Swine influenza A (H1N1) virus (SIV) infection requiring extracorporeal life support in an immunocompetent adult patient with indirect exposure to pigs, Italy, October 2016.

We describe a case of severe swine influenza A(H1N1) virus infection in an immunocompetent middle-aged man in October 2016 in Italy who had only indirect exposure to pigs. The patient developed a severe acute distress respiratory syndrome which was successfully supported by extracorporeal membrane oxygenation and treated with antiviral therapy. The sole risk factor for influenza was a body mass index > 30 kg/m2. After a month of hospitalisation, the patient was discharged in good health.

[New role for hospital department directors in a Milan hospital, Italy]. / Nuovo ruolo del dipartimento nell'ospedale per aree omogenee.

In Italy, the hospital departmental model was introduced over 30 years ago with the aim of fostering collaboration between wards and promoting the appropriate use of resources. However, these objectives have not been consistently met. For this reason, the Strategic Direction of the hospital "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico" in Milan has proposed a new model in which department directors are given a more active role in hospital management and actively participate in decision-making processes.

[A new Emergency Department case management model for nonurgent patients]. / Un nuovo modello di gestione dei pazienti "non urgenti" in Pronto Soccorso.

Emergency Department visits for nonurgent conditions are very widespread and new strategies to provide timely and appropriate medical care for these patients are required. The "Fondazione IRCCS Ca 'Grande" Hospital in Milan, in collaboration with the local health authorities have evaluated a new case management model in which patients classed as nonurgent at triage are diverted to a "continuity of care" outpatient office within the emergency department. This model, based on the integration of hospital and community-based primary healthcare, was effective and led to a significant reduction in waiting times in the ED and to a more appropriate use of resources.

Hepatitis B immune memory in children primed with hexavalent vaccines and given monovalent booster vaccines: an open-label, randomised, controlled, multicentre study.

BACKGROUND: In 2000, hexavac and infanrix hexa were licensed in Europe for primary immunisation of children against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and invasive infections caused by Haemophilus influenzae b. In 2005, hexavac was suspended because of concerns about the long-term immunogenicity of its hepatitis B component. We aimed to assess the duration of immunity and need for booster injections in children primed with these vaccines. METHODS: In an open-label, randomised, controlled, multicentre study in six local health units and at the Bambino Gesù Paediatric Research Hospital in Italy, antibody concentrations were measured 5 years after immunisation of infants with hexavac or infanrix hexa. Children with concentrations of antibodies to hepatitis B surface antigen (anti-HBs) lower than 10 mIU/mL were randomly assigned by simple randomisation to receive a booster of HBVaxPro or engerix B monovalent hepatitis B vaccine and tested 2 weeks later. Primary endpoints were the proportion of children with anti-HBs concentrations of at least 10 mIU/mL, geometric mean concentrations (GMCs) of antibody 5 years after vaccination, and the proportion of children with anti-HBs concentrations lower than 10 mIU/mL who had anamnestic response to booster. The study is registered with Agenzia Italiana del Farmaco, code FARM67NFPN. FINDINGS: 1543 children were enrolled, 833 had received hexavac and 710 infanrix hexa. 831 children who received hexavac and 709 who received infanrix hexa were included in the analysis. 319 children who received hexavac (38.4%, 95% CI 35.1-41.7) had anti-HBs concentrations of at least 10 mIU/mL compared with 590 who received infanrix hexa (83.2%, 80.5-86.0; p<0.0001). GMCs before booster were 4.5 mIU/mL in the hexavac group compared with 61.3 mIU/mL in the infanrix hexa group (p<0.0001). After booster 409 (92.1%, 89.6-94.6) of 444 children primed with hexavac and 99 (94.3%, 89.8-98.7) of 105 primed with infanrix hexa had anti-HBs concentrations of at least 10 mIU/mL (p=0.4); GMCs were 448.7 mIU/mL and 484.9 mIU/mL (p=0·6). The two booster vaccine groups did not differ in number of side-effects; no serious adverse events were reported. INTERPRETATION: 5 years after immunisation with hexavalent vaccines, immunological memory seems to persist in children with anti-HBs concentrations lower than 10 mIU/mL, suggesting that booster doses are not needed. Additional follow-up is needed. FUNDING: Agenzia Italiana del Farmaco.

Epidemiological and clinical features of rotavirus among children younger than 5 years of age hospitalized with acute gastroenteritis in Northern Italy.

BACKGROUND: Rotavirus is the major cause of acute gastroenteritis and severe dehydrating diarrhea in young children. METHODS: To estimate the proportion of hospital admissions for rotavirus acute gastroenteritis and identify the circulating G and P genotypes among children under five years of age, we conducted a prospective observational study from January to December 2008, recruiting children consecutively admitted to six hospitals in Milan and nearby towns in northern Italy. Typing was done on stool samples by reverse transcriptase polymerase chain reaction amplification. RESULTS: Of the 521 stool samples from children with acute gastroenteritis, 34.9% (95%CI, 30.8 to 39.2%) were rotavirus-positive. Two thirds (67.6%) were under two years of age, and 13.2% were under six months. The predominant G type was G1 (40.7%), followed by G9 (22.5%), G2 (13.2%), G3 (5.5%), G4 (3.8%) and G10 (1.6%). Twenty-one (11.7%) mixed-G infections were identified: G1+G10 (8.8%); G1+G9 (1.6%); and G2+G10 (1.2%). Only P[8] (67.6%) and P[4] (12.6%) types were P genotyped. The predominant single G/P combination was G1P[8] (39.7%), followed by G9P[8] (25.3%), G2P[4] (14.3%), and G3P[8] (4.1%). All G-mixed types combined with P[8]. CONCLUSIONS: These findings show an high prevalence of rotavirus infections among children admitted to hospital for acute gastroenteritis caused by different rotavirus strains circulating in the area studied.

[Workplace health promotion: evaluation of evidence of efficacy and methodological recommendations]. / La promozione della salute nei luoghi di lavoro: valutazione di evidenze di efficacia e raccomandazioni metodologiche.

BACKGROUND: During the period 2004-2007 five Italian regions in cooperation with the Universities of Pavia and Perugia and the Italian Cochrane Centre carried out a research project on health promotion programmes. OBJECTIVES: Evaluation of efficacy of health education programmes developed by the Local Health Units from 2000 to 2004. RESULTS: Analysis of 69 of health promotion programmes and 23 Cochrane reviews led to establishing recommendations for health operators; at the workplace the efficacious actions were: to encourage consumption of healthy food (also via automatic distributors of fruit and vegetable snacks) and physical activity, guarantee observance of the smoking ban and/or offer assistance to quit smoking. CONCLUSION: Health promotion projects involve the use of public resources so it is necessary that the potential impact and efficacy be evaluated in the planning process. In particular, it is advisable to examine the data in the literature and assign preference to projects that have proved efficacious.

[Smoking habits among 13-18 year old students in Lombardy]. / L'abitudine al fumo tra gli studenti dai 13 ai 18 anni di età in Lombardia.

OBJECTIVE: to describe the prevalence of smokers among 13- 18-years-old students in Lombardy and to evaluate some related motives. DESIGN: a survey has been carried out with anonymous questionnaires, distributed at the beginning of the school year 2005-2006. SETTING: the study involved 3,593 classes of the third year of middle school and 2,893 classes of the second and the fifth year of high school, sampled among all the schools of Lombardy. PARTICIPANTS: the study interested 11,494 students aged either 13, 15 or 18. MAIN OUTCOME MEASURES: the prevalence of habitual smokers was 6%, 26.5% and 33.2%. RESULTS: a higher percentage of smokers report to have low school performances and to receive more than 15 euros as weekly tip. The number of smokers among family components and friends always appears higher for smoker students. Unemployed fathers and working mothers were higher among smokers. Both parents of smoker students have a lower educational level. CONCLUSION: an organized and systematic regional surveillance could highlight some characteristics of smoking habit among young students useful to set health education programs and to evaluate the efficacy of interventions already being carried out. Besides, it could enhance the awareness of the problem.

Epidemiology of bacterial meningitis in Lombardy Region in the period 2000-2006.

Epidemiological study of bacterial meningitis, particularly those forms susceptible to vaccination, is an indispensable tool in choosing vaccination strategies. Lombardy Region, where approximately 20% of the Italian population resides, has conducted an in-depth study on invasive meningococcal diseases and pneumococcal meningitis using available health statistics and performing a control of single cases to achieve complete knowledge of the phenomenon. The results, relating to the period 2000-2006, indicate limited incidence rates both for the general population and childhood age groups that do not justify hypotheses of a universal offering of the specific vaccines. However, the healthcare system must equip itself with additional tools for the identification of the serogroups and serotypes responsible for disease as a further support for possible choices modifying the current vaccination policies.

The acquired experience and the programs for the prevention of nosocomial infections in Lombardy.

The authors present organization of Lombardy in the nosocomial infections' control. In particular they expose characteristics of Regional Coordination of the Hospital Committees (CR-CIO) and the plans for the CR-CIO in the two year period 2006-2007. Preliminary results of work groups show that the main problems in the control strategies are the difficulties in implementing theoretical notions in care programs. So it is therefore necessary to continue along this path to reach further goals and eventually change the adopted organizational.

[Public health consumption at the Varese health trust]. / I consumi di prestazioni sanitarie nella Asl della Provincia di Varese.

This study is based on a provincial Atlas assessing territorial differences in hospital admissions and out-patient services. The authors have analysed consumer distribution per District as compared to overall provincial consumption. Results show some geographical inequities that are not always associated to epidemiological reasons. As a matter of fact, some services happen to be more crowded than others, which obviously entails the need for more adequate offers and different diagnostic behaviours as regards treatments. It would therefore be advisable if high consumption levels were assessed to be effectively useful in terms of health production.

[Assessment of a mass screening program for breast cancer in the Milan Health Unit 1 (ASL Provincia di Milano 1)]. / Valutazione degli aspetti organizzativi e di processo di una campagna di diagnosi precoce del cancro della mammella nella ASL Provincia di Milano 1.

This study examines the early data of a breast cancer screening campaign (Progetto Donna) set up by the Milan Health Unit 1 in 1999. The authors have focused on some basic organizational aspects of such campaign and the patients' high response to the project showed a good efficiency of this initiative, aimed at informing and awakening people. The high rate of suspiciously positive results checked in several Hospitals, led to a careful assessment of the quality and the standards of radiology services.