Is it reasonable to abandon obligatory vaccinations in Italy? a 2013 survey.

In Italy, infant vaccinations are mandatory for four infectious diseases: diphtheria, polio, tetanus and hepatitis B. In the past, there was widespread apprehension in Italy that doing away with obligatory vaccinations would reduce the coverage rate, but the possibility of making vaccinations optional has recently become more popular. The objectives of this study were to investigate parental willingness to vaccinate their children if those vaccinations were no longer mandatory and to evaluate the variables influencing this intention. We conducted face-to-face structured interviews with 1,039 parents at public health vaccination centres in four cities of the Campania region of southern Italy. Most respondents (91.9%) said that they would certainly (69.4%) or probably (22.5%) vaccinate their children if vaccinations were not mandatory. The belief that vaccinations are effective and safe was positively associated with willingness to vaccinate their children, whereas having heard that autism is a possible adverse reaction to vaccination was inversely associated with willingness to vaccinate. Nevertheless, in the context of the relatively low 2012* [corrected] vaccination coverage rates in Campania (under the national standard of 95%), our results suggest that eliminating mandatory vaccinations is likely to lead to current coverage rates decreasing to unacceptably low levels, significantly below 90%.

Quality improvement of medical records in a teaching hospital.

INTRODUCTION: The aim of this study was to evaluate the quality of the MR compilation in some Operative Units of the "Azienda Ospedaliera Universitaria--II Università di Napoli" (AOU- SUN)-Italy, before and after an intervention of quality improvement, underlining the potential differences in the behaviour of different specialists (physicians vs. surgeons). METHODS: Two random samples of 660 MRs were reviewed. A four-step program was developed: (1) first assessment of the MR; (2) implementation of the MR quality, sending a letter with the purpose of the study, the results obtained in the first step from that ward, the guidelines to correctly fill out the MR; (3) follow-up step four months later; (4) comparison of the data before and after the distribution of the guidelines using indicators of completeness of all sections of MR, clarity of handwriting and presence and clarity of signature. RESULTS: The main concerns were related to the signature of the duty physician (present in 2.0% and legible in only 15.4%), the presence of the letter of discharge (18.0%) and the clarity of the days of hospital stay (32.0%). After the intervention the improvement of the quality of compilation was modest and regarded mainly medical rather than surgical wards. DISCUSSION AND CONCLUSIONS: The improvement was not satisfying since from a medical and a legal point of view the indicators should reach 100% of clarity and completeness. A further study is being carried out to improve the involvement of health care professional, so that such requirements will be perceived as a common goal, not as mere bureaucratic initiatives.

[Implementation of methods for detection of perceived quality: the application of the Picker's method in ASL Napoli 1 DS 50]. / Costruzione e validazione di metodi di rilevazione della qualità percepita: un esempio di applicazione del metodo Picker nel DS 50 dell'ASL NA 1.

The evaluation of the patient satisfaction in primary care is quite difficult to evaluate for lack of appropriate indicators. The objectives of this study were the validation of the method, using the Picker Institute's Inpatient Questionnaire, and the assessment of patient judgment about the quality of primary care in the DS 50. The indicators that have been used included 3 areas: communication, organization and patient-staff relationship. The results showed that the patient-staff relationship area was indicated as the most important for the patients and they pointed out several problem either for human (self-reference of the professional, lack of emotional relationship) and or for organizational aspects (waiting time). The study highlight that in order to improve the utility of such method, the health organization must be able to appropriately evaluate the patients' need, setting them in a specific organizational vision.

[Geriatric questionnaire assessment in the sanitary district 50 of the ASL NA1]. / La valutazione delle schede gerontologiche: l'esperienza del distretto sanitario 50 della ASL Na1.

In this study it has been estimated the prevalence of the disability in the over 65 population, resident in the sanitary district 50 of the ASL NA1. The aim is an appropriate nursing planning based on the needs of the population. The used geriatric questionnaire is provided by law (ex art. 70 comma 1 lettera a. del DPR 270/2000). The general practitioners of the district filled in 6014 questionnaires. The elders that resulted as self-reliant at the ADL and self-sufficient at the IADL are 86.9% and 80.2% respectively. 54.9% of the elders are free from slight or heavy depression. 81.7% are not going to have mental worst damage. Depression is statistically related to a low income and to a low level of self-reliance and self-sufficiency at the ADL and IADL questionnaire. The study evaluated important formative needs of the elders and pointed out some issues regarding the questionnaire structure and its filling in.

[Reasons for turning to healthcare services outside of own area of residence: a study among patients of the AV1 Local Health Unit in Italy]. / Questionario a pazienti della ASL AV1 in mobilità passiva.

In this study, 552 patients from the AV-1 Local Health Unit, who accessed healthcare services outside of their own area or region of residence ("intra- and extra-regional mobility") were interviewed by their general practitioner. The aim was to describe the healthcare "mobility" phenomenon and the reasons patient resort to it. Most cases involve patients who turn to healthcare services outside their local area but within their own region of residence (intraregional mobility). On the other hand cases that involved "extraregional mobility", that is involved patients who accessed healthcare services outside their own region of residence , occurred in Basilicata, Puglia, Emilia Romagna and Lombardia. Reasons given by patients for this choice are, in order of importance: prestige of a specific hospital or hospital department, trusted physician working in a given hospital, disease severity, specialist advice, reduced waiting times, friends' or relatives' suggestions, better hospital services, lack of trust in healthcare services provided locally, advice given by general practitioner.

Causal models in conventional and non-conventional medicines.

The author describes the possible causal models in both conventional and non-conventional therapies. Ontological determinism is used as a metaphysical assumption and linear causalism as a reference model. The linear causalism is here based on the following properties: sufficient condition, necessary condition, specificity, dose-response relationship, unidirectionality and externality. A subdivision of the therapy into two categories is then proposed: strong activity therapies, with strict causation, are close to linear causalism, and correspond to the therapeutic model of conventional medicine; weak activity therapies, with a much weaker type of causation, apparently tending towards indeterminacy, correspond to non-conventional medicines. Considering the internal state of a human being as a causal factor of therapeutic response, the difficulty in interpreting weak activity therapies is in part resolved and the differences with the strong activity therapies are also less pronounced.

Homoeopathy in primary care: self-reported change in health status.

OBJECTIVES: In recent years numerous clinical trials have been carried out to evaluate homoeopathic therapy. Another approach to evaluating homoeopathy is to investigate its impact in primary health care, that is on outpatients to a homoeopathic centre. METHODS: 609 patients on their first visit to a homoeopathic clinic from June 1995 to May 1997 received a telephone call 1 year later in which they were asked to rate their general health compared with 1 year ago. RESULTS: 1 year after first examination 73.5% of patients reported a marked or moderate improvement in their health status. Marked improvement was significantly higher in subjects who stated they were satisfied with the care received, in females, in the 0-15-year-old age group and in patients who completed therapy. CONCLUSIONS: For conditions which are not life-threatening, homoeopathy seems to meet patients' needs in primary health care.

Italy s new vaccination schedule reduced coverage of poliomyelitis vaccine in Naples.

Italy s health ministry introduced changes to the immunisation schedules for children on 7 April 1999, including immunisation against poliomyelitis. The changes included the replacement of the first two childhood doses of oral poliomyelitis vaccine (OPV)

An outbreak of Salmonella enteritidis food poisoning from a commercially produced cheese.

Nine suspected cases of food poisoning were reported from three hospitals to the epidemiology and prevention service (Servizio di Epidemiologia e Prevenzione - SEP) of the local health authority in Naples district (Azienda Sanitaria Locale, ASL NA 4) betw

[Determinism and indeterminism in the study of risk factors for disease]. / Determinismo e indeterminismo nello studio dei fattori di rischio di malattia.

In epidemiology "risk" is stated as a probability. This statement implies adopting a definite position regarding the concept of probability in science: whether it has to be intended as a lack of knowledge or a casual component of biological phenomena. On this fundamental premise the authors discuss the epidemiological implications on the issue of "determinism" of the recent developments of chemical, physical and biological sciences, particularly the quantum mechanics and the theories of complexity. The authors suggest three major interpretations of the relationship between risk factors and disease: strong determinism, weak determinism and dualism determinism/indeterminism. For each one of these positions they discuss the consistency, affinity and implications on epidemiological work.

Appropriateness of admission and hospitalization days in a specialist hospital.

The assessment of hospital utilization is an important tool in the management of Hospital Health Care. The Authors examined the extent and the reasons of inappropriate hospital admission and stay in patients admitted to the Monaldi Hospital, Naples, Italy. Five hundred and thirty three medical records, were analysed. The survey was carried out in the period May-October 1999, using the italian version of the Appropriateness Evaluation Protocol (AEP) method. Of the admissions days, 15.8% were considered inappropriate; the most frequent cause of inappropriateness was waiting period for diagnostic test. The highest percentage of inappropriateness was found for females, for less serious pathologies and in the summer months. Compared to the admissions, the proportion of inappropriateness of the index days was higher (35.5%); the most frequent cause of an inappropriate day of stay was the persistence of mild symptoms which according to the attending physician justified prolonging the stay, while the same variables found for inappropriate admission (female sex, less serious pathologies and summer months) were related to inappropriateness of stay. This survey has allowed us to offer some useful suggestions with a view to making some of the activities of the "Monaldi Hospital" more efficient.

Adverse events following hexavalent vaccine (Hexavac): knowledge and informative sources.

This report describes adverse events to vaccination in eight children in southern Italy. These children were seen in the Emergency Room of a hospital of the Local Health Unit SA2 (Salerno, Italy) after administration of hexavalent vaccine (Hexavac, Aventis-Pasteur). On analysing available documentation on the adverse reactions (label instructions, Medline), the Authors concluded the cases reported were to be expected. However, the label instructions did not give sufficient information on the type and frequency of adverse reactions. If the label instructions are to furnish complete, operative information for the vaccination units, the Italian instructions for the Hexavac vaccine can be considered inadequate.

Prevalence of asthma among young men in a military recruitment office of South Italy.

The prevalence of asthma was studied in 3065 male 18 year-olds, examined in a southern Italy (Basilicata) military recruitment office. The disease was evaluated by questionnaires, pulmonary function tests and specialist diagnosis. The point prevalence of asthma was 1.4%. The disturbance was more frequent in high versus a low level of maternal education (OR: 3.70; 95% CI: 2.00-6.88), in high versus a low level of paternal education (OR: 2.71; 95% CI: 1.48-4.98), in urban residence versus rural residence (OR: 3.04; 95% CI: 1.61-5.75), in first-borns versus nonfirst-borns (OR: 2.46; 95% CI: 1.33-4.53). Home environment (dampness, heating, crowding) was not significantly correlated to asthma. This reported prevalence of asthma is low, compared with overall European and Italian data. The higher risk in urban areas and high level of education has been confirmed. The association between asthma and first-borns is interesting and needs further investigation, focusing on maternal issues like the low maternal age and the mother-child interaction.

Viruses associated with acute respiratory infections in children admitted to hospital in Naples, 1979-82.

A survey of the virological and epidemiological features of acute respiratory diseases in children admitted to hospital in Naples has been carried out; the results of three years of research are reported.Between April 1979 and March 1982, 787 nasopharyngeal swabs were examined. There were 287 (36.5%) positive samples, with the highest isolation rate being found in children with bronchiolitis (39.5%).Among the different viruses isolated, adenovirus was the most common (161 positive samples, 56%); this agent appeared regularly in the different age and disease groups, with a marked increase in prevalence during the winter of 1980. Isolations of herpesvirus, respiratory syncytial virus and enterovirus were less frequent; however, echovirus 3 caused an epidemic in the summer of 1980. Influenza and parainfluenza viruses were seen fairly infrequently; two cases of Reye's syndrome yielded strains of influenza B.