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.

Insulin resistance is a risk factor for high blood pressure regardless of body size and fat distribution in obese children.

BACKGROUND AND AIM: The prevalence of children with hypertension is increasing, especially in obese children. This study was to assess the relationship between blood pressure, indexes of adiposity, body fat distribution and insulin resistance. SAMPLE: 1044 children (M/F: 484/560; aged 6-11 years). Anthropometry and blood pressure were measured and fasting blood samples were tested for triacylglycerol, total cholesterol, HDL cholesterol, glucose, insulin and ALT. The prevalence of high blood pressure in overweight males and females was 14.3 and 6.4%, respectively (chi(2)=16.73, p<0.001) and in obese it was 40.4 and 32.8%, respectively (chi(2)=5.56, p<0.001). High blood pressure increased progressively with BMI z-score categories (chi(2)=67.99, p<0.001) as well as with waist/height ratio (W/Hr) categories (chi(2)=23.51, p<0.001). Hypertensive subject had significantly higher insulin (15.6+/-9.8 vs 11.9+/-7.2, p<0.001 and 20.63+/-14.7 vs 15.26+/-9.8, p<0.001 in males and females respectively) and HOMA(IR) (3.23+/-2.1 vs 2.42+/-1.49, p<0.001 and 4.12+/-2.87 vs 3.07+/-1.98, p<0.001 in males and in females, respectively) than non-hypertensive ones. Among metabolic and cardiovascular risk factors, HOMA(IR) was the only variable able to predict high blood pressure in obese boys and girls, in addition to BMI or body fat distribution (waist, W/Hr). The highest HOMA(IR) category was the most important predicting factor of high blood pressure in overweight and obese children in addition to body size or body fat distribution. CONCLUSIONS: Blood pressure is associated with the degree of overweight and the indices of body fat distribution. Insulin resistance is an independent additional risk factor for hypertension.

Waist circumference as a predictor of cardiovascular and metabolic risk factors in obese girls.

OBJECTIVES: (a). to explore the relationship between waist circumference and certain cardiovascular risk factors in a group of girls; and (b). to assess the clinical relevance of waist circumference in identifying girls with higher cardiovascular risk across puberty. SUBJECTS AND METHODS: One-hundred and fifty-five overweight or obese girls aged 5-16 y were recruited. Overweight and obesity were defined on the basis of BMI, according to Cole. RESULTS: : Waist circumference was significantly correlated with plasma insulin (r=0.43; P<0.001), systolic blood pressure (r=0.22; P=0.007) and IR(HOMA) (r=0.40; P<0.001). A multivariate linear correlation analysis showed that, when adjusted for age and Tanner stage, waist circumference was significantly associated with plasma insulin (r(2)=0.23; P<0.01), IR(HOMA) (r(2)=0.17; P<0.02), systolic and diastolic blood pressure (r(2)=0.20; P=0.006 and r(2)=0.32; P<0.001, respectively). A logistic regression analysis, using IR(HOMA) as the dependent variable, showed that waist circumference was a significant independent risk factor of insulin resistance (IR(HOMA)>or=2.6) in this group of girls (OR 1.10; 95% CI 1.03-1.18; P=0.003), independently of their age and Tanner stage. CONCLUSIONS: Waist circumference of these girls was independently associated with certain cardiovascular risk factors, in particular insulin resistance and diastolic blood pressure, independently of age and Tanner stage. Thus suggesting that waist circumference may be reasonably included in clinical practice as a simple tool that may help to identify sub-groups of obese girls at higher metabolic risk across puberty.