Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination.

The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.

Multicenter evaluation of a fully automated third-generation anti-HCV antibody screening test with excellent sensitivity and specificity.

Early detection of hepatitis C virus (HCV) is an important step in preventing progression to cirrhosis and hepatocellular carcinoma. Serologic assays for anti-hepatitis C (anti-HCV) antibody are valuable first-line tests in the screening and diagnosis of HCV infection. The aim of this multicenter study was to compare the Elecsys(®) Anti-HCV assay with alternative CE-marked Anti-HCV antibody assays against a range of samples that included 1,138 blood donors, 3,553 unselected routine daily specimens, and 46 pre-selected seroconversion panels. Specificity of the Elecsys Anti-HCV assay was 99.5% with blood donor samples and 99.4% with routine clinical specimens. These were similar to those obtained with the Prism(®) Anti-HCV, Architect(®) Anti-HCV assay, ADVIA(®) Centaur Anti-HCV assay and Vitros(®) Eci aHCV assays. Seroconversion sensitivity for the Elecsys Anti-HCV assay was similar to that of the Architect Anti-HCV, AxSYM HCV version 3.0, ADVIA Centaur Anti-HCV, and Vitros Eci aHCV assays. In fact, seroconversion testing on 46 commercially available panels showed that the difference in first detecting a positive blood sample was less than one day between assays (not statistically significant). The Elecsys Anti-HCV assay as well as the Architect, Prism, and Vitros Anti-HCV immunoassays revealed a seroconversion sensitivity of 100%, whereas the ADVIA Centaur HCV immunoassay showed a sensitivity of only 97.5% (39/40). Overall, the performance of the Elecsys Anti-HCV assay was similar to the performances of the comparator CE-marked Anti-HCV antibody assays.

RNA interference in hippocampus demonstrates opposing roles for CREB and PP1alpha in contextual and temporal long-term memory.

We injected small interfering RNAs (siRNAs) directly into the hippocampus of wild-type mice, knocking down expression of cyclic AMP responsive element-binding protein (CREB) and disrupting long-term, but not short-term, memory after both contextual and trace fear conditioning. In contrast, similar knockdown of siRNA for protein phosphatase 1 (PP1) was sufficient to enhance contextual and temporal memory formation, thereby demonstrating with such a gain-of-function effect a lack of any general deleterious effect for this method of RNAi-mediated gene knockdown. Our findings clearly confirm that contextual memory formation involves CREB and PP1 as positive and negative regulators, respectively, and show for the first time that temporal memory formation shares this mechanism. More generally, we establish that direct injection of siRNA into identified adult brain regions yields specific gene knockdowns, which can be used to validate in vivo candidate genes involved in behavioral plasticity.

Hospitalization rate and mean days of hospitalization of notified viral hepatitis cases in Italy. The Seieva Collaborating Group.

The hospitalization rate and the mean days of hospitalization of notified viral hepatitis cases in Italy were estimated by a specific surveillance system for acute viral hepatitis over the period 1987-1992. The hospitalization rate was very high, ranging from 88.8% for hepatitis A to 90.9% for non-A, non-B hepatitis. No changes were observed over time. For each type of hepatitis the highest figure was observed in the 15-24 year age group. The mean days of hospitalization of hepatitis B (24.2) and non-A, non-B (20.5) hepatitis was significantly higher (p < 0.05) than that of hepatitis A (16.5). The highest mean days of hospitalization of hepatitis A and B occurred in the 0-14 year age group, while for non-A, non-B hepatitis it was observed in subjects over 24 years of age. These findings indicate a nearly similar rate of hospitalization of all types of hepatitis. Hepatitis B and non-A, non-B hepatitis show a more prolonged course than hepatitis A.

Incidence and risk factors of acute Delta hepatitis in Italy: results from a national surveillance system. SEIEVA Collaborating Group.

The incidence of hepatitis Delta virus in the general Italian population was estimated by a specific surveillance system for acute viral hepatitis over the period 1987-1992. The hepatitis Delta virus incidence rate declined from 3.1/1,000,000 inhabitants in 1987 to 1.2/1,000,000 in 1992. Males predominated (83.8% of cases); the sex ratio was 5.2. Only 2.5% of cases occurred in subjects younger than 15 years. There were 119 (49.4%) coinfections of Delta and B hepatitis and 122 (50.6%) Delta superinfections in chronic HBsAg carriers. Jaundice was present in 83.6% of cases. The hospitalization rate was 97.5%; median stay in hospital was 25 days (range 1-98 days). The results of multivariate analysis showed that a history of intravenous drug abuse (odds ratio 34.9; confidence interval 95% = 16.8-72.5), household contact with an HBsAg+ carrier (odds ratio 10.7; confidence interval 95% = 4.36-23.30) and a history of two or more sexual partners within the previous 6 months (odds ratio 2.44; confidence interval 95% = 1.34-4.43) were independent risk factors associated with Delta hepatitis. No association was found with the other risk factors considered, such as blood transfusion, surgical intervention, hospitalization, other percutaneous exposures, dental therapy, contact with an icteric case, and household contact with an i.v. drug abuser. These findings indicate that, in Italy, Delta hepatitis currently has a minor impact. In addition to intravenous drug abuse and household contact with an HBsAg+ carrier, heterosexual activity appears to be an efficient route of HDV transmission.

Cyclic nucleotide metabolism in differentiated and undifferentiated epithelial thyroid cells in culture.

A highly differentiated thyroid cell line (FR-RL) was compared with a less differentiated (FR-T Cl1) and an undifferentiated (1-5G) cell line. FR-TL is modulated in vivo and in vitro by thyrotropin and has the lowest adenylate cyclase and guanylate cyclase and the highest phosphodiesterase activities. In contrast, 1-5G tumor cells do not respond to thyrotropin and have the highest adenylate cyclase guanylate cyclase and lowest hydrolyzing enzyme activities. Intermediate enzyme activities were found in FR-T Cl1 cells. The differences between the two normal rat thyroid cell lines are not due to differences in the composition of the growth medium.