Immunization polices in Italy has recently reached important milestones, including the approval of the National Immunization Prevention Plan and of a new law mandatory immunization; this stimulating a lively debate at the scientific, political and societal-level, reflected on the media. We applied a model previously published to quantitatively and qualitatively assess media coverage on vaccines and immunization-related topics on the most read Italian newspaper, "Corriere della Sera", over an 11-year study period (2007-2017). We retrieved relevant key words and articles, reported on included articles' topic, position, approach to immunization and on other selected indicators' summary statistics, temporal trends and correspondence with key epidemiological and policy events. Over the study period the quote "vaccin*" was mentioned on average 325 times per year; with an increase of 150% after the approval of the new law on mandatory immunization in 2017. In the same year, on average, two first-page articles per week were published on the topic. We report a clear association between key events (i.e the H1N1 influenza pandemic, the "Fluad case", the approval of the new law on mandatory immunization) and their media coverage. Overall, 84% of articles had a positive attitude towards immunization, this share decreasing to 79% when only considering articles published after the approval of the law on mandatory vaccination. Media play a crucial role in channelling health-related information and significantly influence health behaviours. We urge public institutions, health authorities and the scientific community not to underestimate the opportunity to monitor media coverage on key healthcare topics and to convey evidence-based health education messages through the media.
Objective: Patients undergoing endovascular aneurysm repair (EVAR) have comorbidities that increase the risk of death, myocardial infarction (MI) and acute kidney injury (AKI). Our aim was to evaluate the incidence and predictors of mortality, MI and AKI after EVAR and to compare AKI incidence with Vascular Surgery Kidney Injury Predictive Score (VSKIPS). Methods: We conducted a retrospective study of EVAR procedures performed between March 2006 and November 2013. We defined mortality at 30 days, MI as an increase in troponin level to >0.034 ng mL -1 in the first 72 h and AKI as an increase in creatinine level to >0.3 mg dL -1 in the first 48 h after surgery. Risk factors were analysed using logistic regression calculating Hosmer-Lemeshow test and the area under the receiver operating curve (AUROC). Results: Ninety-eight patients were included in the study. The incidence of mortality, MI, and AKI was 2%, 5%, and 18%, respectively. AKI increased the risk of MI [odds ratio (OR) 24.4, p=0.006]. Preoperative serum urea level of >50 mg dL -1 (OR 4.97, p=0.038), general anaesthesia (OR 9.64, p=0.002) and surgery duration (OR 1.53, p=0.043) were considered independent predictors of AKI. The AUROC of the AKI model was 0.886 compared with 0.793 of VSKIPS. Conclusion: We found the incidence of mortality, MI and AKI consistent with that of previous studies. However, we may be underestimating the last two because of the short follow-up time. AKI was an independent predictor of MI. Preoperative serum urea level of >50 mg dL
Problem Acute flaccid paralysis (AFP) active surveillance is the gold standard in polio eradication process. Italy was classified in 2017 at intermediate risk of poliovirus reintroduction based on suboptimal poliovirus surveillance. The aim of this study was to restore an adequate level of AFP surveillance in Emilia-Romagna Region. Description of the Problem The Emilia-Romagna's Reference Centre for AFP surveillance, in collaboration with the regional Public Health Service identified a collaborative network for AFP Surveillance by analysing the 2015-2017 Hospital Discharge Registers in all region's hospitals. The surveillance protocol was reviewed with the development of a computerized system of Active Surveillance-Zero Reporting sent by e-mail to doctors in the network every 15 days since October 2018. The goal was to restore the AFP notification system to meet WHO requirements sensitivity, completeness of case investigation, completeness of follow-up and to monitor the active surveillance program adherence. Results The active surveillance network was composed by 49 doctors from both hospital administrations and clinical wards from 4 University Hospitals and 7 Local Health Authorities throughout the region. By the end of 2019, the mean response to each e-mail was 48.5% (SD 7.5%); 7 AFP cases have been reported; 85.7% received a full clinical and virological investigation and 83.3% completed the 60 day's follow-up. The final diagnosis of the cases was: 3 Guillain-Barre, 1 transient polyneuritis after HAV vaccination, 1 neuromyopathy from chronic disease, 1 acute myelitis in patient with DADA2. In 2 cases the paralysis persisted after 60 days. Lessons In 2019, the active surveillance system reached sensitivity, completeness of case investigation and follow-up required. Intervention had no expenses, is easily reproducible, created a direct collaboration between clinical colleagues in the network and the reference center which restored adherence to AFP surveillance. Key messages This work proposes how to improve AFP surveillance in a setting with low polio risk perception due to the absence of cases. Additionally, it reinforces the importance of direct collaboration/teamwork between institutions, regional reference centres and clinicians.
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