Family Pediatrician and Public Health collaboration, an alliance to increase vaccination coverage: an experience with MenB vaccination in Italy

BACKGROUND

Invasive Meningococcal Disease is a severe disease mainly affecting infants and young children. Most infections are caused by serogroups A, B, C, W, X, and Y. In the last 10 years, serogroup B has been the main cause of Invasive Meningococcal Disease in Europe. Recent data resulting from an observational study conducted in Italy show a significant reduction in the number of Invasive Meningococcal Disease cases due to Neisseria meningitidis B after the introduction of vaccine 4CMenB. Thus, the Naples Team of Federation of Italian Primary Care Pediatricians and the Public Health Department started an active collaboration focused on vaccination process management (named "Progetto Via") with the aim of increasing Meningococcal B vaccination coverage.

STUDY DESIGN

Source of data is the regional platform "GE.VA.". Every Primary care Pediatrician uses daily to record vaccination activity. This platform is integrated with data entered by operators of the District/Vaccination Center.

METHODS

Time: January 2019 - December 2019. The Federation of Italian Primary Care Pediatricians/Naples organized a meeting to identify six coordinators. The pediatricians could choose to counsel in their own offices and send children to the vaccination center or to counsel and vaccinate directly in their own clinics.

RESULTS

A total of 78 pediatricians took part in the project: 46 did only counseling and 32 did both counseling and vaccination in their medical clinic. Data obtained show an overall average vaccination coverage growth of about 13% in the first 4 months of the survey, and a further growth of about 11% in the following seven months, with a total growth in the entire period of 24%. The pediatricians' counseling is essential to recover non-compliant subjects, considering both the relationship of trust with the families and the visits already scheduled as an ideal moment for vaccinations' status check.

CONCLUSIONS

The project highlights how an effective collaboration between family pediatricians and the Local Health Authority becomes valuable in getting closer to reach the Ministerial goal of 95%. Vaccination coverage increased significantly when family pediatricians supported the activity of vaccine centers in distress in many regional situations. The trust relationship, the hourly availability and the capillary network of family pediatricians' clinics were key elements for the success of this project and were also recognized by parents.

Interventional ultrasound: experience in 426 orthotopic liver transplantations

BACKGROUND

The purpose of this study was to analyze the role of interventional ultrasound in the treatment of nonvascular complications in liver transplant recipients.

METHODS

Between August 1996 and May 2003, we performed 426 OLTs in 394 patients, 287 men (73%) and 107 women (27%), mean age of 50 +/- 9.5 years (range 17 to 68.2). A total of 2556 diagnostic ultrasound examinations were performed, resulting in a mean of 5.9 per patient (range 2 to 21). The interventional maneuvers included: echo-guided biopsies; drainage of abdominal or thoracic effusions; drainage of abdominal, intrahepatic, or splenic collections; positioning of biliary drains; and use of the "rendezvous" technique.

RESULTS

Six hundred seventy-seven echo-guided interventional maneuvers were performed in 394 OTL patients, comprising 417 (61.6%) biopsies and 260 (38.4%) therapeutic maneuvers. Eighty-one ascite drains were positioned (31.1%); in 73 cases, pleural effusions were drained (28.1%). Sixty-seven abdominal or intrahepatic collections were drained (25.8%), of which 36 (53.7%) were due to bilomas or biliary peritonitis, 15 (22.4%) hematomas, 4 (5.9%) hepatic abscesses, 11 (16.4%) infected abdominal collections, and 1 (1.5%) splenic abscess. Thirty-nine cases (15%) of biliary drainage were performed. In 33 cases (7.9%), the parenchymal biopsies were not diagnostic because of an inadequate specimen. The treatment success rate was 96.1%. No complications related to the therapeutic maneuvers were recorded, but there were 5 biopsy-related complications (1.2%).

CONCLUSIONS

Echo-guided interventional maneuvers are safe, produce a high success rate, and represent an important option in the management of OLT patients.

[Orthotopic urinary diversions: the Paduan ileal neobladder. Experience at the Urologic Division of Magenta]

We refer our experience about continent ileal orthotopic bladder in male patient with bladder tumor we report our selections criteria, with particular attention about technical point of view. We show the results, early and late complications.

Neoplasia del Testicolo: La Nostra Esperienza, Opinioni a Confronto

We treated 79 patients with a neoplastic pathology of the testicle between 1972 and 1993. The average age of patients was 35 (range 17-75). Seminoma were treated with precautional and/or therapeutic cycles of TCT. In the 14 cases (38.8%) of non-seminomatous germ cell tumours (NSGCT) there was a difference between the clinical and the pathological staging after retroperitoneal lymph-node dissection (RPLND). Mortality due to progression of the disease was 3.8%. The 17 patients (47.2%) who underwent RPLND had an andrological follow-up (10 patients with normal ejaculation and 7 with no ejaculation). We confirm the under-staging of preliminary diagnostic investigations. Unlike some authors, we feel that conservative action (orchiectomy alone), is not sufficient even in first stage NSGCT.

[Renal adenocarcinoma: 20 years of surgical experience, 1970-1990]

Epidemiology, diagnostics, staging, surgical procedure and survival data of 219 patients with renal cells carcinoma are reported (1970-1990). Diagnosis is based on Tc and angiography. Possibly in the future high sensitivity methods like Magnetic Resonance could limit the use of invasive techniques. 207 patients underwent radical nephrectomy and 68 of these lymphadenectomy too (para and pre aortic and/or caval). In 41 patients the tumor had involved the venous system and 9 cavatomies, 2 caval resections and 1 atriotomy have been performed. In the stage T1-T2-T3 NoMoVo the survival rate (at. 5 years) is 87%, 80%, and 75% respectively. The survival in N+MoVo patients is 17% (at 5 y.) and in V+NoMo patients 57%.

[Cirsoid aneurysm: apropos of a clinical case]

The authors, after mentioning the anatomopathologic, physiopathologic and clinical features of cyrsoid aneurysms, presently classed in the chapter of the congenital artero-venous fistulas, show a case, angiographically discovered, of cyrsoid aneurysm with palmar location, elsewhere already subjected twice to unsuccessful operation, and successfully operated at the Institute of Surgical Pathology of the Pavia University. The Authors think the morphologic and topographic features of such lesion, its relative local malignancy and trend to relapsing, justify why the old denomination of cyrsoid aneurysm was kept, even in the frame of the more general chapter of artero-venous fistulas.