Action against vaccine-preventable infectious diseases and tuberculosis in Nomad Camps: the experience of a Local Health Unit in Rome.

In Italy the highest incidence of Tuberculosis (TB) cases is in young adult migrants. In 2011, the sanitarystaff of the Local Health Unit (ASL) Roma A promoted a vaccination campaign conducting several public health interventions in Nomad Camps. After notification of a case of TB in the Camp of Via Salaria, out of 357 Mantoux skin tests performed, 93 were positive (26%); subsequently, 5 subjects with radiographic positivity were hospitalized. The vaccination campaign was carried out to prevent the spread of infectious diseases in immigrant communities at high risk of contagion and to avoid the consequent transmission in the host country. As a result, vaccinations coverage among the residents of the Camps increased: 367 vaccinated subjects (30% more than previous year) and 612 administered vaccinations.

H1N1 pandemic influenza: habits and behaviour of the nurses. A public health issue.

BACKGROUND: One of the main concerns related to pandemic H1N1 influenza 2009 is the overwhelming burden on medical structures. The aim of this work is to study the behaviour and attitudes of Nurses in relation to the spreading pandemic in order to develop public health strategies. METHODS: During the spread of Pandemic, in winter 2009, an anonymous questionnaire online of thirty-four questions was available for participants. Data obtained were analyzed using descriptive, univariate and multivariate statistics. RESULTS: A total of 2313 nurses were interviewed. In univariate analysis 72.6% of 573 males (versus 63.9% of 1740 females) have been talk to a doctor (p<0.001). The female group appear less likely to get vaccinated (60.3% vs 51.1%, p<0.001). Multivariate analysis revealed that to be worried (OR=2.82 95% CI: 2.31-3.46), female (OR=0.62 95% CI: 0.51-0.77), age group 30-49 (OR=0.72 95% CI: 0.58-0.90) were associated with the willingness of Get vaccinated. CONCLUSIONS: Prevention, as washing hands and vaccination, are crucial in pandemics events. Given the low rates of acceptance of pandemic vaccination among nurses, public health bodies should consider campaign education, in order to prevent nosocomial transmission, to protect patients and the continuity of the essential health-care infrastructure.

Is there a lack of information on HPV vaccination given by health professionals to young women?

OBJECTIVE: The aim of this survey is to compare the main sources of information about vaccination against Human papillomavirus (HPV) of young women aged over-18 and under-18 years. METHODS: A multicenter study was carried out in Italy through the administration of a questionnaire. Univariate analyses were conducted to evaluate possible differences between age groups and different locations (chi-square test and Fisher test where possible). RESULTS: The sample consisted of 987 young women. The main sources of information about HPV vaccination are represented by magazines/books (23.1%) and TV (20.5%) for the over-18s, while for the under-18s the sources are general practitioners (22.6%) and pediatricians (15.4%). The over-18s with health professionals as parents consult mostly gynecologists (27.7%) and general practitioners (20.5%). DISCUSSION: This study highlights lack of information on HPV vaccination given by health professionals to young women and underlines the need to improve education about cervical cancer, prevention and HPV vaccination.

Influenza vaccination recommended for all adults aged between 50 and 64 years: conceptual basis and methodological limitations.

In the first half of this year the experts of the Italian Society of Hygiene (SItI), along with those of other National Scientific Societies, agreed with the recommendations made by the USA CDC in 2009, and developed a proposal for a vaccination schedule (Vaccine Schedule for Life), in which influenza vaccination is recommended for all adults aged between 50 and 64 years. In the National Plan for Vaccinal Prevention 2012-2014, which was published just before the issue of the SItI Calendar but concluded earlier (end of 2011), influenza vaccination is recommended "only" for all persons > or = 65 years or included in one of the many at-risk categories. The issue is controversial and has generated considerable debate at national and international level. This short note discusses the logical processes and the scientific evidence in support or against the decision to extend the influenza vaccination. The Authors conclude that the epidemiological approach used by SItI experts is appropriate. In any case, further studies on the topic are strongly needed, and their results should be taken into account in the drafting of future vaccination schedules.

Validation of a web-based questionnaire for pregnant women to assess utilization of internet: survey among an Italian sample.

BACKGROUND: Objective of this pilot study was to evaluate the reliability and validity of the web-based questionnaire in pregnant women as a tool to examine prevalence, knowledge and attitudes about internet utilization for health-related purposes, in a sample of Italian pregnant women. METHODS: The questionnaire was composed by 9 sections for a total of 73 items. Reliability analysis was tested and content validity was evaluated using Cronbach's alpha to check internal consistency. Statistical analysis was performed through SPSS 13.0. RESULTS: Questionnaire was administered to 56 pregnant women. The higher value of Cronbach's alpha resulted on 61 items: alpha = 0.786 (n. 73 items: alpha = 0.579). High rate of pregnant women generally utilized internet (87.5%) and the 92.1% confirmed to use internet with the focus to acquire information about pregnancy (p < 0.0001). CONCLUSIONS: The questionnaire showed a good reliability property in the pilot study. In terms of internal consistency and validity appeared to have a good performance. Given the high prevalence of pregnant women that use internet to search information about their pregnancy status, professional healthcare workers should give advice regarding official websites where they could retrieve safe information and learn knowledge based on scientific evidence.

[Implementation of the stewardship model in public health: proposal of an assessment tool for the Italian national prevention plan]. / Implementazione della stewardship in sanità pubblica: proposta di una metodologia valutativa applicabile al piano nazionale della prevenzione.

The stewardship model has been adopted as a system of governance in several countries. In Italy, the Ministry of Health has proposed the use of the stewardship model for implementing the activities of the National Prevention Plan 2010-2012. The authors present the conceptual foundations and methodology used in the development of an assessment tool (audit tool) for evaluating the level of implementation of the stewardship model with regards to the activities of the national prevention plan in all Italian regions.

[Workplace safety in private companies of freights and on the road workers: comparison between small and medium enterprises]. / La sicurezza sul lavoro nelle aziende private del comparto trasporto merci e persone su strada: confronto tra medie e piccole imprese.

BACKGROUND: The road freight and passenger transport sector exposes the workers of this sector to a considerable health risk. Application of the relative legislation to safeguard worker's safety is an obligation for the employer. OBJECTIVES: The aim of the study was to assess the application of current legislation in the trucking sector and ascertain whether there are differences between large and small enterprises. METHODS: The study was conducted through direct interview with managers of road freight and passenger transport companies in the Lazio Region in 2009. Information was collected using a questionnaire composed of 77 items concerning risk assessment and organization aspects in the enterprises. The enterprisers were stratified by number of workers and drivers. To detect possible associations the Chi-squared and Fisher's Exact tests were used. RESULTS: A total of 42 enterprisers participated in the study. Significant differences were found between larger enterprisers (10 workers) and smaller enterprises (< 10 workers), concerning risk assessment from vibrations (p = 0.006), night work (p = 0.026), microclimatic conditions (p = 0.047). Regarding risk prevention/management aspects, the enterprisers with a higher number of workers were more likely to have a workers' representative for safety compared to the smaller enterprises (respectively 88.9% versus 50.0%) and a road accidents Register (77.8% versus 16.7%), with p < 0.001 significance levels. CONCLUSIONS: The risks most frequently assessed, in decreasing order, were: vibrations, manual handling of loads, stress, noise, awkward postures, night work, alcohol consumption, drug addiction and microclimatic conditions. Vibrations, night work and microclimatic conditions risks were assessed to a lower degree in the smaller enterprisers compared to the larger enterprises.

[School teachers' knowledge, attitudes and behaviors towards road safety: results from a multicenter cross-sectional study in Italy]. / Conoscenze, attitudini e comportamenti degli insegnanti in materia di sicurezza stradale: risultati di uno studio trasversale multicentrico in Italia.

The aim of this study is to investigate knowledge, attitudes and behaviors of secondary school teachers towards traffic safety behaviors. The study is concerning data coming from a cross-sectional study using a self-administered questionnaires filled in by school teachers of Lazio and Campania regions. 262 teachers entered into the study. Among the scooter holders, 69.2% did use helmet; 95.8% of people who drives car uses seatbelts. The scooter and bicycle helmet is considered useful for 99.6% and 57.4% of participants. The accident rate depends on the means of transportation used: 10.8% and 19% for bicycle and scooter riders, respectively, and 44.6%for the car drivers. Regarding injuries using a bicycle, teachers with less than 40 years are less involved in accidents compared to the over 40 years (OR = 0.19; p = 0.05), as well as teachers who are married (OR = 0.16; p = 0.03) compared to the other group (single/widowed/divorced). Car accidents involve less frequently women (OR = 0.60; p = 0.05) compared to males. Road accidents prevention is part of the health priorities indicated in the National Health Plan, the National Prevention Plan and Regional Prevention Plans. School teachers' can play an important role in students' education on road safety, and there is the need to improve knowledge and behaviors in this field.

Quality of life and physical activity in liver transplantation patients: results of a case-control study in Italy.

The aim of the study was to assess the quality of life (QOL) and the physical activity of liver transplant recipients compared with the general population. The case-controlled pilot study was accomplished through the administration of 2 questionnaires: 36-item Medical Outcomes Study, Short-Form General Health Survey (SF-36) for quality of life (10 scores) and International Physical Activity Questionnaire (IPAQ) to estimate the physical activity (metabolic equivalent score). Fifty-four patients who underwent liver transplantation using the piggyback technique and 108 controls from the general population at the orthopedic ambulatories were enrolled between 2002 and 2009. Participants had a mean age of 55 years (range, 41-73). The multivariate analysis showed significant differences for some scales of the SF-36: liver transplant recipients displayed lower values for "Mental Composite Score" (P = .043), "physical activity" (P = .001), "role limitations due to physical health" (P = .006), "role limitations due to the emotional state" (P = .006), and "mental health" (P = .010). The metabolic equivalent positively associated with all examined SF-36 scales. The present study focused on the QOL and physical activity of liver transplant recipients, demonstrating that transplant recipients scored lower than the general population. Liver transplantation may allow full recovery of health status, but the physical and social problems persist in some patients. Interventions aimed at improving rehabilitation programs, regular psychosocial support, and follow-up in all phases of treatment may give patients a more satisfying lifestyle after transplantation.

Quality of life among healthcare workers: a multicentre cross-sectional study in Italy.

OBJECTIVE: To evaluate the quality of life among doctors, nurses, and occupational safety and health technologists (OSHT). STUDY DESIGN: Cross-sectional study was undertaken in a population of healthcare workers in 10 Italian regions. METHODS: The Italian version of short form-36 (SF-36) was anonymously and voluntarily self-administered by participants to assess the perceived health-related quality of life (HRQOL). The HRQOL scores for the sample and the Italian population were compared. A multiple linear regression was performed to assess the influence of age, gender, role, socializing time, working time, years spent in healthcare and years spent in the specific department on the SF-36 score. RESULTS: The sample included 324 healthcare workers [57.1% women, mean age 39.0 (standard deviation 10.2) years]: 52.6% were medical doctors, 36.8% were nurses and 10.5% were OSHTs. Workers with a career of >15 years achieved a general health score lower than that of workers with a shorter career, while those who spent more time in socializing activities achieved a higher mental health score. The multivariate analysis showed that increasing age is positively related to role emotional levels (ß = 0.243; P = 0.002), while it appears to be inversely related to general health (ß = -0.218; P = 0.007) and physical function (ß = -0.246; P = 0.001). Nurses had lower scores for bodily pain (ß = -0.214; P < 0.001), social function (ß = -0.242; P = 0.001) and role emotional (ß = -0.211; P = 0.006) compared with doctors. Compared with the general Italian population, healthcare workers had higher scores for general health, physical function, role physical, bodily pain and mental health, and lower scores for vitality, social function and role emotional. CONCLUSIONS: Healthcare workers have different levels of HRQOL related to their professional role. In particular, nurses have lower quality of life. These results may help to identify the main roles and attitudes that could cause frustration, dissatisfaction and emotional stress in healthcare workers.

C-C bond unsaturation degree in monosubstituted ferrocenes for molecular electronics investigated by a combined near-edge x-ray absorption fine structure, x-ray photoemission spectroscopy, and density functional theory approach.

We present the results of an experimental and theoretical investigation of monosubstituted ethyl-, vinyl-, and ethynyl-ferrocene (EtFC, VFC, and EFC) free molecules, obtained by means of synchrotron-radiation based C 1s photoabsorption (NEXAFS) and photoemission (C 1s XPS) spectroscopies, and density functional theory (DFT) calculations. Such a combined study is aimed at elucidating the role played by the C-C bond unsaturation degree of the substituent on the electronic structure of the ferrocene derivatives. Such substituents are required for molecular chemical anchoring onto relevant surfaces when ferrocenes are used for molecular electronics hybrid devices. The high resolution C 1s NEXAFS spectra exhibit distinctive features that depend on the degree of unsaturation of the hydrocarbon substituent. The theoretical approach to consider the NEXAFS spectrum made of three parts allowed to disentangle the specific contribution of the substituent group to the experimental spectrum as a function of its unsaturation degree. C 1s IEs were derived from the experimental data analysis based on the DFT calculated IE values for the different carbon atoms of the substituent and cyclopentadienyl (Cp) rings. Distinctive trends of chemical shifts were observed for the substituent carbon atoms and the substituted atom of the Cp ring along the series of ferrocenes. The calculated IE pattern was rationalized in terms of initial and final state effects influencing the IE value, with special regard to the different mechanism of electron conjugation between the Cp ring and the substituent, namely the σ/π hyperconjugation in EtFC and the π-conjugation in VFC and EFC.

Tobacco use among medical students in Europe: results of a multicentre study using the Global Health Professions Student Survey.

OBJECTIVE: To examine smoking prevalence, knowledge and attitudes, and tobacco cessation training among university students attending European medical schools using the Global Health Professional Students Survey approach. METHODS: A cross-country, cross-sectional study was performed among 12 medical schools in four countries in Europe (Germany, Italy, Poland and Spain). The survey was performed during the second semester of the third year of study from March to May 2009. RESULTS: In total, 2249 subjects entered the study (overall response rate 92%). The overall prevalence of smoking among medical students was 29.3% (95% confidence interval 28.1-34.7), with percentages ranging from 28% in Germany to 31.3% in Italy. This study found that more than two-thirds of medical students believe that health professionals are role models for patients, with different beliefs in Poland (89.6%) and Germany (77.7%) vs Italy and Spain (57.2% and 54.4%, respectively) (P < 0.001). Smoking cessation training at medical school was only reported by 16.5% of students (lowest proportion in Italy, 3.5%) (P < 0.001). In terms of smoking cessation methods, the vast majority (89.8%) of medical students were aware of nicotine patches and gum (highest prevalence in Spain, 96.3%), and 24.4% were aware of the use of antidepressants (highest prevalence in Germany, 33.6%). CONCLUSION: This European survey found that the prevalence of smoking was higher among medical students than the general population. There is a strong need to provide medical students with training in smoking cessation techniques.

[Exposure to noise in the general population and hypertension: results from a pilot case-control study in Rome]. / Esposizione a rumore nella popolazione generale ed iperten- sione arteriosa: risultati di uno studio pilota caso-controllo nella città di Roma.

The aim of the study was to assess the impact of noise pollution on blood pressure values of a sample population in the metropolitan area of Rome. A case-control study was carried out. Cases were patients with hypertension recruited at the Hypertension Center of the Teaching Hospital "Agostino Gemelli" in Rome, whereas controls were healthy people recruited at the same center. Noise exposure was assessed using place of residence of participants, and this related to monitoring air pollution data of Rome. 241 individuals entered the study, 161 cases (80 males and 81 females) and 80 controls (42 males and 38 females), aged on average 55,65 (+/- 12.66) and 57.08 (+/- 14.64) year, respectively. Multivariate analysis showed that being a case is directly associated to increasing age (the risk increases of 5% for each increase of 1 year), salt use (OR = 2.76; 95% CI: 1.18 - 8.48), exposure to a noise level over 65 dBA (OR = 2.09; 95% CI: 1.01 - 4.47), and inversely to physical activity (OR = 0.49; 95% CI: 0.23 - 1.00). These results, could be considered in city and urban green planning, having the last element a mitigating effect on population health.

Seasonal and pandemic influenza: the role of communication and preventive strategies.

Appropriate, timely, and data-driven health information is a very important issue in preventive strategies against influenza. Intuitively, a link between willingness to be vaccinated against seasonal influenza and against pandemic influenza exists, given the similarities in decision-making for this vaccine. International and national literature reviews suggest that progress has been made in order to incorporate and disseminate crisis risk communication principles into public health practice, as such investments in public health could be important for building capacity and practice which aid in the realization of countermeasures in response to a future pandemic and epidemic situation. This study emphasizes the lack of perception by Health Care Workers (HCWs) of the importance of being immunized against seasonal and pandemic influenza and the doubts concerning safety. In the future, particular efforts are needed during vaccination campaigns, to provide more information to HCWs and the general population regarding role and safety of such vaccines.

Knowledge about pandemic flu among Italian health care workers (HCWs): an Italian survey.

INTRODUCTION: In case of pandemics, healthcare workers (HCWs) are the main actors and, at the same time, one of the main targets of preventive measures. This is what occurred in 2009 during the A/HINI pandemic flu. The aim of our survey was to get information about HCWs' knowledge of the A/HINI pandemic flu prevention. MATERIALS AND METHODS: A survey of 32 questions, 11 of which about knowledge towards A/H1N1 pandemic flu, created on the basis of a similar one by the Harvard School of Public Health, was made available on the Italian Journal of Public Health website during the month of October 2009. The survey was advertised with links from various professional websites and by emailing to HCWs' addresses taken from the Italian Society of Hygiene and Public Health (SItI) databases. Descriptive and univariate analyses were conducted in order to assess whether differences exist on the level of knowledge of HCWs (specifically Nurses and Physicians) about preventive measures against the A/H1N1 pandemic flu. RESULTS: 1,960 HCWs answered to the questionnaire, 1,711 (87.3%) Nurses and 249 (12.7%) Physicians. Both Nurses and Physicians seemed to have a high or moderately high interest for A/H1N1 pandemic flu (86.1% vs. 91.2% respectively, p = 0.03). Nurses indicated national newscasts (38.6%) and communications within hospitals or other workplaces (33.8%) as the source of most information about A/H1N1 pandemic flu. On the other hand Physicians got information mostly from Internet (41.8%), but also from communications within their hospital or other workplace (34.5%) (p < 0.001). Not all the Nurses and Physicians knew that contagion is possible by close contact (less than 1 metre) wit someone affected (74.0% and 88.0% respectively, p < 0.001), while 82.3% of Nurses and 71.1% of Physicians reported that face masks protected from getting infected (p < 0.001). CONCLUSION: Information and awareness campaigns on the influenza pandemic should be conducted firstly among HCWs, because of their importance--especially in case of pandemics--as a valuable resource at risk, as a contagion vehicle and as a source of information for the general population.

[The INHES cohort study on the health status of nurses in Italy: research protocol]. / Lo studio di coorte INHES sullo stato di salute negli infermieri in Italia: protocollo di ricerca.

Due to the intense emotional involvement and the often problematic working conditions characterizing their profession, Nurses appear to be especially susceptible to the negative effects of a complex set of stressors, with important repercussions to their health. Nevertheless, scientific literature assessing the health status of Nurses in Italy is still scarce. With INHES (Italian Nurses' HEalth Study), we propose to remedy this gap by implementing a cohort study which will start from the analysis of some local healthcare facilities and which may subsequently extend throughout the country. Study participants will be Nurses selected according to the following inclusion criteria: 1) age between 30 and 55 years; 2) having been employed in the current healthfacilityfor the last five years; 3) having performed care duties in wards or in day care services for the last five years. The objectives of this study, which will be carried out through the administration of a validated questionnaire, are the following: to measure the incidence and prevalence rates of a series of diseases in the nursing population, highlighting potential correlations with working activity, job-related stress or environmental and personal risk factors; to assess the quality of life and psychological health of the participants, evaluating the interference of psychophysical disorders with their work and social activities; to investigate the implementation of wellness promotion, prevention, case management and disability management policies by healthcare facilities. The evidence gathered will provide a valid scientific support for the development of more effective policies for protecting Nurses' health, with positive social and economic repercussions for the entire community.

[The scientific contributions by the Roman School of Hygiene on the microbiological quality of the surface waters of Rome and her County from 1890 to 2010. A systemic review]. / La produzione scientifica della Scuola Romana di Igiene sulla qualità microbiologica dei corpi idrici superficiali di Roma e Provincia dal 1890 al 2010. Una review sistematica.

Research on quality of surface waters has been performed also in Italy during the development of the large urban areas, and in Rome this has been the duty of the Istituto di Igiene of the Sapienza University since 1890. Using MedLine--and also traditional consultation for papers printed before 1968--we identified 100 articles printed in the period 1890-2010. Thirty of them met the inclusion criteria (to have been written by researchers belonging to the Rome universities and to contain microbiological informations about the surface waters of Rome). The majority of papers identified (46.6%) were produced during the years Sixties and Seventies of the 20th century, and 30% in the twenty years to follow (1980-1999). The most frequent microbiological descriptors were "Total coliforms" and "Streptococci". The waterbodies most investigated were the Tiber river and the coastal waters around Fiumicino, where the Tiber flows into the Tyrrhenian sea. The quality of surface waters has always been a central interest of the research performed by the Hygienists of the Roman School. The good quality of the past research and the renovated interest of International Organizations and of the European Union should encourage the public health researchers toward a strategic field of investigation which has strong interconnections with the protection of the individual and community health and also with the protection of the environment.

[Revision of the behavior of Italian universities towards the HBV vaccination and tuberculosis prophylaxis]. / Revisione del comportamento degli Atenei italiani nei con- fronti della vaccinazione anti-HBV e della profilassi anti tubercolare.

Diagnostic screening for hepatitis B and tuberculosis infection bears a very important role for health care professionals even considering the decreasing epidemiological trends. According to the WHO predictions in 2030 these diseases will remain at third and fourth places among the causes of death for infectious diseases in industrial countries. The aim of this study is to verify the presence of hepatitis B and tuberculosis prophylaxis among the entry requirements for Medical Schools (MED) and Healthcare Professions Degree (PS) courses in 2011/2012 enrollment announcements. We examined 39 websites of Italian Public and Private Universities and we discovered 38 different announcements for MED and PS courses looking for any reference about hepatitis B and tuberculosis vaccinations and Mantoux skin test. The statistical analysis is descriptive (frequency tables). Hepatitis B vaccination was required in 7 (18.4%) enrollment announcements for MED and 6 (13.6%) for PS, respectively. Tuberculosis vaccination and/or Mantoux skin test were found among requirements of only 10 announcements for MED and 7 for PS, respectively. According to this study there is a great and unexpected variability among the different universities. A homologation of these requirements would be strongly desirable among Italian regions and on the entire national territory.

Influence of sociodemographic inequalities and chronic conditions on influenza vaccination coverage in Italy: results from a survey in the general population.

OBJECTIVE: To assess inequalities in vaccination against seasonal influenza determined by sociodemographic and health-related factors. STUDY DESIGN: A cross-sectional study was conducted using data from 128,040 subjects aged 1-89 years who participated the national survey 'Health Conditions and Health Care Services Use', conducted by the Italian National Centre of Statistics in 2005. METHODS: This analysis included people aged ≥65 years, and individuals of any age with chronic medical conditions. The outcome variable was vaccination or non-vaccination against influenza in the last 12 months, and the explanatory variables were gender, age, smoking habit, educational level, macro-region of residence, chronic medical conditions, occupational status, marital status, self-assessed health status and self-assessed household income. Univariate and multivariate analyses were conducted using Chi-squared test and multiple logistic regression models. For the latter analysis, results are presented as odds ratios (OR) and 95% confidence intervals (CI) of being vaccination against influenza in the last 12 months. RESULTS: Approximately 20% of subjects had been vaccinated against influenza in the previous 12 months. Older age (≥65 years), current smoker, poor health status, poor self-assessed household income and the presence of at least one chronic condition were positively associated with influenza vaccination (P < 0.05). The lowest ORs for influenza vaccination were found in current smokers (adjusted OR vs non-smokers 0.699, 95% CI 0.697-0.701), young adults (adjusted OR 15-24 years vs ≥65 years 0.073, 95% CI 0.072-0.073; adjusted OR 25-34 years vs ≥65 years 0.097, 95% CI 0.096-0.097), subjects with a lower secondary education or professional school (adjusted OR vs primary education 0.910, 95% CI 0.908-0.913), subjects living in the Islands (adjusted OR vs North-eastern Italy 0.760, 95% CI 0.757-0.763), and unemployed subjects (adjusted OR vs employed 0.867; 95% CI 0.859-0.875). The ORs for vaccination were lower for some chronic conditions (e.g. allergies, cirrhosis) than others (e.g. cancer, stroke, bronchitis). Younger age groups, including children aged 0-14 years, had lower ORs for vaccination. CONCLUSIONS: Socio-economic factors, such as gender, age, educational level, occupational status and macro-region of residence, affect influenza vaccination coverage rates in the Italian general population. In addition, some chronic medical conditions are an obstacle for vaccination.

The evaluation of the microbial safety of fresh ready-to-eat vegetables produced by different technologies in Italy.

AIMS: The study was performed to evaluate the safety of whole and RTE vegetables and to investigate the effectiveness of different preventive strategies for the quality assurance of RTE vegetables collected from three Italian production systems. Producer 1, applied a strict system in compliance with GAP- GMP - HACCP, Producer 2 used chlorine disinfection at a second washing step, and Producer 3 using a physical microbial stabilization. METHODS: During the period 2005-2007, a total of 964 samples including whole vegetables and RTE salads, collected from three different producers in central Italy, were analysed to quantify the aerobic mesophilic count (AMC) and Escherichia coli, and for the presence of Salmonella spp, Listeria monocytogenes, E. coli O157:H7, hepatitis A virus and Norovirus (NoV). RESULTS: None of the whole vegetable samples were positive for L. monocytogenes, E. coli O157:H7, HAV and NoV; however, a low prevalence of Salmonella was found. No pathogens were detected with cultural methods in any of the RTE vegetables analysed, only two RTE samples were positive for L. monocytogenes with PCR, but were not confirmed by the cultural method. The median values of AMC in RTE vegetables measured 24 h after packaging were statistically different among the 3 producers (5·4 × 10(6), 1·5 × 10(7) and 3·7 × 10(7) CFU g(-1), respectively; P=0·011). The lowest level was detected in Producer 1. CONCLUSION: The products that were processed applying rigorously GAP, GMP and HACCP showed a better microbiological quality than those processed with chemical or physical stabilization. STUDY SIGNIFICANCE AND IMPACT: The results of the study evidenced the efficacy of GAP, GMP and HACCP in improving microbiological quality of whole and RTE vegetables.