Redefining the technical and organizational competences of children vaccination clinics in order to improve performance. A practical experience at the ULSS 12 Venetian Public Health and Hygiene Service.

INTRODUCTION: Since Regione Veneto suspended compulsory vaccination for children in 2008, and because of an increasing disaffection of parents to the vaccine practice, the vaccination rates have been slowly but steadily decreasing. The aim of this study was to analyze internal and external factors of immunization reduction and to implement potential solutions of the problem. METHODS: Servizio Igiene e SanitàPubblica of ULSS 12 Venezi-na (SISP - Hygiene and Public Health Service) analyzed and addressed both, the reasons of parents who do not vaccinate their children and the internal problems regarding vaccination clinics management, information to families, procedures and guidelines and, in general, the communication skills of the vaccination staff. RESULTS: A positive trend in vaccination rates was observed, especially in Venice historical centre. Moreover the staff reported a better working atmosphere and benefit from sharing common goals and procedures, even though the workforce was reduced of about 30% in terms of equivalent unit (EU). DISCUSSION: The continuous quality improvement method followed in this experience led to a steady increase in vaccination coverage in all territorial clinics, to a better adhesion of guidelines and standard operating procedures and to a general professional empowerment of SISP staff. The service now offered to the population is better and more efficient, since the workforce has been reduced. Future goals are to improve information about vaccinations among the population.

Piercing and tatooing in high school students of Veneto region: prevalence and perception of infectious releated risk.

INTRODUCTION: Body piercing (P) and tattoo (T) is a growing social phenomenon over recent years. Nowadays in Italy little is known about the prevalence, the attitude, the medical and social consequences of these activities. The purpose of this study is to examine the prevalence distribution and the attitude towards P and T and the perception of the risk for infections, in a sample of high school students living in the four Provinces of the Veneto Region (Italy). METHODS: An anonymous, self administrate multiple-choice questionnaire about piercing and tattoo practices was distributed during the 2009-2010 academic year to a sample of randomly extracted grades to obtain information about sociodemographic characteristics, family educational level, personal attitude, prevalence and perception of the importance of the sanitary, technical and artistic competence of the operator. RESULTS: The correctly compiled questionnaires were 2712 (95.4%). Males and females were respectively 46.2% and 53.8% (mean age 17 +/- 1.7 years). The 20.2% and the 6.4% of all the students had already experienced respectively P and T and resulted "very interested" the 46.7% to P and the 57.4% to T. Esthetical motivations are the main ones referred to use body art. The most part of interviewed subjects (81.6%) think that it is possible to have an infection, but only about 50% of students reported to know specific information about transmission of HIV, Viral Hepatitis and skin infections. The parents' educational levels do not influence the perception of the risk of infection. The majority of interviewed subjects (88.0%) prefers to undergo body art practices in a qualified center. Only the 30% of students recur to a medical help to solve problem of infection. DISCUSSION: The piercing and tattoo prevalence rate in our study (P: 20.2% and T:6.4%) resulted similar to other Italian ones (range reported: P: 20.3-35.1%, T: 4.8-8.6%), showing an increasing trend with age. Since a high rate of interviewed students referred a substantial ignorance about the risk of transmission of body art related infectious diseases, it is suitable to promote as soon as possible among the youth educational interventions and counseling.

The impact of acute intoxications in a toxicological unit care in north east Italy.

Retrospective study in a toxicological unit care (TUC) performed to know the epidemiology of acute intoxication (AI) in Verona (Italy) during years 2008-2009. All data regarding patients with a diagnosis of certain/suspected AI were collected and evaluated: some demographic information, the characteristics of the agent involved, the pattern of exposure, the triage at the admission to TUC and the outcome. 244 cases were analyzed: 45.9% males and 54.9% females, mean age respectively 45.1 and 43.9 years. The monthly distribution of admitted patients resulted fairly constant, except from a light rising prevalence in autumn, with a majority of yellow (45.9%) and green (43.4%) triage code. The pattern of exposure resulted: ingestion (82.7% of cases; age peaks: 18-34 and 35-51 years old; mostly due to food (as mushrooms), drinks, detergents, soap, pharmaceutical, drugs of abuse, caustics substances), contact (10.2% of cases; age peak 18-51) and inhalation (6.9% of cases). In 17.2% of cases the poisoning exposure was intentional. In 63.5% the patients were sent to their general practitioners (45.5% of the yellow and 81.1% of the green coded patients) and in 22.1% of cases they were admitted to clinical rooms (44.6% of the yellow coded patients). In most cases the triage code assigned to the studied patients resulted yellow and green. Considering that the seriousness of the symptoms can appear after several hours from the exposure to toxic substances, a quick and specific intervention to obtain the best therapeutical effectiveness is suitable, in order to save lives or to avoid irremediable health damages.

Is Venice an ideal habitat for Legionella pneumophila?

INTRODUCTION: Legionella bacterium manifests itself in Legionnaire's disease and Pontiac fever, it is mainly found and transmitted by aerosol produced in cooling towers, water distribution plants and medical equipment, and it affects mainly elder persons in poor health. METHODS: The population of Venice Local Health Unit was divided in two areas of study and the incidence of legionellosis in residents of Venice historical centre (Distretto Sanitario 1) and in residents of the mainland and coastal areas (Distretti Sanitari 2, 3, 4) was calculated. The cases were those notified to the Public Health Unit by law, and the population of residents was that of the eligible for health care in the archives of the Local Health Unit. Only cases of legionellosis in residents who had not travelled in the 10 days previous of the onset of disease, and not related to nosocomial clusters were considered. The standardized incidence ratio was then calculated and confidence interval were defined by Poisson distribution. RESULTS: Given the population of the two areas, 59801 in Distretto Sanitario 1 and 237555 in Distretti 2, 3, 4, the raw incidence of disease is respectively 87 per 100000 and 20 per 100000 in time 2002-2010. The standardized incidence ratio for the population of Distretto Sanitario 1 vs the remaining population is 4.3. DISCUSSION: The difference in risk of getting the disease in this two residential areas geographically very close, is probably related to the different buildings' characteristics, old and difficult to maintain in Venice historical centre.

Self-reported sleep disorders in secondary school students: an epidemiological and risk behavioural analysis.

PURPOSE: To estimate the prevalence of self-reported sleep disorders (SD), to examine associations among demographic characteristics and familiar factors with SD, between SD and daytime sleep-related disorders (DD) and between evening habits and SD. METHODS: An anonymous questionnaire was proposed to 1563 students (aged 14-21 years, mean age 16.5 +/- 1.5; 42.8% males, 57.2% females) attending all classes of two high schools in Verona (North-East of Italy). Data were analyzed by some personal and familial characteristics, by definition of three sleeper groups (non problem, occasional problem or problem-sleepers). Moreover SD were put in relation with DD and with some personal evening attitudes. RESULTS: The 75.5% of the subjects report at least one SD. Difficulty falling asleep is the most frequent SD. The DD concern 91.2% of the sample. Females are more involved than males in SD and DD. All SD result strongly associated with the referred DD, except for sleepiness. Sport is significantly correlated with a minor prevalence of SD. Smoking and studying appear to be associated with SD. CONCLUSIONS: Since SD in youth constitute an important Public Health matter with a severe social impact they would be accurately studied to offer youth appropriate counselling given the importance of lifestyle in determining good sleep.

Epidemiology of domestic injuries. A survey in an emergency department in North-East Italy.

INTRODUCTION: Home injuries (HI) represent a social and public health problem worldwide. In Italy, there are 1,300,000-1,700,000 admissions to Emergency Department (ED) for HI and 130,000 hospitalizations every year, but the data are incomplete and fragmentary. A study of the phenomenon was carried out in Emergency Department (ED) of Civil Hospital of Verona to evaluate prevalence, characteristics and possible preventive actions. METHODS: In 2007, 3120 admission for HI have been registered at the Eä of the Civil Hospital of Verona. The distribution was calculated in relation to sex, age, month, code of urgency, outcomes, type and location of trauma. RESULTS: Children in pre-school age, men between 30 and 40 years and women over 60 years are the population groups most at risk, with a fairly homogeneous incidence distribution. Both sexes have similar distributions up to 41-50 years followed by an increase in females and a decrease in males at higher age. The traumas are generally slight (49.8% white code and 42.1% green code) and the hospitalizations represent 5.8% of all recorded HI. The most frequent injuries are wounds/abrasions (28.7%), contusions/crushing (27.7%) and fractures/distortions/ dislocations. The most affected body parts are hands and wrists (25.9%). Head trauma is significantly more frequent in children and elderly people, fracture in elderly people, and burn in adult women and male children. Every year about 30% of the admissions to emergency departments are caused by HI. Even though 92% of the times the events aren't serious, the sanitary cost is consistent due to the elevate number of admissions. It is therefore important to do prevention through sanitary education and adequate building legislation.