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.

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.

Incidence of Type 1 Diabetes among Children and Adolescents in Italy between 2009 and 2013: The Role of a Regional Childhood Diabetes Registry.

BACKGROUND: Surveillance represents a key strategy to control type 1 diabetes mellitus (T1DM). In Italy, national data are missing. This study aimed at evaluating the incidence of T1DM in subjects <18 year olds in Apulia (a large southeastern region, about 4,000,000 inhabitants) and assessing the sensitivity of the regional Registry of Childhood-Onset Diabetes (RCOD) in the 2009-2013 period. METHODS: We performed a retrospective study matching records from regional Hospital Discharge Registry (HDR), User Fee Exempt Registry (UFER), and Drugs Prescription Registry (DPR) and calculated T1DM incidence; completeness of each data source was also estimated. In order to assess the RCOD sensitivity we compared cases from the registry to those extracted from HDR-UFER-DPR matching. RESULTS: During 2009-2013, a total of 917 cases (about 184/year) in at least one of the three sources and an annual incidence of 25.2 per 100,000 were recorded, lower in infant, increasing with age and peaked in 5- to 9-year-olds. The completeness of DPR was 78.7%, higher than that of UFER (64.3%) and of HDR (59.6%). The RCOD's sensitivity was 39.05% (360/922; 95% CI: 34.01%-44.09%). CONCLUSIONS: Apulia appeared as a high-incidence region. A full, active involvement of physicians working in paediatric diabetes clinics would be desirable to improve the RCOD performance.

[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.

[Centralized immunization schedules and regional equity of access: an audit among Apulian healthcare workers]. / Federalismo vaccinale tra autonomia ed equità di accesso: un audit tra gli operatori sanitari in Puglia.

The reform of the Vth Title of the Italian Constitution has given the Regions autonomous power over planning of their immunization programme and immunization calendar. This amendment has federalized Italy's vaccination system and, is justified by epidemiological evidence however casts doubt on its provision of equal rights to health care. The objective of this current study is to gain insight into the opinion of vaccine services officers in the Apulia region on federal immunization and the regional immunization programme. Research was conducted using an anonymous standardized questionnaire to which 302 vaccines services staff responded. 67.4% of respondents believe that the current federal vaccination programme should be maintained, whilst 20.2% believe that the current system should be eradicated and 12.4% believe it should be phased out gradually. The current apulian vaccination calendar provides free and active immunizations for all newborns for the pneumococcal, meningitis C, chickenpox and hepatitis A vaccines. The interviewees believe that the vaccinations provided in the regional immunization programme are very important (average importance out of 10 = 6.1/7). The positive response to the regional vaccination plan given by the health officers explains, at least in part, the conservative attitude tewards federal vaccination plans. It cannot be excluded that sacrificing regional autonomy over vaccination programmes might be considered by the vaccination officers as being responsible for the abandonment of the Region's long established immunization practices. The success of these practices is evident in the case of the Region's Hepatitis A immunization programme where the active provision of this vaccine has drastically reduced the endemicity of the illness in Apulia. These experiences of good practice should be adequately considered in before opting to phase out the current immunisation programme.

An audit of TB prevention on Italian health care workers.

Tuberculosis (TB) is considered an occupational disease in health care workers. The aim of this study is to asses the state of tuberculosis prevention among the personnel of the Vaccination Services of the Puglia Region (Italy), who were given an interview-based standardised questionnaire. Of the 302 replies, TB screening had been undergone by 80.5%, whom 78.6% took advice by the occupational health physician. Of those who were negative to the PPD skin test, 60.6% had received BCG, whom 78% took vaccination advice by the occupational health physician. In Italy, the procedures for the monitoring and prevention of tuberculosis are a consolidated practice for occupational health physicians.

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.

[Epidemiology of HPV infections and cervical cancer in Apulia: a survey study and current data analysis]. / Epidemiologia delle infezioni da HPV e del cervicocarcinoma in Puglia: studi ad hoc e analisi dei dati correnti.

HPV infection is common in sexually active women and is an important risk factor for cervical cancer. The aim of this article is to describe the prevalence of HPV infection, the incidence and the mortality rates for cervical cancer and adherence to screening programs in Apulia in the light of recent introduction of anti-HPV vaccines. The prevalence of HPV was evaluated testing biological samples from 1082 women. The 33% resulted positive for HPV (80% for high-risk genotypes and 20% for low-risk genotypes). The 59% of positive samples showed only a single viral type while 37% multiple genotypes. In Apulia, from 1998 to 2005, a total of 1849 women were hospitalized for cervical cancer with a decreasing trend; the 46% had exo cervical cancer; the 22% endocervical cancer, 29% cancer of cervix without specification and 3% infiltrating cervical cancer. The mortality rate was 1,5 x 100.000. Data from PASSI study regarding cervical cancer screening showed that 62% of Apulian women 25-64 years aged had a Pap smear and 54.7% get it every three years. The viral genotypes circulating in Apulia region are present in anti-HPV vaccines; this item could give information on their introduction together with actions to implement the adherence to screening program that results lower than international standard.

Pain from excitation of identified muscle nociceptors in humans.

The technique of intraneural microstimulation (INMS) combined with microneurography was used to excite and to record impulse activity in identified afferent peroneal nerve fibers from skeletal muscle of human volunteers. Microelectrode position was minutely adjusted within the impaled nerve fascicle until a reproducible sensation of deep pain projected to the limb was obtained during INMS. During INMS trains of 5-10 s in duration and at threshold for sensation, volunteers perceived a well defined area of deep pain projected to muscle. Psychophysical judgements of the magnitude of pain increased with increasing rates of INMS between 5 and 25 Hz. Also, the area of the painful projected field (PF) evoked during trains of INMS of various duration but constant intensity and rate typically expanded with duration of INMS. The intraneural microelectrode was alternatively used to record neural activity originating from primary muscle afferents. Eight slowly adapting units with moderate to high mechanical threshold were identified by applying pressure within or adjacent to the painful PF. Conduction velocities ranged from 0.9 to 6.0 m/s, and fibers were classed as Group III or Group IV. Capsaicin (0.01%) injected into the RF of two slowly conducting muscle afferents (one Group III and one Group IV) produced spontaneous discharge of each fiber and caused intense cramping pain, suggesting that the units recorded were nociceptive. Our results endorse the concept that the primary sensory apparatus that encodes the sensation of cramping muscle pain in humans is served by mechanical nociceptors with slowly conducting nerve fibers. Results also reveal that muscle pain can be precisely localized, although the human cortical function of locognosia for muscle pain becomes blunted as a function of duration of the stimulus.

Identification of muscle afferents subserving sensation of deep pain in humans.

1. Intraneural microstimulation (INMS) and microneurography were used in combination to stimulate and record from muscle nociceptor primary afferent fibers of the common peroneal nerve of healthy volunteers. When pain evoked by INMS was projected to muscle, afferent activity could be evoked by innocuous and noxious pressure applied within the projected painful area. Conduction velocity of single fibers was determined by stimulating the receptive fields (RFs) electrically via needle electrodes inserted into the RF and measuring conduction latency and distance between the RF and recording electrode. 2. Pain projected to muscle during INMS trains 5-10 s in duration at threshold intensity for pain sensation was typically described as cramping and was well localized. Subjects mapped the area of the painful projected field (PF) over the skin using a pointer. 3. Fourteen slowly adaping mechanoreceptors with RF in muscle and with moderate to high receptor threshold were identified within or near the painful PF. Conduction velocities were in the range of Group III (n = 8) and Group IV (n = 6) fibers. Mean RF areas of Group III and Group IV afferents, determined by applying pressure percutaneously, were 2.71 +/- 1.14 (SE) cm2 and 3.40 +/- 1.08 (SE) cm2, respectively. Only one Group III afferent unit exhibited spontaneous activity (< 1 Hz). 4. One additional high-threshold mechanoreceptor was identified, with its RF located in the extensor tendon at the base of the big toe. This fiber had a conduction velocity of 32 m/s. During INMS, a well-localized sharp pain was projected to the tendon.(ABSTRACT TRUNCATED AT 250 WORDS)