Italian National Health Institute Research Articles

Training to improve the vaccination offer: the experience of the AcToVax4NAM project

Abstract Background Developing training activities material with the aim of strengthening vaccination literacy and cultural aware approach among “Professional-FOR-health”, all health and social care workers and other professionals working in the field of the immunization of Newley Arrived Migrants (NAMs), is part of the activities of the project “Access To Vaccination for Newly Arrived Migrants”-AcToVax4NAM (Grant n.101018349, 3rdEU Health Programme). Objectives The Italian project Team, Sapienza University of Rome and Italian National Health Institute, designed the framework for training to strengthen the healthcare system Vaccination Literacy and responsiveness among Professional-FOR-health, in order to increase the capacity building skills and cultural sensitivity of the healthcare system in promoting active immunization of NAMs. The training materials were shared to all Consortium Countries (Cyprus, Germany, Greece, Italy, Malta, Poland, Romania, Spain) to be implemented in their context. Results The targets of the training activities are health professionals responsible for vaccination, professionals from other services that meet NAMs or promote vaccination (GPs/FPs), professionals active in the target area (NGOs). We designed a blended training, face to face sessions, web sessions should alternate. The topics are “Vaccine Literacy”, “Cultural awareness/migrant sensitivity”, “Health promotion tools with community-based approach” and “Entitlement to vaccination for NAMs/NAMs profile”. 4 evaluation tools were constructed: a pre- and post-test learning, an exploratory survey on the level of vaccine literacy of the organisations involved, a satisfaction questionnaire. Conclusions Each country will construct, based on the resources made available, a course that is as adherent as possible to the context of its own country and target group. This type of training can be the groundwork for the changes needed to make the NAMs vaccination process more guaranteed and inclusive. Key messages • It is important to stimulate a training process that enables health professionals to reconnect their daily experiences with a broader context of thinking, for a real empowerment process. • As learners’ cannot be seen as mere recipients of notions and information, their needs, motivations and experiences should be put right at the centre of the training process.

Trends in SARS-CoV-2 clinically confirmed cases and viral load in wastewater: A critical alignment for Padua city (NE Italy)

Since the beginning of the COVID-19 pandemic, wastewater-based epidemiology (WBE) has been depicted as a promising environmental surveillance tool and early warning system. Predictive models for the estimate of COVID-19 cases from wastewater viral loads also earned lot of interest and are currently under development. Hereby a pilot study that compares WBE surveillance data with confirmed cases, total hospitalizations, doses of vaccine administered and predominance of coronavirus variants.Composite 24hrs wastewater samples were collected weekly between September 2021 and July 2022 from Padua wastewater treatment plant. Samples were processed following a previously published method. One-step RT-qPCR was performed for quantification, adapting an Orf1b-nsp14 gene assay. Variant replacement was derived from the monthly bulletins of the Italian National Health Institute. Aggregate data on vaccine doses administered and on COVID-19 prevalence and hospitalizations were retrieved from official reports.Eighty-two samples were processed. Viral loads highlighted 3 major peaks in January, April and July 2022. Quantitation of SARS-CoV-2 in wastewater and clinical surveillance resulted temporally juxtaposable. However, variation of the two curves is not proportional. SARS-CoV-2 showed its highest peak in April, whereas maximum COVID-19 prevalence was achieved in January. Total hospitalizations followed the prevalence trend. Omicron BA.1 started to replace the Delta variant in December 2021. Subsequently, the shift towards Omicron BA.2 occurred between February and April 2022. Finally, BA.4/5 attested around June, somehow preceding the summer peak.Emergence of Omicron BA.1 over Delta could be a possible driver of the increase in both clinical cases and wastewater viral load in January 2022. In late March 2022, Omicron BA.2 replaced BA.1: this reflected in a steep increase of wastewater viral load, but not of COVID-19 confirmed cases. When a dramatic drop in the testing capacity of clinical surveillance occurred, WBE was possibly capable of detecting a substantial increase in viral circulation.

The health impact of hazardous waste landfills and illegal dumps contaminated sites: An epidemiological study at ecological level in Italian Region.

The implementation of idoneous management of hazardous waste, in contrast to illegal practices, is one of the environment and health priorities of the WHO. The aim of the present study, based on a collaborative agreement between the Italian National Health Institute and a Prosecution Office located in Naples North, was to evaluate the health effects of illegal landfills and burning of urban and hazardous waste in the territory of the Prosecution Office. The municipalities included in the study territory were investigated with respect to the regional population. Regression analyses were performed in the study area between four classes of an environmental municipal indicator of waste risk (MRI) previously defined, computing the relative risks (RRs) in 2-4 MRI classes, with respect to the first MRI class (the least impacted). The prevalence of reproductive outcomes and cause-specific mortality and hospitalization were analyzed in the general population and in the 0-19-year-old population using SAS software. An increase of mortality and hospitalization risk in both the genders of the whole area, with respect to regional population, were found for overall all cancer cases, cancer of the stomach, the liver, the lung and the kidney, and ischemic heart diseases. An increase of mortality for leukemias in the 0-19-year-old population and in hospitalization risk for certain conditions originating in the perinatal period were observed. Correlation between MRI and the risk of mortality from breast tumors in women (MRI class 2: RR = 1.06; MRI class 3: RR = 1.15; MRI class 4: RR = 1.11) and between MRI and the risk of hospitalization from testis tumors (MRI class 2: RR = 1.25; MRI class 3: RR = 1.31; MRI class 4: RR = 1.32) were found. The hospitalization risk from breast tumors and asthma exceeded significantly in both genders of three and four MRI classes. Among the 0-19-year-old population, correlation between MRI and hospitalization from leukemias (MRI class 2: RR = 1.48; MRI class 3: RR = 1.60; MRI class 4: RR = 1.41) and between MRI and the prevalence of preterm birth (MRI class 2: RR = 1.17; MRI class 3: RR = 1.08; MRI class 4: RR = 1.25) were found. A correlation between health outcomes and the environmental pressure by uncontrolled waste sites was found. Notwithstanding the limitation of the study, the results promote implementing the actions of environmental remediation and the prosecution of illegal practices.

The impact of COVID-19 on the immigrant population in Italy. Context, methodology and synthesis of the main evidence from the project of the National Institute for Health, Migration and Poverty (INMP) and Italian Regions

COVID-19 acted on health inequalities in two ways: directly, in terms of infection risk and outcomes; indirectly, through effects on the economy, which exacerbated social inequalities. Immigrants have particularly suffered the effects of the pandemic.The Italian National Institute for Health, Migration and Poverty (INMP) has promoted the project "Epidemiology of SARS-CoV-2 (COVID-19) infection and use of health services in immigrant and vulnerable population groups in Italy" in collaboration with the Regions of Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio, and Sicily, to assess the impact of the pandemic in the immigrant population.This is an observational population-based study design, based on weekly monitoring data from the COVID-19 National Surveillance System of the Italian National Health Institute (ISS). The observation period was split into five sub-periods: February-May 2020 (wave I), June-September 2020 (intermediate period I), October 2020-January 2021 (wave II), February-April 2021 (wave III), May-July 2021 (intermediate period II).Access to diagnostic testing was higher among Italians; the incidence curve showed a lower level of infection among immigrants during the three waves and higher in the two intermediate periods. Age-standardized hospitalization rates were higher among immigrants both in noncritical care areas and in the intensive care unit, particularly in the intermediate stages of the epidemic. Immigrant standardized mortality rates were higher than those of Italians since the third period among males and in the fourth period among females.Differences were also observed on a regional basis and by the immigrants' area of origin.

Role of telemedicine network provided by pharmacies to detect acute myocardial infarction in patients with chest pain during coronavirus pandemia

Abstract Background During the lockdown period in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in the Lombardy Region. The current rise in COVID-19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARS-CoV2 infection. During COVID-19 outbreak period, it has been observed a decrease in hospital admissions for acute myocardial infarction. This phenomenon put in serious difficulty the clinical management of COVID-free patients with cardiovascular disease, at the beginning of phase 2 (starting from May 4 2020). Purpose In this scenario, we aimed to verify the impact of telemedicine during lockdown, in comparison with the same period in 2019. Materials and method We analyzed 12-lead ECGs recorded by 5000 country pharmacies, evaluated and stored in one telemedicine platform provided by Health Telematic Network (HTN), in cooperation with our Cardiology Department, Federfarma (Pharmacists' National Association), and Italian National Health Institute. Results During the lockdown period, were recorded 6,104 ECGs in territorial pharmacies, compared to 17,280 ECGs done in the same period in 2019. Chest pain symptom represented the cause of recording ECG in 298 patients (4.88%) during the lockdown period, compared to 402 patients (2.33%) in the same period in 2019, with an increase of 109.86%. In the Lombardy Region, during lockdown period, were reported 118 accesses to territorial pharmacies for chest pain (about 39.50% of total cases in Italy). Among these, 36 accesses were in the province of Brescia (about 30.50%), whereas 28 of them were in the province of Bergamo (about 23.73%). Among ECGs performed, 8 showed typical abnormalities of acute myocardial infarction with ST elevation (STEMI, 2.68%) in the lockdown period, compared to 7 STEMIs (1.74%) detected in the same period in 2019, with an increase of 54.17%. These patients were referred to Emergency Department (ED) suddenly, for the therapeutic intervention. Conclusion These data shown that a large number of patients with cardiovascular symptoms preferred to go to territorial pharmacies rather than hospitals during the COVID outbreak period. Telemedicine played a prominent role in managing patients with cardiovascular symptoms at home. Moreover, this service allowed patients with STEMI to access to the hospitals faster, avoiding the risks of a serious diagnostic delay. Furthermore, by analyzing the data of Lombardy Region, it was possible to show how a significant component of access to local pharmacies for chest pain occurred in the region most affected by the COVID-19 outbreak. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): University of Brescia Number of ECGs recorded for chest painData recorded in Lombardy Region

Impact of telemedicine network provided by local pharmacies in the management of symptomatic tachyarrhytmias during COVID-19 outbreak

BackgroundDuring the lockdown in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in Lombardy. The current rise in COVID-19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARS-CoV2 infection. In other European countries interested by a national lockdown, a decrease in registered new-onset atrial fibrillation (AF) cases was observed. Undiagnosed AF patients can develop complications that could potentially translate into poorer long-term outcomes.PurposeIn this scenario, we aimed to verify the impact of telemedicine (TLM) during lockdown, in comparison with the same period in 2019.Materials and methodWe analyzed 12-lead ECGs recorded by 5000 country pharmacies, evaluated and stored in one TLM platform provided by Health Telematic Network (HTN), in cooperation with our Cardiology Department, Federfarma, and Italian National Health Institute.ResultsDuring the lockdown period in 2020, 6,104 ECGs were performed in territorial pharmacies, compared to 17,280 ECGs recorded in the same period in 2019. Among ECGs performed, we detected AF in 344 patients (5.64%) in lockdown period, compared to 393 cases (2.27%) detected in the same period in 2019, with an increase of 40.25%. We detected also Atrial Flutter in 32 patients (0.52%) in lockdown period, compared to 25 cases (0.14%) detected in the same period in 2019. The difference was +26.92%. Moreover, we found Paroxysmal Supraventricular Tachycardia in 8 patients (0.13%) during lockdown, compared to 6 cases (0.03%) detected in the same period in 2019, with an increase of 23.07%. In lockdown period, a total of 384 patients (6.29%) were referred to ED because of symptomatic tachyarrhythmia, compared to 424 patients (3.47%) referred to ED in the same period in 2019, with an increase of 55.16%. In the Lombardy Region, during lockdown, were reported 194 cases of tachyarrhythmia in territorial pharmacies (about 50.52% of all cases in Italy). Among these, 93 cases of tachyarrhythmia were in the Brescia area (about 47.94%), whereas 50 cases were in the Bergamo one (about 25.77%).ConclusionThese data shown that, during the COVID outbreak, a large number of patients with CV symptoms preferred to go to territorial pharmacies rather than the closer hospital. TLM played a prominent role in managing patients with CV symptoms at home. Moreover, this service allowed to refer to the hospital only patients with clinically relevant tachyarrhythmia, avoiding the risks of treatment delay. This once again underlines how TLM network provided by pharmacies may become an important tool offered to citizens, especially during coronavirus pandemic emergency, within the Italian National Health System.Funding AcknowledgementType of funding sources: Public Institution(s). Main funding source(s): University of Brescia Accesses in ED for tachyarrhythmiasData provided in Lombardy region

Corneal transplant during COVID-19 pandemic: the Italian Eye Bank national report

To investigate the impact of Coronavirus Disease-2019 lockdown on the Italian Eye Bank organization. In this national retrospective, multicentric, cohort study, data from the Italian Eye Bank during both the lockdown and the first month after the lockdown period were retrieved. We compared the Italian Eye Bank metrics with the same timeframe of 2019 and 2018. Data from 13 out of 13 (100%) Italian Eye Banks were included in the analysis. A statistically significant reduction in the number of donor corneas retrieved in 2020 was found as compared to the same period in 2019 and in 2018, respectively (2020 = 1284; 2019 = 3088; 2018 = 3221; ANOVA: p < 0.0001). Only 534 corneas have been distributed by Eye Banks during the COVID-19-lockdown period (2020 = 534; 2019 = 1220; 2018 = 1237. ANOVA: p < 0.0001). Similarly, the number of wasted corneas due to postponed or cancelled surgeries was 421, resulting in a considerable increase as compared to the previous 2 years (2020 = 421; 2019 = 67; 2018 = 84; ANOVA: p = 0.0035). Overall, 45 donor corneas were rejected in accordance with the guidance of the Italian National Health Institute Italian National Transplant Centre (CNT). SARS-CoV-2 pandemic has profoundly affected every social and medical field, including the Eye Bank procurement and distribution programs. The current data collected from all the Italian Eye Banks highlights the present and the forthcoming difficulties that the Eye Bank community is going to experience, as for the ongoing pandemic.

A Dietary Assessment Training Course Path: The Italian IV SCAI Study on Children Food Consumption.

The eating patterns in a population can be estimated through dietary surveys in which open-ended assessment methods, such as diaries and interviews, or semi-quantitative food frequency questionnaires are administered. A harmonized dietary survey methodology, together with a standardized operational procedure, in conducting the study is crucial to ensure the comparability of the results and the accuracy of information, thus reducing uncertainty and increasing the reliability of the results. Dietary patterns (i) include several target variables (foods, energy and nutrients, other food components), (ii) require several explanatory variables (age, gender, anthropometric measurements, socio-cultural and economic characteristics, lifestyle, preferences, attitudes, beliefs, organization of food-related activities, etc.), and (iii) have impacts in several domains: imbalance diets; acute and chronic exposures affect health, specifically non-communicable diseases; and then sanitary expenditure. On the other hand, food demand has impacts on the food system: production, distribution, and food services system; food wastes and other wastes generated by food-related activities of the households (e.g., packaging disposal) have consequences on the “health of the planet” which in turn can have effects on human health. Harmonization and standardization of measurement methods and procedures in such a complex context require an ad hoc structured information system made by databases (food nomenclatures, portion sizes, food atlas, recipes) and methodological tools (quantification methods, food coding systems, assessment of nutritional status, data processing to extrapolate what we consider validated dietary data). Establishing a community of professionals specialized in dietary data management could lead to build a surveillance system for monitoring eating habits in the short term, thus reducing costs, and to arrange a training re-training system. Creating and maintaining the dietary data managers community is challenging but possible. In this context, the cooperation between the CREA Research Centre for Food and Nutrition and the Italian National Health Institute (ISS) promoted and supported by the Italian Ministry of Health may represent a model of best practice that can ensure a continuous training for the professional community carrying out a nutritional study.

Italian Cystic Fibrosis Registry (ICFR). Report 2017-2018

Italian Cystic Fibrosis Registry (ICFR). Report 2017-2018

Low Radiation Environment Switches the Overgrowth-Induced Cell Apoptosis Toward Autophagy

Low radiation doses can affect and modulate cell responses to various stress stimuli, resulting in perturbations leading to resistance or sensitivity to damage. To explore possible mechanisms taking place at an environmental radiation exposure, we set-up twin biological models, one growing in a low radiation environment (LRE) laboratory at the Gran Sasso National Laboratory, and one growing in a reference radiation environment (RRE) laboratory at the Italian National Health Institute (Istituto Superiore di Sanità, ISS). Studies were performed on pKZ1 A11 mouse hybridoma cells, which are derived from the pKZ1 transgenic mouse model used to study the effects of low dose radiation, and focused on the analysis of cellular/molecular end-points, such as proliferation and expression of key proteins involved in stress response, apoptosis, and autophagy. Cells cultured up to 4 weeks in LRE showed no significant differences in proliferation rate compared to cells cultured in RRE. However, caspase-3 activation and PARP1 cleavage were observed in cells entering to an overgrowth state in RRE, indicating a triggering of apoptosis due to growth-stress conditions. Notably, in LRE conditions, cells responded to growth stress by switching toward autophagy. Interestingly, autophagic signaling induced by overgrowth in LRE correlated with activation of p53. Finally, the gamma component of environmental radiation did not significantly influence these biological responses since cells grown in LRE either in incubators with or without an iron shield did not modify their responses. Overall, in vitro data presented here suggest the hypothesis that environmental radiation contributes to the development and maintenance of balance and defense response in organisms.

The CCM Project "Preventing vector-borne diseases through the development and pilot implementation of new operational supporting tools"

The relevant ecological changes due to the anthropological pressure on the planet is causing reactions in the biological systems, which we must understand and characterize at the local scale to assist the adoption of suitable decisions in the public health risk management. The project presented in this paper is focused on the vector-borne diseases, mainly transmitted by mosquitoes. The species of mosquito currently playing an active role of public health importance in Italy are Aedes albopictus, as a vector of Chikungunya, Dengue and Zika viruses, as well as Culex pipiens, as a vector of West Nile and Usutu viruses. Predictive models are indicating the risk of introduction and establishment in the Mediterranean basin of Aedes aegypti, which is causing a mayor concern. The project has been conducted by the Emilia-Romagna, Piemonte, Veneto, Marche and Sicilia Regions, together with the Italian National Health Institute. The aim was to develop and pilot testing new approaches and technological tools possibly assisting the public health system in the management of the risk. The activities have been organized on six specific objectives: 1. Development and field testing of guidelines for the surveillance of invasive mosquito species; 2. Creation of risk maps for Chikungunya, Dengue and Zika viruses based on the quantitative monitoring of Aedes albopictus populations; 3. Shaping web platform models assisting the sharing of data from/to actors involved in the integrated surveillance of West Nile at the regional level; 4. Developing communication formats dealing with vector borne diseases addressing citizen and specific categories; 5. Approaching the cost-benefit analysis in the view to assist decision makers; 6. Sero-surveillance on arboviruses not included in the Ministry directive (Tick Borne Encephalitis and Toscana virus). The achieved results are presented and the acquired experience is made available to promote the adoptions on a larger scale of the approaches and methods to be certainly adapted in the specific contexts. The one health approach seems suitable to address the necessities emerging in this field by taking into consideration the different triggers shaping the dynamics we are observing.

179 Poster - A human-derived acellular dermal matrix for breast reconstruction: The first European experience

Background: The growing diffusion of direct-to-implant breast reconstruction (DTI-BR) following mastectomy for breast cancer (BC) is largely related to the introduction and increasing use in clinical practice of acellular dermal matrices (ADMs). Human-derived ADMs (H-ADMs) showed optimal outcomes in breast reconstruction and a better integration in the host tissues when compared with animal-derived products; according to the European legislation, H-ADMs are considered “human products,” subjected to the European laws on transplantation, and not “medical devices.” The Skin Bank of the Bufalini Hospital (Cesena, Italy) in 2009 obtained from the Italian National Transplant Center and National Health Institute the approval for the production and distribution of a new human cadaver-donor-derived ADM (named with the Italian acronym, MODA – Matrice Omologa Dermica Acellulata – Homologous Decellularized Dermal Matrix); in 2015 we started to use MODA in breast reconstructions following mastectomies for BC. To our knowledge, this is the first European experience about the routine use of H-ADMs in breast reconstruction surgery reported.

From epidemiology to public health decision making: analysis on IMD &amp; vaccination strategy in Italy

Abstract Introduction Invasive Meningococcal Disease (IMD) is one of the most severe vaccine-preventable disease, with high fatality rate and severe sequelae in up to 20% of survivors. MenB, MenC and MenACWY vaccines are available in Italy, but recommendations vary among Italian regions in terms of type of vaccines and targeted age groups. The aim of the study is to describe epidemiology of IMDs in order to provide the best vaccination strategy. Methods IMDs surveillance data in the period 2011-2017 from the Italian National Health Institute were explored. Excel was used to present trend analysis, stratifying by age and serogroups. Results In Italy, during the period 2011-2017, IMDs overall incidence increased from 0.25 cases/100,000 inhabitants in 2011 to 0.33 in 2017. Most cases after 2013 were caused by non-B serogroups (52%, 52%, 66%, 64%, 59% from 2013 to 2017). Although incidence is highest in 1 years old children, the number of cases is highest in the age range 25-64. The number of cases in this age-range had a steady increase after 2013 (36 cases in 2011, 79 in 2017), with serogroups C, W and Y present in more than 65% of cases in 25+ age ranges after 2012. Conclusions IMD is a rare but severe vaccine-preventable disease. The key role of public health is to monitor disease serogroups, trends and outbreaks and strengthen methodological evidence-based tools for decision-making processes, public health policies, planning of healthcare services and intervention measures, including immunization. The increase in incidence shown in the period 2011-2017 in Italy, although probably due to better surveillance, highlighted the high circulation also of non-B serogroups and the importance of the disease in the adult population. Based on our analysis we believe that anti-meningococcal vaccination plan in Italy should include the highest number of preventable serogroups and be aimed to the whole population through a multicohort strategy, including boosters in children and in adults. Key messages Anti-meningococcal vaccination plan in Italy should include all the preventable serogroups and be aimed to the whole population with a multicohort strategy including boosters in children and in adults. The increase in incidence of IMD in the period 2011-2017 in Italy highlighted the high circulation also of non-B serogroups and the importance of the disease in the adult population.

Turning constraints into resources: the experience of TRAIN4M&amp;H training program on migrants’ health

Abstract Background The tender TRAIN4M&amp;H (Provision of training for first-line health professionals and law enforcement officers working at local level with migrants and refugees, and training of trainers- contract 20167204), funded by the EC-DG SANTE under the 3rd EU HP, intended to conduct training programme in all EU/EEA countries for health professionals, law enforcement officers an social workers in front-line countries and coach trainers in the others. Objectives Training was aimed at reinforcing skills, improving understanding and positive attitudes, and promoting a holistic approach in the work with migrants. The boundaries set by the tender included a short training duration; exclusive use of pre-existing and validated training materials; different professional targets. Italian National Health Institute and Sapienza University of Rome designed the training programme. Criteria for content selection and methodological choices were submitted for consultation to an inter-professional Expert Group in two steps. Results Given the limited training timeframe, the delivery of specialised content could not be the focus of this training. It was decided therefore to transform the target requirement into added value, by mixing the target groups into multi-professional classes. This bring a diversity of understandings into the classroom and enhance communication between sectors. The training included also topics such as “context of migration” and “intercultural competences” to create common ground for multi-professional exchange. Similarly, the need to adapt to different EU/EEA contexts argued for a modular structure where Units are selected by the Local Trainer based on a training needs assessment questionnaire sent to trainees beforehand. All materials are on EU Health Policy Platform's Agora (webgate.ec.europa.eu/hpf/). Conclusions Training on migrants' health is a complex process, requiring the engagement of learners from their previous experiences and an interdisciplinary approach. Key messages Inter-professional training programme can be used for the adult trainings especially in case of a cross-sectoral topic as migrants’ health is. Inter-professional training is a strategy that can guide coherently content design, outcome identification and the choice of evaluations tools.

Invasive meningococcal disease in Italy: from analysis of national data to an evidence-based vaccination strategy.

SummaryIntroductionInvasive meningococcal disease (IMD) is one of the most severe vaccine-preventable disease not yet under control. In Italy, although different anti-meningococcal vaccines are available, their offer among regions is heterogeneous. The aim of this study is to describe the epidemiology of IMD in Italy based on analysis of national surveillance data for 2011-2017 to optimize the vaccination strategy.MethodsIMD surveillance data from the Italian National Health Institute were analysed. Microsoft Excel was used to present trend analysis, stratifying by age and serogroups.ResultsIn Italy, during the period 2011-2017, the incidence of IMD increased from 0.25 cases/100,000 inhabitants in 2011 to 0.33 cases/100,000 in 2017. Most cases after 2012 were caused by non-B serogroups. The number of cases in subjects aged 25-64 years increased steadily after 2012 (36 cases in 2011, 79 in 2017), mostly due to non-B serogroups, representing more than 65% of cases in those aged 25+ years.ConclusionsIn the period from 2011 to 2017, the incidence of IMDs increased in Italy. The increase, probably due also to a better surveillance, highlights the importance of the disease in the adult population and the high level of circulation of non-B serogroups in particular after 2012. Our analysis supports an anti-meningococcal vaccination plan in Italy that should include the highest number of preventable serogroups and be aimed at vaccinating a wider population through a multicohort strategy.

Acceptance of e-Learning Programs for Maternity Health Care Professionals Implemented by the Italian Obstetric Surveillance System.

Distance learning efficacy on physician performances and patient health outcomes has been demonstrated. This study explored the participation and evaluation of CME e-learning courses for Italian health care professionals addressing leading causes of maternal mortality identified by the Italian Obstetric Surveillance System (ItOSS) at the Italian National Health Institute, namely postpartum hemorrhage and pregnancy hypertensive disorders. A model for two online free 12-hour case-based training courses was used. Data on participants were collected, anonymized, and transferred to the Italian National Health Institute for later analysis. Participants were requested to sign an online informed consent form. Twenty-one thousand five hundred thirty-two health care professionals enrolled to the courses from 2014 to 2017 as follows: midwives (14,187, 65.9%); obstetricians (3,716, 17.2%); anesthesiologists (1,896, 8.8%); and other medical specialists (1,733, 8.0%). Overall, 85% of participants acquired CME credits. Participants' satisfaction on quality, efficacy, and relevance was very high. ItOSS courses were able to reach a substantial number of different professional profiles involved in perinatal care all over the country; ItOSS courses can be considered an effective way to spread evidence-based good clinical practices. Nevertheless, further studies are needed to verify the improvement in professional health care skills and patient outcomes.

Good practices for the surveillance and control of antimicrobial resistance

Italy is one of the European Countries with the highest level of antimicrobial consumption, both in the community and in hospital settings, and with the highest prevalence of antimicrobial resistant microorganisms. In 2015, the Project "Good practices for the surveillance and control of antimicrobial resistance" was funded by the Italian National Centre for Disease Prevention and Control (CCM): the aim was to promote integrated actions at national level to control antimicrobial resistance, favouring the transfer of existing good practices. The principal objectives of the project were: to describe the Italian scenario of good practices based on literature review; to improve the capacity of surveillance, through achieving consensus on a core set of indicators, including paediatrics, and through the strengthening of the national surveillance system of antimicrobial resistance coordinated by the Italian National Institute of Health; to define tools useful for priority setting; to evaluate the efficacy of intervention programme aimed at promoting the appropriate use of antibiotics among children for upper respiratory tract infections in the community; to set up training programmes on the prudent use of antibiotics in veterinary medicine. Seven regions were enrolled in the project (Emilia-Romagna with the role of programme coordinator, Campania, Calabria, Lazio, Lombardy, Piedmont, Tuscany) and the Italian National Health Institute. The project allowed to document: the scarce spread of control practices at national level (out of 277 studies reviewed, only 6.1% of the cases were targeted to evaluating the effectiveness of intervention programmes); a significant variability among regions both in relation to antimicrobial consumption and antimicrobial resistance prevalence, with a worrying spread in some regions of several antimicrobial resistant organisms responsible for "critical" infections with great potential health impact; the effectiveness of an intervention aimed at promoting appropriate use of antibiotics in frequent infections for children in the community, such as pharingotonsillitis and acute otitis media (35% reduction of antimicrobial consumption between 2010 and 2017 in Emilia-Romagna; an inversion of the ratio amoxicillin/amoxicillin-clavulanate); the need for new indicators to monitor antimicrobial consumption in hospital paediatric wards and of a new national system for timely identification of new antimicrobial resistance profiles; a positive evaluation of the training programme for veterinary physicians. In conclusion, the project has contributed to identify the most critical areas for antimicrobial resistance control and to select appropriate solutions, potentially transferable to the national level.

Italian Cystic Fibrosis Registry (ICFR). Report 2015-2016

Italian Cystic Fibrosis Registry (ICFR). Report 2015-2016

How safe are organs from deceased donors with neoplasia? The results of the Italian Transplantation Network.

Guidelines for donor selection have changed to expand the donor pool, considering potential donors affected by a neoplasm. Aim of this retrospective study is to look at the use of organs from donors with a current or history of neoplasm within the Italian Transplant Network. Data, collected and validated by Italian National Health Institute for the time interval 2006-2015, have been reviewed retrospectively by mean of multivariable pivot tables. Donors with neoplasia represented about 5% of all donors, resulting in about 4% of all transplants. Donors presented a benign neoplasm in 29.08% of cases, a malignancy with variable risk of transmission in 69.75% while in 1.34% the nature of neoplasm could not be assessed. Considering all procedures, rate of transmission of a malignancy was 0.03% (10 cases) of all 29858 transplants of the time interval. Notably, cases of transmission were not from donors of this pool, but from donors that, according to our protocols, had no elements of suspect at time of donation. As recipient safety is always the priority and as guidelines have set exclusion criteria for donors with some specific types of malignancy, these results show that use of this type of donors is safe and improve organ pool. Furthermore represent basis for improvement and standardization of donor assessment protocols suggesting that efforts in data collection systems, to produce complete and homogeneous data, are mandatory.

The tattooed population in Italy: a national survey on demography, characteristics and perception of health risks.

In recent years, Italy has seen a constant upward trend in the practice of tattooing. The Italian National Health Institute has conducted a national survey to determine the prevalence of tattooed people in Italy and to study related features of the phenomenon. Establish the prevalence and characteristics of the tattooed population and evaluate awareness of the risks associated with tattoos, which can contribute to consumer health protection. Computer-assisted telephone interviews and computer-assisted web interviews were completed by a sample of the general population; 7608 people aged between 12 and 75+. The prevalence of tattooed people was 12.8% of the general population in Italy (95% CI: 12.05%-13.55%), equivalent to an estimated 6 900 000 tattooed individuals. Tattoos were more prevalent among women, at 13.8%, while tattooed men accounted for 11.8%. The vast majority of tattooed subjects had decorative tattoos of small dimensions, with a higher prevalence of monochromatic tattoos. Only a minority of tattooed participants reported having cosmetic tattoos (3.0%) or medical tattoos (0.5%). According to the data, 3.3% of tattooed subjects claimed complications or reactions; of these, only 21.3% consulted a dermatologist/general practitioner; more than half (51.3%) did not consult anyone. In general, only 58.2% of the sample were aware of health risks. The Italian survey showed that 36.7% of all tattoos had been performed in the last five years prior to the interview. The estimated prevalence of tattoos in Italy is in agreement with the statistics of the European Union. The prevalence in the age group 35-44 years is almost double that of the Italian population and it is higher in women than in men. Tattooing is relevant to public health. The high number of tattooed Italians, the potential long-term effects on health and the reported complications call for the awareness of health authorities. Appropriate intervention should ensure safer tattooing by reinforcing the training of tattooists, by improving surveillance and by providing information to raise public awareness of the risks and contraindications of tattooing.