Search

L’influenza rappresenta un problema di sanità pubblica con un considerevole impatto dal punto di vista epidemiologico, clinico, economico e sociale. Ciò è riconducibile a più fattori, quali: l’ubiquità e la contagiosità della malattia, la variabilità antigenica dei virus, l’andamento epidemico (e talvolta pandemico) e stagionale, la possibilità di complicanze gravi specialmente in alcune categorie di soggetti (bambini, anziani, persone con comorbosità e malattie croniche), i costi di gestione in caso di complicanze e i costi sociali (giorni lavorativi persi, perdita di produttività, ecc.) [1-4]. Globalmente, ogni anno, il virus influenzale colpisce tra il 5 e il 15% della popolazione adulta (vale a dire da 350 milioni a 1 miliardo di persone) [5], un’incidenza che sale al 20-30% nella popolazione pediatrica [6, 7], in cui il rischio di infezione è maggiore a causa della limitata immunità preesistente dei bambini [8]. Tra i 3 e i 5 milioni di casi di influenza riportati annualmente evolvono in complicanze che causano il decesso in circa il 10% dei casi (vale a dire da 250 a 500 mila persone), soprattutto tra i gruppi di popolazione a rischio (bambini sotto i 5 anni, anziani e persone affette da malattie croniche) [5, 9]. Le infezioni del tratto respiratorio inferiore e superiore sono le principali conseguenze dell’influenza stagionale. È stato stimato che circa 290.000-650.000 decessi per cause respiratorie sono attribuibili all’influenza ogni anno [10]. Inoltre, diverse complicazioni extra-respiratorie, come quelle del sistema cardiovascolare e nervoso, hanno un impatto importante, soprattutto nei pazienti più vulnerabili [10]. In Europa, l’influenza provoca 4-50 milioni di casi sintomatici all’anno, circa 15.000-70.000 decessi [11] e 150.000 ricoveri ospedalieri correlati all’influenza [12]. Specifici gruppi vulnerabili (anziani, pazienti con malattie croniche e comorbosità, bambini di età inferiore ai 5 anni e donne in gravidanza) sono maggiormente

no abstract

Background. Health sciences are steadily developing apps to help people to have correct lifestyle and to help physicians to follow patients with chronic diseases. However, a proper validated tool to evaluate patients’ perception of apps’ still lacks in many languages. Currently, there is an English validated questionnaire called User Version of the Mobile Application Rating Scale (uMARS). Aim of the study is to translate and validate uMARS in Italian. Methods. uMARS questionnaire have been translated into Italian by an official translator from English. Then, questionnaire has been administrated to 100 smartphone users to evaluate the same App at time 1 and at time 2 (after 2 weeks). Paired t test, Pearson Correlation Coefficient, Intraclass Correlation Coefficient (ICCs) and Cronbach’s Alpha were used to evaluate Italian uMARS reliability and validity. Results. Subjects were 100, 52 males (52%) and 48 females (48%). Mean age was 22.8 (SD: 3.4). All the enrolled subjects answered to all questions both at time 0 and at time 1. Paired t test showed no statistically significant difference for each answer or answers group between time 0 and 1 (P>0.05). Cronbach’s alpha was 0.945, as all patients answered to all questions. Each question was furtherly assessed through Pearson correlation coefficient, which demonstrated high reliability, with significant P (<0.05) and Pearson Coefficients higher than 0.7. Similarly, ICC, which was always higher than 0.750. Conclusions. Our results allow the validation of uMARS in Italian language and it may become a reliable and useful tool to evaluate health app.

The burden of diarrheal diseases is very high, accounting for 1.7 to 5 billion cases per year worldwide. Typhoid Fever (TF) and Cholerare potentially life-threatening infectious diseases mainly transmitted through the consumption of food, drink or water that have been contaminated by the feces or urine of subjects excreting the pathogen. TF is mainly caused by Salmonella typhi whereas Cholera is caused by intestinal infection by the toxin-producing bacterium Vibrio cholerae. These diseases typically affect low- and middle-income countries where housing is overcrowded and water and sanitation are poor, or where conflicts or natural disasters have led to the collapse of the water, sanitation and healthcare systems. The mortality rate is higher in children under 5 years. Regarding their geographical distribution, TF has a high incidence in sub-Saharan Africa, India and south-east Asia, while cholera has a high incidence in a few African countries, particularly in the Horn of Africa and the Arabian peninsula. In the fight against these diseases, preventive measures are fundamental.  With modern air travel, transmissible diseases can spread across continents and oceans in a few days, constituting a threat to global public health. Nowadays, people travel for different reasons such as tourism and business. Several surveys have shown that a high proportion of travellers lack adequate information on safety issues, such as timely vaccination and prophylactic medications. The main objective of this overview is to provide the knowledge for travellers to stay healthy while abroad, and thus also to reduce the potential importation of these diseases and their consequent implications for public health and society. The preventive measures to be adopted in the case of travel to countries where these diseases are still endemic are well known: the adoption of safe practices and vaccinations. Vaccination is effec

The burden of diarrheal diseases is very high, accounting for 1.7 to 5 billion cases per year worldwide. Typhoid Fever (TF) and Cholerare potentially life-threatening infectious diseases mainly transmitted through the consumption of food, drink or water that have been contaminated by the feces or urine of subjects excreting the pathogen. TF is mainly caused by Salmonella typhi whereas Cholera is caused by intestinal infection by the toxin-producing bacterium Vibrio cholerae. These diseases typically affect low- and middle-income countries where housing is overcrowded and water and sanitation are poor, or where conflicts or natural disasters have led to the collapse of the water, sanitation and healthcare systems. The mortality rate is higher in children under 5 years. Regarding their geographical distribution, TF has a high incidence in sub-Saharan Africa, India and south-east Asia, while cholera has a high incidence in a few African countries, particularly in the Horn of Africa and the Arabian peninsula. In the fight against these diseases, preventive measures are fundamental.  With modern air travel, transmissible diseases can spread across continents and oceans in a few days, constituting a threat to global public health. Nowadays, people travel for different reasons such as tourism and business. Several surveys have shown that a high proportion of travellers lack adequate information on safety issues, such as timely vaccination and prophylactic medications. The main objective of this overview is to provide the knowledge for travellers to stay healthy while abroad, and thus also to reduce the potential importation of these diseases and their consequent implications for public health and society. The preventive measures to be adopted in the case of travel to countries where these diseases are still endemic are well known: the adoption of safe practices and vaccinations. Vaccination is effec

IntroductionElderly use to develop more complications after influenza and the 90% of deaths for influenza regards them. Indeed, they are among the major target of vaccination campaigns. The use of deprivation indices can help to identify subgroups with lower vaccine uptake. This work was aimed to analyze vaccination coverage of elderly living in Genoa using a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify subgroups of population needing specific actions to improve vaccination coverage.MethodsThe target population was the population aged ≥65 years living in Genoa in the 2009-2013 period. Information about vaccination coverage derived from general practitioners. A combination of linear regression, factor analysis and cluster analysis was used to build the SEHDI at Census Tract (CT) level, deriving data from the 2011 Italian census.ResultsIn Genoa, in 2011, people aged ≥65 years represented the 27.7% of the population. The majority of elderly belonged to medium (45.3%) and medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6% high deprived; 1.3% low deprived). Significant not linear (p<0.05 NL) relationships were observed in both sexes for all respiratory diseases (RD) and COPD mortality, with the highest SMRs values in the high deprivation group of women (1.81, p<0.05 RD; 1.79, p<0.05 COPD). The SMRs for influenza and pneumonia showed a linear positive trend in women (p<0.05), with the highest value in the high deprived (1.97, p<0.05), while in men the trend was NL (p<0.05). A positive linear trend (p<0.05) was found for vaccination coverage, weakly growing at deprivation increase until the medium-high deprived group (from 34.6% to 44.4%), but the high deprivation group showed the lowest value (33,3%).ConclusionsThe results displayed a positive relationship between deprivation and vaccination coverage. This finding should be taken into account in the organization of vacci

BackgroundAlthough benefits of vaccinations have been extensively demonstrated, poor knowledge of the population has resulted in non-optimal vaccine coverage as a result of the hesitancy and negative perception of many parents toward vaccination. Materials and MethodsTo assess the impact of a course on the knowledge and attitudes of future mothers on vaccination, 214 pregnant women participated in a research project undertaken at the Obstetrics and Gynaecology Department of the Careggi University Hospital in Florence (Italy). This involved completion of anonymous questionnaires administered before and after the intervention. A descriptive and statistical analysis was carried out on the results of the collected data by performing comparative evaluations of the responses obtained before and after the intervention. ResultsThere was good adherence to the initiative (98%): the sample population was initially not hostile to vaccines, albeit poorly or insufficiently informed (43%). The educational intervention had a positive impact, especially as a vaccine information tool and for correctly addressing the vaccine hesitancy. After the intervention, women who considered their level of knowledge about vaccines as poor or insufficient were reduced by 30% and the "hesitant" ones were reduced with respect to all aspects of the study, especially about the decision to be vaccinated during pregnancy. ConclusionsHesitancy finds its roots in the absence of accurate information. Healthcare professionals need to improve their communication skills. Competent education delivered during pregnancy, when women are more receptive, may have a highly positive impact. These observations will have to be considered in the planning of delivery preparation courses.

IntroductionIn recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC). A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed.Materials and methodsAnnex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p<0.05). The statistical analyses were performed by SPSS and Stata software.ResultsA total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females. The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%). ConclusionsThis study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside.

IntroductionIn recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC). A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed.Materials and methodsAnnex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p<0.05). The statistical analyses were performed by SPSS and Stata software.ResultsA total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females. The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%). ConclusionsThis study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside.

BackgroundAlthough benefits of vaccinations have been extensively demonstrated, poor knowledge of the population has resulted in non-optimal vaccine coverage as a result of the hesitancy and negative perception of many parents toward vaccination. Materials and MethodsTo assess the impact of a course on the knowledge and attitudes of future mothers on vaccination, 214 pregnant women participated in a research project undertaken at the Obstetrics and Gynaecology Department of the Careggi University Hospital in Florence (Italy). This involved completion of anonymous questionnaires administered before and after the intervention. A descriptive and statistical analysis was carried out on the results of the collected data by performing comparative evaluations of the responses obtained before and after the intervention. ResultsThere was good adherence to the initiative (98%): the sample population was initially not hostile to vaccines, albeit poorly or insufficiently informed (43%). The educational intervention had a positive impact, especially as a vaccine information tool and for correctly addressing the vaccine hesitancy. After the intervention, women who considered their level of knowledge about vaccines as poor or insufficient were reduced by 30% and the "hesitant" ones were reduced with respect to all aspects of the study, especially about the decision to be vaccinated during pregnancy. ConclusionsHesitancy finds its roots in the absence of accurate information. Healthcare professionals need to improve their communication skills. Competent education delivered during pregnancy, when women are more receptive, may have a highly positive impact. These observations will have to be considered in the planning of delivery preparation courses.

IntroductionElderly use to develop more complications after influenza and the 90% of deaths for influenza regards them. Indeed, they are among the major target of vaccination campaigns. The use of deprivation indices can help to identify subgroups with lower vaccine uptake. This work was aimed to analyze vaccination coverage of elderly living in Genoa using a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify subgroups of population needing specific actions to improve vaccination coverage.MethodsThe target population was the population aged ≥65 years living in Genoa in the 2009-2013 period. Information about vaccination coverage derived from general practitioners. A combination of linear regression, factor analysis and cluster analysis was used to build the SEHDI at Census Tract (CT) level, deriving data from the 2011 Italian census.ResultsIn Genoa, in 2011, people aged ≥65 years represented the 27.7% of the population. The majority of elderly belonged to medium (45.3%) and medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6% high deprived; 1.3% low deprived). Significant not linear (p<0.05 NL) relationships were observed in both sexes for all respiratory diseases (RD) and COPD mortality, with the highest SMRs values in the high deprivation group of women (1.81, p<0.05 RD; 1.79, p<0.05 COPD). The SMRs for influenza and pneumonia showed a linear positive trend in women (p<0.05), with the highest value in the high deprived (1.97, p<0.05), while in men the trend was NL (p<0.05). A positive linear trend (p<0.05) was found for vaccination coverage, weakly growing at deprivation increase until the medium-high deprived group (from 34.6% to 44.4%), but the high deprivation group showed the lowest value (33,3%).ConclusionsThe results displayed a positive relationship between deprivation and vaccination coverage. This finding should be taken into account in the organization of vacci

Japanese encephalitis is a vector-borne disease caused by the Japanese encephalitis virus (JEV). JEV is transmitted by mosquitoes to a wide range of vertebrate hosts, including birds and mammals. Domestic animals, especially pigs, are generally implicated as reservoirs of the virus, while humans are not part of the natural transmission cycle and cannot pass the virus to other hosts.Although JEV infection is very common in endemic areas (many countries in Asia), less than 1% of people affected develop clinical disease, and severe disease affects about 1 case per 250 JEV infections. Although rare, severe disease can be devastating; among the 30,000-50,000 global cases per year, approximately 20-30% of patients die and 30-50% of survivors develop significant neurological sequelae.JE is a significant public health problem for residents in endemic areas and may constitute a substantial risk for travelers to these areas. The epidemiology of JE and its risk to travelers have changed, and continue to evolve. The rapid economic growth of Asian countries has led to a surge in both inbound and outbound travel, making Asia the second most-visited region in the world after Europe, with 279 million international travelers in 2015. The top destination is China, followed by Thailand, Hong Kong, Malaysia and Japan, and the number of travelers is forecast to reach 535 million by 2030 (+4.9% per year).Because of the lack of treatment and the infeasibility of eliminating the vector, vaccination is recognized as the most efficacious means of preventing JE.The IC51 vaccine (Ixiaro®) is a purified, inactivated, whole virus vaccine against JE. It is safe, well tolerated, efficacious and can be administered to children, adults and the elderly. The vaccination schedule involves administering 2 doses four weeks apart. For adults, a rapid schedule (0-7 days) is available, which could greatly enhance the feasibility of its use.Healthcare workers should inform both short- and long-term travelers

Japanese encephalitis is a vector-borne disease caused by the Japanese encephalitis virus (JEV). JEV is transmitted by mosquitoes to a wide range of vertebrate hosts, including birds and mammals. Domestic animals, especially pigs, are generally implicated as reservoirs of the virus, while humans are not part of the natural transmission cycle and cannot pass the virus to other hosts.Although JEV infection is very common in endemic areas (many countries in Asia), less than 1% of people affected develop clinical disease, and severe disease affects about 1 case per 250 JEV infections. Although rare, severe disease can be devastating; among the 30,000-50,000 global cases per year, approximately 20-30% of patients die and 30-50% of survivors develop significant neurological sequelae.JE is a significant public health problem for residents in endemic areas and may constitute a substantial risk for travelers to these areas. The epidemiology of JE and its risk to travelers have changed, and continue to evolve. The rapid economic growth of Asian countries has led to a surge in both inbound and outbound travel, making Asia the second most-visited region in the world after Europe, with 279 million international travelers in 2015. The top destination is China, followed by Thailand, Hong Kong, Malaysia and Japan, and the number of travelers is forecast to reach 535 million by 2030 (+4.9% per year).Because of the lack of treatment and the infeasibility of eliminating the vector, vaccination is recognized as the most efficacious means of preventing JE.The IC51 vaccine (Ixiaro®) is a purified, inactivated, whole virus vaccine against JE. It is safe, well tolerated, efficacious and can be administered to children, adults and the elderly. The vaccination schedule involves administering 2 doses four weeks apart. For adults, a rapid schedule (0-7 days) is available, which could greatly enhance the feasibility of its use.Healthcare workers should inform both short- and long-term travelers

Introduction: Decision-making in healthcare should rely on evidence-based approaches able to make possible a transparent and robust assessment of all the aspects related to health technologies. One of the assessment elements is represented by the efficiency that is the specific objective of economic evaluations and also of Health Technology Assessment (HTA). The collection and synthesis of evidence is the first indispensable step in order to foster a proper convey of scientific knowledge to the decision-makers. This work, carried out within a broader project on the transfer of evidence from the scientific to the decision making world, is aimed to release an overview of economic evaluations and HTA on vaccines conducted in Italy. The project was carried out within the activities of the ISPOR Italy-Rome Chapter. Methods: A systematic review of Italian economic evaluations and HTA performed on vaccines and published up to May 2015 was carried out. PubMed, Scopus and the NIHR HTA databases were queried and a hand-search was performed on key journals in the field (Global & Regional Health Technology Assessment; PharmacoEconomics Italian Research Articles; Giornale italiano di HTA; Politiche Sanitarie; HTA Focus - Pills of Clinical Governance; Pillole di Farmacoeconomia; Giornale Italiano di Farmacoeconomia e Farmacoutilizzazione; IJPH; Quaderni dell'IJPH). Studies were considered eligible if showing the results of a full economic evaluations and if performed in Italy. Results: The literature search yielded 10 HTA reports and 33 economic evaluations. Among the latter, 20 (60,6%) were cost-effectiveness analyses. Ten studies (23,3%) assessed the vaccination against S. pneumoniae figuring out that it is cost-effectiveness and even costsaving in cases of newborns and subjects at risk. Nine studies (20,9%) addressed influenza vaccination and demonstrated its dominance on non-vaccination in the elderly. Eight studies (18,6%) evaluated the HPV vaccines concluding that they

Cases of diarrhoeal disease number from 1.7 to 5 billion per year worldwide. One of the main causes of diarrhoeal disease is typhoid fever, which is a potentially life-threatening multi-systemic illness. According to the most recent estimates, a total of 26.9 million typhoid fever episodes occurred in 2010. The geographical distribution of the disease differs widely; in developed countries, the incidence rate per 100,000 per year varies from <0.1 to 0.3, and the disease mainly affects people who travel to endemic areas located in low- and middle-income countries. Low- and middle-income countries are mainly affected owing to the lack of clean water and proper sanitation. In the fight against this plague, prevention is fundamental, and vaccination against typhoid is an effective measure.Vivotif® is an oral live attenuated vaccine which contains a mutated strain of Salmonella (Ty21a) and reproduces the natural infection. The vaccine was first licensed in Europe in 1983 and in the US in 1989, and over the years it has proved efficacious and safe. It is indicated for adults and children from 5 years of age upwards. Specifically, in the most developed countries, vaccination is suggested for high-risk population groups and particularly for international travellers to destinations where the risk of contracting typhoid fever is high. It must also be borne in mind that international travel is increasing. Indeed, international tourist arrivals totalled 1,184 million in 2015 and, on the basis of current trends, international travel is expected to grow by 3% - 4% in 2017.Vivotif® appears to be a powerful means of disease prevention, the importance of which is highlighted by the spread of antibiotic-resistant strains of S. Typhi.

Introduction. Nowadays, four different types of influenza vaccines are available in Italy: trivalent (TIV), quadrivalent (QIV), MF59-adjuvanted (aTIV) and TIV (idTIV) inactivated vaccines. Recently, a concept of the appropriateness (i.e. according to the age and risk factors) of the use of different vaccines has been established in Italy. We conducted a budget impact analysis of switching to a policy, in which the Italian elderly (who carry the major disease burden) received the available vaccines according to their age and risk profile.Methods. A novel budget impact model was constructed with a time horizon of one influenza season. In the reference scenario the cohort of Italian elderly could receive either available vaccine according to 2017/18 season market share. The alternative scenario envisaged the administration of TIV/QIV to people aged 65–74 years at low risk of developing influenza-related complications, while aTIV/idTIV were allocated to high-risk 65–74-year-olds and all subjects aged ≥75 years.Results. Switching to the alternative scenario would determine both significant health benefits and net budget savings. Particularly, it would be possible to prevent additional 8,201 cases of laboratory-confirmed influenza, 988 complications, 355 hospitalizations and 14 deaths. Despite the alternative strategy would be associated with a slightly higher vaccination costs, the total savings derived from fewer influenza events completely reset this increase with net budget savings of 0.13 million.Conclusions. The immunization policy in which influenza vaccines are administered according to the age and risk profile of the Italian elderly is advisable.

Introduction. Nowadays, four different types of influenza vaccines are available in Italy: trivalent (TIV), quadrivalent (QIV), MF59-adjuvanted (aTIV) and TIV (idTIV) inactivated vaccines. Recently, a concept of the appropriateness (i.e. according to the age and risk factors) of the use of different vaccines has been established in Italy. We conducted a budget impact analysis of switching to a policy, in which the Italian elderly (who carry the major disease burden) received the available vaccines according to their age and risk profile.Methods. A novel budget impact model was constructed with a time horizon of one influenza season. In the reference scenario the cohort of Italian elderly could receive either available vaccine according to 2017/18 season market share. The alternative scenario envisaged the administration of TIV/QIV to people aged 65–74 years at low risk of developing influenza-related complications, while aTIV/idTIV were allocated to high-risk 65–74-year-olds and all subjects aged ≥75 years.Results. Switching to the alternative scenario would determine both significant health benefits and net budget savings. Particularly, it would be possible to prevent additional 8,201 cases of laboratory-confirmed influenza, 988 complications, 355 hospitalizations and 14 deaths. Despite the alternative strategy would be associated with a slightly higher vaccination costs, the total savings derived from fewer influenza events completely reset this increase with net budget savings of 0.13 million.Conclusions. The immunization policy in which influenza vaccines are administered according to the age and risk profile of the Italian elderly is advisable.

Cases of diarrhoeal disease number from 1.7 to 5 billion per year worldwide. One of the main causes of diarrhoeal disease is typhoid fever, which is a potentially life-threatening multi-systemic illness. According to the most recent estimates, a total of 26.9 million typhoid fever episodes occurred in 2010. The geographical distribution of the disease differs widely; in developed countries, the incidence rate per 100,000 per year varies from <0.1 to 0.3, and the disease mainly affects people who travel to endemic areas located in low- and middle-income countries. Low- and middle-income countries are mainly affected owing to the lack of clean water and proper sanitation. In the fight against this plague, prevention is fundamental, and vaccination against typhoid is an effective measure.Vivotif® is an oral live attenuated vaccine which contains a mutated strain of Salmonella (Ty21a) and reproduces the natural infection. The vaccine was first licensed in Europe in 1983 and in the US in 1989, and over the years it has proved efficacious and safe. It is indicated for adults and children from 5 years of age upwards. Specifically, in the most developed countries, vaccination is suggested for high-risk population groups and particularly for international travellers to destinations where the risk of contracting typhoid fever is high. It must also be borne in mind that international travel is increasing. Indeed, international tourist arrivals totalled 1,184 million in 2015 and, on the basis of current trends, international travel is expected to grow by 3% - 4% in 2017.Vivotif® appears to be a powerful means of disease prevention, the importance of which is highlighted by the spread of antibiotic-resistant strains of S. Typhi.

Background - A growing body of literature affirms the usefulness of mobile technologies, including mobile applications (apps), in the primary prevention field. The quality of health apps, which today number in the thousands, is a crucial parameter, as it may affect health-related decision-making and outcomes among app end-users. The mobile application rating scale (MARS) has recently been developed to evaluate the quality of such apps, and has shown good psychometric properties. Since there is no standardised tool for assessing the apps available in Italian app stores, the present study developed and validated an Italian version of MARS in apps targeting primary prevention. Methods - The original 23-item version of the MARS assesses mobile app quality in four objective quality dimensions (engagement, functionality, aesthetics, information) and one subjective dimension. Validation of this tool involved several steps; the universalist approach to achieving equivalence was adopted. Following two backward translations, a reconciled Italian version of MARS was produced and compared with the original scale. On the basis of sample size estimation, 48 apps from three major app stores were downloaded; the first 5 were used for piloting, while the remaining 43 were used in the main study in order to assess the psychometric properties of the scale. The apps were assessed by two raters, each working independently. The psychometric properties of the final version of the scale was assessed including the inter-rater reliability, internal consistency, convergent, divergent and concurrent validities. Results - The intralingual equivalence of the Italian version of the MARS was confirmed by the authors of the original scale. A total of 43 apps targeting primary prevention were tested. The MARS displayed acceptable psychometric properties. The MARS total score showed an excellent level of both inter-rater agreement

Influenza is a serious public health problem, since seasonal epidemics affect approximately 5-10% of the population and thus give rise to a heavy social and healthcare burden. The heavy burden of disease is due to several factors, one of which is the biological features of the pathogen. Indeed influenza viruses display high mutation rates and undergo frequent genetic reassortment. Minor variations cause seasonal epidemics and major variations, which result from the hybridization of viruses typical of different animal species, can lead to pandemics.Vaccination remains the most efficacious means of mitigating the harmful healthcare and social effects of influenza. Influenza vaccines have evolved over time in order to offer broader protection against circulating strains. Trivalent vaccines containing two A viruses and one B virus are currently available. However, given the co-circulation of both B virus lineages (B/Yamagata and B/Victoria), quadrivalent vaccines have recently been developed. The new quadrivalent vaccines constitute a great advance, in that they can offer broader strain coverage.Despite the availability of effective and safe influenza vaccines, the Italian public’s trust in vaccination has declined and, in the last few years, influenza vaccination coverage rates have decreased both among the elderly and among at-risk adults. It is therefore necessary that users, in their own interests, regain trust in this important means of disease prevention.In order to mitigate the damage wreaked by influenza, it seems important to: (i) improve clinical-epidemiological and virological surveillance of the disease; (ii) promote the development of new efficacious vaccines, as has recently been done through the introduction of the quadrivalent vaccine; (iii) extend free vaccination to the entire population, as in the US and Canada; (iv) ensure that general healthcare professionals are properly informed and always updated with regard to vaccination; (v) promote public cam

The European Medicines Agency has approved a multicomponent serogroup B meningococcal vaccine (Bexsero®) for use in individuals of 2 months of age and older. A cost-effectiveness analysis (CEA) from the societal and Italian National Health Service perspectives was performed in order to evaluate the impact of vaccinating Italian infants less than 1 y of age with Bexsero®, as opposed to non-vaccination. The analysis was carried out by means of Excel Version 2011 and the TreeAge Pro® software Version 2012. Two basal scenarios that differed in terms of disease incidence (official and estimated data to correct for underreporting) were considered. In the basal scenarios, we considered a primary vaccination cycle with 4 doses (at 2, 4, 6 and 12 months of age) and 1 booster dose at the age of 11 y, the societal perspective and no cost for death. Sensitivity analyses were carried out in which crucial variables were changed over probable ranges. In Italy, on the basis of official data on disease incidence, vaccination with Bexsero® could prevent 82.97 cases and 5.61 deaths in each birth cohort, while these figures proved to be three times higher on considering the estimated incidence. The results of the CEA showed that the Incremental Cost Effectiveness Ratio (ICER) per QALY was €109,762 in the basal scenario if official data on disease incidence are considered and €26,599 if estimated data are considered. The tornado diagram indicated that the most influential factor on ICER was the incidence of disease. The probability of sequelae, the cost of the vaccine and vaccine effectiveness also had an impact. Our results suggest that vaccinating infants in Italy with Bexsero® has the ability to significantly reduce meningococcal disease and, if the probable underestimation of disease incidence is considered, routine vaccination is advisable.

Influenza is a serious public health problem, since seasonal epidemics affect approximately 5-10% of the population and thus give rise to a heavy social and healthcare burden. The heavy burden of disease is due to several factors, one of which is the biological features of the pathogen. Indeed influenza viruses display high mutation rates and undergo frequent genetic reassortment. Minor variations cause seasonal epidemics and major variations, which result from the hybridization of viruses typical of different animal species, can lead to pandemics.Vaccination remains the most efficacious means of mitigating the harmful healthcare and social effects of influenza. Influenza vaccines have evolved over time in order to offer broader protection against circulating strains. Trivalent vaccines containing two A viruses and one B virus are currently available. However, given the co-circulation of both B virus lineages (B/Yamagata and B/Victoria), quadrivalent vaccines have recently been developed. The new quadrivalent vaccines constitute a great advance, in that they can offer broader strain coverage.Despite the availability of effective and safe influenza vaccines, the Italian public’s trust in vaccination has declined and, in the last few years, influenza vaccination coverage rates have decreased both among the elderly and among at-risk adults. It is therefore necessary that users, in their own interests, regain trust in this important means of disease prevention.In order to mitigate the damage wreaked by influenza, it seems important to: (i) improve clinical-epidemiological and virological surveillance of the disease; (ii) promote the development of new efficacious vaccines, as has recently been done through the introduction of the quadrivalent vaccine; (iii) extend free vaccination to the entire population, as in the US and Canada; (iv) ensure that general healthcare professionals are properly informed and always updated with regard to vaccination; (v) promote public cam

Introduzione: Conoscere attitudini e comportamenti della popolazione nei confronti delle vaccinazioni è indispensabile per poter intraprendere azioni mirate. Questo studio, di cui sono stati presentati parte dei risultati allo scorso congresso SItI, ha analizzato anche i fattori associati alla propensione alle vaccinazioni contro N. meningitidis, S. pneumoniae e HPV e le motivazioni alla vaccinazione/non vaccinazione. Metodi: E’ stato somministrato un questionario anonimo a un campione di 530 individui con età compresa tra 19 e 86 anni che hanno usufruito, nel 2013, dei servizi dei Dipartimenti di Prevenzione della ASL Roma A, ASL3 di Genova, ASL2 di Savona e ASL Viterbo. Risultati: Il 96,2%, il 94% e il 92,7% dei responders si è detto favorevole alla vaccinazione contro N. meningitidis, S. pneumoniae e HPV rispettivamente, e il 58,4% ha espresso parere positivo nei confronti del vaccino MenB. L’attitudine alla vaccinazione meningococcica è risultata significativamente maggiore nelle donne, quella contro HPV è risultata associata alla presenza di figli e alla conoscenza della malattia mentre quella contro lo pneumococco al proprio stato vaccinale e alla conoscenza della malattia stessa. Rispetto alla vaccinazione dei propri figli, il 68,8%, l’82,6% e l’84,5% dei responders ha dichiarato di averli vaccinati contro N. meningitidis, S. pneumoniae e HPV rispettivamente. Dal 45% a oltre il 50% ha riportato come principale motivazione la raccomandazione da parte del pediatra o di un altro medico. Anche la paura delle sequele di malattia ha rappresentato una motivazione comune. Le motivazioni alla non vaccinazione sono state invece scarsamente riferite. Conclusioni: Questi dati suggeriscono che azioni volte a incrementare il livello di conoscenza della popolazione e a promuovere un ruolo attivo dei professionisti sanitari nell’offerta vaccinale potrebbero influenzare positivamente attitudini e comportamenti nei confronti delle vaccinazioni prese in esame

Immunisation against meningococcal meningitis has a long history, which has passed through several phases: the studies by Flexner, extraction of the polysaccharide capsule, the development of monovalent and multivalent conjugate vaccines, the outer membrane vesicle vaccines up to the development of effective and safe vaccines for meningococcal B invasive disease through the application of the techniques of molecular biology and reverse vaccinology.The new available vaccines are Bexsero® and Trumenba®. Bexsero® has been approved and is available in Europe, the USA, Canada, Australia and Chile, and is currently under review in Brazil for the prevention of MenB invasive disease in subjects ≥ 2 months. Trumemba® is currently approved only in the USA, for use in adolescents and young adults.At present, the greatest obstacle to the extensive use of these vaccines in industrialised countries is the high cost and the need administer multiple doses in infants. However, in some European countries and in some Italian Regions, strategies (free and active call) to fight the disease through vaccination (Bexsero) are already in place.

HTA is considered the most comprehensive and transparent method of supporting decision-makers in their choices in Public Health.HTA on vaccines is being performed by many experts. However, they often present their studies to colleagues, but not to decision-makers, who should be the main target and current users. It is therefore crucial to improve the transfer of scientific data to decision-makers and all stakeholders.The aims of the present project are: 1) to set up a team of experts to collect economic evaluations and HTA studies on vaccines and assess their actual use in decision-making processes; 2) to constitute regional working groups in order to identify the critical aspects of the communication process and identify the most appropriate method of data transfer.Systematic reviews of economic evaluations and HTA on vaccines and their actual use in decision-making will be used to draw up the basic documents for discussion by the 3 regional working boards. The working groups will discuss the current scientific evidence and communication methods and will try to implement a model of technology assessment with well-defined and objective criteria, in order to better fit pharmaco-economic and HTA methods to the field of vaccinations.Improving the transfer of HTA results to stakeholders, particularly decision-makers, will enable decisions to be taken on the basis of scientific evidence, and appropriate, sustainable actions to be undertaken.

In modern society, a potentially serious adverse event attributed to a vaccination is likely to be snapped up by the media, particu- larly newspapers and television, as it appeals to the emotions of the public. The widespread news of the alleged adverse events of vaccination has helped to create the “urban myth€ that vac- cines cause serious neurological disorders and has boosted anti- vaccination associations. This speculation is linked to the fact that the true causes of many neurological diseases are largely unknown. The relationship between vaccinations and the onset of serious neuropsychiatric diseases is certainly one of coincidence rather than causality. This claim results from controlled studies that have excluded the association between vaccines and severe neurological diseases, therefore it can be said, with little risk of error, that the association between modern vaccinations and seri- ous neurological disorders is a true urban myth.

HTA is considered the most comprehensive and transparent method of supporting decision-makers in their choices in Public Health.HTA on vaccines is being performed by many experts. However, they often present their studies to colleagues, but not to decision-makers, who should be the main target and current users. It is therefore crucial to improve the transfer of scientific data to decision-makers and all stakeholders.The aims of the present project are: 1) to set up a team of experts to collect economic evaluations and HTA studies on vaccines and assess their actual use in decision-making processes; 2) to constitute regional working groups in order to identify the critical aspects of the communication process and identify the most appropriate method of data transfer.Systematic reviews of economic evaluations and HTA on vaccines and their actual use in decision-making will be used to draw up the basic documents for discussion by the 3 regional working boards. The working groups will discuss the current scientific evidence and communication methods and will try to implement a model of technology assessment with well-defined and objective criteria, in order to better fit pharmaco-economic and HTA methods to the field of vaccinations.Improving the transfer of HTA results to stakeholders, particularly decision-makers, will enable decisions to be taken on the basis of scientific evidence, and appropriate, sustainable actions to be undertaken.

Immunisation against meningococcal meningitis has a long history, which has passed through several phases: the studies by Flexner, extraction of the polysaccharide capsule, the development of monovalent and multivalent conjugate vaccines, the outer membrane vesicle vaccines up to the development of effective and safe vaccines for meningococcal B invasive disease through the application of the techniques of molecular biology and reverse vaccinology.The new available vaccines are Bexsero® and Trumenba®. Bexsero® has been approved and is available in Europe, the USA, Canada, Australia and Chile, and is currently under review in Brazil for the prevention of MenB invasive disease in subjects ≥ 2 months. Trumemba® is currently approved only in the USA, for use in adolescents and young adults.At present, the greatest obstacle to the extensive use of these vaccines in industrialised countries is the high cost and the need administer multiple doses in infants. However, in some European countries and in some Italian Regions, strategies (free and active call) to fight the disease through vaccination (Bexsero) are already in place.

In modern society, a potentially serious adverse event attributed to a vaccination is likely to be snapped up by the media, particu- larly newspapers and television, as it appeals to the emotions of the public. The widespread news of the alleged adverse events of vaccination has helped to create the “urban myth€ that vac- cines cause serious neurological disorders and has boosted anti- vaccination associations. This speculation is linked to the fact that the true causes of many neurological diseases are largely unknown. The relationship between vaccinations and the onset of serious neuropsychiatric diseases is certainly one of coincidence rather than causality. This claim results from controlled studies that have excluded the association between vaccines and severe neurological diseases, therefore it can be said, with little risk of error, that the association between modern vaccinations and seri- ous neurological disorders is a true urban myth.

Vaccines are a basic investment in the long term, both for Countries and the whole world – where they are estimated to save 2.5 million lives among children each year. In this perspective vaccine research and development are intensifying; several novel vaccines are authorized, implying that health decision-makers more frequently face constraint problems in planning the available resource allocation. Health Technology Assessment (HTA) is now acknowledged as a key tool for supporting decision-makers in making their choices. HTA is a multidisciplinary method, and the purpose of this article is to outline the issues to be taken into consideration when evaluating the introduction of a new vaccine: epidemiology of the illness, actors involved in its prevention, analysis of the available evidence, mathematical modeling and economic evaluations, ethical aspects, organizational impact on health care facilities and health professionals due to the vaccination campaigns.

Glycopeptide resistance in Staphylococcus aureus is a source of great concern because, especially in hospitals, this class of antibiotics, particularly vancomycin, is one of the main resources for combating infections caused by methicillin-resistant Staphylococcus aureus strains (MRSA). Reduced susceptibility to vancomycin (VISA) was first described in 1996 in Japan; since then, a phenotype with heterogeneous resistance to vancomycin (h-VISA) has emerged. H-VISA isolates are characterised by the presence of a resistant subpopulation, typically at a rate of 1 in 105 organisms, which constitutes the intermediate stage between fully vancomycin-susceptible S. aureus (VSSA) and VISA isolates. As VISA phenotypes are almost uniformly cross-resistant to teicoplanin, they are also called Glycopeptides-intermediate Staphylococcus aureus strains (GISA) and, in the case of heterogeneous resistance to glycopeptides, h-GISA. The overall prevalence of h-VISA is low, accounting for approximately 1.3% of all MRSA isolates tested. Mortality due to h-GISA infections is very high (about 70%), especially among patients hospitalised in high-risk departments, such as intensive care units (ICU). Given the great clinical relevance of strains that are heteroresistant to glycopeptides and the possible negative impact on treatment choices, it is important to draw up and implement infection control practices, including surveillance, the appropriate use of isolation precautions, staff training, hand hygiene, environmental cleansing and good antibiotic stewardship.

In the first part of this overview, we described the life cycle of the influenza virus and the pharmacological action of the currently available drugs. This second part provides an overview of the molecular mechanisms and targets of still-experimental drugs for the treatment and management of influenza.Briefly, we can distinguish between compounds with anti-influenza activity that target influenza virus proteins or genes, and molecules that target host components that are essential for viral replication and propagation. These latter compounds have been developed quite recently. Among the first group, we will focus especially on hemagglutinin, M2 channel and neuraminidase inhibitors. The second group of compounds may pave the way for personalized treatment and influenza management. Combination therapies are also discussed.In recent decades, few antiviral molecules against influenza virus infections have been available; this has conditioned their use during human and animal outbreaks. Indeed, during seasonal and pandemic outbreaks, antiviral drugs have usually been administered in monotherapy and, sometimes, in an uncontrolled manner to farm animals. This has led to the emergence of viral strains displaying resistance, especially to compounds of the amantadane family. For this reason, it is particularly important to develop new antiviral drugs against influenza viruses. Indeed, although vaccination is the most powerful means of mitigating the effects of influenza epidemics, antiviral drugs can be very useful, particularly in delaying the spread of new pandemic viruses, thereby enabling manufacturers to prepare large quantities of pandemic vaccine. In addition, antiviral drugs are particularly valuable in complicated cases of influenza, especially in hospitalized patients.To write this overview, we mined various databases, including Embase, PubChem, DrugBank and Chemical Abstracts Service, and patent repositories.

Influenza is a contagious respiratory acute viral disease charac- terized by a short incubation period, high fever and respiratory and systemic symptoms. The burden of influenza is very heavy. Indeed, the World Health Organization (WHO) estimates that annual epidemics affect 5-15% of the world?s population, causing up to 4-5 million severe cases and from 250,000 to 500,000 deaths. In order to design anti-influenza molecules and compounds, it is important to understand the complex replication cycle of the influenza virus. Replication is achieved through various stages. First, the virus must engage the sialic acid receptors present on the free surface of the cells of the respiratory tract. The virus can then enter the cells by different routes (clathrin-mediated endocytosis or CME, caveolae-dependent endocytosis or CDE, clathrin-caveolae-independent endocytosis, or macropinocyto- sis). CME is the most usual pathway; the virus is internalized into an endosomal compartment, from which it must emerge in order to release its nucleic acid into the cytosol. The ribonucleo- protein must then reach the nucleus in order to begin the pro- cess of translation of its genes and to transcribe and replicate its nucleic acid. Subsequently, the RNA segments, surrounded by the nucleoproteins, must migrate to the cell membrane in order to enable viral assembly. Finally, the virus must be freed to invade other cells of the respiratory tract. All this is achieved through a synchronized action of molecules that perform multi- ple enzymatic and catalytic reactions, currently known only in part, and for which many inhibitory or competitive molecules have been studied. Some of these studies have led to the devel- opment of drugs that have been approved, such as Amantadine, Rimantadine, Oseltamivir, Zanamivir, Peramivir, Laninamivir, Ribavirin and Arbidol. This review focuses on the influenza life- cycle and on the currently available drugs, while potential anti- viral compounds for the preven

Glycopeptide resistance in Staphylococcus aureus is a source of great concern because, especially in hospitals, this class of antibiotics, particularly vancomycin, is one of the main resources for combating infections caused by methicillin-resistant Staphylococcus aureus strains (MRSA). Reduced susceptibility to vancomycin (VISA) was first described in 1996 in Japan; since then, a phenotype with heterogeneous resistance to vancomycin (h-VISA) has emerged. H-VISA isolates are characterised by the presence of a resistant subpopulation, typically at a rate of 1 in 105 organisms, which constitutes the intermediate stage between fully vancomycin-susceptible S. aureus (VSSA) and VISA isolates. As VISA phenotypes are almost uniformly cross-resistant to teicoplanin, they are also called Glycopeptides-intermediate Staphylococcus aureus strains (GISA) and, in the case of heterogeneous resistance to glycopeptides, h-GISA. The overall prevalence of h-VISA is low, accounting for approximately 1.3% of all MRSA isolates tested. Mortality due to h-GISA infections is very high (about 70%), especially among patients hospitalised in high-risk departments, such as intensive care units (ICU). Given the great clinical relevance of strains that are heteroresistant to glycopeptides and the possible negative impact on treatment choices, it is important to draw up and implement infection control practices, including surveillance, the appropriate use of isolation precautions, staff training, hand hygiene, environmental cleansing and good antibiotic stewardship.

In the first part of this overview, we described the life cycle of the influenza virus and the pharmacological action of the currently available drugs. This second part provides an overview of the molecular mechanisms and targets of still-experimental drugs for the treatment and management of influenza.Briefly, we can distinguish between compounds with anti-influenza activity that target influenza virus proteins or genes, and molecules that target host components that are essential for viral replication and propagation. These latter compounds have been developed quite recently. Among the first group, we will focus especially on hemagglutinin, M2 channel and neuraminidase inhibitors. The second group of compounds may pave the way for personalized treatment and influenza management. Combination therapies are also discussed.In recent decades, few antiviral molecules against influenza virus infections have been available; this has conditioned their use during human and animal outbreaks. Indeed, during seasonal and pandemic outbreaks, antiviral drugs have usually been administered in monotherapy and, sometimes, in an uncontrolled manner to farm animals. This has led to the emergence of viral strains displaying resistance, especially to compounds of the amantadane family. For this reason, it is particularly important to develop new antiviral drugs against influenza viruses. Indeed, although vaccination is the most powerful means of mitigating the effects of influenza epidemics, antiviral drugs can be very useful, particularly in delaying the spread of new pandemic viruses, thereby enabling manufacturers to prepare large quantities of pandemic vaccine. In addition, antiviral drugs are particularly valuable in complicated cases of influenza, especially in hospitalized patients.To write this overview, we mined various databases, including Embase, PubChem, DrugBank and Chemical Abstracts Service, and patent repositories.

Influenza is a contagious respiratory acute viral disease charac- terized by a short incubation period, high fever and respiratory and systemic symptoms. The burden of influenza is very heavy. Indeed, the World Health Organization (WHO) estimates that annual epidemics affect 5-15% of the world?s population, causing up to 4-5 million severe cases and from 250,000 to 500,000 deaths. In order to design anti-influenza molecules and compounds, it is important to understand the complex replication cycle of the influenza virus. Replication is achieved through various stages. First, the virus must engage the sialic acid receptors present on the free surface of the cells of the respiratory tract. The virus can then enter the cells by different routes (clathrin-mediated endocytosis or CME, caveolae-dependent endocytosis or CDE, clathrin-caveolae-independent endocytosis, or macropinocyto- sis). CME is the most usual pathway; the virus is internalized into an endosomal compartment, from which it must emerge in order to release its nucleic acid into the cytosol. The ribonucleo- protein must then reach the nucleus in order to begin the pro- cess of translation of its genes and to transcribe and replicate its nucleic acid. Subsequently, the RNA segments, surrounded by the nucleoproteins, must migrate to the cell membrane in order to enable viral assembly. Finally, the virus must be freed to invade other cells of the respiratory tract. All this is achieved through a synchronized action of molecules that perform multi- ple enzymatic and catalytic reactions, currently known only in part, and for which many inhibitory or competitive molecules have been studied. Some of these studies have led to the devel- opment of drugs that have been approved, such as Amantadine, Rimantadine, Oseltamivir, Zanamivir, Peramivir, Laninamivir, Ribavirin and Arbidol. This review focuses on the influenza life- cycle and on the currently available drugs, while potential anti- viral compounds for the preven

Vaccines are a basic investment in the long term, both for Countries and the whole world – where they are estimated to save 2.5 million lives among children each year. In this perspective vaccine research and development are intensifying; several novel vaccines are authorized, implying that health decision-makers more frequently face constraint problems in planning the available resource allocation. Health Technology Assessment (HTA) is now acknowledged as a key tool for supporting decision-makers in making their choices. HTA is a multidisciplinary method, and the purpose of this article is to outline the issues to be taken into consideration when evaluating the introduction of a new vaccine: epidemiology of the illness, actors involved in its prevention, analysis of the available evidence, mathematical modeling and economic evaluations, ethical aspects, organizational impact on health care facilities and health professionals due to the vaccination campaigns.

Introduction. Tobacco smoking, which usually begins in teen- age, is one of the most important lifestyle risk factors for chronic diseases and a major public health problem worldwide. The aims of the study were to determine the prevalence of tobacco smoking and the mean age of initiation among adolescents in Genoa (Italy) and to identify some socio-demographic predictors that could be associated with the onset of smoking. Materials and methods. 2,301 randomly selected students (14- 19 years old) in Genoa completed an ad hoc questionnaire. The Kaplan-Meier method was used to evaluate the instantaneous risk of experimenting with smoking. A multivariate logistic regression model was used to determine whether current or previous smoking status was associated with socio-demographic characteristics. Results. 59.5% of respondents had tried smoking, while 35.6% defined themselves as current smokers. No difference in current smoking prevalence emerged between males and females (35.2% and 35.9%, respectively, p = 0.83). The mean age on initiation was 13.5 years for males and 13.9 years for females. The instantaneous probability of trying smoking changed with age, reaching a maximum at 14 years. Subjects who tried smoking before this age were more inclined to con- tinue smoking. The probability of being a current smoker was significantly higher among students from unmarried-parent families and those attend- ing vocational and technical secondary schools. Conclusions. There is a great need for the activation of new health promotion interventions and enforcement of those already existing, in order to raise awareness of the damage caused by smoking among adolescents, especially those belonging to high- risk groups.

An experimental study was conducted in a hospital in Liguria (northern Italy) on two groups of patients with the same disease severity who were undergoing the same type of surgery (primary hemiarthroplasty). Our aim was to assessing the results of a qual- ity-improvement scheme implemented in the operating room. The quality-improvement protocol involved analyzing a set of parameters concerning the operating team?s behavior and environ- mental conditions that could be attributed to the operating team itself. A program of training and sanitary education was carried to rectify any improper behavior of the operating staff. Two hundred and six hip-joint replacement operations (primary hip hemiarthroplasty - ICD9-CM 81.51) all conducted in the same operating room were studied: 103 patients, i.e. operations performed before the quality-improvement scheme and 103 patients, i.e. operations performed after the quality improvement scheme; all were comparable in terms of type of surgery and severity. The scheme resulted in an improvement in both behavioral and environ- mental parameters and an 80% reduction in the level of microbial air contamination (p inf. 0.001). Patient outcomes improved in terms of average postoperative hospitalization time, the occurrence and duration of fever (>37.5°C) and microbiological contamination of surgical wounds. From an economic point of view, facility efficiency increased by 28.57%, average hospitalization time decreased (p inf. 0.001) and a theoretical increase of ? 1,441,373.58 a year in revenues was achieved.

An experimental study was conducted in a hospital in Liguria (northern Italy) on two groups of patients with the same disease severity who were undergoing the same type of surgery (primary hemiarthroplasty). Our aim was to assessing the results of a qual- ity-improvement scheme implemented in the operating room. The quality-improvement protocol involved analyzing a set of parameters concerning the operating team?s behavior and environ- mental conditions that could be attributed to the operating team itself. A program of training and sanitary education was carried to rectify any improper behavior of the operating staff. Two hundred and six hip-joint replacement operations (primary hip hemiarthroplasty - ICD9-CM 81.51) all conducted in the same operating room were studied: 103 patients, i.e. operations performed before the quality-improvement scheme and 103 patients, i.e. operations performed after the quality improvement scheme; all were comparable in terms of type of surgery and severity. The scheme resulted in an improvement in both behavioral and environ- mental parameters and an 80% reduction in the level of microbial air contamination (p inf. 0.001). Patient outcomes improved in terms of average postoperative hospitalization time, the occurrence and duration of fever (>37.5°C) and microbiological contamination of surgical wounds. From an economic point of view, facility efficiency increased by 28.57%, average hospitalization time decreased (p inf. 0.001) and a theoretical increase of ? 1,441,373.58 a year in revenues was achieved.

Introduction. Tobacco smoking, which usually begins in teen- age, is one of the most important lifestyle risk factors for chronic diseases and a major public health problem worldwide. The aims of the study were to determine the prevalence of tobacco smoking and the mean age of initiation among adolescents in Genoa (Italy) and to identify some socio-demographic predictors that could be associated with the onset of smoking. Materials and methods. 2,301 randomly selected students (14- 19 years old) in Genoa completed an ad hoc questionnaire. The Kaplan-Meier method was used to evaluate the instantaneous risk of experimenting with smoking. A multivariate logistic regression model was used to determine whether current or previous smoking status was associated with socio-demographic characteristics. Results. 59.5% of respondents had tried smoking, while 35.6% defined themselves as current smokers. No difference in current smoking prevalence emerged between males and females (35.2% and 35.9%, respectively, p = 0.83). The mean age on initiation was 13.5 years for males and 13.9 years for females. The instantaneous probability of trying smoking changed with age, reaching a maximum at 14 years. Subjects who tried smoking before this age were more inclined to con- tinue smoking. The probability of being a current smoker was significantly higher among students from unmarried-parent families and those attend- ing vocational and technical secondary schools. Conclusions. There is a great need for the activation of new health promotion interventions and enforcement of those already existing, in order to raise awareness of the damage caused by smoking among adolescents, especially those belonging to high- risk groups.

Neisseria meningitidis is hosted only by humans and colonizes the nasopharynx; it survives in the human body by reaching an equilibrium with its exclusive host. Indeed, while cases of invasive disease are rare, the number of asymptomatic Neisseria menin- gitides carriers is far higher. The aim of this paper is to sum- marize the current knowledge of survival strategies of Neisseria meningitides against the human immune defences. Neisseria meningitidis possesses a variety of adaptive character- istics which enable it to avoid being killed by the immune system, such as the capsule, the lipopolysaccharide, groups of proteins that block the action of the antimicrobial proteins (AMP), pro- teins that inhibit the complement system, and components that prevent both the maturation and the perfect functioning of phago- cytes. The main means of adhesion of Neisseria meningitides to the host cells are Pili, constituted by several proteins of whom the most important is Pilin E. Opacity-associated proteins (Opa) and (Opc) are two proteins that make an important contribution to the process of adhesion to the cell. Porins A and B contribute to neisserial adhesion and penetration into the cells, and also inhibit the complement system. Factor H binding protein (fhbp) binds factor H, allowing the bac- teria to survive in the blood. Neisserial adhesin A (NadA) is a minor adhesin that is expressed by 50% of the pathogenic strains. NadA is known to be involved in cell adhesion and invasion and in the induction of proinflam- matory cytokines. Neisserial heparin binding antigen (NHBA) binds heparin, thus increasing the resistance of the bacterium in the serum. The full article is free available on www.jpmh.org

Neisseria meningitidis is hosted only by humans and colonizes the nasopharynx; it survives in the human body by reaching an equilibrium with its exclusive host. Indeed, while cases of invasive disease are rare, the number of asymptomatic Neisseria menin- gitides carriers is far higher. The aim of this paper is to sum- marize the current knowledge of survival strategies of Neisseria meningitides against the human immune defences. Neisseria meningitidis possesses a variety of adaptive character- istics which enable it to avoid being killed by the immune system, such as the capsule, the lipopolysaccharide, groups of proteins that block the action of the antimicrobial proteins (AMP), pro- teins that inhibit the complement system, and components that prevent both the maturation and the perfect functioning of phago- cytes. The main means of adhesion of Neisseria meningitides to the host cells are Pili, constituted by several proteins of whom the most important is Pilin E. Opacity-associated proteins (Opa) and (Opc) are two proteins that make an important contribution to the process of adhesion to the cell. Porins A and B contribute to neisserial adhesion and penetration into the cells, and also inhibit the complement system. Factor H binding protein (fhbp) binds factor H, allowing the bac- teria to survive in the blood. Neisserial adhesin A (NadA) is a minor adhesin that is expressed by 50% of the pathogenic strains. NadA is known to be involved in cell adhesion and invasion and in the induction of proinflam- matory cytokines. Neisserial heparin binding antigen (NHBA) binds heparin, thus increasing the resistance of the bacterium in the serum. The full article is free available on www.jpmh.org

Influenza constitutes a serious problem for healthcare and social services worldwide, owing to its pattern and the severity of its complications in some categories of subjects at risk, such as the elderly and immunocompromised individuals. The only really effective means of combating influenza is vaccination. The elderly and immunocompromised subjects are refractory or low responders to vaccination. The need for ever more immunogenic and efficacious influenza vaccines, especially for subjects at risk, has prompted the development of adjuvated vaccines. With a view to enhancing the immune response in the elderly and in subjects at risk, the possibility of co-administering immunostimulants as Thymosin ?-1 (T?1) with influenza vaccines has been investigated. T?1 is a biologically active peptide made up of 28 amino acids that can enhance T-cells, dendritic cell and antibody responses, modulate cytokines and chemokines production. Several studies were conducted and showed that T?1 ameliorate the performance of influenza vaccination in elderly and subjects at risk. Although further studies on co-adjuvants are necessary, the future prospects of producing ever more efficacious influenza vaccines appear very promising.

No abstract

Background. Numerous epidemiological studies have shown that air pollution due to both industry and heavy traffic has short- and long-term effects on health. The study was carried out in an industrial area with heavy urban and motorway traffic in the Province of Genoa (Italy). Methods. The study was carried out from June 2005 to July 2008. An epidemiologic study was conducted by monitoring an elementary/ middle school situated in an area of recent industrial development and an elementary/middle school located in an area free from sources of industrial pollution. Furthermore, we conducted an investigation of workers in commercial premises situated in one area of heavy vehicular traffic. In the study areas, environmental monitoring campaigns were carried out in order to determine the association between indoor and outdoor pollution and respiratory disorders. Results and discussion. The study did not bring to light any specific health problems attributable with certainty to industrial emissions. The impact of pollution caused by motor traffic proved to be greater than that due to industrial emissions. More exhaustive sampling campaigns should be implemented in order to quantify the effects of specific sources of emissions and to correlate these sources with pollutants (industry, urban traffic, motorway traffic).

Influenza constitutes a serious problem for healthcare and social services worldwide, owing to its pattern and the severity of its complications in some categories of subjects at risk, such as the elderly and immunocompromised individuals. The only really effective means of combating influenza is vaccination. The elderly and immunocompromised subjects are refractory or low responders to vaccination. The need for ever more immunogenic and efficacious influenza vaccines, especially for subjects at risk, has prompted the development of adjuvated vaccines. With a view to enhancing the immune response in the elderly and in subjects at risk, the possibility of co-administering immunostimulants as Thymosin ?-1 (T?1) with influenza vaccines has been investigated. T?1 is a biologically active peptide made up of 28 amino acids that can enhance T-cells, dendritic cell and antibody responses, modulate cytokines and chemokines production. Several studies were conducted and showed that T?1 ameliorate the performance of influenza vaccination in elderly and subjects at risk. Although further studies on co-adjuvants are necessary, the future prospects of producing ever more efficacious influenza vaccines appear very promising.