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To date, four vaccines have been authorised for emergency use and under conditional approval by the European Medicines Agency to prevent COVID-19: Comirnaty, COVID-19 Vaccine Janssen, Spikevax (previously COVID-19 Vaccine Moderna) and Vaxzevria (previously COVID-19 Vaccine AstraZeneca). Although the benefit–risk profile of these vaccines was proven to be largely favourable in the general population, evidence in special cohorts initially excluded from the pivotal trials, such as pregnant and breastfeeding women, children/adolescents, immunocompromised people and persons with a history of allergy or previous SARS-CoV-2 infection, is still limited. In this narrative review, we critically overview pre- and post-marketing evidence on the potential benefits and risks of marketed COVID-19 vaccines in the above-mentioned special cohorts. In addition, we summarise the recommendations of the scientific societies and regulatory agencies about COVID-19 primary prevention in the same vaccinee categories. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01131-6.

Introduction: Several studies in the adult population have shown that obesity is an independent risk factor for elevated intraocular pressure (IOP), whereas data in the paediatric population are sparse and controversial. The purpose of the present study is to investigate the relationship between body mass index (BMI), blood pressure (BP), and IOP in healthy school children. Methods: The survey was conducted among a random sample of 8-year-old Italian students. Data were collected on their health status and behaviours related to obesity (physical activity, food and drinking habits, etc.). Physical examinations, conducted at school, included measurements of height, weight, BP, and IOP. Results: Five hundred and seventy-six subjects were recruited (92.8% response rate); 42.4% were overweight or obese, 58.9% consumed inadequate daily servings of fruit and vegetables, and 87.5% were involved in sedentary activities. Elevated BP/hypertension (HTN) affected 3.6% and high IOP was revealed in 12.5% of the children. In the multivariate analysis, elevated BP/HTN was the only significant determinant of ocular HTN (OR 5.36, 95% CI 1.95–14.73, p = 0.001). Conclusions: Our results show that high IOP affects 12.5% of 8-year-old school children and appears to be associated with high BP related to a high BMI.

ObjectivesHealthcare workers, in the course of their professional activity, are potentially exposed to chemical, physical and above all biological risks. The aims of our study were to investigate the extent and distribution of needle-stick and sharp injuries (NSIs) in healthcare students, the behaviours and circumstances most frequently associated with NSIs, the frequency of NSI reporting and the adherence to the post-exposure protocols.MethodsThis study involved, through an interviewer-administered structured questionnaire, undergraduate and postgraduate students attending postgraduate medical schools and healthcare professional schools who underwent occupational health visits between January 2015 and July 2018.ResultsOf the 642 students that participated in the study, 95 (14.8%) sustained an NSI during the traineeship and, of these, 59 (62.1%) reported the NSI to the occupational health service. NSIs were significantly more frequent in older subjects (χ²=9.853, p=0.020) and, among medical residents, in surgical residents (χ²=31.260, pConclusionsThe study showed remarkable under-reporting, as well as a lack of preparedness of students for NSI preventive and post-exposure effective measures. Our findings underline that healthcare student education should be reinforced to ensure that safe practices are carried out when needles and sharps are involved, as well as stressing the importance of NSI reporting and adherence to post-exposure prophylaxis protocols.

Objectives In Italy, free HPV vaccination has been offered to 12 years-old girls since 2007, while for males only since 2015. The aims of our study were: to measure HPV vaccination coverage among young women; to assess willingness to receive HPV vaccination among unvaccinated males and females; to evaluate the association of coverage and attitudes with knowledge regarding HPV and with sexual behavior. Methods A cross-sectional survey was conducted in an Italian region among 18–30 year-old students attending medical and healthcare professions schools. Participants completed a self-administered questionnaire exploring knowledge, attitudes and behaviors related to HPV infections, sexually transmitted diseases and their prevention. Information on vaccination status was also verified for each student through the immunization records provided by the participants during the occupational medical visit. Results 517 students were enrolled, with a 97% response rate. Of female participants, 40.5% had received at least one dose of HPV vaccine, while among unvaccinated participants, 60.5% stated their willingness to be vaccinated. A negative attitude towards HPV vaccination was associated with an older age, whereas a correct knowledge that both sexes are at risk of HPV infection, and the knowledge that vaccine protects against cervical cancer were confirmed to be associated to a willingness to receive HPV vaccination. Conclusions Our results showed low HPV vaccination coverage among young women and high reported willingness to receive vaccination among both sexes. More active education on the link between HPV and all related cancers could be beneficial to help prevent significant burden of the HPV-related diseases.

Background Maternal and child health are internationally considered to be among the best measures for assessing health-care quality. The study was carried out with the following aims: 1) to assess the quality of perinatal care (PC) by measuring the frequencies of the five PC indicators developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and comparing results with international standards; 2) to examine whether maternal, pregnancy care and neonatal characteristics could be factors associated with the quality of perinatal care hospital performance, measured through these indicators. Methods We retrospectively reviewed medical charts of women over the age of 18 who experienced delivery in Gynecology/obstetrics wards between January–December 2016, and those of their newborns hospitalized in the Neonatology or Neonatal Intensive Care Unit (NICU) of a public non-teaching hospital in Catanzaro (Italy). Indicators were calculated according to the methodology specified in the manual for JCAHO measures. Univariate and multivariate analyses were performed to test the independent association of maternal, pregnancy care and neonatal characteristics on the adherence to JCAHO PC indicators. Results The records of 1943 women and 1974 newborns were identified and reviewed in order to be included in at least one of the PC indicators. Elective/early-term delivery, was performed in 27.6% of eligible women, far from the recommended goal (0%); cesarean section in nulliparous women with a term, singleton baby in a vertex position exceeded the suggested target of

Background: Several studies have revealed low vaccinations coverage among health-care workers (HCWs) for all vaccinations. The aim of our study was to evaluate the impact of the implementation of an on-site vaccination-dedicated clinic on the vaccination coverage rates of HCWs. Research design and methods: A quasi-experimental pre–post intervention study was carried out among undergraduate and postgraduate students attending medical and health-care professions schools. Results: We enrolled 804 students, 404 in the control and 400 in the experimental group. A significantly higher increase of vaccination coverage in the experimental group than in the control group for all the investigated vaccinations (p

Introduction Exposure to chemical compounds occurs in numerous occupational settings, among which the research and healthcare laboratories have not been adequately investigated. These settings are characterized by an extreme variability of the used compounds and by the frequent turnover of young researchers. The main objectives of the study were to explore the occupational exposure to hazardous chemical substances among research laboratory workers; to assess their awareness and perceptions regarding chemical hazards; to investigate adherence to guidelines on safe handling of chemical compounds; and to analyze the effects of several factors on these outcomes of interest. Methods The survey was conducted among research laboratories workers who were exposed to chemical substances during their activity. Subjects completed a questionnaire exploring knowledge, attitudes and behaviors related to chemical hazards involved in research activities. Results Enrolled subjects were 237, for an 81.7% response rate. More than 90 hazardous chemical substances were used in the surveyed laboratories. A correct knowledge on hazardous chemicals was significantly more likely in younger researchers, in those manipulating a higher number of hazardous chemicals, and in those with a higher number of years of training in the attended laboratory; 54.4% of the workers said they felt very exposed to chemical risk. Correct practices in the laboratories were significantly more likely in researchers who perceived to have a low exposure to chemicals, but a high exposure to biological risk, who agreed with the statement that colleagues handle chemicals following safety procedures and who perceived to have received an adequate training in the management of accidents and first aid. Conclusions Our results showed significant gaps in knowledge and scarce preparedness in the adherence to safety processes to prevent and contain risks related to use of chemical compounds in research laboratories.

Whether the primary Hepatitis B vaccination confers lifelong protection is debated. The aim of the study was to assess the effectiveness of booster doses in mounting a protective HBV immune response in subjects vaccinated 18&ndash, 20 years earlier. The study population consisted of vaccinated students attending medical and healthcare professions schools. A booster dose was offered to subjects with a &lt, 10 mIU/mL anti-HBs titer. The post-booster anti-HBs titer was evaluated after four weeks. The subjects with a &lt, 10 mIU/mL post-booster anti-HBs titer, received a second and third dose of the vaccine and after one month they were retested. A &lt, 10 mIU/mL anti-HBs titer was found in 35.1% of the participants and 92.2% of subjects that were boosted had a &ge, 10 mIU/mL post-booster anti-HBs titer, whereas 7.8% did not mount an anamnestic response. A low post-booster response (10&ndash, 100 mIU/mL anti-HBs) was significantly more likely in subjects with a &lt, 2.00 mIU/mL pre-booster titer compared to those with a 2.00&ndash, 9.99 mIU/mL pre-booster titer. The anamnestic response was significantly related to the baseline anti-HBs levels. A booster dose of the HBV vaccine may be insufficient to induce an immunological response in subjects with undetectable anti-HBs titers. A booster dose might be implemented when an anamnestic response is still present.

To assess the effectiveness of the ventilator bundle in the reduction of mortality in ICU patients.PubMed, Scopus, Web of Science, Cochrane Library for studies published until June 2017.Included studies: randomized controlled trials or any kind of nonrandomized intervention studies, made reference to a ventilator bundle approach, assessed mortality in ICU-ventilated adult patients.Items extracted: study characteristics, description of the bundle approach, number of patients in the comparison groups, hospital/ICU mortality, ventilator-associated pneumonia-related mortality, assessment of compliance to ventilator bundle and its score.Thirteen articles were included. The implementation of a ventilator bundle significantly reduced mortality (odds ratio, 0.90; 95% CI, 0.84-0.97), with a stronger effect with a restriction to studies that reported mortality in ventilator-associated pneumonia patients (odds ratio, 0.71; 95% CI, 0.52-0.97), to studies that provided active educational activities was analyzed (odds ratio, 0.88; 95% CI, 0.78-0.99), and when the role of care procedures within the bundle (odds ratio, 0.87; 95% CI, 0.77-0.99). No survival benefit was associated with compliance to ventilator bundles. However, these results may have been confounded by the differential implementation of evidence-based procedures at baseline, which showed improved survival in the study subgroup that did not report implementation of these procedures at baseline (odds ratio, 0.82; 95% CI, 0.70-0.96).Simple interventions in common clinical practice applied in a coordinated way as a part of a bundle care are effective in reducing mortality in ventilated ICU patients. More prospective controlled studies are needed to define the effect of ventilator bundles on survival outcomes.

Background Hospital stay represents the opportunity for a change of therapy, about which patients may not know indications, contraindications, and mode of administration, which may lead to dosing errors, drug interactions, side effects, etc. It is therefore vital to communicate appropriate information to the discharged patient with a new prescription drug. The purpose of the study was to evaluate: 1) how communication about new chronic therapies is managed at hospital discharge and what kind of information is provided to patients; 2) to what extent patients are aware and confident in the management of these medications; 3) whether the way communication is provided affects patients’ awareness and self-confidence in the management of these therapies. Methods Participants were adult patients who were prescribed at least one new chronic medication at hospital discharge. A telephone interview after hospital discharge was performed to assess whether or not hospital healthcare personnel had given information about prescribed therapies and which aspects of therapies had been object of information. Results Five hundred thirty patients were interviewed. 67.7% reported having received counseling by the hospital physician, while 32.3% by discharge form. Basic information on treatment was provided to the great majority of patients, whereas only few patients reported to have been informed about eventual side effects and related behavior in case of side effects. Conclusions Several aspects of patients’ knowledge and self-confidence on long term medications prescribed at hospital discharge need to be improved and the way communication is provided has a crucial role in the empowerment of patients in the management of these medications.

The aim of this survey was to examine the knowledge, attitudes, and behavior of gynecologists in terms of human papillomavirus (HPV) DNA testing as a primary screening tool for cervical cancer. A national cross-sectional web survey was carried out through multistage sampling using an overall sample of 1000 gynecologists. Gynecologists were asked to fill in a self-administered questionnaire exploring their knowledge, attitudes, and practice toward cervical cancer screening and HPV-DNA testing. A total of 582 gynecologists completed the web questionnaire. Of these, 24.5% were uncertain on the higher sensitivity of HPV-DNA compared with the Pap test, whereas 19% were uncertain on the role of the HPV-DNA test as a primary test in women younger than 30 years old and only 44.9% knew that a negative HPV-DNA test allows for an extension of the test interval to 5 years. Most gynecologists showed a definite positive attitude on the role of screening for cervical cancer prevention and were prepared to accept new technologies. The HPV-DNA test was considered highly effective by 86.9%, whereas 94% recommend/perform HPV-DNA tests in women older than 30 years of age; 25.5% performed HPV-DNA as a primary test, followed by a Pap test in those cases that were positive. Only 56.3% recommended/performed HPV-DNA tests 1 year after a positive HPV-DNA test, followed by a negative Pap test, whereas 42.9% recommended colposcopy. Although the use of the HPV-DNA test is very widespread among Italian gynecologists performing cervical cancer screening, there is lack of standardization of practices according to current guidelines.

The aim of this study was to quantify the burden of avoidable pediatric hospital admissions for Ambulatory care-sensitive conditions (ACSC) and to identify factors related to these preventable hospitalizations. The study was conducted by retrospectively reviewing all medical records of children admitted in a non-teaching 474-bed acute care hospital located in Catanzaro (Italy) for an avoidable hospitalization diagnosis. Two control clinical records involving children hospitalized for clinical conditions not classified as ACSC were randomly selected for each clinical record that included an ACSC. Among the 4293 pediatric hospitalizations, 451 (10.5%) were judged to be preventable. Of these, the most frequent discharge diagnoses were: dehydration (29.7%), pneumonia (17.7%), seizures (15.7%) and chronic obstructive pulmonary disease (12.9%).Children admitted for a preventable hospitalization were more likely to be females, to be younger, to be residents in the same province as the hospital and less likely to have had at least one Community-Based Pediatrician (CBP) access in the previous year and to have used the district health service. The burden of pediatric preventable hospitalizations found in this study is quite high, and the results show that there is still work that lies ahead on the way to improve interaction between hospital and community-based services.

Aida Bianco, Rosa Papadopoli, Valentina Mascaro, Claudia Pileggi, Maria Pavia Department of Health Sciences, Medical School, University of Catanzaro “Magna Græcia”, Catanzaro,Italy Purpose: The overuse, misuse, and underuse of antimicrobial agents often lead to the spread of antibiotic-resistant microorganisms. The aim of our study was to describe the pattern of antibiotic prescriptions for acute respiratory tract infections (RTIs) among the adult population and the factors associated with antibiotic prescribing. Patients and methods: The study involved patients who visited a general practitioner with suspected acute RTI. Patients with diagnosis of acute sinusitis, acute pharyngitis, acute bronchitis, and influenza were included in the study. We evaluated the presence of an indication for antibiotic therapy for selected diseases according to international guidelines. The appropriateness of any prescribed molecule was also evaluated. Results: A total of 1,979 cases of acute RTIs were included: 1,196 (60.4%) pharyngitis, 359 (18.2%) bronchitis, 234 (11.8%) influenza, and 190 (9.6%) sinusitis. An antibiotic prescription was given in 67.3% of the consultations and was not indicated by the guidelines in 66.5% of the total RTIs. Macrolides were the most frequently prescribed antibiotics accounting for 32.5% of all those prescribed, followed by amoxicillin with clavulanic acid (31.1%) and fluoroquinolones (14.2%). The highest overprescription was associated with pharyngitis (65.9%) and the lowest with influenza (4.9%). A throat swab was performed only in 11 of all the patients with a diagnosis of acute pharyngitis. Conclusion: The present study showed a very high frequency of nonevidence-based prescription of antibiotics at the primary care level. Future improvement programs should focus on development of evidence-based guidelines, access to postgraduate training, and better availability of diagnostic tools. Keywords: antibiotic prescribing, appropriateness, general practitioner, primary care, respiratory tract infections, Italy

Background The study aimed to evaluate the distribution of healthcare-associated infections (HAIs), the incidence rates and device utilization ratio (DUR) of device-associated infections (DAIs), as well as the distribution and patterns of antimicrobial resistance of the responsible pathogens. Methods Eligible patients who were admitted to an adult Intensive Care Unit (ICU) from May 1, 2013 to December 31, 2016 were included in the surveillance. Demographics, intrinsic and extrinsic risk factors, information regarding infection and isolated pathogens with antibiogram results were collected. Results One thousand two hundred eighty-three patients were included in the surveillance. One hundred forty-seven HAIs were detected with a cumulative incidence of 9.2 per 100 patients 4-year period and an incidence rate of 17.4 per 1000 patient days. Fifty-six out of 1283 patients were affected by at least one episode of ICU-acquired pneumonia, and 72.7% of these were associated with intubation. ICU-acquired bloodstream infections (BSIs) occurred in 4.4% of patients and 89.5% were catheter-related. ICU-acquired urinary tract infections (UTIs) occurred in 1% of patients, with 84.6% of the episodes being associated with the use of an urinary catheter. The pattern of antimicrobial-resistance in the isolates showed, among the Gram-positive bacteria, that 66.6% and 16.6% of Staphylococcus epidermidis were oxacillin and teicoplanin resistant, respectively. Among the Gram-negative bacteria, carbapenem resistance was found in 91.6% of Acinetobacter baumannii and 28.5% of Klebsiella pneumoniae isolates. Conclusions The majority of HAIs in the ICU studied were associated with the use of invasive devices. Since a significant proportion of these HAIs are considered preventable, reinforcement of the evidence-based preventive procedures are needed. Electronic supplementary material The online version of this article (10.1186/s13756-018-0337-x) contains supplementary material, which is available to authorized users.

Background The Internet represents an increasingly common source of health-related information. Internet and Social Media can be used to promote a prudent use of antibiotics. Objective To establish the extent of Internet and Social Media use to search for antibiotic related information and the potential implications in health care among adult population in Italy. Methods This cross-sectional study was conducted from March to May 2017, among a sample of parents of public school students. A 2-stage cluster sample design was planned. An informed consent form and a questionnaire were given to selected students to deliver to their parents. The questionnaire included questions on knowledge, attitudes, and behavior toward antibiotic use, and questions about Internet use to gather information about antibiotics. Results A total of 913 parents completed the questionnaire, with a 67.4% response rate; 22.1% did not know when it was appropriate to use antibiotics. 32.3% of parents reported self-medication with antibiotics. 73.4% of respondents used the Internet to search for information about antibiotic use. Among social networks users, 46.5% reported the use of these media to get information about antibiotics and 45% of instant messaging app users share information about antibiotics. The results of the multiple logistic regression analysis showed that Internet use to search for antibiotic-related information was higher among females, younger subjects, with a higher level of education, in those who reported self-medication with antibiotics and in those who needed additional information on side effects of antibiotics from the GP compared with those who did not need any additional information. Internet use was significantly less likely in participants with cardiovascular diseases and cancer compared with those without chronic conditions, and in those who reported to strongly agree/agree, or were uncertain about antibiotic use without a GP prescription, compared with those who reported to be disagree/strongly disagree. Conclusions Internet and social media are widely used for antibiotic-related information seeking in the Italian population. Health organizations must consider social media within their communication strategy to promote the appropriate Web use for antibiotic-related information seeking in the general population, although more evidence is needed regarding the optimal mix of communication interventions.

Protective antibodies levels, induced by Hepatitis B virus (HBV) vaccine, persist for long-term after primary immunization, but there is evidence that, as the time since vaccination increases, there is a reduced ability to maintain immune memory. The study aim was to determine the prevalence and the duration of persistence of an anti-HBs titer with ≥10mIU/mL and eventual predictors of reduced seroprotection.The study was conducted among students attending medical and healthcare professions schools from January 2014 to June 2016. Data were collected through the review of medical records completed during the medical surveillance visit. All subjects had received HBV vaccine according to the Italian Ministry of Health indications.The results are reported for 722 subjects. Positive anti-HBs titer was found in 72.6% (95% CI=69-76). The mean age of the subjects was 25.5years. Subjects vaccinated during adolescence and students that had received an adult vaccine dose were significantly more likely to be seroprotected. The longer the time interval since vaccination the lower the probability of being seroprotected; however if the role of time since vaccination was considered after stratification by vaccine dose, a statistically significant association with a lower percentage of seroprotected remains only in the subgroup of subjects who received the pediatric dose. The findings of the multivariate regression analysis partially confirmed those of the univariate analysis.In conclusion, our findings show that over 25% of HBV vaccine recipients had an antiHBs titer10mIU/ml after 18years of more from the primary vaccination. Furthermore, in the case a booster dose would be needed, our results suggest that the vaccination strategy should prefer administration of a vaccine adult dose during early adolescence, since it might offer longer-term protection through adulthood.

Background The role of serum ferritin (SF) as a prognostic factor has been analyzed in patients with myelodysplastic syndromes (MDS) who have undergone hematopoietic stem cell transplantation (HSCT), but the prognostic role of elevated SF levels is still controversial in lower risk MDS patients. Therefore, we performed a meta-analysis of all available published literature to evaluate whether elevated SF levels are associated with a worse overall survival (OS) among patients with low risk MDS. Material and methods A systematic bibliographic search of relevant studies was undertaken in accordance with guidelines for meta-analysis of observational studies in epidemiology. Electronic databases were searched through July 2016 for studies examining the level of SF as a prognostic factor in the adults affected by MDS. Results Six articles were included in the meta-analysis. A significant association between OS and SF was achieved for the threshold of SF≥1000 ng/mL, when the only study that used SF cut-off ≥2000 ng/mL was not included in the meta-analysis (RR = 1.33; 95% CI = 1.06–1.67). The estimated risk was 2.58 (95% CI = 1.41–4.74) when a SF cut-off≥500 ng/mL was considered. Conclusions Our findings underlined a worse survival in patients with MDS who had higher SF levels. The association was stronger and achieved statistical significance after stratification of analyses in which we excluded cut-offs of SF level considered as outliers. These results suggest that negative impact on OS already exist at SF level ≥500 ng/mL. Prospective studies, are needed to better understand this relationship and, above all, to clarify whether earlier iron chelation therapy could improve patients’ OS.

ObjectivesWomen make up approximately half of the world’s one billion migrants. Immigrant women tend to be one of the most vulnerable population groups with respect to healthcare. Cancer screening (CS) and maternal and reproductive health have been included among the 10 main issues pertinent to women’s health. The aim of this study is to explore breast and cervical CS participation and to acquire information regarding access to healthcare services during pregnancy, childbirth and the postpartum period among age eligible immigrant women in Southern Italy.MethodsA structured questionnaire was used to collect data from each participant. Women aged 25–64 years who had not had a hysterectomy and women aged 50–69 years without history of breast cancer were considered eligible for the evaluation of cervical and breast CS participation, respectively. Moreover, women who had delivered at least once in Italy were enrolled to describe antenatal and postpartum care services use. All women were recruited through the third sector and non-profit organisations (NPOs).ResultsRate of cervical CS among the 419 eligible women was low (39.1%), and about one-third had had a Pap test for screening purposes within a 3-year period from interview (32.8%). Regarding breast CS practices, of the 125 eligible women 45.6% had had a mammography for control purposes and less than a quarter (26, 20.8%) had their mammography within the recommended time interval of 2 years. About 80% of the respondents did not report difficulties of access and use of antenatal and postpartum services.ConclusionThis study provides currently unavailable information about adherence to CS and maternal and child health that could encourage future research to develop and test culturally appropriate, women-centred strategies for promoting timely and regular CS among immigrant women in Italy.

The study aims were focused on acquiring information about access to health-care services and to investigate the potential barriers affecting full access to health-care services. The study population consisted of immigrants and refugees aged 18 or more living in Italy for at least 12 months recruited through non-profit organizations. 961 immigrants took part in the study, with a response rate of 98.9 %. Of the participants, 85 % had access to a general practitioner (GP) at least once, and 46.6 and 22.4 % mentioned a minimum one emergency visit and hospital stay, respectively. Diagnostic procedures and/or drug prescriptions (49.7 %), chronic disease control (15.8 %), and preventive interventions (13 %) were the most reported reasons for GP access. This study yielded current and broader insight into the model of health-care utilization among immigrants. The findings adds to our understanding of the third-sector organizations’ role in facilitating immigrants’ access to services offered by the Italian National Health Service, contributing to the extensive discussion on how to best manage migrant health care in Italy.

The use of nonprescription medicines (NPDs) for children illnesses without a doctor’s suggestion can lead to unnecessary medication use and is not free of risks. The aim of our study was to examine attitudes and practice of parents towards NPDs use for their children. We also investigated the conditions that may predict NPDs use. A cross-sectional survey was conducted on parents of children attending Community Based Pediatrician (CBP) consultation and data were collected through structured interviews. Positive attitude on NPDs use was reported by 71.4% of parents, and 61.5% of them had administered NPDs in the previous 6 months. Antipyretic drugs were the most frequently used medication class without the supervision of the CBP. A positive attitude towards NPDs was significantly more frequent in parents who did not use the CBP as the sole source of information about drugs. The study demonstrated a widespread use of NPDs in children in our context, supported by a substantial positive attitude towards their safety. However, considering potential harms related to some NPDs and the finding that most parents rely on CBP advice, role of CBP on appropriate use of NPDs by parents should be emphasized.

Background: The purpose of this study was to determine the frequency and characteristics of paediatric attendance as a source of medically non-urgent problems at an accident and emergency department (ED) of a public non-teaching hospital in Crotone (Italy). Methods: For each patient aged 16 years or younger, there were collected information on demographics and socioeconomic characteristics, medical history, route of referral, clinical complaints that they presented at the moment of their presentation at the ED, duration of presenting problems prior to arrival, hour of arrival, day of the week of arrival, and reason for attending the ED. Data about the consultation process and the final decision made were also recorded. Results: Of a total of 980 patients included in the study, 27.6% had conditions that were definitely non-urgent. Multiple logistic regression analysis showed that the visit was non-urgent in younger population, in females, and in those attending the ED on the weekend. The results of the second multivariable regression analysis model indicate that patients who did not receive medical or surgical examination at the ED, with problems of longer duration prior to arrival at the ED, with non-traumatic injuries, and who did not require inpatient hospital admission were more likely to use the ED as a source of non-urgent care. The most frequent presenting problems for patient visits to ED were injury, respiratory diseases, and digestive symptoms. Conclusion: A closer cooperation within the health care organization system to provide a service responsive to the real needs of patients is essential.

Objective: This study investigated the profile of drivers involved in automobile accidents attending a hospital emergency department (ED) in Catanzaro (Italy). Methods: Car drivers involved in automobile accidents who were registered for emergency care between May 2003 and February 2004 were included in the study. Demographics and details of the accident were collected immediately after admittance, before examination by the medical staff. For each patient, the medical staff completed a form including diagnostic investigations and medical/surgical examination in the ED. Results: Of a total of 424 drivers included in the study 27.4% had conditions that were definitely non-urgent problems. Multiple logistic regression analysis indicated that the use of the ED as a source of non-urgent care was significantly higher among patients who were driving at a lower speed when the accident occurred, among those who presented to the ED before the implementation of the new Italian traffic code, and among those who underwent fewer diagnostic investigations and medical/surgical examinations in the ED. Most of the automobile related lesions occurred in the neck (43.9%) followed by multiple body regions (12.5%) and the upper extremities (10.4%). According to the nature of the injury a third were contusions (34%), followed by pain without physical signs and symptoms (28.8%), and dislocation, sprains, and strains (22.9%). Conclusions: Development of health promotion and education campaigns is required to prevent the use of the ED as a source of non-urgent care by those involved in automobile accidents.

Objective. The objective of this study was to measure inappropriateness of admission and inpatient days in pediatric hospital wards in Catanzaro, Italy, and the effect of different variables on such inappropriateness.Design. A retrospective application was made using the Pediatric Appropriateness Evaluation Protocol list of criteria. For each patient, there were recorded data on: sociodemographic characteristics; distance from home to hospital; date, day of the week, ward, and type of admission; overall and pre-index day length of hospital stay; and location within the stay of the day reviewed.Results. A total of 656 children were reviewed. Overall, 30% of the hospital admissions and 55.5% of days of stay were judged to be inappropriate; for about one third of those admitted inappropriately, the hospital stay was judged to be appropriate. Multiple logistic regression analysis indicated that the inappropriate admission was significantly higher if the admission occurred during the daytime. The inappropriate number of days of hospitalization was significantly higher if the patient was female, if the admission was urgent, in medical wards, for patients who were inappropriately admitted, and for those sampled close to discharge. The main reasons for inappropriate use were hospital organization and an over-cautious physician in the management of a patient.Conclusions. The high degree of inappropriate admission or days of stay in pediatric wards and the reasons for such unnecessary hospital use suggest the need for a more vigilant interaction between hospital and community-based services to mitigate such inappropriateness and for a continuing education system to define standardized guidelines.

Objective The primary purpose of this study is to explore primary care physicians' (PCPs') knowledge, attitudes and self-reported activities provided to patients for smoking cessation. The secondary purpose is to identify the relationships between physician-related characteristics and knowledge, attitudes and self-reported activities for smoking cessation. Method A national cross-sectional web survey was conducted in Italy from April through September 2012. Results 722 PCPs completed the questionnaire. The great majority indicated the correct proportion of smokers among patients with lung cancer, the smoking abstention required for risk reduction after smoking cessation, and tobacco as a known major risk factor for chronic obstructive pulmonary disease (COPD), whereas 28.7% knew the Fagerstrom test for the assessment of nicotine dependence. Almost all PCPs reported that they ask all patients if they smoke, inform about the dangers of smoking and recommend to quit smoking, whereas prescription of recommended drugs for smoking cessation varied from 37.7% for nicotine replacement therapy to 4.9% for varenicline. Conclusion Despite a positive attitude, Italian PCPs are not prepared to deliver effective interventions for smoking cessation in their patients.

Human-papillomavirus (HPV) DNA testing has been proposed as an alternative to primary cervical cancer screening using cytological testing. Review of the evidence shows that available data are conflicting for some aspects. The overall goal of the study is to update the performance of HPV DNA as stand-alone testing in primary cervical cancer screening, focusing particularly on the aspects related to the specificity profile of the HPV DNA testing in respect to cytology. We performed a meta-analysis of randomized controlled clinical trials. Eight articles were included in the meta-analysis. Three outcomes have been investigated: relative detection, relative specificity, and relative positive predictive value (PPV) of HPV DNA testing versus cytology. Overall evaluation of relative detection showed a significantly higher detection of CIN2+ and CIN3+ for HPV DNA testing versus cytology. Meta-analyses that considered all age groups showed a relative specificity that favored the cytology in detecting both CIN2+ and CIN3+ lesions whereas, in the ≥30 years' group, specificity of HPV DNA and cytology tests was similar in detecting both CIN2+ and CIN3+ lesions. Results of the pooled analysis on relative PPV showed a not significantly lower PPV of HPV DNA test over cytology. A main key finding of the study is that in women aged ≥30, has been found an almost overlapping specificity between the two screening tests in detecting CIN2 and above-grade lesions. Therefore, primary screening of cervical cancer by HPV DNA testing appears to offer the right balance between maximum detection of CIN2+ and adequate specificity, if performed in the age group ≥30 years.

BACKGROUND: This survey was intended to investigate prevalence and severity of early childhood caries (ECC) in a sample of children in Southern Italy and to identify factors that may be related to this condition. METHODS: The study was designed as a cross-sectional survey. The study population (children aged 36-71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure. Parents/guardians of all eligible children were invited to participate filling out a structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school. The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices. The WHO caries diagnostic criteria for deciduous decayed, missing and filled teeth (dmft) and surfaces (dmfs) were used to record ECC and severe-ECC (S-ECC). Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs. RESULTS: 515 children participated in the study. 19% had experienced ECC, and 2.7% severe-ECC (S-ECC), with a mean dmft and dmfs scores of 0.51 and 0.99, respectively. Mean dmft was 2.68 in ECC subjects, and 6.86 in S-ECC subjects. Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 1.95; 95% CI = 1.3-2.91) and duration of breastfeeding (OR = 1.26; 95% CI = 1.01-1.57), whereas it was significantly lower in children of more educated mothers (OR = 0.64; 95% CI = 0.42-0.96), and higher in those who had been visited by a dentist in the previous year (OR = 3.29; 95% CI = 1.72-6.33). CONCLUSIONS: Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population.

To elicit information about parents' knowledge, attitudes, and acceptability toward HPV infection and vaccination of male adolescents in Italy; to identify subgroups of this population who exhibit poor knowledge about prevention of HPV infection and reveal negative attitudes toward HPV vaccination in relation to their male sons.Data were collected via self-administered anonymous questionnaire from 1021 parents of males aged 10 to 14 y who were recruited from a random sample of public secondary schools in the South of Italy.Three-quarters (72.6%) reported that the vaccine is a preventive measure for HPV infection and 55.8% that condom use reduces the risk of HPV infection. A high education level, abundant sources of information about HPV infection received from physicians, and knowledge about HPV infection were factors significantly associated with high level of knowledge about preventive measures for HPV infection. 71% revealed their intentions to vaccinate their sons, and this intention was significantly associated with perceived benefits both for HPV vaccination for girls and for childhood recommended vaccinations as well as a need for additional information about HPV vaccination. 53.7% of the eligible parents reported that their daughters had been vaccinated against HPV.Results of the study suggest that the risk of acquiring HPV infection and HPV-related diseases is sorely underestimated. Knowledge on the benefits of adolescents' HPV vaccination in cancer prevention in both sexes should be improved to maximize uptake of HPV vaccination.

Objectives To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs) for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH), to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care. Methods Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged

Background: The Internet represents an increasingly common source of health-related information, and it has facilitated a wide range of interactions between people and the health care delivery system. Objective: To establish the extent of Internet access and use to gather information about health topics and the potential implications to health care among the adult population in Calabria region, Italy. Methods: This cross-sectional study was conducted from April to June 2012. The sample consisted of 1544 adults aged ≥18 years selected among parents of public school students in the geographic area of Catanzaro in southern Italy. A 2-stage sample design was planned. A letter summarizing the purpose of the study, an informed consent form, and a questionnaire were given to selected student to deliver to their parents. The final survey was formulated in 5 sections: (1) sociodemographic characteristics, (2) information about chronic diseases and main sources of health care information, (3) information about Internet use, (4) data about the effects of using the Internet to search for health information, and (5) knowledge and use of social networks. Results: A total of 1039 parents completed the questionnaire, with a response rate equivalent to 67.29%. Regarding health-related information types, 84.7% of respondents used the Internet to search for their own medical conditions or those of family members or relatives, 40.7% of parents reported looking for diet, body weight, or physical activity information, 29.6% searched for vaccines, 28.5% for screening programs, and 16.5% for smoking cessation tools and products. The results of the multiple logistic regression analysis showed that parents who looked for health-related information on the Internet were more likely to be female (OR 1.53, 95% CI 1.05-2.25), with a high school diploma (OR 1.69, 95% CI 1.02-2.81) or college degree (OR 2.14, 95% CI 1.21-3.78), younger aged (OR 0.96, 95% CI 0.94-0.99), with chronic conditions (OR 1.94, 95% CI 1.17-3.19), not satisfied with their general practitioner’s health-related information (OR 0.6, 95% CI 0.38-0.97), but satisfied with information from scientific journals (OR 1.99, 95% CI 1.33-2.98). Conclusions: Our analyses provide important insights into Internet use and health information–seeking behaviors of the Italian population and contribute to the evidence base for health communication planning. Health and public health professionals should educate the public about acquiring health information online and how to critically appraise it, and provide tools to navigate to the highest-quality information. The challenge to public health practice is to facilitate the health-promoting use of the Web among consumers in conjunction with their health care providers. [J Med Internet Res 2013;15(9):e204]

OBJECTIVE: To assess relationship between obesity and chronic shorter sleep duration in children and to determine if lack of sleep represents an independent determinant of childhood Body Mass Index. METHODS: This cross-sectional study was conducted in all children enrolled in the fifth class (approximately 10 years of age) of all public primary schools in Catanzaro (Southern Italy). The overall response rate was 62% resulting in 542 participating children. Parents completed a questionnaire with information on their demographics and socio-economic characteristics, their health status, characteristics of their child birth and health status. The sleeping habits were investigated in the 3 months preceding the consultation and parents were asked to indicate hours of bedtime and wake-up of their children. Multivariate linear regression analysis was performed to examine the association between child BMI and chronic lack of sleep. RESULTS: 36.7% of the children surveyed were overweight or obese. A quarter of children did not routinely play sports and many of them spent more than an hour a day watching TV (60.7%) and using videogames or computer (51.1%). Widespread dietary habits were inadequate, especially concerning vegetables and fruit intake with more than 95% of children who consumed insufficient amounts. The average duration of sleep was equal to 9.4 (SD = ±0.6) hours, and the short-sleepers accounted for 38.9% of the total sample. The results of multivariate analysis showed a significant 0.77 Kg/m(2) increase of BMI for children classified as short compared to normal sleepers (95%CI = 0.16-1.38, p = 0.01). CONCLUSIONS: Chronic lack of sleep appears to be associated to higher BMI even in middle childhood and strongly suggests that public health strategies, focused on promoting healthy lifestyles should include an innovative approach to ensure an adequate duration of sleep at night especially in children, alongside more traditional approaches. Language: en

Background: In Italy patients are supposed to choose their primary care physician (PCP), but many prefer to attend specialists or hospitals. To understand the patients’ decision processes regarding selection of PCP, their attitudes, perceptions and related behaviours on the role of PCPs in Italy were investigated. Methods: A random sample of parents received a questionnaire concerning information on demographic and socio-economic characteristics, health status, utilization of health services, attitudes and behaviours towards PCPs. Results: A total of 387 (48.4%) subjects participated in the study. Of the sample subjects, 70% had attended a PCP in the previous year, 45% a specialist, and 40% a hospital. Reasons for not attending a PCP were absence of health problems (52.5%), preference for specialists (18.8%), and self-care (17.5%). For almost all responders (88.8%) the first medical person they attended regarding health problems was the PCP, mainly because of confidence in professional skills (45.1%), satisfaction regarding the interpersonal relationship (25.8%), easy access to visit (14%), and medical prescriptions (14%). Patients were significantly more willing to visit a PCP if they were of lower education level and had visited a PCP in the previous year; those who preferred a PCP to present severe health problems were significantly more likely to be young, not affected by a chronic disease, and had attended a PCP in the previous year. Conclusions: The majority of patients perceived the role of PCPs as ‘gate-keepers’ and further research is needed to explore how PCPs’ attitudes and behaviour can enhance patients’ trust in primary health care.

The aims of this study were to describe the adherence to CDC guidelines for intrapartum antibiotic prophylaxis (IAP) and to identify possible factors influencing noncompliance with guidelines. We conducted a retrospective study in Italy. Our cohort included women in whom antenatal Group B Streptococcus (GBS) screening was not performed, was performed, but results were not available at the time of labor or delivery and women who were positive for GBS colonization. The indications for complete execution of IAP according to revised CDC guidelines was evaluated. It was considered adequate when performed with a recommended antibiotic at least four hours prior to delivery. The cohort included 902 women. Among those who had performed rectal and vaginal swabs (or recto-vaginal swabs), results were available in 86.9% of vaginal swabs and in 87.1% of rectal swabs and GBS was detected in 59.8% of vaginal swabs and in 71% of rectal swabs. 49.2% women had indication for GBS prophylaxis. Among these, 91.1% received an antibiotic during labor. Totally appropriate IAP was performed in 36.3% deliveries, an inappropriate antibiotic was administered in 10.4% women, the remaining 45.3% women received partially appropriate IAP; of these, 15.5% had received antibiotics through an inappropriate route of administration, 18.2% an inappropriate dosage regimen. Overall, 27.5% women received intrapartum ampicillin with inappropriate timing. Multivariate analysis showed that totally appropriate prophylaxis was significantly more likely in women who had no previous live birth, who had vaginal delivery, and a positive result at antenatal GBS screening. Despite satisfactory GBS screening implementation, there is still a substantial gap between optimal and actual IAP. We hypothesize that the complexity of the CDC guidelines may partially explain this shortcoming. Future efforts will include initiatives focused at enabling and reinforcing adherence to evidence-based prevention practices.

Background To assess the effectiveness of a postdischarge surveillance system to reveal cases of postpartum infections that could be missed by the current in-hospital routine surveillance and to identify predictors of postpartum infections. Methods The prospective surveillance included obstetrics patients. The information recorded included sociodemographic characteristics, infection-predisposing conditions, documentation of extrinsic risk factors, variables related to pregnancy and delivery, and variables related to each patient’s newborn. A telephone interview on Day 30 after hospital discharge was performed to retrieve information related to signs and symptoms of infection. Results One thousand seven hundred five patients agreed to participate for a response rate of 93%. One hundred forty-nine (8.9%) patients contacted by telephone reported at least 1 episode of infection within 30 days of discharge. There were 24 infections occurring during hospitalization, representing only 16.1% of all infections. There was an increased risk of postpartum infections in women with complications during labor, in those who had a caesarean delivery, and in those who reported alcohol consumption during pregnancy. Conclusion Our study demonstrated the need for implementing postdischarge surveillance programs for obstetrics patients that also identify infections following vaginal delivery. Postdischarge surveillance by telephone contact proved to be a feasible and effective method.

Objective. To investigate physicians’ knowledge about evidence-based patient safety practices, their attitudes on preventing and managing medical errors and to explore physicians’ behavior when facing medical errors. Design. A nationwide cross-sectional survey. Setting. We first stratified our population by the 20 Italian regions. Then, within each stratum, we selected by simple random sampling, for each region, one regional general hospital and one district general hospital to yield a sample of 40 hospitals overall. Participants. Twelve hundred physicians involved in direct patient care (30 per hospital) were sent a survey by mail and 696 responded. Main Outcome Measures. Knowledge on patient safety practices, attitudes and practices toward the prevention of medical errors. Results. Physicians’ knowledge of evidence-based safety practices was inconsistent. More than 90% of physicians reported that counting surgical items during an invasive surgical procedure represented a patient safety practice. Positive attitudes about patient safety were revealed by responses, but 44.5 and 44.1%, respectively, agreed or were uncertain about the disclosure of errors to the patients. The pattern of behavior showed that 7.6% of physicians reported to have never been involved in medical errors, and among system failures, ‘overwork, stress or fatigue of health professionals’ was the most highly rated item. Conclusions. The results from our study highlight that greater efforts are needed to facilitate the translation of positive attitudes towards patient safety into appropriate practices that have proven to be effective in the reduction of medical errors.

Objectives The main objective of the present study was to estimate the uptake to quality indicators that reflect the current evidence-based recommendations and guidelines. Methods A retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare & Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequency or median was calculated, as appropriate, for each indicator. A composite score was calculated to estimate the overall performance for each area of care. Results A total of 1772 medical records were reviewed. The adherence rates showed a wide-ranging variability among the selected indicators. The use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for AMI, the use of ACEI or ARB for HF, the use of appropriate thromboembolism prophylaxis and appropriate hair removal for surgical patients almost approached optimal adherence. At the other extreme, rates regarding adherence to smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcal vaccination in pneumonia patients were noticeably intangible. Overall, the recommended processes of care among eligible patients were provided in 70% for AMI, in 32.4% for HF, in 46.4% for PN, and in 46% for SCIP. Conclusions The results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specific conditions, especially on the area of preventive care.

Background Self-reported health status in underserved population of prisoners has not been extensively explored. The purposes of this cross-sectional study were to assess self-reported health, quality of life, and access to health services in a sample of male prisoners of Italy. Methods A total of 908 prisoners received a self-administered anonymous questionnaire pertaining on demographic and detention characteristics, self-reported health status and quality of life, access to health services, lifestyles, and participation to preventive, social, and rehabilitation programs. A total of 650 prisoners agreed to participate in the study and returned the questionnaire. Results Respectively, 31.6% and 43.5% of prisoners reported a poor perceived health status and a poor quality of life, and 60% admitted that their health was worsened or greatly worsened during the prison stay. Older age, lower education, psychiatric disorders, self-reported health problems on prison entry, and suicide attempts within prison were significantly associated with a perceived worse health status. At the time of the questionnaire delivery, 30% of the prisoners self-reported a health problem present on prison entry and 82% present at the time of the survey. Most frequently reported health problems included dental health problems, arthritis or joint pain, eye problems, gastrointestinal diseases, emotional problems, and high blood pressure. On average, prisoners encountered general practitioners six times during the previous year, and the frequency of medical encounters was significantly associated with older age, sentenced prisoners, psychiatric disorders, and self-reported health problems on prison entry. Conclusions The findings suggest that prisoners have a perceived poor health status, specific care needs and health promotion programs are seldom offered. Programs for correction of risk behaviour and prevention of long-term effects of incarceration on prisoners' health are strongly needed.

Background The primary influenza prevention strategy is focused on annual vaccination according to the categories identified in the various countries as being at greatest risk of complications. Many studies were conducted in order to demonstrate that intradermal (ID) vaccine formulation represents a promising alternative to conventional intramuscular (IM) formulation, especially in subjects with an impaired immune system. However, there is no consensus whether the efficacy and safety of ID is equivalent to IM in these subjects. Therefore, we performed a meta-analysis of Randomized Controlled Trials (RCT) to compare the immunogenicity and safety of ID and IM influenza vaccines in subjects with a depleted immune system. Methods We conducted a search strategy of medical literature published until November 2014 in order to identify RCTs that evaluated the immunogenicity and safety of ID compared with IM influenza vaccines in immunocompromized patients. Results We identified a total of 269 citations through research in electronic databases and scanning reference lists. Of these, 6 articles were included in the meta-analysis, for a total of 673 subjects. The seroprotection rate induced by the ID vaccine is comparable to that elicited by the IM vaccine. The overall RR was 1.00 (95 % CI = 0.91 -1.10) for A/H1N1 strain, 1.00 (95 % CI = 0.90-1.12) for A/H3N2 and 0.99 (95 % CI = 0.84 -1.16) for B strain. No significant differences in the occurrence of systemic reactions were detected (17.7 % in the ID group vs 18.2 % in the IM group) with a pooled RR = 1.00 (95 % CI = 0.67 -1.51), whereas ID administration caused significantly more injection site reactions with a mean frequency of 46 % in the ID group compared to 22 % in the IM group, with a pooled RR = 1.89 (95 % CI = 1.40 -2.57). Conclusions The ID influenza vaccine has shown a similar immunogenicity and safety to the IM influenza vaccine in immunocompromized patients, and it may be a valid option to increase compliance to influenza vaccination in these populations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1161-z) contains supplementary material, which is available to authorized users.