An assessment of the effect of hepatitis B vaccine in decreasing the amount of hepatitis B disease in Italy

Abstract Background Hepatitis B (HBV) infection is an important cause of morbidity and mortality and it is associated to a higher risk of chronic evolution in infected children. In Italy the anti-HBV vaccination was introduced in 1991 for newborn and twelve years old children. Our study aims to evaluate time trends of HBV incidence rates in order to provide an assessment of compulsory vaccination health impact. Method Data concerning HBV incidence rates coming from Acute Viral Hepatitis Integrated Epidemiological System (SEIEVA) were collected from 1985 to 2006. SEIEVA is the Italian surveillance national system that registers acute hepatitis cases. Time trends were analysed by joinpoint regression using Joinpoint Regression Program 3.3.1 according to Kim's method. A joinpoint represents the time point when a significant trend change is detected. Time changes are expressed in terms of the Expected Annual Percent Change (EAPC) with 95% confidence interval (95% CI). Results The joinpoint analysis showed statistically significant decreasing trends in all age groups. For the age group 0–14 EAPC was -39.0 (95% CI: -59.3; -8.4), in the period up to 1987, and -12.6 (95% CI: -16.0; -9.2) thereafter. EAPCs were -17.9 (95% CI: -18.7; -17.1) and -6.7 (95% CI: -8.0; -5.4) for 15–24 and ≥25 age groups, respectively. Nevertheless no joinpoints were found for age groups 15–24 and ≥25, whereas a joinpoint at year 1987, before compulsory vaccination, was highlighted in 0–14 age group. No joinpoint was observed after 1991. Discussion Our results suggest that the introduction of compulsory vaccination could have contribute partly in decreasing HBV incidence rates. Compulsory vaccination health impact should be better investigated in future studies to evaluate the need for changes in current vaccination strategy.</p

A randomised controlled trial of a school-based intervention to prevent tobacco use among children and adolescents in Italy

Aim: A randomised field trial was conducted to evaluate a school-based programme to prevent tobacco use in children and adolescents. Subject and methods: The trial included 534 children and 308 adolescents who were randomly selected to receive or not to receive the prevention programme. The prevention programme included: (a) health facts and the effect of smoking, (b) analysis of the mechanisms underlying intiation of smoking and (c) refusal skills training to deal with the social pressures to smoke. A questionnaire was administered before the intervention programme and 2 years later. Results: The prevalence rates of smoking in both groups of children and adolescents were increased at the end of the study. Anyway, the difference of smoking prevalence between the intervention and control groups was statistically significant only for the children’s group (from 18.3 to 18.8% for the intervention group and from 17.8 to 26.9% in the control group) (p = 0.035). As regards reasons that induced the start of smoking, there was a significant increase of the issue "because smokers are fools" (p = 0.004 for children; p < 0.001 for adolescents) and "because smokers are irresponsible" (p ≤ 0.001 for both children and adolescents) in the experimental groups. Conclusion: The results suggest that a school-based intervention programme addressing tobacco use among children and adolescents, based on the development of cognitive and behavioural aspects, can be effective. After 1 year of intervention, smoking prevalence was significantly lower in children belonging to the intervention group than in children not randomised to intervention. Targeting young children before they begin to smoke can be a successful way of prevention

Knowledge, attitudes and behaviour about Sexually Transmitted Infections: a survey among Italian university female students

Aims: Improvements have been made in terms of STIs mortality, but young women still have a lack of attention to the STIs prevention. We investigated the knowledge and attitudes about STIs and their prevention among a sample of Italian university female students. Methods: We designed a questionnaire about knowledge and attitudes toward STIs, Papanicolau test (Pap test) and Human Papilloma Virus (HPV) and had it filled out by 285 young women. Chi-square test, Mann-Whitney test and a multivariable analysis were performed in order to identify associated factors. &nbsp; Results: Knowledge about STIs seems weak, oppositely to knowledge about preventive measures. In line with the results of the univariate analyses, the multivariable one confirmed a higher probability to answer rightly for women who knew the effective behaviours for preventing STIs, women who took information about STIs from Internet, books and TV and those using natural methods (OR 2.77 - 95%CI 1.47-5.23, OR 2.99 - 95%CI 1.62-5.53 and OR 2.55 - 95%CI 1.05-6.18, respectively) and a lower one for students from Cassino and those who knew is possible to recover from STIs (OR 0.38, 95%CI 0.17-0.87 and 0.42, 95%CI 0.20-0.88, respectively). Furthermore, about Pap test it also confirmed the role of a medium-high STIs level of knowledge (OR 2.11, 95%CI 1.02-4.37) and a lower probability to know about it for women from Cassino (OR 0.25, 95%CI 0.09-0.73). Conclusions: Young women are not completely aware of STIs risks and preventive measures. Informational and educational campaigns should be implemented to reach this target group and lighten the current and future burden of STIs

Appropriateness of admission and days of stay in pediatric hospital in Ancona, Italy

Background: In Italy, hospital admission costs account for nearly 42% of total health expenditure; in the Marche region, this share exceeds 50%. High costs of hospitalization, however, can be partly explained by inappropriate use. The aim of this research was to assess the risk factors associated with inappropriate hospital admissions and stay for acute pediatric patients. Methods: Clinical records of children from 30 days to 14 years of age admitted to the wards of orthopedics, pediatrics, pediatric isolation, pediatric surgery and pediatric oncohematology at Salesi Pediatric Hospital of Ancona throughout 2004 were reviewed. The Italian Pediatric Appropriateness Evaluation Protocol (PRUO) was used as a tool for assessing inappropriateness of admission and days of stay. Results: Overall 21.7% (95% CI = 16.1%–22.4%) of hospital admissions and 30.3% (95% CI = 26.0%–34.9%) of days of stay were judged to be inappropriate. Multiple logistic regression analysis indicated that inappropriate admission was significantly associated with type of admission, discharge ward and place of residence. Inappropriateness of stay was significantly higher if admission was to a medical ward and if admission itself was judged inappropriate. Conclusions: In a socioeconomic context in which reducing waste is necessary, ineffective health care interventions are no longer tolerable. As a tool capable of integrating each patient’s specific features with those of the health care process, the pediatric PRUO could be a valid tool in the hands of managers for monitoring the appropriateness of admission and stay

Musculoskeletal injuries among operating room nurses: results from a multicenter survey in Rome, Italy

Aim: Chronic disorders of the musculoskeletal system, particularly low back pain (LBP), are increasing and represent a social and economic problem of growing importance, especially if correlated with working conditions. Health care workers are at higher risk of developing LBP during work shifts in the hospital. The aim of this study was to assess the prevalence of LBP among operating room nurses and to investigate the risk factors for musculoskeletal injuries in the operating room. Methods: We carried out a cross-sectional study that included operating room nurses from nine hospitals. Information on sociodemographic characteristics, lifestyle habits, working activity and psychological attitude of nurses was collected using an anonymous self-administered structured questionnaire. We evaluated the association of frequency, localization and intensity of LBP (FLI) with qualitative variables, making use of univariate analysis, chi-square test and Fisher's exact test. Multiple logistic regression analysis was performed to identify the variables that affected the FLI. The covariates included in the model were the variables that had a p 35 years vs. age <35 (OR = 2.68; 95% CI = 1.17–6.18) and diurnal work shift vs. diurnal/ nocturnal (OR = 4.00; 95% CI = 1.72–9.0) represent risk factors associated with FLI, while physical activity is a protective factor (OR = 0.47; 95% CI = 0.20–1.08). Conclusion: The data suggest that it is important to promote new programs of prevention based on professional training and physical activity among nurses and to improve the organization of work shifts in the hospital

Correlates of HCV seropositivity among familial contacts of HCV positive patients

BACKGROUND: Determinants of intrafamilial HCV transmission are still being debated. The aim of this study is to investigate the correlates of HCV seropositivity among familial contacts of HCV positive patients in Italy. METHODS: A cross-sectional study was conducted with 175 HCV positive patients (index cases), recruited from Policlinico Gemelli in Rome as well as other hospitals in Central Italy between 1995 and 2000 (40% female, mean age 57 ± 15.2 years), and 259 familial contacts. Differences in proportions of qualitative variables were tested with non-parametric tests (χ(2), Yates correction, Fisher exact test), and a p value < 0.05 was considered significant. A multivariate analysis was conducted using logistic regression in order to verify which variables statistically have an influence on HCV positivity in contact individuals. RESULTS: Seropositivity for HCV was found in 8.9% of the contacts. From the univariate analysis, risk factors significantly associated to HCV positivity in the contacts were: intravenous drug addiction (p = 0.004) and intercourse with drug addicts (p = 0.005). The only variables associated significantly and independently to HCV seropositivity in patients' contacts were intercourse with drug addicts (OR = 19.28; 95% CI: 2.01 – 184.94), the retirement status from work (OR = 3.76; 95% CI: 1.17 – 11.98), the time of the relationship (OR = 1.06; 95% CI: 1.00 – 1.11) and tattoos (OR = 7.68; 95% CI: 1.00 – 60.20). CONCLUSION: The present study confirms that having intercourse with a drug addict is the most significant risk factor for intrafamilial HCV transmission. The association with retirement status from work could be related to both a long-term relationship with an index case and past exposure to common risk factors

Socio-demographic determinants of coinfections by HIV, hepatitis B and hepatitis C viruses in central Italian prisoners

BACKGROUND: The coinfections HIV/HCV/HBV are an important health issue in penitentiary communities. The aim of the study was to examine HIV, HBV and HCV coinfections determinants amongst prisoners in the jails of Southern Lazio (Central Italy), in the period 1995-2000. METHODS: Diagnosis of seropositivities for HIV, HBV and HCV was made using ELISA method. A multiple logistic regression analysis was conducted to verify the influence of socio-demographic factors on the HIV/HBV/HCV coinfections. RESULTS: HIV/HCV, HBV/HCV and HIV/HBV coinfections were detected in 42 (4%), 203 (17.9%) and 31 (2.9%) inmates, respectively. These coinfections are significantly associated with the status of drug addiction (OR = 16.02; p = 0.012; OR = 4.15; p &lt; 0.001; OR = 23.57; p = 0.002), smoking habits (OR = 3.73; p = 0.033; OR = 1.42; p = 0.088; OR = 4.25; p = 0.053) and Italian nationality (OR = 7.05; p = 0.009; OR = 2.31; p &lt; 0.001; OR = 4.61; p = 0.04). CONCLUSION: The prevalence of HIV, HBV and HCV seropositivity in jails suggests that information and education programs for inmates could be useful to reduce the spread of such infections

Influence of reduced air pressure methods on dye penetration in standardized voids

Objective. The objective of this study was to evaluate the influence of the moment when reduced pressure is applied on dye penetration patterns. Study design. Nine hundred and sixty glass capillary tubes of different inner diameter (0.3 mm and 0.8 mm), divided into 48 groups, were submerged into dye in 3 different positions (horizontally, opening upwards, and opening downwards) under different vacuum conditions (passive, 5 kPa, 35 kPa, 70 kPa reduced pressure). When reduced pressure was applied half of the groups were submerged into dye before and half of the groups after the application of reduced pressure. Linear dye penetration was measured. Univariate analysis was performed with Mann-Whitney U test and Kruskal-Wallis test to select variables to be included in the regression model. A multiple logistic regression analysis with backward elimination was performed to assess the influence of different covariates on linear dye penetration. Results. The multivariate linear regression showed that the moment of vacuuming had the greatest positive effect on linear dye penetration value (beta = 10.6, P < .0001). Also the level of pressure reduction had a positive effect on the outcome variable (P = 0.2, P < .0001) while the vertical positioning of the tubes has negatively affected the outcome variable both for the open end upside (beta = -1.01, P = .024) and the open end downside (beta = -1.05, P = .019). Diameter of the tubes (P = .442) and immersion time (P = .727) had no effect on the outcome of linear dye penetration. Conclusions. Even minimum air pressure reduction applied before immersion of the specimens allowed the dye to extensively penetrate the voids