The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia.

OBJECTIVE: Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality. METHODS: The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders. RESULTS: A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795). CONCLUSION: Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.

Promoting health and preventing non-communicable diseases: evaluation of the adherence of the Italian population to the Mediterranean Diet by using the PREDIMED questionnaire.

Abstract: A health promotion program was conducted in the Veneto Region in Italy. Participants were screened for non-communicable diseases and were referred to the nutrition clinic. The aim of this study was to assess the adherence to the Mediterranean diet in the Italian population by using the "PREvención con DIeta MEDiterránea" questionnaire. The data showed that 63% of the participants were overweight, 57% presented hypercholesterolemia, 36% were hypertensive and 43% had high blood glucose levels. The results highlighted a low consumption of protective foods against non-communicable diseases such as fruit, vegetables, fresh fish, legumes and oily dried fruit. Overall, only 6% of the subjects who visited the nutritional clinic had the maximum adherence to the Mediterranean diet, 73% had an average adherence, followed by 21% with low adherence. Multivariable analysis between risk factors and socio-demographic characteristics and the adherence to Mediterranean diet revealed that male gender relates directly (p =0.002, AOR = 2.95) to a low adherence. There are three criteria in the questionnaire for a point in favour of Mediterranean diet which we believe to be inadequate, as they are not in accordance with the Italian guidelines for healthy eating. The "PREvención con DIeta MEDiterránea" questionnaire, if associated with a food frequency questionnaire or a food intake record, could become a useful tool for nutritional counseling in our Country.

Time-trend of hospitalizations for anogenital warts in Veneto region in the HPV vaccination era: a cross sectional study (2007-2018).

BACKGROUND: Human papillomavirus (HPV) is a common sexually transmitted pathogen and the cause of several cancers and of anogenital warts. With this study, we estimated the trend of hospitalizations for anogenital warts (AGWs) in the Veneto region (Italy) from 2007 to 2018. METHODS: The analysis included all the hospital discharge records of public and accredited private hospitals occurred in Veneto residents in the timespan 2007-2018. The ICD9-CM code 078.11 considered were those associated with condyloma acuminatum and those associated with surgical interventions for vulval/vaginal warts, penile warts anal warts. Annual total and sex- and age-specific hospitalization rates and trends were calculated and correlated with the different HPV vaccine coverage over the study period. RESULTS: We observed an overall reduction of hospitalization rates for AGWs: from 15.0 hospitalizations every 100,000 Veneto residents in years 2007-08 to 10.9 hospitalizations every 100,000 Veneto residents in year 2017-18 (- 37.4%; p < 0.05). Reduction has been caused by a drop in hospitalizations in females - from a rate of 20.4/100,000 in 2007-2008 to a rate of 10.8/100,000 in 2017-18 (AAPC: -7.1; 95%CI: - 10.6;-3.4); while in males, we observed a slight - but not statistically significant - increase in hospitalization rates. CONCLUSION: The marked decline in hospitalization rates for AGWs in Veneto Region is probably attributable to the high coverage rates of HPV vaccination programs implemented since 2008.

Uncompleted Emergency Department Care (UEDC): a 5-year population-based study in the Veneto Region, Italy.

INTRODUCTION: Uncompleted visits to emergency departments (UEDC) are a patient safety concern. The purpose of this study was to investigate risk factors for UEDC, describing not only the sociodemographic characteristics of patients who left against medical advice (AMA) and those who left without being seen (LWBS), but also the characteristics of their access to the emergency department (ED) and of the hospital structure. METHODS: This was a cross sectional study on anonymized administrative data in a population-based ED database. RESULTS: A total of 9,147,415 patients attended EDs in the Veneto Region from 2011 to 2015. The UEDC rate was 28.7‰, with a slightly higher rate of AMA than of LWBS (15.3‰ vs 13.4‰). Age, sex, citizenship, and residence were sociodemographic factors associated with UEDC, and so were certain characteristics of access, such as mode of admission, type of referral, emergency level, waiting time before being seen, and type of medical issue (trauma or other). Some characteristics of the hospital structure, such as the type of hospital and the volume of patients managed, could also be associated with UEDC. CONCLUSION: Cases of UEDC, which may involve patients who leave AMA and those who LWBS, differ considerably from other cases managed at the ED. The present findings are important for the purpose of planning and staffing health services. Decision-makers should identify and target the factors associated with UEDC to minimize walkouts from public hospital EDs.

Perception and knowledge of HPV-related and vaccine-related conditions among a large cohort of university students in Italy.

HPV is involved in cervical, anal, penile, vulvar and oropharyngeal cancers, as well as genital warts. It is important to investigate knowledge and attitudes among university students, considering in this age a shift in healthcare decision-making from parents to students themselves. The aim of this study was to estimate knowledge and perception of HPV in terms of potential shame for HPV-related conditions, trust in vaccine efficacy and worry for potential side effects. The study involved students (18-25 years old) from the Universities of Padua and Verona, Italy. Socio-demographic and behavioural characteristics were collected with a questionnaire (n = 9988). Female gender and older age were positively associated with higher knowledge. The adjusted logistic regression showed an association between the set of perceptions investigated and the vaccination status, while a direct connection with knowledge was not found. However, another adjusted linear regression showed that a good set of perceptions could be partially explained by a high level of knowledge. Perceptions seem to fill an intermediate position between the knowledge and the decision to get vaccinated. The potential shame deriving from asking for HPV-vaccination was not identified as a relevant barrier. Having received information from healthcare workers, family and school showed to be positively associated with the adhesion to the vaccination policy. This study identifies university students as a possible target for HPV vaccination and pinpoints specific areas that might be targeted as first to encourage vaccine uptake. Primary prevention together with screening programmes remains essential in further reducing the burden of HPV-related diseases.

May car washing represent a risk for Legionella infection?

BACKGROUND: Legionella is a ubiquitous Gram-negative bacterium naturally found in aquatic environments. It can pose a health problem when it grows and spreads in man-made water systems. Legionella pneumophila is the most common cause of Legionnaires' disease nowadays, a community-acquired pneumonia with pulmonary symptoms and chest radiography no different from any other form of infectious pneumonia. Legionella monitoring is important for public health reasons, including the identification of unusual environmental sources of Legionella. METHODS: We report two cases of Legionnaires' disease associated with two different car wash installations in the province of Vicenza, in the Veneto region, northeastern Italy. Patients were not employees of the car wash installations, but users of the service. In both cases, Legionella antigen was detected in urine using the Alere BinaxNOW® Legionella Urinary Antigen, and Legionella antibodies were detected in serum using SERION ELISA classic Legionella pneumophila 1-7 IgG and IgM. Water samples were also analyzed as part of the surveillance program for Legionella prevention and control in compliance with the Italian guidelines. RESULTS: Both patients had clinical symptoms and chest radiography compatible with pneumonia, and only one of them had diabetes as a risk factor. Legionella urinary antigen and serological test on serum samples were positive for Legionella in both patients, even if much slighter in the case A due to the retrospective serological investigation performed a year later the episode and after the second clinical case occurred in the same district. The environmental investigations highlighted two different car wash plants as potential source of infection. A certified company using shock hyperchlorination was asked to disinfect the two plants and, subsequently, control samples resulted negative for Legionella pneumophila. CONCLUSION: Any water source producing aerosols should be considered at risk for the transmission of Legionella bacteria, including car wash installations frequently used by a large number of customers and where poor maintenance probably creates favorable conditions for Legionella overgrowth and spreading. Additional research is needed to ascertain optimal strategies for Legionella monitoring and control, but environmental surveillance, paying careful attention to possible unconventional sources, should remain an important component of any Legionnaires' disease prevention program. Additionally, all available diagnostic methods would be recommended for the confirmation of all cases even in the event of non-serogroup 1 Legionella pneumophila infection, probably underestimated at this time.

Impact of pneumococcal conjugate vaccination: a retrospective study of hospitalization for pneumonia in North-East Italy.

INTRODUCTION: Pneumonia remains a common reason for hospitalizing infants and the elderly worldwide, and streptococcal infection is often responsible. The aim of this study was to assess the burden of pneumonia in a large general population. METHODS: All pneumonia-related hospitalizations from 2004 to 2013 in north-east Italy were identified from the hospital records with a first-listed diagnosis on discharge of bacterial pneumonia, or a first-listed diagnosis on discharge of meningitis, septicemia or empyema associated with a secondary diagnosis of bacterial pneumonia. We identified major comorbidities, calculated agespecific case-fatality rates (CFR), and estimated the related cost to the health care system. RESULTS: Of the 125,722 hospitalizations identified, 96.9% were cases of pneumonia, 2.4% of septicemia, 0.4% of meningitis, and 0.3% of empyema; 75.3% of hospitalizations involved ≥ 65-yearolds. The overall CFR was 12.4%, and it increased with age, peaking in people over 80 (19.6%). The mean annual pneumonia-associated hospitalization rate was 204.6 per 100,000 population, and it peaked in 0- to 4-year-old children (325.6 per 100,000 in males, 288.9 per 100,000 in females), and adults over 65 (844.9 per 100,000 in males, 605.7 per 100,000 in females). Hospitalization rates dropped over the years for the 0-4 year-olds, and rose for people over 80. The estimated overall annual cost of these pneumonia-related hospitalizations was approximately € 41 million. CONCLUSIONS: This study shows that the burden on resources for pneumonia-related hospitalization is an important public health issue. Prevention remains the most valuable tool for containing pneumonia, and vaccination strategies can help in the primary prevention of infection, possibly reducing the number of cases in all age groups.

The new pandemic influenza A/(H1N1)pdm09 virus: is it really "new"?

In June 2009, the World Health Organization (WHO) issued a pandemic alert concerning the spread of an influenza A (H1N1) virus that showed distinctive genetic characteristics vis-à-vis both seasonal influenza strains and vaccine strains. The main mutation occurred in the gene coding for hemagglutinin (HA). Mathematical models were developed to calculate the transmissibility of the virus; the results indicated a significant overlap with the transmissibility of previous pandemic strains and seasonal strains. The remarkable feature of A/(H1N1)pdm09, compared with seasonal strains, is its high fatality rate and its higher incidence among younger people. Data provided by the WHO on the number of deaths caused by A/(H1N1)pdm09 only include laboratory-confirmed cases. Some authors suggest that these data could underestimate the magnitude of the event, as laboratory confirmation is not obtained in all cases. It is important to bear in mind that the A/(H1N1)pdm09 virus is still circulating in the population. It is therefore essential to maintain its epidemiological and virological surveillance.

A surveillance system of Invasive Pneumococcal Disease in North-Eastern Italy.

BACKGROUND: From 2007, in the Veneto Region (Italy), a surveillance system for invasive pneumococcal diseases (IPD) was implemented to estimate the regional epidemiology of IPD and to evaluate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) vaccination. METHODS: Data were collected from 2007 to 2014 and the total, annual and age-specific IPD notification rates were calculated. A Poisson regression model was used to identify the possible risk factors for developing IPD. RESULTS: A total of 713 IPD cases were notified and the overall IPD notification rate was equal to 2.0 cases per 100,000 population (95% CI: 1.7-2.1), with an increasing trend between 2007 and 2014. The pneumococcal serotypes were identified in 608 (85.3%) isolates from biological specimens, and the most distributed serotypes were those contained in PCV13. Children <5 year-old and the adults over 65 year-old showed the highest PCV13 vaccine-type IPD notification rate, equal to 2.7/100,000 and 2.8/100,000, respectively. The risk to develop IPD was greater in children aged <5 years (RR = 8.9, 95% CI: 5.1-15.9; p<0.0001) and in adults aged >65 years (RR = 4.3, 95% CI: 2.7-6.9; p<0.0001), especially in males > 65 years of age (RR = 1.7, 95% CI: 1.0-2.8; p = 0.042). The invasive pneumococcal disease was mainly caused by the PCV13 serotypes (RR = 2.9, 95%CI: 2.3-3.9; p<0.0001), principally after the PCV13 introduction (RR = 2.3, 95% CI: 1.4-3.8; p<0.001). In spite of that, a significant reduction of the overall IPD incidence is evident in the period following the PCV13 vaccine introduction (RR = 0.4, 95% CI: 0.3-0.5; p<0.0001), particularly in children aged <5 years (RR = 0.3, 95% CI: 0.2-0.7; p = 0.002), demonstrating the real efficacy of PCV13 immunization for children. CONCLUSIONS: In the Veneto Region, the surveillance system has allowed to describe the detailed epidemiological profile of invasive pneumococcal disease, pointing out that the most circulating pneumococcal serotypes were those contained in the PCV13 vaccine.

Geocoding health data with Geographic Information Systems: a pilot study in northeast Italy for developing a standardized data-acquiring format.

INTRODUCTION: Geographic Information Systems (GIS) have become an innovative and somewhat crucial tool for analyzing relationships between public health data and environment. This study, though focusing on a Local Health Unit of northeastern Italy, could be taken as a benchmark for developing a standardized national data-acquiring format, providing a step-by-step instructions on the manipulation of address elements specific for Italian language and traditions. METHODS: Geocoding analysis was carried out on a health database comprising 268,517 records of the Local Health Unit of Rovigo in the Veneto region, covering a period of 10 years, starting from 2001 up to 2010. The Map Service provided by the Environmental Research System Institute (ESRI, Redlands, CA), and ArcMap 10.0 by ESRI(®) were, respectively, the reference data and the GIS software, employed in the geocoding process. RESULTS: The first attempt of geocoding produced a poor quality result, having about 40% of the addresses matched. A procedure of manual standardization was performed in order to enhance the quality of the results, consequently a set of guiding principle were expounded which should be pursued for geocoding health data. High-level geocoding detail will provide a more precise geographic representation of health related events. CONCLUSIONS: The main achievement of this study was to outline some of the difficulties encountered during the geocoding of health data and to put forward a set of guidelines, which could be useful to facilitate the process and enhance the quality of the results. Public health informatics represents an emerging specialty that highlights on the application of information science and technology to public health practice and research. Therefore, this study could draw the attention of the National Health Service to the underestimated problem of geocoding accuracy in health related data for environmental risk assessment.

Older adults in Emergency Department: management by clinical severity at triage.

BACKGROUND: The elderly are involved in an ever-increasing proportion of Emergency Department (ED) visits, consuming a large share of the available resources. The aim of this study was to assess elderly individuals' demand for ED hospital care, in terms of the management process and outcomes by level of urgency at triage. METHODS: The design was a retrospective cohort study. Details on ED attendance were drawn from the 2010 dataset of the Local Health Agency n°18 (n=18,648) in the Veneto Region, North-East Italy and the participants were resident seniors seen at the ED aged 65 or more. RESULTS: At triage on arrival, their priority was most often (in 38.63% of cases) considered non-urgent (white triage tag - Wt). In the majority of these cases, the elderly patients were self-referred, although about 1 in 5 of them had been referred by their General Practitioners. The consumption of resources for specialist visit and routine X-rays is higher for non-urgent patients. Injuries, requests for specialist examinations and musculoskeletal disorders account for a large proportion of the reasons why elderly people classified as Wt at triage had gone to the ED. CONCLUSIONS: Our findings show that older patients have high rates of non-urgent ED attendance, especially for minor traumatic events or requests to see a specialist. This picture emphasizes the need to develop new organizational models for delivering care to meet the most common health care needs of this special frail population.

Health consequences of road accidents: insights from local health authority registries.

BACKGROUND: Road accidents are a major public health problem that affect all age groups but their impact is most striking among the young. The aim of this study is to quantify the burden of road traffic injuries, their mortality and direct in-patient economic costs and to identify the age classes at highest risk for severe road traffic injuries, through analysis of data collected by information systems of an Italian Local Health Authority. METHODS: The study was conducted in a Local Health Authority of Veneto Region. Injured people were selected from Emergency Department (2006-2010). Data were linked to the Hospital Information System for hospital admissions and to the Mortality Registry to check 30-day mortality. The direct costs associated to hospitalizations were estimated through Diagnosis Related Group reimbursement rates. Multivariate analysis was performed using hospitalization and mortality as the dependent variables and gender, age, day of week when accident occurred as the independent variables. Traffic injury, hospitalization and mortality incidence rates were calculated by gender and age per 100,000 residents per year. RESULTS: The road traffic injuries were 9,192, decreasing from 2,112 in 2006 to 1,980 in 2010. Among injured persons 55.3% were male (68.1% among 15-19 age class); 41.7% young people aged 15-34 years (43.9% among male, 39.0% among female). Total hospitalisation rate was 5.9%. Overall mortality rate was 0.3% (0.9% among aged 65 or older). The cost of hospital admission was euro 2,742,505 (hospitalization mean cost euro 5,097). Risk of hospitalization and death was higher in male, in elderly and during week end. Young people aged 15-19 had the highest incidence of visits (2,258.4 per 100,000) and high hospitalisation weekend and mortality rates (respectively 101.5 and 8.5). CONCLUSIONS: Analysis at local level, using current data sources, permits to estimate the burden of injuries caused by road-traffic, to describe the characteristics of injured persons and finally to estimate costs of care. All this information could be used to make the population aware of its own risk for road accidents. Linkage of these data with police and transport data is required to focus prevention on higher risk groups and to adopt effective local road safety strategies.

[Sexually transmitted diseases: epidemiological and social aspects]. / Malattie a trasmissione sessuale: aspetti epidemiologici e sociali.

STDs represent a major public health problem for two reasons: their serious sequelae and the facts that they facilitate transmission of HIV. This article presents WHO estimates new cases of some of curable STDs, and italian data from national reporting system (published from ISTAT and ISS). The number of new reported cases decreases in Italy, but reported cases are not all cases. People with STDs tend not to seek treatment or to self-medicate, this behaviour is common in youths. In many cases STDs are asymptomatic in both sexes, particularly in women. Women are also much more vulnerable biologically, culturally, socioeconomically. There is also a lack of notification by physicians. Important social determinants of STDs diffusion are migration and travels. Prevention and control of STDs need collaboration between medical disciplines: gynaecology, urology, dermo-venerology, microbiology, epidemiology, public health. Contributions of nurses, laboratory technician and social workers are also required. The role of public health specialists in the prevention is strictly related to health education. Health education will promote responsible sexual behaviour and early recourse to health services by people with STDs and their sexual partners.