[The progressive patient care program as a model of field training of public health practitioners: the experience of the Roman Public Health Academy]. / L'ospedale ad Intensità di cura come modello di formazione condivisa sul campo: l'esperienza dell'Accademia Romana di Sanità Pubblica.

The management of healthcare facilities has become increasingly complex in recent years, leading to a greater demand for public health physicians in Italy. Public Health physicians are responsible for evaluating community needs, with particular attention to health determinants and, at the same time, to final user feedback. During their training, they must acquire the competencies to manage a wide range of problems. The Roman Public Health Academy (ARSP) was developed to motivate young residents in Public Health to acquire the knowhow, skills and abilities required of a public health practitioner. It therefore implemented a special training program offering different educational opportunities for residents. In particular, the program offers a team of three young residents field training opportunities, allowing them to become engaged in solving complex technical and management problems. In this paper we describe the methods through which, following a specific request by the director of a hospital in Rome, the team supported a project involving the reorganization of several hospital wards. The aim of the reorganization was to enhance the performance and efficiency of the wards, according to the Progressive Patients Care program.

[Update of recommendations for the prevention of Hepatitis A in Italy]. / Aggiornamento delle raccomandazioni per la prevenzione dell'Epatite A in Italia.

The epidemiology of hepatitis A is changing worldwide. Italy has become a country with low-middle endemicity due to improved socio-economic and sanitary conditions. In Italy, vaccination against hepatitis A is offered only to some high risk groups in accordance with the National Vaccine Plan 2012-2014. A guideline edited in 2002 is available which identifies groups at higher risk of acquiring the disease and gives recommendations for the use of Hepatitis A vaccine. The aim of the paper is to evaluate the need for an update of this guideline. The review of the literature confirms the risk groups but shows some new data for some categories, in particular attention should be paid to immigrates visiting friends and relatives in the native country and to family members and contacts of adopted children.

[Communicating the benefits and risks of vaccination: a focus on the PFCC (Patient and Family Centered Care) approach]. / I segreti della comunicazione in ambito vaccinale.

In recent years an important reduction in the access to vaccination was noticed in Italy. Health care workers involved in health promotion must necessarily find new strategies to overcome the mistrust of the population. The application of some instruments of counselling in the vaccination field can improve the therapeutic alliance, making users to take the best decisions for their own wellness. The approach called Patient- and Family-Centered Care includes the relational processes within the skills of the health care worker.

[Vaccines and autism: a myth to debunk?]. / Vaccini ed autismo: un mito da sfatare?

Thanks to vaccinations the incidence of many seriously debilitating or life threatening diseases and the resulting infant mortality or disability have been drastically reduced. In populations, who are no more aware of the risk of these infections, the attitude of suspicion and fear towards the vaccinations is expanding and in some cases reaches a worldwide media coverage as was the case for the measles, mumps and rubella vaccine (MMR). In 1998, a British doctor, Andrew Wakefield, and co-authors, published in "Lancet" a study in which he suggested the existence of "a new variant of autism" associated with intestinal inflammation. He proposed the administration of the MMR vaccine as a possible. cause of the inflammatory process. The hypothesis suggested by Wakefield led to a drastic drop in vaccination coverage in the UK and to the failure to achieve adequate levels of immunization in many countries, with a consequent increase in the incidence of measles and its complications. Wakefield work stimulated a broad discussion in the scientific community and many studies conducted over the next few years contradicted the research results of the English physician. In 2004, journalist Brian Deer conducted an accurate investigation that revealed how the Wakefield research presented many not regular aspects and was performed with predominantly economic objectives. In 2010, Wakefield was expelled from the General Medical Council, while the "Lancet" retracted the paper. The scientific research conducted in recent years confirm the inconsistency of the relationship between MMR vaccine and autism. The possible association with other factors, such as autoimmune processes, hyperactivation of mast cells in the hypothalamus, use of paracetamol in genetically predisposed children are currently investigated.

[Contraindications to vaccinations: no news is good news]. / Controindicazioni alle vaccinazioni: nessuna nuova, buona nuova.

Contraindications to vaccinations represent an extremely debated topic. In this paper the literature revision is presented, taking into account different vaccines and aspects related to allergies. There were no significant differences compared to the Guide to contraindications to vaccinations, edited in 2009. Therefore, only a revision including new available vaccines and an updating of the citations would be necessary. This revision should be intended as an opportunity to renovate the Guide, transferring it on an informatics platform. This should enhance the usability and facilitate a constant update of the Guide.

Empathy in vaccination counselling: a survey on the impact of a three-day residential course.

BACKGROUND: In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known. This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients' ratings of the level of empathy of physicians and nurses working in vaccination centers. METHODS: The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children. Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups. RESULTS: Analysis of the questionnaires showed an increase of "excellent" scores and statistically significant differences between the pre- and post -course median values. Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course. CONCLUSIONS: This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents' adherence to vaccination programs.

Knowledge and attitude of pregnant women toward flu vaccination: a cross-sectional survey.

OBJECTIVE: The study was conducted to explore the knowledge of pregnant women about influenza, influenza vaccine during pregnancy and the attitudes regarding immunization. METHODS: A questionnaire based on the model proposed by Yudin in 2009 was translated, adapted and administered to 309 pregnant women in the third trimester of pregnancy between October 1 and December 1, 2013 at San Giovanni Calibita Fatebenefratelli hospital of Rome (Italy). RESULTS: Most of the interviewed women (68.9%) answered that influenza is highly contagious, 34.6% of them believed that pregnant women have the same risk of complications as non-pregnant women. Only 5.8% were aware that the vaccine is recommended for women in the second and third trimester of pregnancy and only 14.2% of women answered that the vaccine is safe during pregnancy. Only 3/309 women reported recommendation and offer of vaccination during current pregnancy, but none of them was vaccinated. CONCLUSIONS: Overall, knowledge regarding influenza, implications during pregnancy and influenza vaccine was poor among pregnant women. In Italy, the National Vaccine Prevention Plan 2012-2014 recommends influenza vaccine during pregnancy, but only 18/309 were aware of this recommendation. These results suggest that in order to increase influenza vaccine acceptance it is necessary to improve pregnant women knowledge about influenza and to offer education to healthcare providers.