Knowledge, attitudes and behaviors regarding influenza vaccination among Hygiene and Preventive Medicine residents in Calabria and Sicily.

Vaccinating health care workers is considered to be one of the most important steps in preventing the transmission of the influenza virus to vulnerable patients. Public Health physicians are the main promoters and executors of influenza vaccination campaigns for both healthcare workers and the general population. The objective of the present survey was to analyze the knowledge, attitudes and practices regarding influenza vaccination among Hygiene and Preventive Medicine Residents. 64% of the participants had not been vaccinated against the influenza virus in the past 5 years, and 29% had been vaccinated only occasionally , with only 7.2% of the study popu-lation having been vaccinated every year. 20.3% of those surveyed were vaccinated in the 2010/2011 season. The best strategy to increase vaccination rates among health care workers according to the study participants was the participation of future public health operators to multidisciplinary training (34.8%). the main factors associated with influenza vaccination compliance were having been vaccinated in the previous season for 2011/2012 (OR [95%]: 41.14 [7.56 - 223.87]) and having received the vaccination always or occasionally during the previous 5 years for both 2010/2011 (p-value <0.0001) and 2011/2012 (p-value <0.0001). The findings of this study suggest that future public health physicians with a history of refusing influenza vaccination in previous years usually tend to maintain their beliefs over time. Changing this trend among Hygiene and Preventive Medicine residents is the real challenge for the future, and it can be achieved through organization of multidisciplinary training, improvement of university education and increasing the involvement of Hygiene and Preventive Medicine residents in influenza vaccination campaigns both for the gen-eral population and health care workers

Antiphospholipid antibodies as cause of pregnancy loss

Antiphospholipid antibodies detected by lupus anticoagulant, anticardiolipin or anti-beta2 glycoprotein I assays were associated with fetal loss. Rather than being diagnostic tools only, antiphospholipid antibodies are thought to be pathogenic. The strongest demonstration of their pathogenic role lies in the ability to induce fetal resorptions--the experimental equivalents of the human fetal losses--when passively infused in pregnant naive animals. However, still debated is how the antibodies might induce the obstetrical manifestations. Thrombotic events at the placental levels might be related to endothelial cell activation, inhibition of protein C/S system and fibrinolysis as well as to Annexin V displacement. However, the thrombophilic state apparently cannot explain all the miscarriages and a direct antibody-mediated damage on the trophoblast has been suggested. During differentiation to syncytium, trophoblasts express cell membrane anionic phospholipids that can bind beta2 glycoprotein I, the main cationic phospholipid binding protein recognized by the antiphospholipid antibodies. Adhered beta2-glycoprotein I might be recognized by the antibodies that, once bound, strongly interfere with in vitro trophoblast cell maturation so resulting in a defective placentation. These mechanisms have been suggested to play a role in early fetal loss, while thrombotic events would be responsible for miscarriages late in the pregnancy

Pathogenic role of anti-beta2 glycoprotein 1 antibodies on human placenta: functional effects related to implantation and roles of heparin

Most of the clinical manifestations of the antiphospholipid syndrome (APS) can be related to thrombotic events; however, placental thrombosis cannot explain all of the pregnancy complications that occur in women with this syndrome. In this regard, it has been hypothesized that antiphospholipid (aPL) antibodies can directly attack trophoblasts, but it is still unclear what pathogenetic mechanisms play a role and which aPL antibodies subpopulations are involved. Although it has been assumed that aPL antibodies are directed against anionic phospholipids (PLs), current advances in the field suggest that antibodies to PL-binding plasma protein such as beta2-glycoprotein-I (beta2-GPI) are the clinically relevant aPL antibodies. It appears that following the attachment of beta2-GPI to PLs, both molecules undergo conformational changes that result in the exposure of cryptic epitopes within the structure of beta2-GPI allowing the subsequent binding of antibodies. aPL antibodies detected by anti-beta2-GPI assays are associated with fetal loss. However, there is still debate on how the antibodies might induce the obstetrical manifestations. The significantly improved outcome of pregnancies treated with heparin has stimulated interest in the drug's mechanisms of action. Several mechanisms could explain its beneficial effects, because in addition to a direct effect of heparin on the coagulation cascade, it might protect pregnancies by reducing the binding of aPL antibodies, reducing inflammation, facilitating implantation and/or inhibiting complement activation. Further investigations are needed to better understand how aPL antibodies induce obstetric complications and to better clarify the functional role of heparin in the human placenta leading to more successful therapeutic option

Percezione della importanza della vaccinazione antinfluenzale tra gli specializzandi in Igiene e Medicina Preventiva Italiani. Studio conoscitivo della Consulta dei Medici in Formazione Specialistica della S.It.I

Riassunto Uno studio conoscitivo condotto tra i medici in formazione specialistica in Igiene, Medicina Preventiva e Sanità Pubblica italiani è stato condotto in 25 scuole di specializzazione italiane di tale disciplina (78,1% del totale). Ciascun partecipante è stato intervistato tramite un questionario anonimo ed autosomministrato con domande riguardo attitudini, pratiche e conoscenze sull’influenza e la relativa vaccinazione. La vaccinazione contro l’influenza stagionale 2010-2011 e 2011-2012 è significativamente associata con l’essersi vaccinato almeno 3 volte nelle ultime cinque stagioni influenzali. Gli specializzandi che hanno preso parte durante il loro percorso formativo a campagne di vaccinazione nella popolazione generale sono più propensi a vaccinarsi nelle due stagioni vaccinali prese in esame. Secondo i medici in formazione in Igiene e Medicina Preventiva italiani, per implementare le coperture vaccinali e le attitudini a raccomandare la vaccinazione antinfluenzale alla popolazione generale sono necessari corsi di formazione multidisciplinari (48.2%) e una migliore formazione universitaria sull’argomento (23.3%)