Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal

Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014±2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system

Childhood vaccinations: A pilot study on knowledge, attitudes and vaccine hesitancy in pregnant women

Background. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women. Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome. Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent. Conclusion. The questionnaire proved reliable and is suitable for further studies

Effect of Hypoxia-Induced Micro-RNAs Expression on Oncogenesis

MicroRNAs (miRNAs) are small non-coding RNAs that negatively regulate gene expression at the post-transcriptional level. An aberrant regulation of gene expression by miRNAs is associated with numerous diseases, including cancer. MiRNAs expression can be influenced by various stimuli, among which hypoxia; however, the effects of different types of continuous hypoxia (moderate or marked) on miRNAs are still poorly studied. Lately, some hypoxia-inducible miRNAs (HRMs, hypoxia-regulated miRNAs) have been identified. These HRMs are often activated in different types of cancers, suggesting their role in tumorigenesis. The aim of this study was to evaluate changes in miRNAs expression both in moderate continuous hypoxia and marked continuous hypoxia to better understand the possible relationship between hypoxia, miRNAs, and colorectal cancer. We used RT-PCR to detect the miRNAs expression in colorectal cancer cell lines in conditions of moderate and marked continuous hypoxia. The expression of miRNAs was analyzed using a two-way ANOVA test to compare the differential expression of miRNAs among groups. The levels of almost all analyzed miRNAs (miR-21, miR-23b, miR-26a, miR-27b, and miR-145) were greater in moderate hypoxia versus marked hypoxia, except for miR-23b and miR-21. This study identified a series of miRNAs involved in the response to different types of continuous hypoxia (moderate and marked), highlighting that they play a role in the development of cancer. To date, there are no other studies that demonstrate how these two types of continuous hypoxia could be able to activate different molecular pathways that lead to a different expression of specific miRNAs involved in tumorigenesis

Childhood vaccinations. Validation of a tool for measuring knowledge, attitudes and vaccine hesitancy in pregnant women

Background. The objective of this pilot study was to test a questionnaire aimed at assessing knowledge of and attitudes towards vaccination, as well as intention to vaccinate, among pregnant women. Methods. The questionnaire was self-administered by 49 pregnant women attending antenatal classes at three Family Centers in Rome. Results. Poor knowledge of vaccinations, inadequate attention from healthcare professionals, recurrent consultation of unreliable sources of information, and misconceptions about the side effects of vaccines, all contribute to vaccine hesitancy. Where appropriate, questionnaire sections were shown to be internally consistent. Conclusion. The questionnaire proved reliable and is suitable for further studies

IF A MISTAKE OR DO SOMETHING WRONG, IT WILL DO IN TRIPLICATE…… INVESTIGATION ABOUT CASES OF REPORTS FOR MOBBING AT INAIL OFFICE FROM APULIA REGION IN THE YEARS 2010-2014

Mobbing may cause the appearance of reactive mental disorders related and based to a pathogen and peculiar working environment. Usually in “Mobbing” cases we analyze the point of view of the patient, what he believes he has suffered, we listen to his reasons, we record his suffering but often it’s not possible to check and verify if this is true checking with the other party, with the Employer. Our purpose is to understand and recognize if the Mobbing situation is really in place and the quality of the Mobbing action accomplished by the employer. Our aim is to evaluate the psychological aspect that are usually examined only from the patient / “alleged victim” point of view, both clinical and forensic. The doctor has no tool to evaluate – very rarely it happens – about complains, about the mobbing environment, about downgrading of duties. For this reason, the research on data and records for years 2010-2014 provided by INAIL – Apulia Region, even if based only on official acts and documents, is in our point of view important: we have been able to have a better understanding on a complex phenomenon like the Mobbing and regarding the damage evaluation of the medical/legal, psychological, psychiatric/forensic aspects

[The elimination of measles and rubella in Italy]

Despite the WHO target for measles and rubella elimination in 2015, outbreaks still occur in all WHO Regions. After a description of the epidemiological situation of measles and rubella worldwide and especially in Europe, this paper aims to provide a detailed analysis of the current epidemiological context of Italy. The surge in the number of measles cases since the beginning of 2017, together with vaccination coverage still far from the 95% target, requires priority actions to be taken to achieve the elimination goals. Alongside the recently approved decree reintroducing compulsory vaccinations for school admissions, further measures are needed and should include the increase in the commitment of the 21 Regions; the implementation of supplemental immunization activities; improving the communication skills of health care workers; ensuring an effective communication with citizens; the enhancement of the surveillance network

Effectiveness over time of a multimodal intervention to improve compliance with standard hygiene precautions in an intensive care unit of a large teaching hospital

Background: Standard hygiene precautions are an effective way of controlling healthcare-associated infections. Nevertheless, compliance with hand hygiene (HH) guidelines among healthcare workers (HCWs) is often poor, and evidence regarding appropriate use of gloves and gowns is limited and not encouraging. In this study, we evaluated the ability over time of a multimodal intervention to improve HCWs compliance with standard hygiene precautions. Methods: Trend analysis of direct observations of compliance with HH guidelines and proper glove or gown use was conducted in the medical/surgical intensive care unit (ICU) of Umberto I Teaching Hospital of Sapienza University of Rome. The study consisted of two phases: a six-month baseline phase and a 12-month post-intervention phase. The multimodal intervention was based on the World Health Organization strategy and included education and training of HCWs, together with performance feedback. Results: A total of 12,853 observations were collected from November 2016 to April 2018. Overall compliance significantly improved from 41.9% at baseline to 62.1% (p < 0.001) after the intervention and this improvement was sustained over the following trimesters. Despite variability across job categories and over the study period, a similar trend was observed for most investigations. The main determinants of compliance were job category (with nurses having the highest compliance rates), being a member of ICU staff and whether delivering routine, as opposed to emergency, care. HH compliance was modified by glove use; unnecessary gloving negatively affected HH behaviour while appropriate gloving positively influenced it. Conclusions: The multimodal intervention resulted in a significant improvement in compliance with standard hygiene precautions. However, regular educational reinforcement and feedback is essential to maintain a high and uniform level of compliance

Seasonal influenza vaccination among health-care workers. The impact of different tailored programs in four University hospitals in Rome

Seasonal influenza vaccination (SIV) of health-care workers (HCWs) is recommended in most countries to protect them and their patients from infection. Although SIV can reduce the risk of influenza complications among vulnerable patients, vaccination uptake is generally unsatisfactory. The present study aimed to assess the impact of different programs in promoting SIV uptake among HCWs during the season 2017/2018 in four teaching hospitals in Rome. A multicentric cross-sectional study was carried out, in order to describe the four different campaigns and to assess their impact by identifying and developing a set of indicators that provide information about the vaccination services, the percentage of invited HCWs, the vaccinators’ workforce and the vaccination coverage rates. The hospitals organized different strategies: Hospital 1, 3 and 4 organized educational courses for HCWs and actively invited every single HCW through e-mail. All the hospitals organized a dedicated unit for influenza vaccination, and Hospital 1 added on-site vaccination sessions that required a large number of staff. Hospital 1 and hospital 4 registered a comparable vaccination coverage rate, 12.97% and 12.76%, respectively, while it was 6.88% in Hospital 2 and 4.23% in Hospital 3. Our indicators demonstrated to be effective and useful for analyzing the different SIV campaigns. The results suggest that the best practice to promote SIV among HCWs should include multiple approaches. Among those, an easy access to the vaccination site seems to play a key role in determining a higher vaccination coverage

Siti Internet e social media per la diffusione di un'informazione completa e verificabile in tema di vaccinazioni in una regione d'Italia: l'esperienza di "Vaccinarsi in Lazio".

INTRODUZIONEVaccinarsi in Lazio \ue8 uno dei portali web regionali che ruotano intorno al sito VaccinarS\uec. Nato dalla collaborazione tra enti, regioni, universit\ue0, aziende sanitarie locali e societ\ue0 scientifiche, questo sito unisce gli esperti attivi a livello regionale sul tema della protezione vaccinale. Obiettivo di questa iniziativa \ue8 fornire ai cittadini e agli operatori sanitari, in particolare della Regione Lazio, un\u2019informazione completa, comprensibile e verificabile, tale da facilitare le decisioni e il confronto su questo tema oltre i luoghi comuni, i miti e la falsa scienza. MATERIALI E METODIIl sito Vaccinarsi in Lazio contiene cinque sezioni principali (Le Vaccinazioni nel Lazio, Scienza e Conoscenza, Info utili, In Evidenza, Contattaci). Il portale si avvale del lavoro di uno staff tecnico (composto prevalentemente da medici in formazione specialistica in Igiene e Medicina Preventiva) e un comitato tecnico-scientifico, oltre alla collaborazione di un panel di esperti di alto valore scientifico. Inoltre, sono state predisposte le pagine facebook\u2122 e twitter\u2122 che rilanciano sui social media i contenuti presenti sul sito.RISULTATISebbene sia in rete solo dall\u2019aprile del 2018, il portale ha pubblicato oltre 100 pagine web su vari aspetti legati alle vaccinazioni. Sono presenti sul sito: una scheda informativa per ogni malattia prevenibile da vaccino e per ogni rispettivo vaccino, una sottosezione vantaggi e rischi reali delle vaccinazioni, una contro la disinformazione e una sui viaggi internazionali. Inoltre nella sezione \u201cInfo utili\u201d si trova la pagina sugli ambulatori vaccinali presenti sul territorio, che \ue8 stata la pagina web pi\uf9 visitata dopo l\u2019homepage. Infine, il sito aggiorna gli utenti su eventi e notizie di rilevanza nazionale e regionale sul tema vaccinale. CONCLUSIONIVaccinarsi in Lazio s\u2019inserisce nel mondo della corretta informazione sul tema delle vaccinazioni che ha visto impegnati enti, istituzioni ed esperti in un\u2019azione di presidio del web al fine di proteggere i cittadini da decisioni pericolose per la propria salute. In questo contesto, un elemento d\u2019innovazione \ue8 dato dalla vicinanza con il territorio che rende pi\uf9 facile cogliere i problemi emergenti e i bisogni formativi della cittadinanza. L\u2019opinione degli autori \ue8 che iniziative come questa siano un valido metodo per contrastare il preoccupante fenomeno dello scetticismo verso le vaccinazioni