Impact of a Human Papillomavirus Vaccination Program within Organized Cervical Cancer Screening: Cohort Study.

BACKGROUND: We assessed the effectiveness of an HPV (human papillomavirus) vaccination program in lowering cervical abnormality risk, and conferring herd protection. METHODS: Retrospective cohort study using linked screening and vaccination administrative health data of the general population of Ancona Province, Italy. We included all female residents born in 1990-1993, eligible for catch-up HPV vaccination up to age 25 years, and adhering to organized screening in 2015-2020 (n = 4,665). Cervical abnormalities rates were compared between: Vaccinated and unvaccinated women, and cohorts with high and low vaccination uptake. Analyses were adjusted for age, country of birth, screening tests number, laboratory, and municipality average income. Main outcomes were ASC-US+ or LSIL+ Pap smears, and CIN1+ or CIN2+ histology. RESULTS: Mean screening age was 26.6±1.5 years, and 1,118 screened women (24.0%) were vaccinated (mean vaccination age 19.2±1.5 years). The diagnosed cervical abnormalities were: 107 LSIL+ (2.3%), 70 CIN1+ (1.5%), and 35 CIN2+ (0.8%). The adjusted odds ratios of LSIL+, CIN1+, and CIN2+ among vaccinated versus unvaccinated women were, respectively: 0.55 [(95% confidence interval (CI), 0.33-0.91)], 0.43 (95% CI, 0.22-0.86), and 0.31 (95% CI, 0.11-0.91). Among the unvaccinated, those in the highest-uptake (45.3%) 1993 cohort, versus the last pre-vaccination 1990 cohort, showed AORs of LSIL+ and CIN1+ of 0.23 (95% CI, 0.10-0.50), and 0.22 (95% CI, 0.07-0.69), respectively. CONCLUSIONS: In the first evaluation from Central Italy, catch-up HPV vaccination considerably reduced the risk of all cervical abnormalities diagnosed within organized screening, and conferred an elevated degree of herd protection among unvaccinated women. IMPACT: The high protection conferred by HPV vaccination suggests the need to update cervical screening.

A proposal for a comprehensive approach to infections across the surgical pathway.

Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.

Potential testing of reprocessing procedures by real-time polymerase chain reaction: A multicenter study of colonoscopy devices.

BACKGROUND: Reprocessing of endoscopes is key to preventing cross-infection after colonoscopy. Culture-based methods are recommended for monitoring, but alternative and rapid approaches are needed to improve surveillance and reduce turnover times. A molecular strategy based on detection of residual traces from gut microbiota was developed and tested using a multicenter survey. METHODS: A simplified sampling and DNA extraction protocol using nylon-tipped flocked swabs was optimized. A multiplex real-time polymerase chain reaction (PCR) test was developed that targeted 6 bacteria genes that were amplified in 3 mixes. The method was validated by interlaboratory tests involving 5 reference laboratories. Colonoscopy devices (n = 111) were sampled in 10 Italian hospitals. Culture-based microbiology and metagenomic tests were performed to verify PCR data. RESULTS: The sampling method was easily applied in all 10 endoscopy units and the optimized DNA extraction and amplification protocol was successfully performed by all of the involved laboratories. This PCR-based method allowed identification of both contaminated (n = 59) and fully reprocessed endoscopes (n = 52) with high sensibility (98%) and specificity (98%), within 3-4 hours, in contrast to the 24-72 hours needed for a classic microbiology test. Results were confirmed by next-generation sequencing and classic microbiology. CONCLUSIONS: A novel approach for monitoring reprocessing of colonoscopy devices was developed and successfully applied in a multicenter survey. The general principle of tracing biological fluids through microflora DNA amplification was successfully applied and may represent a promising approach for hospital hygiene.

New market labor and obesity: A nation-wide Italian cross-sectional study.

OBJECTIVES: To investigate the prevalence of obesity among different types of employment status in the Italian working population, and to examine associated risk factors. MATERIAL AND METHODS: Cross-sectional survey of 36 814 people that declared to have been occupied with the same type of contract for at least 5 years was analyzed. Multivariable logistic regression models were built considering workers' sex, age, education, family body mass index (BMI) category, leisure time and occupational physical activity, weight control habits, smoking habit, use of drugs, number of working hours per week, and type of working contract. RESULTS: After adjusting for covariates, the importance of temporary-employment was confirmed by multivariate analysis, with odds ratio (OR) = 1.32 for obesity (95% confidence interval (CI): 1.07-1.63) with respect to employed persons; the association was even more important in workers occupied for more than 40 h/week (OR = 1.69, 95% CI: 1.07-2.66); moreover, shiftwork was confirmed as a risk factor for obesity in workers (OR = 1.06, 95% CI: 0.94-1.2). Dealing with different occupational group, some categories were associated with obesity; in particular, this phenomenon involved people employed in agriculture (OR = 1.44, 95% CI: 1.22-1.7), transportation (OR = 1.53, 95% CI: 1.26-1.85), and public administration (OR = 1.31, 95% CI: 1.1-1.55). CONCLUSIONS: Our analysis suggest that obesity is strongly correlated with temporary employment. Maybe the way out this pathway to obesity in the future might be working better, choosing organizational flexibility rather than fixed term. Int J Occup Med Environ Health 2016;29(6):903-914.