[Evaluation and containment of cardiovascular risk in a large number of "healthy" subjects]. / Valutazione e contenimento del rischio cardiovascolare su grandi numeri di soggetti "sani".

Cardiovascular diseases are the primary cause of death and represent a public health problem both in terms of mortality and morbidity. Since many risk factors for cardiovascular disease can be corrected with active interventions, we proposed a structured model operating in ways similar to cancer screening: active recall of healthy subjects, offers to intervene in selected subjects. In the experimental model adopted by the Local Health Unit n. 17--Este and the Local Health Unit n. 7--Pieve di Soligo, after pre-evaluation/exclusion by the general practitioner subjects aged between 45 and 59 years were recalled and evaluated by a trained health assistant using anthropometric measurements, screening blood pressure, fasting blood glucose, and evaluation of lifestyle. If their values were abnormal, the health assistant invited them to participate, and counseled them on some initiatives to make changes. The proposed model was demonstrated to be a good model both because using previously tested structured models, it revealed an elevated number of subjects with hypertension and hyperglycemia that were before undetected and because it placed up front strategic actions of the Prevention Departments. In addition, in follow-up, improvements in lifestyle were seen in subjects who had been counseled to alter them.

[Results and development in cancer screening programs]. / Risultati e sviluppi dei programmi di screening oncologici.

In order to contribute to the definition of good model for cancer screening programs, the paper reports an overview of Veneto Local Health Units' results according to required "gold standard" defined by the authors. The analysis was based on a standard attesting that the program is running stabely and a standard for the organisation requiring that general management is performed by a unique central unit, supplied with a unique software and a working group equipped with specific know-how. Ten of the 21 Locale Health Unit of Veneto Region chose to assign to Prevention Department (Public Health Department) all the three screening programs included in the National Prevention Plan. Among these we found the two achieving the defined gold standard (Thiene and Pieve di Soligo). Management model implemented in these units showed a framework for excellence.

[Overcoming mandatory vaccination policy: first steps]. / Il superamento dell'obbligo vaccinale: prime esperienze.

Steps toward overcoming mandatory vaccination policy follow two main tracks: scientific and administrative. Scientific course checks starting conditions of the project in Veneto Region and monitors the effects of policy. Thanks to sensibilization regional programs and partecipation to national campaigns of vaccination, Veneto Region has achieved high coverage for all actively promoted vaccinations. Specific projects has been implemented in order to improve vaccination system quality, particularly with regard to infectious diseases and vaccine adverse events surveillance, training workers and informatization. On 23rd March 2007 Veneto Region passed the regional law number 7 called "Sospensione dell'obbligo vaccinale per l'età evolutiva" becoming in force for children born since January 1st 2008. The law provides for the institution of a scientific committee having the task of monitoring both vaccination coverage and preventable infectious diseases incidence after overcoming mandatory vaccination policy.

Comparison of three different influenza vaccines in institutionalised elderly.

The reactogenicity and the humoral immune response to three influenza vaccines were evaluated in a randomised, double-blind trial at nursing homes in north-east Italy in winter 1998-1999. Of the 285 subjects, who completed the follow-up, 93 were administered virosomal vaccine, 99 received MF59-adjuvanted vaccine and 93 had split vaccine. Ten subjects (0.3%) reported local and/or systemic reactions in the first week after immunisation. After 4 weeks, protection rates (> or = 40) were near 100% for the H1N1 and B strain and 76.0% against H3N2. The MF59-adjuvanted vaccine group had higher geometric mean titres than the other two. However, the true clinical benefit of the new adjuvanted vaccine should be further substantiated by comparative protective studies. Our results suggest that immune response to influenza vaccination in institutionalised elderly is satisfactory.

Seroprevalence of HIV infection among pregnant women in the Veneto region (north-east Italy).

A heterogeneous population of 4396 consecutive pregnant women (86.6% indigenous, 13.4% immigrants) attending the Department of Obstetrics and Gynecology of the University of Padua (north-east Italy) were counselled and tested for HIV infection between September 1995 and December 1997. Sociodemographic and sanitary data were collected on each case. Anti-HIV prevalence was 0.57%. Intravenous drug use and foreign birth accounted for 28% and 24%, respectively, of the anti-HIV positive cases; 44% of the HIV-positive subjects reported no risk factors. In the logistic regression HIV positivity proved independently associated with intravenous drug use (adjusted OR 76. 6), sexually transmitted diseases (adjusted OR 13.2), unmarried status (adjusted OR 4.8), birth outside the European Union (EU) (adjusted OR 3.1) and age (adjusted OR 1.1). Heterosexual HIV spread appears to be a major concern. The monitoring of trends in HIV infection among subgroups should be continued in order to control the AIDS epidemic appropriately both by promoting HIV counselling and individual care, and by watching for changes in the social background.

Prevalence of antibodies against hepatitis C virus in the elderly: a seroepidemiological study in a nursing home and in an open population. The Collaborative Group.

BACKGROUND: The prevalence of antibodies against hepatitis C virus (anti-HCV) increases in the general population with advancing age. Several discrepancies exist in the epidemiology of HCV, however, when selected elderly population groups are tested. OBJECTIVE: To evaluate the HCV prevalence in two groups of elderly people living in the same geopgraphical area of northeast Italy, i.e., one including residents of a nursing home, the other including subjects living at home. METHODS: The overall sample included 496 subjects (mean age 79.31 +/- 8.9 years); 288 were in a nursing home, and 208 were living at home. Enrollment in the latter group was based on all subjects over 65 years old listed under the public health service in the same district. The overall rate of adhesion to the study was 90%. Each subject was administered an anonymous questionnaire testing sociodemographic data and risk factors for HCV infection. Serological tests included: anti-HCV and hepatitis B virus serum markers. Multiple logistic regression analysis was performed to evaluate risk factors for anti-HCV positivity. RESULTS: Anti-HCV positivity was found in 34 of 288 (11.8%) elderly in the nursing home and in 23 of 208 (11.1%) in the open population. When the total population was considered, females exhibited a significantly a higher prevalence of anti-HCV than males (13.4 vs. 7.5%, p < 0.05). In both males and females, the highers rate of anti-HCV prevalence was found among the 75- to 79-year-old subjects. A decline in anti-HCV prevalence was observed in the very old subjects (over 80 years of age). None of the anti-HCV-positive subjects was found to be coinfected with hepatitis B surface antigen. However, multiple logistic regression analysis identified the age group between 70 and 79 years, female gender, and positivity for antihepatitis B surface antigen and/or antihepatitis B core antigen as independent variables significantly associated with HCV prevalence. CONCLUSIONS: The prevalence of anti-HCV proved identical among elderly people living in the nursing home or at home, suggesting that nursing homes do not represent a risk factor for HCV infections; the significant association between HCV prevalence and antihepatitis B surface antigen and/or antihepatitis B core antigen positivity supports a common route of transmission of the two viruses; these findings would suggest that there was an epidemic of HCV infection during the Second World War and in the years immediately afterwards.

Hepatitis C virus, hepatitis B virus and human immunodeficiency virus infection in pregnant women in North-East Italy: a seroepidemiological study.

BACKGROUND: Pregnant women can be considered a sentinel population, because they are a relatively unselected population whose prevalence data may be extended to the general population. METHODS: A seroepidemiological study was carried out in Padua (North-East Italy) to assess the epidemiological aspects of HCV. HBV and HIV infection in 2059 pregnant women consecutively seen at the Department of Obstetrics and Gynaecology during 1996. Out of them, 1804 (87.2%) were indigenous and 255 (12.8%) immigrants. Sociodemographical and sanitary data were collected for each woman. RESULTS: The overall prevalence of anti-HCV was 1.9% (42.5% with detectable HCV-RNA); HBsAg was found in 1.0%: the prevalence of anti-HIV was 0.3%. Findings are substantially consistent with the epidemiological picture of such infections in the general population of our geographic area. A parenteral risk factor for HCV infection was found in 19 subjects (47.5%): 18 were intravenous drug users and 1 a blood transfusion recipient. HBsAg seroprevalence was higher in immigrants than in autochthonous (3.1% vs. 0.7% respectively, p < 0.01). One of the 6 anti-HIV positive women was intravenous drug user. Logistic regression analysis was carried out for each viral agent to determine which characteristics were independently associated with infection: anti-HCV prevalence resulted independently associated to Italian origin (OR: 3.7), unmarried status (OR: 2.7), unemployed condition (OR: 6.1) and history of previous abortion (OR: 2.8). HBsAg prevalence was independently associated to unemployed condition (OR: 10.8), whereas HIV positivity was significantly related to the unmarried status (OR: 18.5). CONCLUSION: Our study pinpoints the need of screening all pregnant women for HCV and HIV infection, in addition to the HBsAg screening which is compulsory in Italy.

Influenza vaccines: antibody responses to split virus and MF59-adjuvanted subunit virus in an adult population.

The humoral immune response generated by two commercial influenza vaccines was evaluated in a randomised, double-blind trial performed in the Public Department of Dolo Health District (North-east Italy) during the winter season 1997-1998. Ninety-eight subjects were immunised with a split virus vaccine and ninety-six with a MF59-adjuvanted subunit virus vaccine (SU/MF59). The pre- and postvaccination (approximately 30 days) antibody titres were determined by hemagglutination inhibition test (HI). After immunisation protective titre rates (> or = 1:40) were near 100% against virus A strain and 82.5% against B strain. Both vaccines caused significant rises in geometric mean antibody titres (GMTs); however, people who received SU/MF59 vaccine were found to develop a greater immune response compared to the group immunised with SVV. According to logistic regression analysis the unprotective prevaccination immune status and the use of SU/MF59 were identified as independent factors significantly increasing the response to immunisation.

Hepatic and extrahepatic malignancies in primary biliary cirrhosis.

Hepatocellular carcinoma (HCC) is rarely reported as a complication of primary biliary cirrhosis (PBC). However, data suggest that patients with PBC have an increased incidence of breast cancer when compared with the general population. Our aim was to analyze the incidence of malignancies in a large series of PBC patients from North-East Italy; to compare findings with those obtained in the general population of the same geographical area, as derived from the general cancer registry; and to study any possible adjunctive risk factor for malignancy. The overall sample included 175 patients (9 males, 166 females). The mean age at presentation was 50.8 years (range 23-77); 17 patients had histological stage I, 45 had stage II, 76 had stage III, and 37 had stage IV. The prevalence of gynecological diseases obtained from the past history of the females included 19.9% miscarriages, 12% hysterectomies, and 2.4% curettages. The follow-up period was 1,187 person/years (average 6.8 yrs per person as a mean). The comparison of the incidence of malignancies between the study group and the general population was obtained by the proportional incidence ratio (PIR), which is the ratio between the cases observed and the expected number of cases in the study group. Logistic regression analysis was performed utilizing the risk factors significantly associated with cancer development in the univariate analysis. Extrahepatic malignancies developed in eight cases (4.5%) and HCC in a further four cases (2.3%), all associated with cirrhosis. Two of the four patients with HCC had a superinfection with hepatitis C virus (HCV). Breast cancer developed only in two patients. The PIR for HCC was 26.27 (95% CI 6.8-46.5), whereas the PIR for breast cancer was 0.43. The logistic regression analysis indicated that a history of cigarette smoking and HCV-RNA positivity were independent variables for the development of HCC. HCC has a relatively high prevalence in PBC and HCV superinfection may play an important part in favoring HCC. The incidence of breast cancer is not significantly higher in PBC than in the general population of the same area.

HBV and HCV infection among non-European Union immigrants in North-East Italy.

The status of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among non-European Union (non-EU) immigrants in North-East Italy was evaluated. Among the 1683 individuals tested the prevalence of HBsAg was 8.9% (150 subjects) and of HBV antibodies (anti-HBc with/without anti-HBs) was 38.9% (654 subjects). The distribution of HBV serological markers showed significant differences according to region of origin; the highest prevalence of infection (76.9%) and carriage (16.1%) was found in immigrants from sub-Saharan Africa. Among the 933 individuals screened for HCV infection, prevalence of antibody was much lower (0.9%) than that observed in the Italian general population (3.2-12.6%). The large number of HBV carriers among immigrants could increase the number of new adult infections due to life-style habits or professional risks in the host population. In contrast, the risk of HCV spread from non-EU immigrants is very low.

Epidemiological aspects of tuberculosis in the Padua Health District 1985-1996.

The present study was carried out in order to monitor the epidemiology of Mycobacterium tuberculosis disease in the Padua Health District over the period 1985-1996 with a view to the situation in some population subgroups. The average annual rate per 100,000 persons per year was 7.9 with a peak in 1994 (15.6 per 100,000 persons). The most significant variations are not per annum but between the periods 1985-1990 and 1991-1996 (average rates per 100,000 persons: 4.8 and 10.9, respectively). The trend shows an increasing frequency in all age groups and especially among the elderly. Immigration from endemic areas and human immunodeficiency virus (HIV) infection appear to contribute to the increase the number of notified cases among adults. In the last four years an increase of tuberculosis cases was also observed among subjects with professional exposure risk. Improvements of programs both at national and regional level are believed to be essential to the tuberculosis control.