The missed Constitutional Reform and its possible impact on the sustainability of the Italian National Health Service.

The rejection of the Constitutional Law Bill No.1429-D in the December 2016 referendum, has stimulated a cause for reflection on current health legislation and the future prospects of the Italian National Health Service; also in the context of the recent approval of the new Essential Levels of care (LEA) and other relevant laws approved by the Parliament. This article analyzes possible future legislative and organizational scenarios with particular regard to issues related to National health system's sustainability.

[Re-organization of health services in Italy and the role of medical directors of hospitals and local health units]. / Il Direttore sanitario aziendale e il processo di riorganizzazione dei servizi ospedalieri e territoriali.

Health authorities, medical directors and managers are called to face increasing and inter-related challenges regarding the ongoing financial crisis, aging of the population and the need to acquire innovative medical technologies. These challenges need to be tackled in order to ensure sustainability of the healthcare systems and appropriateness and quality of healthcare services. In Italy, the role of medical directors has progressively evolved over the years and now requires strengthened managerial skills and additional professional expertise and skills to plan, implement and evaluate the new systems of government. We performed an extensive literature review and a qualitative study involving six semi-structured interviews with key actors (health managers) in order to explore and clarify the possible future role of medical directors in Italy and what training should be provided to residents in Hygiene and Preventive Medicine.

Flu vaccination in elite athletes: A survey among Serie A soccer teams.

Scant data is available on immunization policies and practices among professional athletes. Following up on a recent review on the topic, we conducted a survey among Italian Serie A soccer teams during the influenza season 2015-16, to explore vaccination practices and attitudes as well as influenza vaccine uptake. The survey covered a sample of over 600 professional athletes from 20 teams and was carried out in collaboration with the Italian Association of Physicians of Professional Football Teams (L.A.M.I.CA.). For each team, the head of the medical staff was interviewed (structured telephone interviews, 100% response rate). Seasonal influenza vaccine was actively offered in 75% of Serie A teams with a median coverage rate of 40% (range 0%-100%). Vaccines are often administered after matches or training sessions. We report vaccine hesitancy associated with fear of adverse events, poor communication and other selected determinants. Vaccination in elite athletes, if correctly managed, represents a powerful, cost-effective and long lasting preventive tool. In times where vaccines are losing public confidence, our findings are a useful basis to inform the planning, implementation and evaluation of interventions to promote prevention in sports medicine.

[Guidelines for immunization practices in professional athletes]. / Raccomandazioni Vaccinali per gli atleti professionisti1.

The specific risks for communicable diseases in professional athlets is analysed with particular regard to soccer players. Considering the increased risks for infectious diseases transmission due the particular esposures and the periodical decrease of the immune system (the so called "open window") specific guidelines for immunization practices are here suggested: a check for the standard immunizations of childhood and adolescency, the routine immunizations (seasonal flue and decennial booster doses for tetanus and diphteria) and the management of particular circustamces in case of epidemics or intercontinental tournaments.