the 15 days after first dose, respectively. No one expected adverse event was observed in the 30 days after vaccination.

Conclusions

First data obtained from this study confirms the absolute safety of monovalent rotavirus vaccination also in preterm newborns with gestational age ≥28 weeks. Results could represent for public health physicians and for neonatologists a key tool for standardize rotavirus vaccination in very Italian NICU.

Key messages

Rotavirus vaccination is extremely safe in preterm newborns with gestational age ≥28 weeks. Rotavirus vaccination should be routinely implemented in Italian and European NICUs.

Systematic review and meta-analysis of determinants associated with HPV vaccination uptake in Europe

Background

Human papillomavirus (HPV) vaccines are the most important strategy to prevent HPV-related cancers and benign lesions. However, low immunization levels observed in several countries requires a deeper analysis of determinants associated with HPV vaccination uptake. Aim of the research is to identify the main determinants associated with HPV vaccination uptake among European adolescents, through a systematic literature review and meta-analysis.

Methods

The research was conducted on electronic databases including PubMed/MEDLINE and SCOPUS, identifying 1147 studies. Original articles published between 2000 and 2018 were retrieved, with restriction criteria applied to the European region and to the English language. Qualitative and quantitative studies describing the positive and negative determinants underlying vaccination uptake were analyzed. Adjusted and Crude Odds Ratios and their Confidence Intervals were extracted and included in the meta-analysis.

Results

After screening and eligibility processes, 28 articles were included in the meta-analysis. HPV vaccination uptake is significantly associated with correct information given by health-care workers, educational interventions organized at school about HPV and a gynecologist visits. Receiving information from parents and/or friends and a lack of information about HPV are significantly associated with lower vaccination adherence. Moreover, low socio-economic status and religious conviction represent additional barriers to HPV vaccination adherence.

Conclusions

One of the main future challenge for public health authorities will be the increase of HPV vaccination coverage rates. To reach this objective should be necessary to provide an unambiguous communication to general population and to promote educational interventions in the school setting. by all HCWs that play a key role in HPV vaccination recommendation (public health physicians, gynecologists, general practitioners, pediatricians).

Key messages

Health-care professionals play a key role in HPV vaccine recommendation, contributing to vaccination acceptance. Tailored and standardized educational intervention in school settings could improve knowledge and beliefs on HPV vaccines, improving adolescents and parents confidence towards vaccination.

Pre-post school educational intervention assessment on HPV vaccination attitudes and willingness

Background

In Italy, vaccination coverage against human Papilloma Virus (HPV) showed a decreasing trend during last years. Different reasons could lead to a decrease in HPV vaccination confidence, such as not taking part to school seminars on HPV infection and vaccination. A pre-post intervention study was conducted in order to assess the improvement of knowledge, attitudes and behavior on HPV-related diseases and willingness on HPV vaccination among secondary school students.

Methods

Two anonymous pre-post intervention questionnaires made up of 25 and 8 items, respectively, were administered to a representative sample of students attending secondary schools of Palermo, Italy. Between the two questionnaire administration, an educational intervention on HPV-related diseases and HPV vaccination, conducted by Public Health medical residents at the University of Palermo, was carried out.

Results

During 2017/2018 and 2018/2019 school years, a sample of 1702 students, attending 18 first-grade secondary schools of the Province of Palermo, was enrolled. Evaluating a 10-scale likert question on the willingness of the children regarding vaccination against HPV, a significant increase of the average score from 8.50 (SD ± 1.79) to 9.01 (SD ± 1.50) (p value <0.001) was observed after intervention. At the multivariate analysis, male students (adjOR 1.76; 95% CI 1.28-2.42) and students attending schools in areas with a high deprivation index (adjOR 1.25; CI 95 % 1.01-1.55), showed a lower increase in HPV vaccination willingness after the educational intervention. In addition, 188 children from 5 schools of more deprived areas, not yet immunized, were vaccinated against HPV.

Conclusions

Standardized educational interventions in the school environment could increase confidence towards HPV and other vaccinations among students. Furthermore, vaccination offer at schools could represent a fundamental strategy to increase vaccination coverage, especially in more deprived areas.

Key messages

The research confirms the effectiveness of school educational interventions in increasing HPV vaccination confidence. Vaccination offer at schools could represent a fundamental strategy to increase vaccination coverage especially in more deprived areas.

Misuse and addiction to mobile phone in a sample of first-grade secondary school students of Palermo

Background

Nowadays, smartphone overuse affects massively teenagers and young adults. From 2014 to 2018 in Italy, for the 11-17 years age group, there has been an increase from 79.9% to 85.8% of daily mobile phone users. This project aims to investigate usage prevalence and misuse/addiction of mobile phones in a representative sample of first-grade secondary school students of the Province of Palermo, Italy, carrying out educational interventions to promote a proper and conscious use of smartphone.

Materials and Methods

An anonymous, standardized and previously validated pre-intervention questionnaire consisting of 39 items on general socio-demographic characteristics, attitudes and habits regarding smartphone usage, was administered online to 10-15 years old students of the Palermo's Province. Moreover, two additional sets of 11 and 15 items contributed to calculate a Misuse and an Addiction Score, respectively. After administration, educational interventions aimed at promoting the correct and conscious use of the smartphone, were carried out.

Results

A total of 1600 students belonging to 16 schools, responded to the questionnaire. 93% of the sample had a personal smartphone and 84% had a personal profile on at least one social network. About 15% of the sample experienced cyber bullying episodes and 30% accessed to adult content online (38% of parents didn't set parental control on the devices). Overall, 78.3% of the sample showed a moderate to severe misuse and 38.3% a moderate to severe addiction to mobile phones.

Conclusions

The uncontrolled and unconscious use of smartphones among adolescents exposes to different health risks including psycho-social and cognitive-relational problems. Results obtained demonstrate high levels of misuse and addiction to mobile devices in a representative sample of students in a developed Country, suggesting the need to implement educational interventions and the development of guidelines to encourage a responsible use of smartphones.

Key messages

The present study highlights an uncontrolled and unconscious use of mobile phones among 11-15 years old aged students in Southern Italy. The implementation of educational intervention at school and the development of guidelines regulating smartphone usage among adolescents, should represent a future global health priority.

Transforming waiting pauses into opportunity for physical activity: the “Activate your Wait” project

Physical activity is recognised as a major health determinant, with positive effects on health, environmental sustainability and economy. However, worldwide, 1 in 4 adults, and 3 in 4 adolescents do not currently meet the recommendations for physical activity set by the World Health Organization. Notably, the prevalence of inactivity varies considerably within and between countries, and can be as high as 80% in some adult subpopulations. From the urgent need to implement strategies to fight sedentary behaviour, and considering that physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure, the project “Activate your Wait” was born. The project aim is to transform the waiting pauses during everyday life into opportunities to perform simple stretching and active mobilization exercises. The pilot study was carried out in September 2019 at the Terme S. Egidio, Suio Terme Castelforte (Italy). It was divided in three phases: in the pre-intervention phase a questionnaire evaluated the interest in the project (96 responders); during the intervention phase, lasting three days, examples of simple exercises that people can do by themselves were illustrated and undertaken by about 120 participants; in the post-intervention an evaluation questionnaire was administered (71 responders). The intervention aroused great participation and high approval (97%), and resulted in an increase both in willingness to perform exercises during daily waiting breaks (68% vs 94%) and belief in positive results of physical activity on health (74% vs 96%). In a context where the opportunities for physical activity are decreasing and a sedentary lifestyle has reached a high level, this project represents a contribution to the increase in the awareness of the importance of physical activity and the promotion of the culture of movement in the entire population, with an opportunity of easy accessibility in different contexts of life, at all ages.

Key messages

Physical activity is a major determinant of health, therefore it is fundamental to take all possible opportunities to be active. Waiting pauses are the perfect chance to exercise.

The role of the Community Pharmacist in promoting vaccinations among general population according to the National Vaccination Plan 2017-2019: results from a survey in Sicily, Italy

INTRODUCTION

The 2017-2019 Italian National Vaccination Plan promotes the improvement of knowledge and attitudes of healthcare workers about vaccine prevention, in order to spread a vaccination culture among general population. Similarly to the General Practitioner, the Pharmacist represents a fundamental forefront for both patients and healthy people, also in promoting vaccine acceptance. This research aims to analyze knowledge and attitudes about vaccines of Community Pharmacists and to evaluate the burden of vaccination counselling during their work activities.

MATERIAL AND METHODS

A standardized, self-administered and previously validated questionnaire, including 5 sections and 28 items, was submitted to a sample of Community Pharmacists working in Western Sicily. The survey was carried out through an online questionnaire, that investigated socio-demographic data, knowledge and attitudes towards vaccination and the role of the Pharmacist as vaccination counselor during his work.

RESULTS

A total of 120 Pharmacists were surveyed. 99.2% of them were definitely agreed with the Regional Vaccination Schedule. A large majority (n = 114, or 95%) were fully vaccinated and have vaccinated, or would vaccinate in future, their children. According to Community Pharmacists interviewed, at least 90% of clients asked for further explanations about vaccination, and the citizens' trust towards vaccination increased (30%) or remained stable (54.2%) over time in the last 5 years. Finally, as reported by interviewed Pharmacists, a correct counselling provided by General Practitioners (GPs) and Family Pediatricians was the main boost in increasing vaccination confidence, instead of mass-media and web misinformation that has led to skepticisms among general population.

CONCLUSION

The study demonstrated the key role of the Community Pharmacist for their consumers in vaccination counselling. In future, a strong collaboration between Community Pharmacists and all the actors promoting vaccination themes (GPs, family Pediatricians, public health workers) will be essential, as well as a uniform and standardized University training on vaccination themes for all these categories.

Effectiveness of an educational intervention on seasonal influenza vaccination campaign adherence among healthcare workers of the Palermo University Hospital, Italy

INTRODUCTION

Healthcare workers are continuously exposed to the risk of being infected by influenza viruses during their work, thus representing a threat especially for fragile patients. Although the Italian Ministry of Health strongly recommends influenza vaccination for all HCWs, coverage levels in Italy are still far from the expected. Several studies report that one of the preferred strategies to improve vaccination coverage among Healthcare Workers is improving vaccination knowledge through specific multidisciplinary courses. To assess the effectiveness of an educational intervention on influenza vaccination coverage among Healthcare Workers a study was conducted at "Paolo Giaccone" University Hospital of Palermo, in the occasion of the 2016/2017 seasonal influenza vaccination campaign.

MATERIAL AND METHODS

Educational interventions on influenza infection and vaccination were organized involving personnel of the hospital units in which patients were more fragile. The Healthcare Workers who volunteered attend the course were considered as the intervention group, while two controls for each case, composed by Healthcare Workers not attending it, were randomly selected from the same unit. For both groups, a questionnaire was used to investigate attitude and behaviors toward influenza vaccination, while vaccination coverage data were obtained throughout the Hospital informational data system.

RESULTS

Overall, out of the 125 participants, 38 (30.4%) followed the course (intervention group) and 87 (69.6%), not attending the course, represented the control group; later, only 43 Healthcare Workers out of 125 (34.4%) underwent vaccination during the season considered. In particular, after the educational intervention, 42% of the attending Healthcare Workers got vaccinated, while vaccination prevalence in the control group was 31%. The Healthcare Workers who underwent vaccination reported, before the intervention, a higher risk perception for contracting (transmitting) influenza compared to those not vaccinated (p<0.05), while no significant difference in risk perception of transmitting influenza to their patients was reported between the two groups.

DISCUSSION

Despite the training provided, and an improvement in vaccination adherence by the Healthcare Workers involved, coverage obtained was lower than recommended to reduce influenza spread in hospital contexts. In conclusion, our data suggest that specific training alone may play a role in the improvement of influenza vaccination adherence, but it should be integrated by a wider range of public health measures, including mandatory vaccination.

Circulating IL-8 levels are increased in patients with type 2 diabetes and associated with worse inflammatory and cardiometabolic profile

AIMS

Interleukin-8 (IL-8) is a chemokine involved in systemic immunity, macrophages infiltration and activation in adipose tissue and may play a significant role in the pathogenesis of type 2 diabetes (T2D) and atherosclerosis. Aims of this study were to evaluate circulating IL-8 levels in adult patients with T2D in comparison with non-diabetic subjects and to describe clinical and biochemical correlates of IL-8 concentration.

METHODS

For this cross-sectional study, we enrolled 79 consecutive T2D individuals referring to our diabetes outpatient clinics at Sapienza University of Rome, and 37 sex, age and BMI comparable non-diabetic subjects as a control group. Clinical parameters and medical history were recorded; fasting blood sampling was performed for biochemistry and for measuring serum IL-8, IL-6, TNF-α, CRP, adiponectin and 25(OH)vitamin D [25(OH)D] levels.

RESULTS

Patients with T2D exhibited significantly higher serum IL-8 levels than non-diabetic subjects (69.27 ± 112.83 vs. 16.03 ± 24.27 pg/mL, p < 0.001). In diabetic patients, increased IL-8 concentration correlated with higher IL-6 (p < 0.001), TNF-α (p = 0.02), FBG (p = 0.035), HbA1c (p = 0.04) and LDL-C (p = 0.04) and with lower adiponectin (p = 0.02) and 25(OH)D (p = 0.003) concentrations.

CONCLUSIONS

Patients with T2D display a marked elevation of circulating IL-8 levels which identify subjects with worse inflammatory, glycometabolic and lipid profile and lower vitamin D levels. Further studies are warranted for evaluating a possible role of IL-8 as a novel marker for risk stratification in T2D patients.

Knowledge and training needs on built environment and indoor health of Italian public health residents: a national survey

INTRODUCTION

The Working Group for Hygiene of Built Environment and the National Council of Residents of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a nation-wide survey to evaluate the knowledge and training needs on Built Environment and Indoor Health of Italian public health residents.

RESULTS

The compliance was very high (52,4%), covering the totality of Italian postgraduate schools. The results underline a severe lack of theoretical formation and practical training, but also diffuse discrepancies across the country, and show a strong interest of residents on this topic.

CONCLUSIONS

The authors propose to adopt a national core curriculum, and suggest some strategies to improve learning.

Improvement in vaccination knowledge among health students following an integrated extra curricular intervention, an explorative study in the University of Palermo

INTRODUCTION

Vaccination coverages threaten to decrease because of false beliefs in their unsafety and inefficacy. Therefore formation of future health-care workers on this topic is fundamental to deal with any doubt and to promote active immunization among general population.

METHODS

In order to assess health-care students' knowledge about vaccination before an integrated seminar on this topic, and to evaluate their improvement after the educational intervention, an integrated educational intervention was held by a multidisciplinary team. Before and after the seminar, 118 students of medicine and biology schools at Palermo University were asked to answer 10 multiple-choice questions regarding vaccine history, mechanism of action, side effects, composition, use and nowadays issues (hesitancy). Two more questions investigating possible changes on students' attitudes towards vaccination and the usefulness of the formative intervention, were added at the post-test phase of the survey.

RESULTS

Eighty-one out of 118 students (68.6%) answered to both pre- and post-test questions. 97.6% and 81.5% of the participating group also completed the two additional questions about their improvement in knowledge (question 11) and attitudes (question 12) towards vaccinations. The post-test results showed a significant improvement for all questions administered, except for number 3 (about a specific immunological content), with an overall percentage of correct answers increasing from 38.8% to 77.6% (p©< 0.001).

CONCLUSIONS

The present explorative study put the basis for future studies, stronger in the methodology, and highlights the importance of educating health-care professions students by integrated extra-curricular intervention to be held early in their degree curricula and in order to improve knowledge and attitudes towards vaccinations and to prepare them to promote vaccines among the general population.

Influenza vaccination in high-risk groups: a revision of existing guidelines and rationale for an evidence-based preventive strategy

Influenza, an infectious respiratory disease, is one of the main causes of excess winter deaths (EWDs) in Europe. Annual flu epidemics are associated with high morbidity and mortality rates, especially among the elderly, those with underlying health conditions and pregnant women. Health Care Workers (HCWs) are also considered at high risk of both contracting influenza and spreading the virus to vulnerable patients. During the 2014/2015 season, the excess winter mortality rates observed in countries of the northern hemisphere (EuroMOMO network) and in Italy (+13%) were strongly related to the intensity of influenza circulation. Influenza vaccination is the most important public health intervention to prevent seasonal influenza transmission and infection. However, to date, influenza vaccination coverage reported in Europe (including high-risk groups) is still largely unsatisfactory. This study analyzes some international and European guidelines on influenza vaccination and the rationale that underlies evidence- based public health intervention for the prevention of influenza among the principal high-risk groups: a) the elderly (subjects aged 65 years or older); b) subjects with underlying health conditions; c) pregnant women; d) healthcare workers. Only by achievement recommended influenza vaccination coverage among high-risk groups in all European countries can we reduce the burden of disease.

Prevention and treatment of nephrolithiasis: a review on the role of spa therapy

The prevalence and incidence of nephrolithiasis is reported to be increasing across the world. It is a disease of increased urinary concentration of stone-forming salts. The physicochemical mechanism of stone formation includes precipitation, homogenous/heterogeneous nucleation, growth, aggregation and concretion of various modulators in urine. Necessary condition to develop stones is urinary supersaturation, due to reduced urinary volume or to an excesses solutes. Fluid intake is the main determinant of urine volume. Urine dilution can significantly decrease both the crystallization rate of the urinary salts and the aggregation of the crystals. A correct fluid intake can act on different effects: urinary tract washing, urinary volume increasing and dilution of solutes. In addition mineral waters have other particular features: greater diuretic effect, more important urinary dilution with solutes and microbial concentration reduction, urinary pH changes, superior washout effect due to mechanical effects and ureteral contractions. Adequate water intake is the most important conservative strategy in urolithiasis prevention; particularly hydropinotherapy with oligomineral water should be considered as an important instrument to prevent stones in subjects predisposed to the disease (family members of people suffering from kidney stones), to reduce relapses, and can help to eliminate residual fragments also after extracorporeal shock wave lithotripsy. It is recommended a management with increased mineral water intake to promote urine volume of at least 2.5L each day to prevent stone formation. Obviously water intake shall be varied in relation to the presence of contraindications or any diseases.

Education and training among Italian postgraduate medical schools in public health: a comparative analysis

BACKGROUND

The postgraduate medical Schools in Public Health (locally known as School of Hygiene and Preventive Medicine) should ensure adequate scientific and technical knowledge and professional skills in preventive medicine, health promotion and healthcare planning as provided by Ministerial Decree 285/2005. The Italian Committee of Medical Residents in Hygiene, Preventive Medicine and Public Health of the Italian Society of Hygiene, Public Health and Preventive Medicine - S.It.I. (Consulta Nazionale dei medici in formazione specialistica S.It.I.) has always been engaged in monitoring activities on public health teaching, guaranteeing the homogeneity of educational proposals among all national Schools in Public Health. The purpose of this study is to provide a 'snapshot' of public health education and training in Italy and to identify the improvement actions needed for implementing an innovative and homogeneous public health training.

METHODS

A cross-sectional study was carried out over a period of three months (March to May 2013). A self-administered questionnaire was e-mailed to local Committee's delegates of all 32 postgraduate medical Schools in Public Health in Italy. The questionnaire was structured in four sections: general information, University education and training, extra-University training, interdisciplinary activities. The majority of local Committee's delegates have agreed to be enrolled in the survey.

RESULTS

A total of 28 questionnaires were returned (88% response rate). The number of residents in each Italian School in Public Health ranged from 7 to 31. The distribution of professors in relation to residents is not similar for each University Schools. The ratio professors/residents spanning from 0.2 to 2. About teaching, only 4 University Schools offered all courses requested by Ministerial Decree 285/2005. Most of them offered at least 75% of the requested courses, but there were Schools in which the courses were less than 50%. The vast majority of schools held more than 60% of the qualifying activities considered essential according to the Decree, while 2 Schools were below 50%. All Schools required an internship of 6-12 months in local health authority offices (ASL), mainly concerning the Department of Prevention activities. In all Schools a period of stay in a Hospital Medical Direction was scheduled, while professional activities at Residential care homes were very rarely included in training programmes. Many Schools allowed residents to attend companies with biological hazard or to follow similar activities in dedicated services of ASL. Finally, in the majority of Schools, a training period in various local (Service for Water Control), regional (Departments) or national (Ministry, National Institute of Health) health facilities was contemplated and, in some cases, also in other Universities or Research Institutes.

CONCLUSIONS

Although the Ministerial Decree indicates the essential milestones of the public health education, flexibility is seen as an important element in order to optimize resources and contextualize the adequate education of residents. In any case, at least regarding public health courses, the majority of University education and extra-University training activities should be carried out by all Schools. In order to obtain shared knowledge and skills, the Ministerial Decree should be revised taking into account flexibility and changing as intrinsic characteristics of public health profession and learners should be involved in the reform to strengthening the role of public health teaching.

Whole body vibration in sport: a critical review

Whole body vibration training is a recent area of study in athletic conditioning, health and rehabilitation. This paper provides a review of the effectiveness of this type of training in sport. A search was conducted across several electronic databases and studies on effects of whole body vibration training on sport performance were reviewed. Thirteen articles were included in the final analysis. The following variables were considered: participants investigated (sex and age), characteristics of the vibration (frequency and amplitude), training (type of sport, exposure time and intensity, tests used, type of study, effects examined and results obtained). This review considers proposed neural mechanisms and identifies studies that have demonstrated the effectiveness of WBV in sports. It considers where WBV might act and suggests that vibration can be an effective training stimulus. Future studies should focus on evaluating the long-term effects of vibration training and identify optimum frequency and amplitude, improve strength and muscular performance.

Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs. A randomized controlled clinical study

BACKGROUND

Plantar fasciitis is one of the most common causes of pain in the inferior heel and is very frequent in some running sports. It affects up to 10% of general population and accounts for 11% to 15% of all foot pain symptomatology. Several treatments have been suggested, but there is no evidence supporting a specific conservative management strategy.

AIM

Evaluation of the efficacy of combined cryoultrasound therapy on chronic plantar fasciitis with heel spurs resistant to pharmacological and instrumental therapies.

DESIGN

Single-blind randomized clinical trial.

POPULATION

102 consecutive patients affected by chronic plantar fasciitis with painful symptomatology for at least 6 months, intensity of pain higher than 5 on the VAS score, presence of heel spurs, use of plantar orthoses and ineffectiveness of previous therapies.

METHODS

The patients were randomized into two groups: Group A treated with cryoultrasound therapy and Group B with cryotherapy. Our protocol was based on 10 daily treatments, lasting 20 minutes. Each participant was evaluated using VAS score before (T0) the treatment and 3 months (T1), 12 months (T2) and 18 months (T3) after. Effectiveness index was calculated from T1 to T3.

RESULTS

Both treatments have been found effective. The difference in pain intensity on the VAS scale between the two groups at T2 was 4.35 points in favor of Group A (IC 95% 3.75; 4.95; P<0.001), reaching the primary end point. The difference in pain intensity on the VAS scale between the two groups at T1, T2 and T3 was 3.00, 4.35 and 4.81 respectively, showing a statistically significant difference between VAS average scores at all follow-ups in favor of Group A. Scores of at least 66% at the effectiveness index were only achieved in Group A (P values <0.001).

CONCLUSION

Cryoultrasound therapy could be an efficient treatment option for chronic plantar fasciitis.

CLINICAL REHABILITATION IMPACT

Cryoultrasound therapy promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis, granted its high therapeutic efficiency, patients' satisfaction, its limited cost and its short and repeatable protocol of use.

Analysis of appeals against the ruling of occupational physicians lodged with the Prevention and Occupational Epidemiology Operative Unit, ASP Palermo (Palermo Health Authority), from 2008-2010

INTRODUCTION

The responsibility of the Department for Prevention and Safety at the workplace of the Palermo Health Authority (ASP) is to monitor and coordinate the activity of occupational physicians operating in Palermo and its province. One of its obligations is to examine appeals "against the judgment of occupational physicians", "..and, after carrying out further investigation, confirm, modify or reverse the ruling itself" (art. 41, par. 6, legislative Decree 81/08).

OBJECTIVES

The purpose of this study was to analyze the appeals lodged against a judgment of fitness for work" submitted to the "Health Prevention and Occupational Epidemiology Operative Unit" of the Department of Prevention and Safety at the Workplace of the ASP Palermo, from 2008 to 2010.

METHODS

The total number of appeals lodged during the three-year period was 211, 174 of which were finalized.

RESULTS

The most frequent job category among the appellants was that of blue-collar workers, in various sectors, covering 44.5% of the subjects under study (93 cases). In 64.2% of the processed appeals (131 cases), the judgment of the physician was modified, while in the remaining 36.8% (73 cases) it was confirmed. The work fitness judgment with restrictions was the category against which most appeals were lodged, and the diseases in question mostly concerned the osteoarticular and cardiovascular systems.

CONCLUSION

In a context of continuous change in the labour field and the related risks to the health and safety of workers, the occupational physician must approach the worker in a comprehensive manner, through an assessment of the possible health problems and the working environment in which he/she operates.

A proposal for an evidence-based model of the screening for the colorectal carcinoma in an Italian setting

INTRODUCTION

The aim of this paper is to improve the feasibility perception of policymakers, health care workers and target population about the cost-effectiveness of the implementation of colorectal screening as Public Health strategy.

METHODS

Retrospective study by application of a three-step model designed for a local setting in Sicily (Palermo and its Province) in order to distribute Fecal Occult Blood Tests (FOBTs), offer colonoscopy and surgery, by district allocation of pharmacies, public digestive endoscopic centres and oncologic and general surgery units. Mean adherence to consolidated colorectal screening programs in Italy was applied in order to evaluate the feasibility of an operative model in our area.

RESULTS

Applying the model to the target population (269,368 individuals of both sexes), it can be expected a mean percentage of 79% delivered invitation and a mean participation rate of 46.3% accounting for a total of 213,070 invited individuals and 98,651 participating in the first round of the program. Furthermore, considering the national mean of 6% positive FOBT, 82% of colonscopy adhesion and 7% CRC detection rate, it can be scheduled a burden for health care structures involved in the program accounting for 49,325 FOBTs, 2,338 colonscopies and 141 surgeries for each year.

DISCUSSION

This work demonstrates the feasibility of a colorectal screening project in our area, showing a sustainable impact for local health care involved structures. Furthermore, this program may be spread as an applicative model to other areas, adapting the project to the needs of the local setting in which the colorectal screening will be organized.

[Abolishing mandatory routine medical and laboratory examination of food handlers may have influenced the reporting trends of foodborne diseases? Frequency of notified foodborne illnesses in Southern Italy from 1996 to 2009]

The aim of this study is to compare notifications of foodborne diseases in Southern Italy, before and after abolishing mandatory medical and laboratory examination routine. Data were obtained from the National Epidemiological Report of Health Ministry, that includes the annual summaries of foodborne infectious illnesses notified in Italy. The average number of foodborne diseases per million inhabitants per year decreased after the abolishment of health card for all examined conditions. There was a statistically significant reduction in all Regions for Salmonellosis and in Basilicata, Calabria, Campania and Sicily for Brucellosis. Abolishing health card of food handlers workers did not increase trends of foodborne illnesses and foodborne epidemics in Southern Italy. Examined data confirm the substantial effectiveness of food handlers self-control and training as essentials instruments of Evidence Based Prevention.

Multidetector computed tomography arthrography of the shoulder: diagnostic accuracy and indications

BACKGROUND

The presence of subcutaneous implants, such as permanent defibrillators, is an absolute contraindication to the use of magnetic resonance imaging (MRI). Moreover, MRI is unadvisable in subjects with metallic hardware near the area of study, as artifacts generated by such materials distort image quality.

PURPOSE

To evaluate the diagnostic accuracy and indications of arthrography with multidetector computed tomography arthrography (arthro-MDCT) of the shoulder in patients with absolute or relative contraindications to MRI and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard.

MATERIAL AND METHODS

After intraarticular injection of iodixanol and volumetric acquisition, 70 shoulders in 70 patients (30 females, 40 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. The patients had arthralgia but no radiologically detected fractures. They could not be studied by MRI because of absolute contraindications (subcutaneous electronic implants), surgical metal implants, or claustrophobia. In 28 of the 70 patients who had had previous shoulder surgery, the arthro-CT examination was preceded by an MRI on the same day. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study.

RESULTS

In the 42 non-operated patients, the comparison between arthro-MDCT and arthroscopy showed sensitivity and specificity ranging between 87% and 100%. In the 28 operated shoulders, arthro-MDCT had an accuracy of 94% compared with 25% with MRI. Interobserver agreement was almost perfect (kappa=0.95) in the evaluation of all types of lesions, both on MDCT and MRI. When arthro-MDCT was compared with MRI in the postoperative patients by a McNemar test, a significant difference (P<0.05) was found between these two techniques.

CONCLUSION

Arthro-MDCT of the shoulder is a safe technique that provides accurate diagnosis in identifying chondral, fibrocartilaginous, and intraarticular ligamentous lesions in patients who cannot be evaluated by MRI, and in patients after surgery.

Cis-trans isomerization of polyunsaturated fatty acid residues in phospholipids catalyzed by thiyl radicals

Phospholipids containing trans-unsaturated fatty acid residues are the major products of the thiyl radical attack on L-alpha-phosphatidylcholine from soybean lecithin in homogeneous solution or in liposomes (LUVET). Thiyl radicals act as the catalyst for the cis-trans isomerization, and the number of catalytic cycles depends on the reaction conditions. The presence of approximately 0.2 mM oxygen does not influence the reaction outcome but accelerates the efficiency of cis-trans isomerization in homogeneous solution. Under these conditions, the PUFA peroxidation is found to be unimportant. A detailed study of the isomerization of methyl linoleate including product studies indicates the formation of a small amount of conjugated dienes that act as inhibitors. Indeed, all-trans-retinol substantially retarded the isomerization process.

[A new questionnaire for assessing the quality of life of patients with intermittent claudication]

BACKGROUND

Quality of life assessment is becoming increasingly relevant for evaluating the impact of disease and treatments and for deciding priorities when allocating resources. This is especially true in intermittent claudication where the goal of therapy is not the cure of the disease but rather to alleviate its symptoms and improve the patient's functional capabilities. At present, however, no generic scale fits all criteria for the ideal quality of life measuring in intermittent claudication.

METHODS

We developed a questionnaire aimed at evaluating the specific limitations encountered by claudicants in the physical activity and in the social and emotional functioning. The present study evaluated the questionnaire for validity, reliability, and sensitivity to change, attributes considered to be essential for a questionnaire to be useful.

RESULTS

In 30 patients with intermittent claudication, the scores of the four sections of the questionnaire significantly correlated with the scores of the corresponding sections of the Nottingham Health Profile. This indicates that the questionnaire is valid. For each of the four subscales, the intraclass correlation coefficient was > 0.75, thus showing a high test re-test reliability. Also the internal consistency is strong with alpha coefficient ranging from 0.79 to 0.89. Finally, the questionnaire was administered to 9 patients before and 4 weeks after percutaneous transluminal angioplasty for claudication. After the intervention, the improvement in walking performance paralleled the improvement in quality of life. This indicates that the questionnaire is sensitive to change.

CONCLUSIONS

Our questionnaire appears to be a valid and reliable quality of life measure in intermittent claudication.

[The treatment of pathologic calcification of shoulder tendons with E.D.T.A. bisodium salt by mesotherapy]

The Authors treated at the Physiotherapy Service of the Clinic Orthopedic in Parma, 31 patients affected by shoulder's calcific tendonpathie++ were treated with E.D.T.A. bisodium salt they were painful and showed functional restriction besides they all shared a crystal's hydroxyapatite deposition. It was considered the pain by the Scott-Huskisson analogous--visual scale and the radiographic variation of calcification. It was noticed that with minimum pharmacological doses satisfying therapeutical results were achieved. That was not only as far as pain was concerned (disappeared in 29 patients (93.5%), but it was also obtained a significant reduction (4 patients 13%) or in some cases the disappearing of calcifications (25 patients 80%).

Use of heterologous collagen: Our experience

– The use of bovine collagen cross-linked with glutaraldehyde microspheres is considered a good procedure in the treatment of incontinence caused by ISD. Its widespread use is due to the absence of toxicity, easiness of injection and lack of invasiveness. On the other hand its high cost and lack of long-term efficacy has to be considered. The authors report their preliminary experience in using collagen GAX to treat 5 women with ISD, 2 with recurrent SUI and 2 with vesico-vaginal fistulas. Although an unusual treatment for the latter, it could be considered as an alternative mini-invasive tool in these pathologies. The results were as follows: in the patients with ISD, 3 were cured (42.8%) and 2 improved (28.5%), while the 2 SUI patients remained the same (28.5%). Treatment of the vesico-vaginal fistulas was unsuccessful.

Revascularization after 3 hours of coronary arterial occlusion: effects on regional cardiac metabolic function and infarct size

Two experimental series of closed chest dogs were compared: Group A (five dogs with 7 days of continuous occlusion of the proximal left anterior descending coronary artery); and Group B (six dogs with 7 days of reperfusion after 3 hours of acute occlusion of the same artery). Hemodynamic measurements, ventricular wall motion, coronary sinus blood flow and regional metabolism in both coronary occluded and nonoccluded segments of the left ventricle were measured sequentially. The infarct size was characterized by detailed histopathologic analysis. In the control dogs (Group A), mechanical and metabolic function remained severely depressed after 7 days of occlusion, and mean infarct size was 31.6 percent. In Group B, significant mechanical and metabolic dysfunction developed during 3 hours of occlusion and did not improve during the 1st hour of reperfusion. However, after 7 days of reperfusion, function returned to near preocclusion level. Mean infarct size was 14.2 percent, but in two of the six dogs infarct size was 43 percent and 23 percent, respectively. The study confirmed the unstable character of the early phase of reperfusion, attributed to cell swelling, edema and hemorrhages that resulted in inadequate coronary reflow, arrhythmias and functional derangements. Prolonged reperfusion for 7 days reduced mean infarct size and improved cardiac function.