Parents' and caregivers' role toward childhood vaccination in Albania: assessment of predictors of vaccine hesitancy.

Background: Vaccination has saved millions of lives through the protection of individuals and populations from communicable diseases. Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccines despite the availability of vaccination services, has become a growing global concern. The objective of this study was to investigate parents'/caregivers' hesitancy toward childhood vaccination and its predictors in Albania. Study design: A cross-sectional survey was conducted. Methods: The data comes from a survey conducted on a sample of parents/caregivers (89.6% mothers) of children aged 6 months to 8 years at health care vaccination centers in seven Albanian cities from December 2020 to February 2021. Parents/caregivers (one per child) were interviewed by trained healthcare staff using a standardized questionnaire on six main content domains, including immunization behavior, beliefs about vaccine safety and efficacy, attitudes about vaccines, vaccination confidence, estimation of vaccine delay, and the intention to immunize children against SARS-CoV-2, and a self-reported hesitancy. The Albanian Ministry of Health approved the questionnaire, after it was translated, validated and adapted to the local setting. Statistical analyses included independent sample t-tests (p<0.05) and a logistic regression (OR; 95% C.I.). Results: A total of 475 parents/caregivers of children aged from 6 months to 8 years, attending childhood vaccination in public health services, were interviewed. To the question "how hesitant you are about childhood vaccination", a high number of parents/caregivers (46%) responded that they do not feel hesitant at all, and 32% were not hesitant, a small number of parents/caregivers said they are very hesitant (5%) or somewhat hesitant (12%). A binary logistic model was fitted to the data to test the hypothesis regarding the relationship between parental vaccine hesitancy and possible predictors. A lower parental attitude toward childhood vaccines (OR = 3.7; 95% C.I. 1.102-12.421), a health center with a high vaccine delay (OR = 2.878; C.I. 95% 1.735-4.773), and low confidence in health staff information (OR = 2.042; 95% C.I. 1.156-3.605) were all independent predictors of parental vaccine hesitancy. Regarding intention to vaccinate children against COVID-19, when available, nearly 75% of parents/caregivers showed hesitancy. Conclusions: Our results highlighted the role of positive parents'/caregivers' attitudes toward childhood vaccines followed by high staff confidence and good health center organization in order to deal with vaccine hesitancy, particularly for traditional and well-known childhood vaccines. Nevertheless, the hesitancy can be a critical barrier for childhood vaccination when we have to introduce a new vaccine, as is demonstrated in the recent vaccination campaign against the ongoing pandemic of SARS-CoV2.

Exploring Tdap and influenza vaccine uptake and its determinants in pregnancy: a cross-sectional study.

Background: The literature claims that an increased risk of complications from pertussis and influenza exists for pregnant women and infants. Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines seem to decrease this risk so that several countries are committed to increase vaccination uptake, but not all of them know their own vaccination coverage and factors that motivate this population to vaccination. Study Design: A cross-sectional survey was conducted. Methods: We conducted this survey to estimate among pregnant women: 1) the vaccine coverage, 2) the availability of information, 3) the knowledge about maternal Tdap and influenza vaccination, 4) the factors that could have driven unvaccinated pregnant women to have themselves vaccinated. In addition, determinants of Tdap and influenza vaccine uptake and correct knowledge about vaccine-preventable diseases and vaccination in pregnancy were assessed using univariate and multivariate analyses. Results: Of the 250 women included in the present study, only 58 (23.2%, 95% Confidence Interval (CI): 18-28.4%) and 21 (8.1%, 95% CI: 5-11.8%) reported that they had been vaccinated with Tdap and influenza vaccine, respectively, during their current pregnancy. The most common reasons cited for getting themselves vaccinated was having background knowledge of the health problems due to the diseases prevented by Tdap and influenza vaccines, awareness regarding these vaccines being recommended in pregnancy, knowledge of their effectiveness and/or side effects, and having been informed about vaccination by a healthcare professional. Conclusions: Influenza and Tdap vaccine uptake among pregnant women in Italy is low, however, the present study showed that women are available to get vaccinated during pregnancy when adequately informed about the vaccines recommended.

Who will be lost? Identifying patients at risk of loss to follow-up in Malawi. The DREAM Program Experience.

OBJECTIVES: Retention of subjects in HIV treatment programmes is crucial for the success of treatment. We evaluated retention/loss to follow-up (LTFU) in subjects receiving established care in Malawi. METHODS: Data for HIV-positive patients registered in Drug Resource Enhancement Against AIDS and Malnutrition centres in Malawi prior to 2014 were reviewed. Visits entailing HIV testing/counselling, laboratory evaluations, nutritional evaluation/supplementation, community support, peer education, and antiretroviral (ART) monitoring/pharmacy were noted. LTFU was defined as > 90 days without an encounter. Parameters potentially associated with LTFU were explored, with univariate/multivariate logistic regression analyses being performed. RESULTS: Fifteen thousand and ninety-nine patients registered before 2014; 202 (1.3%) were lost to follow-up (LTFU) (1.3%). Nine (0.5%) of 1744 paediatric patients were LTFU vs. 1.4% (n = 193) of 13 355 adults (P < 0.001). Subjects who were LTFU had fewer days in care than retained subjects (1338 vs. 1544, respectively; P < 0.001) and a longer duration of ART (1530 vs. 1300 days, respectively; P < 0.001). Subjects who were LTFU had higher baseline HIV viral loads (P = 0.016) and higher body mass indexes (P < 0.001), were more likely to live in urban settings (88% of patients who were LTFU lived in urban settings) with better housing [relative risk (RR) 2.3; 95% confidence interval (CI) 1.67-3.09; P < 0.001], and were more likely to be educated (RR 1.88; 95% CI 1.42-2.50; P < 0.001). Distance to the centre and cost of transportation were associated with LTFU (RR 3.4; 95% CI 2.84-5.37; P < 0.001), as was absence of a maternal figure (RR 1.57; 95% CI 1.17-2.09; P < 0.001). Viral load, distance index, education and a maternal figure were predictive of LTFU. CONCLUSIONS: Educated, urbanized HIV-infected adults living far from programme centres are at high risk of LTFU, particularly if there is no maternal figure in the household. These variables must be taken into consideration when developing retention strategies.

Trend and determinants of acute inpatient care for the elderly in Italy from 2001 to 2011.

BACKGROUND: The population over 64 years of age is the main user of acute hospital care services. The elderly admission rates represent a marker for the appropriateness of the model of care. The aim of this study was to assess trends and determinants of acute in-patient care among the elderly in Italy between 2001 and 2011. STUDY DESIGN: Retrospective analysis of data included in the Italian Hospital Discharge Form Database. METHODS: Data from the Italian Hospital Discharge Form Database, Italian Ministry of Health, for the years 2001, 2006 and 2011 were analyzed for individuals over 64 years of age. Inpatient admission (> 1 day) rates across Italian Regions were calculated and compared with demographic variables and out-of-hospital care indicators. Univariate and multivariate analysis were used to determine independent relationship among variables. RESULTS: From 2001 to 2011 the elderly hospital admission rate decreased from 302.1/1,000 in 2001, to 222.4 in 2011, accounting for an overall decrease of about 28%. The decline in admission rates was less pronounced among individuals > 74 y (26.4%) than among those 65-74 y (32.1%). Hospitalization rates decreased in all Italian administrative regions between 2001 and 2011, even if the hospitalization rates in 2011 were still very different through the different Italian regions, ranging from 180.3/1,000 in Piedmont to 278.1/1,000 in Molise for people > 64 y. The multivariate linear regression was statistically significant in explaining the variations in hospitalization rates among the different Italian administrative regions (F: 3.637; p = 0.024; adjusted R2 = 0.57) and pointed to the role played by the proportion of the elderly (as percentage of the total population, p=0.043) and the rate of variation of acute care beds from 2004 to 2011 (p=0.001). Variables related to community-based care did not show any association with the hospital admissions rate among the elderly. CONCLUSIONS: The trend toward decline in elderly inpatient admissions is still present in 2011 as it was in 2001. Determinants of elderly hospital care in Italy are related to the increased number of elderly individuals and the reduction of hospital beds. Out-of-hospital care does not correlate with the variation of in-patient care so the overall care appropriateness could be negatively affected.

Unequal access, low vaccination coverage, growth retardation rates among immigrants children in Italy exacerbated in Roma immigrants.

AIM: Currently children of immigrants are the fastest growing segment of the Italian population under the age of 18. The present study reports the challenges to health services access, the vaccination coverage, the health and nutritional status of a sample of 1310 children of immigrants attended from February 2004 to May 2012 the health center "Medicina Solidale" of the "Policlinico Tor Vergata" in the suburban area of the VIII Municipality of Rome. METHODS: The data were collected using clinical archives of the health center. We analyzed the socio-demographic conditions, health problems and nutritional status on admission to the health center. The anthropometric evaluation was carried out according to international standards of child growth WHO 2006 and the statistical analysis was performed using SPSS version 19, and including risk estimation, Mantel Haentzel statistics and t-test. RESULTS: Sixty-six percent of the children were born in Italy, 62% had never had regular health care and 3.4% of children older than six months had never received any of the immunizations. It has been estimated that being Roma the risk of not been vaccinated is equal to OR=5.4 (IC95%: 2.8-10.1). Seventy-seven percent of unvaccinated children had at least one illiterate parent. This condition was strongly associated with non-immunization (OR=15:36 [IC95%: 6.4-36.4]). Growth retardation was common in Roma children as compared to other ethnicities. CONCLUSION: Significant public health efforts are needed to improve access to health services for immigrant populations and to solve relevant inequalities.

Hepatitis B virus mother-to-child transmission among HIV-infected women receiving lamivudine-containing antiretroviral regimens during pregnancy and breastfeeding.

The study included 309 HIV-infected pregnant women receiving a lamivudine-containing antiretroviral regimen from week 25 of gestational age until 6 months postpartum, during breastfeeding. Twenty-seven of them (8.7%) were hepatitis B virus surface antigen (HBsAg) positive; at baseline, hepatitis B virus (HBV) DNA levels >3 log(10) IU/mL (with a median level of 6.2 log(10) IU/mL) were found in 10 women, who at one, three and six months postpartum had median levels of 5.2 log(10) IU/mL, 4.5 log(10) IU/mL and 2.8 log(10) IU/mL, respectively. Twenty-four of the 30 breast milk samples evaluated had undetectable HBV DNA and the other six had values between 15 and 155 IU/mL. Median lamivudine concentrations were 1070 ng/mL in serum and 684 ng/mL in breast milk. Among the 24 HBV-exposed children with available samples, 16 always tested negative, four had a transient infection, one had an undetermined status and three (12.5%) first tested positive at Month 12 or Month 24. Among the children born to the HBV-uninfected mothers of the same cohort, the rate of HBsAg positivity at 12-24 months was 2% (4/196). Our finding of the absence of significative levels of HBV DNA in the breast milk of co-infected mothers supports the present recommendations for breastfeeding in HBV-infected women. Horizontal transmission can be hypothesized for the infections detected in children at 12-24 months. Children born to HBV-positive mothers remained at higher risk of postnatal HBV acquisition compared to those born to HBV-negative women.

The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme.

DREAM (Drug Resources Enhancement against AIDS and Malnutrition) is a multiregional health program active in Mozambique since 2002 and provides free of charge an integrating package of care consisting of peer to peer nutritional and health education, food supplementation, voluntary counseling and testing, immunological, virological, clinical assessment and HAART (Highly Active AntiRetroviral Treatment). The main goals of this paper are to describe the state of health and nutrition and the adequacy of the diet of a sample of HIV/AIDS patients in Mozambique on HAART and not. A single-arm retrospective cohort study was conducted. 106 HIV/AIDS adult patients (84 in HAART), all receiving food supplementation and peer-to-peer nutritional education, were randomly recruited in Mozambique in two public health centres where DREAM is running. The programme is characterized by: provision of HAART, clinical and laboratory monitoring, peer to peer health and nutritional education and food supplementation. We measured BMI, haemoglobin, viral load, CD4 count at baseline (T0) and after at least 1 year (T1). Dietary intake was estimated using 24h food recall and dietary diversity was assessed by using the Dietary Diversity Score (DDS) at T1. Overall, the patients'diet appeared to be quite balanced in nutrients. In the cohort not in HAART the mean BMI values showed an increases but not significant (initial value: 21.9 ± 2.9; final value: 22.5 ± 3.3 ) and the mean haemoglobin values (g/dl) showed a significant increases (initial value: 10.5+ 2.1; final value: 11.5 ± 1.7 p< 0.024) . In the cohort in HAART, both the mean of BMI value (initial value: 20.7 ± 3.9; final value: 21.9 ± 3.3 p< 0.001) and of haemoglobin (initial value: 9.9 ± 2.2; final value: 10.8 ± 1.7 p< 0.001) showed a higher significant increase. The increase in BMI was statistically associated with the DDS in HAART patients. In conclusion nutritional status improvement was observed in both cohorts. The improvement in BMI was significant and substantially higher in HAART patients because of the impact of HAART on nutritional status of AIDS patients. Subjects on HAART and with a DDS > 5, showed a substantial BMI gain. This association showed an additional expression of the synergic effect of integrating food supplementation, nutritional education and HAART on the nutritional status of African AIDS patients and also highlights the complementary role of an adequate and diversified diet in persons living with HIV/AIDS in resources limited settings.

The DREAM model's effectiveness in health promotion of AIDS patients in Africa.

This study evaluates the effectiveness of a holistic model for treating people living with AIDS in Africa; the model aims to improve knowledge about AIDS prevention and care, increase trust in the health centre, impact behaviour, and promote a high level of adherence to HAART. The study took place in the context of the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) programme in Mozambique, designed by the Community of Sant'Egidio to treat HIV patients in Africa. It provides patients with free anti-retroviral drugs, laboratory tests (including viral load), home care and nutritional support. This is a prospective study involving 531 patients over a 12-month period. The patients, predominantly poor and with a low level of education, demonstrated a good level of knowledge about AIDS (more than 90% know how it is transmitted) and trust in the treatment, with a relatively small percentage turning to traditional healers. Overall the patients had a low level of engaging in risky sexual behaviour and a very good level of adherence to HAART (69.5% of the 531 subjects had a pill count higher than 95%). The positive results of the programme's educational initiatives were confirmed with the patients' good clinical results.

[A child health promotion intervention in Albania: results and lessons learned]. / Promozione e cura della salute infantile in Albania: risultati e lezioni apprese da un intervento di sanità pubblica.

Albania is a Balkan country in South-Eastern Europe which, in recent years, has undergone complex demographic, political and economical changes. A notable drop in infant and maternal mortality rates and a significant rise in economic indicators have been observed in recent years. Despite this, over 15% of the population living in the northern and north-eastern areas of the country lives in extreme poverty conditions. In recent years various healthcare system reforms have been introduced, including the introduction of private healthcare and improvement of the main hospital infrastructures but not much has been done to increase the provision of essential healthcare services especially in rural and poor areas. Inequalities in health care are therefore widespread and these particularly affect children living in critical areas. In this paper we describe a paediatric healthcare intervention programme conducted in Albania from 2002 to 2004, aimed at improving the health and nutrition status of children and tackling healthcare system inequalities. The intervention consisted in offering free healthcare services and assistance, delivered through the Albanian healthcare system, to 5280 children. It also involved a health education programme for the mothers. The impact of the programme on the prevalence of infant malnutrition was evaluated by examining the medical records of 1745 infants followed for at least 6 months. Prevalence of malnutrition significantly decreased, from 13.4% to 4.2% during the study period. Mortality in children aged 0-5 years also showed a considerable drop. These results confirm that an efficient and sustainable model of paediatric healthcare assistance in Albania is possible.

Seroprevalence of HHV8 in a cohort of HIV-negative and HIV-positive patients in Mozambique.

Kaposi Sarcoma shows several different clinical and epidemiological patterns. In Sub-Saharan Africa, where the HIV achieves an high prevalence of infection, the KS can be found both in HIV positive than in HIV negative patients, and the diffusion of the HHV8 virus is endemic. The aim of the work is to evaluate the HHV8 seroprevalence in Mozambique. Moreover the relationship of some main indicators, as CD4 and CD8 cells count, HIV viral load, Body Mass Index and haemoglobin values have been calculated in a part of the DREAM Cohort, (HIV positive patients enrolled in the Community of Sant'Egidio program to fight AIDS in the Sub-Saharan Africa). In the HIV positive cohort HHV8 negative and HHV8 positive groups show statistical significance (p < 0.05) in CD4 cells count, a strong significance (p = 0.01) in CD8 cells count and a significance also in Haemoglobin levels (p = 0.35). The difference in Haemoglobin levels (0.5 g/dl) is related more to a statistical than a clinical significance. The study confirms the free circulation of the HHV8 virus in the Mozambican population, with a prevalence rate of 51.1%, similar than that measured in bordering countries. Considering the CD8 value within the HIV positive sub-cohort a strong correlation with the positivity for HHV8 and the immunological status is suggested.

Pediatric highly active antiretroviral therapy in Mozambique: an integrated model of care.

AIM: To test the impact of a public health model to implement HIV pediatric care in Limited Resource Settings. METHODS: A retrospective study on the clinical files of 679 Mozambican children (mean age 4.4 years; SD 3.2), has been carried out. The pediatric patients received HAART (Highly Active Anti-Retroviral Therapy) in the framework of DREAM, a nationwide public health program offering an integrated model of care to HIV patients including free-of-charge HAART and monitoring, nutritional assessment and supplementation, peer-to-peer education, active tracing of the dropped out patients. RESULTS: HAART was started in 297 subjects out of 679. The median time of treatment was 286 (IQ 25-75:125-465). Mortality rate was lower in the sub-sample receiving HAART (8.4%; CI 95%: 5.2-11.6 vs 13.1%; CI 95%: 9.7-16.5). After 6 months of treatment the percentage of viral load lower than 400 copies/mL rose from 4.9% to 46.3%. The percentage of patients with less than 15% of CD4 cells out of the total lymphocyte count and the percentage of patients below the 2 z-score decreased from 56.4% and 58.1% to 8.8% and 38.1% respectively. CONCLUSIONS: Pediatric HAART in limited resource settings often face difficulties to handle complex treatment schemes, but the implemented model seems to be an effective tool to reduce mortality rate in HIV positive pediatric population.

Iron deficiency anemia and feeding practices in Albanian children.

Iron deficiency is the most prevalent nutritional problem of humans. In northern Albania, nutritional deficiencies are widespread among children but there is a lack of biochemical data. The aim of this study was to assess the prevalence rate of the iron deficiency anemia in a sample of northern Albanian children. A group of 112 children aged 6-60 months, recruited during the routine vaccinations, was enrolled in a cross-sectional health examination survey that included venou blood measurements of iron status. The survey was conducted during 2000 in Lezha District. The mean age was 17.1 +/- 10 months, the majority of the children were living in rural areas (61%), 47.8% were female. The mean level of hemoglobin was lower than the reference value (10.3 +/- 1.1). Iron deficiency Anemia occurred in 47 children (47%) and more likely during the first year of the life (51%). Fifty seven children were fed with whole cow's milk, among them 44 were IDA. The risk value to be anemic or iron deficient for infants aged 6 to 12 months that were fed with whole cow's milk before the fourth months of life was high (OR = 6.2 (C.L.1.0-38)). In conclusion, the high prevalence of IDA and the relationship with early feeding of whole cow's milk suggest to consider iron deficiency in infancy and childhood in Albania as an important nutritional public health problem and to implement strategies for his detection, treatment and prevention.

A large infantile gastroenteritis outbreak in Albania caused by multiple emerging rotavirus genotypes.

By the end of December 2000, the epidemiological system 'Alert' of the Public Health Institute in Tirane reported an outbreak of acute gastroenteritis. The outbreak involved children in Tirane and in the rural area. In total, 2722 children were seen in Tirane Hospital and 982 (56.4%) were treated for acute gastroenteritis. The age group with the highest morbidity was 0-5 years (89.7%), followed by the 6-9 (6.2%) and 10-15 years age groups (4.1%). The distribution of acute gastroenteritis cases, which occurred along the same water distribution system, suggests a waterborne origin. The nucleic acid amplification confirmed the co-circulation of different genotypes of rotavirus, mainly P[8]G9 and P[8]G3, responsible for the outbreak. Other enteric viruses such as astrovirus serotype 1, adenovirus and Norovirus, genogroups I and II were detected. Co-infections with different rotavirus genotypes and even with different enteric viruses were detected in several samples.

Tirane, Albania: survey on drinking water quality and facilities.

To develop a realistic model of the situation, a study was carried out in four different socioeconomic and hygienic areas of Tirane, namely in the modern and historical centre as well as in the intermediate and peripheral areas. In each area interviewers from the city's Public Health Directorate, contacted randomly, door-to-door, the residents, submitting a questionnaire and collecting water samples at the same time. Our data show relevant differences regarding distribution and quality of drinking water between the centre and peripheral areas. One third of water samples revealed the presence of microorganisms, whereas one fifth had no residual chlorine. Altogether more than 200,000 people in the peripheral areas of Tirane live under low level hygienic conditions. The recent outbreaks of cholera, poliomyelitis and the hyperendemic hepatitis A disease are the dramatic results of the low quality drinking water.

Child malnutrition in north Albania: results from an anthropometric survey.

In order to assess child malnutrition, an anthropometric cross-sectional survey of children aged 0-36 months was conducted in selected rural, urban and mountainous areas of Northern Albania in May 1997. The results showed a high prevalence of low anthropometric indices in rural and mountainous areas with a trend of similar magnitude in northern rural areas. In Northern Albania child malnutrition is a public health priority. As the main risk factor for underweight we found a recent history of diarrhoea (OR = 2.45) together with female gender (OR = 2.28), rural (OR = 2.09) or mountain (OR = 1.61) residency. Absence of sanitation, marker of poor housing conditions, also showed a significant association (OR = 1.55) with underweight. Low birthweight (OR = 1.12) was confirmed as an important risk factor for underweight condition. In conclusion these findings underline the importance of support appropriate mother and child health and nutritional programmes in rural areas of Northern Albania.

Genomic characterization of human and environmental polioviruses isolated in Albania.

Between April and December 1996, a serious outbreak of poliomyelitis occurred in Albania; almost 140 subjects were involved, and the episode presented an unusually high mortality rate (12%). During the outbreak, water samples from the Lana River in Tirana, Albania, and stool samples from two cases of paralytic poliomyelitis were collected and analyzed for the presence of polioviruses. Six polioviruses were isolated from the environmental and human samples, according to standard methods. All the samples were characterized by partial genomic sequencing of 330 bases across the 5' untranslated region (5'-UTR) (nucleotide positions 200 to 530) and of 300 bases across the VP1 region (nucleotide positions 2474 to 2774). Comparison of these sequences with those present in data banks permitted the identification of environmental isolates Lana A and Lana B as, respectively, a Sabin-like type 2 poliovirus and an intertypic recombinant poliovirus (Sabin-like type 2/wild type 1), both bearing a G instead of an A at nucleotide position 481. The two other environmental polioviruses were similar to the isolates from the paralytic cases. They were characterized by a peculiar 5'-UTR and by a VP1 region showing 98% homology with the Albanian epidemic type 1 isolates reported by other authors. This study confirms the environmental circulation in Albania of recombinant poliovirus strains, likely sustained by a massive vaccination effort and by the presence in the environment of a type 1 poliovirus, as isolated from the Lana River in Tirana about 2 months before the first case of symptomatic acute flaccid paralysis was reported in this town.

[The general practitioner faced with the choice of hospitalization: an analysis of the data from the Follow-Up System computerized network]. / Il medico di medicina generale di fronte alla scelta del ricovero: analisi dei dati della Rete informatizzata "Follow-Up System".

The Project "Informatization of the General Practitioner" aimed at networking the work stations of a randomized set of 150 general practitioners equipped with the "Follow-Up System" software, for the collection of information related to the activity carried out, to be electronically transferred to a central unit was developed in the frame of the finalized Project of the National Research Council: "Prevention and Control of the Disease Factors". During the project activity, a study on prescribed hospitalizations was carried out. The contents of items regarding hospitalization diagnosis show that diagnoses concerning diseases included in chapter ICD-9: "Symptoms, signs and morbid conditions not well defined" represent 30.3% of the total; most of these undefined syndromes can be identified under the item "abdominal pain" with 18.2% of cases. Obviously in the case of appendicitis (12.1% of hospitalizations) the hospitalization carried out by the physician resulted to be necessary, in the case of biliary lithiasis (8 cases, 7.4%), the physician could have treated the patient without hospitalization. The interest of such data is to induce a sort of provocation in order to observe, within 8% of hospitalizations following abdominal pain, what rate of hospitalization could be avoided, giving the adequate support to the general practitioner in order to decide the behaviour to have.