Densità di popolazione e SARS-CoV-2: uno studio epidemiologico di urban health.

Despite SARS-CoV-2 transmission being a complex phenomenon, greater population density seems to be a risk factor. The aim of this study was to analyze through an epidemiologic urban health approach the relationship between population density and SARS-CoV-2 incidence using data which are comparable with regard to testing strategies. All 10,300 SARS-CoV-2 confirmed cases between October and December 2020 were included. We conducted separate analysis by gender standardizing and stratifying by age and month. In the Province Capital (p.d.=765 inhabitants/km2), standardized SARS-CoV-2 incidence rate was higher than the expected, both in men (SIR=1.17, 95%CI=1.12;1.22, p<0.0001) and women (SIR=1.20, 95%CI=1.15;1.25, p<0.0001). In municipalities with p.d. >200 inhabitants/km2, standardized SARS-CoV-2 incidence rate was similar to the expected (p>0.05). In municipalities with p.d. <200 inhabitants/km2, standardized SARS-CoV-2 incidence rate was lower than the expected, both in men (SIR=0.85, 95%CI=0.81;0.90, p<0.0001) and women (SIR=0.84, 95%CI=0.80;0.88, p<0.0001). Stratified analysis by months with likelihood ratio test showed heterogeneity of the p.d. effect in men and women (p<0.05). SARS-CoV-2 incidence rate seemed to be higher in most densely populated areas, both in men and women. Our results confirmed the great importance of restrictive measures as well as the importance of limiting the epidemic wave in the initial stages and could help guide pandemic management strategies according to urban context and population density.

The recommended lifetime immunization schedule from the board of vaccination calendar for life in Italy: A continuing example of impact on public health policies.

The Vaccination Calendar for Life is an alliance of scientific and professional societies of public health physicians, paediatricians and general practitioners in Italy which provides a periodical update on the ideal, scientifically driven vaccination calendar throughout lifetime. Since 2012, the Lifetime Immunization Schedule has represented a benchmark for Regional and National Authorities to set up the updated list of vaccines provided actively and free of charge to infants, children, adolescents, adults and the elderly by inclusion in the Triennial National Vaccination Plan (TNVP), and in the Essential Levels of Care (LEA). The impact of the different editions of the Lifetime Immunization Schedule on the TNVP was deep, representing the inspiring source for the present vaccination policy. The 2019 edition called for more attention to pregnant women immunization; risk groups vaccination; uniform high coverage with the MMRV vaccine; extension of Meningococcal B vaccination also at adolescent age; use of quadrivalent conjugate meningococcal vaccine also at 1 year of life; progressive decrease of the age of free-of-charge offer of influenza to ≥ 60 and then to ≥ 50 year-old population; implementation of flu immunization ages 6 months-6 years; HPV vaccination also offered to 25-year old women at the time of the first screening (gender neutral immunization already offered); sequential PCV13-PPV23 pneumococcal vaccination in 65 year-old subjects; increased coverage with rotavirus vaccine in infants and zoster vaccine in the elderly.

Impact of the environment on the health: From theory to practice.

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

Maintain and increase vaccination coverage in children, adolescents, adults and elderly people: Let's avoid adding epidemics to the pandemic: Appeal from the Board of the Vaccination Calendar for Life in Italy: Maintain and increase coverage also by re-organizing vaccination services and reassuring the population.

The Board of the Vaccination Calendar for Life (Bonanni et al., 2014, 2017) [1,2]), a coalition of four major scientific and professional societies of public health physicians, pediatricians and general practitioners in Italy, made an appeal to health authorities in order to sustain vaccination in COVID-19 times. The five pillars to maintain and increase vaccination coverage at all ages are described as follows: 1) Guarantee paediatric vaccination coverage to all newborns and paediatric boosters and adolescent immunizations, not interrupting active calls and scheduled sessions. 2) Re-organise the way paediatric and adolescent vaccinations are offered. 3) Set-up recovery programs for vaccinations not carried out after the start of the COVID-19 emergency. 4) Provide the preparation of tenders for the supply of flu vaccines with suitable quantities to increase coverage in all Regions and Autonomous Provinces with extreme urgency. 5) Prepare plans to increase coverage for influenza, pneumococcal, tetanus diphtheria and shingles. The Board of the Calendar for Life appeals to the National and Local Health Authorities for a strong and coordinated commitment in favor of the widest offer and acceptance of vaccinations, whose vital importance for collective health is now even more evident to all, in order to avoid that delays in the necessary initiatives should add damage from other epidemics to those suffered by our population due to the COVID-19 pandemic.

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

INTRODUCTION: Invasive 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. METHODS: IMD surveillance data from the Italian National Health Institute were analysed. Microsoft Excel was used to present trend analysis, stratifying by age and serogroups. RESULTS: In 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. CONCLUSIONS: In 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.

Universal proposal strategies of anti-HPV vaccination for adolescents: comparative analysis between school-based and clinic immunization programs.

INTRODUCTION: A promising approach to increase teenager's adherence to immunization against HPV is the administration of vaccinations within the school facilities. The Local Health Unit of Taranto experienced two different vaccine strategy proposals in the twelve-year-olds: the first one was the usual active call strategy in the outpatient clinic, while the second one provided the involvement of the schools in the area. The aim of the study is to evaluate the results of the proposed vaccination strategies in both sexes and in towns of different sizes in order to identify an effective path for achieving vaccine coverage improvement. METHODS: To estimate the number of anti-HPV vaccine doses administered in adolescents of the 2003 cohort, we used the computerized vaccination system data of the Apulia Region. Then, once analyzed, the data for anti-HPV vaccine were broken down by gender, vaccine strategy and size of the town of residence. Analyses performed by using STATA SE 14. RESULTS: The multiple logistic regression points out that, females (OR = 3.2; p < 0.01), living in small towns (OR = 1.3; p < 0.01) and school vaccination strategy (OR = 2; p < 0.01) increase the likelihood of completing the anti-HPV vaccine cycle in adolescents. The comparative assessment of anti-HPV coverage strategies, suggests that school vaccination has resulted in significantly better outcomes than outpatient clinic one, for all the groups considered (overall 72.3% vs 55.6%). CONCLUSIONS: The involvement of school institutes can define a winning organizational model to get a wider adolescent's adherence to immunization programs, especially in bigger towns. The school vaccination strategy could improve anti-HPV vaccine adherence also in males, who perceives a lower HPV-related diseases risk than females.

Assessment of coverage and analysis of the determinants of adherence to influenza vaccination in the general practitioners of Taranto.

BACKGROUND: In Italy, the general practitioner (GP) is the operations manager of the campaigns regarding influenza immunization. He/she identifies people eligible for vaccination among the clients, invites them actively and administers the vaccine. The GPs are directly in contact with the target population that should be vaccinated and their opinion about the flu vaccine may ultimately influence the decision of the patient to accept or not the vaccination. This study aims to assess levels of immunization for influenza vaccination among GPs and factors influencing their adherence to the vaccinations recommended for GPs in the province of Taranto (Apulia region, Southern Italy). METHODS: We conducted a cross-sectional study among 471 general practitioners working in the province of Taranto during the February-March period of 2016. We emailed all GPs a self-administered web-based standardized questionnaire. The questionnaire analyzed the self-reported flu vaccination coverage, knowledge, perception and positions of the GPs with regard to the forecasted vaccinations of the in-risk categories among their patients. RESULTS: A total of 229 (48.6%) GPs participated in the survey. In the 2015/2016 influenza season, the vaccination coverage among the interviewed GPs was 76.4% (n = 175). A patient number ≥ 900 increased the likelihood to have been vaccinated in the 2015/2016 season (OR = 3.3; P < 0.01). Overall only 79.9% prefers to use the adjuvated vaccines on patients > 64 and the 58% of GPs who chose not to get vaccinated considers influenza as a non-risk pathology for a healthy subject. CONCLUSIONS: The coverage achieved among the Taranto's ASL GPs during the 2015/16 season reaches the minimum threshold set by the Minister, but they could implement their knowledge and their participation in relation to the anti-influenza vaccine in order to discard all the wrong or clearly unfounded common beliefs. The best strategy in order to optimize the governance system seems to be the empowerment of primary care physicians, to be fulfilled through actions shared with the Public Healthcare Services based on training, communication and projects supporting vaccine coverage.

The Official Control beyond the Official Control. How To Plan And Schedule Controls Starting From Risk Assessment Along The Agro-Food Supply Chain.

Every year the Italian Ministry of Health, on the basis of regional data, draws up the "Report on Official Controls" to be submitted to the Parliament. The report contains abundant data, diagrams and charts and illustrates the number and type of official controls (OC) performed by the pertinent Bodies (Ministry of Health, Regional and Local Health Authorities) over the previous year on Food Business Operators (FBO), in accordance with the EC Regulation 882/2004. The trend - which has consolidated over the years - relates to the multiplicity of OC and shows a decrease of such controls compared to an increase in "non-conformities". OC frequency is established by the Regional Authorities on the basis of the categorisation of both a "generic risk" for companies calculated taking into account the probability of occurrence of a "non-conformity", and a "specific" risk, assessed on the basis of the results of the OC actually performed on a given "Operatore del Settore Alimentare" (Food Sector Operator, in Italian: OSA). Thus, categorisation (i.e. the probability of occurrence of non-conformities) is the main driver of the OC scheduling and planning process. We have been asking ourselves whether the current OC planning/scheduling method is still suitable for ensuring food safety in the face of internalisation of the food supply chain. As a matter of fact, food safety is now becoming increasingly variable due to the globalization of consumption where "farm to fork", rather than "border to fork", food safety must be ensured. On the basis of these considerations, a different OC planning /scheduling method is being proposed based on the assessment of risks and the estimation of the occurrence of the same along the agro-food chain.

[Managing the difficult balance between employment needs and public health in large industrial sites]. / Gestire il difficile equilibrio tra esigenze occupazionali e salute pubblica nei grandi siti industriali

Environmental pressures affecting Taranto area led institutional commitment to the local Health (LHA) and Environment Agency, which have helped to provide data in support of epidemiological and health impacts evidence.This is relevant in view of the issues related to the public health which led the Apulia Region to enact measures for environmental monitoring of dioxins (Regional Law 44/2008) and protection of food safety (Regional Council Deliberation 1442/2009). The LHA investigated three lines of development: monitoring of food matrices, studies of human biomonitoring and the establishment of local Cancer Registry. Same time to the actions of the Taranto Judiciary, Apulia Region has enacted the RL 24/12, integrating the legislative gap present into the Environmental Authorization procedures, which will allow the Health Damage Assessment, through the correlation between environmental monitoring data, biomonitoring and Cancer Registry. The next step will see the LHA involved in managing effective and feasible prevention initiatives. The Special Health and Environment Plan objective is to monitor the Taranto population health status, to screen the health determinants, to estimate the toxicologically relevant indicators of possible contamination and, if possible, to modify the correlations between risk factors, body burden, and specific diseases.

[Increasing immunization coverage in adults and elderly by creating structural relationships with general practitioners]. / Aumentare le coperture vaccinali nell'adulto e nell'anziano creando rapporti strutturali con la Medicina di Famiglia.

In order to reach vaccination coverage in adults, the elderly and in high risk subjects, a tight network of collaboration between preventive medicine specialists and general practitioners must be created in the same way that they must be created with pediatricians. In fact, this strategy has brought about very high coverage rates in childhood vaccinations. The solution to propose once again would thus be to develop partnerships between the protagonists of the network (community health district, department of prevention, general practitioners, primary care physicians) so that synergies may be created which permit the realisation of common and specific training programs.

Meditations on the Italian population of low interest to the vaccination campaign against the pandemic from H1N1v. The point of view of the region.

In this article we developed a technical reflection on the organization of the National Pandemic Influenza A H1N1 variant plan, implemented in the Italian Region and in specific in the Local Health Agency Taranto. The audit has raised some critical issues that led to the limited success of the vaccination campaign. Among the critics it was really difficult to find quickly and easily those healthy individuals at risk for disease. Therefore it raises the need to prepare a special population register as an essential preliminary step necessary for the active call of the target population in anticipation of a possible pandemic wave. In this vein, the Prevention Department of Taranto has developed a recording database system that has been experienced during the influenza vaccination campaign for the 2010-2011 season.

[Nutrition prevention intervention for cancers: "Med-Food Anticancer Program"]. / L'intervento di prevenzione nutrizionale dei tumori: "Med-Food Anticancer Program".

Several studies recommend the Mediterranean diet and daily physical activity to prevent cancer development. These recommendations, however must be transformed into public health structured programmes, so that they assume operational effectiveness. The aim of the diet and lifestyle intervention called Med-Food Anticancer Program (MFAP) is to promote the Mediterranean diet and physical activity in the adult population. In particular; the target for participants in the intervention is the increased consumption of legumes, fish, whole grain bread and cereals, fruits and vegetables, and the decreased consumption of meat, cheese and foods of animal origin. At the same time, it is recommended to make at least ten thousand steps a day. Two studies have shown the effectiveness of MFAP.

Malignant cancer mortality in Province of Taranto (Italy). Geographic analysis in an area of high environmental risk.

BACKGROUND: A geographic analysis of the causes of death is an important tool for assessing the effectiveness of Public Health initiatives. The aim of this study is to analyse the causes of death between 2000 and 2004, to discover any excess mortality from cancer in Province of Taranto, an area at high environmental risk. METHODS: Mortality data from cancer were selected from the Puglia Regional Nominative Causes of Death Registry. Crude and standardized rates and Standardized Mortality Ratios (SMR) were calculated for the five Provinces of the Puglia Region, their capital cities and in four concentric rings around the industrial area located in Province of Taranto. RESULTS: . Even if the highest death rate for all tumours resulted in the Province of Lecce (24.9 x 10,000), in the cities of Lecce and Bari (29 x 10,000), the distribution of the SMRs in Province of Taranto showed an excess of mortality (+10%) in the ring next to industrial area. For lung cancer the highest rate was reported in city of Taranto (6 x 10,000) and the highest risk (+24%) in the ring next to industrial area. Moreover, in this area 9 (70%) of the 13 considered malignant tumours types presented an excess of mortality. CONCLUSION: The results uphold the data reported in the published literature. It is fundamental to intensify research into other risk factors (exposure at work and aberrant lifestyles). Moreover, there is an increasing need for a Regional Cancer Register.

Application of a scorable neurological examination to near-term infants: longitudinal data.

The aim of this study was to follow the evolution of neurological findings in a cohort of near-term infants born between 35 and 37 weeks. A total of 448 infants born between 35 and 36.9 weeks gestational age with normal cranial ultrasonograms or only minor abnormalities, were studied using the Hammersmith Infant Neurological Examination, at 6, 9 and 12 months (corrected for prematurity). Our results showed that while some items such as cranial nerve and movements showed minimal changes over time, other items mainly related to "tone", "posture" and "reflexes" showed progressive maturation. There was no significant difference between the infants born at 35 and 36 weeks gestation. When compared to term infants assessed at the same age intervals, our cohort showed a wider variability of scores. Mean and 10 (th) percentile for global scores were lower than those reported for term infants suggesting that when assessing infants born at 35 and 36 weeks the optimality scores used for infants born full-term should not be used as normative data. Our results, providing longitudinal data in near-term infants without brain lesions, can be used as a reference in both clinical and research setting to monitor early neurological signs in those children.

[Impact of cerebral palsy in patients discharged from neonatal intensive care units]. / Incidenza delle paralisi cerebrali infantili nei dimessi dalle unità di terapia intensiva neonatale.

AIM: The aim of this study was to assess the impact and the peculiarities of cerebral palsy (CP) in children discharged from our neonatal intensive care unit (NICU) from January 1998 to April 2004. METHODS: A total of 2 303 children were discharged from our NICU during this period and 1 912 were followed up for 1 year through neurological examination (traditional, Brazelton, general movements) and cranial ultrasound (US); high-risk newborns were evaluated with brain magnetic resonance imaging (MRI) too. RESULTS: In 65 children (3.4% of the follow-up group) were diagnosed CP, and classified as follows: 21 (32%) diplegia, 19 (29%) quadriplegia, 20 (31%) hemiplegia, 4 (6%) double hemiplegia, 1 (2%) dyskinetic form. In diplegia and quadriplegia prevailed low birth weight infants (less than or equal to 2,500 g) and preterm infants, while in hemiplegia prevailed normal birthweight infants (greater than 2,500 g) and infants at term. The main MRI findings were: in diplegia 82% periventricular white matter lesions; in quadriplegia 94% periventricular and/or subcortical white matter lesions; in hemiplegia 95% bilateral periventricular or subcortical white matter lesions, predominating on contralateral cerebral hemisphere; in double hemiplegia 100% periventricular and/or subcortical white matter lesions, 100% enlargement of subarachnoid spaces; in dyskinetic form 100% basal ganglia lesions. CONCLUSIONS: The impact of CP in children discharged from our NICU, in agreement with the literature, is higher than in the total population of newborns, thus it is very important to evaluate carefully high-risk newborns during hospitalization and follow-up, through neurological examination and radiologic imaging (US, MRI), for an accurate and early treatment.

[Evaluation of the role of occupational and environmental exposure to inorganic arsenic in the urinary excretion of the metal: preliminary data]. / Valutazione del ruolo dell'esposizione professionale e ambientale ad arsenico inorganico (iAs) sull'eliminazione urinaria del metallo: dati preliminari.

INTRODUCTION: Urinary inorganic arsenic is an expression of occupational exposure to the metal, provided that there is no history of ingestion of foods containing high concentrations of inorganic and/or organic arsenic. The present study was conducted to assess the contribution of professional and environmental exposure to inorganic arsenic on urinary excretion of the metal. MATERIALS AND METHODS: We examined 195 workers at a steelfoundry in Taranto, exposed to very low concentrations of inorganic arsenic and two control groups consisting of 105 subjects resident near the factory and 144 subjects resident approximately 20 Km away. All participants were administered a questionnaire enquiring about general characteristics, lifestyle, occupational and extra occupational exposure to arsenic. Urinary arsenic was determined by atomic-absorption spectrophotometry. RESULTS: Exposed and non exposed subjects were similar as regards general characteristics and lifestyle. The environmental concentration of arsenic for the foundryworkers was invariably lower than 0.1 microg/m3. Urinary excretion of arsenic was higher in the subjects in all three groups, examined singly and together, if they had eaten crustaceans and/or shellfish in the three days before urine collection. There was a significant positive correlation with the consumption of shellfish and a significant negative correlation with the number of days since the last crustacean/shellfish meal. Multiple regression analysis showed a dependence of urinary elimination of arsenic on the days since the last crustacean/shellfish meal. DISCUSSION: The absence of occupational exposure to arsenic allowed us to attribute the higher urinary elimination of arsenic to ingestion of crustaceans and/or shellfish in the three days before collection of the urine, both in subjects exposed to inorganic arsenic and in the two groups belonging to the general population. Our results support the hypothesis that inorganic arsenic, determined by atomic-absorption spectrophotometry, may derive from the catabolism of organic arsenic compounds contained in crustaceans and/or shellfish included in the diet.