Analysis of appeals against the ruling of occupational physicians lodged with the Prevention and Occupational Epidemiology Operative Unit, ASP Palermo (Palermo Health Authority), from 2008-2010

Introduction: The responsibility of the Department for Prevention and Safety at the workplace of the Palermo Health Authority (ASP) is to monitor and coordinate the activity of occupational physicians operating in Palermo and its province. One of its obligations is to examine appeals “against the judgment of occupational physicians”, “...and, after carrying out further investigation, confirm, modify or reverse the ruling itself ” (art. 41, par. 6, legislative Decree 81/08). Objectives: The purpose of this study was to analyze the appeals lodged against a “judgment of fitness for work” submitted to the “Health Prevention and Occupational Epidemiology Operative Unit” of the Department of Prevention and Safety at the Workplace of the ASP Palermo, from 2008 to 2010. Methods: The total number of appeals lodged during the three-year period was 211, 174 of which were finalized. Results: The most frequent job category among the appellants was that of blue-collar workers, in various sectors, covering 44.5% of the subjects under study (93 cases). In 64.2% of the processed appeals (131 cases), the judgment of the physician was modified, while in the remaining 36.8% (73 cases) it was confirmed.The work fitness judgment with restrictions was the category against which most appeals were lodged, and the diseases in question mostly concerned the osteoarticular and cardiovascular systems. Conclusion: In a context of continuous change in the labour field and the related risks to the health and safety of workers, the occupational physician must approach the worker in a comprehensive manner,through an assessment of the possible health problems and the working environment in which he/she operates

Factors associated with poor adherence to MMR vaccination in parents who follow vaccination schedule.

Due to median vaccination coverage far from elimination level, Italy is still an European country with high number of measles cases per million of people. In this study we explored potential socioeconomic, medical and demographic factors which could influence the propensity of family members for measles vaccination schedule. A cross-sectional study was performed through a questionnaire administered to the parents of children who received the first dose of MMR vaccine in two different vaccination centers in the Palermo area from November 2012 to May 2013. Overall, the role played by internet (OR 19.8 P = 0.001) and the large number of children in a family (OR 7.3 P 64 0.001) were the factors more associated to be unvaccinated, whereas the birth order of the child (OR 0.3 P =<0.05 for the oldest children vs. the closer young one) and reporting a lack of MMR vaccination as a "personal decision" (OR 0.19 P 64 0.01) inversely correlated with the risk of quitting vaccination. These findings can be useful for a better knowledge of disaffection to vaccination practice in local settings and could contribute to improve and maintain timely uptake, suggesting approaches to optimize the uptake of MMR tailored to the needs of local populations

Vaccinazione anti-hpv in Italia: conoscenze, attitudini e comportamenti delle vaccinande e delle madri delle vaccinande in uno studio multicentrico.

OBIETTIVI: L’obiettivo dello studio è di valutare conoscenze, attitudini e comportamenti delle Madri delle Vaccinande e delle Vaccinande stesse (over 18 e under 18) riguardo la prevenzione primaria e secondaria nei confronti del carcinoma della cervice uterina. METODI: Lo studio multicentrico, previsto da un Progetto di Ricerca di Interesse Nazionale, è stato condotto dalle Università di Roma “Sapienza”, Palermo, Roma Cattolica, Cassino e Ferrara attraverso un’indagine campionaria. La survey confronta Madri delle Vaccinande e Vaccinande e le differenze fra gruppi sono state analizzate con il test del 2. RISULTATI: La ricerca ha coinvolto 962 Vaccinande e 444 Madri delle Vaccinande. Dal confronto tra Vaccinande over 18 (Vover18) e Vaccinande under 18 (Vunder18) è emerso che l’81,7% delle prime e il 52,1% delle seconde conosce il Pap test come screening (p<0,001); le principali fonti di informazione sulla vaccinazione anti-HPV per le Vover18 sono: riviste (23,1%), TV (20,5%) e ginecologo (19,1%); le Vunder18 invece si rivolgono a: medico di famiglia (22,4%), pediatra (14,6%) e ASL (13,7%). Le Madri delle Vaccinande over18 (MVover18) e le Madri delle Vaccinande under 18 (MVunder18) ritengono che l’infezione da HPV possa provocare il tumore della cervice uterina (86,8% e 89,4% rispettivamente), ma solo il 4,6% e l’1,7% rispettivamente riconosce il rischio di incorrere in cancro del cavo orale. Il 61,9% delle MVover18 ed il 52% delle MVunder18 dichiara di non aver ricevuto alcuna informazione a riguardo dal ginecologo (p=0,05); oltre ad essere consapevole che il vaccino debba essere somministrato prima dei rapporti sessuali, il 13,8% sia delle MVover18 sia delle MVunder18 ritiene che una donna si possa vaccinare in qualunque momento e ad ogni età (il 23% e il 27,1% rispettivamente). Il 48,6% delle MVover18 e il 24% delle MVunder18 dichiarano aver partecipato a screening per la prevenzione del tumore della cervice uterina organizzato dall’ASL. Dal confronto delle MVover18 e Vover18 risulta che sono maggiormente le figlie (89,9%) rispetto alle madri (74,3%) a riconoscere che anche dopo la vaccinazione sia necessario sottoporsi periodicamente a Pap test (p<0,001). In merito al genere che dovrebbe vaccinarsi, il 42,7% delle Vunder18 e il 35,6% delle MVunder18 indicano sia i maschi sia le femmine (p=0,05). CONCLUSIONI: Il carcinoma della cervice uterina è causato da infezione da HPV e può essere prevenuto attraverso la vaccinazione precoce. È necessario, pertanto, costruire una rete informativa sempre più efficace con il supporto dei professionisti del settore sanitario. L’empowerment del cittadino è la migliore strategia di prevenzione

Transcranial motor-evoked potentials monitoring can detect spinal cord ischemia more rapidly than spinal cord-evoked potentials monitoring during aortic occlusion in rats

In this study, we evaluated the efficacy of transcranial motor-evoked potentials (tc-MEPs), compared with segmental spinal cord-evoked potentials (SCEPs), for detecting spinal cord ischemia (SCI) and assessed the relationship between neurological outcome and tc-MEPs or SCEPs in the rat aortic occlusion model. In the rats, SCI was induced by aortic occlusion for 10 min with a balloon catheter. At first, tc-MEPs (Group A: n = 6) or segmental SCEPs (Group B: n = 6) was recorded during SCI. Second, in using the quantal bioassay for the relationship between an interval of aortic occlusion and the probability of positive response in tc-MEPs or segmental SCEPs, the P50MEP and P50SCEP which represent the interval of aortic occlusion associated with 50% probability of assessment of ischemic spinal cord dysfunction by tc-MEP and SCEP were analyzed. The amplitude of tc-MEPs decreased significantly at 30 s and disappeared completely at 2 min after aortic occlusion. In Group B, it took about 6 min after aortic occlusion to diminish SCEP signal amplitude by approximately 50%. P50MEP obtained in the quantal analysis was 0.3 ± 0.1 min. P50SCEP was calculated as 6.2 ± 0.5 min that was significantly (P < 0.01) longer than P50MEP. Our data indicated that tc-MEP monitoring could detect the onset of SCI so rapidly in comparison with segmental SCEP monitoring, which could provide therapeutic windows in a surgical approach that includes spinal cord protection

Pediatric selective mutism and sleep disorders: A pilot restrospective case control-study

Introduction: Selective mutism (SM) is characterized by the persistent inability to speak in some specific contexts (i.e. school, home, social contexts) or within interaction with peer group and/or adults when a normal verbal linguistic competence may be expected, according to DSM5 criteria. The main sleep disorders in children with neurodevelopmental disorders are represented by difficulty in falling asleep at night (51%) and nocturnal awakenings (67%).The main goal of the present study is verify the putative relationship between sleep disorders and selective mutism in children.Materials and methods: 30 children were diagnosed with SM (13 males and 17 females) with mean age 9.47 (SD +/- 129). The case-control group was composed by 30 typically developing children (TDC) (12 males and 18 females) (mean age 8.95; SD +/- 2.01; p = 0238). All the subjects of both groups were recruited within the same urban area, Caucasian and homogeneous in socio-economic level. SDSC questionnaire was used in order to assess the sleep habits in both groups.Results: The two groups (SM and TDC) were similar for age and gender. About the presence of reported sleep disorders, SM children show a significantly higher prevalence of reported sleep troubles than TDC subjects (Graph 1).Conclusion: The present pilot restrospective case control-study has shown the presence of sleep disorders in children with SM. This new comorbidity has not been previously reported in clinical literature

Clinical variables associated with treatment changes in Parkinson's disease: results from the longitudinal phase of the REASON study

To assess over a period of 9 months in a sample of Italian Parkinson's disease (PD) patients reasons leading the neurologist to modify dopaminergic treatment and patients' causes of dissatisfaction with ongoing therapy. To evaluate the influence of disease severity on therapy persistence. A disease severity balanced sample of PD patients with stable anti-parkinsonian drugs (APD) treatment was enrolled and evaluated every 3 months. Patients requiring APD treatment modifications were discontinued from the study. The probability to modify APD treatment is greater for higher motor (UPDRS scores) and non-motor symptoms (NMSS score) severity. Both from neurologist's and patient's perspective, motor symptoms were the main determinants underlying APD treatment modifications. Non-motor symptoms were cause of dissatisfaction with ongoing APD treatment for 52 % of the patients, while only 36 % of the neurologists considered these as valid reasons for therapy change. REASON is the first study in PD patients that prospectively examined reasons driving APD treatment changes. Results show that the disease severity significantly increases the probability of APD treatment change. Patients attribute greater relevance than neurologists to non-motor symptoms as reason requiring treatment changes. This confirms that patient and neurologist perceptions only partially overlap